# Distinct neural representational changes following cross-format number tutoring in children with mathematical difficulties

## TL;DR

A tutoring program helped children with math difficulties by improving their brain's ability to connect numbers with quantities, aligning them with typically developing peers.

## Contribution

The study shows that cross-format tutoring can normalize neural representations in children with mathematical difficulties.

## Key findings

- CFN tutoring improved numerical and arithmetic fluency in children with MD.
- Neural representational similarity in MD children normalized after tutoring, matching TD peers.
- Parietal and parahippocampal regions showed the most significant neural changes.

## Abstract

Children with mathematical difficulties (MD) often struggle to connect abstract numerical symbols with corresponding nonsymbolic quantities, a foundational skill for mathematical development. We evaluated a 4-week personalized cross-format number (CFN) tutoring program designed to strengthen these symbolic–nonsymbolic mappings in children with MD aged 7–10 years. CFN tutoring was associated with significant improvements in numerical and arithmetic fluency. Neural representational similarity (NRS) analysis revealed that deficient cross-format NRS in children with MD was normalized following tutoring, aligning with pre-tutoring levels of typically-developing (TD) peers. This normalization was most pronounced in parietal and parahippocampal regions known to support quantity and spatial representation. We observed a distinctive pattern of neural plasticity across groups—children with MD showed increased cross-format NRS following tutoring, while TD children showed a decrease—suggesting a nonlinear, skill-dependent plasticity. These findings underscore the need for developmentally tailored interventions to support children with MD through targeted, evidence-based strategies.