The development of visuospatial abilities and their impact on laparoscopic skill acquisition: a clinical longitudinal study.

OBJECTIVES: To investigate how visuospatial abilities develop and influence intraoperative laparoscopic performance during surgical residency training programmes. BACKGROUND: Laparoscopic surgery is a challenging technique to acquire and master. Visuospatial ability is an important attribute but most prior research have predominantly explored the influence of visuospatial abilities in lab-based settings and/or among inexperienced surgeons. Little is known about the impact of visuospatial profiles on actual laparoscopic performance and its role in shaping competency. METHOD: A longitudinal observational cohort study using a pair-matched design over 27 months. At baseline, visuospatial profiles of 43 laparoscopic surgeons of all expertise levels and 19 control subjects were compared. The development of visuospatial abilities and their association with intraoperative performance of 18 residency surgeons were monitored during the course of their laparoscopic training. RESULTS: Laparoscopic surgeons significantly outperformed the control group on the measure of spatial visualisation (U = 273.0, p = 0.03, η2 = 0.3). Spatial visualisation was found to be a significant predictor of laparoscopic expertise (R2 = 0.70, F (1.60) = 6.788, p = 0.01) and improved with laparoscopic training (B = 4.01, SE = 1.83, p = 0.02, 95% CI [0.40, 7.63]). From month 6 to 18, a strong positive correlation between spatial visualisation and intraoperative depth perception (r = 0.67, p < 0.01), bimanual dexterity (r = 0.60, p < 0.01), autonomy (r = 0.78, p < 0.01) and the total score (r = 0.70, p < 0.01) were observed but a strong relationship remained only with autonomy (r = 0.89, p < 0.01) and total score (r = 0.80, p < 0.01) at 18 months. CONCLUSION: In this longitudinal cohort study, visuospatial abilities associate with laparoscopic skills and improve with training. Spatial visualisation may be characteristic of laparoscopic expertise as it has clear association with competency development during laparoscopy residency training programme.

The importance of visuospatial abilities for verbal number skills in preschool: Adding spatial language to the equation.

Children's verbal number skills set the foundation for mathematical development. Therefore, it is central to understand their cognitive origins. Evidence suggests that preschool children rely on visuospatial abilities when solving counting and number naming tasks despite their predominantly verbal nature. We aimed to replicate these findings when controlling for verbal abilities and sociodemographic factors. Moreover, we further characterized the relation between visuospatial abilities and verbal number skills by examining the role of spatial language. Because spatial language encompasses the verbalization of spatial thinking, it is a key candidate supporting the interplay between visuospatial and verbal processes. Regression analysis indicated that both visuospatial and verbal abilities, as assessed by spatial perception and phonological awareness, respectively, uniquely predicted verbal number skills when controlling for their respective influences, age, gender, and socioeconomic status. This confirms the spatial grounding of verbal number skills. Interestingly, adding spatial language to the model abolished the predictive effects of visuospatial and verbal abilities, whose influences were completely mediated by spatial language. Verbal number skills thus concurrently depend on specifically those visuospatial and verbal processes jointly indexed through spatial language. The knowledge of spatial terms might promote verbal number skills by advancing the understanding of the spatial relations between numerical magnitudes on the mental number line. Promoting spatial language in preschool thus might be a successful avenue for stimulating mathematical development prior to formal schooling. Moreover, measures of spatial language could become an additional promising tool to screen preschool children for potential upcoming difficulties with mathematical learning.

Analysis of Visuospatial Abilities in Chiari Malformation Type I.

The involvement of the cerebellum in visuospatial abilities has been evidenced in numerous studies, based on the cerebellar-cortical circuitry. This domain has been evaluated in several patients with cerebellar disorders, but the assessment of visuospatial processing in Chiari malformation type I (CM-I) is scarce. The aim of this study is to analyze the visuospatial performance between CM-I adult patients and healthy controls. Participants have been tested using Block Design and Visual Puzzles subtests of the Wechsler Adult Intelligence Scale (WAIS), the Benton Judgment of Line Orientation test, and the Rey-Osterrieth Complex Figure test. The anxious-depressive symptomatology, the physical pain, and the premorbid intelligence have been controlled for, as well. The CM-I patients showed a significantly lower performance; however, after analyzing and controlling for the effect of clinical variables and psychopathological symptomatology, the main effect was maintained for visual puzzles and line orientation tasks. The findings suggest that CM-I patients show a poorer performance in tasks that require an exercise of perceptual reasoning without motor demand, accompanied by visualization and mental imagery of the stimuli. This study contributes towards the reinforcement of the evidence on the cognitive alterations associated to CM-I.

Timing of peripubertal steroid exposure predicts visuospatial cognition in men: Evidence from three samples.

Experiments in male rodents demonstrate that sensitivity to the organizational effects of steroid hormones decreases across the pubertal window, with earlier androgen exposure leading to greater masculinization of the brain and behavior. Similarly, some research suggests the timing of peripubertal exposure to sex steroids influences aspects of human psychology, including visuospatial cognition. However, prior studies have been limited by small samples and/or imprecise measures of pubertal timing. We conducted 4 studies to clarify whether the timing of peripubertal hormone exposure predicts performance on male-typed tests of spatial cognition in adulthood. In Studies 1 (n = 1095) and 2 (n = 173), we investigated associations between recalled pubertal age and spatial cognition in typically developing men, controlling for current testosterone levels in Study 2. In Study 3 (n = 51), we examined the relationship between spatial performance and the age at which peripubertal hormone replacement therapy was initiated in a sample of men with Isolated GnRH Deficiency. Across Studies 1-3, effect size estimates for the relationship between spatial performance and pubertal timing ranged from. -0.04 and -0.27, and spatial performance was unrelated to salivary testosterone in Study 2. In Study 4, we conducted two meta-analyses of Studies 1-3 and four previously published studies. The first meta-analysis was conducted on correlations between spatial performance and measures of the absolute age of pubertal timing, and the second replaced those correlations with correlations between spatial performance and measures of relative pubertal timing where available. Point estimates for correlations between pubertal timing and spatial cognition were -0.15 and -0.12 (both p < 0.001) in the first and second meta-analyses, respectively. These associations were robust to the exclusion of any individual study. Our results suggest that, for some aspects of neural development, sensitivity to gonadal hormones declines across puberty, with earlier pubertal hormone exposure predicting greater sex-typicality in psychological phenotypes in adulthood. These results shed light on the processes of behavioral and brain organization and have implications for the treatment of IGD and other conditions wherein pubertal timing is pharmacologically manipulated.

The role of the motor subtypes on the relationship between anxiety and cognitive dysfunctions in Parkinson's disease.

Anxiety is a common neuropsychiatric symptom in Parkinson's disease (PD). Until now, anxiety has been consistently related to cognitive deficits and severity of motor symptoms, whereas the association between anxiety and motor subtypes (TD-PD, tremor dominant and PIGD-PD, postural instability/gait disturbances dominant) revealed contrasting results. The present study aims to investigate the relationship between PD motor subtypes and anxiety and to explore whether the relationship between anxiety and cognitive deficits occurs in a specific PD motor subtype. Consecutive PD outpatients were recruited and divided into TD-PD and PIGD-PD groups according to Jankovic et al.'s criteria. All participants underwent a neuropsychological battery to evaluate anxiety, apathy, the global cognitive functioning, memory abilities, executive and visuo-constructional functions. Thirty-six patients with TD-PD and 35 patients with PIGD-PD were enrolled. The two groups did not differ on demographical and clinical variables. As for the severity of anxiety, no significant difference between the two groups was found. Regression analysis revealed that higher anxiety score was associated with poorer performance on constructional visuospatial test in both TD-PD and PIGD-PD. Clinical variables were not associated with anxiety in the two groups. Our findings indicated that the severity of anxiety was not associated with any PD motor subtypes. Moreover, regression analysis revealed that impaired visuo-constructional abilities are related to anxiety independently of PD motor subtypes. Since altered fronto-parietal network might be one of the pathogenetic mechanisms underpinning anxiety and constructional visuospatial deficits, the treatment of cognitive dysfunctions might reduce anxious symptoms.

Hemispheric asymmetry and homotopy of resting state functional connectivity correlate with visuospatial abilities in school-age children.

Hemispheric specialization of cognitive functions is a developmental process that shapes the brain from the gestational stage to adulthood. Functional connectivity of the resting brain has been largely used to infer the hemispheric organization of the spontaneous brain activity. In particular, two main properties have been largely explored throughout development: hemispheric asymmetry of functional connectivity and homotopic functional connectivity. However, their relation with specific cognitive processes typically associated with hemispheric specialization, such as visuospatial abilities, remains largely unexplored. Such relationships could be particularly relevant for the quest of developmental cognitive biomarkers in childhood, a significant maturation period of visuospatial abilities. Moreover, the relation between asymmetry and homotopy of brain functional connectivity is not well understood. We have examined these two properties in a sample of 60 typically developing children between 6 and 10 years of age, and explored their relation with visuospatial abilities. First, we identified a strong negative relation between homotopy and asymmetry across the brain. In addition, these properties showed areas in the posterior portion of the brain, with significant correlation with performance in visual memory and visual attention tasks. These results highlight the relevance of the hemispheric organization of spontaneous brain activity for developmental cognition, particularly for visuospatial abilities.

Clock Drawing Test: A Simple Scoring System for the Accurate Screening of Cognitive Impairment in Patients with Mild Cognitive Impairment and Dementia.

BACKGROUND/AIM: The Clock Drawing Test (CDT) is a valid alternative screening tool to the Mini-Mental State Examination (MMSE) and, crucially, it may be completed faster. The aim of our study was to standardize and simplify the CDT scoring system for screening in three common conditions: mild cognitive impairment (MCI), Alzheimer's disease (AD) and mixed dementia (MD). METHODS: We included 188 subjects (43 healthy volunteers, 49 patients with MCI, 54 patients with AD, and 42 patients with MD), who performed the MMSE and CDT. The CDT was evaluated using a modified 4-point scoring system. RESULTS: The healthy subjects had the highest median values for the MMSE and CDT, followed by patients with MCI, AD and MD. The optimal cut-off for all patients and each patient group separately was 3 out of 4 points. Sensitivity was 89% for AD, 93% for MD and 83% for all patients, while specificity was 91%. The MMSE produced similar results. In comparison to the MMSE, sensitivity for MCI was significantly higher using the CDT (20 vs. 69%, respectively). CONCLUSION: A simple, 4-point scoring system may be used as a screening method for fast and accurate detection of cognitive impairment in patients with MCI, AD and MD.

Cognitive, Behavioral, and Adaptive Profiles in Williams Syndrome With and Without Loss of GTF2IRD2.

Williams syndrome (WS) is a neurodevelopmental disorder that results from a heterozygous microdeletion on chromosome 7q11.23. Most of the time, the affected region contains ~1.5 Mb of sequence encoding approximately 24 genes. Some 5-8% of patients with WS have a deletion exceeding 1.8 Mb, thereby affecting two additional genes, including GTF2IRD2. Currently, there is no consensus regarding the implications of GTF2IRD2 loss for the neuropsychological phenotype of WS patients. OBJECTIVES: The present study aimed to identify the role of GTF2IRD2 in the cognitive, behavioral, and adaptive profile of WS patients. METHODS: Twelve patients diagnosed with WS participated, four with GTF2IRD2 deletion (atypical WS group), and eight without this deletion (typical WS group). The age range of both groups was 7-18 years old. Each patient's 7q11.23 deletion scope was determined by chromosomal microarray analysis. Cognitive, behavioral, and adaptive abilities were assessed with a battery of neuropsychological tests. RESULTS: Compared with the typical WS group, the atypical WS patients with GTF2IRD2 deletion had more impaired visuospatial abilities and more significant behavioral problems, mainly related to the construct of social cognition. CONCLUSIONS: These findings provide new evidence regarding the influence of the GTF2IRD2 gene on the severity of behavioral symptoms of WS related to social cognition and certain visuospatial abilities. (JINS, 2018, 24, 896-904).

The impact of Toxocara-seropositivity on attention and motor skills in children with attention-deficit hyperactivity disorder.

BACKGROUND: The study aims to compare neurological soft signs and executive functions between Toxocara-seropositive and seronegative groups in children with attention-deficit/hyperactivity disorder. METHODS: The study included 60 boys with ADHD, aged 7-12. After blood samples were taken, the Stroop Color Word Test and Judgment of Line Orientation test (JLOT) were implemented to measure executive functions. Neurological soft signs were evaluated with Physical and Neurological Examination for Subtle Signs (PANESS). RESULTS: Serological tests were positive for Toxocara antibodies in 20 cases. There was no significant difference between Toxocara seropositive and seronegative regarding age, socioeconomic status, developmental stages, and ADHD severity. However, Toxocara-seropositive children had higher Stroop time and Stroop interference scores and lower JLOT scores than Toxocara-seronegative children. Furthermore, Toxocara-seropositive children exhibited more neurological soft signs, such as gait and station abnormalities, dysrhythmia, and a longer total time in timed movements compared to Toxocara-seronegative children. CONCLUSION: Our study indicates a link between Toxocara-seropositivity and impaired neurological soft signs and executive functions in ADHD. Further research is needed to understand ADHD mechanisms, develop practical treatments considering immunological factors, and thoroughly evaluate how Toxocara seropositivity affects executive functions and motor skills in children with ADHD.

Associations between neurological soft signs, executive functions, and brain-derived neurotrophic factor in boys with attention-deficit hyperactivity disorder.

Background: To determine the association between neurological soft signs, executive functions, and serum brain-derived neurotrophic factor (BDNF) levels in children with attention-deficit hyperactivity disorder (ADHD). Methods: Serum BDNF levels were measured in 87 drug-naive boys with ADHD, aged 7-12 years. The Revised Physical and Neurological Examination for Subtle Signs for neurological soft signs, Stroop Color-Word Test for attention functions, and Judgment of Line Orientation Test (JLOT) for visuospatial abilities were performed. Results: Age correlated negatively with dysrhythmia, total time, and total overflow in timed movements, Stroop Color-Word Time (SCWT), and serum BDNF levels. The JLOT significantly negatively correlated with Total Gaits and Stations (P1) and Total Time in Timed Movements (adjusted R 2 = 0.247). In addition, SCWT maintained a significant correlation with Total Overflow in Timed Movements (adjusted R 2 = 0.206). There was no correlation between serum BDNF levels and NSS. Conclusion: The association between NSS, visuospatial abilities, and selective attention may express a maturational delay in ADHD pathophysiology. Moreover, BDNF may play a role in this maturational delay. Future studies should investigate the contribution of BDNF to neuronal maturation in ADHD.

How the Effect of Virtual Reality on Cognitive Functioning Is Modulated by Gender Differences.

Virtual reality (VR) can be a promising tool to simulate reality in various settings but the real impact of this technology on the human mental system is still unclear as to how VR might (if at all) interfere with cognitive functioning. Using a computer, we can concentrate, enter a state of flow, and still maintain control over our surrounding world. Differently, VR is a very immersive experience which could be a challenge for our ability to allocate divided attention to the environment to perform executive functioning tasks. This may also have a different impact on women and men since gender differences in both executive functioning and the immersivity experience have been referred to by the literature. The present study aims to investigate cognitive multitasking performance as a function of (1) virtual reality and computer administration and (2) gender differences. To explore this issue, subjects were asked to perform simultaneous tasks (span forward and backward, logical-arithmetic reasoning, and visuospatial reasoning) in virtual reality via a head-mounted display system (HDMS) and on a personal computer (PC). Our results showed in virtual reality an overall impairment of executive functioning but a better performance of women, compared to men, in visuospatial reasoning. These findings are consistent with previous studies showing a detrimental effect of virtual reality on cognitive functioning.

Cognitive predictors of Social processing in congenital atypical development.

According to current accounts of social cognition, the emergence of verbal and non-verbal components of social perception might rely on the acquisition of different cognitive abilities. These components might be differently sensitive to the pattern of neuropsychological impairments in congenital neurodevelopmental disorders. Here, we explored the association between social and non-social cognitive domains by administering subtests of the NEPSY-II battery to 92 patients with Intellectual and Developmental Disability (IDD). Regardless the level of intellectual functioning and presence of congenital brain malformations, results revealed that visuospatial skills predicted emotion recognition and verbal component of Theory of Mind, whereas imitation predicted the non-verbal one. Future interventions might focus on spatial and sensorimotor abilities to boost the development of social cognition in IDD.

Resting State Dynamic Reconfiguration of Spatial Attention Cortical Networks and Visuospatial Functioning in Non-Verbal Learning Disability (NVLD): A HD-EEG Investigation.

Nonverbal learning disability (NVLD) is a neurodevelopmental disorder characterized by deficits in visuospatial processing but spared verbal competencies. Neurocognitive markers may provide confirmatory evidence for characterizing NVLD as a separate neurodevelopmental disorder. Visuospatial performance and high-density electroencephalography (EEG) were measured in 16 NLVD and in 16 typically developing (TD) children. Cortical source modeling was applied to assess resting-state functional connectivity (rs-FC) in spatial attention networks (dorsal (DAN) and ventral attention networks (VAN)) implicated in visuospatial abilities. A machine-learning approach was applied to investigate whether group membership could be predicted from rs-FC maps and if these connectivity patterns were predictive of visuospatial performance. Graph theoretical measures were applied to nodes inside each network. EEG rs-FC maps in the gamma and beta band differentiated children with and without NVLD, with increased but more diffuse and less efficient functional connections bilaterally in the NVLD group. While rs-FC of the left DAN in the gamma range predicted visuospatial scores for TD children, in the NVLD group rs-FC of the right DAN in the delta range predicted impaired visuospatial performance, confirming that NVLD is a disorder with a predominant dysfunction in right hemisphere connectivity patterns.

Visuospatial ability and student approach to learning as predictors of academic performance on written versus laboratory-based assessments in human anatomy.

As hours devoted to human anatomy curricula fall under threat and curricular delivery methods remain in flux, many new teaching innovations are emerging, which require comprehensive evaluation to ensure evidence-based teaching is maintained. Although grades are the predominant measure of 'learning', alternative metrics can assess more nuanced and meaningful outcomes. Two common predictors of students' three-dimensional understanding of the body and depth of learning are visuospatial abilities and approaches to learning, respectively. This study evaluated and compared the relative predictive power of these metrics on written and laboratory-based assessments in a human anatomy course. Deep approaches to learning and visuospatial abilities were expected to positively correlate with overall performance, with visuospatial abilities being the more salient predictor, especially on laboratory-based assessments. Additionally, visuospatial abilities were expected to positively correlate with deep learning approaches and negatively correlate with surface learning approaches. Multiple linear regression models controlling for covariates found that both visuospatial abilities (p = 0.049; p = 0.014) and deep learning approaches (p = 0.001; p = 0.001) were independent significant predictors of final and laboratory-based grades, while only deep learning approaches were significantly predictive of written grades (p = 0.007). There was no significant relationship between visuospatial abilities and approaches to learning. Given these findings and the increased reliance on visuospatially demanding digital learning activities in anatomy, both metrics should be considered when evaluating the impact of teaching innovations. Further, educators should design learning resources and environments that train visuospatial abilities and promote deeper learning approaches to maximize students' success.

Improving Soccer Players' Memorization of Soccer Tactics: Effects of Visual Realism, Soccer Expertise, and Visuospatial Abilities.

In this study, we aimed to examine the effect of visual realism on soccer players' memorization of soccer tactics according to their level of expertise and visuospatial abilities. We divided 48 volunteers into novice and expert soccer players and had them first perform a multitask visuospatial abilities (VSA) test and then undergo training with three dynamic soccer scenes, each presented with varied levels of realism (schematic, moderately realistic, and highly realistic). We then tested players' memorization and reproduction of the soccer scenes and measured their visual processing with eye-tracking glasses to identify their cognitive processes during memorization. We found that reducing visual realism improved visual processing and memorization when compared to higher realism (p < .001). Second, both higher (vs. lower) player expertise and higher (vs. lower) VSA influenced visual processing and enhanced memorization efficiency (p < .001). Third, there were significant interaction effects between visual realism, player expertise, and player VSA (p < .001) such that players with high VSA benefited more from reduced (vs. accentuated) visual realism than did players with low VSA. Thus, increasing visual realism can hinder tactical learning effectiveness, especially for learners who lack domain expertise and visuospatial abilities. Practically speaking, coaches and educators might improve their communications by tailoring tactical instructions to learners' cognitive skills.

Differential Patterns of Domain-Specific Cognitive Complaints and Awareness Across the Alzheimer's Disease Spectrum.

Background: Characterizing self- and informant-reported cognitive complaints, as well as awareness of cognitive decline (ACD), is useful for an early diagnosis of Alzheimer's disease (AD). However, complaints and ACD related to cognitive functions other than memory are poorly studied. Furthermore, it remains unclear which source of information is the most useful to distinguish various groups on the AD spectrum. Methods: Self- and informant-reported complaints were measured with the Everyday Cognition questionnaire (ECog-Subject and ECog-StudyPartner) in four domains (memory, language, visuospatial, and executive). ACD was measured as the subject-informant discrepancy in the four ECog scores. We compared the ECog and ACD scores across cognitive domains between four groups: 71 amyloid-positive individuals with amnestic AD, 191 amnestic mild cognitive impairment (MCI), or 118 cognitively normal (CN), and 211 amyloid-negative CN controls, selected from the ADNI database. Receiver operating characteristic curves analysis was performed to evaluate the accuracy of the ECog and ACD scores in discriminating clinical groups. Results: Self- and informant-reported complaints were generally distributed as follows: memory, language, executive, and visuospatial (from the most severe to the least severe). Both groups of CN participants presented on average more memory and language complaints than their informant. MCI participants showed good agreement with their informants. AD participants presented anosognosia in all domains, but especially for the executive domain. The four ECog-StudyPartner sub-scores allowed excellent discrimination between groups in almost all classifications and performed significantly better than the other two classifiers considered. The ACD was excellent in distinguishing the participants with AD from the two groups of CN participants. The ECog-Subject was the least accurate in discriminating groups in four of the six classifications performed. Conclusion: In research, the study of complaint and anosognosia should not be reduced solely to the memory domain. In clinical practice, non-amnestic complaints could also be linked to Alzheimer's disease. The presence of an informant also seems necessary given its accuracy as a source of information.

The fMRI correlates of visuo-spatial abilities: sex differences and gender dysphoria.

The contribution of brain regions to visuospatial abilities according to sex differences and gender identity is inconsistently described. One potential explaining factor may be the different tasks employed requiring a variable load of working memory and other cognitive resources. Here we asked to 20 cis and 20 transgender participants to undergo functional Magnetic Resonance Imaging during performance of a judgement line of orientation test that was adapted to explore the basic visuospatial processing while minimizing the working memory load. We show that V1 activation may be viewed as a brain area with enhanced activation in males, regardless of participants' gender identity. On its turn, gender identity exclusively influences the visuospatial processing of extrastriate visual areas (V5) in women with gender dysphoria. They showed enhanced V5 activation and an increased functional connectivity between V5 and V1. Overall our neuroimaging results suggest that the basic visuospatial abilities are associated with different activations pattern of cortical visual areas depending on the sex assigned at birth and gender identity.

Block Design Performance in Williams Syndrome: Visuospatial Abilities or Task Approach Skills?

The block design task (BDT) is a visuospatial measure that individuals with Williams syndrome (WS) perform poorly on. However, it is unclear what underlies their impaired performance. This study investigated whether poorer performance is a result of visuospatial difficulties, executive function (EF) difficulties, atypical looking strategies, or a combination of these. Eleven individuals with WS participated alongside mental age (MA)- and chronological age (CA)-matched control groups. Eye movements were recorded while they took the BDT. Dwell times and visits to areas of interest in WS differed from CA, but not MA, groups. Findings suggest that BDT abilities of individuals with WS are delayed, but not atypical. Delays result from visuospatial and attention-switching difficulties rather than atypical looking strategies.

Effectiveness of Serious Games for Visuospatial Abilities in Elderly Population with Cognitive Impairment: A Systematic Review and Meta-Analysis.

We explore the effectiveness of serious games for visuospatial abilities among older adults with cognitive impairment by conducting a systematic review. Out of 548 identified publications, seven randomized controlled trials (RCTs) were included in this review. According to a meta-analysis of four RCTs, there is no statistically significant difference (p=0.28) in visuospatial abilities between serious game and control groups. Further, the included RCTs noted no statistically significant difference in the visuospatial ability when comparing serious games to conventional exercise (one study) and other serious games (two studies). One RCT demonstrated a statistically significant effect of serious games on the visuospatial ability when compared with conventional cognitive training. This review could not prove the effectiveness of serious games in enhancing visuospatial abilities for older adults with cognitive impairment. Thus, serious games should not be offered or used for enhancing visuospatial abilities amongst the elderly population with cognitive impairment. More robust RCTs are needed to make firm conclusions on the efficacy of serious games.

The association of basic numerical abilities and math achievement: The mediating role of visuospatial and arithmetical abilities.

Basic numerical abilities such as number line estimation have been observed repeatedly to be associated with mathematical achievement. Recently, it was argued that the association between basic numerical abilities and mathematical achievement is fully mediated by visuospatial abilities. However, arithmetical abilities have not yet been considered as influencing this association, even though solution strategies in number line estimation as well as mathematical achievement often involve arithmetical procedures. Therefore, we investigated the mediating role of arithmetical and visuospatial abilities on the association between number line estimation and mathematical achievement in a sample of n = 599 German elementary school students. The results indicated that arithmetical abilities as well as visuospatial abilities mediated the association between number line estimation and mathematical achievement. However, neither visuospatial nor arithmetical abilities fully mediated the association between number line estimation and mathematical achievement when considered in isolation. This substantiates the relevance of the intertwined development of visuospatial and arithmetical abilities as well as basic numerical abilities such as number line estimation (i.e., the combination of domain-specific numerical and domain-general abilities) driving mathematical achievement.