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Brain activity in bilingual developmental dyslexia:

An fMRI study
a a a
Haeme R. P. Park , Gjurgjica Badzakova-Trajkov & Karen E. Waldie
a
Research Centre for Cognitive Neuroscience and Department of Psychology , The
University of Auckland , Auckland , New Zealand
Published online: 25 Oct 2011.

To cite this article: Haeme R. P. Park , Gjurgjica Badzakova-Trajkov & Karen E. Waldie (2012) Brain activity in
bilingual developmental dyslexia: An fMRI study, Neurocase: The Neural Basis of Cognition, 18:4, 286-297, DOI:
10.1080/13554794.2011.588182

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 NEUROCASE
2012, 18 (4), 286–297

Brain activity in bilingual developmental dyslexia:

An fMRI study

Haeme R. P. Park, Gjurgjica Badzakova-Trajkov, and Karen E. Waldie

Research Centre for Cognitive Neuroscience and Department of Psychology, The University
of Auckland, Auckland, New Zealand

The aim of this study was to identify the neural substrates of an adult English-German bilingual with dyslexia (in
both languages) during lexical decision-making using functional magnetic resonance imaging (fMRI). A lexical
Downloaded by [Selcuk Universitesi] at 02:52 01 January 2015

decision task with five conditions in a block design was employed (nonverbal shape judgment, lettercase judgment,
regular word judgment, irregular word judgment, and nonword judgment), and the activation was compared to a
non-dyslexic control bilingual and a control monolingual participant. Both of the control participants matched the
dyslexic bilingual BK on age, sex, IQ, handedness, and education level. Results indicated that the bilingual adult
with dyslexia was strongly right lateralized for stimuli that required phonological processing, a profile that differed
particularly from the activation observed from the monolingual participant. These results are consistent with the
idea of increased activation (mostly in the right hemisphere) during linguistic tasks in adults with dyslexia and in
late proficient bilinguals relative to monolinguals. Findings also suggest that the additional activation observed in
both of the bilinguals are similar, suggesting that these effects are not additive in the dyslexic bilingual.

Keywords: Lexical decision; Reading; Language; fMRI; Cerebral laterality; Bilingualism.

Reading is a complex cognitive task which is
acquired slowly throughout childhood and requires
explicit teaching. To read and write well, a per-
son needs orthographic knowledge, which involves
the ability to translate spoken language into a
written form, as well as phonological awareness,
which is the ability to understand sound struc-
tures and detect phonemes (Harm & Seidenberg,
1999; Hoien, Lundberg, Stanovich & Bjaalid, 1995;
Fromkin, 2000; Joubert et al., 2004). Phonological
awareness, especially, has been determined to be
one of the strongest predictors of reading ability
(Castles & Coltheart, 2004; McBride-Chang, 1995).
Jackson and Coltheart’s Dual-Route Cascade
model (DRC) describes reading as having
two routes, lexical and non-lexical (Jackson &
Coltheart, 2001). The lexical component works
by matching the word to the orthographic lex-
icon of the individual, which allows the reader
to understand irregular and regular words. The
non-lexical component functions by mapping
letters to their phonological sounds, and allows
the pronunciation of regular words and non-
words. These specific spelling-to-sound rules
are operated by phonemes, and are named
grapheme-phoneme correspondence rules (GPC;
Coltheart, Rastle, Perry, Langdon, & Ziegler,
2001; Joubert et al., 2004). When these pro-
cesses are interrupted and/or the reader is unable
to utilize the GPC system, he/she is thought
to have dyslexia (Demonet, Taylor, & Chaix,
2004).

Address correspondence to Karen E. Waldie, PhD, Department of Psychology, The University of Auckland, Private Bag 92019,
Auckland 1142, New Zealand. (E-mail: k.waldie@auckland.ac.nz).

c 2012 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business
http://www.psypress.com/neurocase http://dx.doi.org/10.1080/13554794.2011.588182

Developmental dyslexia is a hereditary neurode-
velopmental disorder, which is diagnosed if an indi-
vidual is unable to learn to read with proper facility
despite normal intelligence, intact senses, proper
instruction, and normal motivation (APA, 2000;
4th ed. revised, DSM-IV TR). As noted, a spe-
cific phonological processing deficit is thought to
characterize the decoding impairment of the major-
ity of individuals with dyslexia (Demonet et al.,
2004). Their ability to sound out a word by using
the GPC rule system is highly compromised, and
the individual is unable to fluently read pronounce-
able nonwords such as blint. The underlying neural
impairment(s) has been more difficult to determine,
however.
A disturbance in planum temporal asymme-
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try has been traditionally assumed to be causally
related to dyslexia but recent evidence suggests
that parietal (rather than temporal) asymmetry
is the most relevant morphological characteristic
(see review by Habib, 2000). Robichon and Habib
(1998), for example, found that the parietal oper-
culum is less asymmetrical in dyslexics than in
controls, and that the degree of asymmetry of this
area is inversely related to phonological task perfor-
mance. Dyslexic adults also show reduced left but
increased right hemisphere activation in temporal-
parietal regions during phonological processing, a
pattern the opposite of that observed in typical
readers (Shaywitz et al., 1998).
More recent reviews of neuroimaging studies,
namely functional magnetic resonance imaging
(fMRI), have similarly emphasized a reduction
or absence of activity in left hemisphere tem-
poroparietal cortex in dyslexic individuals during
language tasks (McCrory, 2004; Maisog, Einbinder,
Flowers, Turkeltaub, & Eden, 2008; Temple, 2002).
McCrory (2004) found different activation pat-
terns during reading tasks in dyslexic participants
compared to typical readers in language-related
left hemispheric regions, including the inferior
frontal gyrus and the angular gyrus. Demonet
et al. (2004) also reported that activation in the
right hemispheric regions were more robust in
dyslexic participants when compared to typical
readers. Such results emphasize that there are
neural differences between dyslexic readers and
those who read normally when engaged in lin-
guistic processes (Eden et al., 2004), with the
right hemispheric activity thought to be a compen-
satory mechanism, perhaps due to the extra cogni-
tive effort required during phonological processing
(Grigorenko, 2001; Joseph, Noble, & Eden, 2001;
BRAIN ACTIVITY IN BILINGUAL DYSLEXIA 287
Pugh et al., 2008; Vellutino, Fletcher, Snowling, &
Scanlon, 2004).
Interestingly, the additional cortical activity
reported in adults with dyslexia during linguistic
tasks has also been reported in bilingual individ-
uals (i.e., those who are able to speak and use
two languages). The idea that language is more
widely and bilaterally represented in bilinguals
has been investigated using a range of techniques.
These include cortical stimulation (Ojemann &
Whitaker, 1978), electroencephalography (Genesee
et al., 1978), tachistoscopic and dichotic-listening
(as reviewed by Hull & Vaid, 2006) and, more
recently, with neuroimaging techniques such as
fMRI (e.g., Kim, Relkin, Lee, & Hirsch, 1997; Illes
et al., 1999; Meschyan & Hernandez, 2006; Pillai
et al., 2003). Although Paradis (2004) argued that
the right hemisphere is no more involved during L2
processing than it is for L1, there still appears to be
considerable debate whether the neural bases of lan-
guage organization in bilinguals is exactly identical
to monolinguals.
As reviewed by Abutalebi (2008), bilinguals gen-
erally utilize the same cortical networks as mono-
linguals during language tasks. However, when the
second language (L2) of a bilingual is compared
to the native language (L1), there are reports of
greater left hemispheric “spread”. Researchers also
stress the importance of factors such as the age
of L2 acquisition and proficiency level when L1
and L2 activity in bilinguals are compared (Illes
et al., 1999; Meschyan & Hernandez, 2006; Perani
et al., 1998).
Investigating the role of such factors,
Wartenburger et al. (2003) found that the cor-
tical representation of grammaticality judgments
is only affected by age of acquisition, whereas the
cortical representation of semantic judgments is
affected by language proficiency. More extensive
activations were observed in areas such as the
left inferior frontal gyrus (Broca’s area) and right
middle gyrus (Wartenburger et al., 2003). More
global activations were also observed in Liu, Hu,
Guo, and Peng’s study (2010) where regions such
as the putamen, supplementary motor areas and
cerebellum were bilaterally activated during a pic-
ture naming task in L2, compared to L1. Using a
dual-task language paradigm, Badzakova-Trajkov,
Kirk, and Waldie (2008) also found more bilateral
involvement in late L2 speakers (living in their
L2/English environment) compared to monolin-
gual control participants. The authors concluded
that late proficient bilinguals may engage both
 288 PARK, BADZAKOVA-TRAJKOV, WALDIE
hemispheres to a greater extent than monolinguals
when reading.
The observation that these two different exper-
imental groups (i.e., bilingual participants who
read proficiently, and monolingual individuals with
developmental dyslexia) both appear to utilize
additional areas of cerebral cortex during language
tasks than is typical of monolingual proficient read-
ers, presented to us interesting questions regarding
the brain activity of individuals who are both bilin-
gual and diagnosed with dyslexia. Much of the
existing literature on bilingual dyslexia has focused
on assessing the cognitive skills of children who
are not achieving as expected in their second lan-
guage (e.g., Everatt, Smythe, Adams, & Ocampo,
2000; Miller Guron, & Lundberg, 2003). Very lit-
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tle is known about the neural characteristics of
dyslexic bilinguals. The very limited neuroimaging
research has tended to focus on directly compar-
ing the activity resulting from the two languages
(L1 and L2) in dyslexic participants (e.g., Karanth,
1992; Wydell & Kondo, 2003). In an electroen-
cephalography (EEG) study by Oren and Breznitz
(2005), the researchers found that dyslexic readers
had slower neural responses in both languages, par-
ticularly L2, compared with control participants.
Non-dyslexic bilinguals showed either similar or
shorter evoked potential latencies in L2 compared
to L1.
Here, our aim was to address questions regard-
ing the brain activity in bilingual dyslexia by using
fMRI during five different lexical decision tasks.
Activity during the language tasks was compared to
two age-, gender-, and IQ-matched controls: a typi-
cally reading bilingual adult and a typically reading
monolingual adult.
METHODS
Participants
Adult dyslexic bilingual
BK is a 35-year-old German-English right-
handed female with developmental dyslexia. She
is a native Austrian who started learning English
(L2) at school from the age of 10. She is a profi-
cient speaker of both German and English, and is
well-educated with tertiary qualifications including
a Masters in Graphic Design. She migrated to New
Zealand in 2003, and has been living and working
in her L2 environment since then.
BK was diagnosed with dyslexia in the German
language at the age of 8 in her native Austria.
In 2006 she was administered a battery of tests
by a neuropsychologist that included the Wechsler
Adult Intelligence Scale (WAIS; Wechsler, 1971),
the Wide Range Achievement Test (WRAT-3;
Wilkinson, 1993), the Coltheart online reading
test (Coltheart, 2004), and the Woodcock–Johnson
Tests of Achievement (Woodcock, Mather, &
McGrew, 2001). In brief, the results revealed that
BK had a full-scale IQ of 114 and a reading age
(in English) of 10 years. Her nonword reading
was extremely poor, suggesting a primary problem
with phonological processing. She has no history of
neurological problems or mental health problems.
Control participants
The bilingual control participant, IH, is a 31-
year-old German-English right-handed female who
started learning English (L2) at school at the age of
14. She migrated to New Zealand in 2007 and is cur-
rently studying full-time towards a PhD. The same
battery of tests revealed an IQ of 116 and an adult-
level reading age. She has no history of learning
problems, neurological problems, or mental health
problems. This participant was deemed to have a
late acquisition of her second language, similar to
BK (>6 years of age), and high degree of English
speaking proficiency. L2 proficiency was not objec-
tively measured. As both BK and IH received
graduate degrees (and wrote theses in English), edu-
cational level was used to approximate proficiency.
The monolingual control, RW, is a 28-year-old
right-handed female born in New Zealand, who
recently completed her Masters degree. Her Full-
Scale IQ is 115, she is reading at an adult-level
reading age, and she has no history of learning
problems, neurological problems, or mental health
problems.
Stimuli and procedure
A blocked experimental design with a “go/no-go”
lexical decision response paradigm was employed
in this study (e.g., participants were instructed
to respond to a correct answer with their right-
hand by pressing a mouse button and refrain from
responding for the incorrect response). Ten exper-
imental and 10 fixation/baseline blocks were used
for the five conditions/tasks in the study (two exper-
imental blocks per condition). Each experimental
block lasted for 48 seconds and was preceded by

an 18-second fixation/baseline block. Stimuli were
presented in Courier New Bold, 35 font size, using
E-Prime (Psychological Software Tools, Pittsburgh,
PA). Twenty stimuli were randomly presented in a
black font on a grey background for each experi-
mental block. Each stimulus was presented for 2000
ms followed by a 400-ms interstimulus interval,
which was a blank grey screen.
The nonverbal task consisted of black shapes
with either pointy or smooth edges. The partici-
pant was required to press the mouse button for
shapes with at least one sharp edge. The letter-
case judgment task consisted of upper-case and
lower-case letters (e.g., NKWZL or jdfgn). The par-
ticipant was required to press the mouse button for
upper-case stimuli (50% of trials). The regular word
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lexical decision task consisted of real words (con-
crete nouns) and pronounceable nonwords matched
on length (e.g., BANK or LORC). The participant
was required to press the mouse button for stim-
uli that were real words (50% of trials). Stimuli
in the irregular word condition were words which
did not follow the grapheme-phoneme correspon-
dence (GPC) rules, and pronounceable nonwords
matched on length (e.g., SHOE or NINT). The
participant was required to press the mouse but-
ton for stimuli that were real words (50% of trials).
Stimuli in the nonword lexical decision task (also
referred to as the “phonological” task) were all
nonwords, but half were pseudohomophones (i.e.,
PHEAT, BRANE), and pronounceable nonsense
words again matched on length (e.g., CORTO). The
participant was required to press the mouse button
for stimuli that sounded like a real word (subjects
were instructed to think but not speak out loud).
All participants were required to run through as
many practice trials of the experimental block as
necessary to achieve 90% accuracy. No feedback
was given during the experimental trials. The accu-
racy data were also recorded. All procedures were
approved by the University of Auckland Human
Participants Ethics Committee.
Image acquisition
Images were acquired using a 1.5T Siemens
Avanto scanner (Erlangen, Germany). Scanning
sessions began with acquisition of T1-weighted
structural volumes using 3D MP-RAGE sequence
(TR = 11 ms; TE = 4.94 ms; flip angle: 15◦ ; FOV:
25.6 × 20.8 cm; 170 to 176 axial slices parallel to
the AC-PC line; matrix size: 256 × 208; interslice
BRAIN ACTIVITY IN BILINGUAL DYSLEXIA 289
gap: 0 mm; resulting in 1 × 1 × 1 mm voxels, axial
acquisition, parallel to AC-PC line, ensuring whole
brain coverage). Thirty-two scans were acquired for
each condition along with 60 scans for the fixation
period resulting in a total of 220 T2∗ -weighted vol-
umes for each of the subjects (nonverbal, lettercase
judgment, regular, irregular, and nonword task) in
the EPI sequence. In addition, 2 initial “dummy”
scans were also collected at the beginning of each
sequence to control for T1 saturation but these were
not included in the analysis.
The EPI acquisition sequence parameters were as
follows: TR = 3000 ms; TE = 50 ms; flip angle = 90◦
FOV = 19.2 cm; matrix size: 64 × 64; with inter-
leaved slice acquisition, starting at the bottom; 30
slices parallel to AC-PC line; slice thickness: 3 mm;
25% gap: resulting in 3 × 3 × 4 mm voxels.
Image pre-processing and analysis
SPM5 software (Wellcome Department of Imaging
Neuroscience, London, UK; http://www.fil.
ion.ucl.ac.uk) was used for image processing and
analysis. The first volume of the first session was
used as a reference for coregistration of the first
volume for the rest of the sessions. The remaining
volumes were realigned to the first volume within
each session and a mean of all volumes across the
conditions were created.
The T1-weighted structural image was coregis-
tered to the mean of the functional volumes. By
using the unified segmentation procedure, normal-
ization parameters were estimated (Ashburner &
Friston, 2005). This was then used to normal-
ize both the functional and structural images to
the stereotactic coordinate system defined by the
Montreal Neurological Institute (MNI). Lastly, the
functional volumes were spatially smoothed using
an anisotropic Gaussian filter of 9 × 9 × 12 mm
(three times the voxel size) at full-width at half-
maximum (FWHM).
For each participant, the pre-processed func-
tional volumes were subjected to 1st-level or fixed-
effects analysis using the general linear model
applied at each voxel across the whole brain.
Conditions were modeled by boxcar waveform con-
volved with a canonical haemodynamic response
function. Contrast images of interest were also
produced for: (1) Nonverbal minus (i.e., versus)
Baseline; (2) Lettercase judgment versus Baseline;
(3) Regular word versus Baseline; (4) Irregular word
versus Baseline; (5) Nonword task versus baseline;
 290 PARK, BADZAKOVA-TRAJKOV, WALDIE
and (6) Nonword task versus Lettercase judgment.
An uncorrected threshold of p < .01, and a con-
tiguity threshold of 10 voxels was used for each
comparison and each subject.
Laterality Index calculations
A laterality index (LI) was calculated to determine
the language lateralization for each of the subjects
for the conditions of interest. This was done by
computing the number of voxels that were signifi-
cantly activated in a region of interest in each cere-
bral hemisphere using the LI toolbox available from
the official SPM website (Wilke & Lidzba, 2007).
Laterality indices range in values from –1 to +1,
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with the extremes representing right hemispheric
and left hemispheric lateralization, respectively.
 
activation(left) − activation(right)
LI =   hemispheres, especially in the inferior frontal and
activation(left) + activation(right)
The toolbox applies a bootstrapping technique
that allows about 10,000 indices to be calculated at
different thresholds yielding a robust mean, max-
imum, and minimum LI. Taking thresholds into
account, an overall weighted bootstrapped LI is
calculated. This weighted mean LI was calculated
for two regions of interest (ROIs) defined anatom-
ically, the frontal and temporal lobes. These ROIs
were predefined in the LI toolbox (Wilke & Lidzba,
2007).
RESULTS
Functional MRI results for each of the subjects
were analyzed and organized according to the con-
trast of interest. The six contrasts used for the
current study were, in order of presentation of the
findings: (1) Nonverbal minus (i.e., versus) Baseline;
(2) Lettercase judgment versus Baseline; (3)
Regular word versus Baseline; (4) Irregular word
versus Baseline; (5) Nonword task versus baseline;
and (6) Nonword task versus Lettercase judgment.
For the Nonverbal task and Lettercase judgment
contrasts, both of which did not require a high
level linguistic processing, all three subjects showed
predicted cortical activation in both left and right
occipital areas such as the superior and middle
occipital gyri. Bilateral activity in the cerebellum
was also observed. Other activated areas included
the left lingual and fusiform gyri and the right
angular gyrus.
In the Regular word versus Baseline condition,
BK showed significant right hemispheric activity in
the superior frontal gyrus and the lingual gyrus.
Left hemispheric activations were also seen in the
lingual and frontal gyri. IH also showed significant
bilateral activation in the fusiform gyrus and infe-
rior frontal gyrus. RW showed the least amount of
activation. In contrast to the bilingual participants,
RW’s activations were mainly lateralized to the left
hemisphere in regions such as the left angular and
fusiform gyri.
In the Irregular word versus Baseline condition,
both BK and IH showed both right and left hemi-
spheric activity. BK showed robust activation in
the left inferior and middle temporal gyri, and the
left lingual and precentral gyri. Right hemisphere
activity was observed in the angular and lingual
gyri, and the middle occipital and frontal gyri. IH
showed robust activity in both the left and right
the precentral gyri. RW again showed significant
activations which were lateralized to the left hemi-
sphere including the inferior frontal gyrus, superior
and inferior parietal lobule and the postcentral
gyrus. This pattern of left hemispheric lateralization
was consistent across all conditions for RW.
These hemispheric differences between the
monolingual and the bilingual participants were
especially clear in the Nonword task versus
Baseline condition (see Table 1). BK showed signif-
icant activations lateralized to the right hemisphere
in the inferior and superior frontal gyri, superior
parietal lobule and the angular and lingual gyri.
Other additional activity was observed in the left
middle and inferior frontal gyri as well as the left
inferior temporal gyrus. IH again showed signif-
icant bilateral activity with activations present in
the fusiform gyrus and the precentral gyrus. Much
of the activity observed was in both hemispheres,
including left superior and inferior parietal lobule,
right inferior frontal gyrus and left superior frontal
and occipital gyri. RW showed left lateralized acti-
vations with the most significant activity observed
in the left inferior and middle occipital gyri and the
lingual gyrus.
The results from the Nonword minus Lettercase
judgment contrast showed very clear differences
between the three participants, and particularly
between the bilingual dyslexic and the control bilin-
gual (see Table 2 and Figure 1). BK showed the least
amount and spread of activation out of the three
subjects (Figure 1A). Activity was lateralized to the
right hemisphere, with significant activations in the
 BRAIN ACTIVITY IN BILINGUAL DYSLEXIA 291

TABLE 1
Cortical regions showing significant activations in the three participants for the Nonword
task versus Baseline only

Region Cluster Extent mm3 T XYZ BA

Activations for the Nonword task vs. Baseline contrast

BK
L. Middle Occipital G. 776 6.79 −36 −94 2 18
L. Inferior Temporal G. 6.68 −48 −70 −4 19
R. Inferior Frontal G. 454 6.47 48 35 29 9
R. Lingual G. 649 6.33 24 −88 −4 18
L. Precentral G. 193 5.78 −54 2 38 6
R. Middle Orbital G. 16 5.39 27 35 −16 11
L. Middle Frontal G. 240 4.92 −42 44 5 46
R. Precentral G. 50 4.40 48 2 38 6
R. Inferior Parietal L. 190 4.38 36 −58 47 7
R. Angular G. 4.16 54 −64 50 40
IH
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L. Fusiform G. 3768 9.74 −39 −70 −10 19

R. Fusiform G. 9.24 33 −82 −13 19
L. Superior Parietal L. 190 7.07 −30 −70 59 7
R. Inferior Frontal G. 283 6.64 45 8 32 9
L. Precentral G. 194 6.35 −48 8 38 8
R. Middle Frontal G. 135 5.69 39 −4 62 6
L. Postcentral G. 100 5.38 −42 −37 50 40
R. Precentral G. 22 4.29 57 −7 50 3
L. Superior Frontal G. 14 4.15 −21 −4 74 6
R. Insula L. 52 3.95 39 20 5 13
RW
L. Inferior Occipital G. 1253 7.91 −45 −85 −4 19
L. Lingual G. 7.30 −15 −100 −7 17
L. Inferior Frontal G. 430 7.87 −48 2 29 6
L. Precentral G. 7.62 −39 −1 35 6
R. Superior Parietal L. 67 7.04 30 −64 68 7
R. Inferior Frontal G. 90 4.96 42 2 29 6
L. Inferior Frontal G. 75 4.94 −45 32 14 46
L. Middle Frontal G. 4.15 −45 44 5 46
R. Inferior Occipital G. 415 4.83 45 −70 −7 19
R. Inferior Frontal G. 39 4.68 45 32 29 9
L. Inferior Frontal G. 50 4.58 −51 14 5 44

Cluster extent in mm3 , t-values, Brodmann areas (BA) and Talairach coordinates for the peak
activation voxel are also shown.

right middle frontal and orbital gyri. Activity in the
left cerebellum was also observed. IH showed sig-
nificant bilateral activity with robust activations in
the left and right inferior frontal gyri and inferior
temporal gyri (Figure 1B). Other activity was found
in the right middle frontal gyrus, right superior
parietal lobule and the right inferior and middle
temporal gyri. Further left hemispheric activations
were observed in the precentral gyrus. Significant
activations were found mainly in the left hemisphere
for RW, suggesting left lateralization for language
(Figure 1C). Regions of activity observed included
the left inferior frontal gyrus, left inferior parietal
lobule and the left precentral gyrus, as well as the
left inferior occipital gyrus. In the right hemisphere,
activations were seen in the middle frontal gyrus
and the cerebellum. The descriptive behavioural
results (see Figure 2) showed that the control par-
ticipants outperformed BK in most of the tasks. It
should be noted, however, that BK’s performance
on the Nonword task was only marginally worse
than the controls. This was due in part to the
control subjects finding the task difficult as well.
The laterality indices results for the Nonword
task versus Lettercase judgment contrast indicated
clear differences between the bilingual subjects and
the monolingual subject, with RW showing a strong
left lateralization for language compared to BK
 292 PARK, BADZAKOVA-TRAJKOV, WALDIE

TABLE 2
Cortical regions showing significant activations in the three participants for the Nonword
task versus Lettercase only

Region Cluster Extent mm3 T XYZ BA

Activations for the Nonword task vs. Lettercase judgment

BK
R. Middle Orbital G. 12 3.97 27 35 −16 11
R. Middle Frontal G. 34 3.63 45 29 26 46
L. Cerebellum 11 3.07 −36 −52 −25
IH
R. Inferior Frontal G. 257 5.12 45 14 35 9
R. Middle Frontal G. 3.36 48 29 26 46
L. Inferior Frontal G. 144 4.44 −57 8 29 9
L. Precentral G. 3.58 −48 5 47 6
R. Superior Parietal L. 219 4.37 36 −67 59 7
R. Middle Occipital G. 4.07 33 −85 32 19
R. Cerebellum 37 4.00 21 −67 −16
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L. Inferior Temporal G. 45 3.83 −51 −64 −1 19

R. Inferior Temporal G. 59 3.72 45 −46 −13 37
R. Supramarginal G. 3.64 63 −40 50 40
R. Inferior Occipital G. 23 3.58 30 −85 −10 18
R. Middle Temporal G. 44 3.53 60 −52 −1 37
R. Pallidum 21 3.40 21 −10 2
R. Cerebellum 18 3.32 9 −82 −25
RW
R. Middle Orbital G. 86 4.87 27 44 −10 11
L. Inferior Parietal L. 176 4.67 −51 −43 41 40
L. Superior Parietal L. 2.95 −24 −52 44 7
R. Superior Parietal L. 33 4.58 30 −64 68 7
L. Inferior Frontal G. 314 4.50 −51 5 29 9
L. Precentral G. 4.32 −36 −4 35 6
R. Middle Frontal G. 74 4.36 24 41 29 9
L. Inferior Frontal G. 135 4.04 −51 14 2 47
R. Cerebellum 192 4.04 33 −79 −16
L. Inferior Occipital G. 129 4.03 −51 −79 −4 19
L. Middle Occipital G. 3.23 −39 −94 5 18
L. Inferior Frontal G. 112 3.99 −45 32 14 46
L. Middle Frontal G. 3.47 −45 44 5 46

Cluster extent in mm3 , t-values, Brodmann areas (BA) and Talairach coordinates for the peak
activation voxel are also shown.

and IH (see Figure 3). BK showed consistent right
hemispheric dominance for both regions of inter-
est (frontal and temporal lobes) in comparison to
IH who exhibited a more bilateral activation for
language in the temporal lobe.
DISCUSSION
The results from the present study indicate that
different neural networks subserve linguistic func-
tioning in the dyslexic bilingual (BK), the control
bilingual (IH), and the control monolingual (RW).
Differences between participants were particularly
evident in the regular, irregular and nonword lex-
ical decision tasks, which indicate that clear brain
activation differences were only observed during
linguistic processing and not during the nonverbal
or lettercase judgment tasks.
In the nonverbal condition, similar bilateral acti-
vations were observed for all three participants.
These were mainly limited to the occipital and tem-
poral lobes, with some parietal and minimal frontal
activity. This pattern was also observed for the
lettercase judgment condition. These results were
expected, as both conditions include stimuli that
are not semantically based and require low levels of
cognitive effort. Interestingly, BK showed the most
significant clusters and spread of activations in both
conditions, suggesting that adults with dyslexia may
utilize a larger area of the brain for a range of
tasks.

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Figure 1. Significant clusters of activation for the dyslexic bilingual (A), the control bilingual (B), and the control monolingual (C) for
the Nonword versus Lettercase judgment contrast on section overlay.
The monolingual RW showed significant and
strong left lateralization, particularly in the
occipito-temporal region and inferior frontal cor-
tex during all three linguistic tasks. The left inferior
frontal gyrus is involved in both speech perception
and phonological aspects of reading (Habib, 2000;
Owen, Borowsky, & Sarty, 2004). Some right
hemispheric activity was also observed. This was
expected, as complete lateralization of language
tasks to the left hemisphere is rarely observed.
Evidence suggests that the right hemisphere
participates in certain aspects of language recog-
nition and identification (Fabbro, 2001; Waldie &
BRAIN ACTIVITY IN BILINGUAL DYSLEXIA 293
Mosley, 2000). Right hemisphere involvement is
also somewhat dependent on task methodology.
Demonet, Thierry, and Cardebat (2005) noted
that reduced asymmetry is often associated with
single-word processing rather than syntax or
sentence processing and in comprehension tasks
(rather than production tasks). This observation is
in line with the current findings using lexical deci-
sion. Nevertheless, the extent of right hemisphere
activity was small in RW compared to the bilingual
subjects.
In contrast, the dyslexic bilingual BK showed
relative hypoactivation of the left hemisphere
 294 PARK, BADZAKOVA-TRAJKOV, WALDIE
1.2
BK
1 IH
RW
0.8
Accuracy
0.6
0.4
0.2
0
Nonverbal Letter Case Regular Irregular Phonological
Task conditions
Figure 2. Accuracy rates for the dyslexic bilingual (BK), the
control bilingual (IH), and the control monolingual (RW) for
each of the five task conditions.
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Figure 3. Mean frontal and temporal lobe laterality indices (LI)
for each of the three subjects for the Nonword versus Lettercase
judgment contrast. The subjects were compared in English only
(L2 for bilinguals). Positive LIs indicate greater activity in the
left hemisphere, and negative LIs indicate greater activity in the
right hemisphere.
(particularly posterior regions) compared to both
control subjects during the three linguistic tasks.
In addition, relative hyperactivation of the right
hemisphere were observed in regions such as the
inferior frontal and fusiform gyri, suggesting that
these areas were recruited as a compensatory sys-
tem, possibly in lieu of inadequate left hemisphere
functioning. This is consistent with earlier findings
with dyslexic children and adults (Demonet et al.,
2004; Eden et al., 2004; Shaywitz et al., 1998; Simos,
Breier, Fletcher, Bergman, & Papanicolaou, 2000;
Waldie & Mosley, 2000). In a recent meta-analysis
by Maisog et al. (2008), the authors found that,
across numerous brain imaging studies, dyslexic
readers showed hypoactivity compared to nor-
mal readers in left posterior hemispheric regions,
including the inferior parietal and superior tem-
poral cortices. Behaviourally, BK was less accurate
on these tasks than the control subjects, suggest-
ing that recruitment of additional right hemisphere
areas was only partially able to compensate for
the weak left hemisphere network. Surprisingly,
the Nonword condition elicited poor performances
across all three subjects (including the two con-
trol participants), indicating that this task was more
difficult than the other tasks. Nevertheless, BK per-
formed the worst, as expected, with an accuracy
of 50%.
The control bilingual IH consistently exhibited
a bilateral pattern of activation across all the
task conditions. Interestingly, activity in the left
occipito-temporal regions was limited for both BK
and IH during the Regular word task. Therefore, it
is possible that the additional cortical recruitment
in bilinguals (when using their second language)
and dyslexics is due to the same deficient acti-
vation in the left occipito-temporal region. This
region is traditionally associated with lexical deci-
sion making, with studies such as Binder et al.
(1997) indicating that the superior temporal gyrus,
fusiform and angular gyri play important roles in
word comprehension at a linguistic-semantic level.
Subtracting the activity resulting from the
Lettercase judgment task from the Nonword task
revealed the largest activation differences between
the bilingual and monolingual participants. This
analysis was performed to reveal cortical areas most
likely to be directly involved in linguistic processing
rather than lower-level processing such as non-
semantic judgments, attention maintenance and
response production. BK, diagnosed with phono-
logical dyslexia, showed no left inferior frontal
activity for this subtraction condition, suggesting
this area is completely disengaged for tasks involv-
ing phonological assembly. This was partially, but
poorly, compensated by the engagement of homol-
ogous right hemisphere areas. This supports studies
showing that lesions in the inferior frontal area
result in deficits in the ability to assemble phonemes
into words (Price, 2000).
The right frontal activity seen in BK is most likely
a compensatory measure to counterbalance the lack
of activity seen in the left hemisphere (Simos et al.,
2000; Waldie, 2005). Despite this, the right hemi-
sphere has very limited capacity when it comes to
phonological processing. The difficulty with read-
ing nonwords supports the idea that phonological
awareness is almost entirely mediated by the left
hemisphere (Lindell, 2006).

The control bilingual IH showed significant
activations in both the left and right inferior frontal
areas, which indicate that the typical left hemi-
spheric reading network was successfully utilized.
The additional cortical activity observed in IH’s
case is likely to be linked to the fact that English
words were used rather than her native German.
This is consistent with findings of compensatory
neural activity in bilinguals when using their second
language, as the extra cortical effort often elicits
recruitment of other areas during linguistically-
demanding activities (Abutalebi, 2008; Abutalebi,
Tettamanti, & Perani, 2009; Badzakova-Trajkov
et al., 2008; Kim et al., 1997; Meschyan &
Hernandez, 2006; Neville & Bavelier, 1998;
Wartenburger et al., 2003).
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Overall, the control monolingual participant
showed robust left hemispheric activity, especially
in the regions that are dedicated to linguistic pro-
cessing such as the occipito-temporal and infe-
rior frontal regions. The dyslexic bilingual showed
relative hypoactivation of the left frontal areas
and hyperactivation of the right frontal regions.
The control bilingual showed normal left hemi-
spheric activations and relative hyperactivation of
the right frontal regions. Both dyslexics and bilin-
guals appear to recruit support from additional
cortical regions. These fMRI results were also sup-
ported by the laterality index results, where both
BK and IH showed a more atypical pattern of lat-
eralization for lexical-decision making compared to
RW, who was strongly left lateralized. For indi-
viduals with dyslexia, cortical activation in these
regions are likely to be insufficient for normal read-
ing. Nevertheless, these effects do not seem to be
additive in the dyslexic bilingual, with the strength
and spread of these extra cortical activations being
similar to the typically reading bilingual control.
One of the limitations of the present study was
the lack of L1 data (German was not included in the
language paradigm). It was therefore not possible
to compare the cortical activations across all three
subjects in their first language. This was not con-
sidered to be a major limitation, however, as there
is ample evidence that L1 and L2 are organized in
the same cortical networks in a similar manner (see
reviews by Abutalebi, 2008; Indefrey, 2006; Perani
& Abutalebi, 2005).
The current findings, suggesting slightly differ-
ent linguistic networks in each participant, stress
the need to assess reading proficiency and whether
research participants are able to speak proficiently
BRAIN ACTIVITY IN BILINGUAL DYSLEXIA 295
in a second language. Our study also increases
understanding of bilingual dyslexia, raising the
possibility that these individuals are atypically
lateralized and may depend on alternate cortical
resources during language processing.
Original manuscript received 6 December 2010
Revised manuscript accepted 23 March 2011
First published online 25 October 2011
REFERENCES
Abutalebi, J. (2008). Neural aspects of second lan-
guage representation and language control. Acta
Psychologica, 128, 466–478.
Abutalebi, J., Tettamanti, M., & Perani, D. (2009). The
bilingual brain: Linguistic and non-linguistic skills.
Brain & Language, 109, 51–54.
APA (American Psychiatric Association) (2000).
Diagnostic and Statistical Manual of Mental Disorders
(4th ed. revised, DSM-IV TR). Washington, DC:
American Psychiatric Association.
Ashburner, J., & Friston, K.J. (2005). Unified segmenta-
tion. NeuroImage, 26, 839–851.
Badzakova-Trajkov, G., Kirk, I. J., & Waldie, K. E.
(2008). Dual-task performance in late proficient bilin-
guals. Laterality, 13, 201–216.
Coltheart, M. (2004). How to choose a treatment.
In Developmental Disorders of Language and
Literacy. Retrieved November 19, 2009, from
http://www.maccs.mq.edu.au/ddoll/p_treatment.htm.
Coltheart, M., Rastle, K., Perry, C., Langdon, R.,
& Ziegler, J. (2001). DRC: A dual route cascaded
model of visual word recognition and reading aloud.
Psychological Review, 108, 204–256.
Demonet, J.-F., Taylor, M. J., & Chaix, Y. (2004).
Developmental dyslexia. Lancet, 363, 1451–1460.
Demonet, J.-F., Thierry, G., & Cardebat, D. (2005).
Renewal of the neurophysiology of language:
Functional neuroimaging. Physiological Review, 85,
49–95.
Eden, G. F., Jones, K. M., Cappell, K., Gareau, L.,
Wood, F. B., Zeffiro, T. A., et al. (2004). Neural
changes following remediation in adult developmental
dyslexia. Neuron, 44, 411–422.
Everatt, J., Smyth, I., Adams, E., & Ocampo, D.
(2000). Dyslexia screening measures and bilingualism.
Dyslexia, 6, 42–56.
Fabbro, F. (2001). The bilingual brain: Cerebral represen-
tation of languages. Brain and Language, 79, 211–222.
Genesee, F., Hamers, J., Lambert, W. E., Mononen, L.,
Seitz, M., & Starck, R. (1978). Language processing
strategies in bilinguals: A neuropsychological study.
Brain and Language, 5, 1–12.
Grigorenko, E. L. (2001). Developmental dyslexia: An
update on genes, brains, and environment. Journal of
Child Psychology and Psychiatry, 42, 92–125.
Habib, M. (2000). The neurological basis of developmen-
tal dyslexia. Brain, 123, 2373–2399.
 296 PARK, BADZAKOVA-TRAJKOV, WALDIE
Harm, M. W., & Seidenberg, M. S. (1999). Phonology,
reading acquisition, and dyslexia: Insights from
connectionist models. Psychological Review, 106,
491–528.
Hull, R., & Vaid, J. (2006). Laterality and language
experience. Laterality, 11, 436–464.
Illes, J., Francis, W. S., Desmond, J. E., Gabrieli, J. D. E.,
Glover, G. H., Poldrack, R., et al. (1999). Convergent
cortical representation of semantic processing in bilin-
guals. Brain and Language, 70, 347–363.
Indefrey, P. (2006). A meta-analysis of hemody-
namic studies on first and second language pro-
cessing: Which suggested differences can we trust
and what do they mean? Language Learning, 56,
279–304.
Jackson, N. E., & Coltheart, M. (2001). Routes to reading
success and failure. New York, NY: Psychology Press.
Joseph, J., Noble, K., & Eden, G. (2001). The neu-
robiological basis of reading. Journal of Learning
Downloaded by [Selcuk Universitesi] at 02:52 01 January 2015
Disabilities, 34, 566–579.
Joubert, S., Beauregard, M., Walter, N., Bourgouin, P.,
Beaudoin, G., Leroux, J.-M., et al. (2004). Neural cor-
relates of lexical and sublexical processes in reading.
Brain and Language, 89, 9–20.
Karanth, P. (1992). Developmental dyslexia in bilingual-
biliterates. Reading and Writing, 4, 297–306.
Kim, K. H. S., Relkin, N. R., Lee, K.-M., & Hirsch, J.
(1997). Distinct cortical areas associated with native
and second languages. Nature, 388, 171–174.
Lindell, A. K. (2006). In your right mind: Right
hemisphere contributions to language process-
ing and production. Neuropsychology Review, 16,
131–148.
Liu, H., Hu, Z., Guo, T., & Peng, D. (2010). Speaking
words in two languages with one brain: Neural overlap
and dissociation. Brain Research, 1316, 75–82.
Maisog, J. M., Einbinder, E. R., Flowers, D. L.,
Turkeltaub, P. E., & Eden, G. F. (2008). A meta-
analysis of functional neuroimaging studies on
dyslexia. Annals of the New York Academy of Sciences,
1145, 237–259.
McCrory, E. (2004). The neurocognitive basis of devel-
opmental dyslexia. In R. Frackowiack (Ed.), Human
brain function (2nd ed.). London, UK: Elsevier
Academic Press.
Meschyan, G., & Hernandez, A. E. (2006). Impact of
language proficiency and orthographic transparency
on bilingual word reading: An fMRI investigation.
NeuroImage, 29, 1135–1140.
Miller Guron, L., & Lundberg, I. (2003). Identifying
dyslexia in multilingual students: Can phonologi-
cal awareness be assessed in the majority language?
Journal of Research in Reading, 26, 69–82.
Neville, H. J., & Bavelier, D. (1998). Neural organiza-
tion and plasticity of language. Current Opinion in
Neurobiology, 8, 254–258.
Ojemann, G. A., & Whitaker, H. A. (1978). The bilingual
brain. Archives of Neurology, 35, 409–412.
Oren, R., & Breznitz, Z. (2005). Reading processes in
L1 and L2 among dyslexic as compared to reg-
ular bilingual readers: behavioral and electrophys-
iological evidence. Journal of Neurolinguistics, 18,
127–151.
Owen, W. J., Borowsky, R., & Sarty, G. E. (2004). FMRI
of two measures of phonological processing in visual
word recognition: Ecological validity matters. Brain
and Language, 90, 40–46.
Paradis, M. (2004). A Neurolinguistic Theory of
Bilingualism. Amsterdam: John Benjamins Publishing
Company
Perani, D., & Abutalebi, J. (2005). The neural basis of
first and second language processing. Current Opinion
in Neurobiology, 15, 202–206.
Perani, D., Paulesu, E., Galles, N. S., Dupoux, E.,
Dehaene, S., Bettinardi, V., et al. (1998). The bilingual
brain. Proficiency and age of acquisition of the second
language. Brain, 121, 1841–1852.
Pillai, J. J., Araque, J. M., Allison, J. D., Sethuraman, S.,
Loring, D.W., Thiruvaiyaru, D., et al. (2003).
Functional MRI study of semantic and phonological
language processing in bilingual subjects: preliminary
findings. NeuroImage, 19, 565–576.
Price, C. J. (2000). The anatomy of language:
Contributions from functional neuroimaging. Journal
of Anatomy, 197, 335–359.
Pugh, K. R., Frost, S. J., Sandak, R., Landi, N.,
Gueckl, J. G., Constable, R. T., et al. (2008).
Effects of stimulus difficulty and repetition on
printed word identification: An fMRI compari-
son of nonimpaired and reading-disabled adoles-
cent cohorts. Journal of Cognitive Neuroscience, 20,
1146–1160.
Robichon, F., & Habib, M. (1998). Abnormal callosal
morphology in male adult dyslexics: Relationships
to handedness and phonological abilities. Brain and
Language, 62, 127–146.
Shaywitz, S. E., Shaywitz, B. A., Pugh, K. R., Fulbright,
R. K., Constable, R. T., Mencl, W. E., et al. (1998).
Functional disruption in the organization of the brain
for reading in dyslexia. Proceedings of the National
Academy of Sciences of the United States of America,
95, 2636–2641.
Simos, P. G., Breier, J. I., Fletcher, J. M., Bergman, E.,
& Papanicolaou, A. C. (2000). Cerebral mechanisms
involved in word reading in dyslexic children: A mag-
netic source imaging approach. Cerebral Cortex, 10,
809–816.
Temple, E. (2002). Brain mechanisms in normal and
dyslexic readers. Current Opinion in Neurobiology, 12,
178–183.
Vellutino, F. R., Fletcher, J. M., Snowling, M. J., &
Scanlon, D. M. (2004). Specific reading disability
(dyslexia): What have we learned in the past four
decades? Journal of Child Psychology and Psychiatry,
45, 2–40.
Waldie, K. E. (2005). Introduction to developmental neu-
roscience: Neurological development and the mech-
anisms underlying reading. In J. Low & P. Jose
(Eds.), Lifespan development: New Zealand perspec-
tives. Auckland, New Zealand: Pearson.
Waldie, K. E., & Mosley, J. L. (2000). Hemispheric
specialization for reading. Brain and Language, 75,
108–122.
Wartenburger, I., Heekeren, H. R., Abutalebi, J., Cappa,
S. F., Villringer, A., & Perani, D. (2003). Early set-
ting of grammatical processing in the bilingual brain.
Neuron, 37, 159–170.
Wilke, M., & Lidzba, K. (2007). LI-tool: A new toolbox
to assess lateralization in functional MR-data. Journal
of Neuroscience Methods, 163, 128–136.

Wilkinson, G. S. (1993). Wide Range Achievement Test–
Revision 3. Wilmington, DE: Jastak Association.
Woodcock, R. W., Mather, N., & McGrew, K. S. (2001).
Woodcock-Johnson III Tests of Cognitive Abilities
Examiner’s Manual. Itasca, IL: Riverside.
Downloaded by [Selcuk Universitesi] at 02:52 01 January 2015
BRAIN ACTIVITY IN BILINGUAL DYSLEXIA 297
Wydell, T. N., & Kondo, T. (2003). Phonological deficit
and the reliance on orthographic approximation
for reading: A follow-up study on an English-
Japanese bilingual with monolingual dyslexia. Journal
of Research in Reading, 26, 33–48.