The quality of parent–child interaction during shared reading (“shared reading quality”) is strongly linked to cognitive and relational benefits. However, the relationship between shared reading quality and activation and synchronization of reading-related brain networks has not yet been characterized. The current study involved 22 4-year-old girls who completed functional MRI including a validated stories listening task, and a primary parent. Prior to MRI, video observation of the parent and child reading together was conducted and later coded using a standardized scoring form quantifying parent–child verbal and nonverbal interaction. Behavioral measures included demographics and a maternal depression scale. To achieve this goal, fMRI stories-listening data was utilized to create a diffusion maps algorithm and then to classify the level of parent–child interaction during the shared reading observation. The algorithm clustered children with higher parent–child engagement scores with fMRI diffusion patterns in regions of the brain known to support reading. This study establishes proof-of-concept that applying this diffusion maps algorithm to brain functional connectivity data can reliably predict parent–child interaction during shared book reading. It also suggests that an algorithmic approach may be a novel, data-driven means to quantify parent–child interaction in different contexts (e.g., reading, play) and populations.

Environmental factors such as Home Literacy Environment (HLE), screen time, and parental executive functions (EF) may influence the development of the child's EF. The purpose of this study was to determine the effect of these factors on behavioral and neurobiological measures of EF in 4-year-old children. Electroencephalogram (EEG) data were collected while children performed the Attention Network Task (ANT), showing a smaller difference between incongruent and congruent conditions is related to better EF abilities. Data were analyzed using an Event-Related Potential (ERP) technique focusing on the N200 and P300 components (reflecting executive control and orienting attention, respectively). N200 and P300 differences (delta) between amplitudes and latencies for the incongruent and congruent conditions were computed and correlated with child EF skills, HLE, screen exposure, and parental EF. Screen exposure was associated with lower EF in children and their parents. Additionally, smaller differences between N200 amplitudes and latencies for the incongruent vs. congruent conditions were associated with higher HLE scores. In contrast, greater differences between P300 amplitudes and latencies were related to longer screen time. HLE was positively associated with EF's neurobiological (EEG) and behavioral measures, and screen time was negatively associated with these measures. This study also highlights the important relationship between parental EF (i.e., family predisposition) and EF's neurobiological and behavioral measures in their children.

Purpose of ReviewThe incorporation of digital technologies and their use in youth's everyday lives has been increasing rapidly over the past several decades with possible impacts on youth development and mental health. This narrative review aimed to consider how the use of digital technologies may be influencing brain development underlying adaptive and maladaptive screen-related behaviors.Recent FindingsTo explore and provide direction for further scientific inquiry, an international group of experts considered what is known, important gaps in knowledge, and how a research agenda might be pursued regarding relationships between screen media activity and neurodevelopment from infancy through childhood and adolescence. While an understanding of brain-behavior relationships involving screen media activity has been emerging, significant gaps exist that have important implications for the health of developing youth.SummarySpecific considerations regarding brain-behavior relationships involving screen media activity exist for infancy, toddlerhood, and early childhood; middle childhood; and adolescence. Transdiagnostic frameworks may provide a foundation for guiding future research efforts. Translating knowledge gained into better interventions and policy to promote healthy development is important in a rapidly changing digital technology environment.

AIM:Media use in children has exploded in the past several decades, most recently fuelled by portable electronic devices. This study aims to explore differences in functional brain connectivity in children during a story-listening functional MRI (fMRI) task using data collected before (1998) and after (2013) the widespread adoption of media. METHODS:Cross-sectional data were collected from English-speaking 5- to 7-year-old children at Cincinnati Children's Hospital Medical Center, USA, of a functional MRI narrative comprehension task completed in 1998 (n = 22) or 2013 (n = 25). Imaging data were processed using a graph theory approach, focusing on executive functions, language and visual processing networks supporting reading. RESULTS:Group differences suggest more efficient processing in the fronto-parietal network in the pre-media group while listening to stories. A modulation of the visual and fronto-parietal networks for the post-media exposure group was found. CONCLUSION:Further studies are needed to assess effects over time in the more exposed group to discern a causal effect of portable devices on cognitive networks.

Screen-based media has become a prevailing part of children's lives. Different technologies provide limitless access to a wide range of content. This accessibility has immensely increased screen exposure among children, showing that this exposure is associated with decreased cognitive abilities. This study was designed to evaluate how the neurobiological correlates for different sub-components of screen exposure, such as level of access, content, and frequency, are related to different cognitive abilities. Resting-state functional MRI data were collected in 29 native English-speaking children (8-12 years old), in addition to cognitive-behavioral measures. Functional connectivity measures within and between several networks related to cognitive control and attention were calculated [fronto-parietal (FP), cingulo-opercular (CO), dorsal attention (DAN), ventral attention (VAN), salience, default mode (DMN), cerebellar networks]. Sub-components of screen exposure were measured using the Screen-Q questionnaire. Higher access to screens was related to lower functional connectivity between neural networks associated with basic attention skills and cognitive control (i.e., DAN and salience). In addition, higher levels of parent-child interaction during screen exposure were related to increased functional connectivity between networks related to cognitive control and learning (i.e., CO and cerebellar). These findings suggest that screen exposure may reduce the engagement of basic attention and modulation of cognitive control networks and that higher levels of parent-child interaction engage cognitive control networks. An enhanced understanding of these processes can provide an important scientific basis for future educational and medical approaches regarding screen exposure.

The expanded simple view of reading (SVR) model suggests that word decoding, language comprehension and executive functions are necessary for reading comprehension. Children with reading difficulties (RDs) often have deficits in critical components of reading established in the expanded SVR model and alterations in brain function of reading-related regions. Maternal education could provide children with advantageous educational opportunities or resources that support reading acquisition. The primary goal of this study was to examine the contributions of maternal education to the behavioural and neurobiological correlates of the expanded SVR model. Seventy-two 8- to 12-year-old children with RDs and typical readers (TRs) completed reading, behavioural and an functional magnetic resonance imaging stories-listening task to determine the functional connectivity of the receptive language network to the whole brain in association with maternal education. Higher maternal education was associated with better vocabulary in children with RDs and positive functional connectivity between the receptive language network and regions related to visual processing in children with RDs versus TRs. These data suggest that maternal education supports the ability to comprehend oral language and engagement of neural networks that support imagination/visualization in children with RDs.

Literacy is a major social determinant of health, rooted in skills that develop during early childhood. Children arriving at kindergarten unprepared to learn to read are more likely to have low reading proficiency thereafter. General and health literacy are highly correlated, affecting understanding of health conditions, treatment adherence, and transition to self-care and adult healthcare services. The American Academy of Pediatrics (AAP) recommends literacy and school readiness promotion during well-visits and neurodevelopmental surveillance is emphasized across primary and subspecialty care. While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and chronic medical conditions are less appreciated and under-researched. This review applies an eco-bio-developmental framework to explore literacy across five complex chronic conditions affecting millions of children worldwide: asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease. In each, integration of an efficient reading brain network may be impacted by direct factors, such as ischemia, anesthesia, and/or medications, and also indirect factors, such as altered parent-child routines, hospital stays, and missed school. By integrating literacy into care management plans for affected children, pediatric primary care and specialty providers are poised to identify risks early, target guidance and interventions, and improve academic and health outcomes. IMPACT: While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and/or chronic medical conditions such as asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease are substantial, less appreciated, and under-researched. General and health literacy are highly correlated, with implications for the understanding one's health condition, treatment adherence, and transitioning to self-care, which is especially important for children with complex and/or chronic illness. Pediatric primary care and specialty providers are poised to integrate reading and literacy into care management plans for children with complex and/or chronic illness, including early screening, guidance, support, and interventions.

Literacy development is a complex process. It is well established that the Home Literacy Environment influences literacy development. To better understand the influence of the Neighborhood Literacy Environment, we examined the distribution of public library branches across neighborhoods in an American midwestern city and associations between book circulation rates and childhood poverty rates. This study used children's book circulation data provided by the Hamilton County Public Library in the state of Ohio (U.S.). The primary outcome variable was the branch-specific, five-year mean circulation rate of books-per-child living within the branch neighborhood. The predictor variable was the childhood poverty rate of the neighborhood. There was a significant, moderate negative correlation between book circulation and childhood poverty rates (Spearman's r= -0.52, p<0.001). Using data from a public library system in a large midwestern American city, this study found significant disparities in branch access and children's book circulation in high-poverty neighborhoods.

Ten to 15% of school-age children have reading difficulties (RD, or dyslexia), defined by deficits in phonological processing, fluency, and executive functions (EFs). Although RD is referred to as a genetic disorder, reading ability may also be affected by environmental factors such as inadequate exposure to literacy and a lack of parental involvement. These environmental components are a part of the socioeconomic status (SES) measure, which is defined by parental occupation, educational attainment, and household income and are positively correlated to reading ability. The goal of the current study was to relate maternal education, a construct of SES to executive functions (EFs) that relate to reading in children with RD compared to typical readers (TRs) using behavioral and neurobiological resting-state fMRI data. The results show that higher maternal education is negatively correlated to inhibitory control for TRs and not for children with RD. Higher maternal education was also associated with negative functional connectivity of the frontal-parietal network to the left central opercular cortex and left occipital gyrus for children with RD compared to TRs. These results suggest that higher maternal education has contrasting roles on the behavioral and neurobiological correlates of EFs for children with RD compared to TRs. We conclude that higher education levels for mothers may provide their children with a structured environment and educational resources that may assist their children with RD and TRs with cognitive development based on their reading profile.

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Early language exposure and shared parent-child reading, as assessed by maternal reading ability and fluency, affect the child's future language and cognitive abilities. The aim of the current study was to explore the association between maternal reading ability and fluency and diffusion properties of language- and cognition-related white matter tracts in their pre-school age children using diffusion tensor imaging (DTI). DTI data were acquired from fifteen girls (mean age: 3.83 +/- 0.49 years). Reading ability and fluency were assessed in their mothers. Effects of hemisphere and node on diffusion properties were measured at 100 points along white matter tracts related to language and cognitive abilities. Significant positive correlations were found between maternal reading ability and fractional anisotropy in left and right dorsal and ventral language and executive functions-related tracts, while maternal reading fluency was associated with higher fractional anisotropy in ventral tracts, mainly in the left hemisphere. Fractional Anisotropy was significantly higher in the left compared to the right arcuate, cingulum cingulate, and inferior longitudinal fasciculus and higher in the right compared to the left superior longitudinal fasciculus. Our results signify the importance of maternal reading as a facilitator of the child's future language and cognitive abilities.

An adverse relationship between screen exposure time and brain functional/structural connectivity was reported in typically developing children, specifically related to neurobiological correlates of reading ability. As children with reading difficulties (RD) suffer from impairments in reading and executive functions (EF), we sought to determine the association between the ratio of screen time duration to reading time duration and functional connectivity of EF networks to the entire brain in children with RD compared to typical readers (TRs) using resting state data. Screen/reading time ratio was related to reduced reading and EF abilities. A larger screen/reading time ratio was correlated with increased functional connectivity between the salience network and frontal-EF regions in children with RD compared to TRs. We suggest that whereas greater screen/reading time ratio is related to excessive stimulation of the visual processing system in TRs, it may be related to decreased efficiency of the cognitive control system in RDs.

Background Maternal depression can influence the early activity of a mother reading stories to a young child, as depressed mothers are less likely to read to their children. Here, maternal depression association to neurobiological circuitry of narrative comprehension, visualization, and executive functions during stories listening was examined in 21 4-year-old girls and their mothers. Maternal depression scores were collected from the mothers, and functional MRI during stories listening was collected from the children. Results Increased maternal depression was related to decreased functional connectivity between visualization and auditory regions and increased connectivity between the right visual cortex and dorsolateral prefrontal cortex in the children. Conclusions This study highlights the need to monitor maternal depression and provide interventions to ensure positive linguistic outcomes in children.

This Viewpoint characterizes literacy as a unique domain of child development separate from spoken language acquisition that can be promoted and monitored through early pediatric primary care intervention.

OBJECTIVES:Dialogic reading (DR) is a shared storybook reading intervention previously shown to have a positive effect on both literacy and general language skills. The aim of this study was to examine the effect of DR compared to screen-based intervention on electrophysiological markers supporting narrative comprehension using EEG.METHODS:Thirty-two typically developing preschoolers, ages 4 to 6 years, were assigned to one of two intervention groups: Dialogic Reading Group (DRG, n = 16) or Screen Story Group (SSG, n = 16). We examined the effect of intervention type using behavioral assessment and a narrative comprehension task with EEG.RESULTS:The DRG showed improved vocabulary and decreased functional connectivity during the stories-listening task, whereas the SSG group showed no changes in vocabulary or connectivity. Significantly decreased network strength and transitivity and increased network efficiency were observed in the DRG following intervention. Greater network strength and transitivity at follow-up were correlated with increased vocabulary.CONCLUSIONS:The results suggest the beneficial effect of DR in preschool-age children on vocabulary and EEG-bands related to attention in the ventral stream during narrative comprehension. Decreased functional connectivity may serve as a marker for language gains following reading intervention.SIGNIFICANCE:DR intervention for preschool-age children may reduce interfering connections related to attention, which is related to better narrative comprehension.

Exposure to screens has been shown to reduce attention span in children. Increased slow-wave (theta band) and decreased fast-wave (beta and gamma bands) generated from EEG, as well as increased theta/beta ratio, have been observed in children with Attention-Deficit-Hyperactivity-Disorder (ADHD). This study examined the relationship between 6-weeks screen exposure and attention abilities in typically developing preschoolers using EEG during rest. Theta and beta bands were compared, and visual attention and parental reports for attention abilities were controlled. Results suggested that the active control group showed improved visual-attention abilities following the exposure to stories, whereas the screen group did not show improved visual attention. EEG results suggested a higher connectivity in theta vs. beta bands in the screen group, but not in the control group. Results support the negative relationship between screen exposure and attention-related patterns generated from EEG in typically developing preschool children.

This chapter aims to highlight the importance of autoantigen discovery for the development of immunological interventions following diagnosis and/or progression of type 1 diabetes, an autoimmune disease that specifi cally targets and destroys pancreatic β cells within the Islets of Langerhans. Both humoral (B-cell) and cell-mediated (T-cell) autoimmunity will be discussed, specifi cally focusing on the experimental models through which novel autoantigens have been discovered, characterized, and exploited for diagnostic purposes.

Reading is an acquired skill that relies on cognitive-control and language abilities. Home reading environment has been positively correlated with activation in parietal-temporal-occipital association cortex supporting mental imagery and narrative comprehension during a story-listening task in preschool-age children. However, the degree to which maternal reading ability influences early brain development, specifically neural circuits involved with language and reading, is not well understood. The current study explored the relationship between maternal reading ability and functional connectivity within the language network, between the language network and networks related to cognitive control and visual processing, as well as between the language network and the entire brain (network-to-voxel analysis) of preschool-age children during a resting state. Thirteen 4-year-old girls and their mothers participated in this study, involving cognitive testing and functional magnetic resonance imaging, including a resting-state scan. Maternal reading ability was negatively correlated with functional connectivity within the child’s language network at rest, and also with areas involved in visual processing, cognitive-control, and semantics. These results suggest that children whose mothers exhibit decreased reading ability may demonstrate a greater engagement of the language network and neural circuits related to visual word recognition, cognitive-control, and semantic processing, which later in life support reading.

As Health Economics reaches a quarter century of publication and our founding editor, Alan Maynard, is stepping down from his role, the editorial team would like to take the opportunity to thank Alan and all others who have contributed to the editorial board over those 25 years. With the rapid expansion of research in health economics, and its increasing application to policy-making in the 1980s, authors were seeking publication in a wide range of medical, social science and policy journals. Academic publishers sensed a ‘gap in the market’ and, as director of the Centre for Health Economics at the University of York at the time, Alan was often approached. He resisted the calls for some time, but in 1991 agreed with John Wiley to edit a new journal. He enlisted the help of John Hutton, then a senior research fellow in the Centre for Health Economics, and Frances Sharp, and in April 1992, the first issue of Health Economics was published. Alan was the ideal person to lead the new venture. Health Economics was always intended by the editors and publishers to be an international journal. Alan was able to exploit his international reputation as well as his contacts in academia and health policy-making for the benefit of the initiative. From the start, the editorial board had a broad international membership, and Alan was able to enlist important contributions to the journal. Once the journal was established, the editorial team found itself coping with increasing volumes of submissions. A balance had to be struck between raising the acceptance criteria whilst maintaining accessibility for authors. Alan played an important part in maintaining the standard of published papers through his high expectations and rigorous editing. The expansion in health economics research and work of publishable standard was reflected in the increase in the annual number of issues from 4 in 1992 to 6 in 1994, and then to 8 in 1998 and 12 by 2003. In the early years, the majority of submissions were from Europe and North America, with just 10% of submissions coming from the rest of the world. That figure has risen to nearly 30%, and the distribution of papers is now spread across the globe, with submissions coming from many countries with emerging health economics research programmes. Alan established a tradition of pithy editorials that gave a timely health economics perspective on issues in health policy. He wrote several himself and enlisted contributions from those he encountered in the course of his academic and policy work. Alan's interest in the journal was all-embracing. He took a close interest in design issues. The predominantly yellow cover was his idea, and he claimed that the decision was evidence-based, as research had shown that yellow is the colour that is most noticeable to the human eye. Alan has been adept at ensuring that the journal is properly resourced and that the organisational structure evolved with the changing pattern of work. Even with Alan's departure, the journal has grown to have four editors (including two based in the United States), an editorial assistant and a large international team of associate editors who handle the reviewing and selection of papers in their specialist areas. To acknowledge the key contribution of the editorial board to the growth and success of the journal, we have listed all those who have contributed to the board over the past 25 years at the end of this editorial. Alan has always risen to the challenges of editing a journal. From the early days when submissions were low, to the present day where promising papers sometimes have to be directed to other journals given space constraints, he has been determined to encourage rigorous research in health economics and to provide a publication in which this relevant research is made accessible. We should like to thank him for all that he has done and wish him well for the future. Frances Sharp (1992-)

Reading is one of the most important academic abilities that establishes the foundation for a child's success in school. Therefore, early and accurate diagnosis of reading challenges is crucial for prevention of later academic failure. One challenge in early detection of reading difficulties is that the ability to read typically is acquired explicitly when a child is four to six years of age. However, reading ability relies on development of more basic abilities prior to reading acquisition, starting from birth. Conclusion Language, cognitive control and literacy milestones can be evaluated and trained from birth to better acquire reading later in life.