Action video games nullify phonological difficulties in pre-readers at risk for dyslexia

How can video games already successfully employed to improve reading in dyslexia and attention in children with ADHD improve speech sound perception skills in preschoolers with language difficulties?
Published in Neuroscience
Action video games nullify phonological difficulties in pre-readers at risk for dyslexia

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Our lab, during the last decades, mainly studied neurodevelopmental disorders such as dyslexia, a hereditary and severely invalidating learning disability that affects literacy acquisition despite typical intelligence and adequate education. Dyslexia is often associated with undesirable outcomes such as lower educational attainment and loss of self-confidence, because reading is instrumental to civilization and to daily life and learning.
Learning to read requires mapping letter-string (graphemes) into the corresponding phonological sounds (phonemes). The dominant hypothesis sustained that the core deficit of dyslexia was a dysfunction in phoneme perception, that is to processing the smallest distinctive sound elements that constitute language (Shaywitz, N Engl J Med 1998; Gabrieli, Science 2009; Peterson & Pennington, The Lancet, 2012).
However, our longitudinal (Franceschini et al., Curr Biol 2012; Bertoni et al. Neuropsychologia 2019) and training studies (Franceschini et al., Curr Biol 2013; Gori et al., Cer Cortex 2016) have demonstrated that dyslexia could be due to visual attention deficits. In particular, a training based on action video games that improve visual attention (Green & Bavelier, Nature 2003; Bavelier & Green Neuron 2019), enhances reading efficiency in children with DD (Franceschini et al., Curr Biol 2013; Sci Rep 2017). Accordingly, action video games are now known as a good remediation tool also for children with attention deficit hyperactivity disorder (Kollins et al., Lancet Digital Health 2020).
Unexpectedly, some of our studies have also found an improvement in phonological processing, as a consequence of improved attention processes, in children with dyslexia after training with action video games (Franceschini et al., Sci Rep 2017; Gori et al., Cer Cortex 2016; Franceschini & Bertoni, 2019). A recent meta-analysis clearly confirmed this intriguing result (Puccio et al., Int J Hum-Comp Inter 2023).
However all these studies done from our lab or from independent labs around the world focused on children with the dyslexia diagnosis. Unfortunately the dyslexia diagnosis can be done, based on the mother tongue language, after the second or even the third year of primary school. Consequently we are missing the chance to train these children during their peak of neuroplasticity that ends before they start the primary school. Our lab's final mission was dyslexia prevention using the full potential of the peak of neuroplasticity. In our lab we started to brainstorm in order to identify and train some important predictors of dyslexia that could be measured way before the end of the second year of primary school. We thought that the improvement in processing speed induced by action video games could be not only visual, but could also be auditory, inducing a better phoneme perception also in children with language disorders. Children with language disorder presenting a pre-reading phonological processing deficit, such as difficulties in phoneme perception and phonological working memory, are, indeed, at high-risk to develop future dyslexia. Of course the main point for us was that language can be measured way before reading acquisition.
Thus, the current study is the result of our bet: we tested the action video games effects upon three consolidated language-based predictors of reading development in a sample of 79  at-risk and 41 non-at-risk pre-readers for dyslexia.
At-risk children were impaired in either phonemic perception (i.e., phoneme discrimination, e.g., are “PACA” and “BACA” same or different?), phonological working memory or rapid automatized naming (i.e., RAN of colors).
At-risk children were assigned to different groups by using an unequal allocation randomization: (1) AVG (n=43), (2) Serious Non-Action Video Game (NAVG, n=11), (3) treatment-as-usual (i.e., speech therapy, n=11), and (4) waiting list (n=14).
Controlling for pre-training performance, pre- and post-training comparisons show that only phoneme perception presented a significantly higher improvement in the AVG group compared to the waiting list, the NAVG, and the treatment-as-usual groups, as well as the combined active groups (n=22). 
This cross-modal neuroplasticity change: (i) leads to a recovery in phoneme perception when compared to the not-at-risk pre-readers; (ii) is present in more than 80% of AVG at-risk pre-readers, and; (iii) is maintained at a 6-month follow-up.
The present findings indicate, for the first time, that this fun multisensory attentional training positively affects also the speed of processing for the smallest distinctive sound elements that constitute language in pre-readers at risk for dyslexia, paving the way for innovative prevention programs. 
Since neither phonological working memory nor rapid naming were enhanced by action video games, we suggest that the possible action of impact of this unconventional prevention program includes the right-lateralized ventral stimulus-driven attentional and salience neural network. Indeed, both phonological working memory and rapid naming are typically lateralized in the left language and reading neural networks. 
This experimental prevention study dramatically changes the current scientific landscape of dyslexia challenging the traditional phonological hypothesis based on the left language neural network. Our specific experimental design, investigating pre-reading children employing a training study, does not present the typical scientific limitations often hampering the scientific literature on the topic (Goswami 2015 Nature Rev Neurosci), and therefore it shows a strong causal relationship.  These results open up  to innovative prevention studies with the aim to fight several neurodevelopmental disorders characterized by multisensory attention dysfunctions even before their diagnosis.  

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Cognitive Neuroscience
Life Sciences > Biological Sciences > Neuroscience > Cognitive Neuroscience
Behavioral Neuroscience
Life Sciences > Biological Sciences > Neuroscience > Behavioral Neuroscience

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