Laterality

Asymmetries of Brain, Behaviour, and Cognition

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Magic Hats and Teddy Bear picnics: Language and

visuospatial lateralisation tasks for children

Josephine E. Quin-Conroy, Yanyu Chen, Donna M. Bayliss & Nicholas A.

Badcock

To cite this article: Josephine E. Quin-Conroy, Yanyu Chen, Donna M. Bayliss & Nicholas A.
Badcock (2022) Magic Hats and Teddy Bear picnics: Language and visuospatial lateralisation
tasks for children, Laterality, 27:2, 232-256, DOI: 10.1080/1357650X.2021.2020808

To link to this article: https://doi.org/10.1080/1357650X.2021.2020808

Published online: 12 Jan 2022.

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LATERALITY: ASYMMETRIES OF BRAIN, BEHAVIOUR, AND COGNITION
2022, VOL. 27, NO. 2, 232–256
https://doi.org/10.1080/1357650X.2021.2020808

Magic Hats and Teddy Bear picnics: Language and

visuospatial lateralisation tasks for children
Josephine E. Quin-Conroy , Yanyu Chen , Donna M. Bayliss and
Nicholas A. Badcock
School of Psychological Science, University of Western Australia, Crawley, Western Australia,
Australia

ABSTRACT
The behavioural outcomes associated with atypical cerebral lateralization
during the early stages of cognitive development is an interesting research
venture. However, there are few tasks for assessing lateralization in young
children. The current study describes the Magic Hat task and the Teddy Bear
Picnic task, which were designed to measure the lateralization of language
and visuospatial attention, respectively, in children as young as three years
old. Forty-five adults were recruited to complete the child-friendly tasks as
well as the Word Generation and Landmark tasks whilst functional
Transcranial Doppler ultrasound (fTCD) measured cerebral blood flow
velocity. As expected, at the group level, the Magic Hat task produced left
hemisphere lateralization, and the Teddy Bear Picnic task produced right
hemisphere lateralization. Both tasks demonstrated high internal reliability
(α > .80). The laterality indices produced by the Magic Hat task correlated
with the Word Generation task, ρ = .52, p = .001. Likewise, the laterality
indices produced by the Teddy Bear Picnic task correlated with the Landmark
task, ρ = .45, p = .028. Thus, the Magic Hat and Teddy Bear Picnic tasks are
reliable and valid measures of language and visuospatial lateralization,
suitable for toddlers and young children using fTCD.

ARTICLE HISTORY Received 22 September 2021; Accepted 15 December 2021

KEYWORDS Lateralisation; language; visuospatial; child; fTCD

Functional cerebral lateralization (henceforth referred to as lateralization) is a

phenomenon wherein particular cognitive functions are predominately pro-
cessed in a single hemisphere. This occurs for several cognitive processes
such as language, visuospatial attention and decision-making, face encoding,
and manual praxis (Gerrits, Verhelst, & Vingerhoets, 2020; Hervé, Zago, Petit,
Mazoyer, & Tzourio-Mazoyer, 2013). In most people, language production is
predominately lateralized to the left hemisphere of the brain and visuospatial

CONTACT Josephine E. Quin-Conroy [email protected] School of

Psychological Science, University of Western Australia, M304, 35 Stirling Hwy, Crawley, Western Australia
6009, Australia
© 2022 Informa UK Limited, trading as Taylor & Francis Group
 ASYMMETRIES OF BRAIN, BEHAVIOUR, AND COGNITION 233

processes are predominately lateralized to the right (Carey & Johnstone, 2014;
Zago et al., 2016). However, it is possible for individuals to display the oppo-
site pattern (i.e., language lateralized to the right hemisphere and visuospa-
tial processes lateralized to the left hemisphere), or for these functions to
occur equally in both hemispheres (also called “bilateral” organization;
Knecht et al., 2000; Vingerhoets, 2019).
Researchers have shown particular interest in the relationship between
lateralization and cognitive or behavioural outcomes, particularly in the
context of language development (Bishop, 2013). Stronger language laterali-
zation has been found to be associated with better language ability (Everts
et al., 2009; Gur et al., 1994; Mellet et al., 2014), and atypical language later-
alization occurs more frequently in individuals with developmental language
and literacy disorders, such as dyslexia (Illingworth & Bishop, 2009), specific
language impairment (Badcock, Bishop, Hardiman, Barry, & Watkins, 2012;
Whitehouse & Bishop, 2008), and autism spectrum disorders (Kleinhans,
Müller, Cohen, & Courchesne, 2008). Visuospatial lateralization is far less
studied, and the few studies provide conflicting evidence on its association
to visuospatial ability (Everts et al., 2009; Thomason et al., 2009). The inter-
action between language and visuospatial lateralization is also the subject
of a handful of studies – there is evidence that individuals who have a
typical pattern of language and visuospatial lateralization (i.e., leftward
language and rightward visuospatial) have better language ability compared
to individuals with both functions lateralized to the one hemisphere (e.g., left-
ward language and leftward visuospatial; Lust, Geuze, Groothuis, & Bouma,
2011; Powell, Kemp, & García-Finaña, 2012). This interaction is an interesting
avenue for future research, particularly regarding lateralization in early child-
hood and its relationship with subsequent cognitive and behavioural out-
comes. For example, atypical language and visuospatial lateralization in
school-aged children may be related to poorer academic performance (Stel-
lern, Collins, & Bayne, 1987). As children under five already display lateralized
language function (Kohler et al., 2015), it may be the case that early lateraliza-
tion can predict later language ability, or alternatively that language ability
during development influences how functions lateralize. These theories are
currently difficult to test because there are very few tasks for assessing later-
alization in children below the age of five. This paper reports on two child-
friendly tasks for determining language and visuospatial lateralization, suit-
able for children under the age of five. Before reviewing the child-friendly
tasks, we introduce the techniques used in this field.
Many techniques have been used to assess lateralization. Perhaps the
most accurate is the Wada test; named after its creator Dr. Juhn Wada, it
was developed as a pre-operative language lateralization test for patients
with intractable epilepsy (Rasmussen & Milner, 1977). The test involves inject-
ing sodium amobarbital into the left or right internal carotid artery, thereby
234 J. E. QUIN-CONROY ET AL.

inhibiting the functions of either the left or right brain hemisphere, respect-
ively. This technique is direct and accurate, but also invasive and risky, and
therefore inappropriate for general research. Other early techniques for asses-
sing lateralization were behavioural in nature, often relying on visual half-field
and dichotic listening to estimate the dominant hemisphere for different cog-
nitive functions (e.g., McGlone & Davidson, 1973; Säisä, Silfvenius, & Christian-
son, 1990; Stellern et al., 1987). These techniques are inexpensive and
relatively easy to administer but show weak correlations with the Wada
test and are less effective at identifying atypical language lateralization (Pel-
letier, Sauerwein, Lepore, Saint-Amour, & Lassonde, 2007).
More recently, non-invasive neuroimaging techniques have become more
commonplace in research contexts. Functional magnetic resonance imaging
(fMRI) is a popular choice, which localizes brain activity by measuring blood-
oxygen-level dependent signals during a language or visuospatial task (Pelle-
tier et al., 2007). Other techniques include electroencephalography (EEG),
which measures electrical activity from the outer surface of the brain, or func-
tional near-infrared spectroscopy (fNIRS), which uses optic imaging to
measure cerebral blood flow. These three techniques successfully estimate
language lateralization, with fMRI in particular being considered a reliable
alternative to the Wada test (Arun, Smitha, Rajesh, & Kesavadas, 2018;
Bauer, Reitsma, Houweling, Ferrier, & Ramsey, 2014; Spironelli & Angrilli,
2010). However, each technique has considerable drawbacks for research
with young child participants. For example, fMRI is expensive to use,
affected by movement, and can cause anxiety and claustrophobia leading
to high failure rates in young children (Byars et al., 2002; Pelletier et al.,
2007). Likewise, EEG studies with young children typically suffer from high
attrition rates, partly due to excessive movement artifacts in the data (Bell
& Cuevas, 2012), and both EEG and fNIRS are limited to measuring only the
surface level of the cortex.
Functional transcranial Doppler ultrasound (fTCD) is another non-invasive
neurophysiological technique commonly used in lateralization research
(Lohmann, Ringelstein, & Knecht, 2006). This technique uses two ultrasound
probes to measure blood flow velocity in the left and right middle cerebral
arteries. From this, cognitive activity in each hemisphere – and therefore func-
tional lateralization – is inferred from changes in velocity. FTCD presents a
number of advantages over other methods, as it is inexpensive, portable,
easy to apply, and robust to movement to the degree that participants can
talk while data is being collected, making it well-suited for use with young
children (Badcock & Groen, 2017; Lohmann et al., 2006). The main drawback
of fTCD is its low spatial resolution and inability to localize activity within each
brain hemisphere; however, this is suitable for most lateralization research
which is only concerned with global hemispheric differences in activation.
FTCD has also been validated as highly concordant with the Wada test and
 ASYMMETRIES OF BRAIN, BEHAVIOUR, AND COGNITION 235

fMRI (Deppe et al., 2000; Jansen et al., 2004; Knecht, Deppe, Ebner, et al.,
1998).
The fTCD technique is suitable for measuring the lateralization of brain
activity in young children. However, to utilize this technique, we require
tasks that can elicit language or visuospatial processing while also being
appropriate for the target age group. Several tasks have been used to elicit
language and visuospatial processing in fTCD paradigms for adults, the
most common being the Word Generation task and the Landmark task
respectively (Jansen et al., 2004; Knecht, Deppe, Ebner, et al., 1998). The
Word Generation task requires participants to alternate between silently gen-
erating words that start with a particular letter, and a rest period where the
participant is instructed to “let their mind go blank” to allow their brain
activity to normalize before the next trial. The Landmark task is a type of
line bisection task which requires the participant to judge the horizontal
location of a vertical line relative to the midpoint of a horizontal line, again
alternated by rest periods to allow for normalization of brain activity. Child-
friendly alternatives with low complexity and instructions that require
limited language skills do exist, such as the Picture Description language
task (Lohmann, Dräger, Müller-Ehrenberg, Deppe, & Knecht, 2005), the Ani-
mation Description language task (Bishop, Watt, & Papadatou-Pastou,
2009), the What Box language task (Badcock et al., 2018), and the Rabbits
visuospatial memory task (Groen, Whitehouse, Badcock, & Bishop, 2011).
However, each has significant drawbacks that need to be considered.
The Picture Description and Animation Description tasks involve showing
the participant either an image of a common object or a 12 s wordless
cartoon clip, respectively. Participants are then asked to describe the image
or clip, followed by a rest period. Both tasks have been used to attain reliable
estimates of language lateralization in young children; Bishop et al. (2009)
administered both tasks to 4-year-old children, and Hodgson, Hirst, and
Hudson (2016) reported use of the Animation Description task in a sample
of 3- to 10-year-olds. However, Badcock et al. (2018) suggested that the
need for sustained attention and overt speech production of full sentences
makes them less suitable for younger ages. It is true that many children of
3 years or more could complete either task without issue. However, those
who cannot or will not answer aloud due to delays in expressive language
development or shyness would have considerable difficulties completing
the task, as will younger children whose language is still emerging. The
What Box language task attempted to circumvent these shortcomings by
only requiring the participant to label a single object shown on the screen
between rest periods. This task is less demanding on language skills; it only
requires participants to generate a single word for each trial, instead of pro-
ducing full sentences of description, and does not require overt language
production as covert generation produces comparable language
236 J. E. QUIN-CONROY ET AL.

lateralization to overt labelling (Badcock, Nye, et al., 2012; Wilke et al., 2005),
making it a more feasible alternative for a wider range of young children (or
other populations) with various levels of expressive language capability.
Indeed, Kohler et al. (2015) used the What Box task in a sample of 1- to 5-
year-old children and found an overall leftwards lateralization for language
at the group level. However, the correspondence between performance on
the What Box task and the Word Generation task is low; in adults, laterality
indices (LIs; a number describing the strength and direction of lateralization)
produced by the two tasks only displayed a disattenuated correlation of ρ =
0.40, suggesting that the What Box task is a relatively weak measure of
language lateralization when compared to the gold-standard Word Gener-
ation task. This may be due to the low processing demands per trial of the
What Box task; the generation of one word produces less brain activity
than sustained word generation, which could lead to an inaccurate esti-
mation of language lateralization. In this case, increasing the number of
labels per trial could increase language-related brain activity, which would
in turn improve the accuracy of estimated language lateralization
The Rabbits visuospatial memory task is the only task (that the authors are
aware of) that has been used to determine visuospatial lateralization in chil-
dren. In this task, 20 “holes” (circles) are shown on a touchscreen monitor for
five seconds, six of which have a rabbit in them. The holes are then replaced
with a blank screen for ten seconds, before they reappeared again sans
rabbits. Participants are asked to touch the holes that originally contained
the rabbits. The Rabbits task requires short-term memorization in addition
to visuospatial decision-making, which increases the complexity of the task
compared to the standard Landmark task. The task has been used success-
fully with children as young as six years old (Groen et al., 2011; Groen, White-
house, Badcock, & Bishop, 2012), but the increased cognitive demands could
be problematic for younger children. Additionally, it requires a touchscreen
enabled monitor, which is not always available. An ideal child-friendly visuos-
patial task for the purposes of determining lateralization would be closer in
design to the Landmark task (i.e., a line bisection task without memorization
elements), as this would be both easier for young children and more compar-
able to the results of most adult visuospatial lateralization studies.
The aim of the current study was to test the reliability and validity of the
Magic Hat and Teddy Bear Picnic tasks for measuring language and visuospa-
tial lateralization, respectively. The Magic Hat task is a modified version of the
What Box task. In the Magic Hat task, as in the What Box task, participants are
presented of images of objects and asked to label the object. Key changes in
the Magic Hat task include increasing the number of objects per trial from
one to four and shortening the object-labelling time to increase language
processing demands and thus increase the blood flow velocity response.
The Teddy Bear Picnic task is a visuospatial task designed to be closely
 ASYMMETRIES OF BRAIN, BEHAVIOUR, AND COGNITION 237

aligned to the processing demands of the Landmark task. Images of food

replace the horizontal line and a flashing knife replaces the vertical landmark.
On each trial, the knife appears at multiple horizontal positions and the aim of
the game is to “cut” the food in half by indicating when the knife is at the mid-
point of the food. In this study, we compared the new tasks with the Word Gen-
eration task and the Landmark task, respectively, in a sample of adults, because
both tasks are strongly supported as language and visuospatial lateralization in
adults and thus can provide a reference against which to compare the new
tasks (Jansen et al., 2004; Knecht, Deppe, Ebner, et al., 1998). We assessed
the internal reliability and validity of the new tasks by comparing the measures
of lateralization derived by the language tasks and the spatial tasks. The criteria
for determining the validity of the novel tasks was for each to have a positive
correlation of at least medium strength (i.e., Spearman’s rho of at least .40;
Dancey & Reidy, 2007) with the established tasks, respectively.

Materials and methods

Participants
Undergraduate psychology students and community members of the Univer-
sity of Western Australia were invited to participate if they were adults who
spoke English as a first language and had no known neurological conditions
(such as epilepsy or brain damage). Forty-five participants in total were
recruited to the study. The data of six participants (13.3% of the total) were
not included in the analysis due to inadequate fTCD signals (n = 5) or not speak-
ing English as a first language (n = 1), leaving 39 participants for analysis. Of
those participants, twenty-five self-reported as female, and fourteen as male.
The average age was 23.4 years old (range = 17-51 years; 10 participants pre-
ferred not to say). Thirty-two participants self-reported as right-handed, and
seven as left-handed. Student participants received course credit for partici-
pation, and non-students received $30 remuneration. All participants gave
their informed consent prior to participation. Ethics approval was granted by
the University of Western Australia Human Research Ethics Committee (RA/4/
20/6096).

Apparatus
Blood flow velocity in the left and right middle cerebral arteries was
measured simultaneously using either a DWL Multidop T device or a DWL
Doppler-Box device (DWL Elektronische Systeme, Singen, Germany). The
two 2 MHz transducer probes were positioned over the temporal windows
using a Diamon headset. Computer tasks were presented on a 21.5 inch
Dell SX2210 monitor using PsychoPy3 (v2020.2.5; Peirce et al., 2019).
238 J. E. QUIN-CONROY ET AL.

Participants were seated at a viewing distance of 50 cm from the monitor.

Event markers for each epoch were sent to the Multidop system via serial-
port pulses using a Neurospec MMBT-S Trigger Interface Box (NEUROSPEC
AG, Stans, NW, Switzerland).

Stimuli
All tasks are available on the Open Science Framework at https://osf.io/
62m3u/. Figure 1 shows example stimuli for the four tasks.

Word Generation Task

The Word Generation task consisted of 20 trials, one for each letter of the
English alphabet excluding “j”, “q”, “v”, “x”, “y”, and “z”. Each trial began with
a 35 s normalization period. During this time, the word “Relax” was shown
for 5 s followed by a blank screen for the remaining 30 s and the participant
was instructed to try to relax and let their mind go blank. A tone played and
the words “Clear mind” appeared on the screen for 5 s to alert the participant
to the beginning of the word generation period. A letter was presented on the
screen for 15 s, and the participant was instructed to silently think of as many
words as possible starting with the presented letter. Then the letter was
replaced by the word “Speak” and the participant spoke aloud the silently gen-
erated words. The trial ended either 20 s later or when the participant pressed
the space bar to indicate they had spoken every silently-generated word.
Spoken words were recorded for offline transcription.

Landmark Task
The Landmark task used in this study is based on the Landmark task
described by Rosch, Bishop, and Badcock (2012). The task consisted of 20
trials. As with the Word Generation task, each trial began with a 30 s normal-
ization period. During this time, the word “Relax” was shown for 5 s followed
by a blank screen for the remaining 30 s and the participant was instructed to
relax and let their mind go blank. A tone played and the words “Clear mind”
were shown to alert the participant to the beginning of the trials. A fixation
circle (width of 13.3° visual angle, height of 3.3° visual angle) was then dis-
played in the centre of the screen for 1 s to locate the landmark stimulus.
Each trial involved making six landmark decisions. At the beginning of
each landmark decision, the participant was presented with a horizontal
line (10° visual angle) which was bisected by a short vertical line (i.e., the land-
mark; 2° visual angle). The landmark bisected the horizontal line at its mid-
point for three stimuli, and at a non-midpoint position for three stimuli. For
non-midpoint stimuli, the landmark position was a randomized point
between 1° to 2° visual angle away from the true midpoint either to the
left or right. The order of the six stimulus positions was randomized every
 ASYMMETRIES OF BRAIN, BEHAVIOUR, AND COGNITION 239

Figure 1. Examples of stimuli used for the Word Generation task, the Landmark task, the
Magic Hat task, and the Teddy Bear Picnic task.
Note: Example stimuli for the language tasks (A. Word Generation and B. Magic Hat) and the spatial tasks
(C. Landmark task and D. Teddy Bear Picnic task). In addition, the possible landmark positions are shown
in grey for the Landmark task (E) and the Teddy Bear Picnic task (F).

trial. Participants were instructed to make a keyboard button response indi-

cating if the landmark was positioned at the true midpoint of the horizontal
line or not; half of the participants were instructed to press the “z” button to
indicate that the landmark was at the midpoint and the “/” button to indicate
the landmark was not at the mid-point, and vice versa for the other half of the
participants.
The landmark stimuli were shown for 200 ms, and then replaced by a visual
mask. A second visual mask then appeared 200 ms later, which remained on
240 J. E. QUIN-CONROY ET AL.

the screen until 1700ms had lapsed from the beginning of a trial or until the
participant made a response, at which time the third visual mask replaced the
second for the remaining time of the trial. The visual masks covered an area of
10° x 5° in size and consisted of 100 randomly generated lines (50 white, 50
black). Trials lasted 1700ms regardless of participant response. Accuracy
and reaction times were saved.

Magic Hat Task

The Magic Hat task consisted of 25 trials. Each trial began with a 19 s anima-
tion for the normalization period. This involved 5 s of the background image
(a blurred, symmetrical image of an innocuous environment which changed
each trial), then 9 s during which a cartoon face with a top hat and a wand
“moved” in steps down and then up the screen accompanied by movement
sound effects. For the remaining 5 s, the top hat “fell” into the lower half of
the screen, a voice (female, Australian accent) said “Look!”, and the face
waved its wand (accompanied by a chime sound). Following this, a 12 s
object labelling period began. The hat was replaced with four different
objects in succession. Each object was displayed for 3 s, along with a voice
asking what the object was (e.g., “What’s this?”, “What’s that?”, “What is
it?”) and the verbal label of the object after a 2 s delay. Participants were
instructed to verbally label the objects when prompted; although the task
should still be effective at eliciting language production if the words are pro-
duced covertly (see Badcock et al., 2018), overt language production is prefer-
rable because it gives an indication of task compliance. Following the object
labelling period, the face remained on the screen for 4 s while a celebratory
sound played (e.g., “Yay!”, “Yeah!”, crowd cheering). A voice then said “Shh”
and a hand making a “Shh” motion appeared on the face for the remaining
5 s of the period.
One hundred unique objects were included in the task. Objects were
chosen from the Australian-English dataset within the Wordbank database
(Frank, Braginsky, Yurovsky, & Marchman, 2017) based on words most fre-
quently known by 30-month-olds in the dataset. Images for the object
were sourced from several image databases, namely the Bank of Standar-
dized Stimuli database (Brodeur, Guérard, & Bouras, 2014), the MultiPic data-
base (Duñabeitia et al., 2018), and the THINGS database (Hebart et al., 2019).
Participants’ verbal responses were recorded and coded in terms of whether a
response was made and if the response was congruent with the object’s
given label (e.g., “TV” for the object “TV”) or alternate label (e.g., “monitor”
for the object “TV”).

Teddy Bear Picnic task

In the Teddy Bear Picnic task, an image of a knife moved to different points of
a piece of food, and the participant was asked to indicate when the knife was
 ASYMMETRIES OF BRAIN, BEHAVIOUR, AND COGNITION 241

in the middle of the food. There were 20 trials in the task. Each trial displayed
one of twenty types of food, each with six possible unique images. The
different food types, presented in a randomized order, were: apples, biscuits,
burgers, cakes, carrots, chips, chocolates, crackers, croissants, cupcakes,
donuts, fairy-bread, lollies, muffins, oranges, pizza, gummy snakes, strawber-
ries, tomatoes, and watermelon. Trials began with a 5 s period that displayed
a plate in the middle of the screen and the six possible images for that type of
food surrounding the plate, accompanied by a voice (female, Australian
accent, but not the same voice as in the Magic Hat task) labelling the food
type (e.g., “Let’s cut up some apples”, “Let’s cut up some biscuits”, etc.). At
the beginning of the food cutting period, the plate was shown on its own
for 500 ms, and then one of the food images (chosen at random, all 10.8°
in width) appeared on the screen. A knife was displayed for 100 ms at 500
ms intervals (i.e., flashing). For each food image, the knife flashed zero to
fives times, always finishing at the midpoint (note: for zero flashes, the
knife was only positioned at the mid-point). For the non-middle positions,
the knife appeared at a randomized location between 1.9° and 3.6° from
the midpoint, alternating left and right, until it was positioned at the mid-
point, at which point it continued flashing at 500 ms intervals until a
button response was made (i.e., pressing the spacebar). A button response
before the knife was positioned in the middle had no effect on the trial.
After a correct response was made, the knife was shown at the midpoint of
the food image for 400 ms accompanied by a chopping sound to reinforce
the response. The process repeated for different food images until 12 s had
lapsed from the beginning of the food cutting period, at which point the
food cutting period would end after a correct response to the current food
image. A normalization period, lasting 22 s, followed the food cutting
period. The plate remained on the screen for 2 s, and then a 10 s animation
of a teddy bear “moving” in steps to the centre of the screen, “eating” one of
the food images and “dancing” (i.e., rotating slightly left and right) was
shown, accompanied by sound effects. For the following 10 s, the screen
faded to black, and the voice said “Shh”.
The majority of food stimuli was sourced from the Cross-Cultural Food
Image Database (Toet et al., 2019) and the Food-Pics Database (Blechert,
Lender, Polk, Busch, & Ohla, 2019). Additional images were taken by researcher
JQ. Images were selected to be approximately symmetrical in shape and easily
identifiable or edited to achieve an approximately symmetrical shape. All
images were presented with the same width spanning a visual angle of 10.8°.

Data analysis
The fTCD data was processed offline using the MATLAB-based summary-suite
called DOPOSSCI version 3.6.4 (Badcock, Holt, Holden, & Bishop, 2012; see
242 J. E. QUIN-CONROY ET AL.

https://github.com/nicalbee/dopStep). Data was processed using the steps

described by Deppe, Knecht, Henningsen, and Ringelstein (1997) and
Badcock et al. (2018).
The raw fTCD data was imported into MATLAB and event markers were
extracted. Event markers indicated the beginning of the stimulus period.
Data transformation involved linear correction for heart cycle patterns (see
Badcock et al., 2018). Extreme values beyond −3 and 4 standard deviations
from mean activation, affecting less than 5% of the data, were corrected
using MATLAB’s “linspace” function to draw a straight line between values
1.5 s either side of the extreme value. Epochs were extracted from the data
relative to each marker from −15 to 35 s for the Word Generation task,
from −15 to 25 s for the Landmark task, from −15 to 20 s for the Magic
Hat task, and from −10 to 20 s for the Teddy Bear Picnic task. Data from
the left and right channels for each epoch were normalized to a mean of
100. Epochs were rejected if they contained values below 70 or above 130,
or if a left-minus-right difference was greater than 20 times the participant’s
inter-quartile range.
The epochs were baseline corrected, which was calculated within the pre-
trial rest period for each task. For the Word Generation and Landmark tasks,
the baseline period was selected to be −15 to −5 s before the trial period
based on previous research (Badcock et al., 2018; Flöel et al., 2001; Knecht,
Deppe, Ringelstein, et al., 1998). Given the 5- to 7-second delay in activation
due to neurovascular coupling (Rosengarten, Osthaus, & Kaps, 2002), the
baseline period for the Magic Hat task and the Teddy Bear Picnic task was
chosen as −8 to −3 s before the trial period, which corresponds with the
end of the normalization period for both tasks. The period of interest (POI)
for all tasks was 5–15 s after the markers. Timelines for all the tasks, including
each tasks’ baseline and period of interest, are shown in Figure 2.
Laterality indices for each task were calculated as the mean left-minus-
right blood flow velocity difference within the entire period of interest
(Petit, Badcock, & Woolgar, 2020; Woodhead, Rutherford, & Bishop, 2018).
Based on previous research (Badcock et al., 2018), a minimum of 10 epochs
were required for the calculation of LIs for each task. Positive LIs indicate left-
ward lateralization, and negative LIs indicate rightward lateralization. Internal
reliability for each task was estimated in two ways; odd-even trial split-half
reliabilities are presented, as is common in fTCD lateralization research
(Badcock et al., 2018; Groen et al., 2011; Illingworth & Bishop, 2009), as well
as Cronbach’s alpha calculated across all acceptable epochs for each partici-
pant. Associations between language and visuospatial task LIs were tested
using Spearman’s rank order correlations to reduce the impact of extreme
LIs (see Badcock et al., 2018). Additionally, individual laterality indices were
categorized as left, right, or neither based on the 95% confidence interval
overlap with zero (i.e., an LI was labelled as left lateralized if the lower
 ASYMMETRIES OF BRAIN, BEHAVIOUR, AND COGNITION 243

Figure 2. Timelines for the Word Generation task, the Landmark task, the Magic Hat
task, and the Teddy Bear Picnic task.
Note: POI = period of interest.

confidence interval was greater than zero, etc.). To test the relationship
between categorisations for the language and visuospatial tasks, categories
were coded ordinally (left = 1, bilateral = 0, right = −1) and correlated using
the Spearman method. Behavioural data for the Magic Hat and Teddy Bear
Picnic tasks was also correlated against the LIs for each task respectively, to
test if task performance affected LIs. The data, as well as the scripts used to
analyse the data, are available on the Open Science Framework at https://
osf.io/62m3u/.

Procedure
The child-friendly tasks differ in presentation to the adult tasks, in terms of
colourful backgrounds, fun sounds, and diverse stimuli designed to engage
young children. Therefore, to avoid possible between-task habituation
effects (Vingerhoets & Stroobant, 1999) caused by completing the novel
tasks before the adult ones, participants completed the adult tasks first,
and the child-friendly tasks second. Twenty-nine participants completed all
four tasks in a counterbalanced order; half of the participants completed
the language tasks first (i.e., [1] Word Generation, [2] Landmark, [3] Magic
Hat, [4] Teddy Bear Picnic), and the other half completed the spatial tasks
first (i.e., [1] Landmark, [2] Word Generation, [3] Teddy Bear Picnic, [4]
Magic Hat). We used a Bayesian-stopping rule to determine our sample
244 J. E. QUIN-CONROY ET AL.

size. Bayes Factors were based on the Spearman rank order correlation (see
van Doorn, Ly, Marsman, & Wagenmakers, 2020) between the LIs for the
two language tasks and the two visuospatial tasks. An upper Bayes Factor
of 3 and lower Bayes Factor of .3 was chosen a priori as thresholds for
sufficient evidence for or against the hypothesized relationship between
tasks (Wetzels et al., 2011). The Bayes Factor associated with LIs generated
from the visuospatial tasks exceeded the upper threshold (BF10 = 7.54, n =
24), indicating conclusive data for the Landmark and Teddy Bear Picnic
tasks (i.e., a relationship between the tasks). The Bayes Factor for the
language tasks did not exceed either threshold (BF10 = 2.75, n = 25). There-
fore, subsequent participants only completed the language tasks (i.e., [1]
Word Generation, [2] Magic Hat). Bayes Factors were re-analysed at the end
of each testing week. Including 11 additional participants, the Bayes Factor
for the language tasks exceeded the upper threshold (BF10 = 17.95, n = 36)
and data collection was discontinued. A complete diagram outlining the
flow of participants in the study is presented in Figure 3 for clarity.

Results
Thirty-six participants (three exclusions) had 10 or more acceptable epochs
for both the Word Generation and Magic Hat tasks, and therefore were
included in the language task analyses. Twenty-four participants (two exclu-
sions) had 10 or more acceptable epochs for the Landmark and Teddy Bear
Picnic tasks, and therefore were included in the visuospatial task analyses.
Median, IQR, and range of accepted epochs for each task are presented in
Table 1. No LI values were beyond 3 SDs from the mean.
The mean number of words generated per trial during the Word Gener-
ation task was 7.0 (SD = 2.2, min = 2.6, max = 11.7). Behavioural data for the
Magic Hat task was not collected for 13 participants due to recording error,
however this is not a major issue because the purpose of the Magic Hat
behavioural data is to ensure task engagement, and all 13 participants
were noted to be engaged throughout the task. For the remaining partici-
pants (n = 23), the mean proportion of congruent word labels (out of 100
words total in the task) was 91.1% (SD = 43.9%, min = 79%, max = 99%), the
mean proportion of alternate responses was 8.7% (SD = 3.7%, min = 1%,
max = 20%), and the mean proportion of trials with no responses given
was 0.1% (SD = 0.1%, min = 0%, max = 1%). The most common alternate
responses given were “rabbit” instead of “bunny” (n = 18), “bath” instead of
“bathtub” (n = 13), “parrot” instead of “bird” (n = 13), and “cookie” instead
of “biscuit” (n = 12). Theoretically, the exact label given by the participant is
irrelevant, as long as they are producing language by assigning a label to
the object. However, to ensure that there is no effect of perceived errors
(i.e., the task label being different to the participant’s label) on LIs, the
 ASYMMETRIES OF BRAIN, BEHAVIOUR, AND COGNITION 245

Figure 3. Participant Flow Diagram.

Note: fTCD = functional transcranial Doppler ultrasound.

Magic Hat LIs were correlated with participants’ proportion of congruent and
alternative answers. Magic Hat LIs were correlated with participants’ pro-
portion of congruent and alternative answers. There was a small, non-signifi-
cant correlation between Magic Hat LIs and the proportion of congruent
answers, ρ = .14, p = .530, or proportion of alternate answers, ρ = .13, p
= .554; thus, we consider the alternate answers to be inconsequential.

Table 1. Median and spread of epochs across participants for language (n = 36) and
visuospatial (n = 24) tasks.
Task Median (IQR) Range
Language Word Generation 20 (1) 13–20
Magic Hat 25 (1) 12–25
Visuospatial Landmark 20 (0) 16–20
Teddy Bear Picnic 20 (0) 14–20
Note: The Magic Hat task includes 25 possible epochs, all other tasks include 20 possible epochs.
246 J. E. QUIN-CONROY ET AL.

Table 2 shows the accuracy and reaction times for the Landmark and
Teddy Bear Picnic tasks. Responses to the Teddy Bear Picnic task were
faster and more accurate than the Landmark task. These differences are as
expected, given that the child-friendly task was designed to be less difficult
than the Landmark task. Teddy Bear Picnic LIs were non-significantly corre-
lated with task reaction time, ρ = -.02, p = .914, or accuracy, ρ = -.24, p
= .554. The slowest mean reaction time for an individual participant for the
Teddy Bear Picnic task was 322 ms (SD = 68 ms). This indicates that the par-
ticipants predominantly responded before the knife flashed at the midpoint a
second time (i.e., at 500 ms).
Group-averaged change in blood flow velocity for the left and right middle
cerebral arteries and left-minus-right difference waveforms for all four tasks
are shown in Figure 4. The Word Generation and Landmark responses are
qualitatively similar to previous fTCD research using these tasks, showing
characteristic preparation and response peaks and maximal left-minus-right
difference within the period of interest. Of note for the child-friendly tasks
are the multiple peaks in the Magic Hat task, likely related to stimulus
onset, and the smooth increase in the Teddy Bear Picnic, which is likely
due to the variation in stimulus presentation timing across trials. Importantly,
both child-friendly tasks show a maximal left-minus-right difference within
the periods of interest. Table 3 presents mean LIs for each task, as well as
the results of one-sample t-tests to determine statistical difference from
zero and internal reliability. The mean LIs for all four tasks were significantly
different from zero. Word Generation and Magic Hat LIs were positive, indicat-
ing left lateralization across the sample. Landmark and Teddy Bear Picnic LIs
were negative, indicating right lateralization across the sample. The odd-even
split-half reliability for all four tasks was significant and greater than .7, indi-
cating a level of internal reliability in-line with or greater than past fTCD
research (Badcock et al., 2018; Groen et al., 2011; Illingworth & Bishop,
2009). All Cronbach’s α exceeded .8 for all tasks, indicating good internal
reliability for psychological research (Nunnally & Bernstein, 1994).
The relationship between LIs for the language tasks and visuospatial tasks
are shown in Figure 5. There was a statistically significant, moderate corre-
lation between LIs for the Word Generation and Magic Hat task, ρ = .52, p
= .001. There was also a statistically significant, moderate correlation
between LIs for the Landmark task and the Teddy Bear Picnic task, ρ = .45,
p = .028. Participants were categorized as being left lateralized, right

Table 2. Accuracy (%) and mean reaction time (ms) for the visuospatial tasks.
Accuracy (%) Reaction Time (ms)
Mean (SD) Range Mean (SD) Range
Landmark 93.78 (3.51) 84.17–99.17 569 (158) 88 - 766
Teddy Bear Picnic 99.5 (0.52) 98.22–100.00 298 (17) 265 - 322
 ASYMMETRIES OF BRAIN, BEHAVIOUR, AND COGNITION 247

Figure 4. Group-averaged change in blood flow velocity for the Word Generation, Magic
Hat, Landmark, and Teddy Bear Picnic tasks.
Note: Blood flow velocity change for the left (unbroken blue line) and right (dashed red line) middle
cerebral arteries for the language tasks (A. Word Generation and B. Magic Hat) in the top row and visuos-
patial tasks (C. Landmark and D. Teddy Bear Picnic) in the bottom row. The green dotted line represents
the left-minus-right difference. Shaded ranges show the 95% confidence intervals. The baseline period
and period of interest are shown in grey.

lateralized, or bilateral for each task according to 95% confidence intervals (as
explained in the Materials and Methods section). Table 4 reports the number
and proportion of participants in each category for each task. For the language
tasks, 72.2% of participants (n = 26) had the same categorization for both tasks.
For the visuospatial tasks, 62.5% of participants (n = 15) had the same categor-
ization for both tasks. There was a positive, moderate relationship between cat-
egorisations for the language tasks, ρ = .52, p = .001, and the visuospatial tasks,
ρ = .42, p = .004. This indicates that the LIs produced by the child-friendly tasks
are convergent with those of the adult counterparts, regardless of whether raw
LIs or LI categorisations are used. Visual inspection of Figure 5 indicated a poss-
ible difference in the size of 95% confidence intervals between the child-friendly

Table 3. Laterality index descriptive and inferential statistics, odd-even split-half (ρ) and
Cronbach’s α reliabilities for the Word Generation, Magic Hat, Landmark, and Teddy Bear
Picnic tasks.
Task n Mean (SD) Range t a
Cohen’s d ρ b
Cronbach’s α
Word Generation 36 1.69 (1.92) −4.77–5.44 5.28** .88 .80** .84
Magic Hat 36 1.08 (1.95) −4.54–4.82 3.33* .55 .85** .86
Landmark 24 −2.19 (1.98) −6.67–1.37 −5.43** 1.12 .73* .87
Teddy Bear Picnic 24 −1.62 (1.73) −5.88–1.71 −4.57** .94 .71* .83
a
The results of a one-sample t-test to determine statistically significant difference from zero. b Adjusted
using the Spearman-Brown prophesy formula. *p < .01. **p < .001.
248 J. E. QUIN-CONROY ET AL.

Figure 5. Scatter plots of the laterality indices for the language and visuospatial tasks.
Notes: LI = laterality index. Language task LIs (Word Generation and Magic Hat, n = 36) are shown in
panel A, and visuospatial task LIs (Landmark and Teddy Bear Picnic, n = 24) are shown in panel
B. Spearman correlations and p-values for each plot are included. Error bars display the 95% confidence
intervals for each participant, coded by colour and pattern according to the LI categorization of each
task: an unbroken blue line indicates left lateralization, a dashed red line indicates right lateralization,
and a dotted purple line indicates bilaterality. In addition, black circles indicate participants in the
same category for both tasks (e.g., both tasks indicate left lateralization), and white circles indicate par-
ticipants in different categories for both tasks (e.g., one task indicates left lateralization, and one task
indicates bilaterality). A dashed grey line is included as a visual reference for consistent LI mappings.

Table 4. Numbers (percentages) of participants in each category by task.

Task Left Bilateral Right
Language Word Generation 23 (63.8%) 12 (33.3%) 1 (2.7%)
Magic Hat 17 (47.2%) 16 (44.4%) 3 (8.3%)
Visuospatial Landmark 1 (4.2%) 5 (20.8%) 18 (75.0%)
Teddy Bear Picnic 1 (4.2%) 12 (50%) 11 (45.8%)

tasks and adult tasks. To test this, paired samples t-tests were run between par-
ticipants’ LI standard deviation across all epochs of the Word Generation task
(M = 2.89, SD = 0.78), the Magic Hat task (M = 3.70, SD = 1.58), the Landmark
task (M = 3.07, SD = 0.93), and the Teddy Bear Picnic task (M = 3.51, SD = 1.08).
There was a large significant difference between the language tasks, t(35)
3.32, p = .002, d = .55, and a medium significant difference between the visuos-
patial tasks, t(23) −3.05, p = .006, d = .43.

Discussion
Very few tasks for determining language and visuospatial lateralization exist
for young children, and those that do exist have considerable drawbacks
 ASYMMETRIES OF BRAIN, BEHAVIOUR, AND COGNITION 249

relating to task complexity and validity when compared to gold-standard

adult tasks. This represents a problem for researchers wishing to examine
language and/or visuospatial lateralization in early development. The
current paper describes two novel tasks, the Magic Hat and Teddy Bear
Picnic tasks, which were developed to solve this problem. Measures of later-
alization for both tasks were compared against the gold-standard fTCD tasks
for adults, the Word Generation task and the Landmark task respectively. Both
language tasks produced an overall leftward lateralization, and both visuos-
patial tasks produced an overall rightward lateralization, as expected
(Badcock et al., 2018; Hervé et al., 2013), with acceptable internal reliability.
LIs generated by the Magic Hat task were moderately associated with LIs gen-
erated by the Word Generation task. Likewise, LIs generated by the Teddy
Bear Picnic task were moderately associated with the LIs generated by the
Landmark task. Both associations exceeded the benchmark of ρ = .4, based
on the standard set by previous research (Badcock et al., 2018). Overall, this
paper provides evidence for the reliability and validity of the child-friendly
tasks in adults, demonstrating the Magic Hat and Teddy Bear Picnic tasks
to be research ready measures of language and visuospatial lateralization.
The Magic Hat task presents an alternative to previous child-friendly fTCD
language tasks, such as the Picture Description (Lohmann et al., 2005), the Ani-
mation Description (Bishop et al., 2009), and What Box (Badcock et al., 2018).
The split-half reliability of the Magic Hat task (.85) was slightly below that of
the Picture Description and Animation Description tasks (.93 and .91 respect-
ively; Bishop et al., 2009), but still well above acceptable limits of reliability
for both split-half reliability coefficients and Cronbach’s alpha (Nunnally & Bern-
stein, 1994). The Magic Hat task also has a similar Spearman correlation with
the Word Generation task for adults (ρ = .52) as the Picture Description and Ani-
mation Description tasks (ρ = .51 and ρ = .47 respectively; Bishop et al., 2009).
Overall, this suggests that the Magic Hat task is comparably reliable and valid to
both previous tasks. Unlike the Picture Description and Animation Description
tasks however, the Magic Hat task does not require sustained attention
throughout the stimulus period and does not require production of full sen-
tences or overt language, making it preferable when working with populations
who have difficulties with sustained attention or overt language production.
Compared to its predecessor, the What Box task, the Magic Hat task is superior
in measures of both reliability and validity (the What Box task had a split-half
reliability of .71 and a disattenuated correlation of ρ = .40; Badcock et al.,
2018). This is likely due to the increase of words per epoch from one in the
What Box task to four in the Magic Hat task, as well as the decrease in time
given to respond to each word. By increasing the language demand of the
task, we have likely increased the cerebral blood flow velocity response to
language stimuli, thus increasing the likelihood of attaining an accurate
measurement of language lateralization for any given epoch.
250 J. E. QUIN-CONROY ET AL.

To our knowledge, the Teddy Bear Picnic task is the first reported fTCD task
for determining lateralization of visuospatial attention in children under the
age of five. The Rabbits task has been used in several instances to measure
visuospatial lateralization in children six years and above (Groen et al.,
2011, 2012). However, the Rabbits task is a measure of visuospatial
memory, whereas the Teddy Bear Picnic and Landmark tasks are considered
measures of visuospatial attention. Memory and attention are both visuospa-
tial processes typically served by a right-hemispheric visuospatial network
(Awh & Jonides, 2001), which is reflected in the fact that both types of
tasks produce right lateralization in fTCD studies (Lust et al., 2011; White-
house & Bishop, 2009). However, as noted by Whitehouse and Bishop
(2009), little is known about how visuospatial memory and attention laterali-
zation are related, particularly in terms of early development. In addition, the
Teddy Bear Picnic task was designed to be suitable for children under the age
of five, unlike the Rabbits task, and does not require a touchscreen monitor.
For these reasons, the Teddy Bear Picnic task is an attractive alternative to the
Rabbits task for researchers wishing to directly compare fTCD results between
adults and children, or those interested in early stages of visuospatial devel-
opment and lateralization.
An incidental finding of note in the current study is the increased LI varia-
bility for both child-friendly tasks. For the Magic Hat and Teddy Bear Picnic
tasks, participants showed a more inconsistent left-minus-right difference
across individual epochs compared to the Word Generation task and Landmark
task. This difference can be observed in the error bars in Figure 5 (i.e., greater LI
variation is reflected in larger 95% confidence intervals). Importantly, LIs and
laterality categorisations still showed a medium correlation between the
language and visuospatial tasks, indicating that the greater variability in LIs
likely did not have a substantial impact on lateralization estimates for the
child-friendly tasks. The increased LI variability is likely a result of the variation
within the task designs; both child-friendly tasks display novel stimuli in each
block in the form of different objects to label/bisect. Additionally, the normal-
ization periods are designed to be more engaging for young children, and are
therefore “busier” in the child-friendly tasks – with a cartoon face moving up
and down the screen in the Magic Hat task and a teddy bear eating food in
the Teddy Bear Picnic – compared to the blank screen and clear mind instruc-
tions in the Word Generation task and Landmark task. In this case, the greater LI
variation can be viewed as a necessary compromise for increased task engage-
ment and completion when administered with young children.

Conclusion
This paper has reported on two novel fTCD tasks designed to be fun and easy
for children less than five years old, while allowing researchers to measure
 ASYMMETRIES OF BRAIN, BEHAVIOUR, AND COGNITION 251

language and visuospatial lateralization. Both tasks have low language and
cognitive demands, making them ideal for use with toddlers and young chil-
dren. The tasks can also be used to measure language or visuospatial latera-
lization in a wide range of other populations, including those with language
or spelling difficulties (e.g., dyslexia, specific language impairment, autism) or
difficulties with memory and task adherence (e.g., intellectual impairment,
brain damage, or aging).

Acknowledgements
We would like to thank Jessica Quin-Conroy and Jasmine Quin-Conroy for generously
lending their time and voice talents to the creation of the tasks. We would also like to
thank Murray Mayberry for early discussions about the tasks.

Disclosure statement
No potential conflict of interest was reported by the author(s).

Funding
This research is supported by an Australian Government Research Training Program
(RTP) Offset under Grant 10306140.Department of Education, Skills and Employment,
Australian Government

Data Availability Statement

Data associated with this paper can be found and accessed on the Open Science Fra-
mework at https://osf.io/62m3u/.

ORCID
Josephine E. Quin-Conroy http://orcid.org/0000-0001-9961-5301
Yanyu Chen http://orcid.org/0000-0003-0652-3139
Donna M. Bayliss http://orcid.org/0000-0001-5940-5211
Nicholas A. Badcock http://orcid.org/0000-0001-6862-4694

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