Aphantasia

What Causes Aphantasia?

Doctors and researchers have not yet determined exactly what causes aphantasia, and there are likely several factors that lead to the onset of the disorder in most cases. It is probably associated with problems in the parts of the brain responsible for processing visual information.

Many people with aphantasia seem to have been born with the condition, but some case studies suggest that it can be acquired following an injury or an event such as a stroke that causes damage to part of the brain.

Is Aphantasia Hereditary?

Research into possible genetic components of aphantasia has been limited to date, but studies have suggested the condition may run in some families. These studies have indicated that people with aphantasia are ten times more likely than the general population to have a close relative with the condition.

Although these studies strongly suggest that genes play a role in the development of aphantasia, more research is necessary to identify the gene or genes that might be responsible.

How Is Aphantasia Detected?

Many people with aphantasia are unaware they’re affected until they learn that others can form mental imagery. This often doesn’t happen until adolescence or early adulthood. Until this point, they may believe that their difficulty with mental images is typical.

How Is Aphantasia Diagnosed?

Diagnosis of aphantasia typically begins with a physical assessment followed by a psychological evaluation. First, doctors will usually try to rule out medical conditions that could be causing the symptoms. After these potential physical conditions have been ruled out, the diagnostic process moves on to possible psychological causes.

Diagnostic steps may include:

• A physical exam. This exam will be aimed at ruling out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

Because the neurological origin of aphantasia is unclear, there is not yet any definitive test or procedure to diagnose the condition. Diagnosis is usually based on a patient’s responses to a questionnaire that gauges their ability to form mental images. However, this type of self-assessment is subjective and could be prone to errors.

Researchers are looking into the association between aphantasia and brain activity. Future diagnostic tests such as functional magnetic resonance imaging (fMRI) scans might be able to identify the neurological characteristics of aphantasia.

How Is Aphantasia Treated?

There is currently no treatment for aphantasia. However, the condition may not cause significant impairments, and treatment may not be necessary in most cases.

How Does Aphantasia Progress?

Scientists are not yet sure how aphantasia affects people throughout their lifetime. The condition seems to vary in severity from case to case, and its long-term effects likely are different for different people. Although the condition affects visual imagery and other forms of imagination, people with aphantasia appear to be able to compensate for the limitations, and many are able to succeed in creative pursuits.

Some possible complications of aphantasia include:

• Difficulty remembering or “reliving” significant life events
• Difficulty remembering details or factual information
• Difficulty imagining hypothetical situations
• Difficulty imagining possible future events

How Is Aphantasia Prevented?

There is no known way to prevent aphantasia.

Aphantasia Caregiver Tips

Some people with aphantasia also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with aphantasia:

• Some people with aphantasia also have a form of agnosia called prosopagnosia.
• Aphantasia may sometimes be associated with other developmental conditions such as dyscalculia, dyslexia, or autism.

Aphantasia Brain Science

In the past, some scientists have been skeptical of aphantasia as a functional neurological disorder. Instead, they thought that the inability of some people to form mental images was merely a difference in how they described their typical cognitive processes. However, more recent research has convinced most scientists that aphantasia is a real neurological condition with a physical origin. Studies have found differences in brain activity between people with aphantasia and those with typical imaginations.

The differences in brain activity are likely centered in the visual cortex, the part of the brain responsible for processing visual input and integrating that input with more complex functions such as memory and planning. Functional magnetic imaging (fMRI) scans have shown that people with aphantasia use different parts of their brains when processing complex images. These differences in processing may underlie their inability to produce visual memories and images.

Aphantasia Research

Title: Improving the Academic Performance of First-Grade Students With Reading and Math Difficulty

Stage: Enrolling by Invitation

Principal Investigator: Douglas Fuchs, PhD

Vanderbilt University 

Nashville, TN

The main purpose of this clinical trial is to explore the short-term effects of coordinated intervention versus the business-as-usual school program on the primary endpoints of post-intervention word-reading fluency and arithmetic fluency. The study population is students who begin 1st grade with delays in word reading and calculations. Students who meet entry criteria are randomly assigned to coordinated intervention across reading and math, reading intervention, math intervention, and a business-as-usual control group (schools’ typical program). The 3 researcher-delivered interventions last 15 weeks (3 sessions per week; 30 minutes per session). Students in all 4 conditions are tested before the researcher-delivered intervention begins and after it ends.

First-grade students who meet study entry criteria are identified near the start of the school year using a 3-stage screening process. Students who enter the study complete the pre-test battery.

Then, students are randomly assigned at the individual level to coordinated intervention, reading intervention, math intervention, or a business-as-usual control group (the schools’ typical classroom instruction with supplemental intervention schools choose to provide). Research staff deliver the intervention in the coordinated intervention condition, in the reading intervention condition, and in the math intervention condition 1:1 for 15 weeks (three 30-min sessions per week, scheduled in line with teacher input to avoid students missing important content). Adherence to the researcher-delivered interventions is monitored via audio recordings and live observations.

The content of each researcher-delivered intervention is aligned with the school district’s 1st-grade foundational reading & math learning standards; relies on explicit instruction, and incorporates fluency-building activities, word reading, and/or arithmetic problems; incorporates procedures designed to build engagement and perseverance. Reading intervention is designed to build skills in letter-sound associations, decoding, sight words, and contextualized reading. Math intervention is designed to build number knowledge, counting strategies, and arithmetic skills. The coordinated intervention addresses the same instructional objectives as reading intervention & math intervention.

When the researcher-delivered intervention ends, students in all four conditions complete the post-test assessment battery. Testers are blind to students’ study conditions. Adherence to testing protocols is monitored via audio recordings. The primary endpoints are post-test word-reading fluency and arithmetic fluency.

Title: Attention and Achievement: A Mind-Wandering Investigation

Stage: Recruiting

Principal Investigator: Paul T. Cirino, PhD

University of Houston 

Houston, TX

This study assesses the impact of mind-wandering on reading and math. Specifically, 120 middle school student participants will receive descriptive measures (of achievement, attention, and related factors, including mind-wandering). They will receive a brief (~30 min) lesson in reading and math (order counterbalanced). Participants will receive a brief pre-test, the lesson, and then a post-test on the reading and math outcomes. 75% of the participants will receive a brief manipulation that sets up the influence of mind-wandering, as well as redirects when probe-caught mind-wandering occurs. The remaining participants will receive only redirects, and only randomly. Among participants to receive the mind-wandering manipulation, an equal number will receive this only for reading, only for math, and for both reading and math.

Title: Transcranial Magnetic Stimulation for BECTS (TMS4BECTS)

Stage: Recruiting

Principal Investigator: Fiona M. Baumer, MD

Stanford University 

Palo Alto, CA

Benign epilepsy with centrotemporal spikes (BECTS) is the most common pediatric epilepsy syndrome. Affected children typically have mild seizure disorders. They also have moderate language, learning, and attention difficulties that impact their quality of life more than the seizures. Separate from the seizures, these children have very frequent abnormal activity in their brains known as interictal epileptiform discharges (IEDs, or spikes), which physicians currently do not treat. These IEDs arise near the motor cortex, a region in the brain that controls movement.

In this study, the investigators will use a form of non-invasive brain stimulation called transcranial magnetic stimulation (TMS) to determine the impact of IEDs on brain regions important for language to investigate: (1) if treatment of IEDs could improve language; and (2) if brain stimulation may be a treatment option for children with epilepsy.

Participating children will wear electroencephalogram (EEG) caps to measure brain activity. The investigators will use TMS to stimulate the brain region where the IEDs originate to measure how this region is connected to other brain regions. Children will then receive a special form of TMS called repetitive TMS (rTMS) that briefly reduces brain excitability. The study will measure if IEDs decrease and if brain connectivity changes after rTMS is applied.

The investigators hypothesize that IEDs cause language problems by increasing connectivity between the motor cortex and language regions. The investigators further hypothesize that rTMS will reduce the frequency of IEDs and also reduce connectivity between the motor and language regions.