Developmental dyscalculia as a disconnection syndrome, neurocognitive

modeling and diagnosis

Version 30 January 2023
Bernhard Krön, KPH Wien/Krems (Austria)
M bernhard.kroen@univie.ac, T +43 680 1285929

Abstract
Developmental dyscalculia is distinguished from unspecific mathematical learning
difficulties. Common diagnostic procedures are critically discussed. With reference to
neuroscientific studies, the hypothesis is discussed that developmental dyscalculia is a
specific disconnection syndrome caused by impaired development of certain cerebral neural
pathways (a component of the superior longitudinal fasciculus), which impairs the
connection between an area important for numerical competence (the intraparietal sulcus)
and other brain areas.
Consistent with this neurophysiological model, a cognitive model is described in which
mental connections between purely geometric representations (dot patterns, number lines)
and other kinds of representations (language, symbols, situations in word problems) are
impaired. This is the first neurocognitive description of developmental dyscalculia. This
model not only explains typical symptoms but is also the starting point for a new diagnostic
approach that aims to better distinguish developmental dyscalculia from nonspecific
mathematical learning difficulties. Examples of corresponding diagnostic items are
presented.

1. Introduction
If difficulties with basic arithmetic persist after elementary school, this may lead to serious
problems in everyday life (dealing with money, especially cash, time planning, driver’s
license, etc.), in further education or when looking for a job. The use of calculators and
smartphones does not resolve such problems.
In a report by the Every Child a Chance Trust/KPMG (Gross J., Hudson C. and Price D. 2009),
the annual economic damage caused by poor numeracy skills in the UK (lack of skilled labor,
public social spending, private insolvency, etc.) was estimated at £2.4 billion, which is higher
than the economic damage caused by dyslexia.
Mathematical learning difficulties (MLD), which can be caused by various factors, need to be
distinguished from Developmental Dyscalculia (DD). The latter is probably a congenital
neurological developmental disorder. Individuals with dyscalculia are recommended
qualified individual tuition over a longer period (Haberstroh and Schulte-Körne 2019).
It is estimated that between 3% and 7% of the population is affected by DD (see Chapter 6).
In Austria this would be between 270,000 and 630,000 people. Although free tutoring
programs in small groups are available in some regions to provide general additional support
to pupils, individual tutoring by a qualified person with relevant experience currently costs
around 50 euros per hour, which is affordable only for people from socially privileged
backgrounds. In Austria alone, at least 200,000 people with DD from socially disadvantaged
backgrounds do not receive adequate support and suffer serious professional and economic
disadvantages as a result.
There is much less research on dyscalculia than on dyslexia, which means that current
diagnostic procedures are unreliable (see Chapter 5) and often lead to false positive
diagnoses. As a result, educators who identify comprehension problems, familial or other
difficulties as the real cause of mathematical learning difficulties in children with false-
positive diagnoses may get the impression that DD as a developmental disorder does not
exist. However, based on neuroscientific evidence, it is undisputed in the relevant scientific
literature that DD exists as a specific developmental disorder.
The difficulties in diagnosis lead to a vicious circle for purely quantitative empirical studies:
the unsatisfactory state of research means that cognitive explanatory models for dyscalculia
are not available. Without such models, standardized tests can only detect unspecific MLD,
but not DD. For new quantitative empirical studies, this means that the group of test
subjects will not only include people with DD, but also people who have been diagnosed as
false positives. If the composition of the test and control group does not correspond to the
object of the study (DD), the gain in knowledge will remain limited, thus completing the
vicious circle. New cognitive models, such as the one presented in this paper, or empirical
studies in which subjects are identified not only by means of standard test batteries but also
by qualitative assessment by people who have a lot of experience with DD, may show ways
out of this circle.
Books aimed at a wider audience include Butterworth (2019) and Emerson and Babtie (2013,
2014, 2015). Of particular note is the new book by Noël and Karagiannakis (2022), which is
based on Noël's hypotheses pointing in a similar direction as the present article.

2. Mathematical Learning Difficulties (MLD) and Developmental Dyscalculia (DD) - a

clarification of terms
Mathematical learning difficulty (MLD) refers to a significantly low level of performance in
counting and arithmetic (four basic operations) with natural numbers, including word
problems and calculations with monetary amounts. The low level of performance is related
to the previous education received (school level). Diagnostically relevant is the course
material of the primary education. Difficulties with higher mathematics in secondary level
are not considered in the present context.
Developmental dyscalculia is a neural developmental disorder according to ICD 10 (F81.2),
ICD 11 (6A03.2) and DSM5. As such, it cannot be cured, but the symptoms can largely be
alleviated or eliminated.
There are few documented cases of acquired acalculia. This is a lesion of relevant neuronal
areas in the parietal cortex, e.g. due to a stroke or an injury, which leads to a severe
limitation of numerical abilities (cf. Butterworth 2019).
Individuals with DD may develop sufficient numeracy skills with considerable effort and
support, but they have to deal with certain limitations throughout their lives. Thus, if
affected individuals achieve a sufficient level of arithmetical performance, they still have DD,
but no MLD. Therefore, three cases can be distinguished:
1. Individuals with DD and no MLD
2. Individuals with DD and MLD
3. Individuals with MLD and no DD
 Individuals with DD Individuals with MLD

Figure 1. Developmental Dyscalculia (DD) and Mathematical Learning Difficulties (MLD)

3. Developmental dyscalculia as a disconnection syndrome - neuroscientific findings

A disconnection syndrome is caused by parts of the white matter being impaired in their
function, either due to a lesion (e.g. stroke) or due to a developmental disorder in which
they did not develop optimally in the first place, for example, they did not grow ramified
enough. Sometimes an impaired connection between the cerebral hemispheres is referred
to as "the disconnection syndrome", which may cause confusion, because this has nothing to
do with disjunction syndrome we are talking about in this article.
There is a lot more research on dyslexia than on dyscalculia. Dyslexia is genetically
determined and also a neurodevelopmental disorder. The assumption that dyslexia is a
disconnection syndrome is relatively old (Paulesu et al. 1996). Current research supports this
hypothesis. Connections between temporal (temporal area) and frontal regions are affected
(Boets et al. 2013).
Rykhlevskaia, Uddin, Kondos and Menon (Rykhlevskaia et al., 2009) from Stanford University
(CA, USA) were the first to hypothesize that dyscalculia is also a disconnection syndrome.
What techniques and what methods were used in this study?
The brains of different individuals are shaped differently. However, with the help of voxel-
based morphometry, abnormalities in the MRI findings can be allocated neuroanatomically.
Fractional anisotropy (FA) is used as a measure of how parallel or how ramified white matter
tracts are. A value close to zero corresponds to a more parallel alignment of nerve fibers, a
value close to one means that the fibers are more ramified. A reduced FA in the white
matter near a certain area of the grey matter can be interpreted to mean that this area is
more poorly connected to other areas than in individuals in the control group.
In the previously mentioned study (Rykhlevskaia et al., 2009), 47 children aged 7 to 9 years
in the 2nd or 3rd grade were examined. Of these, 23 had been diagnosed with DD. The 24
children in the control group were selected in such a way that the control group was
matched to the experimental group in terms of gender, IQ, reading competence and working
memory. High-resolution structural MRI images identified impaired grey matter in temporal
and parietal areas (including the intraparietal sulcus). Reduced white matter volume was
found in areas adjacent to the parietal-temporal cortex. Functional diffusion tensor imaging
revealed significantly reduced FA in this area.
Rykhlevskaia et al. conclude that several dysfunctional neural circuits are essentially due to
reduced or impaired white matter in specific areas. The hypothesis is formulated that
dyscalculia is at its core a disconnection syndrome.
Kucian et al. (2014) conducted their study with 30 children aged about 10 years, 15 each
with and 15 without dyscalculia. Again, it could be concluded that dyscalculia is a
disconnection syndrome. Kucian et al. explain certain deviations of their results from those
of Rykhlevskaia et al. by the fact that in the latter study the analysis was rather limited to
regions in which a volume reduction of the white matter could previously be detected.
However, they themselves carried out the analysis of FA globally.
The superior longitudinal fasciculus (SLF) is the largest associative nerve fiber bundle in the
human brain. Kucian et al. conclude: "Comparison of mean FA (...) revealed prominent and
highly significant deficits in the posterior SLF on both hemispheres in children with DD. The
posterior part of the SLF is in closest proximity to the intraparietal sulcus."
A detailed overview of the current state of science regarding the SLF is given by Janelle et al.
(2022). Earlier autopsies could not localize the SLF properly. Using diffusion tensor imaging,
four independent components of the SLF were first found in non-human primates in vivo:
SLF I, SLF II, SLF III and the fasciculus acuatus. The SLF I connects regions of the superior
parietal lobe with the frontal lobe. The regions with reduced FA found in (Kucian et al. 2014)
should correspond to the SLF I, but it must be mentioned here that the aforementioned
subdivision of the SLF into four components has not yet been proven ultimately.
Bugden and Ansari (2014) provide an overview of neurocognitively relevant studies.

4. Unconscious counting, dyscalculia and memory

Since people with dyscalculia have greater difficulties in mastering the multiplication table or
in simple sums and differences, the claim that they have difficulties in remembering or
retrieving arithmetic facts from memory, "deficits in retrieval of math facts (e.g., the
multiplication table)", has been established, see (Haberstroh and Schulte-Körne 2019).
However, there is no convincing evidence that dyscalculia is causally related to reduced
memory or to a reduced ability to remember facts. If those affected need significantly more
time when solving certain simple arithmetic problems or come up with incorrect results,
then this is usually not a question of memory.
For example, if a person with DD has difficulties with simple multiplications (times table), it
may be due to a lack of geometric or pictorial-associative mental representations and it may
be due to poor semi-conscious automation, as a result of poor conscious mental arithmetic
skills. However, these possible causes have nothing to do with general memory problems.
Of course, results of certain challenging calculations can occasionally simply be learned by
heart, e.g. difficult products from the multiplication table such as 7 ⋅ 8 = 56. However,
children often calculate consciously using counting strategies for small sums or using other
strategies. When such conscious operations are performed repeatedly, they gradually
become more and more semi-conscious. In some cases, e.g. with very simple sums, these
procedures become completely unconscious, see below.
Conscious processes becoming gradually more and more unconsciousness by repetition, is
called automation. Unconscious or semiconscious neural processes have two major
advantages over conscious processes: they are faster and cost less energy. Automation is
known from various everyday situations. For example, children learn to tie a stitch
laboriously, but after prolonged practice the procedure becomes automated.
Automations are omnipresent and it is not surprising that they also occur in arithmetic.
When children form sums in the number range 9 or 10 (e.g. 4 + 3) they usually do not learn
this by heart, but they visualize this calculation or solve the problem by counting, e.g. with
the help of their fingers. The more often a child does this, the more automated it becomes.
The hypothesis is that such processes, once automated, are carried out unconsciously in the
same way as the children carried out the calculation consciously at the beginning, often
counting in the case of 4 + 3, and therefore unconsciously counting later. In contrast to
tying stitches, the automated counting process at 4 + 3 is performed completely
unconsciously. Individuals may then mistakenly believe that they retrieve the result from
memory in such tasks.
Fayol and Thevenot (2012) measured response times for simple arithmetic tasks in adults. As
a result, the hypothesis of unconscious counting arithmetic was formulated. For the topic of
dyscalculia as a disconnection syndrome, the conjecture expressed in this thesis that these
counting processes could also have something to do with geometric ideas, e.g. of
arrangements as on a number line, is particularly interesting, see Chapter 9.
Barrouillet, P. and Thevenot, C. (2013) were able to confirm this hypothesis in a study with
91 adults solving simple addition tasks with summands 1, 2, 3 or 4. A linear relationship was
found between the size of the sum (2 to 8) and the response time. The larger the sum, the
longer the response time. However, if the children were to recall the results from their
memory, the response times would have to be approximately the same.
Thevenot, Barrouillet, Castel and Uittenhove (2016) were able to empirically prove this
hypothesis in another study with 42 children aged 10. It is interesting that tasks with
identical summands (1+1, 2+2 etc.) could be solved significantly faster. Why such tasks
(called tie-problems) are solved faster can only be speculated. Perhaps the children in this
study had already become familiar with these calculations using the doubling strategy
(arrangement of pairs of dots), which is equivalent to counting in steps of two (2, 4, 6,...) and
is advantageous compared to simple counting.
Thevenot et al. (2020) measured response times with and without a training phase for
simple arithmetic tasks in which letters were used instead of numbers according to their
position in the alphabet. While tasks with larger summands were generally solved with non-
counting strategies, unconscious counting processes were found for smaller summands, as
expected. Thevenot et al. are critical of the assumption that unconscious counting processes
are replaced by direct memory links over time: „(...) we have dethroned one of the main
arguments that procedures are taken over by memory retrieval after repeated practice by
showing that the slopes relating solution times to addends are still not negligible after 12 or
even 25 sessions of training.“
The modern didactics of multiplication tables according to Gaidoschik (2022) is based on
comprehension-oriented derivations and contrasts with the outdated technique of just
learning them by heart. The aim is to be able to determine results in a few seconds after
partial or complete automation. Whereas the outdated demand to answer as quickly as
possible is at odds with this current didactic. Probably also due to a still widespread
understanding of how to learn multiplication tables, the opinion has been established that
poor memorization of arithmetic facts would be a central symptom of dyscalculia.
Attout and Majerus (2015) observed problems with working memory related to ordering
numbers in individuals with dyscalculia. However, such findings can also be explained by
impaired interconnected processes rather than memory deficiency.
Bagnoud et al. (2021) are also critical of the opinion that the ability to recall mathematical
facts from memory is reduced in dyscalculia.
It can be assumed that automated unconscious counting develops when children have been
taught to solve simple additions in this way in kindergarten or in first grade. Krön (2022)
discusses non-verbal number didactics. There, number and arithmetic competences are to
be developed in the number range 10 without counting processes. Those who work out
additions with small summands in this way will probably not develop unconscious counting
processes.

5. The challenge of diagnosis

In a meta-analysis, Haberstroh and Schulte-Körne (2019) summarize several studies, list
typical symptoms of dyscalculia and discuss a diagnostic algorithm (ICD 10).
The core of current diagnostic procedures is the identification of arithmetic deficits, mostly
in relation to the schooling received so far. Often, a general IQ test is also conducted. If the
results of the arithmetic test are clearly below what would be typical for this school level,
the so-called discrepancy criterion is fulfilled. In addition, it should be ensured that no
disorders other than DD have led to this result. How the latter is to be accomplished remains
unclear, especially when the time available for making the diagnosis is limited. Ehler,
Schroeders and Fritz-Stratmann (2012) present the criticism of this discrepancy criterion in
general and conducted a study on 458 children. Their conclusion was that the use of IQ as a
criterion for comparison is not useful.
Common other disorders that can cause poor performance on a numeracy test include
ADHD and anxiety disorders (school anxiety).
There are several reasons why the current diagnostic methods are unsuitable and lead to
numerous false positive diagnoses, which are discussed below.
1. Quality ADHD diagnosis takes time and often cannot be carried out simultaneously and
seriously when a diagnosis of DD is made.
2. If a child has ADHD, standardized numeracy tests cannot determine whether a MLD is a
consequence of ADHD symptoms or whether the child also has DD. Individuals with
ADHD and MLD can easily be given a false positive diagnosis of DD as a result.
3. In the diagnostic algorithm according to Haberstroh and Schulte-Körne, a positive DD
diagnosis is made not only in the case of a positive ADHD diagnosis, but also in the case
of an anxiety disorder. Thus, if fear of a teacher or bullying leads to school anxiety and
subsequently to a MLD, the child is falsely positively diagnosed with DD.
4. Other false positive diagnoses are made because of family problems (separation of
parents) or experience of abuse. Traumatic experiences or very stressful situations can of
course be the cause of a massive drop in academic performance, which can become
noticeable more quickly in mathematics than in other subjects. Even if such background
factors are qualitatively clarified when a diagnosis is made (which is usually not the case),
the current diagnostics cannot decide whether a MLD is caused by family problems, for
example, or whether DD is present.
5. Comprehension difficulties in class can also lead to false positive diagnoses. For example,
if a child has not internalized the basic concepts of division in word problems, i.e. does
not understand what division means in a real life context, this can lead to massive
performance deficits and subsequently to a false positive diagnosis of DD. An analysis of
 mathematical comprehension difficulties is currently not carried out in psychological
diagnostics.
6. The method of discrepancy analysis (IQ vs. mathematical performance level) is also very
problematic for methodological reasons, irrespective of the difficulties described above,
especially in the statistical marginal areas, see Tischler (2019).
7. A diagnostic criterion should also be the time when MLD first occur, which is often not
taken into account and can hardly be objectively assessed retrospectively. A child who is
able to calculate the number range 100 without any problems in second grade does not
have DD. Occasionally, children are diagnosed with dyscalculia who have noticeable
difficulties only in the third or fourth grade or in secondary school (cf. point 5), but who
were able to work out the material of the first two grades .Such misdiagnoses are further
evidence that school level-specific numeracy tests are not suitable diagnostic
instruments.
Criticism of current diagnostic practice is not new, see for example de Almeida Gomides
M.R. et al. (2021), Butterworth and Laurillard (2016) and Butterworth (2003). Butterworth
(2003) developed the computer program Dyscalculia Screener. It uses computer-assisted
timing in a number range where children without dyscalculia use techniques for mental
arithmetic, but children with dyscalculia often only count (though partially automated),
which can be determined by response time. A given maximum time frame, on the other
hand, is less useful, because it makes a difference whether a child is laboriously counting to
solve a task just within the given time or whether he or she can quickly give a correct
answer.
Experienced doctors often diagnose conditions with which they are familiar and whose
symptoms they can classify, without following fixed diagnostic algorithms or performing
standardized tests. People who have a lot of experience with dyscalculia in practice can
distinguish between DD and MLD in the same way when they see, for example, the way in
which the person makes progress in learning arithmetic, because this difference can be seen
in the development of learning progress rather than in selective arithmetic achievement
tests. It would of course be of great advantage if there were objective testing procedures
that could do this, also for reasons of cost.
If a child has MLD and attempts are made to address it in a one-to-one environment, it is the
way the child is learning and building skills, rather than the current level of performance,
that is important to consider. For example, children with ADHD but without DD can often
catch up quickly on missed school material in short, high-quality individual lessons in an
ADHD-sensitive environment in a largely empty room without distractions. In the case of
actual dyscalculia, one often encounters extreme difficulties in learning progress, even in
individual lessons, which are very different from the learning difficulties of non-affected
persons. It is also typical for people with dyscalculia that short-term learning progress seems
to disappear after a few days. As discussed in Chapter 4, this is not due to general memory
problems, but to a lack of neural networking when working.

6. Comorbidity of developmental dyscalculia und ADHD

Numerous publications claim a frequent combined occurrence of DD and ADHD. For the
following reasons it can be assumed that these are two independent disorders:
1. According to the current state of research, DD is a congenital neural developmental
disorder that leads to a localized impairment in the development of certain long-range
 neural pathways, see chapter 3. ADHD, on the other hand, is thought to involve a
functional impairment of the neurotransmitter system. The fact that DD and ADHD
appear to have such different etiologies argues against the existence of a relationship
between these disorders.
2. Based on previous studies, Monuteaux et al. (2005) suggested that ADHD and DD are
inherited independently. They studied 140 individuals affected by ADHD along with their
174 siblings and 280 parents, and 120 individuals in the control group without ADHD
with 128 siblings and 239 parents, and concluded (Abstract, page 86), "Our findings
support the hypothesis that ADHD and dyscalculia are independently transmitted in
families and are etiologically distinct."
3. Of course, children with symptoms of ADHD are more likely to develop MLD. As
explained in Chapter 5, current diagnostics cannot distinguish between MLD and DD. As
a result, children with ADHD and MLD can easily be diagnosed with DD when they do not
have it. This seems to be the main reason why an increased comorbidity of ADHD and DD
is often claimed.
It is not yet possible to say definitively whether the two disorders, DD and ADHD, occur
completely independently of each other or whether there is a slight correlation.
Estimates of the prevalence of DD vary. Shalev (2007), for example, gives 5-7% as an
estimate, whereas Gross J., Hudson C. and Price D. (2009) suggest more like 3%. Butterworth
(2004) cites studies with values between 3.6 and 6.5 %.
If we take the lower end of these estimates, i.e. around 3%, due to the frequent false
positive diagnoses, and assume a prevalence of 5% for ADHD and that both disorders occur
independently of each other, then only 0.15% (0.03 ⋅ 0.05 = 0.0015) of the population would
suffer from both disorders at the same time.

7. Neuronal systems related to numbers (ANS, OTS) and the intraparietal sulcus (IPS)
The cardinality of a set is the number of its elements. Numerosity is the same as cardinality,
but without number abstraction, i.e. without number symbols or number words being
involved. For example, many non-human animals understand the numerosity of small sets,
they can judge which set has more or less elements (see Nieder 2019), but they do not
understand what the cardinality of a set is, because they are not familiar with the human
concept of number.
Caray (2001) and later Feigenson, Dehaene and Spelke (Feigenson 2004) distinguish two
innate neuronal systems that play a role in the recognition and estimation of numerosity:
the Approximate Number System (ANS) and the Object Tracking System (OTS). The latter is
also called Parallel Individuation System (PIS). The extent to which the OTS is an independent
system or whether more global structures play a role is still the subject of discussion (see
Chapter 5.2 in Nieder 2019).
When an individual looks at two distinguishable sets of objects, the ANS can be used to
decide which of the sets has more elements, without knowing the exact number of
elements. According to Weber-Fechner's law for sensory perception, it is not the difference
in the number of elements that determines whether a correct decision can be made, but the
relative difference (percentage). The Weber-Fechner quotient (or Weber quotient) indicates
the relative difference that can just be detected. The closer it is to 0, the better the ANS
works. The Weber quotient of the ANS can be measured free of charge on the website
panamath.org (Panamath 2010). Pictures with yellow and blue dots are shown and the test
person has to decide in a short time which of the pictures shows more dots.
The ANS is a very old neural system in evolutionary history. It can be assumed that all
vertebrates have such a system (Nieder 2019). Typical applications in nature concern swarm
behaviour (e.g. of fish or birds). When the swarm splits up, an individual will judge which
part is the larger and will join that part. Grazing animals can use their ANS to judge where
there are more interesting forage plants.
The intraparietal sulcus (IPS) is a furrow (lat. sulcus) in the parietal lobe (bilateral). In
primates, it is considered the location of the ANS and plays a central role in solving simple
computational tasks (see Chapter 6 in Nieder 2019 and Dehane et al. 2003). The IPS is also
active in visuospatial movements or controlling (see e.g. Simon et al. 2002). Through learning
experiences, the IPS increasingly forms language-independent representations of numerical
quantities (Ansari 2008, Rosenberg-Lee et al. 2009, Nieder 2019).
The algorithm or neural network underlying the ANS is unknown. Since the IPS is involved in
the control of spatial movements as well as the ANS, it can be assumed that the spatial
competencies of the IPS also play a central role for the ANS. The following model of how the
ANS functions as a neural network is speculative, see Figure 2:
1. layer: object recognition. After visual input of two sets A and B, the individual objects are
identified.
2. layer: abstraction. In a two-dimensional mental representation, recognized objects are
replaced by similar representations (A and B).
3. layer: finding pairs through spatial movement. Through spatial mental movements, the
representatives are brought together in pairs. The spatial movement of bringing the
representatives together is comparable to the coordinated spatial movements of grasping
with the hand, for example. The function of the IPS is therefore similar in both cases. Any
pair of representatives that have found each other is considered neutralized.
4. layer: interpretation. If only representatives of one type remain, or if after pairwise
neutralization an image is obtained that can be matched with a known image from memory,
then it is recognized which set has more elements.
If no result is obtained with an image in the 4th layer, it is sent back to the 3rd layer. This
process reflects the fact that ANS improves with practice. If the number of elements is very
large, the ANS fails and switches to texture matching in sections of the images.
Speculations of this kind should inspire future research or encourage the implementation of
similar networks or models with computer programs.
 Figure 2. Model of the ANS
That the ANS and the OTS are in fact two different systems was shown in experiments with
infants. Feigenson Carey and Hauser (2002) conducted so-called cracker experiments on 10-
and 12-month-old babies. In these experiments, one biscuit after the other was placed in
two cups for the child to see. The child wants to eat these biscuits and indicates which cup of
biscuits he or she wants. The infants preferred (statistically significantly) 3 or 2 biscuits to
one biscuit and 3 biscuits to 2 biscuits. However, when 4 or more biscuits were placed in a
cup, the choice was made at random. This seems paradoxical because it was not recognized
that 4 was more than 1, although it was recognized that 3 was more than 1. One can assume
that in a serial experimental design (i.e. the objects are shown one after the other and not at
the same time) the OTS is activated and this is innate only for the numbers 1 to 3. As soon as
a fourth biscuit is placed in the cup, the OTS switches off, the babies thus lose their decision
support and have to choose randomly. One can assume that the OTS, unlike the ANS, is not
located alone in one location in the brain and that innate number neurons play a role in this.
Xu (2003) conducted a study in which six-month-old infants were shown dot pictures. By
observing the eyes, this simultaneous (parallel) presentation of objects revealed that 8 dots
could be distinguished from 4 dots, but not 4 dots from 2 dots, nor 2 dot from 1 dot. It can
be assumed that the ANS reacts and becomes active during parallel presentation of the
stimuli if each of the two sets has at least 4 elements. The number 4 could thus be
interpreted as the stimulus threshold for the ANS.

8. The disconnection hypothesis

Price et al (2007) suggest parietal dysfunction as a cause of dyscalculia, without specifying
whether they consider impairment of the IPS itself to be the cause of the disorder, although
their functional magnetic resonance imaging study found a functionally impaired IPS in
affected individuals. An impairment of SLF I that subsequently affects the IPS could also be
called a parietal dysfunction in this terminology, see Chapter 3.
Mazzocco, Feigenson and Halberda (2011) suggest that poor ANS performance is causally
related to DD. What was actually observed in this study is undisputed. It is a well-known
correlation: high values of the Weber-Fechner quotient tend to be associated with low
arithmetic performance, and low values tend to be associated with higher performance.
However, it should not be concluded from this that a defective ANS is the cause of DD,
because then all people with DD would have a defective ANS. This is certainly not the case,
as this study also shows.
Noël and Rousselle (2011) also argue that an impaired ANS cannot be the cause of DD, but
that its development can be impaired as a consequence of DD. Noël M.-P. and Karagiannakis
G. (2022) argue similarly, see chapter 1.2.1 and other references cited therein.
A student who studied elementary education had only very good marks in her school-leaving
certificate (Abitur) except for mathematics. Prior to her studies, this very eloquent lady had
had a successful career at an international level in a field of work in which numbers hardly
played a role at all. However, she showed clear symptoms of DD, e.g. she would hide both
hands under the table when doing simple additions (such as 7+6) and count with her fingers.
After discussion and exercises, the diagnosis was confirmed. The ANS test carried out with
panamath.org showed a good Weber arithmetic quotient of 0.17. This puts her in the top
30% of her age group. In any case, a defective ANS cannot possibly be the cause of her DD.
Butterworth (2019) proposes the so-called "defective number module hypothesis", which
states that DD is not caused by so-called global neural impairments, but by the impairment
of a specific and definable module in the brain. The question of which module this is, and
how it is located neuroanatomically, remains unanswered.
Park and Brannon (2013) could show that training the ANS in adults improves the ability to
perform addition and subtraction. Similar findings would not be surprising for children
either. However, it would be unrealistic to believe that ANS training alone can eliminate the
symptoms of DD.
The disconnection hypothesis says that the impairment that causes DD can be found in long
nerve tracts that connect parietal regions and thus the IPS with other areas. The statistically
measurable impairments of the IPS and the ANS are therefore not the cause of dyscalculia,
but a consequence of the poor connection of the IPS through the superior longitudinal
fasciculus (SLF) or through the SLF I (see Chapter 3). Accordingly, in a very well diagnosed
cohort of people with dyscalculia, all those affected would have to show an impairment in
the SLF (or SLF I). An impairment of the IPS is therefore likely to be functional in certain
tasks, but not always structural. An impairment of the IPS is therefore likely to be functional
in certain tasks, but not always structural. The mean of the Weber-quotient of the ANS in the
test group would be above the mean of the control group, but not all individuals with DD will
have an ANS with a performance below the average.
The specific separation hypothesis states that DD is caused by a congenital impairment of
the development of the SLF I.
Although there is no direct empirical evidence for this hypothesis, it represents a model that
explains all existing psychological and neuroscientific findings without contradiction, which is
explained in more detail in the following chapter. However, it has to be said again that the
existence of the SLF I as a clearly delimitable substructure of the SLF has not yet been finally
proven, see Chapter 3 and (Janelle et al. 2022).
Wilson and Dehaene (2007) formulate several hypotheses on the causes of dyscalculia.
Regarding the "core deficit hypothesis" they write: "(...) at least some types of dyscalculia
may be due to an impairment of functioning and/or structure in the HIPS, and/or in its
connections to other numerical cognition regions." Here HIPS refers to the horizontal (i.e.
bilateral) intraparietal sulcus.
9. The neurocognitive model
It can be assumed that geometric representations or their abstractions are used when
making spatial movements. Examples of pictorial representations are dot patterns, such as
four dots in a square with the meaning 4 = 2 + 2, or a square of dots with another dot (inside
or outside the square), or three dots in a row with an additional pair of dots. The latter
representations of 5 correspond to 4 + 1 or 3 + 2. These representations are not stored pixel
by pixel like photographs, but in an abstract geometric way.
In addition to point patterns, mental representations of a number line are also important for
mental calculations, which are inevitably logarithmically scaled in the imagination, see also
Nieder (2019). It has been known for some time that many people mentally arrange smaller
numbers on the left and larger numbers on the right. Recent research suggests that this is
not a cultural convention but innate. Newborns show a tendency to associate smaller
numerosities more to the left and larger ones more to the right (Di Giorgio et al. 2018,
Felisatti et al. 2020). A recent study shows that even bees tend to associate smaller
numerosities to the left and larger ones to the right (Giurfa 2022).
Mental movements play a role in calculations. The number 8 can be imagined on a number
line between 5 and 10. The distance to 5 is 3, the distance to 10 is 2. 4 is seen as 2+2 (e.g.
points in a square). To calculate 8 + 4, look at 8 on the number line, move from 8 to the right
to 10 and then to 12, see Figure 3.

Figure 3. Segment of the mental number line for 8 + 4.

Near the number 18 we can imagine a similar picture as near the number 8. The same holds
for 28, 38, etc. For example, when we calculate 28+4, we transfer the mental image of the
area around the 8 to the area around the 28, and the addition of the two twos representing
the four takes place after a translation. In these mental processes, typical IPS elements (dot
patterns, number line and spatial movements) are combined with mathematical formalism
or language input. It is this combination that is impaired in DD. Although people with DD can
successfully do arithmetic with geometric teaching materials or by using written calculation
algorithms, the purely mental representation of geometric number representations and
other inputs (language, symbols) at the same time, e.g. with eyes closed, is impaired.
Even before neuroscience had found the first evidence of a disconnection syndrome (see
Rykhlevskaia et al. 2009, Kucian et al. 2014), Rousselle R. and Noël M.P. (2007) were able to
observe a phenomenon that fits in with this concept. They found that affected children have
difficulties in accessing numerosity via numerical symbols, but not in processing numerosity
per se.
In short, the cognitive model of the disconnection hypothesis states that in DD the ability to
mentally link purely geometric representations and associated spatial movements with
verbal or symbolic information in problem solving thought processes is impaired when this
problem solving requires repeated switching back and forth between the geometric and
other representations.
The combination of cognitive and neuroanatomical model for DD as a disconnection
syndrome is shown in Figure 4. To repeat the abbreviations used in the graph: intraparietal
sulcus (IPS), developmental dyscalculia (DD), superior longitudinal fasciculus (SLF). The "I" in
SLF I refers to the subdivision of the SLF according to Janelle et al. (2022).

Figure 4. Neurocognitive model for DD as a disconnection syndrome

10. Examples of diagnostic items

The diagnostic items in this chapter have been tested in practice on people with and without
DD, but not yet in a scientific study. They consist of three parts: a) explanations, b)
introductory items, c) test items.
Introductory tasks are particularly simple and do not relate to the dyscalculia-specific
problem. This is to give the test persons, who often suffer from mathematics or school
anxiety, an initial feeling of success and to test whether they have grasped the nature of the
task.
Die Testaufgaben beziehen sich auf die Schwierigkeiten im Sinne des kognitiven Modells aus
Kapitel 9. Sie sollen nur gelöst werden können, indem geometrische Strukturen mit Zähl-
bzw. Rechenvorgängen rein mental verknüpft werden, insbesondere ohne Zuhilfenahme von
Fingern, Anschauungsmaterial oder Schreibutensilien. Daher wird dabei von den Probanden
verlangt, die Augen zu schließen und eventuell auch die Hände auf den Tisch zu legen.
The test items refer to the difficulties in the sense of the cognitive model from Chapter 9. It
should only be possible to solve them by linking geometric structures with counting or
arithmetic processes purely mentally, especially without the aid of fingers, visual aids or
writing utensils. For this reason, the participants are required to close their eyes and possibly
also to place their hands on the table.
The level of difficulty is adapted to the age and gradually increased during the test. There is a
risk that older or particularly intelligent people with DD will find alternative solutions by
using logical constructions to compensate for their lack of geometric imagination. This can
be counteracted by increasing the difficulty of the tasks or by adapting the tasks so that the
evasion strategy does not work, and by asking the subjects how they went about solving the
problem.
Diagnostic item 1. The power of 5 für for numbers 5 to 9.
For sums of the numbers 2 to 9 with a carry over ten, the following strategies are common:
• If the first summand is smaller than the second, it is often easier to swap the summands,
e.g. instead of 3 + 9 you calculate 9 + 3.
• Counting. E.g. 9 + 3 is determined by counting “10, 11, 12”. This strategy is considered
inefficient and error-prone and should be replaced by other strategies. People with DD
tend to use this strategy more often than those not affected.
• Based on number bonds (i.e. decompositions of numbers as sums) of the numbers 2 to
10, the first summand is added up to 10 and the rest is carried over, e.g. 7 + 8 = 7 + 3 + 5
= 10 + 5. The bonds of the numbers up to 10 should be available quickly and without
conscious counting, also for additions up to a given number (e.g. 4 and how much is 9?)
or for subtractions, which children with DD often have difficulties with.
• Alternatively, the so-called power of 5 can be used. In this case, the numbers 6 to 9 are
thought of as 5 + 1 to 5 + 4, see Figure 5, and in the case of sums, the two fives are added
to 10, e.g. 7 + 8 = (5 + 2) + (5 + 3) = 10 + 2 + 3. A sum with carry over (here 7 + 8) is
reduced to a smaller sum without carry over (here 2 + 3).
Teaching this addition using the power of 5 can be used as a diagnostic tool if the child does
not yet know this technique. Either a picture like the one in Figure 5 is presented first, or
tokens are used.

Figure 5. Diagnostic item 1 – the power of 5 for numbers 5 to 9.

The first five dots or tokens for each number are blue, the others are red. As an introductory
task, the student is for example asked how many red dots the 7 has (correct answer two).
The next question is about the number with say three red dots. Then the strategy of the
power of five is explained using different sums. It is explained that two blue groups of five
add up to 10 and then only the red dots have to be added up. So instead of 6 + 8 one just
needs to calculate 1 + 3 with the result 14. The child is then asked to name the number of
red dots in each number with his/her eyes closed.
The test phase, in which this addition strategy is to be performed with the eyes closed, only
begins when this calculation strategy has been mastered with the material and the correct
number of red dots can be named with the eyes closed. If the test person indicates that he
or she is unable to perform this strategy or repeatedly gives incorrect answers, this is an
indication of DD.
In principle, it makes sense for learners to freely choose a calculation strategy. Occasionally
asking learners to try out a particular strategy does not contradict this principle.
Diagnostic item 2. Nine squares. The item is suitable for children from about the end of the
first grade. If older or particularly intelligent children develop strategies to avoid the mental
imagination, then item 3 can be used.
 Figure 6. Diagnostic item 2 – nine squares.
The first two pictures in Figure 6 serve as explanation while the following texts are shown
and read out:
• Nine squares form a 3 × 3 - pattern.
• The squares are numbered row by row from left to right. We start with any number at
the top left, here with the 4.
The third and fourth pictures belong to introductory tasks. The following texts are shown
and read out:
• The squares in the rows are again numbered row by row from left to right. Which
number is at the bottom left when there is 4 in the top center?
• The squares in the rows are numbered row by row from left to right. Which number is on
the top left if 13 is in the middle on the right?
If the introductory items can be solved, the following (or similar) test items will be set
without the display of a picture.
• If 14 is in the middle at the bottom (in the bottom row), what number is in the middle at
the top? Close your eyes while you look for the answer.
Diagnostic item 3. Cross of squares. Again, particularly intelligent adolescents or adults may
be able to develop logical solutions to this more demanding item without mental imagery,
but this is more difficult than for item 2. For younger children, however, this task may simply
be too difficult, even if they do not have DD.

Figure 7. Diagnostic item – Cross of squares.

The first two pictures are used for explanation, the third one is an introductory task. The
following texts are shown and read aloud for the three pictures.
• 25 squares form a 5x5 pattern. Four squares are removed, creating a cross.
• The squares are numbered line by line from left to right.
• In the first square at the top left is any number, in this case an 8. Which number is in the
fourth line on the far right?
Test items without pictures can be as follows:
 • If 9 is in the first line on the far right, what number is in the bottom line on the left? Close
your eyes while you look for the answer.
• Wenn in der Mitte der ersten Zeile die 12 steht, welche Zahl steht dann in der letzten
Zeile in der Mitte? Schließe die Augen, während du die Antwort suchst.
Diagnostic item 4. Eight-pointed star. Like item 2, this item can already be used at the end of
the first school year. With older children with DD, it can again be assumed that strategies to
avoid mental imagination are used. The fifth picture shows an introductory task, the others
are explanatory. As the six images in Figure 8 are displayed one after the other, the following
six texts are shown and read aloud:

Figure 8. Diagnostic item 4 – Eight-pointed star.

• An X is placed on a cross.
• This creates an eight-pointed star.
The third picture is shown without a text. The texts from the fourth image onwards are as
follows:
• We start on the left with 7 and number the points of the star clockwise. Memorie this
picture!
• Which number is on the bottom right?
• Now we start with the 7 at the bottom and number the pionts clockwise again.
The following test items could be used. No picture is shown.
• We start with the 7 at the bottom and number the points of the star clockwise again.
Which number is on the far right? Close your eyes while you look for the answer.
• We start with the 7 on the right and number the star clockwise again. Which number is
on the left? Close your eyes while you look for the answer.
Diagnostic item 5. Star with eight points and reflections. Item 5 is a more demanding
continuation of item 4. The first two pictures in figure 9 belong to explanations, the third
picture to an introductory task, the fourth to a test task. The following four texts are shown
and read aloud:

Figure 9. Diagnostic item 5 – Eight-pointed star with reflection.

• The points of the star can be mirrored across the vertical axis
• or across the horizontal axis.
Introductory point: The points of the star are numbered clockwise from 6 at the top to 13. A
dwarf starts a walk on the points of the star, starting from the left (start), as follows: First he
goes three steps counter-clockwise, then he is mirrored on the vertical axis, then he goes
four steps clockwise and then he is mirrored on the horizontal axis. At which number is he
now?
Test item: The points of the star are numbered clockwise starting with 4 at the top. The
starting point is again on the left.
The picture is not shown from now on and the test task continues: Close your eyes while
retracing the following walk. First the dwarf walks five steps clockwise and is then mirrored
on the horizontal axis. Afterwards he walks five steps clockwise and is mirrored again on the
horizontal axis. At which number is he now?
For further developments, it will be important to also create items that are intended for
children before they start school.

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