Developmental dyslexia (DD) is a significant learning disability impacting literacy acquisition. While phonological processing deficits are commonly associated with DD, research suggests that visual and auditory attentional deficits, particularly sluggish attentional shifting, may also play a crucial etiological role. Sluggish attentional shifting can prolong sensory input, increasing neural noise and impairing the cortical representation of speech sounds essential for reading. Action video games (AVGs), characterized by fast-paced events and high cognitive loads, have shown promise in enhancing attentional control and neuroplasticity. Previous studies have demonstrated AVG's positive impact on visual attention, processing speed, and reading skills in both typical and dyslexic readers. This study investigates whether AVG training can improve three key predictors of reading development—phonemic awareness, phonological working memory, and rapid automatized naming—in pre-readers at risk for DD. The hypothesis is that AVGs enhance the "accumulation of evidence", thereby accelerating attentional shifting and improving phonological skills, potentially mitigating the risk of developing DD.

Extensive research supports the link between attentional control and reading development. Studies employing AVG, traditional, and game-based executive function training programs have shown improvements in reading skills in both typical and dyslexic readers. However, few studies have examined the impact of AVG training on specific reading-related predictors in at-risk pre-readers. Existing research highlights the efficacy of AVGs in enhancing visual attention and processing speed, as well as phonological processing and reading fluency. Some studies indicate that AVGs improve auditory attention and phonological working memory. These findings suggest that AVGs could potentially address the core deficits contributing to DD, such as sluggish attentional shifting and impaired phonological processing, by improving the "accumulation of evidence".

One hundred and twenty pre-readers (79 at-risk, 41 not-at-risk for DD) were recruited. At-risk children were assigned to four groups using unequal allocation randomization: (1) AVG (n=43), (2) Serious Non-Action Video Game (SNAVG; n=11), (3) Treatment-as-usual (speech therapy; n=11), and (4) Waiting list (n=14). Reading-related skills were assessed using three tasks: phonemic discrimination (PD), pseudoword repetition (PWR), and rapid automatized naming (RAN). The AVG group played "Space Invaders Extreme 2" for at least 20 sessions of 45 minutes each. The SNAVG group played serious minigames designed to train skills related to reading without AVG characteristics. The SPEECH group received traditional speech therapy focusing on phonological awareness and grapheme-to-phoneme mapping. Pre- and post-training assessments were conducted, with a 6-month follow-up for the AVG group. Statistical analyses included ANCOVA and paired sample t-tests with bootstrapping.

Significant differences in individual gains (ΔT1-T0) were found in phonemic discrimination (PD), with the AVG group showing significantly higher improvements than the waiting list, SNAVG, and SPEECH groups. Post-hoc analysis confirmed these findings, with the AVG group’s improvement significantly higher than each control group individually, and remaining significant when comparing to the combined active control group (SNAVG and SPEECH). Paired sample t-tests showed that only the AVG group exhibited significant improvement in PD. Importantly, more than 80% of at-risk pre-readers in the AVG group showed gains in PD exceeding the mean gain in the control groups. The improvement in phonemic awareness observed in the AVG group was maintained at the 6-month follow-up. No significant differences were observed in PWR or RAN across groups.

The findings demonstrate that AVG training specifically enhances phonemic awareness in pre-readers at risk for DD, suggesting a far-transfer effect. This improvement is substantial and long-lasting, leading to a recovery in phonemic awareness comparable to that of not-at-risk children. The lack of significant effects on PWR and RAN suggests that AVGs might specifically target the neural circuits underlying phonemic awareness. The high frequency of efficacy in the AVG group (over 80%) highlights the clinical relevance of this unconventional remediation approach. The ineffectiveness of the speech therapy and SNAVG groups underscores the potential of AVGs to engage mechanisms (reward and attentional control) crucial for rapid information processing and learning. This study extends prior research by demonstrating the preventive potential of AVGs in addressing core phonological deficits in at-risk pre-readers.

This study provides strong evidence for the efficacy of AVG training in improving phonemic awareness in pre-readers at risk for developmental dyslexia. The significant, long-lasting, and widespread effects observed suggest that AVGs could be incorporated into preventive programs for DD. Future research should investigate the underlying neural mechanisms and explore the potential of AVGs in other neurodevelopmental disorders with attentional deficits. Larger-scale studies with longer-term follow-ups are needed to further confirm these findings and to assess the impact on overall reading development.

The relatively small sample size of the control groups (SNAVG, SPEECH, and WAIT) is a limitation. However, the findings remain robust even when the AVG group is compared to the combined active control group. The criterion for identifying at-risk children might be considered liberal. The study lacks data on neural correlates of AVGs’ effects on phonemic awareness, and the follow-up period was limited to 6 months. The intensity of speech therapy differed from that of AVG and SNAVG, which may have influenced the results. Future studies should address these limitations by using larger sample sizes, longer follow-up periods, and incorporating neuroimaging techniques.