DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY ORIGINAL ARTICLE
White matter properties associated with pre-reading skills in
6-year-old children born preterm and at term
CORY K DODSON
KATHERINE E TRAVIS
LAUREN R BORCHERS
VIRGINIA A MARCHMAN
HEIDI M FELDMAN
1 Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; 2 Department of Psychology,
Stanford University, Stanford, CA, USA; 3 The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan; 4 Department of English Literature and
Linguistics, Bar Ilan University, Ramat Gan, Israel.
Correspondence to Heidi M Feldman, Medical School Ofﬁce Building, 1265 Welch Rd. Rm x163, Stanford, CA 94305, USA. E-mail: firstname.lastname@example.org
This article is commented on by Laporta-Hoyos on page 641 of this issue.
Accepted for publication 2nd March 2018.
Published online 3rd May 2018.
AF-L Left arcuate fasciculus
SES Socio-economic status
SLF-L Left superior longitudinal
UF-R Right uncinate fasciculus
To assess associations between white matter properties and pre-reading skills
(phonological awareness and receptive and expressive language) in children born preterm
and at term at the onset of reading acquisition.
Six-year-old children born preterm (n=36; gestational age 22–32wks) and at term
(n=43) underwent diffusion magnetic resonance imaging and behavioural assessments.
Tracts were selected a priori based on ﬁndings from a study of 6-year-old children born at
term: the left-hemisphere arcuate fasciculus and superior longitudinal fasciculus, and right-
hemisphere uncinate fasciculus. Using linear regression, we assessed associations between
fractional anisotropy of tracts and phonological awareness and receptive and expressive
language scores. We investigated whether associations were moderated by prematurity.
Fractional anisotropy of the left-hemisphere arcuate fasciculus contributed unique
variance to phonological awareness across birth groups. The association between fractional
anisotropy of the right-hemisphere uncinate fasciculus and receptive and expressive
language was signiﬁcantly moderated by prematurity.
A left-hemisphere tract was associated with phonological awareness in
both birth groups. A right-hemisphere tract was associated with language only in the term
group, suggesting that expressive and receptive language is mediated by different white
matter pathways in 6-year-old children born preterm. These ﬁndings provide novel insights
into similarities and differences of the neurobiology of pre-reading skills between children
born preterm and at term at reading onset.
Preterm birth affects nearly 10% of infants born in the
Children born preterm are at risk for adverse
neurodevelopmental outcomes, including deﬁcits in atten-
tion, working memory, executive function, language, and
A recent meta-analysis conﬁrmed that children
born preterm, on average, scored 0.48 standard devia-
tions below children born at term in reading.
meta-analysis found a signiﬁcant gap between groups
born preterm and at term in reading that increased
between the ages of 6 to 12 years, especially for reading
Precursor skills for reading include
phonological awareness and language abilities. Measures
of each of these precursors in isolation have signiﬁcantly
predicted later reading abilities in children born at term.
Compared with children born at term, 6-year-old chil-
dren born preterm have demonstrated deﬁcits in early
pre-reading skills, including phonological awareness and
These early behavioural differences
likely account for why children born preterm are unlikely
to achieve reading levels similar to their typically devel-
Understanding the neurobiological basis of
early pre-reading abilities in both children born preterm
and at term may provide insight into the process of
learning to read. Studies to date have primarily examined
how early pre-reading skills relate to neurobiological
properties, such as metrics of white matter pathways, in
children born at term but not in children born preterm
at the early stages of learning to read.
Preterm birth is associated with injury to the white mat-
ter of the brain.
Microstructural properties of white mat-
ter tracts can be quantiﬁed with diffusion magnetic
resonance imaging (MRI) using metrics such as fractional
anisotropy and mean diffusivity.
Using diffusion MRI,
studies of neonates have found increased mean diffusivity
among children born preterm.
Among children and ado-
lescents, studies have observed altered fractional anisotropy
values in preterm versus term participants.
the current sample of 6-year-old children, we replicated a
© 2018 Mac Keith Press DOI: 10.1111/dmcn.13783 695