From emergent literacy to reading: how learning to read changes a child's brain

A greater modulation of the visual and fronto-parietal networks for children in a post-media versus pre-media exposure group

AIM

Media use in children has exploded in the past several decades, most recently fuelled by portable electronic devices. This study aims to explore differences in functional brain connectivity in children during a story-listening functional MRI (fMRI) task using data collected before (1998) and after (2013) the widespread adoption of media.

METHODS

Cross-sectional data were collected from English-speaking 5- to 7-year-old children at Cincinnati Children's Hospital Medical Center, USA, of a functional MRI narrative comprehension task completed in 1998 (n = 22) or 2013 (n = 25). Imaging data were processed using a graph theory approach, focusing on executive functions, language and visual processing networks supporting reading.

RESULTS

Group differences suggest more efficient processing in the fronto-parietal network in the pre-media group while listening to stories. A modulation of the visual and fronto-parietal networks for the post-media exposure group was found.

CONCLUSION

Further studies are needed to assess effects over time in the more exposed group to discern a causal effect of portable devices on cognitive networks.

Neural Signature of Rhyming Ability During Story Listening in Preschool-Age Children

PURPOSE

Rhyming is a phonological skill that typically emerges in the preschool age range. Prosody/rhythm processing involves right-lateralized temporal cortex, yet the neural basis of rhyming ability in young children is unclear. The study objective was to use functional MRI (fMRI) to quantify neural correlates of rhyming abilities in preschool-age children.

METHOD

Healthy pre-kindergarten child-parent dyads were recruited for a study visit including MRI and the Preschool and Primary Inventory of Phonological Awareness (PIPA) rhyme subtest. MRI included a fMRI task where the child listened to a rhymed and unrhymed story without visual stimuli. fMRI data were processed using the CONN functional connectivity (FC) toolbox, with FC computed between 132 regions of interest (ROI) across the brain. Associations between PIPA score and FC during the rhymed vs. unrhymed story were compared accounting for age, sex and maternal education.

RESULTS

45 children completed MRI (age 54+8 months, 37-63; 19M 26F). Median maternal education was college graduate. FC between ROIs in posterior Default Mode (imagery) and right-Fronto-Parietal (executive function) networks was more strongly positively associated with PIPA score during the rhymed compared to the unrhymed story (F(2,39) = 10.95, p-FDR = 0.043), as was FC between ROIs in right-sided language (prosody) and Dorsal Attention networks (F(2,39) = 9.85, p-FDR = 0.044).

CONCLUSIONS

Preschool-age children with better rhyming abilities had stronger FC between ROIs supporting attention and prosody, and also between ROIs supporting executive function and imagery, suggesting rhyme as a catalyst for attention, visualization and comprehension. These represent novel neural biomarkers of nascent phonological skills.

Shared Reading of the Families With the Children With Chronic Disease

The aim of the study is to evaluate shared reading of families of children with chronic diseases. The mothers of children aged 2 to 6 years with chronic health problems who applied to the pediatric outpatient clinic between January and May 2022 were the study group, and the mothers of children with an acute health problem were the control group. The sociodemographic information form and "Child-Parent Shared Reading Activities Scale" were applied. At the end of the interview, 3 questions about shared reading were asked. A total of 187 children were enrolled in the study: 92 and 95 in the chronic disease group and control group, respectively. 57.6% of mothers of chronically ill children reported that the parents almost never did shared reading with their child. It was found that all mothers knew the importance of reading, but they could not support especially in the risky chronic disease group.

Beliefs and Motivations Regarding Early Shared Reading of Parents From Low-Income Households: A Qualitative Study

OBJECTIVE

Parent-child "shared" reading is a catalyst for development of language and other emergent literacy skills. The American Academy of Pediatrics recommends that parents initiate shared reading as soon as possible after birth. Persistent disparities exist in reading resources, routines, and subsequent literacy outcomes, disproportionately impacting low-income households. We sought to understand beliefs, motivations, and experiences regarding shared reading during early infancy among parents from low-income households.

METHODS

In this qualitative exploratory study, parents of infants aged 0 to 9 months from low-income households who had initiated shared reading ("readers") and those who had not ("nonreaders") were purposefully recruited to participate in individual semistructured virtual interviews. These interviews were coded using inductive thematic analysis by a 3-member team with diverse backgrounds.

RESULTS

A total of 21 parents participated (57% readers, 86% mothers). Infants were 86% African American/Black, with a mean age of 3 months. Barriers noted by readers and nonreaders were i) competing demands on time, ii) lack of resources, and iii) parental mental health. An additional barrier noted solely by nonreaders was iv) it's too early/baby is not ready. Two benefits of reading were noted by both groups: 1) parents as child's first teachers and 2) reading catalyzes the child's development. Benefits noted exclusively by readers included 3) reading begets more reading, 4) bonding, 5) "it works," and 6) "two-for-one" shared reading (other children involved).

CONCLUSIONS

This study provided insights into barriers and benefits regarding shared reading by socioeconomically disadvantaged parents of infants and has the potential to inform reading-related guidance and interventions.

Early Literacy Developmental Activities and Pre-Kindergarten Learning Skills in the Context of Childhood Adversity

OBJECTIVE

School readiness (SR) encompasses a wide range of skills that affect children's ability to succeed in school and later in life. Shared reading is an important strategy that assists children in gaining SR skills, whereas adverse childhood experiences (ACEs) negatively affect a child's SR. This study assessed if early literacy developmental activities (shared reading, singing, or storytelling) were associated with improved SR among children with and without ACEs.

METHODS

2020-2021 National Survey of Children's Health data were used for analysis. We identified children aged 3-5 years to assess their exposure to ACEs, participation in reading/storytelling/singing, and overall SR.

RESULTS

In a sample of 17,545 children, 29% of children were exposed to one or more ACEs. Seventy-seven percent of children with no ACEs received daily early literacy developmental activities compared to 23% of children who experienced any ACE. On ordinal logistic regression, daily early literacy developmental activities were associated with 56% greater odds of higher SR among children not exposed to ACEs (OR: 1.56; 95% CI: 1.29, 1.88; P < .01). Among children exposed to ACEs, daily early literacy developmental activities were also associated with higher SR (OR: 1.50; 95% CI: 1.06, 2.13; P = .02).

CONCLUSIONS

Shared reading, storytelling, and singing are associated with improved SR in both children who have and have not been exposed to ACEs. However, children exposed to ACEs had fewer experiences with early literacy developmental activities. Future efforts should address the barriers that limit shared reading, singing, or storytelling for children exposed to ACEs.

Executive functions abilities in preschool-age children are negatively related to parental EF, screen-time and positively related to home literacy environment: an EEG study

Environmental factors such as Home Literacy Environment (HLE), screen time, and parental executive functions (EF) may influence the development of the child's EF. The purpose of this study was to determine the effect of these factors on behavioral and neurobiological measures of EF in 4-year-old children. Electroencephalogram (EEG) data were collected while children performed the Attention Network Task (ANT), showing a smaller difference between incongruent and congruent conditions is related to better EF abilities. Data were analyzed using an Event-Related Potential (ERP) technique focusing on the N200 and P300 components (reflecting executive control and orienting attention, respectively). N200 and P300 differences (delta) between amplitudes and latencies for the incongruent and congruent conditions were computed and correlated with child EF skills, HLE, screen exposure, and parental EF. Screen exposure was associated with lower EF in children and their parents. Additionally, smaller differences between N200 amplitudes and latencies for the incongruent vs. congruent conditions were associated with higher HLE scores. In contrast, greater differences between P300 amplitudes and latencies were related to longer screen time. HLE was positively associated with EF's neurobiological (EEG) and behavioral measures, and screen time was negatively associated with these measures. This study also highlights the important relationship between parental EF (i.e., family predisposition) and EF's neurobiological and behavioral measures in their children.

Neural synchrony underlies the positive effect of shared reading on children's language ability

Although it is well recognized that parent-child shared reading produces positive effects on children's language ability, the underlying neurocognitive mechanisms are not well understood. Here, we addressed this issue by measuring brain activities from mother-child dyads simultaneously during a shared book reading task using functional near infrared spectroscopy hyperscanning. The behavioral results showed that the long-term experience of shared reading significantly predicted children's language ability. Interestingly, the prediction was moderated by children's age: for older children over 30 months, the more the shared reading experience, the better the language performance; for younger children below 30 months, however, no significant relationship was observed. The brain results showed significant interpersonal neural synchronization between mothers and children at the superior temporal cortex, which was closely associated with older children's language ability through the mediation of long-term experience of shared reading. Finally, the results showed that the instantaneous quality of shared reading contributed to children's language ability through enhancing interpersonal neural synchronization and increasing long-term experience. Based on these findings, we tentatively proposed a theoretical model for the relationship among interpersonal neural synchronization, shared reading and children's language ability. These findings will facilitate our understanding on the role of shared reading in children's language development.

Active Home Literacy Environment: parents' and teachers' expectations of its influence on affective relationships at home, reading performance, and reading motivation in children aged 6 to 8 years

Studies highlight the benefits of active Home Literacy Environment on learning and reading habits. This model is based on harnessing family involvement, resources and capabilities to create learning opportunities around reading, engaging in practices related to written language at home. However, it is less common to find applied research with children from the age of six, with older ages and already initiated in reading decoding. The aims are confirming and improving the expectations of families and teachers of a group of children (6-8 years old) regarding the effect of an active Home Literacy Environment program on the improvement of affective relationships between parents and children, reading performance, and children's reading motivation. The method and procedure followed included carrying out an active Home Literacy Environment program for 18 months with a group of children (aged 6 to 8 years), their families and their teachers, and measures of all variables were collected at four times, using an Ad Hoc instrument designed for families and teachers. The results show that participants had high expectations about the influence of the Home Literacy Environment on the improvement of all variables even before the implementation of the program, improving their expectations about its effects on positive affective relationships at home and on reading achievement after the intervention. In conclusion, we suggest the need to continue investigating the effects of the active Home Literacy Environment program applied to children aged 6 to 8 years, older than those traditionally investigated. As well as their effects on family relationships, reading ability, and reading motivation.

Neuroimaging of brain connectivity related to reading outcomes in children born preterm: A critical narrative review

Premature children are at high risk for delays in language and reading, which can lead to poor school achievement. Neuroimaging studies have assessed structural and functional connectivity by diffusion MRI, functional MRI, and magnetoencephalography, in order to better define the "reading network" in children born preterm. Findings point to differences in structural and functional connectivity compared to children born at term. It is not entirely clear whether this discrepancy is due to delayed development or alternative mechanisms for reading, which may have developed to compensate for brain injury in the perinatal period. This narrative review critically appraises the existing literature evaluating the neural basis of reading in preterm children, summarizes the current findings, and suggests future directions in the field.

The relationship between home environment and early childhood development of left-behind children under 3 years in rural China

BACKGROUND

Home environment provides stimulation and learning opportunities required for children's early development. However, few studies have focused on the effects of home environment on left-behind children's development in rural China. The study aimed to investigate the relationship between home environment and early childhood development of left-behind children under 3 years old in rural China.

METHODS

Information about sociodemographic characteristics, caregivers' mental health, home environment and children's development was collected. Infant/Toddler Home Observation for Measurement of the Environment Inventory (IT-HOME) was used to assess home environment. Child's development was evaluated with the Chinese version of the Ages & Stages Questionnaire - third edition.

RESULTS

Elevated caregivers' depressive symptoms were associated with a higher risk of total suspected development delay. An increase of one score in the IT-HOME resulted in a 7% decrease in total suspected development delay. Higher scores in the dimensions of involvement and variety were associated with a lower risk of suspected development delay adjusting for covariates.

CONCLUSIONS

Our results have implications for home-based intervention aiming at promoting nurturing care as well as caregivers' mental health, which is required for early development of young left-behind children in rural areas of China.

Higher theta-beta ratio during screen-based vs. printed paper is related to lower attention in children: An EEG study

Reading is considered a non-intuitive, cognitively demanding ability requiring synchronization between several neural networks supporting visual, language processing and higher-order abilities. With the involvement of technology in our everyday life, reading from a screen has become widely used. Several studies point to challenges in processing written materials from the screen due to changes in attention allocation when reading from a screen compared to reading from a printed paper. The current study examined the differences in brain activation when reading from a screen compared to reading from a printed paper focusing on spectral power related to attention in fifteen 6-8-year-old children. Using an electroencephalogram, children read two different age-appropriate texts, without illustrations, presented randomly on the screen and on a printed paper. Data were analyzed using spectral analyses in brain regions related to language, visual processing, and cognitive control, focusing on theta vs. beta waveforms. Results indicated that while reading from a printed paper was accompanied by higher energy in high-frequency bands (beta, gamma), reading from the screen was manifested by a higher power in the lower frequency bands (alpha, theta). Higher theta compared to the beta ratio, representing challenges in allocating attention to a given task, was found for the screen reading compared to the printed paper reading condition. Also, a significant negative correlation was found between differences in theta/beta ratio for screen vs paper reading and accuracy level in the age-normalized Sky-Search task measuring attention and a positive correlation with performance time. These results provide neurobiological support for the greater cognitive load and reduced focused attention during screen-based compared to print-based reading and suggest a different reliance on attention resources for the two conditions in children.

Associations between digital media use and brain surface structural measures in preschool-aged children

The American Academy of Pediatrics recommends limits on digital media use ("screen time"), citing cognitive-behavioral risks. Media use in early childhood is ubiquitous, though few imaging-based studies have been conducted to quantify impacts on brain development. Cortical morphology changes dynamically from infancy through adulthood and is associated with cognitive-behavioral abilities. The current study involved 52 children who completed MRI and cognitive testing at a single visit. The MRI protocol included a high-resolution T1-weighted anatomical scan. The child's parent completed the ScreenQ composite measure of media use. MRI measures included cortical thickness (CT) and sulcal depth (SD) across the cerebrum. ScreenQ was applied as a predictor of CT and SD first in whole-brain regression analyses and then for regions of interest (ROIs) identified in a prior study of screen time involving adolescents, controlling for sex, age and maternal education. Higher ScreenQ scores were correlated with lower CT in right-lateralized occipital, parietal, temporal and fusiform areas, and also lower SD in right-lateralized inferior temporal/fusiform areas, with substantially greater statistical significance in ROI-based analyses. These areas support primary visual and higher-order processing and align with prior findings in adolescents. While differences in visual areas likely reflect maturation, those in higher-order areas may suggest under-development, though further studies are needed.

Improving Reading Skills Using a Computerized Phonological Training Program in Early Readers with Reading Difficulties

In the last years, there has been a big effort to identify risk factors for reading difficulties and to develop new methodologies to help struggling readers. It has been shown that early intervention is more successful than late intervention, and that intensive training programs can benefit children with reading difficulties. The aim of our study is to investigate the effectiveness of an intensive computerized phonological training program designed to improve reading performance in a sample of children with reading difficulties at the early stages of their reading learning process. Thirty-two children with reading difficulties were randomly assigned to one of the two intervention groups: RDIR (children with reading difficulties following a computerized intensive remediation strategy) (n = 20) (7.01 ± 0.69 years), focused on training phonemic awareness, decoding and reading fluency through the computational training; and RDOR (children with reading difficulties following an ordinary remediation strategy) (n = 12) (6.92 ± 0.82 years), which consisted of a reinforcement of reading with a traditional training approach at school. Normal readers (NR) were assigned to the control group (n = 24) (7.32 ± 0.66 years). Our results indicate that both the RDIR and RDOR groups showed an increased reading performance after the intervention. However, children in the RDIR group showed a stronger benefit than the children in the RDOR group, whose improvement was weaker. The control group did not show significant changes in reading performance during the same period. In conclusion, results suggest that intensive early intervention based on phonics training is an effective strategy to remediate reading difficulties, and that it can be used at school as the first approach to tackle such difficulties.

Exploratory Mixed-Methods Study of a Primary Care-Based Intervention Promoting Shared Reading During Infancy

Parent-child "shared" reading can be a rich source of language exposure. Clinic-based programs, notably Reach Out and Read (ROR), are intended to enhance this. However, ROR has been traditionally introduced at 6 months and only recently expanded to younger ages. This study explored efficacy of an intervention delivered during pediatric well visits promoting shared reading prior to 6 months old, in terms of home reading attitudes and routines. The intervention group received children's books and anticipatory guidance about benefits of shared reading, whereas the control group received general age-related anticipatory guidance. Surveys were administered at the child's newborn (pre-intervention) and 6-month (post-intervention) well visits. Significant findings at 6 months included more frequent shared reading (P = .03), greater comfort reading at this age (P = .01), and greater importance attributed to shared reading (P = .04) in the intervention group relative to controls. These support the expansion of early literacy interventions such as ROR into early infancy.

Functional MRI research involving healthy children: Ethics, safety and recommended procedures

AIM

This specific review aims to expose clinicians, researchers and administrators in hospitals to the importance, procedures and safety of fMRI studies to promote the increased utilisation of such studies in different geographical places worldwide. The child's brain is developing rapidly, both structurally and functionally. These functional changes can only be detected using functional scans generated from an MRI machine and referred to as a functional MRI (fMRI). This method may be used clinically in complex medical and surgical conditions (e.g., epilepsy surgery), but these days are often used for research purposes. However, due to ethical and logistical considerations, fMRI in the paediatric population is not widely and equally used in different geographical places.

CONCLUSIONS

The benefits of using this method to define the functional changes occurring in the developing brain are discussed in this review, along with desensitisation methods recommended when working with this vulnerable population in research and even in a clinical setting.

Chronic pediatric diseases and risk for reading difficulties: a narrative review with recommendations

Literacy is a major social determinant of health, rooted in skills that develop during early childhood. Children arriving at kindergarten unprepared to learn to read are more likely to have low reading proficiency thereafter. General and health literacy are highly correlated, affecting understanding of health conditions, treatment adherence, and transition to self-care and adult healthcare services. The American Academy of Pediatrics (AAP) recommends literacy and school readiness promotion during well-visits and neurodevelopmental surveillance is emphasized across primary and subspecialty care. While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and chronic medical conditions are less appreciated and under-researched. This review applies an eco-bio-developmental framework to explore literacy across five complex chronic conditions affecting millions of children worldwide: asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease. In each, integration of an efficient reading brain network may be impacted by direct factors, such as ischemia, anesthesia, and/or medications, and also indirect factors, such as altered parent-child routines, hospital stays, and missed school. By integrating literacy into care management plans for affected children, pediatric primary care and specialty providers are poised to identify risks early, target guidance and interventions, and improve academic and health outcomes. IMPACT: While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and/or chronic medical conditions such as asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease are substantial, less appreciated, and under-researched. General and health literacy are highly correlated, with implications for the understanding one's health condition, treatment adherence, and transitioning to self-care, which is especially important for children with complex and/or chronic illness. Pediatric primary care and specialty providers are poised to integrate reading and literacy into care management plans for children with complex and/or chronic illness, including early screening, guidance, support, and interventions.

Parental Book-Reading to Preterm Born Infants in NICU: The Effects on Language Development in the First Two Years

Background: After preterm birth, infants are at high risk for delays in language development. A promising intervention to reduce this risk is represented by the exposure to parental voices through book-reading in Neonatal Intensive Care Units (NICU). This study investigated the possible advantages of book-reading to preterm neonates during their NICU stay on their subsequent language development. Methods: 100 families of preterm infants were recruited. The parents of 55 preterm infants (Reading Group) received a colored picture-book on NICU admission and were supported to read to their neonate as often as possible and to continue after hospital discharge. Forty-five infants (Control Group) were recruited before the beginning of the intervention. Infant language development was assessed with the Hearing and Language quotients of the Griffith Mental Development Scale at the corrected ages of 3, 6, 9, 12, 18 and 24 months. Results: Regardless of group membership, Hearing and Language mean quotients decreased between 9 and 18 months; nevertheless, this decrease was considerably reduced in the Reading group, compared to the Control Group. Conclusions: Reading in NICUs represents a suitable intervention that could positively influence language development and parent-infant relationships in preterm children. The study findings support its implementation as a preventive measure.

Brief version of the CAMCOG for illiterate older adults with Alzheimer's dementia

BACKGROUND

The Cambridge Cognition Examination (CAMCOG) is one of the most used cognitive assessment batteries for older adults.

OBJECTIVE

To evaluate a brief version of the CAMCOG for illiterate older adults (CAMCOG-BILL) with Alzheimer's dementia (AD) and healthy controls (CG).

METHODS

Cross-sectional case-control study with 246 illiterate older adults (AD [n=159] and CG [n=87], composed by healthy seniors without cognitive complaints) who never attended school or took reading or writing lessons. Diagnosis of AD was established based on the NIA-AA and DSM-5 criteria. All participants were assessed with the CAMCOG by a researcher blinded for diagnosis. To assess the consistency of the chosen CAMCOG-BILL sub-items, we performed a binary logistic regression analysis.

RESULTS

Both the CAMCOG and the CAMCOG-BILL had satisfactory psychometric properties. The area under the curve (AUC) was 0.932 (p<0.001) for the original version of CAMCOG and 0.936 for the CAMCOG-BILL. Using a cut-off score of ≥60 (CAMCOG) and ≥44 (CAMCOG-BILL), both instruments had the same sensitivity and specificity (89 and 96%, respectively).

CONCLUSION

The CAMCOG-BILL may be a preferred tool because of the reduced test burden for this vulnerable subgroup of illiterate patients with dementia.

Maternal depression is associated with decreased functional connectivity within semantics and phonology networks in preschool children

INTRODUCTION

Maternal depression is characterized by a lack of emotional responsiveness and engagement with their child, which may lead to the child's decreased cognitive, and language outcomes all related to the child's future reading outcomes. The relations between maternal depression and functional connectivity in neural circuits supporting language in the child was explored.

METHODS

Eleven 4-year-old girls completed language abilities assessment and resting-state functional magnetic resonance imaging scan. Their mothers completed the Beck's Depression Inventory (BDI) to examine maternal depression when the child was 12 months old and at the age of 4. Functional connections within the child's resting-state phonology, semantics, language networks were correlated with maternal BDI scores at the age of 4 years.

RESULTS

Higher maternal depression was associated with the child's decreased within the semantic and phonological networks connectivity during rest. Higher maternal depression at 4 years moderated the relationship between early depression scores and functional connectivity within the phonological network.

CONCLUSIONS

Maternal depression in the first year of life is related to functional connections of phonological processing and enhanced by current maternal depression levels. We conclude that after a mother gives birth, resources should be provided to minimize depressive symptoms and interventions should be applied to support their child's language development for future reading acquisition.

Validation of The Reading House and Association With Cortical Thickness

BACKGROUND AND OBJECTIVES

The American Academy of Pediatrics recommends literacy and school readiness promotion during well visits. The Reading House (TRH) is a children's book-based screener of emergent literacy skills in preschool-aged children. Vocabulary, rhyming, and rapid naming are core emergent skills, and reading abilities are associated with thicker cortex in the left hemisphere. Our objective was to expand validity of TRH relative to these skills and explore association with cortical thickness.

METHODS

Healthy preschool-aged children completed MRI including a T1-weighted anatomic scan. Before MRI, TRH and assessments of rapid naming (Comprehensive Test of Phonological Processing, Second Edition), rhyming (Pre-Reading Inventory of Phonological Awareness), vocabulary (Expressive Vocabulary Test, Second Edition), and emergent literacy (Get Ready to Read!) were administered. Analyses included Spearman-ρ correlations (r _ρ) accounting for age, sex, and socioeconomic status (SES). MRI analyses involved whole-brain measures of cortical thickness relative to TRH scores, accounting for covariates.

RESULTS

Seventy children completed assessments (36-63 months old; 36 female) and 52 completed MRI (37-63 months; 29 female). TRH scores were positively correlated with Comprehensive Test of Phonological Processing, Second Edition (r _ρ = 0.61), Expressive Vocabulary Test, Second Edition (r _ρ = 0.54), Get Ready to Read! (r _ρ = 0.87), and Pre-Reading Inventory of Phonological Awareness scores (r _ρ = 0.64; all P < .001). These correlations remained statistically significant across age, sex, and SES groups. TRH scores were correlated with greater thickness in left-sided language and visual cortex (P-family-wise error <.05), which were similar for higher SES yet more bilateral and frontal for low SES, reflecting a less mature pattern (P-family-wise error <.10).

CONCLUSIONS

These findings expand validation evidence for TRH as a screening tool for preschool-aged children, including associations with emergent skills and cortical thickness, and suggest important differences related to SES.

Beyond Reading Modulation: Temporo-Parietal tDCS Alters Visuo-Spatial Attention and Motion Perception in Dyslexia

Dyslexia is a neurodevelopmental disorder with an atypical activation of posterior left-hemisphere brain reading networks (i.e., temporo-occipital and temporo-parietal regions) and multiple neuropsychological deficits. Transcranial direct current stimulation (tDCS) is a tool for manipulating neural activity and, in turn, neurocognitive processes. While studies have demonstrated the significant effects of tDCS on reading, neurocognitive changes beyond reading modulation have been poorly investigated. The present study aimed at examining whether tDCS on temporo-parietal regions affected not only reading, but also phonological skills, visuo-spatial working memory, visuo-spatial attention, and motion perception in a polarity-dependent way. In a within-subjects design, ten children and adolescents with dyslexia performed reading and neuropsychological tasks after 20 min of exposure to Left Anodal/Right Cathodal (LA/RC) and Right Anodal/Left Cathodal (RA/LC) tDCS. LA/RC tDCS compared to RA/LC tDCS improved text accuracy, word recognition speed, motion perception, and modified attentional focusing in our group of children and adolescents with dyslexia. Changes in text reading accuracy and word recognition speed—after LA/RC tDCS compared to RA/LC—were related to changes in motion perception and in visuo-spatial working memory, respectively. Our findings demonstrated that reading and domain-general neurocognitive functions in a group of children and adolescents with dyslexia change following tDCS and that they are polarity-dependent.

Memory Deficits in Children with Developmental Dyslexia: A Reading-Level and Chronological-Age Matched Design

Developmental Dyslexia (DD) is considered a multifactorial deficit. Among the neurocognitive impairments identified in DD, it has been found that memory plays a particularly important role in reading and learning. The present study aims to investigate whether short-term memory (STM) and long-term memory (LTM) deficits could be related to poor reading experience or could be causal factors in DD. To verify that memory deficits in DD did not simply reflect differences in reading experience, 16 children with DD were not only compared to 16 chronological age-matched children (CA) but also to 16 reading level-matched children (RL) in verbal, visual-object, and visual-spatial STM and LTM tasks. Children with DD performed as well as RL, but worse than CA in all STM tasks. Considering LTM, the three groups did not differ in Visual-Object and Visual-Spatial Learning tasks. In the Verbal LTM task, DD recalled significantly fewer words than CA but not RL, while CA and RL showed a similar performance. The present results suggest that when reading experience was equated, children with DD and typical readers did not differ in STM and LTM, especially in the verbal modality, weakening claims that memory has a causal effect in reading impairments.

Children Use Regions in the Visual Processing and Executive Function Networks during a Subsequent Memory Reading Task

Memory encoding is a critical process for memory function, which is foundational for cognitive functioning including reading, and has been extensively studied using subsequent memory tasks. Research in adults using such tasks indicates the participation of visual and cognitive-control systems in remembered versus forgotten words. However, given the known developmental trajectories of these systems, the functional neuroanatomy of memory encoding in children may be different than in adults. We examined brain activation for silent word reading and checkerboard viewing during an event-related reading task in 8-12 year-old children. Results indicate greater activation for checkerboard viewing than lexical processing in early visual regions, as well as for lexical processing versus checkerboard viewing in regions in left sensorimotor mouth, cingulo-opercular and dorsal-attention networks. Greater activation for remembered than forgotten words was observed in bilateral visual system and left lateralized regions within the ventral- and dorsal-attention, cingulo-opercular and fronto-parietal networks. These findings suggest a relatively mature reliance on the cognitive-control system, but greater reliance on the visual system in children when viewing words subsequently remembered. The location of regions with greater activity for remembered words reinforces the involvement of the attention and cognitive-control systems in subsequent memory in reading.

Functional connectivity alterations associated with literacy difficulties in early readers

The link between literacy difficulties and brain alterations has been described in depth. Resting-state fMRI (rs-fMRI) has been successfully applied to the study of intrinsic functional connectivity (iFc) both in dyslexia and typically developing children. Most related studies have focused on the stages from late childhood into adulthood using a seed to voxel approach. Our study analyzes iFc in an early childhood sample using the multivariate pattern analysis. This facilitates a hypothesis-free analysis and the possible identification of abnormal functional connectivity patterns at a whole brain level. Thirty-four children with literacy difficulties (LD) (7.1 ± 0.69 yr.) and 30 typically developing children (TD) (7.43 ± 0.52 yr.) were selected. Functional brain connectivity was measured using an rs-fMRI acquisition. The LD group showed a higher iFc between the right middle frontal gyrus (rMFG) and the default mode network (DMN) regions, and a lower iFc between the rMFG and both the bilateral insular cortex and the supramarginal gyrus. These results are interpreted as a DMN on/off routine malfunction in the LD group, which suggests an alteration of the task control network regulating DMN activity. In the LD group, the posterior cingulate cortex also showed a lower iFc with both the middle temporal poles and the fusiform gyrus. This could be interpreted as a failure in the integration of information between brain regions that facilitate reading. Our results show that children with literacy difficulties have an altered functional connectivity in their reading and attentional networks at the beginning of the literacy acquisition. Future studies should evaluate whether or not these alterations could indicate a risk of developing dyslexia.

Associations between home literacy environment, brain white matter integrity and cognitive abilities in preschool-age children

AIM

Caregiver-child reading is advocated by health organisations, citing cognitive and neurobiological benefits. The influence of home literacy environment (HLE) on brain structure prior to kindergarten has not previously been studied.

METHODS

Preschool-age children completed assessments of language (EVT-2, CTOPP-2 Rapid Object Naming) and emergent literacy skills (Get Ready to Read!, The Reading House) followed by diffusion tensor imaging (DTI). Parents completed a survey of HLE (StimQ-P₂ READ), which has four subscales. DTI measures included axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD) and fractional anisotropy (FA).

RESULTS

Forty-seven children completed DTI (54 ± 7 months, range 36-63; 27 girls). StimQ-P₂ READ scores correlated with higher EVT-2, GRTR and TRH scores, controlling for age and gender (P < .01), and also with lower AD, RD and MD in tracts supporting language and literacy skills, controlling for age, gender and income (P < .05, family-wise error corrected). Correlations were strongest for the Bookreading Quantity subscale, including with higher scores on all cognitive measures including CTOPP-2, and also with higher FA in left-lateralised literacy-supporting tracts, controlling for age, gender and income.

CONCLUSION

More nurturing home reading environment prior to kindergarten may stimulate brain development supporting language and literacy skills, reinforcing the need for further study.

Relationship Between Eye-Movement Patterns, Cognitive Load, and Reading Ability in Children with Reading Difficulties

Children with reading difficulties (RD) share challenges in executive functions (EF). Neurobiological correlates provide evidence for EF challenges during reading among these readers, but an online cognitive load detection mechanism has yet to be developed. Nevertheless, eye-movement tracking can provide online data of reading patterns (pupil dilation, fixations) and, indeed, atypical eye-movement patterns of children with RD during reading have been documented. To identify eye-movement patterns related to increased cognitive load during reading in children with RD compared to typical readers, eye movements of 8-12-year-old English-speaking children were recorded during their reading of sentences with increasing difficulty (sentences that make sense, then sentences that do not make sense) and comparing incorrect and correct responses. Children with RD demonstrated greater pupil dilation when reading sentences that make sense than when reading sentences that do not make sense and also when reading incorrectly, compared to typical readers. Increased pupil dilation in children with RD when reading sentences correctly was positively correlated with phonological awareness capabilities. Higher phonological awareness and reading abilities were related to increased pupil dilation only in children with RD during correct reading, which is related to a heavier cognitive load. Results suggest that in addition to traditional findings of altered fixation patterns in children with RD, increased pupil dilation during reading may reflect EF challenges among this population. These findings can potentially be used to adapt online written materials for children with RD based on their fixation and pupil dilation patterns.

Literacy acquisition: Reading development

Reading is a complex, multifactorial, and dynamic skill. Most of what we currently know about neural correlates underlying reading comes from studies carried out with adults. However, considering that adults are skilled readers, findings from these studies cannot be generalized to children who are still learning to read. The advancement of neuroimaging techniques allowed researchers to investigate the developmental fingerprints and neurocircuitry involved in reading in children. To highlight the contribution of neuroimaging in understanding reading development, we look at both reading components, namely, word identification and reading comprehension. This chapter covers the three literacy periods-emergent, early, and conventional literacy-to better understand how reading acquisition affects neural networks. Further, we discuss our findings in light of different cognitive reading models. Although it is important to consider both spatial and temporal measurements to provide a holistic account of reading-related brain activity, the current chapter focuses on the functional activation and connectivity of reading-related areas in typically developing children.

Associations Between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children

IMPORTANCE

The American Academy of Pediatrics (AAP) recommends limits on screen-based media use, citing its cognitive-behavioral risks. Screen use by young children is prevalent and increasing, although its implications for brain development are unknown.

OBJECTIVE

To explore the associations between screen-based media use and integrity of brain white matter tracts supporting language and literacy skills in preschool-aged children.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study of healthy children aged 3 to 5 years (n = 47) was conducted from August 2017 to November 2018. Participants were recruited at a US children's hospital and community primary care clinics.

EXPOSURES

Children completed cognitive testing followed by diffusion tensor imaging (DTI), and their parent completed a ScreenQ survey.

MAIN OUTCOMES AND MEASURES

ScreenQ is a 15-item measure of screen-based media use reflecting the domains in the AAP recommendations: access to screens, frequency of use, content viewed, and coviewing. Higher scores reflect greater use. ScreenQ scores were applied as the independent variable in 3 multiple linear regression models, with scores in 3 standardized assessments as the dependent variable, controlling for child age and household income: Comprehensive Test of Phonological Processing, Second Edition (CTOPP-2; Rapid Object Naming subtest); Expressive Vocabulary Test, Second Edition (EVT-2; expressive language); and Get Ready to Read! (GRTR; emergent literacy skills). The DTI measures included fractional anisotropy (FA) and radial diffusivity (RD), which estimated microstructural organization and myelination of white matter tracts. ScreenQ was applied as a factor associated with FA and RD in whole-brain regression analyses, which were then narrowed to 3 left-sided tracts supporting language and emergent literacy abilities.

RESULTS

Of the 69 children recruited, 47 (among whom 27 [57%] were girls, and the mean [SD] age was 54.3 [7.5] months) completed DTI. Mean (SD; range) ScreenQ score was 8.6 (4.8; 1-19) points. Mean (SD; range) CTOPP-2 score was 9.4 (3.3; 2-15) points, EVT-2 score was 113.1 (16.6; 88-144) points, and GRTR score was 19.0 (5.9; 5-25) points. ScreenQ scores were negatively correlated with EVT-2 (F2,43 = 5.14; R2 = 0.19; P < .01), CTOPP-2 (F2,35 = 6.64; R2 = 0.28; P < .01), and GRTR (F2,44 = 17.08; R2 = 0.44; P < .01) scores, controlling for child age. Higher ScreenQ scores were correlated with lower FA and higher RD in tracts involved with language, executive function, and emergent literacy abilities (P < .05, familywise error-corrected), controlling for child age and household income.

CONCLUSIONS AND RELEVANCE

This study found an association between increased screen-based media use, compared with the AAP guidelines, and lower microstructural integrity of brain white matter tracts supporting language and emergent literacy skills in prekindergarten children. The findings suggest further study is needed, particularly during the rapid early stages of brain development.

Hyperconnectivity during screen-based stories listening is associated with lower narrative comprehension in preschool children exposed to screens vs dialogic reading: An EEG study

OBJECTIVES

Dialogic reading (DR) is a shared storybook reading intervention previously shown to have a positive effect on both literacy and general language skills. The aim of this study was to examine the effect of DR compared to screen-based intervention on electrophysiological markers supporting narrative comprehension using EEG.

METHODS

Thirty-two typically developing preschoolers, ages 4 to 6 years, were assigned to one of two intervention groups: Dialogic Reading Group (DRG, n = 16) or Screen Story Group (SSG, n = 16). We examined the effect of intervention type using behavioral assessment and a narrative comprehension task with EEG.

RESULTS

The DRG showed improved vocabulary and decreased functional connectivity during the stories-listening task, whereas the SSG group showed no changes in vocabulary or connectivity. Significantly decreased network strength and transitivity and increased network efficiency were observed in the DRG following intervention. Greater network strength and transitivity at follow-up were correlated with increased vocabulary.

CONCLUSIONS

The results suggest the beneficial effect of DR in preschool-age children on vocabulary and EEG-bands related to attention in the ventral stream during narrative comprehension. Decreased functional connectivity may serve as a marker for language gains following reading intervention.

SIGNIFICANCE

DR intervention for preschool-age children may reduce interfering connections related to attention, which is related to better narrative comprehension.

Altered Functional Connectivity of the Executive Functions Network During a Stroop Task in Children with Reading Difficulties

Children with reading difficulties (RDs) often receive related accommodations in schools, such as additional time for examinations and reading aloud written material. Existing data suggest that these readers share challenges in executive functions (EFs). Our study was designed to determine whether children with RDs have specific challenges in EFs and define neurobiological signatures for such difficulties using magnetic resonance imaging (MRI) data. Reading and EFs abilities were assessed in 8-12-year-old children with RDs and age-matched typical readers. Functional MRI data were acquired during a Stroop task, and functional connectivity of the EFs defined network was calculated in both groups and related to reading ability. Children with RDs showed lower reading and EFs abilities and demonstrated greater functional connectivity between the EFs network and visual, language, and cognitive control regions during the Stroop task, compared to typical readers. Our results suggest that children with RDs utilize neural circuits supporting EFs more so than do typical readers to perform a cognitive task. These results also provide a neurobiological explanation for the challenges in EFs shared by children with RDs and explain challenges this group shares outside of the reading domain.

Functional Connectivity of Attention, Visual, and Language Networks During Audio, Illustrated, and Animated Stories in Preschool-Age Children

The American Academy of Pediatrics recommends that parents read with their children early and often and limits on screen-based media. While book sharing may benefit attention in children, effects of animated content are controversial, and the influence of either on attention networks has not previously been studied. This study involved functional magnetic resonance imaging (fMRI) of three separate active-task scans composed of similar 5-min stories presented in the same order for each child (audio → illustrated → animated), followed by assessment of comprehension. Five functional brain networks were defined a priori through literature review: dorsal attention network (DAN), ventral attention network (VAN), language (L), visual imagery (VI), and visual perception (VP). Analyses involved comparison of functional connectivity (FC) within- and between networks across formats, applying false discovery rate correction. Twenty-seven of 33 children completed fMRI (82%; 15 boys, 12 girls; mean 58 ± 8 months old). Comprehension of audio and illustrated stories was equivalent and lower for animation (p < 0.05). For illustration relative to audio, FC within DAN and VAN and between each of these and all other networks was similar, lower within-L, and higher between VI-VP, suggesting reduced strain on the language network using illustrations and imagery. For animation relative to illustration, FC was lower between DAN-L, VAN-VP, VAN-VI, L-VI, and L-VP, suggesting less focus on narrative, reorienting to imagery, and visual-language integration. These findings suggest that illustrated storybooks may be optimal at this age to encourage integration of attention, visual, and language networks, while animation may bias attention toward VP.

The Reading House: A Children's Book for Emergent Literacy Screening During Well-Child Visits

BACKGROUND

The American Academy of Pediatrics recommends literacy promotion and developmental assessment during well-child visits. Emergent literacy skills are well defined, and the use of early screening has the potential to identify children at risk for reading difficulties and guide intervention before kindergarten.

METHODS

The Reading House (TRH) is a children's book designed to screen emergent literacy skills. These are assessed by sharing the book with the child and using a 9-item, scripted scoring form. Get Ready to Read! (GRTR) is a validated measure shown to predict reading outcomes. TRH and GRTR were administered in random order to 278 children (mean: 43.1 ± 5.6 months; 125 boys, 153 girls) during well-child visits at 7 primary care sites. Parent, child, and provider impressions of TRH were also assessed. Analyses included Rasch methods, Spearman-ρ correlations, and logistic regression, including covariates age, sex, and clinic type.

RESULTS

Psychometric properties were strong, including item difficulty and reliability. Internal consistency was good for new measures (r_{Co- α} = 0.68). The mean TRH score was 4.2 (±2.9; range: 0-14), and mean GRTR was 11.1 (±4.4; range: 1-25). TRH scores were positively correlated with GRTR scores (r _s = 0.66; high), female sex, private practice, and child age (P < .001). The relationship remained significant controlling for these covariates (P < .05). The mean TRH administration time was 5:25 minutes (±0:55; range: 3:34-8:32). Parent, child, and provider impressions of TRH were favorable.

CONCLUSIONS

TRH is a feasible, valid, and enjoyable means by which emergent literacy skills in 3- and 4-year-old children can be directly assessed during primary care.

Children With Dyslexia and Typical Readers: Sex-Based Choline Differences Revealed Using Proton Magnetic Resonance Spectroscopy Acquired Within Anterior Cingulate Cortex

Children with dyslexia exhibit slow and inaccurate reading, as well as problems in executive functions. Decreased signal activation in brain regions related to visual processing and executive functions has been observed with functional magnetic resonance imaging with reports of sex differences in brain patterns for visual processing regions. However, the underlying neurochemistry associated with deficits in executive functions for children with dyslexia has not been thoroughly evaluated. Reading ability and executive functions were assessed in fifty-three children [ages 8-12 years old, dyslexia (n = 24), and typical readers (n = 30)]. We employed short echo, single voxel, proton magnetic resonance spectroscopy to evaluate the perigenual anterior cingulate cortex (ACC). Pearson correlations were calculated between metabolite concentrations and measures of reading, processing speed, and executive function. Logistic regression models were used to determine the effects of brain metabolite concentrations, processing speed, and reading scores on dyslexia status. Differences by child's sex were also examined. Compared to typical readers, higher global executive composite t-score is associated with greater odds for dyslexia (OR 1.14; 95% CI 1.05, 1.23); increased processing speed appears to be protective for dyslexia (OR 0.95; 95% 0.89-1.00). After adjustment for multiple comparisons, females with dyslexia showed strong and significant negative correlations between processing speed and myo-inositol (r = -0.55, p = 0.005) and choline (r = -0.54, p = 0.005) concentrations; effect modification by sex was confirmed in linear regression models (psex∗Cho = 0.0006) and (psex∗mI = 0.01). These associations were not observed for males or the group as a whole. These findings suggest that children with dyslexia share difficulty in one or more areas of executive function, specifically those related to response time. Also, metabolite changes in the ACC may be present in children with dyslexia, especially for females, and may hold value as possible markers for dyslexia.

Children with a very low birthweight showed poorer reading skills at eight years of age but caught up in most areas by the age of 10

AIM

We evaluated the development of reading skills in very low birthweight (VLBW) children and controls at 8-10 years of age.

METHODS

This study was part of a longitudinal study of VLBW infants born between January 1998 and December 1999 in Sweden. We recruited 49 VLBW children and 44 sex and age-matched full-term controls when they started school at the age of seven and tested them using identical methods for decoding, rapid naming ability, reading comprehension, and spelling and cognitive skills at about eight and 10 years of age. Univariate analysis of variance was performed to assess the effects of VLBW on reading performance at each age and to evaluate the differences between the groups and ages.

RESULTS

Very low birthweight children scored significantly lower in all domains of reading at 7.8 ± 0.3 years, but the performance gap had narrowed by 9.8 ± 0.3 years. Significant catch-up gains were found in phonological awareness, rapid naming ability and reading comprehension. The differences between the groups were minor at 10 years, when controlled for non-verbal cognition.

CONCLUSION

Very low birthweight children demonstrated worse reading performance at eight years of age than term-born controls. The gap in reading skills between the groups had largely narrowed two years later.

Shared reading quality assessment by parental report: preliminary validation of the DialogPR

Background

The American Academy of Pediatrics (AAP) recommends shared reading beginning as soon as possible after birth to promote healthy development. Shared reading quality can strongly influence outcomes, especially in children from low-SES households. Dialogic reading is a method developed to enhance verbal interactivity and engagement through book sharing, advocated by the AAP and clinic-based programs such as Reach Out and Read. There is no brief, validated, caregiver report measure of dialogic reading or shared reading quality currently available.

Methods

This cross-sectional study involved 49 healthy mother-child dyads (mean child age 4.5 yrs., SD = 0.6 yrs.) from 2 separate MRI-based studies. The DialogPR was administered by trained research coordinators following MRI, along with the READ subscale of the validated StimQ-P measure of home cognitive environment. The DialogPR consists of eight items developed in consultation with experts in early literacy, based on the PEER/CROWD dialogic reading conceptual model. Estimated reading level is 6th grade. Descriptive statistics were computed at both the item and scale levels. Modern theory Rasch methods were used to analyze all eight DialogPR items along with preliminary estimates of reliability and validity.

Results

Our combined sample involved 15 boys and 34 girls, and was diverse in terms of age, household income, and maternal education. DialogPR administration time was less than 2 min, with no problems reported. The DialogPR demonstrated strong internal consistency and reliability (Cronbach’s alpha = 0.82), and criterion-related validity with the StimQ-P READ (Spearman’s rho coefficient = 0.53). Rasch analysis revealed strong psychometric properties in terms of reliability, variability in item difficulty, and inter-item and item-measure correlations.

Conclusions

Preliminary evidence suggests that the DialogPR may be an efficient means to assess shared reading quality and dialogic reading via caregiver report for clinical and research purposes, warranting further investigation.

Brain connectivity in children is increased by the time they spend reading books and decreased by the length of exposure to screen-based media

AIM

This study compared the time spent using screen-based media or reading on the functional connectivity of the reading-related brain regions in children aged 8-12.

METHODS

We recruited 19 healthy American children from a private school in Cincinnati, USA, in 2015-6 after advertising the study to parents. The parents completed surveys on how many hours their children spent on independent reading and screen-based media time, including smartphones, tablets, desktop or laptop computers and television. The children underwent magnetic resonance imaging that assessed their resting-state connectivity between the left visual word form area, as the seed area, and other brain regions, with screen time and reading time applied as predictors.

RESULTS

Time spent reading was positively correlated with higher functional connectivity between the seed area and left-sided language, visual and cognitive control regions. In contrast, screen time was related to lower connectivity between the seed area and regions related to language and cognitive control.

CONCLUSION

Screen time and time spent reading showed different effects on functional connectivity between the visual word form area and language, visual and cognitive control regions of the brain. These findings underscore the importance of children reading to support healthy brain development and literacy and limiting screen time.

Neuroimaging of decoding and language comprehension in young very low birth weight (VLBW) adolescents: Indications for compensatory mechanisms

In preterm children with very low birth weight (VLBW ≤ 1500 g), reading problems are often observed. Reading comprehension is dependent on word decoding and language comprehension. We investigated neural activation–within brain regions important for reading–related to components of reading comprehension in young VLBW adolescents in direct comparison to normal birth weight (NBW) term-born peers, with the use of functional magnetic resonance imaging (fMRI). We hypothesized that the decoding mechanisms will be affected by VLBW, and expect to see increased neural activity for VLBW which may be modulated by task performance and cognitive ability. The study investigated 13 (11 included in fMRI) young adolescents (ages 12 to 14 years) born preterm with VLBW and in 13 NBW controls (ages 12–14 years) for performance on the Block Design and Vocabulary subtests of the Wechsler Intelligence Scale for Children; and for semantic, orthographic, and phonological processing during an fMRI paradigm. The VLBW group showed increased phonological activation in left inferior frontal gyrus, decreased orthographic activation in right supramarginal gyrus, and decreased semantic activation in left inferior frontal gyrus. Block Design was related to altered right-hemispheric activation, and VLBW showed lower WISC Block Design scores. Left angular gyrus showed activation increase specific for VLBW with high accuracy on the semantic test. Young VLBW adolescents showed no accuracy and reaction time performance differences on our fMRI language tasks, but they did exhibit altered neural activation during these tasks. This altered activation for VLBW was observed as increased activation during phonological decoding, and as mainly decreased activation during orthographic and semantic processing. Correlations of neural activation with accuracy on the semantic fMRI task and with decreased WISC Block Design performance were specific for the VLBW group. Together, results suggest compensatory mechanisms by recruiting additional brain regions upon altered neural development of decoding for VLBW.

How to create a successful reader? Milestones in reading development from birth to adolescence

Reading is one of the most important academic abilities that establishes the foundation for a child's success in school. Therefore, early and accurate diagnosis of reading challenges is crucial for prevention of later academic failure. One challenge in early detection of reading difficulties is that the ability to read typically is acquired explicitly when a child is four to six years of age. However, reading ability relies on development of more basic abilities prior to reading acquisition, starting from birth.

CONCLUSION

Language, cognitive control and literacy milestones can be evaluated and trained from birth to better acquire reading later in life.