White matter properties and reading in children born preterm:
a step forward
1 Departament de Psicologia Cl
ınica i Psicobiologia, Universitat de Barcelona,
Barcelona; 2 Institut de Neuroci
encies. Universitat de Barcelona, Barcelona,
This commentary is on the original article by Dodson et al. on pages
695–702 of this issue.
Preterm birth seems to be increasing, with an estimated
prevalence of 11% of all live births worldwide in 2010.
Importantly, 31% of children born preterm present life-
long neurodevelopmental effects. Executive function and
language/learning difﬁculties are common sequelae of pre-
term birth, and are associated with increased health care
costs and educational needs. Reading skills are essential for
educational progress, as they are the gateway to academic
achievement and general knowledge. Together with previ-
ous work, the diffusion magnetic resonance study by Dod-
son et al.
advances our understanding of the neural basis
of this key learning difﬁculty in children born preterm.
Firstly, their ﬁndings suggest that phonological aware-
ness is similar in children born at term and preterm at the
early stages of learning to read, and that in both groups
this ability is supported by dorsal tracts. In view of their
results, it would be interesting to explore the association
between phonological awareness and white matter
microstructure in tracts other than the left-hemisphere
arcuate fasciculus in participants born preterm. Positive
results might indicate the contribution of compensatory
mechanisms that bring the performance of children born
preterm up to the level of participants born at term. To
address these questions, the use of a whole brain approach
that does not require a priori selection of tracts of interest
might provide new insights.
Secondly, the authors report an association (which is
moderated by prematurity) between fractional anisotropy
of the right uncinate fasciculus and receptive and expres-
sive language. Interestingly, the authors posit that the lack
of association in their preterm sample might be because
the uncinate fasciculus myelates late and is slow to develop.
Given that participants were in the early stages of learning
to read, it would be interesting to monitor their reading
acquisition and its neural correlate to check this hypothe-
sis. Additionally, to further understand the origin of read-
ing difﬁculties in children born preterm and their neural
basis, the results should be interpreted in light of studies
reporting delayed event-related potentials and mismatch
negativity responses to speech sounds in 3-month old chil-
dren born preterm. It has been suggested that these mea-
sures can be used for the early identiﬁcation of the risk of
One strength of this study is that both fractional aniso-
tropy and mean diffusivity results are reported. These mea-
sures are related but different, and so reporting both gives
a fuller picture of the neural bases underlying pre-reading
skills. Another important strength is that results are con-
trolled for non-verbal intellectual abilities. It might be
argued, however, that the basic neuropsychological pro-
cesses that have been reported to be impaired in children
born preterm, such as visual perception and attention,
may underlie reading difﬁculties as well. In particular,
accurate signalling of shifts of attention by the visual sys-
tem seem to be a key ability underlying reading perfor-
Thus, the fact that these functions were not
directly assessed may represent a limitation.
Overall, the study provides novel insights into the simi-
larities and differences of the neurobiology of pre-reading
skills in children born preterm and at term. These insights
help to explain the previously reported variations observed
by this research group in the neurobiology of reading in
older participants born at term and preterm. Future studies
including children born moderate/late preterm are also
warranted as this seems to be the most frequent type of
Finally, we strongly encourage: further
research with larger samples; an exploration into the effects
of being a pre-reader/reader; the use of a whole brain
approach; and ideally a longitudinal follow-up. The infor-
mation provided by these studies could be used to assist
reading acquisition in children born preterm.
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