A small percentage of the population struggles with a complete lack of navigational skills; most are men, which is rich

“Where am I?” A snapshot of the developmental topographical disorientation among young Italian adults. Laura Piccardi et al. PLoS, July 20, 2022. https://doi.org/10.1371/journal.pone.0271334

Abstract: In the last decade, several cases affected by Developmental Topographical Disorientation (DTD) have been described. DTD consists of a neurodevelopmental disorder affecting the ability to orient in the environment despite well-preserved cognitive functions, and in the absence of a brain lesion or other neurological or psychiatric conditions. Described cases showed different impairments in navigational skills ranging from topographic memory deficits to landmark agnosia. All cases lacked a mental representation of the environment that would allow them to use high-order spatial orientation strategies. In addition to the single case studies, a group study performed in Canada showed that the disorder is more widespread than imagined. The present work intends to investigate the occurrence of the disorder in 1,698 young Italian participants. The sample is deliberately composed of individuals aged between 18 and 35 years to exclude people who could manifest the loss of the ability to navigate as a result of an onset of cognitive decline. The sample was collected between 2016 and 2019 using the Qualtrics platform, by which the Familiarity and Spatial Cognitive Style Scale and anamnestic interview were administered. The data showed that the disorder is present in 3% of the sample and that the sense of direction is closely related to town knowledge, navigational strategies adopted, and gender. In general, males use more complex navigational strategies than females, although DTD is more prevalent in males than in females, in line with the already described cases. Finally, the paper discusses which protective factors can reduce DTD onset and which intervention measures should be implemented to prevent the spread of navigational disorders, which severely impact individuals’ autonomy and social relationships.

Discussion

The present online investigation aimed to estimate the presence of DTD in a large young Italian sample to better understand the spread of this condition in the population. Thus, we considered the percentage of the DTD in a sample of 1,698 participants, using as a basic criterion 2 standard deviations below the means of the SOD. Then, we also investigated the critical factors predictive of both the SOD and DTD. As in Iaria and Barton’s study [74], we confirmed that the rate of occurrence of the disorder is not a rare condition; rather, it affects 3% of young people undermining their autonomy and ability to work away from family boundaries.

As concerns the predictive factors of SOD, the analyses showed that gender more than educational level is strictly related to SOD. In particular, although females use more landmark-based navigational strategies and complain more difficulties in SOD, males show a higher risk of DTD than females. Indeed, given a glance at the DTD literature, the most of the single cases described are males; this means that although males have better visuospatial and navigational skills than females, they are also the most fragile [69, 70, 72, 75, 77]. Moreover, SOD was related to TK and Survey competencies. Iaria and co-workers [87] clarified that normal navigators can switch from one strategy to another by increasing their familiarity with the environment. This means that it is possible to implement higher navigational skills by acting on environmental knowledge. Also in Nori and Piccardi [37] emerged that when the individual was familiar with the environment, even if s/he generally preferred low navigational strategies, s/he was able to perform more complex navigational tasks in that specific environment, therefore, citizens of Bologna who were familiar with a neighbourhood of the city were able to recognize rotated monuments of the city even though their ability to mentally rotate an object was low [37, 84].

Consistent with these results, we found that TK and the Survey strategy are negatively related to DTD, suggesting that they can be protective factors in counteracting the onset of DTD. In this vein, Bartonek and co-workers [88–90] showed that children with cerebral palsy and motor disability manifested differences in topographic working memory as a function of the degree of autonomy to explore the environment, regardless of motor impairment. Our results also showed that the use of advanced navigational strategies (survey strategies) is not associated with the presence of DTD. In line with this finding, we also showed that individuals who achieve high spatial skills do not complain of RLC, which is generally involved in navigational disorders [60]. Consistent with this result, Giancola et al. [36] showed that survey strategies also characterise samples of experienced navigators, such as military pilots. According to Verde et al. [32, 33, 91, 92] this professional category is already selected on the basis of spatial and navigational skills. In addition, the military training would reinforce the survey strategy even more, including all those cognitive processes related to navigation, such as the ability to mentally rotate two and three-dimensional objects [93] or the ability to make directional and metric judgments.

Undoubtedly, the presence of a navigational deficit can also make the subject anxious and more reluctant to explore the environment, so it is difficult to determine how much one comes before the other. This result is particularly interesting in light of Lopez et al.’s [94] study, which showed that the role of the direct experience with exploring hometown on spatial mental representations appeared to be more important in the elderly than in young people. Our sample includes young people, therefore we can imagine that TK and the Survey strategy protects not only seniors from the detrimental effects of ageing on spatial mental representations but also young people in acquiring spatial competence by reducing the risk of navigational disorders.

Given the key role of spatial strategies, our results imply navigational training starting with pre-schoolers, in order to prevent the DTD, such as the one already used in Boccia et al. [95], which allows implementing spatial orientation and autonomy skills from the earliest years of life, starting in kindergarten. The introduction of navigational training in education settings may be useful not only for healthy children but also for children with different types of disabilities (e.g. sensory-motor impairments or acquired brain-damaged or ADHD: [96]), who show several navigational disorders. Furthermore, given that simply enhancing cognitive performance is insufficient to reduce a sense of inadequacy about one’s ability [97], the introduction of training activities specifically designed to improve metacognition would improve self-efficacy in individuals with respect to their SOD and related activities, and by consequence would reduce the risk of DTD. In this vein, De Lisi and Wolford [98] showed children improvements in mental rotation through the daily practice of the popular video game Tetris. This policy of intervention could have important spin-offs increasing also social life.

The current research is not without limitations. First, the study was conducted using an online self-reported survey. In the future it will be important to investigate DTD in presence using a battery of navigational tests. For example, no significant result was found in terms of MoT (active and/or passive movements in the environment). Probably this aspect should be investigated differently by quantifying more precisely the movements and their duration and stratifying the sample by strategies developed. Future work should investigate this component along with environmental characteristics (size of the place where one lives; the presence of distant landmarks; need to travel far to receive medical care or to use school services). Second, individuals with DTD were not tested for other cognitive deficits using a battery of neuropsychological tests, but were only asked to report if they suffered from cognitive disorders. Third, the diagnosis of DTD was not supported by structural imaging data in order to exclude the presence of any brain lesions.

In conclusion, the present study allowed us to identify in a large sample of young Italians the presence of DTD and its occurrence. It has also allowed us to observe protective factors that are associated with good navigational skills and that in the future can be used within protocols for the prevention of the development of spatial orientation disorders, as well as to promote these skills by reducing the gender gap that still emerged in this sample.