The challenge of remote treatment in neuropsychological intervention for reading and spelling in dyslexia: A prospective observational cohort study.

Telemedicine approaches have proved to be valuable solutions for the delivery of treatment for many health-related issues, and crucial during the pandemics. Nonetheless, the efficacy of such Web-based practices in developmental dyslexia needs to be thoroughly evaluated. To this aim, the effects of a multi-componential program for neuropsychological intervention in dyslexia delivered as an outpatient program were compared with those obtained with a remotely delivered, Web-based treatment, based on the same methodological principles and delivered with the same duration and intensity. The treatment-related changes obtained with a combination of visual hemisphere-specific stimulation and training of visual-spatial attention through action video games, were compared to those obtained through remote treatment via the Tachidino Web-based platform. Both treatments had a duration of 4 weeks. The same battery of reading and phonemic awareness tests was delivered in presence, before and after treatment, as well as at 6-months follow-up. User satisfaction was assessed through parents and user questionnaires. Both treatments were significantly and similarly effective in improving reading speed, reading accuracy, and writing accuracy. No reduction in the effects was observed after treatment discontinuation. The Web-based treatment may thus offer a valid alternative to in-person intervention, optimizing the flexibility, capillary diffusion and cost-effectiveness of intervention.

Attentional modulation as a mechanism for enhanced facial emotion discrimination: The case of action video game players.

Action video game players (AVGPs) outperform nonvideo game players (NVGPs) on a wide variety of attentional tasks, mediating benefits to perceptual and cognitive decision processes. A key issue in the literature is the extent to which such benefits transfer beyond cognition. Using steady-state visual evoked potentials (SSVEP) as a neural measure of attentional resource allocation, we investigated whether the attentional benefit of AVGPs generalizes to the processing of rapidly presented facial emotions. AVGPs (n = 36) and NVGPs (n = 32) performed a novel, attention-demanding emotion discrimination task, requiring the identification of a target emotion in one of two laterally presented streams of emotional faces. The emotional faces flickered at either 2.0 Hz or 2.5 Hz. AVGPs outperformed NVGPs at detecting the target emotions regardless of the type of emotion. Correspondingly, attentional modulation of the SSVEP at parieto-occipital recording sites was larger in AVGPs compared with NVGPs. This difference appeared to be driven by a larger response to attended information, as opposed to a reduced response to irrelevant distractor information. Exploratory analyses confirmed that this novel paradigm elicited the expected pattern of event-related potentials associated with target detection and error processing. These components did not, however, differ between groups. Overall, the results indicate enhanced discrimination of facial emotions in AVGPs arising from enhanced attentional processing of emotional information. This presents evidence for the attentional advantage of AVGPs to extend beyond perceptual and cognitive processes.

Effects of Action Video Game Play on Arithmetic Performance in Adults.

This experimental study investigated the state (short-term) effects of action video game (AVG) training on arithmetic performance and their persistence over time. In addition, it examined group differences between experienced and novice AVGers. Twenty-nine college students without a prior AVG experience were randomly assigned to one of the two training groups: AVG and non-AVG. After 40 minutes of video game training, the arithmetic problem-solving speed and accuracy of non-AVG group increased, while the AVG group's arithmetic performance decreased, thus suggesting a possibility of state effects of a non-AVG training on arithmetic performance. The state effects did not persist over time; on a delayed posttest, both groups' arithmetic performance was similar to their pretraining scores. In addition, there were nonsignificant differences in arithmetic performance between experienced and novice AVGers. Implications for investigating the game mechanics and transfer mechanism between the game and transfer task are discussed.

Multiple Causal Links Between Magnocellular-Dorsal Pathway Deficit and Developmental Dyslexia.

Although impaired auditory-phonological processing is the most popular explanation of developmental dyslexia (DD), the literature shows that the combination of several causes rather than a single factor contributes to DD. Functioning of the visual magnocellular-dorsal (MD) pathway, which plays a key role in motion perception, is a much debated, but heavily suspected factor contributing to DD. Here, we employ a comprehensive approach that incorporates all the accepted methods required to test the relationship between the MD pathway dysfunction and DD. The results of 4 experiments show that (1) Motion perception is impaired in children with dyslexia in comparison both with age-match and with reading-level controls; (2) pre-reading visual motion perception-independently from auditory-phonological skill-predicts future reading development, and (3) targeted MD trainings-not involving any auditory-phonological stimulation-leads to improved reading skill in children and adults with DD. Our findings demonstrate, for the first time, a causal relationship between MD deficits and DD, virtually closing a 30-year long debate. Since MD dysfunction can be diagnosed much earlier than reading and language disorders, our findings pave the way for low resource-intensive, early prevention programs that could drastically reduce the incidence of DD.

Action video game play facilitates the development of better perceptual templates.

The field of perceptual learning has identified changes in perceptual templates as a powerful mechanism mediating the learning of statistical regularities in our environment. By measuring threshold-vs.-contrast curves using an orientation identification task under varying levels of external noise, the perceptual template model (PTM) allows one to disentangle various sources of signal-to-noise changes that can alter performance. We use the PTM approach to elucidate the mechanism that underlies the wide range of improvements noted after action video game play. We show that action video game players make use of improved perceptual templates compared with nonvideo game players, and we confirm a causal role for action video game play in inducing such improvements through a 50-h training study. Then, by adapting a recent neural model to this task, we demonstrate how such improved perceptual templates can arise from reweighting the connectivity between visual areas. Finally, we establish that action gamers do not enter the perceptual task with improved perceptual templates. Instead, although performance in action gamers is initially indistinguishable from that of nongamers, action gamers more rapidly learn the proper template as they experience the task. Taken together, our results establish for the first time to our knowledge the development of enhanced perceptual templates following action game play. Because such an improvement can facilitate the inference of the proper generative model for the task at hand, unlike perceptual learning that is quite specific, it thus elucidates a general learning mechanism that can account for the various behavioral benefits noted after action game play.

Action Video Games Improve Direction Discrimination of Parafoveal Translational Global Motion but Not Reaction Times.

Playing action video games enhances visual motion perception. However, there is psychophysical evidence that action video games do not improve motion sensitivity for translational global moving patterns presented in fovea. This study investigates global motion perception in action video game players and compares their performance to that of non-action video game players and non-video game players. Stimuli were random dot kinematograms presented in the parafovea. Observers discriminated the motion direction of a target random dot kinematogram presented in one of the four visual quadrants. Action video game players showed lower motion coherence thresholds than the other groups. However, when the task was performed at threshold, we did not find differences between groups in terms of distributions of reaction times. These results suggest that action video games improve visual motion sensitivity in the near periphery of the visual field, rather than speed response.

Habitual action video game playing is associated with caudate nucleus-dependent navigational strategies.

The habitual playing of video games is associated with increased grey matter and activity in the striatum. Studies in humans and rodents have shown an inverse relationship between grey matter in the striatum and hippocampus. We investigated whether action video game playing is also associated with increased use of response learning strategies during navigation, known to be dependent on the caudate nucleus of the striatum, when presented in a dual solution task. We tested 26 action video game players (actionVGPs) and 33 non-action video game players (nonVGPs) on the 4-on-8 virtual maze and a visual attention event-related potential (ERP) task, which elicits a robust N-2-posterior-controlateral (N2pc) component. We found that actionVGPs had a significantly higher likelihood of using a response learning strategy (80.76%) compared to nonVGPs (42.42%). Consistent with previous evidence, actionVGPs and nonVGPs differed in the way they deployed visual attention to central and peripheral targets as observed in the elicited N2pc component during an ERP visual attention task. Increased use of the response strategy in actionVGPs is consistent with previously observed increases in striatal volume in video game players (VGPs). Using response strategies is associated with decreased grey matter in the hippocampus. Previous studies have shown that decreased volume in the hippocampus precedes the onset of many neurological and psychiatric disorders. If actionVGPs have lower grey matter in the hippocampus, as response learners normally do, then these individuals could be at increased risk of developing neurological and psychiatric disorders during their lifetime.

How the visual aspects can be crucial in reading acquisition? The intriguing case of crowding and developmental dyslexia.

Developmental dyslexia (DD) is the most common neurodevelopmental disorder (about 10% of children across cultures) characterized by severe difficulties in learning to read. According to the dominant view, DD is considered a phonological processing impairment that might be linked to a cross-modal, letter-to-speech sound integration deficit. However, new theories-supported by consistent data-suggest that mild deficits in low-level visual and auditory processing can lead to DD. This evidence supports the probabilistic and multifactorial approach for DD. Among others, an interesting visual deficit that is often associated with DD is excessive visual crowding. Crowding is defined as difficulty in the ability to recognize objects when surrounded by similar items. Crowding, typically observed in peripheral vision, could be modulated by attentional processes. The direct consequence of stronger crowding on reading is the inability to recognize letters when they are surrounded by other letters. This problem directly translates to reading at a slower speed and being more prone to making errors while reading. Our aim is to review the literature supporting the important role of crowding in DD. Moreover, we are interested in proposing new possible studies in order to clarify whether the observed excessive crowding could be a cause rather than an effect of DD. Finally, we also suggest possible remediation and even prevention programs that could be based on reducing the crowding in children with or at risk for DD without involving any phonological or orthographic training.

Play in video games.

Video game play is remarkably ubiquitous in today's society given its recent emergence only in the late 1950s. While this fast evolution could exemplify the power of play, video games exploit but also extend other types of play. Here, we review a classification of the ecosystem of video games useful in the emerging field of the cognitive neuroscience of video games. We then discuss how video games may leverage different play types, considering first locomotor-rotational, object, and social play before highlighting the importance of role, rule, and pretend play in video games. With an eye toward comparative studies of the neural bases of play across species, we discuss whether video games may fulfil the five criteria from Burghardt (2005) to identify play. Finally, in line with play's possible preparatory role for adulthood, we review the positive impact on cognition and future learning of action-like video games. Highlighting that not all video games have this impact, we note more granular hypotheses about the biological functions of play are to be encouraged.

Psychophysiological, but Not Behavioral, Indicator of Working Memory Capacity Predicts Video Game Proficiency.

Visual working memory (VWM) is the ability to actively maintain visual information over short periods of time and is strongly related to global fluid intelligence and overall cognitive ability. In our study, we used two indices of visual working memory capacity: the behavioral estimate of capacity (K) and contralateral delay activity (CDA) in order to check whether training in a Real-Time Strategy (RTS) video game StarCraft II can influence the VWM capacity measured by the change detection task. We also asked a question whether individual differences in behavioral and psychophysiological indices of VWM can predict the effectiveness of video game training. Sixty-two participants (non-players) were recruited to the experiment. Participants were randomly assigned to either experimental (Variable environment), active control (Fixed environment), and passive control groups. Experimental and active control groups differed in the type of training received. Training consisted of 30 h of playing the StarCraft II game. Participants took part in two EEG sessions (pre- and post-training) during which they performed the VWM task. Our results showed that working memory capacity (K calculated according to Pashler's formula) increases after training in both experimental groups, but not in a control group. We have also found a correlation between average visual working memory capacity (calculated as K) and mean CDA amplitude no matter which group we are looking at. And, last but not least, we have found that we can predict the amount of improvement in the RTS video game by looking at the psychophysiological indices (CDA amplitude) recorded at baseline (before training), but only in the experimental group. We think that the strength of the psychophysiological indicator of VWM capacity might be a marker of the future success in video game acquisition.

The Influence of Action Video Games on Attentional Functions Across Visual and Auditory Modalities.

Attention can help an individual efficiently find a specific target among multiple distractors and is proposed to consist of three functions: alerting, orienting, and executive control. Action video games (AVGs) have been shown to enhance attention. However, whether AVG can affect the attentional functions across different modalities remains to be determined. In the present study, a group of action video game players (AVGPs) and a group of non-action video game players (NAVGPs) selected by a video game usage questionnaire successively participated in two tasks, including an attention network task-visual version (ANT-V) and an attention network task-auditory version (ANT-A). The results indicated that AVGPs showed an advantage in orienting under the effects of conflicting stimuli (executive control) in both tasks, and NAVGPs may have a reduced ability to disengage when conflict occurs in visual task, suggesting that the AVGs can improve guidance toward targets and inhibition of distractors with the function of executive control. AVGPs also showed more correlations among attentional functions. Importantly, the alerting functions of AVGPs in visual and auditory tasks were significantly related, indicating that the experience of AVGs could help us to generate a supramodal alerting effect across visual and auditory modalities.

A new look at the cognitive neuroscience of video game play.

A growing body of literature has investigated the effects of playing video games on brain function and behavior. One key takeaway from this literature has been that not all entertainment video games are created equal with respect to their effects on cognitive functioning. The majority of the research to date has contrasted the cognitive impact of playing first- or third-person shooter games (together dubbed "action video games") against the effects of playing other game types. Indeed, when the research began in the late 1990s, action video games placed a load upon the perceptual, attentional, and cognitive systems in a manner not seen in other video games. However, the video game industry has shifted dramatically over the intervening years. In particular, first- and third-person shooter games are no longer unique in the extent to which they load upon cognitive abilities. Instead, a host of other game genres appear to place similar degrees of load upon these systems. This state of affairs calls for a paradigm shift in the way that the cognitive neuroscience field examines the impact of video game play on cognitive skills and their neural mediators-a shift that is only just now slowly occurring.

The Contrasting Effects of an Action Video Game on Visuo-Spatial Processing and Proactive Cognitive Control.

First person shooter or action video games represent one of the most popular genres within the gaming industry. Studies reveal that action gaming experience leads to enhancements of visuo-spatial processing. In contrast, some correlational evidence reveals that experience with action video games may be associated with reduced proactive cognitive control. The two primary goals of the current study were to test the causal nature of the effect of action gaming on proactive cognitive control and to examine whether an increase in visuo-spatial processing and a decrease in proactive cognitive control arise from the same amount of experience playing an action video game. Participants completed tasks measuring visuo-spatial processing and cognitive control before and after 10 practice sessions involving one of three video games or were assigned to a no gaming experience control group. The data revealed the typical increase in visuo-spatial processing and a decrease in proactive, but not reactive, cognitive control following action game training. The sizes of these two training effects were similar in magnitude, but interpretation of the effects was constrained by baseline differences between the four groups of subjects. The possibility of a causal effect of action gaming on proactive cognitive control is interesting within the context of correlational evidence linking greater action gaming experience to reduced cognitive control, poor decision making, and increased impulsivity.

Moderating effects of visual attention and action video game play on perceptual learning with the texture discrimination task.

There is currently substantial controversy regarding the reliability of observed patterns of perceptual learning. Contributing to this controversy are a lack of accounting for individual differences and how variations in training can give rise to different patterns of learning. Here we sought to investigate the impact of individual differences in attention, as measured with the Useful Field of View (UFOV) task, and action video game use on perceptual learning in a large sample of subjects trained on a Texture Discrimination Task (TDT). We examined baseline performance on the TDT, learning on the initially trained TDT stimuli and transfer to a subsequently trained background orientation. We find that participants showing better performance on the UFOV task performed better on the TDT, and also showed greater learning and transfer to an untrained background orientation. On the other hand, self-report of action video game play only inconsistently related performance, learning or transfer on the TDT. Further, we failed to replicate previous findings that training with different backgrounds gives rise to interference on the TDT. Together these results suggest that, while differences between individuals and differences in task structure play a role in perceptual learning, previous findings on the impact of action video game use and interference between training stimuli in perceptual learning may be idiosyncratic.

How difficult is it for adolescents to maintain attention? The differential effects of video games and sports.

Despite a large body of evidence suggests positive effects of playing action video games and practising sports on various visual attentional skills, the impact of these activities on the ability to maintain attention over prolonged periods of time (i.e., sustained attention) has been largely neglected. Here, we first explored free-time habits on a group of 310 adolescents by means of a self-reported questionnaire. We found an inverse relationship between the time spent with sports and video games, but not with other extra-scholastic activities: the time spent practising sports and playing video games clearly competed with each other, with the more-intensive-sport practitioners being less involved in video game play. Next, we directly measured sustained attention and other attentional skills in a subgroup of 76 participants, divided as a function of their time spent in sports and action video games. In particular, sustained attention was assessed by means of two tasks: a classic exogenous task, requiring participants to attend to a flashing visual stimulus; and an internal (endogenous) sustained attention task, requiring participants to synchronise their manual responses to the rhythm of auditory pulses presented in an earlier phase. As previously documented, we found that action video game players displayed worse ability to maintain attention over time, as compared with non-action players. In striking contrast, intensive sports practice was associated with an increased ability to maintain attention over time. Overall, these findings unveil distinct cascading effects on sustained attention induced by doing sport and playing action video games.

The Effectiveness of Interventions for Developmental Dyslexia: Rhythmic Reading Training Compared With Hemisphere-Specific Stimulation and Action Video Games.

Developmental dyslexia is a very common learning disorder causing an impairment in reading ability. Although the core deficit underlying dyslexia is still under debate, significant agreement is reached in the literature that dyslexia is related to a specific deficit in the phonological representation of speech sounds. Many studies also reported an association between reading skills and music. These findings suggest that interventions aimed at enhancing basic auditory skills of children with DD may impact reading abilities. However, music education alone failed to produce improvements in reading skills comparable to those resulting from traditional intervention methods for DD. Therefore, a computer-assisted intervention method, called Rhythmic Reading Training (RRT), which combines sublexical reading exercises with rhythm processing, was implemented. The purpose of the present study was to compare the effectiveness of RRT and that of an intervention resulting from the combination of two yet validated treatments for dyslexia, namely, Bakker's Visual Hemisphere-Specific Stimulation (VHSS) and the Action Video Game Training (AVG). Both interventions, administered for 13 h over 9 days, significantly improved reading speed and accuracy of a group of Italian students with dyslexia aged 8-14. However, each intervention program produced improvements that were more evident in specific reading parameters: RRT was more effective for improvement of pseudoword reading speed, whereas VHSS + AVG was more effective in increasing general reading accuracy. Such different effects were found to be associated with different cognitive mechanisms, namely, phonological awareness for RRT and rapid automatized naming for VHSS + AVG, thus explaining the specific contribution of each training approach. Clinical Trial registration: ClinicalTrials.gov NCT02791841.

Play to Win: Action Video Game Experience and Attention Driven Perceptual Exploration in Categorization Learning.

Categorization learning is a fundamental and complex cognitive ability. The present EEG study examined how much action video gamers differ from non-gamers in the usage of visual exploration and attention driven perceptual analyses during a categorization learning task. Seventeen healthy right-handed non-gamers and 16 healthy right-handed action video gamers performed a visual categorization task with 14 ring stimuli, which were divided into two categories. All stimuli had the same structure but differed with respect to their color combinations and were forming two categories including a prototype, five typical stimuli and one exception. The exception shared most similarities with the prototype of the opposite group. Prototypes and typical stimuli were correctly categorized at an early stage of the experiment, whereas the successful categorization of exceptions occurred later. The behavioral data yield evidence that action video gamers perform correct categorizations of exceptions earlier than non-gamers. Additionally, groups differed with respect to differential expressions of the attention related P150 ERP component (early perceptual analysis) and the N170 ERP component, which reflected differential processing demands for the stimulus material. In comparison to non-gamers, the analyses of the eye movements yield for action video gamers different, more central fixations possibly indicating covert peripheral processing. For both groups fixations as well as saccades decrease and in the case of exceptions, one of the two segments that are decisive for correct categorization shows higher fixation rates at the end of the experiment. These findings indicate for both groups a learning process regarding the stimulus material. Regarding the group differences, we interpret the results to indicate that action video gamers show a different stimulus exploration, use an enhanced early perceptual analysis of the stimulus material and therefore may detect changes in objects faster and learned the belonging of the stimuli to their categories in an earlier trial phase.

The Color-Word Stroop Task Does Not Differentiate Cognitive Inhibition Ability Among Esports Gamers of Varying Expertise.

This study set out for the first time to identify whether gamers of low, intermediate, and elite skill level in a prominent esports game, Counter-Strike: Global Offensive, demonstrated increasingly superior performance on a test of a specific cognitive skill (cognitive inhibition). Here we tested low, intermediate, and high ranked gamers and compared their performance on a color-word Stroop Task and also compared the performance of players in each gaming rank group to non-gamers. Contrary to our hypothesis, the Stroop Task did not differentiate significantly gamers of varying expertise. Although, we found that when considering both accuracy and response times, elite gamers performed significantly better than both intermediate and low ranked gamers on the simple choice reaction time condition and both elite and novice gamers performed significantly better than intermediate ranked gamers on the incongruent condition (a measure of cognitive inhibitory ability).

Is action video gaming related to sustained attention of adolescents?

Over the past few years, an increasing number of studies have shown that playing action video games can have positive effects on tasks that involve attention and visuo-spatial cognition (e.g., visual search, enumeration tasks, tracking multiple objects). Although playing action video games can improve several cognitive functions, the intensive interaction with the exciting, challenging, intrinsically stimulating and perceptually appealing game environments may adversely affect other functions, including the ability to maintain attention when the level of stimulation is not as intense. This study investigated whether a relationship existed between action video gaming and sustained attention performance in a sample of 45 Italian teenagers. After completing a questionnaire about their video game habits, participants were divided into Action Video Game Player (AVGP) and Non-Action Video Game Player (NAVGP) groups and underwent cognitive tests. The results confirm previous findings of studies of AVGPs as they had significantly enhanced performance for instantly enumerating a set of items. Nevertheless, we found that the drop in performance over time, typical of a sustained attention task, was significantly greater in the AVGP compared with the NAVGP group. This result is consistent with our hypothesis and demonstrates a negative effect of playing action video games.

Neural bases of enhanced attentional control: Lessons from action video game players.

OBJECTIVES: The ability to resist distraction and focus on-task-relevant information while being responsive to changes in the environment is fundamental to goal-directed behavior. Such attentional control abilities are regulated by a constant interplay between previously characterized bottom-up and top-down attentional networks. Here we ask about the neural changes within these two attentional networks that may mediate enhanced attentional control. MATERIALS AND METHODS: To address this question, we contrasted action video game players (AVGPs) and nonvideo game players (NVGPs) in a Posner-cueing paradigm, building on studies documenting enhanced attentional control in AVGPs. RESULTS: Behavioral results indicated a trend for more efficient target processing in AVGPs, and better suppression in rare catch trials for which responses had to be withheld. During the cue period, AVGPs recruited the top-down network less than NVGPs, despite showing comparable validity effects, in line with a greater efficiency of that network in AVGPs. During target processing, as previously shown, recruitment of top-down areas correlated with greater processing difficulties, but only in NVGPs. AVGPs showed no such effect, but rather greater activation across the two networks. In particular, the right temporoparietal junction, middle frontal gyrus, and superior parietal cortex predicted better task performance in catch trials. A functional connectivity analysis revealed enhanced correlated activity in AVGPs compared to NVGPs between parietal and visual areas. CONCLUSIONS: These results point to dynamic functional reconfigurations of top-down and bottom-up attentional networks in AVGPs as attentional demands vary. Aspects of this functional reconfiguration that may act as key signatures of high attentional control are discussed.