Evidence for superior parietal impairment in Williams syndrome

Effect of cervical and lumbosacral spina bifida cystica on volumes of intracranial structures in children

PURPOSE

Spina bifida is a major disorder that occurs when the membranes of the spinal cord and medulla fail to close during the embryonic period and affects the individual for the rest of life. Some physical, mental, and social difficulties can be observed in the lives of children with spina bifida after surgery. The aim of this study is to determine what kind of volumetric changes occur in the brain when spina bifida occurs in different regions of the cord.

METHODS

The volume of intracranial structures of 14 children aged 1 to 9 years (7 cervical, 7 lumbosacral) with different levels of spina bifida compared with vol2Brain.

RESULTS

Spina bifida occurring in the cervical region was found to cause a greater volumetric reduction in subcortical structures, cortex and gyrus than spina bifida occurring in the lumbosacral region.

CONCLUSION

We believe that our study will help clinicians involved in the management of this disorder.

Parcellation-based tractographic modeling of the dorsal attention network

INTRODUCTION

The dorsal attention network (DAN) is an important mediator of goal-directed attentional processing. Multiple cortical areas, such as the frontal eye fields, intraparietal sulcus, superior parietal lobule, and visual cortex, have been linked in this processing. However, knowledge of network connectivity has been devoid of structural specificity.

METHODS

Using attention-related task-based fMRI studies, an anatomic likelihood estimation (ALE) of the DAN was generated. Regions of interest corresponding to the cortical parcellation scheme previously published under the Human Connectome Project were co-registered onto the ALE in MNI coordinate space and visually assessed for inclusion in the network. DSI-based fiber tractography was performed to determine the structural connections between relevant cortical areas comprising the network.

RESULTS

Twelve cortical regions were found to be part of the DAN: 6a, 7AM, 7PC, AIP, FEF, LIPd, LIPv, MST, MT, PH, V4t, VIP. All regions demonstrated consistent u-shaped interconnections between adjacent parcellations. The superior longitudinal fasciculus connects the frontal, parietal, and occipital areas of the network.

CONCLUSIONS

We present a tractographic model of the DAN. This model comprises parcellations within the frontal, parietal, and occipital cortices principally linked through the superior longitudinal fasciculus. Future studies may refine this model with the ultimate goal of clinical application.

The neural basis of complex audiovisual objects maintenances in working memory

Working memory research has primarily concentrated on studying our senses separately; the neural basis of maintaining information from multiple sensory modalities in working memory has been not well elucidated. It is debated whether multisensory information is maintained in the form of modality-specific representations or amodal representations. The present study investigated what brain regions were engaged in both types of complex audiovisual objects maintenances (semantically congruent and incongruent) using functional magnetic resonance imaging and conjunction analysis, and examined in which form to maintain multisensory objects information in working memory. The conjunction analysis showed that there was common brain regions activation involving left parietal cortex (e.g., left angular gyrus, supramarginal gyrus, and precuneus) while maintaining semantically congruent audiovisual object, whereas the common brain regions activation including the bilateral angular, left superior parietal lobule, and left middle temporal gyrus was found during maintaining semantically incongruent audiovisual objects. Importantly, the shared conjoint brain regions activation consists of bilateral angular gyrus and left middle frontal gyrus was observed while maintaining both types of semantically congruent and incongruent complex audiovisual objects. These brain regions may play different role while maintaining these complex multisensory objects, such as supramodel storage per se and intentional attention. The findings of the present studymight support the amodal view that working memory has a central storage system to maintain multisensory information from different sensory inputs.

Williams Syndrome, Human Self-Domestication, and Language Evolution

Language evolution resulted from changes in our biology, behavior, and culture. One source of these changes might be human self-domestication. Williams syndrome (WS) is a clinical condition with a clearly defined genetic basis which results in a distinctive behavioral and cognitive profile, including enhanced sociability. In this paper we show evidence that the WS phenotype can be satisfactorily construed as a hyper-domesticated human phenotype, plausibly resulting from the effect of the WS hemideletion on selected candidates for domestication and neural crest (NC) function. Specifically, we show that genes involved in animal domestication and NC development and function are significantly dysregulated in the blood of subjects with WS. We also discuss the consequences of this link between domestication and WS for our current understanding of language evolution.

Learning by observation and learning by doing in Down and Williams syndromes

New skills may be learned by active experience (experiential learning or learning by doing) or by observation of others' experience (learning by observation). In general, learning by observation reduces the time and the attempts needed to learn complex actions and behaviors. The present research aimed to compare learning by observation and learning by doing in two clinical populations with different etiology of intellectual disability (ID), as individuals with Down syndrome (DS) and individuals with Williams syndrome (WS), with the hypothesis that specific profiles of learning may be found in each syndrome. To this end, we used a mixture of new and existing data to compare the performances of 24 individuals with DS, 24 individuals with WS and 24 typically developing children on computerized tasks of learning by observation or learning by doing. The main result was that the two groups with ID exhibited distinct patterns of learning by observation. Thus, individuals with DS were impaired in reproducing the previously observed visuo-motor sequence, while they were as efficient as TD children in the experiential learning task. On the other hand, individuals with WS benefited from the observational training while they were severely impaired in detecting the visuo-motor sequence in the experiential learning task (when presented first). The present findings reinforce the syndrome-specific hypothesis and the view of ID as a variety of conditions in which some cognitive functions are more disrupted than others because of the differences in genetic profile and brain morphology and functionality. These findings have important implications for clinicians, who should take into account the genetic etiology of ID in developing learning programs for treatment and education.

Increased glia density in the caudate nucleus in williams syndrome: Implications for frontostriatal dysfunction in autism

Williams syndrome (WS) is a rare neurodevelopmental disorder with a well-described, known genetic etiology. In contrast to Autism Spectrum Disorders (ASD), WS has a unique phenotype characterized by global reductions in IQ and visuospatial ability, with relatively preserved language function, enhanced reactivity to social stimuli and music, and an unusual eagerness to interact socially with strangers. A duplication of the deleted region in WS has been implicated in a subset of ASD cases, defining a spectrum of genetic and behavioral variation at this locus defined by these opposite extremes in social behavior. The hypersociability characteristic of WS may be linked to abnormalities of frontostriatal circuitry that manifest as deficits in inhibitory control of behavior. Here, we examined the density of neurons and glia in associative and limbic territories of the striatum including the caudate, putamen, and nucleus accumbens regions in Nissl stained sections in five pairs of age, sex, and hemisphere-matched WS and typically-developing control (TD) subjects. In contrast to what is reported in ASD, no significant increase in overall neuron density was observed in this study. However, we found a significant increase in the density of glia in the dorsal caudate nucleus, and in the ratio of glia to neurons in the dorsal and medial caudate nucleus in WS, accompanied by a significant increase in density of oligodendrocytes in the medial caudate nucleus. These cellular abnormalities may underlie reduced frontostriatal activity observed in WS, with implications for understanding altered connectivity and function in ASD. © 2017 Wiley Periodicals, Inc. Develop Neurobiol 78: 531-545, 2018.

Array CGH - A Powerful Tool in Molecular Diagnostic of Pathogenic Microdeletions - Williams-Beuren Syndrome - A Case Report

ABSTRACT: Williams-Beuren syndrome (WBS) (OMIM 194050) is caused by interstitial deletions or duplications of the 7q11.23 chromosomal region and characterised through a complex phenotype. We described a case diagnosed clinically and genetically confirmed through aCGH. Genetic assessment identified three microdeletions with a total size of 1.35 Mb located at 7q11.23. The deleted regions encompasses more than 30 genes including several protein coding genes such as ELN, LIMK1, FZDS, WBSCR22, WBSCR27, WBSCR28, STX1A, CLDN3, CLDN4, LAT2, ABHD11 or EIF4H .

Out with the Old and in with the New--Is Backward Inhibition a Domain-Specific Process?

Effective task switching is supported by the inhibition of the just executed task, so that potential interference from previously executed tasks is adaptively counteracted. This inhibitory mechanism, named Backward Inhibition (BI), has been inferred from the finding that switching back to a recently executed task (A-B-A task sequence) is harder than switching back to a less recently executed task (C-B-A task sequence). Despite the fact that BI effects do impact performance on everyday life activities, up to now it is still not clear whether the BI represents an amodal and material-independent process or whether it interacts with the task material. To address this issue, a group of individuals with Williams syndrome (WS) characterized by specific difficulties in maintaining and processing visuo-spatial, but not verbal, information, and a mental age- and gender-matched group of typically developing (TD) children were subjected to three task-switching experiments requiring verbal or visuo-spatial material to be processed. Results showed that individuals with WS exhibited a normal BI effect during verbal task-switching, but a clear deficit during visuo-spatial task-switching. Overall, our findings demonstrating that the BI is a material-specific process have important implications for theoretical models of cognitive control and its architecture.

Geometric and featural systems, separable and combined: Evidence from reorientation in people with Williams syndrome

Spatial reorientation by humans and other animals engages geometric representations of surface layouts as well as featural landmarks; however, the two types of information are thought to be behaviorally and neurally separable. In this paper, we examine the use of these two types of information during reorientation among children and adults with Williams syndrome (WS), a genetic disorder accompanied by abnormalities in brain regions that support use of both geometry and landmarks. Previous studies of reorientation in adolescents and adults with WS have shown deficits in the ability to use geometry for reorientation, but intact ability to use features, suggesting that the two systems can be differentially impaired by genetic disorder. Using a slightly modified layout, we found that many WS participants could use geometry, and most could use features along with geometry. However, the developmental trajectories for the two systems were quite different from one other, and different from those found in typical development. Purely geometric responding was not correlated with age in WS, and search processes appeared similar to those in typically developing (TD) children. In contrast, use of features in combination with geometry was correlated with age in WS, and search processes were distinctly different from TD children. The results support the view that use of geometry and features stem from different underlying mechanisms, that the developmental trajectories and operation of each are altered in WS, and that combination of information from the two systems is atypical. Given brain abnormalities in regions supporting the two kinds of information, our findings suggest that the co-operation of the two systems is functionally altered in this genetic syndrome.

A dual comparative approach: integrating lines of evidence from human evolutionary neuroanatomy and neurodevelopmental disorders

The evolution of the human brain has been marked by a nearly 3-fold increase in size since our divergence from the last common ancestor shared with chimpanzees and bonobos. Despite increased interest in comparative neuroanatomy and phylogenetic methods, relatively little is known regarding the effects that this enlargement has had on its internal organization, and how certain areas of the brain have differentially expanded over evolutionary time. Analyses of the microstructure of several regions of the human cortex and subcortical structures have demonstrated subtle changes at the cellular and molecular level, suggesting that the human brain is more than simply a 'scaled-up' primate brain. Ongoing research in comparative neuroanatomy has much to offer regarding our understanding of human brain evolution. Through analysis of the neuroanatomical phenotype at the level of reorganization in cytoarchitecture and cellular morphology, new data continue to highlight changes in cell density and organization associated with volumetric changes in discrete regions. An understanding of the functional significance of variation in neural circuitry can further be approached through studies of atypical human development. Many neurodevelopmental disorders cause disruption in systems associated with uniquely human features of cognition, including language and social cognition. Understanding the genetic and developmental mechanisms that underlie variation in the human cognitive phenotype can help to clarify the functional significance of interspecific variation. By uniting approaches from comparative neuroanatomy and neuropathology, insights can be gained that clarify trends in human evolution. Here, we explore these lines of evidence and their significance for understanding functional variation between species as well as within neuropathological variation in the human brain.

Perceiving and acting in depth in Williams syndrome and typical development

Individuals with the neurodevelopmental disorder Williams syndrome (WS) often report difficulty processing and acting in depth, such as crossing roads or reaching for objects; however little research attention has been directed at understanding depth perception and action in depth in WS and whether deficits in depth perception have an ocular or perceptual root in this group. This study assessed the extent and relationship of deficits in stereopsis (binocular, three dimensional vision) and actions performed in depth in WS, as well as in typically developing participants (TD) matched for non-verbal ability. Stereoacuity was age-appropriate in the TD group but at the level of a TD three year old in WS; one third of the WS group did not show evidence of stereopsis. When monocularly acting in depth there was no difference between the WS and TD groups. When binocularly acting in depth the WS group that did not exhibit stereopsis were significantly poorer than the TD group and the WS group that exhibited stereopsis. When assessing the relationship between stereoacuity and action in depth, stereoacuity negatively correlated with binocular action in depth for the WS group with stereopsis, but not the TD group. Therefore, no deficits in monocular depth perception in WS were evidenced, yet significant deficits are exhibited in binocular depth perception and action. Importantly action in depth under binocular viewing may be a useful gross screening measure for stereodeficits in WS. Remediation of depth perception deficits in WS could train further understanding of monocular cues to compensate for poor stereopsis.

Altered brain connectivity in sagittal craniosynostosis

OBJECT

Sagittal nonsyndromic craniosynostosis (sNSC) is the most common form of NSC. The condition is associated with a high prevalence (> 50%) of deficits in executive function. The authors employed diffusion tensor imaging (DTI) and functional MRI to evaluate whether hypothesized structural and functional connectivity differences underlie the observed neurocognitive morbidity of sNSC.

METHODS

Using a 3-T Siemens Trio MRI system, the authors collected DTI and resting-state functional connectivity MRI data in 8 adolescent patients (mean age 12.3 years) with sNSC that had been previously corrected via total vault cranioplasty and 8 control children (mean age 12.3 years) without craniosynostosis. Data were analyzed using the FMRIB Software Library and BioImageSuite.

RESULTS

Analyses of the DTI data revealed white matter alterations approaching statistical significance in all supratentorial lobes. Statistically significant group differences (sNSC < control group) in mean diffusivity were localized to the right supramarginal gyrus. Analysis of the resting-state seed in relation to whole-brain data revealed significant increases in negative connectivity (anticorrelations) of Brodmann area 8 to the prefrontal cortex (Montreal Neurological Institute [MNI] center of mass coordinates [x, y, z]: -6, 53, 6) and anterior cingulate cortex (MNI coordinates 6, 43, 14) in the sNSC group relative to controls. Furthermore, in the sNSC patients versus controls, the Brodmann area 7, 39, and 40 seed had decreased connectivity to left angular gyrus (MNI coordinates -31, -61, 34), posterior cingulate cortex (MNI coordinates 13, -52, 18), precuneus (MNI coordinates 10, -55, 54), left and right parahippocampus (MNI coordinates -13, -52, 2 and MNI coordinates 11, -50, 2, respectively), lingual (MNI coordinates -11, -86, -10), and fusiform gyri (MNI coordinates -30, -79, -18). Intrinsic connectivity analysis also revealed altered connectivity between central nodes in the default mode network in sNSC relative to controls; the left and right posterior cingulate cortices (MNI coordinates -5, -35, 34 and MNI coordinates 6, -42, 39, respectively) were negatively correlated to right hemisphere precuneus (MNI coordinates 6, -71, 46), while the left ventromedial prefrontal cortex (MNI coordinates 6, 34, -8) was negatively correlated to right middle frontal gyrus (MNI coordinates 40, 4, 33). All group comparisons (sNSC vs controls) were conducted at a whole brain-corrected threshold of p < 0.05.

CONCLUSIONS

This study demonstrates altered neocortical structural and functional connectivity in sNSC that may, in part or substantially, underlie the neuropsychological deficits commonly reported in this population. Future studies combining analysis of multimodal MRI and clinical characterization data in larger samples of participants are warranted.

Developmental changes in mental rotation ability and visual perspective-taking in children and adults with Williams syndrome

Williams syndrome (WS) is a genetic disorder caused by the partial deletion of chromosome 7. Individuals with WS have atypical cognitive abilities, such as hypersociability and compromised visuospatial cognition, although the mechanisms underlying these deficits, as well as the relationship between them, remain unclear. Here, we assessed performance in mental rotation (MR) and level 2 visual perspective taking (VPT2) tasks in individuals with and without WS. Individuals with WS obtained lower scores in the VPT2 task than in the MR task. These individuals also performed poorly on both the MR and VPT2 tasks compared with members of a control group. For the individuals in the control group, performance scores improved during development for both tasks, while the scores of those in the WS group improved only in the MR task, and not the VPT2 task. Therefore, we conducted a second experiment to explore the specific cognitive challenges faced by people with WS in the VPT2 task. In addition to asking participants to change their physical location (self-motion), we also asked them to adopt a third-person perspective by imagining that they had moved to a specified location (self-motion imagery). This enabled us to assess their ability to simulate the movement of their own bodies. The performance in the control group improved in both the self-motion and self-motion imagery tasks and both performances were correlated with verbal mental age. However, we did not find any developmental changes in performance for either task in the WS group. Performance scores for the self-motion imagery task in the WS group were low, similar to the scores observed for the VPT2 in this population. These results suggest that MR and VPT2 tasks involve different processes, and that these processes develop differently in people with WS. Moreover, difficulty completing VPT2 tasks may be partly because of an inability of people with WS to accurately simulate mental body motion.

Space and language in Williams syndrome: insights from typical development

One of the holy grails of cognitive science is to understand the causal chain that links genes and cognition. Genetic syndromes accompanied by cognitive effects offer natural experiments that can uniquely inform our understanding of this chain. In this article, we discuss the case of Williams syndrome (WS), which is characterized by a set of missing genes on chromosome 7q11.23, and presents with a unique cognitive profile that includes severe spatial impairment along with strikingly fluent and well-structured language. An early inference from this profile was the idea that a small group of genes could directly target one cognitive system while leaving others unaffected. Recent evidence shows that this inference fails. First, the profile within the spatial domain is varied, with relative strength in some aspects of spatial representation but severe impairment in others. Second, some aspects of language may fail to develop fully, raising the question of how to compare the resilience and fragility of the two key cognitive domains in this syndrome. Third, much research on the profile fails to place findings in the context of typical developmental trajectories. We explore these points and propose a new hypothesis that explains the unusual WS cognitive profile by considering normal mechanisms of cognitive development that undergo change on an extremely prolonged timetable. This hypothesis places the elements of the WS cognitive profile in a new light, refocuses the discussion of the gene-cognition causal chain for WS and other disorders, and more generally, underlines the importance of understanding cognitive structure in both typical and atypical development. WIREs Cogn Sci 2013, 4:693-703. doi: 10.1002/wcs.1258 Conflict of interest: The authors have declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website.

Magnitude representations in Williams syndrome: differential acuity in time, space and number processing

For some authors, the human sensitivity to numerosities would be grounded in our ability to process non-numerical magnitudes. In the present study, the developmental relationships between non numerical and numerical magnitude processing are examined in people with Williams syndrome (WS), a genetic disorder known to associate visuo-spatial and math learning disabilities. Twenty patients with WS and 40 typically developing children matched on verbal or non-verbal abilities were administered three comparison tasks in which they had to compare numerosities, lengths or durations. Participants with WS showed lower acuity (manifested by a higher Weber fraction) than their verbal matched peers when processing numerical and spatial but not temporal magnitudes, indicating that they do not present a domain-general dysfunction of all magnitude processing. Conversely, they do not differ from non-verbal matched participants in any of the three tasks. Finally, correlational analyses revealed that non-numerical and numerical acuity indexes were both related to the first mathematical acquisitions but not with later arithmetical skills.

Cerebellar vermis abnormalities and cognitive functions in individuals with Williams syndrome

In Williams syndrome (WS) cerebellar measures were only indirectly related to behavioral outcomes. T1-weighted magnetic resonance images and neuropsychological data were acquired to investigate whether cerebellar vermis differences were present in 12 WS individuals compared with 13 chronological age-matched controls and whether WS cerebellar vermis measures were related to cognitive scores. In WS participants, we observed a significant increase in the volume of the posterior superior cerebellar vermis (lobules VI-VII) and an atypical ratio between width and height of the cerebellar vermis. Furthermore, we found an inverse correlation between cerebellar posterior vermis volume and scores on implicit learning, phonological fluency and the verbal short-term memory tasks. The present study supported a role for the posterior cerebellar vermis in higher cognitive processes and indicated that the cerebellar vermis abnormalities (enlargement) in WS individuals have an effect in worsening the cognitive performance in specific domains.

Altered microstructure within social-cognitive brain networks during childhood in Williams syndrome

Williams syndrome (WS) is a neurodevelopmental condition caused by a hemizygous deletion of ∼26-28 genes on chromosome 7q11.23. WS is associated with a distinctive pattern of social cognition. Accordingly, neuroimaging studies show that WS is associated with structural alterations of key brain regions involved in social cognition during adulthood. However, very little is currently known regarding the neuroanatomical structure of social cognitive brain networks during childhood in WS. This study used diffusion tensor imaging to investigate the structural integrity of a specific set of white matter pathways (inferior fronto-occipital fasciculus [IFOF] and uncinate fasciculus [UF]) and associated brain regions [fusiform gyrus (FG), amygdala, hippocampus, medial orbitofrontal gyrus (MOG)] known to be involved in social cognition in children with WS and a typically developing (TD) control group. Children with WS exhibited higher fractional anisotropy (FA) and axial diffusivity values and lower radial diffusivity and apparent diffusion coefficient (ADC) values within the IFOF and UF, higher FA values within the FG, amygdala, and hippocampus and lower ADC values within the FG and MOG compared to controls. These findings provide evidence that the WS genetic deletion affects the development of key white matter pathways and brain regions important for social cognition.

Neural correlates of visual integration in Williams syndrome: gamma oscillation patterns in a model of impaired coherence

Williams syndrome (WS) is a clinical model of dorsal stream vulnerability and impaired visual integration. However, little is still known about the neurophysiological correlates of perceptual integration in this condition. We have used a 3D structure-from-motion (SFM) integrative task to characterize the neuronal underpinnings of 3D perception in WS and to probe whether gamma oscillatory patterns reflect changed holistic perception. Coherent faces were parametrically modulated in 3D depth (three different depth levels) to vary levels of stimulus ambiguity. We have found that the electrophysiological (EEG/ERP) correlates of such holistic percepts were distinct across groups. Independent component analysis demonstrated the presence of a novel component with a late positivity around 200 ms that was absent in controls. Source localization analysis of ERP signals showed a posterior occipital shift in WS and reduced parietal dorsal stream sources. Interestingly, low gamma-band oscillations (20-40 Hz) induced by this 3D perceptual integration task were significantly stronger and sustained during the stimulus presentation in WS whereas high gamma-band oscillations (60-90 Hz) were reduced in this clinical model of impaired visual coherence, as compared to controls. These observations suggest that dorsal stream processing of 3D SFM stimuli has distinct neural correlates in WS and different cognitive strategies are employed by these patients to reach visual coherence. Importantly, we found evidence for the presence of different sub-bands (20-40 Hz/60-90 Hz) within the gamma range which can be dissociated concerning the respective role on the coherent percept formation, both in typical and atypical development.

Learning without representational change: development of numerical estimation in individuals with Williams syndrome

Experience engenders learning, but not all learning involves representational change. In this paper, we provide a dramatic case study of the distinction between learning and representational change. Specifically, we examined long- and short-term changes in representations of numeric magnitudes by asking individuals with Williams syndrome (WS) and typically developing (TD) children to estimate the position of numbers on a number line. As with TD children, accuracy of WS children's numerical estimates improved with age (Experiment 1) and feedback (Experiment 2). Both long- and short-term changes in estimates of WS individuals, however, followed an atypical developmental trajectory: as TD children gained in age and experience, increases in accuracy were accompanied by a logarithmic-to-linear shift in estimates of numerical magnitudes, whereas in WS individuals, accuracy increased but logarithmic estimation patterns persisted well into adulthood and after extensive training. These findings suggest that development of numerical estimation in WS is both arrested and atypical.

Electrophysiological study of face inversion effects in Williams syndrome

OBJECTIVE

In order to evaluate whether face perception is intact or not in Williams syndrome (WS), the face inversion effects (FIE) in the event-related potential (ERP) or magnetoencephalography (MEG) were investigated in three teenaged patients with WS.

METHODS

Responses to the inverted faces and upright faces were compared using MEG for one 13year old girl with WS (subject A) and ERP for boys with WS at 16 and 14years of age (subjects B and C, respectively).

RESULTS

Although age-matched control children showed FIE in both MEG and ERP studies, two subjects (A and B) with WS showed no FIE at all. The neurophysiological data of ERP in subject B was significantly different from those of the age-matched controls. On the other hand, a boy with WS (subject C) showed typical FIE in the same manner as the age-matched controls.

CONCLUSIONS

The difference between those with or without FIE was not explained merely by the chronological age, a simple delay in mental age or in the ability to discriminate among upright faces. The absence of FIE may be related to the severity of a deficit in the dorsal pathway function that is characteristic to the syndrome.

Genetic mapping of brain plasticity across development in Williams syndrome: ERP markers of face and language processing

In Williams Syndrome (WS), a known genetic deletion results in atypical brain function with strengths in face and language processing. We examined how genetic influences on brain activity change with development. In three studies, event-related potentials (ERPs) from large samples of children, adolescents, and adults with the full genetic deletion for WS were compared to typically developing controls, and two adults with partial deletions for WS. Studies 1 and 2 identified ERP markers of brain plasticity in WS across development. Study 3 suggested that, in adults with partial deletions for WS, specific genes may be differentially implicated in face and language processing.

Conceptualizing neurodevelopmental disorders through a mechanistic understanding of fragile X syndrome and Williams syndrome

PURPOSE OF REVIEW

The overarching goal of this review is to compare and contrast the cognitive-behavioral features of fragile X syndrome (FraX) and Williams syndrome and to review the putative neural and molecular underpinnings of these features. Information is presented in a framework that provides guiding principles for conceptualizing gene-brain-behavior associations in neurodevelopmental disorders.

RECENT FINDINGS

Abnormalities, in particular cognitive-behavioral domains with similarities in underlying neurodevelopmental correlates, occur in both FraX and Williams syndrome including aberrant frontostriatal pathways leading to executive function deficits, and magnocellular/dorsal visual stream, superior parietal lobe, inferior parietal lobe, and postcentral gyrus abnormalities contributing to deficits in visuospatial function. Compelling cognitive-behavioral and neurodevelopmental contrasts also exist in these two disorders, for example, aberrant amygdala and fusiform cortex structure and function occurring in the context of contrasting social behavioral phenotypes, and temporal cortical and cerebellar abnormalities potentially underlying differences in language function. Abnormal dendritic development is a shared neurodevelopmental morphologic feature between FraX and Williams syndrome. Commonalities in molecular machinery and processes across FraX and Williams syndrome occur as well - microRNAs involved in translational regulation of major synaptic proteins; scaffolding proteins in excitatory synapses; and proteins involved in axonal development.

SUMMARY

Although the genetic variations leading to FraX and Williams syndrome are different, important similarities and contrasts in the phenotype, neurocircuitry, molecular machinery, and cellular processes in these two disorders allow for a unique approach to conceptualizing gene-brain-behavior links occurring in neurodevelopmental disorders.

Quantitative analysis of gray and white matter in Williams syndrome

Williams syndrome is a developmental disorder with a genetic basis, which results in an uneven cognitive profile with relatively strong language skills and severely impaired visuospatial abilities. To better understand the brain structure underlying this profile, we compared individuals with Williams syndrome with controls using multimodal neuroimaging data and new analytic methods (diffeomorphic mapping and atlas-based analysis). People with Williams syndrome had basal ganglia atrophy, while the fusiform, the medium temporal gyri, and the cerebellar cortex were relatively preserved. The right superior longitudinal fasciculus, the left frontooccipital fasciculus, the caudate, and the cingulum demonstrated increased fractional anisotropy, whereas the corticospinal tract revealed decreased values. These findings may be linked to the uneven cognitive profile evident in Williams syndrome.

Morphometry of corpus callosum in Williams syndrome: shape as an index of neural development

Brain abnormalities in Williams syndrome (WS) have been consistently reported, despite few studies have devoted attention to connectivity between different brain regions in WS. In this study, we evaluated corpus callosum (CC) morphometry: bending angle, length, thickness and curvature of CC using a new shape analysis method in a group of 17 individuals with WS matched with a typically developing group. We used this multimethod approach because we hypothesized that neurodevelopmental abnormalities might result in both volume changes and structure deformation. Overall, we found reduced absolute CC cross-sectional area and volume in WS (mean CC and subsections). In parallel, we observed group differences regarding CC shape and thickness. Specifically, CC of WS is morphologically different, characterized by a larger bending angle and being more curved in the posterior part. Moreover, although CC in WS is shorter, a larger relative thickness of CC was found in all callosal sections. Finally, groups differed regarding the association between CC measures, age, white matter volume and cognitive performance. In conclusions, abnormal patterns of CC morphology and shape may be implicated in WS cognitive and behavioural phenotype.

Understanding motor acts and motor intentions in Williams syndrome

Williams syndrome (WS) is a rare genetic disorder associated with unusually hyper-social demeanor and ease with strangers. These personality traits are accompanied by difficulties in social interactions, possibly related, at least in part, to a difficulty in understanding others' mental states. Studies on mentalizing capacities in individuals with WS have often led to contrasting results, some studies revealing specific impairments, others highlighting spared mentalizing capacities. So far, however, no study investigated the performance of individuals with WS in non-inferential understanding of others' motor intentions. In the present study we investigated this capacity by using a computer-based behavioral task using pictures of hand-object interactions. We asked individuals with WS first to describe what the other was doing (i.e. a task implying no kind of intention reading), and secondly, if successful in answering the first question, to describe the motor intention underlying the observed motor acts (i.e. why an act was being done, a task requiring non-inferential motor intention understanding). Results showed that individuals with WS made more errors in understanding what the other was doing (i.e. understanding a motor act) compared to both mental-age matched controls and chronological-age matched peers with typical development, while showing mental-age appropriate performance in understanding why an individual was acting (i.e. understanding a motor intention). These findings suggest novel perspectives for understanding impairments in social behavior in WS.

Visually guided step descent in children with Williams syndrome

Individuals with Williams syndrome (WS) have impairments in visuospatial tasks and in manual visuomotor control, consistent with parietal and cerebellar abnormalities. Here we examined whether individuals with WS also have difficulties in visually controlling whole-body movements. We investigated visual control of stepping down at a change of level in children with WS (5-16-year-olds), who descended a single step while their movement was kinematically recorded. On each trial step height was set unpredictably, so that visual information was necessary to perceive the step depth and position the legs appropriately before landing. Kinematic measures established that children with WS did not use visual information to slow the leg at an appropriate point during the step. This pattern contrasts with that observed in typically developing 3- and 4-year-old children, implying severe impairment in whole-body visuomotor control in WS. For children with WS, performance was not significantly predicted by low-level visual or balance problems, but improved significantly with verbal age. The results suggest some plasticity and development in WS whole-body control. These data clearly show that visuospatial and visuomotor deficits in WS extend to the locomotor domain. Taken together with evidence for parietal and cerebellar abnormalities in WS, these results also provide new evidence for the role of these circuits in the visual control of whole-body movement.

Gait adaptation during obstacle crossing reveals impairments in the visual control of locomotion in Williams syndrome

Recent evidence indicates that individuals with Williams syndrome (WS), a rare genetically based neurodevelopmental disorder, show abnormalities of parietal and cerebellar regions of the brain that may be involved in the visual control of locomotion. Here we examined whether parietal and cerebellar abnormalities contribute to deficits in spatiotemporal characteristics and foot placement variability during obstacle crossing in adults with WS, when compared with an IQ-matched group of adults with Down syndrome (DS) and typically developing adult controls. We used the GAITRite walkway to examine the spatiotemporal characteristics and foot placement variability relative to a small ground-based obstacle in the travel path. We found that adults with WS showed late adjustments to spatiotemporal gait characteristics alongside an exaggerated and more spatially constrained visual guidance of foot positioning in the final steps prior to stepping over the obstacle. In contrast, the adults with DS showed longer step duration and more variable step length and step duration during the crossing and recovery steps after the obstacle, suggestive of cerebellar dysfunction. Although the controls were able to reduce the variability of foot placement across the obstacle crossing trials, both the WS and DS groups did not become more consistent with practice. These findings indicate a less flexible and overly constrained visuomotor system in WS, which is consistent with more widespread and diffuse abnormalities in parietal and cerebellar regions.

Changes in frontal-parietal activation and math skills performance following adaptive number sense training: preliminary results from a pilot study

Number sense is believed to be critical for math development. It is putatively an implicitly learned skill and may therefore have limitations in terms of being explicitly trained, particularly in individuals with altered neurodevelopment. A case series study was conducted using an adaptive, computerised programme that focused on number sense and general problem-solving skills. The study was designed to investigate training effects on performance as well as brain function in a group of children with Turner syndrome who are at risk for math difficulties and altered development of math-related brain networks. Standardised measurements of math and math-related cognitive skills as well as functional magnetic resonance imaging (fMRI) were used to assess behavioural and neurobiological outcomes following training. Participants demonstrated significantly increased basic math skills, including number sense, and calculation as well as processing speed, cognitive flexibility and visual-spatial processing skills. With the exception of calculation, increased scores also were clinically significant (i.e., recovered) based on reliable change analysis. Participants additionally demonstrated significantly increased bilateral parietal lobe activation and decreased frontal-striatal and mesial temporal activation following the training programme. These findings show proof of concept for an accessible training approach that may be potentially associated with improved number sense, math and related skills, as well as functional changes in math-related neural systems, even among individuals at risk for altered brain development.

Small Subitizing Range in People with Williams syndrome

Recent evidence suggests that the rapid apprehension of small numbers of objects-- often called subitizing-- engages a system which allows representation of up to 4 objects but is distinct from other aspects of numerical processing. We examined subitizing by studying people with Williams syndrome (WS), a genetic deficit characterized by severe visuospatial impairments, and normally developing children (4-6.5 years old). In Experiment 1, participants first explicitly counted displays of 1 to 8 squares that appeared for 5 s and reported "how many". They then reported "how many" for the same displays shown for 250 ms, a duration too brief to allow explicit counting, but sufficient for subitizing. All groups were highly accurate up to 8 objects when they explicitly counted. With the brief duration, people with WS showed almost perfect accuracy up to a limit of 3 objects, comparable to 4 year-olds but fewer than either 5 or 6.5 year-old children. In Experiment 2, participants were asked to report "how many" for displays that were presented for an unlimited duration, as rapidly as they could while remaining accurate. Individuals with WS responded as rapidly as 6.5 year-olds, and more rapidly than 4 year-olds. However, their accuracy was as in Experiment 1, comparable to 4 year-olds, and lower than older children. These results are consistent with previous results indicating that people with WS can simultaneously represent multiple objects, but that they have a smaller capacity than older children, on par with 4 year-olds. This pattern is discussed in the context of normal and abnormal development of visuospatial skills, in particular those linked to the representation of numerosity.

Development of human visual function

By 1985 newly devised behavioral and electrophysiological techniques had been used to track development of infants' acuity, contrast sensitivity and binocularity, and for clinical evaluation of developing visual function. This review focus on advances in the development and assessment of infant vision in the following 25 years. Infants' visual cortical function has been studied through selectivity for orientation, directional motion and binocular disparity, and the control of subcortical oculomotor mechanisms in fixation shifts and optokinetic nystagmus, leading to a model of increasing cortical dominance over subcortical pathways. Neonatal face processing remains a challenge for this model. Recent research has focused on development of integrative processing (hyperacuity, texture segmentation, and sensitivity to global form and motion coherence) in extra-striate visual areas, including signatures of dorsal and ventral stream processing. Asynchronies in development of these two streams may be related to their differential vulnerability in both acquired and genetic disorders. New methods and approaches to clinical disorders are reviewed, in particular the increasing focus on paediatric neurology as well as ophthalmology. Visual measures in early infancy in high-risk children are allowing measures not only of existing deficits in infancy but prediction of later visual and cognitive outcome. Work with early cataract and later recovery from blinding disorders has thrown new light on the plasticity of the visual system and its limitations. The review concludes with a forward look to future opportunities provided by studies of development post infancy, new imaging and eye tracking methods, and sampling infants' visual ecology.

From genes to brain development to phenotypic behavior: "dorsal-stream vulnerability" in relation to spatial cognition, attention, and planning of actions in Williams syndrome (WS) and other developmental disorders

Visual information is believed to be processed through two distinct, yet interacting cortical streams. The ventral stream performs the computations needed for recognition of objects and faces ("what" and "who"?) and the dorsal stream the computations for registering spatial relationships and for controlling visually guided actions ("where" and "how"?). We initially proposed a model of spatial deficits in Williams syndrome (WS) in which visual abilities subserved by the ventral stream, such as face recognition, are relatively well developed (although not necessarily in exactly the same way as in typical development), whereas dorsal-stream functions, such as visuospatial actions, are markedly impaired. Since these initial findings in WS, deficits of motion coherence sensitivity, a dorsal-stream function has been found in other genetic disorders such as Fragile X and autism, and as a consequence of perinatal events (in hemiplegia, perinatal brain anomalies following very premature birth), leading to the proposal of a general "dorsal-stream vulnerability" in many different conditions of abnormal human development. In addition, dorsal-stream systems provide information used in tasks of visuospatial memory and locomotor planning, and these systems are closely coupled to networks for attentional control. We and several other research groups have previously shown deficits of frontal and parietal lobe function in WS individuals for specific attention tasks [e.g., Atkinson, J., Braddick, O., Anker, S., Curran, W., & Andrew, R. (2003). Neurobiological models of visuospatial cognition in children with Williams Syndrome: Measures of dorsal-stream and frontal function. Developmental Neuropsychology, 23(1/2), 141-174.]. We have used the Test of Everyday Attention for Children (TEA-Ch) which aims to attempt to separate components of attention with distinct brain networks (selective attention, sustained attention, and attention control-executive function) testing a group of older children with WS, but this test battery is too demanding for many children and adults with WS. Consequently, we have devised a new set of tests of attention, the Early Childhood Attention Battery (ECAB). This uses similar principles to the TEA-Ch, but adapted for mental ages younger than 6 years. The ECAB shows a distinctive attention profile for WS individuals relative to their overall cognitive development, with relative strength in tasks of sustained attention and poorer performance on tasks of selective attention and executive control. These profiles, and the characteristic developmental courses, also show differences between children with Down's syndrome and WS. This chapter briefly reviews new research findings on WS in these areas, relating the development of brain systems in WS to evidence from neuroimaging in typically developing infants, children born very preterm, and normal adults. The hypothesis of "dorsal-stream(s) vulnerability" which will be discussed includes a number of interlinked brain networks, subserving not only global visual processing and formulation of visuomotor actions but interlinked networks of attention.

A kinematic analysis of visually-guided movement in Williams syndrome

Previous studies have reported that people with the neurodevelopmental disorder Williams syndrome exhibit difficulties with visuomotor control. In the current study, we examined the extent to which visuomotor deficits were associated with movement planning or feedback-based on-line control. We used a variant of the Fitts' reciprocal aiming task on a computerized touchscreen in adults with WS, IQ-matched individuals with Down syndrome (DS), and typically developing controls. By manipulating task difficulty both as a function of target size and amplitude, we were able to vary the requirements for accuracy to examine processes associated with dorsal visual stream and cerebellar functioning. Although a greater increase in movement time as a function of task difficulty was observed in the two clinical groups with WS and DS, greater magnitude in the late kinematic components of movement-specifically, time after peak velocity-was revealed in the WS group during increased demands for accuracy. In contrast, the DS group showed a greater speed-accuracy trade-off with significantly reduced and more variable endpoint accuracy, which may be associated with cerebellar deficits. In addition, the WS group spent more time stationary in the target when task-related features reflected a higher level of difficulty, suggestive of specific deficits in movement planning. Our results indicate that the visuomotor coordination deficits in WS may reflect known impairments of the dorsal stream, but may also indicate a role for the cerebellum in dynamic feed-forward motor control.

Object recognition in Williams syndrome: uneven ventral stream activation

Williams syndrome (WS) is a genetic disorder associated with severe visuospatial deficits, relatively strong language skills, heightened social interest, and increased attention to faces. On the basis of the visuospatial deficits, this disorder has been characterized primarily as a deficit of the dorsal stream, the occipitoparietal brain regions that subserve visuospatial processing. However, some evidence indicates that this disorder may also affect the development of the ventral stream, the occipitotemporal cortical regions that subserve face and object recognition. The present studies examined ventral stream function in WS, with the hypothesis that faces would produce a relatively more mature pattern of ventral occipitotemporal activation, relative to other objects that are also represented across these visual areas. Using functional magnetic imaging, we compared activation patterns during viewing of human faces, cat faces, houses and shoes in individuals with WS (age 14-27), typically developing 6-9-year-olds (matched approximately on mental age), and typically developing 14-26-year-olds (matched on chronological age). Typically developing individuals exhibited changes in the pattern of activation over age, consistent with previous reports. The ventral stream topography of individuals with WS differed from both control groups, however, reflecting the same level of activation to face stimuli as chronological age matches, but less activation to house stimuli than either mental age or chronological age matches. We discuss the possible causes of this unusual topography and implications for understanding the behavioral profile of people with WS.

Developmental profiles for multiple object tracking and spatial memory: typically developing preschoolers and people with Williams syndrome

The ability to track moving objects, a crucial skill for mature performance on everyday spatial tasks, has been hypothesized to require a specialized mechanism that may be available in infancy (i.e. indexes). Consistent with the idea of specialization, our previous work showed that object tracking was more impaired than a matched spatial memory task in individuals with Williams syndrome (WS), a genetic disorder characterized by severe visuo-spatial impairment. We now ask whether this unusual pattern of performance is a reflection of general immaturity or of true abnormality, possibly reflecting the atypical brain development in WS. To examine these two possibilities, we tested typically developing 3- and 4-year-olds and people with WS on multiple object tracking (MOT) and memory for static spatial location. The maximum number of objects that could be correctly tracked or remembered (estimated from the k-statistic) showed similar developmental profiles in typically developing 3- and 4-year-old children, but the WS profile differed from either age group. People with WS could track more objects than 3-year-olds, and the same number as 4-year-olds, but they could remember the locations of more static objects than both 3- and 4-year-olds. Combining these data with those from our previous studies, we found that typically developing children show increases in the number of objects they can track or remember between the ages of 3 and 6, and these increases grow in parallel across the two tasks. In contrast, object tracking in older children and adults with WS remains at the level of 4-year-olds, whereas the ability to remember multiple locations of static objects develops further. As a whole, the evidence suggests that MOT and memory for static location develop in tandem typically, but not in WS. Atypical development of the parietal lobe in people with WS could play a causal role in the abnormal, uneven pattern of performance in WS. This interpretation is consistent with the idea that multiple object tracking engages different mechanisms from those involved in memory for static object location, and that the former can be particularly disrupted by atypical development.

Vision in developmental disorders: is there a dorsal stream deficit?

The main aim of this review is to evaluate the proposal that several developmental disorders affecting vision share an impairment of the dorsal visual stream. First, the current definitions and common measurement approaches used to assess differences in both local and global functioning within the visual system are considered. Next, studies assessing local and global processing in the dorsal and ventral visual pathways are reviewed for five developmental conditions for which early to mid level visual abilities have been assessed: developmental dyslexia, autism spectrum disorders, developmental dyspraxia, Williams syndrome and Fragile X syndrome. The reviewed evidence is broadly consistent with the idea that the dorsal visual stream is affected in developmental disorders. However, the potential for a unique profile of visual abilities that distinguish some of the conditions is posited, given that for some of these disorders ventral stream deficits have also been found. We conclude with ideas regarding future directions for the study of visual perception in children with developmental disorders using psychophysical measures.

Bridging the gene-behavior divide through neuroimaging deletion syndromes: Velocardiofacial (22q11.2 Deletion) and Williams (7q11.23 Deletion) syndromes

Investigating the relationship between genes and the neural substrates of complex human behavior promises to provide essential insight into the pathophysiology of mental disorders. One approach to this inquiry is through neuroimaging of individuals with microdeletion syndromes that manifest in specific neuropsychiatric phenotypes. Both Velocardiofacial syndrome (VCFS) and Williams syndrome (WS) involve haploinsufficiency of a relatively small set of identified genes on the one hand and association with distinct, clinically relevant behavioral and cognitive profiles on the other hand. In VCFS, there is a deletion in chromosomal region 22q11.2 and a resultant predilection toward psychosis, poor arithmetic proficiency, and low performance intelligence quotients. In WS, there is a deletion in chromosomal region 7q11.23 and a resultant predilection toward hypersociability, non-social anxiety, impaired visuospatial construction, and often intellectual impairment. Structural and functional neuroimaging studies have begun not only to map these well-defined genetic alterations to systems-level brain abnormalities, but also to identify relationships between neural phenotypes and particular genes within the critical deletion regions. Though neuroimaging of both VCFS and WS presents specific, formidable methodological challenges, including comparison subject selection and accounting for neuroanatomical and vascular anomalies in patients, and many questions remain, the literature to date on these syndromes, reviewed herein, constitutes a fruitful "bottom-up" approach to defining gene-brain relationships.

Effects of external and internal cues on gait function in Williams syndrome

Williams syndrome (WS), a rare genetically based neurodevelopmental disorder, is characterized by gait abnormalities that resemble basal ganglia-parkinsonian deficits in the internal regulation of stride length. In the current study, we explored whether visual or attentional cues would improve gait function in adults with WS, when compared to adults with Down syndrome (DS) and neurologically normal controls. The spatiotemporal characteristics of gait were measured using the GAITRite walkway while participants walked with visual cues set at 20% greater than preferred stride length (externally cued), or with an attentional strategy of maintaining the stride length without the assistance of visual cues (internally cued). Although the WS and DS groups were able to achieve the criterion and normalize stride length in both conditions, the WS group significantly reduced their gait speed and cadence in the externally cued condition when compared to controls. In the internally cued condition, the WS group also showed reduced speed and increased intra-individual variability in speed and stride time. These findings suggest that the primary deficit is not one of difficulty regulating stride length in WS, but rather indicates more widespread dysfunction within visuomotor regions.

Impaired geometric reorientation caused by genetic defect

The capacity to reorient in one's environment is a fundamental part of the spatial cognitive systems of both humans and nonhuman species. Abundant literature has shown that human adults and toddlers, rats, chicks, and fish accomplish reorientation through the construction and use of geometric representations of surrounding layouts, including the lengths of surfaces and their intersection. Does the development of this reorientation system rely on specific genes and their action in brain development? We tested reorientation in individuals who have Williams syndrome (WS), a genetic disorder that results in abnormalities of hippocampal and parietal areas of the brain known to be involved in reorientation. We found that in a rectangular chamber devoid of surface feature information, WS individuals do not use the geometry of the chamber to reorient, failing to find a hidden object. The failure among people with WS cannot be explained by more general deficits in visual-spatial working memory, as the same individuals performed at ceiling in a similar task in which they were not disoriented. We also found that performance among people with WS improves in a rectangular chamber with one blue wall, suggesting that some individuals with WS can use the blue wall feature to locate the hidden object. These results show that the geometric system used for reorientation in humans can be selectively damaged by specific genetic and neural abnormalities in humans.

Insights into brain development from neurogenetic syndromes: evidence from fragile X syndrome, Williams syndrome, Turner syndrome and velocardiofacial syndrome

Over the past few decades, behavioral, neuroimaging and molecular studies of neurogenetic conditions, such as Williams, fragile X, Turner and velocardiofacial (22q11.2 deletion) syndromes, have led to important insights regarding brain development. These investigations allow researchers to examine "experiments of nature" in which the deletion or alteration of one gene or a contiguous set of genes can be linked to aberrant brain structure or function. Converging evidence across multiple imaging modalities has now begun to highlight the abnormal neural circuitry characterizing many individual neurogenetic syndromes. Furthermore, there has been renewed interest in combining analyses across neurogenetic conditions in order to search for common organizing principles in development. In this review, we highlight converging evidence across syndromes from multiple neuroimaging modalities, with a particular emphasis on functional imaging. In addition, we discuss the commonalities and differences pertaining to selective deficits in visuospatial processing that occur across four neurogenetic syndromes. We suggest avenues for future exploration, with the goal of achieving a deeper understanding of the neural abnormalities in these affected populations.

Development of visuospatial ability and kanji copying in Williams Syndrome

Williams syndrome is known for uneven cognitive abilities. Visuospatial difficulties such as a failure in constructing objects are considered to be characteristic and may influence the copying of Japanese semantic characters, kanji. In contrast to previous investigations, which were done mainly cross-sectionally, this study focused on the developmental aspects of the symptoms, to get a better view of the mechanism. Developmental changes in visuospatial abilities (including copying two-dimensional figures, three-dimensional figures, and kanji) in four boys with Williams syndrome, ages 4 to 11 years, were longitudinally observed for 6-9 years. The Benton's three-dimensional block construction tests and the Yerkes test were also performed. Some of the results were compared with those of mental age-matched children. The observation revealed improvements in performance for copying two-dimensional figures, as well as for copying kanji, in the Williams syndrome participants; however, copying three-dimensional figures tended to remain difficult, especially if in a transparent view. Obtaining three-dimensional information using pictorial cues seemed to remain difficult for the Williams syndrome participants even at the later stage of study monitoring. This difficulty might be correlated with the core dysfunction of Williams syndrome.

Mathematical skills in Williams syndrome: insight into the importance of underlying representations

Williams syndrome (WS) is a developmental disorder characterized by relatively spared verbal skills and severe visuospatial deficits. Serious impairments in mathematics have also been reported. This article reviews the evidence on mathematical ability in WS, focusing on the integrity and developmental path of two fundamental representations, namely those that support judgments of "how much" (i.e., magnitude) and "how many" (i.e., number of objects). Studies on magnitude or "number line" representation in WS suggest that this core aspect of mathematical ability, is atypical in WS throughout development, causing differences on some but not all aspects of math. Studies on the representation of small numbers of objects in WS are also reviewed, given the proposed links between this type of representation and early number skills such as counting. In WS, representation appears to be relatively typical in infancy but limitations become evident by maturity, suggesting a truncated developmental trajectory. The math deficits in WS are consistent with neurological data indicating decreased gray matter and hypoactivation in parietal areas in WS, as these areas are implicated in mathematical processing as well as visuospatial abilities and visual attention. In spite of their deficits in core mathematical representations, people with WS can learn many mathematical skills and show some strengths, such as reading numbers. Thus individuals with WS may be able to take advantage of their relatively strong verbal skills when learning some mathematical tasks. The uneven mathematical abilities found in persons with WS provide insight into not only appropriate remediation for this developmental disorder but also into the precursors of mathematical ability, their neural substrates, and their developmental importance.