PEACFUL
COEXISTENCE
by Lynn Richman
Lynn Richmann is professor and directory of the division of pediatric psychology at the University of Iowa College of Medicine. He directs the Pediatric Learning Disorders Clinic. This article is adapted from his presentation at the conference on hyperlexia held in Oak Brook Illinois, October, 1996.
When you speak about hyperlexia, you must talk about language learning disorder. When you talk about them both, you need to address autism. More recently, when you talk about hyperlexia, you need to think about the nonverbal learning disorders as well. When you talk about hyperlexia and nonverbal learning disorders, you must talk about Asperger's syndrome. When you talk about all of these, you always need to consider that Attention Deficit Disorder may be a coexisting trait.
When talking about any of these learning functions, two spectrums are important. First is the social perception spectrum, running from low to high awareness of social cues and appropriate behaviors. Second is the cognitive balance spectrum, measuring both performance (non-verbal) IQ and verbal IQ. Rather than being an unrelated set of characteristics, hyperlexia is best understood in the context of these spectrums and how the various disorders are expressed on these continuums.
In our work, we have identified two subtypes of hyperlexia. One group has a language disorder, which is what you generally see in the literature. Another group has a visual spatial motor disorder. In our group with language learning disorders, we often found lower verbal IQ and higher performance IQ. We found superior visual memory in almost al cases.
For the visual spatial motor type, we often found a lower performance or nonverbal IQ and a higher verbal IQ. It seems unusual to talk about a higher verbal IQ in a child who has a language disorder, but when you look at the nonverbal learning disordered kids or Asperger's Syndrome, you see children who have relatively intact language in many ways but have difficulty in the use of language pragmatically. This group had superior auditory memory, but they had impaired cognitive organization. The language learning disorder group had more phonics errors when they were reading, whereas the visual spatial disordered type had very few phonics errors.
| Hyperlexia Language Disorder | Hyperlexic Visual-Spatial Disorder | |
|---|---|---|
| Expressive language deficit, despite good rote memory skills. Language is delayed, echolalic and perserverative. Problems in understanding overall meaning beyond rote recall. Autistic like symptoms. | Definition | Visual spatial and/or motor delay of disorder. Language pragmatic deficit in expressing and interpreting experiential aspects of language and environment. Asperger-like symptoms. |
| Problems with reading comprehension may not show up in the early grades because of good memory. Make tangential associations, which produce offbeat responses. Immature, unaware of other's reactions, does not consider consequences of behavior. Distractible and inpulsive, but this may be related ot a language deficit. Processing speed is a problem. Autistic symptoms drop off as language improves. | Symptoms | May have letter and word reversals but reading comprehension good. Difficulty with worksheets and copying problems from the blackboard or book. Unorganized and inpulsive. Social inperceptions, problems reading nonverbal cues. Does not learn from experience and continues to make same mistakes. |
| Needs intensive language therapy. As language improves, integrate language and social skills training. Allow more time; slow down the speed of tests. De-emphasize oral reading ability and work on reading for meaning. | Remediation | Avoid purely visual approaches; use strength in verbal reading. Talk through perceptual tasks. Avoid copying from blackboard. Allow child to answer orally or tape record when possible. Use congnitive behavior modification to reduce impulsivity. Needs social training to increase social perception. |
Using language functionally, reading other people's intentions are areas where language problems occur. Children with Asperger's Syndrome usually have a deficity in nonverbal skills, and I would cal that a cognitive problem. There are often problems in visual motor integration skills, visual spacial orientation and spatial memory. Often these characteristics are not measured and therefore missed. They need to be looked at.
We can view hyperlexia as an overlap between autism and language learning disorder, or between Asperger's Syndrome and a nonverbal disorder. The hyperlexic child in the language disorder category is more likely to have deficits in language association, expressive language, reading comprehension and some social difficulties. However, many of the children with language learning disorders do not have major social perceptual problems. Those that do overlap with the autism group.
Children with the nonverbal learning disorder type of hyperlexia overlap with Asperger's kids, who have a very low social perception. The characteristics of the nonverbal language disorder hyperlexia are deficits in visual spatial organization, fine motor coordination and math. The children will have adequate to advanced level of word recognition, good verbal learning and a high amound of verbal output. However, social imperceptions and inappropriate affect are common.
Asperger's kids generally have better use of some aspects of language than children with Autism. Asperger's kids often wish to be sociable but fail, and that is a cardinal feature to look at. The child with autism has such difficulty socializing that he does not even try. Cognitive symptoms and social symptoms need to be looked at together as core features of both autism and Asperger's syndrome.
Rather than being a separate diagnosis, hyperlexia may be a coexisting diagnosis. The hyperlexia child can fit into some categories that have already been established.
Interest in hyperlexia is growing as we get more information out across the country. We have the problem of fitting it into the context of current diagnostic categories. Those diagnostic categories may not be valid for the hyperlexic child if you simply use the checklist to see if a child qualifies for a diagnosis. If hyperlexia becomes listed as a primary disorder, many children will be misdiagnosed, just as other problems are misdiagnosed now. If you think about the content of verbal and nonverbal skills and the level of social perception and don't jump to conclusions, children with hyperlexia can be identified under a system of coexisting diagnoses.
Article originally appeared in the Winter 1997 AHA Newsletter