Sleepiness, Neuropsychological Skills, and Scholastic Learning in Children

Abstract: Excessive daytime sleepiness is a frequent condition among children and adolescents that may lead to several and significant daytime consequences, including impaired neurocognitive skills and scholastic performance. Here, we evaluated in one hundred and ninety-one unselected primary school children, the relationship between sleepiness and a wide range of cognitive and academic skills through a standardized neuropsychological test battery. In order to assess the statistical relationship, we performed a partial least squares path modelling, a non-parametrical approach which combined a model of paths between latent variables and the coefficients between indicators and dimensions. Results were validated through the bootstrap approach and suggest that sleepiness is not associated with all cognitive and scholastic abilities, but only with those relying on verbal abilities and complex cognitive functions (i.e., reading comprehension, oral/syntactic comprehension, spelling, and mathematic skills). Our data suggest the idea that sleepiness in children is associated mostly with “higher” (mainly verbal) cognitive function(s), while the visuospatial domain was not affected

Evaluating a new verbal working memory-balance program: a double-blind, randomized controlled trial study on Iranian children with dyslexia

Abstract: Background: It is important to improve verbal Working Memory (WM) in reading disability, as it is a key factor in learning. There are commercial verbal WM training programs, which have some short-term effects only on the verbal WM capacity, not reading. However, because of some weaknesses in current verbal WM training programs, researchers suggested designing and developing newly structured programs that particularly target educational functions such as reading skills. In the current double-blind randomized clinical trial study, we designed a new Verbal Working Memory-Balance (VWM-B) program which was carried out using a portable robotic device. The short-term effects of the VWM-B program, on verbal WM capacity, reading skills, and postural control were investigated in Iranian children with developmental dyslexia. Results: The effectiveness of the VWM-B program was compared with the VWM-program as a traditional verbal WM training. In comparison with VWM-program, the participants who received training by the VWM-B program showed superior performance on verbal WM capacity, reading skills, and postural control after a short-term intervention. Conclusions: We proposed that the automatized postural control resulting from VWM-B training had a positive impact on improving verbal WM capacity and reading ability. Based on the critical role of the cerebellum in automatizing skills, our findings support the cerebellar deficit theory in dyslexia. Trial registration: This trial was (retrospectively) registered on 8 February 2018 with the Iranian Registry of Clinical Trials (IRCT20171219037953N1)

Immersive virtual reality methods in cognitive neuroscience and neuropsychology: the Virtual Reality Everyday Assessment Lab (VR-EAL).an immersive neuropsychological test battery of everyday cognitive functions

In cognitive neuroscience and neuropsychology, the collection of cognitive and behavioural data is predominantly achieved by implementing paper-and-pencil and computerized (i.e., 2D and 3D applications) assessments. However, these psychometric tools in clinics and/or laboratories display several limitations and discrepancies between the observed performance in the laboratory/clinic and the actual performance of individuals in everyday life. The functional and predictive association between an individual's performance on a set of neuropsychological tests and the individual's performance in various everyday life settings is called ecological validity. Ecological validity is considered an important issue that cannot be resolved by the currently available assessment tools. Virtual reality head-mounted displays (HMD) appear to be effective research tools, which may address the problem of ecological validity in neuropsychological testing. However, their widespread implementation is hindered by virtual reality induced symptoms and effects (VRISE) and the lack of skills in virtual reality software development. In this PhD, a technological systematic literature review of the reasons for adverse symptomatology was conducted and suggestions and technological knowledge for the implementation of virtual reality HMD systems in cognitive neuroscience provided. The review indicated features pertinent to display, sound, motion tracking, navigation, ergonomic interactions, user experience, and computer hardware that should be considered by researchers. Subsequently, a meta-analysis of 44 neuroscientific or neuropsychological studies involving virtual reality HMD systems was performed. The meta-analysis of the virtual reality studies demonstrated that new generation HMDs induce significantly less VRISE and marginally fewer dropouts. Importantly, the commercial versions of the new generation HMDs with ergonomic interactions had zero incidents of adverse symptomatology and dropouts. HMDs equivalent to or greater than the commercial versions of contemporary HMDs accompanied with ergonomic interactions are suitable for implementation in cognitive neuroscience. Another aim of this PhD was to devise a brief tool to appraise and report both the quality of software features and VRISE intensity quantitatively; such a tool does not currently exist. The Virtual Reality Neuroscience Questionnaire (VRNQ; Kourtesis et al., 2019) was developed to assess the quality of virtual reality software in terms of user experience, game mechanics, in-game assistance, and VRISE. Forty participants aged between 28 and 43 years were recruited (18 gamers and 22 non-gamers) for the study. They participated in 3 different virtual reality sessions until they felt weary or discomfort and subsequently filled in the VRNQ. The results demonstrated that VRNQ is a valid tool for assessing virtual reality software as it has good convergent, discriminant, and construct validity. The maximum duration of virtual reality sessions should be between 55 and 70 min when the virtual reality software meets or exceeds the parsimonious cut-offs of the VRNQ, and the users are familiarized with the virtual reality system. Also, gaming experience does not affect how long virtual reality sessions should last. Furthermore, while the quality of virtual reality software substantially modulates the maximum duration of virtual reality sessions, age and education do not. Finally, deeper immersion, better quality of graphics and sound, and more helpful in-game instructions and prompts were found to reduce VRISE intensity. The VRNQ facilitates the brief assessment and reporting of the quality of virtual reality software features and/or the intensity of VRISE, while its minimum and parsimonious cut-offs may appraise the suitability of virtual reality software for implementation in research and clinical settings. However, the development of virtual reality software is predominantly dependent on third parties (e.g., freelancers or companies) with programming and software development skills. A solution that will promote the adoption of immersive virtual reality as a research and clinical tool might be the in-house development of virtual reality research/clinical software by computer science literate cognitive scientists or research software engineers. In Chapter 4, guidelines are offered for the development of virtual reality software in cognitive neuroscience and neuropsychology, by describing and discussing the stages of the development of Virtual Reality Everyday Assessment Lab (VR-EAL), the first neuropsychological battery in immersive virtual reality. Techniques for evaluating cognitive functions within a realistic storyline are discussed. The utility of various assets in Unity, software development kits, and other software are described so that cognitive scientists can overcome challenges pertinent to VRISE and the quality of the virtual reality software. In addition, VR-EAL is evaluated in accordance with the necessary criteria for virtual reality software for research purposes. The virtual reality neuroscience questionnaire (VRNQ) was implemented to appraise the quality of the three versions of VR-EAL in terms of user experience, game mechanics, in-game assistance, and VRISE. Twenty-five participants aged between 20 and 45 years with 12–16 years of full-time education evaluated various versions of VR-EAL. The final version of VR-EAL achieved high scores in every sub-score of the VRNQ and exceeded its parsimonious cut-offs. It also appeared to have better in-game assistance and game mechanics, while its improved graphics substantially increased the quality of the user experience and almost eradicated VRISE. The results substantially support the feasibility of the development of effective virtual reality research and clinical software without the presence of VRISE during a 60-min virtual reality session. In Chapter 5, validation of VR-EAL as an assessment of prospective memory, episodic memory, attention, and executive functions using an ecologically valid approach is examined. Performance on the VR-EAL, an immersive virtual reality neuropsychological battery, is examined against an extensive paper-and-pencil neuropsychological battery. Forty-one participants (21 females) were recruited: 18 gamers and 23 non-gamers who attended both an immersive virtual reality and a paper-and-pencil testing session. Bayesian Pearson correlation analyses were conducted to assess construct and convergent validity of the VR-EAL. Bayesian t-tests were performed to compare virtual reality and paper-and-pencil testing in terms of administration time, similarity to real life tasks (i.e., ecological validity), and pleasantness. VR-EAL scores were significantly correlated with their equivalent scores on the paper-and-pencil tests. The participants’ reports indicated that the VR-EAL tasks were considered significantly more ecologically valid and pleasant than the paper-and-pencil neuropsychological battery. The VR-EAL battery also had a shorter administration time. The VR-EAL appears to be an effective neuropsychological tool for the assessment of everyday cognitive functions, and has enhanced ecological validity, a highly pleasant testing experience, and does not induce cybersickness. In the final part of this thesis, the preparatory attentional and memory (PAM) and the multiprocess theories of prospective memory are examined by attempting to identify the cognitive functions which may predict the individual’s performance on ecologically valid prospective memory tasks in the same group of participants described in Chapter 5. Bayesian t-tests were conducted to explore the differences among different prospective memory tasks (e.g., event-based and time-based) and prospective memory tasks with varying delays between encoding and the recall of the intended action (e.g., short-delay versus long-delay). Bayesian linear regression analyses were performed to examine the predictors of VR-EAL scores. The results revealed that the type of prospective memory task does not play a significant role in everyday prospective memory functioning, but instead the length of delay between encoding and retrieving the prospective memory intention plays a central role. Support for the PAM and MP frameworks was found in non-focal and focal event-based tasks respectively. However, the findings, inferring a dynamic interplay between automatic and intentional monitoring and retrieval processes, agree with the inclusive approach of the multiprocess framework. Also, the role of executive functions appears crucial in everyday PM. Finally, everyday PM is predominantly facilitated by episodic memory, visuospatial attention, auditory attention, and executive functions. In conclusion, this PhD thesis attempted to show how immersive virtual reality research methods may be implemented efficiently without the confounding effect of cybersickness symptomatology in order to enhance the ecological validity of neuropsychological testing and contribute to our understanding of everyday cognitive ability

Technology in Rehabilitative Interventions for Children

This Special Issue is aimed to offer an overview of studies presenting new rehabilitation approaches addressed to children with neurodevelopmental disorders, designed to enhance the effects of learning processes through the use of new technologies. The contributions of this Special Issue, authored by researchers and clinicians from some of the most valued Italian scientific institutions in the field of neurodevelopmental disorders, can offer some useful data and advice on the use of technology in rehabilitation and telerehabilitation to researchers, rehabilitators, clinicians and pratictioners (psychologists, neuropsychologists, speech therapists, etc.)

Auditory - Visual Matching in Learning Disabilities : Intervention Studies from Finland and Sweden

The present thesis discusses relevant issues in education: 1) learning disabilities including the role of comorbidity in LDs, and 2) the use of research-based interventions. This thesis consists of a series of four studies (three articles), which deepens the knowledge of the field of special education. Intervention studies (N=242) aimed to examine whether training using a nonverbal auditory-visual matching computer program had a remedial effect in different learning disabilities, such as developmental dyslexia, Attention Deficit Disorder (ADD) and Specific Language Impairment (SLI). These studies were conducted in both Finland and Sweden. The intervention’s non-verbal character made an international perspective possible. The results of the intervention studies confirmed, that the auditory-visual matching computer program, called Audilex had positive intervention effects. In Study I of children with developmental dyslexia there were also improvements in reading skills, specifically in reading nonsense words and reading speed. These improvements in tasks, which are thought to rely on phonological processing, suggest that such reading difficulties in dyslexia may stem in part from more basic perceptual difficulties, including those required to manage the visual and auditory components of the decoding task. In Study II the intervention had a positive effect on children with dyslexia; older students with dyslexia and surprisingly, students with ADD also benefited from this intervention. In conclusion, the role of comorbidity was apparent. An intervention effect was evident also in students’ school behavior. Study III showed that children with SLI experience difficulties very similar to those of children with dyslexia in auditory-visual matching. Children with language-based learning disabilities, such as dyslexia and SLI benefited from the auditory-visual matching intervention. Also comorbidity was evident among these children; in addition to formal diagnoses, comorbidity was explored with an assessment inventory, which was developed for this thesis. Interestingly, an overview of the data of this thesis shows positive intervention effects in all studies despite learning disability, language, gender or age. These findings have been described by a concept inter-modal transpose. Self-evidently these issues need further studies. In learning disabilities the aim in the future will also be to identify individuals at risk rather than by deficit; this aim can be achieved by using research-based interventions, intensified support in general education and inclusive special education. Keywords: learning disabilities, developmental dyslexia, attention deficit disorder, specific language impairment, language-based learning disabilities, comorbidity, auditory-visual matching, research-based interventions, inter-modal transposeSuomessa ja Ruotsissa tehdyssä oppimisvaikeustutkimuksessa kuntoutettiin menestyksekkäästi eri-ikäisiä oppilaita. Erityisopetuksen oppilaiden määrä on kasvanut. Tilanne korostaa ennaltaehkäisevän ja varhaisen tuen merkitystä. Väitöstutkimuksessa oppimisvaikeuksista kärsiviä oppilaita on menestyksekkäästi kuntoutettu auditiivis-visuaalisen aistitiedon yhdistämistä (Audilex) harjoittavalla tietokoneohjelmalla. Interventioissa tutkittiin alakoulu –ja lukioikäisiä oppilaita (N=242), joilla on lukemis- ja kirjoittamishäiriöitä, tarkkaavaisuushäiriöitä tai kielenkehityksenhäiriöitä. Prof. Karman kehittämä Audilex –ohjelma on tarkoitettu lukivalmiuksien harjoitteluun perustuen auditiivisen ja visuaalisen aistitiedon yhdistämiseen sekä auditiivisen strukturoinnin teoriaan (voidaan tarkoittaa myös musikaalisuutta). Tietokoneohjelma on ei-kielellinen, joka mahdollisti sekä suomalaisten että ruotsalaisten oppilaiden kuntouttamisen. Yleensä kielten rakenteen erilaisuus on haaste oppimisvaikeustutkimukselle; huomion arvoisena tutkimustuloksena voidaankin pitää kuntoutuksen käyttömahdollisuuksia eri maissa ja kieliympäristöissä. Kuntoutuksen tuloksena lukihäiriöisten, myös lukioikäisten oppilaiden lukemistaidot paranivat. Voidaan olettaa, että lukivaikeuksien taustalla on häiriöitä havainnoinnissa, joita tarvitaan auditiivisen ja visuaalisen aistitiedon yhdistämisessä. Komorbiditeetti eli erilaisten oppimisvaikeuksien päällekkäinen esiintyminen tuli esille, sillä myös tarkkavaisuushäiriöiset ja kielenkehityksenhäiriöistä kärsivät oppilaat saivat hyviä tuloksia lukikuntoutuksesta. Nämä tulokset rohkaisevat interventioiden käyttöä erilaisissa oppimisvaikeuksissa, kuten myös ennakoivana ja varhaisen tuen muotona. Positiivisia tuloksia voidaan perustella myös ohjelman tarkkavaisuutta, keskittymistä ja motivaatiota parantavilla ominaisuuksilla. Erityisen huomion arvoista on se, että kuntoutusjakson jälkeen oppilaiden koulumotivaatio lisääntyi. Tutkimustulosten merkittävänä yhteenvetona voidaan todeta, että Audilex –interventiosta ovat hyötyneet kaikki oppimisvaikeusryhmät; positiivisiin tuloksiin eivät myöskään vaikuttaneet kieliympäristö, oppilaiden sukupuoli tai ikä. Tätä mielenkiintoista ilmiötä selitetään kuntoutusohjelman ja -jakson rakenteella sekä erityisesti kahden aistitiedon yhdistämisestä syntyvillä uusilla taidoilla, älykkyydellä, jonka aivojen plastisiteetti mahdollistaa. Oppimisvaikeuksien kuntoutuksen tärkeä tavoite on uusien taitojen siirtäminen muuhun koulutyöhön; näin oppilaat löytävät omat vahvuutensa ja heidän itsetuntonsa paranee

Entraîner le contrôle attentionnel chez la personne âgée : perspective comportementale et cérébrale

L’objectif principal de cette thèse est d’évaluer l’effet des interventions cognitives sur le contrôle attentionnel en faisant appel à des mesures comportementales et à des mesures d’imagerie par résonance magnétique fonctionnelle (IRMf). La thèse comprend cinq articles empiriques. L’objectif de la première étude (Chapitre II) était d’examiner la source des différences reliées à l’âge au niveau du contrôle attentionnel. Les résultats suggèrent que les participants âgés présentent plus de difficultés que les jeunes adultes à varier le niveau d’attention à allouer à chacune des tâches selon la consigne d’emphase attentionnelle, reflétant un problème de contrôle attentionnel. La deuxième étude (Chapitre III) visait à comparer l’efficacité de trois types d’entraînement attentionnels chez la personne âgée. Les résultats montrent des effets spécifiques selon l’entraînement reçu. Seuls les participants âgés ayant suivi un entraînement à priorité VARIABLE, dans lequel ils étaient appelés à varier le niveau d’attention à allouer à chacune des tâches à travers plusieurs blocs, améliorent leurs capacités de contrôle attentionnel suite à l’entraînement. Cette amélioration ne peut être expliquée par la pratique aux tâches en attention focalisée, ni la pratique en double-tâche sans modulation attentionnelle. L’objectif de la troisième étude (Chapitre IV) était d’examiner si les bénéfices d’un entraînement à priorité VARIABLE pouvaient se transférer sur des tâches similaires à celles entraînées et sur des tâches plus représentatives du quotidien, à l’aide d’un paradigme de double-tâche immersive en réalité virtuelle (RV). Les résultats montrent qu’un entraînement à priorité VARIABLE améliore les capacités de contrôle attentionnel et, pour la première fois, que les effets bénéfiques de cet entraînement peuvent se transférer à un paradigme de double-tâche en RV chez une population âgée. De plus, nous montrons que les âgés bénéficient autant, voire même plus que les jeunes adultes, d’une intervention visant le contrôle attentionnel et que l’âge n’influence pas les effets de transfert obtenus. La quatrième étude (Chapitre V) examinait l’impact des entraînements attentionnels sur les changements d’activation en IRMf. Les résultats suggèrent que le cerveau est hautement plastique, même à un âge avancé, et que les changements d’activation obtenus diffèrent selon le type d’intervention reçu. Un entraînement à priorité VARIABLE, visant l’apprentissage de stratégies de contrôle attentionnel et les capacités métacognitives, est le seul qui produit des augmentations d’activation dans une région frontale impliquée dans la coordination multitâche et le contrôle attentionnel. Un entraînement visant la pratique répétée de tâche en attention focalisée produit plutôt des diminutions d’activation dans les régions préalablement recrutées. Enfin, l’objectif de la cinquième étude (Chapitre VI) était d’évaluer le décours temporel des changements d’activation à l’aide de trois séances en IRMf. On observe une augmentation d’activation suivie d’un plateau dans des régions reliées aux stratégies apprises pour l’entraînement à priorité VARIABLE, alors que les changements d’activation suite à un entraînement en pratique répétée sont caractérisés par une courbe en U-Inversée. Les résultats de cette dernière étude montrent que les changements d’activation sont non linéaires au cours de l’entraînement et, de façon similaire aux résultats obtenus dans la quatrième étude, modulés par le type d’intervention donné.The main objective of this thesis was to evaluate the effect of cognitive interventions on attentional control using behavioral measures and functional magnetic resonance imaging (fMRI). The thesis comprises five empirical articles. The aim of the first study (Chapter II) was to examine the cause of age-related differences in attentional control. The results suggest that, compared to younger adults, older participants have more difficulty varying the level of attention to be allocated to each task according to the attentional focus that is required, reflecting a difficulty with attentional control. The second study (Chapter III) aimed to compare the effectiveness of three types of computerized attentionnal training in older adults. The results show specific effects depending on the type of training received. Only the older participants who followed the VARIABLEpriority training, in which they had to vary the level of attention allocated to each task across several blocks, showed improvement in their attentional control skills following training. This improvement cannot be explained by repeated practice in the tasks under focused attention or in the dual-task condition without attentional variation. The aim of the third study (Chapter IV) was to assess whether the benefits of VARIABLE-priority training could transfer to tasks similar to those trained and to tasks that are more representative of everyday life, using an immersive dual-task paradigm in virtual reality (VR). The results show that VARIABLE-priority training improves attentional control abilities and, for the first time, that the beneficial effects of this training can be transferred to a dual-task paradigm in VR in older adults. Furthermore, we show that older adults benefit as much, if not more than younger adults, from an intervention aiming to improve attentional control, and that age does not have an effect on the transfer effects observed. The fourth study assessed (Chapter V) the impact of attentional training on changes in fMRI activation. The results suggest that the brain is highly plastic, even in old age, and that the changes in activation are different depending on the type of intervention. VARIABLEpriority training, which aims to teach attentional control strategies and metacognitive abilities, is the only one that produces increases in activation in a frontal region involved in multitasking and attentional control. Repeated practice of a task under focused attention, on the other hand, causes decreases in activation in regions that were previously recruited. Finally, the aim of the fifth study (Chapter VI) was to evaluate the time course of activation changes across three fMRI sessions. An increase in activation followed by a plateau in regions related to the strategies learned for the VARIABLE-priority training is observed, while the activation changes following repeated practice are characterized by an inverse U-shape function. The results of the latter study show that activation changes are non-linear during training and, similarly to the results obtained in the fourth study, are modulated by the type of intervention followed

Neoliterate adult dyslexia and literacy policies : a neurocognitive research review of a curious unexplored phenomenon

There are about 750 million adult illiterates who in principle could learn fluent reading. However, adult literacy programs have performed poorly. Various social and operational reasons may be responsible. This paper explores the role of some neurocognitive reasons in adult performance. Automatic readers of a script detect letters and words effortlessly and involuntarily. Adults learning new scripts find it hard to attain this performance. Whether illiterate or educated, adults learning a new script detect letters slowly, may make mistakes, understand little, soon abandon the task, and may also forget what they learned. When neoliterates glance at a text, they often see a jumble of letters and may process only a few of their features. They must activate reading consciously andsound out each letter. The difficulties are perceptual, and interviews suggest that perceptual distortions may continue for decades. This phenomenon called “neoliterateadult dyslexia” (NAD) has escaped attention, possibly because few educated adults need to learn new scripts, and because the adult literacy failures are often attributed to social reasons. The phenomenon also may have been missed because researchers of perceptual learning use simpler stimuli. Automaticity in reading musical notation and air traffic control may reflect similar age-related learning difficulties. In the brain, the problem may originate at the early stages of the parietal cortex at the dorsal reading path, which constricts short-term visual memory. The visual areas V1 and perhaps V4 may also be involved. Deficits affect the ventral path that provides parallel processing and direct ‘print-to-meaning’ reading. Some neuronal groups may have a sensitive period that affects the capacity to collect frequency data and to integrate the appropriate features of letters and words. Then adults do not learn to perceive letter shapes and words as easily as most children do. A lack of data and research makes it difficult to design effective interventions.The adults’ difficulties are not linguistic. Dysfluent readers simply cannot decipher the symbols in sufficient time to get to the meaning of texts, or they do so after considerable conscious visual effort. Therefore language competence seems to have little relationship to the visuospatial tasks described in this document. Language knowledge does help predict likely words when judgements must be made on the basis of just a few letter features, but the relative ease of linguistic identification may lead to reading errors. The readers’ symptoms resonate with descriptions of severe and unremitting developmental dyslexia. Certain perceptual deficits may arise during adolescence and become more severe in adulthood. Some adults may become better readers than others. But learning a script at increasingly later ages seems related to worse outcomes, though no data exist to map this trajectory. To explore this curious phenomenon, this review brings together a range of insights from of neurocognitive research, notably studies on (a) perceptual learning, including studies on feature integration and face recognition; (b) neurocognitive studies aimed at dyslexic children, (c) studies of adults suffering from brain damage that causes alexia, and (d) performance of adult literacy programs. Implications and potential remedies are also presented. The author posits the hypothesis that perhaps all people become dyslexics for new alphabets at about age 19, and thatability to read new alphabets fluently decreases with age. Neoliterate adult dyslexia (NAD) may partly account for the difficulties of adult literacy programs. Thus it seems to impact about 750 million adult illiterates. For this reason, the paper calls for urgent research into this phenomenon

Inhibitory Control Training

Inhibitory control is a critical neurocognitive skill for navigating cognitive, social, and emotional challenges. It rapidly increases during the preschool period and is important for early cognitive development, as it is a crucial component of executive functioning, self-regulation, and impulsivity. Inhibitory control training (ICT) is a novel intervention in which participants learn to associate appetitive cues with inhibition of behavior. It is being considered a promising approach in the treatment of psychopathology and appetitive behaviors. This book aims to bring together knowledge on the topic, considering research, clinic, and forensic field of intervention. Indeed, this book can be considered an excellent synopsis of perspectives, methods, empirical evidence, and international references