Evidence for a role of synchrony but not common fate in the perception of biological group movements.

Extensive research has shown that observers are able to efficiently extract summary information from groups of people. However, little is known about the cues that determine whether multiple people are represented as a social group or as independent individuals. Initial research on this topic has primarily focused on the role of static cues. Here, we instead investigate the role of dynamic cues. In two experiments with male and female human participants, we use EEG frequency tagging to investigate the influence of two fundamental Gestalt principles - synchrony and common fate - on the grouping of biological movements. In Experiment 1, we find that brain responses coupled to four point-light figures walking together are enhanced when they move in sync vs. out of sync, but only when they are presented upright. In contrast, we found no effect of movement direction (i.e., common fate). In Experiment 2, we rule out that synchrony takes precedence over common fate by replicating the null effect of movement direction while keeping synchrony constant. These results suggest that synchrony plays an important role in the processing of biological group movements. In contrast, the role of common fate is less clear and will require further research.

Electrophysiological correlates of self-related processing in adults with autism.

The term "self-bias" refers to the human propensity to prioritize self- over other-related stimuli and is believed to influence various stages of the processing stream. By means of event-related potentials (ERPs), it was recently shown that the self-bias in a shape-label matching task modulates early as well as later phases of information processing in neurotypicals. Recent claims suggest autism-related deficits to specifically impact later stages of self-related processing; however, it is unclear whether these claims hold based on current findings. Using the shape-label matching task while recording ERPs in individuals with autism can clarify which stage of self-related processing is specifically affected in this condition. Therefore, this study sought to investigate the temporal course of self-related processing in adults with and without autism. Thirty-two adults with autism and 27 neurotypicals completed a shape-label matching task while ERPs were concomitantly recorded. At the behavioral level, results furnished evidence for a comparable self-bias across groups, with no differences in task performance between adults with and without autism. At the ERP level, the two groups showed a similar self-bias at early stages of self-related information processing (the N1 component). Conversely, the autism group manifested a lessened differentiation between self- and other-related stimuli at later stages (the parietal P3 component). In line with recent claims of later phases of self-related processing being altered in autism, we found an equivalent self-bias between groups at an early, sensory stage of processing, yet a strongly diminished self-bias at a later, cognitive stage in adults with autism.

Reduced Primacy Bias in Autism during Early Sensory Processing.

Recent theories of autism propose that a core deficit in autism would be a less context-sensitive weighting of prediction errors. There is also first support for this hypothesis on an early sensory level. However, an open question is whether this decreased context sensitivity is caused by faster updating of one's model of the world (i.e., higher weighting of new information), proposed by predictive coding theories, or slower model updating. Here, we differentiated between these two hypotheses by investigating how first impressions shape the mismatch negativity (MMN), reflecting early sensory prediction error processing. An autism and matched control group of human adults (both n = 27, 8 female) were compared on the multi-timescale MMN paradigm, in which tones were presented that were either standard (frequently occurring) or deviant (rare), and these roles reversed every block. A well-replicated observation is that the initial model (i.e., the standard and deviant sound in the first block) influences MMN amplitudes in later blocks. If autism is characterized by faster model updating, and thus a smaller primacy bias, we hypothesized (and demonstrate using a simple reinforcement learning model) that their MMN amplitudes should be less influenced by the initial context. In line with this hypothesis, we found that MMN responses in the autism group did not differ between the initial deviant and initial standard sounds as they did in the control group. These findings are consistent with the idea that autism is characterized by faster model updating during early sensory processing, as proposed by predictive coding accounts of autism.SIGNIFICANCE STATEMENT Recent theories of autism propose that a core deficit in autism is that they are faster to update their models of the world based on new sensory information. Here, we tested this hypothesis by investigating how first impressions shape brain responses during early sensory processing, and hypothesized that individuals with autism would be less influenced by these first impressions. In line with earlier studies, our results show that early sensory processing was influenced by first impressions in a control group. However, this was not the case in an autism group. This suggests that individuals with autism are faster to abandon their initial model, and is consistent with the proposal that they are faster to update their models of the world.

Measuring spontaneous mentalizing with a ball detection task: putting the attention-check hypothesis by Phillips and colleagues (2015) to the test.

Theory of Mind (ToM) or mentalizing refers to the ability to attribute mental states (such as desires, beliefs or intentions) to oneself or others. ToM has been argued to operate in an explicit and an implicit or a spontaneous way. In their influential paper, Kovács et al. (Science 330:1830-1834, 2010) introduced an adapted false belief task-a ball detection task-for the measurement of spontaneous ToM. Since then, several studies have successfully used versions of this paradigm to investigate spontaneous ToM. This paradigm has, however, been criticized by Phillips et al. (Psychol Sci 26(9):1353-1367, 2015), who argue that the effects are fully explained by timing artifacts in the paradigm, namely differences in timing of the attention check. The main objective of the current study is to test this attention-check hypothesis. An additional aim was to relate the findings to autism spectrum disorder (ASD) symptomatology in our neurotypical sample, as ASD has been linked to deficits in spontaneous mentalizing. We applied an adjusted version of the paradigm in which the timings for all conditions are equalized, ruling out any potential timing confounds. We found significant main effects of own and agent beliefs on reaction times. Additionally, we found a significant 'ToM-effect': When participants believe the ball is absent, they detect the ball faster if the agent believes the ball would be present rather than absent, which refers to the original effect in the paper of Kovács et al. (2010), taken as evidence for spontaneous ToM and which was contested by Phillips et al. (2015). Our findings cannot be explained by the attention-check hypothesis. Effects could not be associated with ASD symptoms in our neurotypical sample, warranting further investigation on the link between spontaneous mentalizing and ASD.

Defining the neural correlates of spontaneous theory of mind (ToM): An fMRI multi-study investigation.

There is a major debate in the theory of mind (ToM) field, concerning whether spontaneous and explicit ToM are based on the same or two distinct cognitive systems. While extensive research on the neural correlates of explicit ToM has demonstrated involvement of the temporo-parietal junction (TPJ) and the medial prefrontal cortex (mPFC), few studies investigated spontaneous ToM, leaving some open questions. Here, we implemented a multi-study approach by pooling data from three fMRI studies to obtain a larger sample to increase power and sensitivity to better define the neurocognitive mechanisms underlying spontaneous ToM. Participants watched videos in which an agent acquires a true or false belief about the location of a ball. Thus, the belief of the agent and that of the participant could either match or differ. Importantly, participants were never asked to consider the belief of the agent and were only instructed to press a button when they detected the presence of the ball after an occluder fell at the end of each video. By analysing the blood-oxygen level dependent signal during the belief formation phase for false versus true beliefs, we found a cluster of activation in the right, and to a lesser extent, left posterior parietal cortex spanning the TPJ, but no mPFC activation. Region of interest (ROI) analysis on bilateral TPJ and mPFC confirmed these results and added evidence to the asymmetry in laterality of the TPJ in spontaneous ToM. Interestingly, the whole brain analysis, supported by an overlap with brain maps, revealed maximum activation in areas involved in visuospatial working memory and attention switching functions, such as the supramarginal gyrus, the middle temporal gyrus, and the inferior frontal gyrus. By contrast, evidence for the presence of brain-behaviour correlations was mixed and there was no evidence for functional connectivity between the TPJ and mPFC. Taken together, these findings help clarifying the brain system supporting spontaneous ToM.

The influence of action observation on action execution: Dissociating the contribution of action on perception, perception on action, and resolving conflict.

For more than 15 years, motor interference paradigms have been used to investigate the influence of action observation on action execution. Most research on so-called automatic imitation has focused on variables that play a modulating role or investigated potential confounding factors. Interestingly, furthermore, a number of functional magnetic resonance imaging (fMRI) studies have tried to shed light on the functional mechanisms and neural correlates involved in imitation inhibition. However, these fMRI studies, presumably due to poor temporal resolution, have primarily focused on high-level processes and have neglected the potential role of low-level motor and perceptual processes. In the current EEG study, we therefore aimed to disentangle the influence of low-level perceptual and motoric mechanisms from high-level cognitive mechanisms. We focused on potential congruency differences in the visual N190 - a component related to the processing of biological motion, the Readiness Potential - a component related to motor preparation, and the high-level P3 component. Interestingly, we detected congruency effects in each of these components, suggesting that the interference effect in an automatic imitation paradigm is not only related to high-level processes such as self-other distinction but also to more low-level influences of perception on action and action on perception. Moreover, we documented relationships of the neural effects with (autistic) behavior.

Regulation of emotion in ADHD: can children with ADHD override the natural tendency to approach positive and avoid negative pictures?

Studies have demonstrated inefficient use of antecedent-focused emotion regulation strategies in children with ADHD attention-deficit/hyperactivity disorder (ADHD). In the current study we tested for the first time if ADHD is also associated with difficulties in response-focused strategies by measuring the ability to override action tendencies induced by emotional information. Performance data on a computer-based approach-avoidance paradigm of 28 children with ADHD and 38 typically developing children between 8 and 15 years of age were analyzed, by comparing a congruent condition in which they were instructed to approach positive and avoid negative pictures and an incongruent condition where they had to override these automatic reactions and approach negative and avoid positive pictures. Children also rated the valence and salience of the pictures. Children with ADHD and typically developing children rated the emotional valence of the pictures appropriately and similarly, while positive pictures were rated as more arousing by children with ADHD. Solid congruency effects were found indicating that the task measured response-focused emotion regulation; however groups did not differ in this respect. Our findings do not support a deficit in emotion regulation in ADHD in terms of the ability to override natural tendencies to approach positive and avoid negative pictures.

Altered intrinsic organisation of brain networks implicated in attentional processes in adult attention-deficit/hyperactivity disorder: a resting-state study of attention, default mode and salience network connectivity.

Deficits in task-related attentional engagement in attention-deficit/hyperactivity disorder (ADHD) have been hypothesised to be due to altered interrelationships between attention, default mode and salience networks. We examined the intrinsic connectivity during rest within and between these networks. Six-minute resting-state scans were obtained. Using a network-based approach, connectivity within and between the dorsal and ventral attention, the default mode and the salience networks was compared between the ADHD and control group. The ADHD group displayed hyperconnectivity between the two attention networks and within the default mode and ventral attention network. The salience network was hypoconnected to the dorsal attention network. There were trends towards hyperconnectivity within the dorsal attention network and between the salience and ventral attention network in ADHD. Connectivity within and between other networks was unrelated to ADHD. Our findings highlight the altered connectivity within and between attention networks, and between them and the salience network in ADHD. One hypothesis to be tested in future studies is that individuals with ADHD are affected by an imbalance between ventral and dorsal attention systems with the former playing a dominant role during task engagement, making individuals with ADHD highly susceptible to distraction by salient task-irrelevant stimuli.

Anticipatory processes in brain state switching - evidence from a novel cued-switching task implicating default mode and salience networks.

The default mode network (DMN) is the core brain system supporting internally oriented cognition. The ability to attenuate the DMN when switching to externally oriented processing is a prerequisite for effective performance and adaptive self-regulation. Right anterior insula (rAI), a core hub of the salience network (SN), has been proposed to control the switching from DMN to task-relevant brain networks. Little is currently known about the extent of anticipatory processes subserved by DMN and SN during switching. We investigated anticipatory DMN and SN modulation using a novel cued-switching task of between-state (rest-to-task/task-to-rest) and within-state (task-to-task) transitions. Twenty healthy adults performed the task implemented in an event-related functional magnetic resonance imaging (fMRI) design. Increases in activity were observed in the DMN regions in response to cues signalling upcoming rest. DMN attenuation was observed for rest-to-task switch cues. Obversely, DMN was up-regulated by task-to-rest cues. The strongest rAI response was observed to rest-to-task switch cues. Task-to-task switch cues elicited smaller rAI activation, whereas no significant rAI activation occurred for task-to-rest switches. Our data provide the first evidence that DMN modulation occurs rapidly and can be elicited by short duration cues signalling rest- and task-related state switches. The role of rAI appears to be limited to certain switch types - those implicating transition from a resting state and to tasks involving active cognitive engagement.

Non-suicidal self-injury in adolescence: a longitudinal study of the relationship between NSSI, psychological distress and perceived parenting.

OBJECTIVE: The present study investigates whether either adolescents' psychological distress and/or perceived parenting predicted the occurrence of NSSI. Furthermore, the consequences of NSSI are examined in a three-wave longitudinal study. DESIGN: The sample at time 1 (age 12) consisted of 1396 adolescent reports and 1438 parent reports. At time 2 (age 13), 827 adolescent reports and 936 parent reports were obtained. Time 3 (age 14) included 754 adolescent reports and 790 parent reports. Psychological distress of adolescents was measured using the Strengths and Difficulties Questionnaire. Perceived parenting behaviors were examined by the Parental Behavior Scale and the Psychological Control Scale. RESULTS: A total of 10% of the adolescents engaged in NSSI at least once before age 15. Higher psychological distress of adolescents at time 1 was associated with the presence of NSSI at time 2 or 3. The association between psychological distress at time 1 and perception of decreased parental rule setting at time 3 was mediated by the presence of NSSI at time 2. CONCLUSIONS: The present study showed that psychological distress at age 12 predicts NSSI over time and that parental awareness of NSSI changes the perception of parenting behaviors.

Top-down biological motion perception does not differ between adults scoring high versus low on autism traits.

The perception of biological motion is an important social cognitive ability. Models of biological motion perception recognize two processes that contribute to the perception of biological motion: a bottom-up process that binds optic-flow patterns into a coherent percept of biological motion and a top-down process that binds sequences of body-posture 'snapshots' over time into a fluent percept of biological motion. The vast majority of studies on autism and biological motion perception have used point-light figure stimuli, which elicit biological motion perception predominantly via bottom-up processes. Here, we investigated whether autism is associated with deviances in the top-down processing of biological motion. For this, we tested a sample of adults scoring low vs high on autism traits on a recently validated EEG paradigm in which apparent biological motion is combined with frequency tagging (Cracco et al., 2022) to dissociate between two percepts: 1) the representation of individual body postures, and 2) their temporal integration into movements. In contrast to our hypothesis, we found no evidence for a diminished temporal body posture integration in the high-scoring group. We did, however, find a group difference that suggests that adults scoring high on autism traits have a visual processing style that focuses more on a single percept (i.e. either body postures or movements, contingent on saliency) compared to adults scoring low on autism traits who instead seemed to represent the two percepts included in the paradigm in a more balanced manner. Although unexpected, this finding aligns well with the autism literature on perceptual stability.

Differences in own-face but not own-name discrimination between autistic and neurotypical adults: A fast periodic visual stimulation-EEG study.

Self-related processing is thought to be altered in autism, with several studies reporting that autistic individuals show a diminished neural response relative to neurotypicals for their own name and face. However, evidence remains scarce and is mostly based on event-related potential studies. Here, we used EEG to measure the neural activity of autistic adults (20 for faces, 27 for names) and neurotypical adults (24 for faces, 25 for names) while they were watching rapidly alternating faces and names, through a relatively new technique called Fast Periodic Visual Stimulation. We presented strangers' faces or names at a base frequency of 5.77 Hz, while one's own, a close other's, and a specific stranger's face/name was presented at an oddball frequency of 1.154 Hz. The neurotypical group showed a significantly greater response to their own face than both close other and stranger faces, and a greater response for close other than for stranger faces. In contrast, in the autism group, own and close other faces showed stronger responses than the stranger's face, but the difference between own and close other faces was not significant in a bilateral parieto-occipital cluster. No group differences in the enhanced response to familiar names were found. These results replicate and extend results obtained using traditional electroencephalographic techniques which suggest atypical responses to self-relevant stimuli in autism.

Attentional set and explicit expectations of perceptual load determine flanker interference.

Task-irrelevant stimuli often capture our attention despite our best efforts to ignore them. It has been noted that tasks involving perceptually complex displays can lead to reduced interference from distractors. The mechanism behind this effect is debated, with some accounts emphasizing the "perceptual load" of the stimuli themselves and others emphasizing the role of proactive control. Here, in three experiments, we investigated the roles of perceptual load, proactive control, and reward motivation in determining distractor interference. Participants performed a visual search task of high, low, or intermediate load, with flanking task-irrelevant distractors. Each trial was preceded by a cue indicating the level of perceptual load (Experiments 1-3) as well as the potential reward that could be earned (Experiments 2 and 3). In all three experiments, the attentional set induced by the preceding trial and cued proactive expectation of perceptual load interacted to determine flanker interference, which was significant for all trial types except trials cued as high load which were also preceded by high load. These effects were not modulated by reward motivation, although in the final experiment reward did significantly improve performance overall. Thus, successful distractor exclusion does not depend upon motivation or load per se but does require an expectation of high load. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mind the instructions: Reward cues are liked first, wanted later.

Current theories propose that mental effort is invested only when the anticipated benefits, such as rewards, outweigh the associated costs, like task difficulty. Yet, it remains unclear whether this motivational and mitigating aspect of reward processing is reflected in the evaluation of reward/difficulty cues as such, and to what extent it depends on task experience. In a pre-registered experiment (N = 84), we used the affect misattribution procedure (AMP) to gauge affective evaluations of nonword cues predicting reward and task difficulty levels. Contrary to previous studies, the AMP was administered at the outset, after cue instructions, and after the cues were used in a random dot motion (RDM) task. Compared to baseline, cues predicting a larger reward were evaluated more positively after RDM task experience, and most importantly, already after cue instructions, with no difference between the two phases. This evaluative effect manifested in increased performance after larger reward cues in the RDM task. Our results suggest that AMP effects may generally capture performance expectations which are independent of task experience. Importantly, these instructed expectations of reward and difficulty play a crucial role in the evaluation and subsequent investment of mental effort.

Infants' mu suppression during the observation of real and mimicked goal-directed actions.

Since their discovery in the early 1990s, mirror neurons have been proposed to be related to many social-communicative abilities, such as imitation. However, research into the early manifestations of the putative neural mirroring system and its role in early social development is still inconclusive. In the current EEG study, mu suppression, generally thought to reflect activity in neural mirroring systems was investigated in 18- to 30-month-olds during the observation of object manipulations as well as mimicked actions. EEG power data recorded from frontal, central, and parietal electrodes were analysed. As predicted, based on previous research, mu wave suppression was found over central electrodes during action observation and execution. In addition, a similar suppression was found during the observation of intransitive, mimicked hand movements. To a lesser extent, the results also showed mu suppression at parietal electrode sites, over all three conditions. Mu wave suppression during the observation of hand movements and during the execution of actions was significantly correlated with quality of imitation, but not with age or language level.

EEG frequency tagging evidence of intact social interaction recognition in adults with autism.

To explain the social difficulties in autism, many studies have been conducted on social stimuli processing. However, this research has mostly used basic social stimuli (e.g., eyes, faces, hands, single agent), not resembling the complexity of what we encounter in our daily social lives and what people with autism experience difficulties with. Third-party social interactions are complex stimuli that we come across often and are also highly relevant for social functioning. Interestingly, the existing behavioral studies point to altered social interaction processing in autism. However, it is not clear whether this is due to altered recognition or altered interpretation of social interactions. Here, we specifically investigated the recognition of social interaction in adults with and without autism. More precisely, we measured neural responses to social scenes depicting either social interaction or not with an electroencephalogram frequency tagging task and compared these responses between adults with and without autism (N = 61). The results revealed an enhanced response to social scenes with interaction, replicating previous findings in a neurotypical sample. Crucially, this effect was found in both groups, with no difference between them. This suggests that social interaction recognition is not atypical in adults with autism. Taken together with the previous behavioral evidence, our study thus suggests that individuals with autism are able to recognize social interactions, but that they might not extract the same information from those interactions or that they might use the extracted information differently.

A pupillometric investigation of state regulation in adults scoring high versus low on ADHD symptomatology.

According to the state regulation deficit (SRD) account, ADHD is associated with difficulties regulating tonic arousal levels, which may be due to inefficient effort allocation. We aimed to test the SRD account by using a target detection task with three different event rates (ER; 700 ms, 1800 ms, 6000 ms), in order to manipulate the tonic arousal state and its effects on performance and pupil indices in adults with high (n = 40) versus low (n = 36) ADHD symptom levels. In an additional condition, a fast ER (700 ms) was accompanied by auditory white noise (WN), to further increase tonic arousal level. The ER manipulation had a clear effect on RT and variability of RT. These effects were more pronounced for the high-ADHD group, especially for variability of RT with decreasing ER, suggestive of deficient upregulation of a tonic arousal state in that group, in line with their self-reported SRDs in daily life. Adding WN to the fast condition led to more errors, however similarly for both groups. Contrary to our predictions, the ER manipulation had no effect on tonic pupil size (as a measure of tonic arousal). Phasic pupil amplitude (as a measure of cognitive effort) linearly increased with decreasing ER, suggesting more effort allocation during slower ERs. WN decreased phasic pupil amplitude, but had no impact on tonic pupil size. Importantly, however, no ADHD-related differences were present for the pupil indices. In conclusion, adults with elevated levels of ADHD symptoms reported more SRDs in daily life and showed a performance pattern that suggests difficulties in upregulating but not downregulating the tonic arousal state. Surprisingly, these findings were not accompanied by group differences in pupillometric indices. This casts some doubts on the relationship between these measures of autonomic nervous system activity and state regulation, in particular in the context of ADHD symptomatology.

Adults with Autism Prefer Person-First Language in Dutch: A Cross-Country Study.

The correct language to refer to someone with a diagnosis of autism spectrum disorder has received a lot of attention in recent years. Studies in English-speaking countries found a main identity-first language (IFL) preference (e.g. autistic person) opposed to a person-first language preference (PFL) (e.g. person with autism) among adults with autism. However, a recent study conducted in a Dutch-speaking country (the Netherlands) reported a PFL preference (Buijsman et al., 2023). The goal of the current study was to gain insights into language preferences in two Dutch-speaking countries and, in contrast to previous studies, give participants the option to indicate not having a specific language preference. In the current study, we asked 414 Dutch-speaking adults with autism, living either in Belgium or the Netherlands, to fill in an online questionnaire about their language preference. We found that over half of the participants had a PFL preference (54%), followed by having no preference (27%). Only 14% of them had an IFL preference, and 5% proposed another term. Having more years of education was identified as a predictor for having an IFL preference when compared to a PFL preference, while being older predicted having no preference compared to a PFL preference. The majority of Dutch-speaking adults with autism showed a PFL preference, which is in contrast to findings from English-speaking countries, but in accord with a recent study conducted in the Netherlands (Buijsman et al., 2023). Implications of this finding for language use are discussed.

The relevance of familiarity in the context of self-related information processing.

Humans are inclined to preferentially process self-related content, referred to as the "self-bias." Different paradigms have been used to study this effect. However, not all paradigms included a familiar other condition (but rather an unfamiliar other condition), needed to differentiate self-specific effects from the impact of familiarity. The primary goal of our study was to test the suitability for studying the self-bias of two paradigms that provide robust measures of salience effects-that is, the Repetition Blindness (RB) effect and the Emotional Stroop (ES) interference-while addressing the familiarity confound. We further explored whether self-bias effects were related to autism symptomatology, as a reduced self-bias in autism has been reported in previous research. In an online procedure, 82 adults performed an RB task and an ES task in a counterbalanced order, while being presented with both self- and familiar other-related stimuli. Results of both frequentist and Bayesian analyses did not provide evidence in favour of a specific self-bias on either task: we found no significant modulation of the RB effect, nor of the ES interference, for the own versus a close other's name. Moreover, no link with autism symptomatology was found. Tackling a crucial shortcoming from earlier studies, our investigation raises awareness on the importance of accounting for familiarity when investigating self-related processing.

A cross-sectional study on the neurocognitive outcomes in vestibular impaired school-aged children: are they at higher risk for cognitive deficits?

This study aimed to assess if children with a vestibular impairment (VI) are more prone to have neurocognitive deficits compared to typically developing (TD) peers, taking into account important confounding factors with hearing loss being the most important. The neurocognitive performance of fifteen VI children (6-13 years old) was compared to that of an age-, handedness- and sex-weighted group of TD peers (n = 60). Secondly, their performance was also compared to matched groups of TD and hearing impaired (HI) children to evaluate the involvement of HI. The protocol comprises cognitive tests assessing response inhibition, emotion recognition, visuospatial memory, selective and sustained attention, visual memory and visual-motor integration.Based on the results, the VI group had significantly reduced scores on 'social cognition' (p = 0.018), 'executive functions' (p < 0.01), and 'perceptual-motor functioning' (p = 0.020) compared to their TD and HI peers. For the categories 'complex attention' and 'learning and memory' no differences could be observed. Analogous to the findings of previous literature, the symptoms of a VI are often not limited to the primary functions of the system, but also comprise an impact on emotional and cognitive performance. Therefore, more holistic rehabilitation approaches should be encouraged, with a screening and attention for cognitive, emotional and behavioral dysfunctions in the vestibular population. Since this is one of the first studies to investigate the involvement of a VI in a child's cognitive development, these findings support the need for studies further characterizing the impact of a VI, the underlying pathophysiology and the effect of different rehabilitation procedures.