Dyslexia is a severely invalidating learning disability that affects literacy acquisition despite normal intelligence and adequate instruction []. Dyslexia is often associated with undesirable outcomes, such as lower educational attainment and loss of self-confidence [], because reading is essential for all aspects of learning from using older school books to the latest technology (e.g., ebooks and smart phones).

Although an impaired auditory discrimination of spoken language (phonological processing) is widely assumed to characterize dyslexic individuals [], dyslexia remediation is far from being fully achieved []. Improvements in auditory-phonological processing do not automatically increase reading abilities []. Recent evidence suggests that dyslexia could arise from a basic crossmodal letter-to-speech sound integration deficit []. Remediation based on explicit, systematic instruction on letter-to-speech integration (decoding strategies) appears to be the most efficient treatment []. However, all the existing treatments are controversial and demand high levels of resources. Moreover, the cognitive processes underlie the improvements in reading ability remain unclear [].

Attentional dysfunction is an important core deficit in dyslexic individuals []. Letters must be precisely selected from among other cluttering graphemes [] by rapid orientation of visual attention [] before the correct letter-to-speech sound integration applies []. Efficient attention improves the perception of stimuli [] and increases the development of neural connections [] between letter and speech sound []. An attentional deficit reduces the success of traditional dyslexia treatments, because learning ability is hampered by spatial and temporal attention dysfunction. Thus, treatment of attentional deficits could be crucial in dyslexia remediation.

Since video game training has been proven to increase attention abilities [], we investigated the effects of video games on children with dyslexia. In contrast to typical perceptual learning findings in which performance improvement for supra- or subliminal features is strictly stimulus specific [], attentional action video game (AVG) training should produce learning that transfers well beyond the task domain []. It is predicted that AVG training will improve letter-to-speech sound mapping (phonological decoding) and, consequently, reading abilities.

To test this hypothesis, we measured the phonological decoding of pseudowords and word text reading skills in 20 children with dyslexia before (T1) and after (T2) two video game trainings. Ten dyslexic children were assigned to AVG and ten to nonaction video game (NAVG) training (see the Supplemental Experimental Procedures available online). Chronological age, full intelligence quotient (IQ), reading severity (measured in speed and errors during reading of word and pseudoword clinical lists), and phonological skills were similar in the two groups (see Table S1 ). The two groups did not differ at T1 in both reading and attentional measurements (all p values >0.1). Each child was individually treated by playing a commercial Wii video game (Rayman Raving Rabbids) for a total of 12 hr. The single minigames were selected to create the action and nonaction treatments (see the Supplemental Experimental Procedures and Supplemental Results ). Informed written consent was obtained from the parents of each child, and the Scientific Institute E. Medea ethic committee approved the research protocol. The entire research process was conducted according to the principles expressed in the Declaration of Helsinki.

Reading Improvements

∗2 (time: T1 and T2) ∗2 (group: AVG and NAVG) mixed ANOVA. The mean between the three pseudoword reading inefficiencies and the word text reading inefficiency (see (1,18) = 5.50, p = 0.03, η2 p = 0.23], showing an improvement in general reading abilities across the two groups. Crucially, the time∗group interaction was also significant [F (1,18) = 6.40, p = 0.02, η2 p = 0.26]; general reading abilities improved in the AVG (mean = 39.33) but not the NAVG (mean = −1.5; see (18) = 3.30, p < 0.01 and (18) = 1.97, p = 0.03, respectively; see also 25 Dye M.W.G.

Green C.S.

Bavelier D. Increasing speed of processing with action video games. Figure 1 Training-Related Changes in Reading Abilities Show full caption ∗, significant difference. Error bars represent the SE. See also Pseudoword and word text reading abilities were measured before (T1) and after (T2) NAVG and AVG treatment in children with dyslexia. The general reading improvement is the mean between the pseudoword and the word text reading inefficiency (speed/accuracy) that is reduced by the training. Only AVG players showed significant general reading improvements (A). The general reading inefficiency is showed before (T1) and after (T2) training in NAVG and AVG group (B). Pseudoword (C) and word text (D) reading improvements were significant only in AVG group. Pseudoword (E) and word text reading inefficiency (F) is showed before (T1) and after (T2) training in NAVG and AVG group. Pseudoword and word text reading inefficiency were both significantly reduced only in AVG players. The reading improvements—induced by the AVG training—involve both phonological decoding and lexical reading. The two groups did not differ at T1 in all the reading measurements., significant difference. Error bars represent the SE. See also Tables S1–S3, S5, and S6 The reading inefficiency was measured as a ratio between speed (defined as the time in seconds necessary to read the specific item, depending of the task) and accuracy (defined as the ratio between the correct response and the total number of items). This measure was chosen to control for the tradeoff between reading speed and accuracy. Training-related changes in reading inefficiency were analyzed by a 2 (task: pseudoword decoding and word text reading)2 (time: T1 and T2)2 (group: AVG and NAVG) mixed ANOVA. The mean between the three pseudoword reading inefficiencies and the word text reading inefficiency (see Table S2 ) was labeled general reading abilities. The time main effect was significant [F= 5.50, p = 0.03, η= 0.23], showing an improvement in general reading abilities across the two groups. Crucially, the timegroup interaction was also significant [F= 6.40, p = 0.02, η= 0.26]; general reading abilities improved in the AVG (mean = 39.33) but not the NAVG (mean = −1.5; see Figures 1 A and 1B ) players. Pseudoword phonological decoding and word text reading were both significantly improved in the AVG compared to the NAVG players [see Figure 1 C, t= 3.30, p < 0.01 and Figure 1 D, t= 1.97, p = 0.03, respectively; see also Figures 1 E and 1F and Tables S2 and S3 for details]. The reading improvements after the AVG training were characterized by the increased reading speed without a cost in accuracy. This result is in agreement with the improved speed of processing already found associated with AVG [].

11 Zorzi M.

Barbiero C.

Facoetti A.

Lonciari I.

Carrozzi M.

Montico M.

Bravar L.

George F.

Pech-Georgel C.

Ziegler J.C. Extra-large letter spacing improves reading in dyslexia. (18) = 2.79, p = 0.01] than the NAVG group (mean 0.05 syll/s). The relevance of this result can be fully appreciated by noting that the pseudoword-decoding improvements obtained after 12 hr of AVG training (mean 0.18 syll/s) were higher than the mean improvements expected in a dyslexic child (0.15 syll/s) after 1 year of spontaneous reading development. Similarly, the AVG group (mean 0.39 syll/s) posted a larger improvement [t (18) = 2.52, p = 0.02] in word text reading skills than the NAVG group (mean 0.08 syll/s). Consistently, the improvement in word text reading speed obtained after 12 hr of AVG training (mean 0.39 syll/s) was higher than the improvement expected (0.3 syll/s) in a dyslexic child without treatment for one year. Moreover, the AVG speed reading improvements were bigger than those obtained by the highly demanding traditional phonological and orthographic treatments and equal to the letter-to-speech integration training (see the To establish the reliability of these findings, we computed the analysis in syllables per seconds, which is an important clinical reading index used in both consistent and inconsistent orthographies []. In the reading speed of pseudoword-decoding tasks, the AVG group (mean 0.18 syllable [syll]/s) showed a bigger improvement [t= 2.79, p = 0.01] than the NAVG group (mean 0.05 syll/s). The relevance of this result can be fully appreciated by noting that the pseudoword-decoding improvements obtained after 12 hr of AVG training (mean 0.18 syll/s) were higher than the mean improvements expected in a dyslexic child (0.15 syll/s) after 1 year of spontaneous reading development. Similarly, the AVG group (mean 0.39 syll/s) posted a larger improvement [t= 2.52, p = 0.02] in word text reading skills than the NAVG group (mean 0.08 syll/s). Consistently, the improvement in word text reading speed obtained after 12 hr of AVG training (mean 0.39 syll/s) was higher than the improvement expected (0.3 syll/s) in a dyslexic child without treatment for one year. Moreover, the AVG speed reading improvements were bigger than those obtained by the highly demanding traditional phonological and orthographic treatments and equal to the letter-to-speech integration training (see the Supplemental Results ).

6 Vidyasagar T.R.

Pammer K. Dyslexia: a deficit in visuo-spatial attention, not in phonological processing. Thus, AVG training improves not only the basic letter-to-speech sound integration—indexed by increased pseudoword reading efficiency—but also lexical recognition, measured by the word text reading as recently suggested by Vidyasagar and Pammer []. Finally, to quantify the reliability at individual level of this group improvement, we analyzed the improvement in the general reading abilities (see Figure 1 A). Eight out of ten (80%) AVG players statistically differed from the NAVG group’s mean improvements. In addition, seven out of ten (70%) AVG players were at least 1 SD above the mean of the NAVG in the general reading improvements.

Considering that children with dyslexia could present reading comprehension problems as consequence of the core reading decoding deficit, further studies could directly investigate the possible effect of AVG on this higher level reading parameter.

∗2 (group: AVG and NAVG) mixed ANOVA revealed no significant main effects or interaction, suggesting that reading enhancement driven by AVG training is unrelated to phonological short-term memory improvements. We also measured changes in phonological skills after treatment, using a phoneme-blending task (see Table S1 and the Supplemental Experimental Procedures ). A 2 (time: T1 and T2)2 (group: AVG and NAVG) mixed ANOVA revealed no significant main effects or interaction, suggesting that reading enhancement driven by AVG training is unrelated to phonological short-term memory improvements.

Two months after the end of the treatment (T3), we followed up on reading improvements induced by AVG training by retesting the phonological decoding skill in six out of ten dyslexic children that did not perform any treatment or training between T2 and T3. A dependent sample t test comparison revealed a nonsignificant difference in pseudoword-decoding skill between T2 and T3 performance, indicating a long-lasting reading improvement from AVG training (see Tables S2 and S3 ).