Dyslexia May Involve Both Vision And Hearing
Wake Forest University Baptist Medical Center
2003-11-10
WINSTON-SALEM, N.C. Dyslexia may stem from how the brain processes sight and sound together rather than simply a problem "decoding" the written word reported researchers from Wake Forest University Baptist Medical Center.
"For the first time, there is evidence that dyslexia is a multi-sensory disorder," says Mark Wallace, Ph.D., associate professor of neurobiology and anatomy. "It isn't solely a problem with visual processing or with language. This is a novel way of looking at the disorder."
Wallace said the finding could lead to a simple test for early diagnosis even before school age and better methods for teaching people with reading disabilities.
"Until now, experts have thought that dyslexia was either a visual processing problem or a problem involving language areas of the brain," said Wallace. "But our study suggests that it's actually a problem combining visual information with auditory information."
For the study, 36 people with dyslexia and 29 people without the disorder were tested on their ability to tell which of two lights appeared first. The participants sat in front of a video monitor and pushed a button to report their perception. In both dyslexic and non-dyslexic individuals, sounds presented through headphones were found to help performance.
When lights were accompanied by a sound, participants were better at discriminating lights presented very close together in time. For participants without dyslexia, the sound needed to occur within about 150 milliseconds of the light to get such a benefit. Longer intervals failed to help. People with dyslexia, however, showed benefits even with delays as long as 350 milliseconds.
. "In essence, the brain fuses things that happen very close together in time, and for dyslexics, this fusion appears to happen over longer periods of time than in non-dyslexic persons," said Wallace. "We believe this time difference is the fundamental problem that dyslexics have when learning to read. Early reading involves matching what you see with what you hear. But in dyslexics, we believe this matching process is disrupted. The sights and sounds of words are inappropriately matched. So, while the average person very quickly matches the written word "dog" with the sound "dog," a child with dyslexia may have much more difficulty."
Lynn Flowers, Ph.D., a co-researcher and assistant professor of neuropsychology, said the study demonstrates that lifelong dyslexic individuals integrate visual and auditory information differently than good readers. "The study did not use letters and speech sounds, suggesting that there may be a very basic sensory integration deficit in dyslexia that underlies reading difficulties," Flowers said.
Wallace said the finding suggests better ways to teach people with reading disabilities.
"We believe that the most effective approaches will use a combination of visual and auditory cues," he said. "Because the brain is very changeable in young children, we hope that by using such methods early, we could change the brain's architecture so that the children could process sight and sound normally."
He said the finding provides a basis for the effectiveness of a method called the Orton-Gillingham approach that relies on the use of sight and sound together to teach reading.
Wallace said the test could be used for early diagnosis because it doesn't involve reading, just the ability to push a button when a light comes on.
The researchers are now using functional magnetic resonance imaging, a technology for viewing the brain and seeing which areas "light up" when they are activated, to learn more about the disorder.
"We're exploring what happens in the brain when a person with dyslexia reads," said Wallace. "The future is exciting. We hope this is the first in a long series of studies to learn more about this common and often debilitating disorder."
Wake Forest University Baptist Medical Center is a health system comprised of North Carolina Baptist Hospital and Wake Forest University School of Medicine
More Evidence Shows That Children's Brains With Dyslexia Respond Abnormally To Language Stimuli
The University of Texas Health Science Center at Houston
2003-10-27
WASHINGTON -- Researchers have additional evidence that reading problems are linked to abnormal sound processing, thanks to high-precision pictures of the brain at work. In a recent study, when children without reading problems tried to distinguish between similar spoken syllables, speech areas in the left brain worked much harder than corresponding areas in the right brain, whose function is still unknown. But when children with dyslexia made the same attempt, those right-brain areas actually worked harder, going into overdrive after a brief delay. These findings appear in Neuropsychology, which is published by the American Psychological Association (APA).
Psychologists at The University of Texas Health Science Center at Houston targeted the suspect brain areas by isolating speech-processing sites from sites involved with other aspects of language, such as memory and meaning. As a result, they believe their research contributes to the identification of a central marker of the deficit that makes it hard for people with dyslexia to process similar but different sounds - in both spoken and written form. The results parallel prior evidence gathered by the Houston team that brains of children with dyslexia also respond abnormally during reading.
The researchers studied the brain activity of 12 children with and 11 children without dyslexia during a simple speech perception task. The children were eight to 12 years old. Magnetoencephalography (MEG), a non-invasive, high-resolution form of functional imaging, highlighted precise activity in participants' left and right temporoparietal (TP) language areas while the children discriminated between spoken pairs of syllables, such as /ga/ and /ka/. This kind of task, known as phonological processing, is fundamental to acquiring reading skill. The temporoparietal areas are on the surface in the back of the brain.
While distinguishing between sounds, the non-impaired readers showed more relative activity in the speech part of the left TP area. During the same task, after a slight delay, impaired readers showed a sharp peak of relative activation in corresponding (but functionally mysterious) areas on the right side. The poorer the child's performance in phonological processing, the more their right brains "lit up" during that task.
The results, says co-author Joshua Breier, Ph.D., suggest that children with dyslexia "may lack the predominant involvement of left-hemisphere auditory association cortices" shown by children and adults without reading problems.
Dyslexia may affect up to 17 percent of the school-age population and can continue into adulthood. Reading experts have long suspected that many reading problems, especially in decoding letter sounds, are rooted in the brain and have more to do with sound than sight. Brain imaging studies have confirmed that suspicion and helped to put to rest any notion that dyslexia, although it can make a child feel "stupid" and be a problem in school, reflects visual problems or a lower overall intelligence.
"The neurological deficit appears to be specific to very restricted areas of the brain," says Breier, "and can occur in children with a wide range of general intellectual function."
Such findings are helping to shape national education policy. In fact, co-author Jack Fletcher, Ph.D., points out that most states, following federal guidelines, have for decades used a discrepancy between IQ and reading tests to determine eligibility for special education in the learning disability category, which accounts for more than half of all students in special education. However, several national bodies have, in the past year, proposed allowing states to use alternative means of establishing eligibility. Legislation is in progress. Breier explains that given the research, "The use of IQ in reading disability definitions, at least for these children, is not appropriate." Adds Fletcher, "It's poor reading that's important."
And, poor reading can improve. "The present study shows that reliable brain correlates can be identified in individual children," Breier points out. Given that effective teaching changes brain activation patterns, he says, "the brain in people with reading difficulties is responsive to intense intervention."
Further research will gauge the reliability of the findings, which were established with a participant number typical of a brain-imaging study, using high-precision measurements. In addition, the Houston researchers hope to determine under which treatment conditions MEG brain imaging might be associated with how well a child with dyslexia responds to intervention.
Article: "Abnormal Activation of Temporoparietal Language Areas During Phonetic Analysis in Children with Dyslexia," by Joshua I. Breier, Ph.D.; Panagiotis G. Simos, Ph.D.; Jack M. Fletcher, Ph.D.; Eduardo M. Castillo, Ph.D.; Wenbo Zhang, Ph.D.; and Andrew C. Papanicolaou, Ph.D.; The University of Texas Health Science Center at Houston; Neuropsychology, Vol. 17, No. 4.
Short-term Dyslexia Treatment Strengthens Key Brain Regions
American Academy Of Neurology
2003-07-28
ST. PAUL, MN After only three weeks of reading instruction, brain scans in children with dyslexia develop activation patterns that match those of normal readers, according to a study published in Neurology, the scientific journal of the American Academy of Neurology. These findings indicate that children with dyslexia use the same regions of their brains as other readers, and that specialized instruction can rapidly compensate for some types of reading deficits.
Dyslexic children in this study had above average intelligence but scored approximately 30 percent lower than average on standard reading tests. The dyslexic children and a group of good readers of the same age underwent functional magnetic resonance imaging (fMRI) to map their brain activation patterns during two types of reading tests. The children with dyslexia then received a three-week training program based on principles outlined by the National Reading Panel (http://www.nationalreadingpanel.org), convened by the National Institute of Child Health and Human Development. Both groups of children then underwent a second brain scan. The experiment was conducted during the summer, to avoid confounding effects from school instruction.
The reading tests during the brain scan measured the ability of the children to decide whether certain letter combinations could stand for certain sounds (for example, could "ow" and "oa" make the same sound?) and whether certain letter patterns in words created meaningful relationships between words (for example, does the "er" in "builder" make it related to the word "build"? does the "er" in "corner" make it related to the word "corn"?). Both skills are key elements of the reading process.
Both dyslexic children and normal readers used the same specific parts of their brains to perform these tasks, says lead study author Elizabeth Aylward, PhD, with the department of radiology at the University of Washington in Seattle. However, the activation of these regions was much weaker in dyslexic children, reflecting their poorer performance on these tasks.
After the three-week reading program the levels of brain activation were essentially the same in the two groups. Aylward says these results indicate that instruction doesn't "rewire" the brain of the dyslexic child, but instead strengthens the normal circuits which are already in use.
One of the most encouraging results of the study, she says, is that "we can document changes in the brain even after a fairly short training period," suggesting that appropriate in-school training has great potential for improving the reading ability of dyslexic children.
Reading and spelling disabilities, which occur despite normal intelligence, affect 10 to 15 percent of school-age children in the United States. Early diagnosis and proper instruction significantly improve the dyslexic child's reading achievement outcome.
Rutgers Researcher: Brains In Dyslexic Children Can Be 'Rewired' To Improve Reading Skills
2003-03-05
(NEWARK) In a scientific first, researchers have shown that the brains of dyslexic children can be "rewired" through intensive remedial training to function more like those found in normal readers.
Paula Tallal, Board of Governors Professor of Neuroscience at Rutgers-Newark, and other members of a multi-university research team used brain-imaging scans of dyslexic children to demonstrate that areas of the brain critical to reading skills became activated for the first time and began to function more normally after only eight weeks of special training. In addition, other regions of the brain also lit up on the functional magnetic resonance imaging (fMRI) scans in a compensatory process that the dyslexics may have used as they learned to read more fluently.
The researchers' groundbreaking findings were published Feb. 24 by the Proceedings of the National Academy of Sciences Early Edition. The other authors include faculty from Stanford and Cornell universities, the University of California's Los Angeles and San Francisco campuses, and one of the co-founders of Oakland-based Scientific Learning Corporation.
Dyslexia, sometimes called "word blindness," is a disorder that affects 5 to 10 percent of Americans, and is characterized by difficulties in processing language. Usually these problems are severe enough to interfere with performance in school, but they cannot be attributed to a poor education, personal motivation, or impaired sight or hearing.
The investigators, working at Stanford, extensively used Fast ForWord Language, a computer program designed by Tallal and other researchers at Scientific Learning Corporation. The program focuses on helping children become more adept at processing the rapidly changing sounds inside words. A dyslexic child may, for example, have difficulties distinguishing between letters that rhyme, such as B and D.
"If you hear the sound 'ba' in 'butter' and 'da' in 'Doug,' the only way we know the difference is in the first 40 milliseconds of the onset of those sounds," Tallal explained. "The ability to extract sounds out of words is what is called phonological awareness." Words can be broken into sounds, and these sounds have to be mentally connected with letters. Although the process might seem intuitive, it is actually a learned skill, Tallal said.
One portion of the study involved asking children if two letters of the alphabet rhymed, while their brains were imaged with fMRI scans. The scans of the 20 dyslexic children in the experiment who struggled with the task contrasted sharply with those of the 12 normal readers in the experiment's control group. The dyslexics' scans showed a lack of activity in the language-critical temporal regions of the brain.
The training program, which included dyslexic children aged 8 to 12 years, was designed to help them learn to process and interpret the very rapid sequence of sounds within words and sentences by exaggerating them and slowing them down.
"These are the building blocks you have to have in place before you can learn to read," Tallal said. "I think Fast ForWord is building the scaffolding for reading, and doing it based on scientific knowledge of the most efficient and effective way of helping the brain learn."
The dyslexic children used the Fast ForWord Language computer program for 100 minutes a day, five days a week, as part of their regular school day. The program consisted of seven exercises adapted as computer games. In one exercise, for example, when a picture of a boy and a toy was shown, a voice from the computer asked the player to point to the boy a step that required understanding the very brief difference in the sound of each word's first consonant.
"Each child worked at his or her own level," Tallal said. The goal was to have the children process sounds correctly in words and sentences of increasing length and grammatical complexity, she added. The study's authors emphasized that continuous intervention would be necessary to make the dyslexics' improvements in reading skills stick and advance.
"In light of President [George W.] Bush's legislation, 'No Child Left Behind,' which mandates that only scientifically validated applications be used for intervening with children, this program has the potential to help address the crisis we are facing in the large number of children failing to meet [educational] standards," Tallal observed.
UCSF-Led Team Offers New Insight Into Neurological Basis Of Dyslexia
1999-05-26
Researchers are reporting direct neurological evidence that the region of the brain that processes brief, rapidly successive sounds is functionally abnormal in adults with the reading disability known as dyslexia.
The findings, documented through simultaneous brain imaging and behavioral tests, strongly indicate, the researchers said, that adult dyslexics have an enduring neurological deficit in their ability to process these brief, rapidly successive sounds.
They suspect that the deficiency contributes to difficulties in early speech and language learning, and leads to a weakness in the subsequent mental leap in abstraction to words on a page that enables people to learn to read.
The study was published in Proceedings of the National Academy of Science.
Perhaps the most provocative aspect of the finding, the researchers said, is the clear and direct neurological evidence that reading deficits are generated, at least in part, by a deficit at a very fundamental level of cortical processing of sound inputs.
"Our findings indicate that there is a basic problem in signal reception, as complex sound information streams into the cerebral cortical system underlying aural speech representation," said the senior author of the study, Michael Merzenich, PhD, the Francis A. Sooy Professor of Otolaryngology and a member of the Keck Center for Integrative Neuroscience at UC San Francisco. "The way that the brain processes sound in poor readers is very different from its processing and representation of rapidly changing sound inputs in competent readers."
"Our research indicates that adult dyslexics are representing the sound parts of words by the activation of cortical neuron populations in a weaker and less salient form within their cortical aural speech processing system. We believe that they, therefore, are not delivering the normal forms of representation of the separable sound parts of words to the regions of the brain involved in speech perception and reading," he said.
The authors emphasize that their findings do not discount the additional involvement of higher levels of brain processing in dyslexia, where more complex combinations of information lead to the recognition and interpretation of speech.
At the same time, they argue that the very elementary defect in the brain's processing of sound must be playing an important role in the generation of relatively weak neuronal representations of the sound parts of aural speech.
And this elementary neurological deficit, they said, could provide a target for remedial therapies aimed at training the brain to increase the speed and accuracy with which it processes rapidly successive and rapidly changing sounds.
The sound-processing function occurs at a base, or entry, level of sound processing in the brain, and is believed to be a primary step in the brain's representation of normal speech sounds and its creation of speech and language-reception abilities. The process ultimately culminates with a listener learning to recognize the sound parts of words, and to translate these word sounds as written letters.
Previous behavioral studies have suggested that the inability to parse the rapidly successive, changing sounds that make up words, the phonemes of language, may be the primary basis of language-learning impairments in children. Scientists have long argued that children who have difficulty parsing word sounds are destined to have difficulty successfully initiating reading.
Other behavioral studies have indicated that most people with dyslexia, characterized by a difficulty with reading, also have impairments in the fidelity of their auditory reception. However, because most dyslexics ultimately develop facile speech reception and production capabilities, the significance of this problem for the origin of reading impairments has been unclear.
The researchers conducted their current study in seven dyslexic adults who were of normal intelligence but severely challenged by reading, spelling and writing. Results were compared with those recorded in seven adults of normal intelligence who were competent readers.
The dyslexic adults performed poorly on standardized reading tests. And, as has been shown to be the case with the great majority of adult dyslexics, these poor readers (ages 18-42) also performed poorly on a variety of tests that measured their ability to discern rapidly successive sound stimuli.
In one of these sound-discerning tests, adults were exposed to two sounds that differed in frequency and that occurred a tenth or a fifth of a second apart. They were then asked to identify the sounds and to replay the sequence in which they were presented. Their brain activity was simultaneously recorded using magnetoencephalographic brain imaging, which measures magnetic field fluctuations generated by spatially localizable human brain activity with millisecond precision.
In these studies, the UCSF team focused on the activity generated by the rapidly successive sounds evoked from the "primary" auditory cortical areas, where information about aural speech flows into the cerebral cortex's processing system for language.
Poor readers did report hearing the two very brief sounds, and often knew that in some way they weren't the same, but they were unable to identify them, or to reliably reconstruct the sequence in which they were represented.
"The reason," said Srikantan Nagarajan, PhD, an assistant adjunct professor of otolaryngology and a member of the Keck Center for Integrative Neuroscience at UCSF, and the lead scientist of the study, "was demonstrated by the abnormal way that the brain of the poor-reading subjects responded to these rapidly successive sound events."
"In normal readers, the auditory cortex generated clear, separate representations of sounds occurring within the time dimensions of a syllable," said Nagarajan. "In poor readers, the brain separately generated only very weak representations of sound events past the first sound.
"In the normal reader, successive intra-syllabic sound events are separately represented in high fidelity within the processing channels of the 'primary' auditory cortex. In the impaired reader, they are not," he said.
"These findings are consistent with the increasing evidence," said Merzenich, "that language-impaired and reading-impaired children are a very broadly synonymous population. Scientists have historically argued that only a small percentage of dyslexics have a clear history of early language impairment and fundamental auditory processing deficits. To the contrary, we have seen that most poor readers and most language-impaired children share these same fundamental listening and brain processing abnormalities."
Moreover, he said, "The studies show that these fundamental listening problems clearly persist across a lifetime, even while the basic speech reception abilities of these individuals can ultimately achieve a relatively normal competency."
Co-authors of the study were Henry Mahncke, PhD, a research fellow in the Keck Center at UCSF; Talya Salz, of Scientific Learning Corporation in Berkeley, CA; Paula Tallal, PhD, co-director of the Center for Molecular and Behavioral Neuroscience at Rutgers University, Newark, NJ; and Timothy Roberts, PhD, assistant professor of radiology in the Biomagnetic Imaging Laboratory, Department of Radiology, at UCSF.
The study was funded by the National Institutes of Health, the Office of Naval Research, Hearing Research Inc., and the Coleman fund.
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