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HYPERLEXIA
The topic of hyperlexia intrigued me because I thought I knew what it was. I did not! Recently I read an article on dyslexia that mentioned hyperlexia as the opposite of dyslexia but with hyperlexia there was no comprehension. I had already diagnosed, in my own mind, two or three students at my school as having this problem. Although the information on hyperlexia is sketchy and at times contradictory I am no longer trying to put those particular students into the hyperlexia box. My purpose, with this paper, is to interpret the knowledge that exists on hyperlexia and organize this knowledge into what hyperlexia is, the connection to autism, PDD and nonverbal learning disorders, assessment and remediation and the brain connection. The literature on the subject of hyperlexia indicates that it is far more likely to occur in boys so I will be using the pronoun he when referring to a hyperlexic child.

THE SYNDROME OF HYPERLEXIA

The American Hyperlexia Association (aha) gives three guidelines to use when considering a hyperlexia diagnosis. These guidelines are social interaction, repetitive behavior, and communication problems. If a child exhibits these signs then he probably will meet the criteria for the autistic spectrum disorder called Pervasive Developmental Disorder (PDD) as described in the Diagnostic and Statistical Manual IV (DSM-IV). (Bligh, 1995) Hyperlexia is not a medical diagnosis so PDD is used to classify children in order to provide services under the Individuals with Disabilities Education Act (IDEA). In addition to these three very important factors is the presence of a precocious ability to read, far above what would be considered normal for the chronological age.

Social interaction is an important characteristic of hyperlexia. These children do not interact well with their peers. They have abnormal social skills and have difficulty in socializing. This difficulty is caused by a child s inability to comprehend the intentions of others through their words and language, emotions and expressions (Kroll, 1998). The hyperlexic child will find it easier to grasp language information that they see, better then that which they listen to (Kroll, 1998). In a social situation where there is only verbal interaction the child with hyperlexia will not understand the intention of the spoken words so he will be apt to be a loner and play by himself. Children with hyperlexia tend to be aloof from other children since they do not know what to say to facilitate interactions (Kupperman).

Repetitive behavior is the second important component of hyperlexia. This behavior may exhibit itself in echolalia, perserveration and engaging in repetitive patterns of behavior such as reading with an abnormal intensity, repetitive motor mannerisms (hand flapping) or preoccupation with parts of objects (Bligh, 1995). The hyperlexic child learns expressive language by echoing what he hears. He will memorize complete sentences and phrases without understanding the meaning of the words. These same phrases will then be repeated verbatim at a time when it may be totally inappropriate. The hyperlexic may also have mild to severe stuttering problems. He has an intense need to keep routines and may engage in ritualistic or self-stimulating behavior. He has sensitivity to loud noises and strong odors.

Communication problems keep the hyperlexic child from acting appropriately with other people. In addition to the inability to comprehend the intention of others he will also be unable to express himself and his intentions. He may repeat a phrase he has heard and memorized because he is unable to formulate and organize his own thoughts. The hyperlexic child also has difficulty understanding directions and listening to group instructions. He will have problems putting the spoken word into a meaningful context. As the child progresses through school he will have an increasingly difficult time reading content area material and judging the relevance of this material or using it to defend or support his opinion. This is when reading comprehension becomes an issue.

My first exposure to the word hyperlexia caused me to assume that it was a simple issue of reading with no comprehension. I have worked with two boys who could decode any word but had very poor comprehension. Hyperlexia, obviously covers a much wider range of issues than poor reading comprehension. Comprehension is masked in the young hyperlexic because of a high intelligence and great memory for repetition. They have the ability to repeat everything they have read or heard. As the child gets older he displays an increasing inability to read new information and apply it to his own world. It must be realized that these comprehension issues need to be addressed as language-comprehension issues, not as reading comprehension issues.

The precocious reading ability will often emerge in the hyperlexic before the age of five. Early speech and language attempts were echolalic (both immediate and delayed). Language was learned in chunks and whole phrases and even entire dialogues were used in conversation. (Barouski) Early speech may consist of saying letters rather than words. The skill of reading was not taught to the hyperlexic child and usually between the ages of 18 and 24 months his ability to name letters and numbers is amazing. By three years they see printed words and read them, sometimes before they have learned to talk. They are fascinated by the printed word. (Kupperman, etal)

AUTISM, PDD, NONVERBAL LEARNING DISABILITY?

In the early years hyperlexia shares many characteristics with autism. The most noticeable is the inability to make meaningful eye contact, inability to build relationships, tantruming, screaming. (Kovach) Behavior problems also exist for the hyperlexic and the autistic because of the inability to understand others intentions and to communicate properly. They have severe problems with social perception. The autistic child has difficulty with changes in routine, engages in unusual play with toys or objects, has difficulty relating to people and has communication problems. The autistic also engages in repetitive body movements. These autistic characteristics are also observed in the child with hyperlexia. The difference seems to be that autistic children exhibit these characteristics for years but the hyperlexic child will connect the minute the communication bridge is built, (Kovach). The precocious reading ability can be used to teach the hyperlexic the skills they lack. The push by some people is to have hyperlexia be a separate diagnosis apart from the autism spectrum.

A developmental disability that shares many of the characteristics of autism is Pervasive Developmental Disorder (PDD). When children display similar behaviors but do not meet the criteria for autistic disorder, they may receive a diagnosis of PDD. (NICHCY) Children with hyperlexia are given the diagnosis of PDD so they will be able to receive special education services. As previously stated the hyperlexic child will learn to properly communicate and relate to other people leaving only the language disorder needing remediation. Hyperlexia is not a medical term and it is believed that it will never become one. It is, however, a term which describes children with the medical diagnosis of PDD. The hyperlexic children have similar symptomotology, language learning style and social learning style. Most important, they have a better prognosis compared to most other children with the medical diagnosis of PDD. (Bligh, 1995)

Nonverbal learning disorders (NLD) is another disorder that has been associated with hyperlexia. The child with NLD will also display difficulties with social interaction, have an exceptional memory for rote material and engages in rote reading at a very young age. Children who suffer from NLD often go unnoticed in school because they seem so bright. Like the hyperlexic a child with NLD will find the higher grades in school to be the most difficult because of the greater demands made on his ability to properly communicate. Many times a child with a diagnosis of NLD will have had a history of hyperlexia.

The literature on hyperlexia supports the notion that at any given time any one of these three disorders may be applied to a child who has hyperlexia. There are statements of support for labeling a hyperlexic child with autism, PDD or NLD and there are just as many statements in support of a separate category in the DSM-IV for hyperlexia. The fact that a hyperlexic child has a better prognosis for improvement causes me to support the belief that hyperlexia is a PDD. This label would be given knowing that proper remediation should improve the developmental delays the child exhibits.

ASSESSMENT AND REMEDIATION

It is important to properly assess a child who is suspected to have hyperlexia. There are many steps involved in such an assessment. The most important would be:

History concern about lack of speech development, fascination for numbers and letters, a strong auditory memory, an amazing ability to spell, only enjoys visual mechanical toys and trains, sensitive to loud noises, has tantrums that are not calmed by words but instead by distraction or music and lack of friends.

Observation child has difficulty following verbal instructions, a short attention span, unusual use of language such as chunk quotations from videos (Markovitch, 1997), strong willed and expects his own way, is male.

Testing assess reading ability and comprehension by asking him to relate the information in the story, visual ability by asking him to do puzzles and manipulate small objects ( hyperlexic children generally show a good fine motor ability in manipulating these objects and play with them appropriately Kupperman, etal) standardized speech language receptive and expressive tests should also be used.

Diagnostic Impressions if the child is hyperlexic he will present these characteristics:

1. Precocious ability to read.

2. Difficulty in understanding language

3. Learns expressive language by echoing and memorization

4. Difficulty in answering who, what, why questions

5. Rigid in behaviors.

6. Rarely initiates conversations

7. Likes to keep to predictable routines

8. Throws temper tantrums

To be a true hyperlexic the child must have a precocious ability to read and a significant language disorder.

As with assessment there are many suggestions for remediation with the hyperlexic child. The ideal situation for the hyperlexic in a school setting would include:

1. Small class size this will provide peers to learn from but not overwhelm the child with too much input.

2. Many visuals label as much as possible

3. Structure the class routine and post schedules and schedule changes

4. Teaching of facial expressions through pictures and role playing

5. Plenty of opportunities for social interaction even if they need to be scripted

6. Use music while giving the words to the songs on paper

7. Preparing for fire drills, loud noises

8. Giving written as well as verbal instructions

9. Giving examples of expressing feelings with words and facial expressions

10. Speaking slow allowing for extra processing time and being ready to repeat

11. Using humor

These suggestions would certainly facilitate learning for

all children not just the hyperlexic child. The child with hyperlexia will also need special education and speech language services. Once the ability to communicate through conversation is improved the hyperlexic child will improve his social interactions and the tantrums and behavior issues will subside.

THE BRAIN CONNECTION

Very little information exists on the connection between hyperlexia and brain function. At this time researchers are investigating areas such as neurological damage and biochemical imbalance in the brain. (NICHCY) for causes of autism and PDD. One researcher made the connection that in hyperlexic children the reptilian part of the brain tends to be dominant because they do not understand the world around them. The cortex "has no chance to be receptive to learning more complicated concepts." (NICHCY) because the cerebellum is under stress from environmental stimuli.

It has also been mentioned that the auditory pathways in the brain do not function properly in hyperlexic children. The visual pathways do function properly so the hyperlexic will take in all information visually.

Brain scans have been performed on people with NLD and these scans show mild abnormalities of the right cerebral hemisphere. The people who were scanned had reported some type of brain trauma early in their development. These neurological insults involve significant destruction of white matter connections in the right hemisphere, which are important for intermodal integration (Thompson, 1997). This early damage of the right hemisphere is believed to be the cause of NLD.

One interesting article discussed the fact that the parts of the brain that control imitation have been identified. Imitation is the way hyperlexics learn. Imitation is also lacking in the hyperlexic. Researchers believe that the process of imitation allows people to develop important social skills, such as reading facial and other body gestures. (UniSci) Isn t it interesting that the hyperlexic will use imitation to learn written language but can not use imitation to develop social skills?

The two areas of the brain that are identified are Broca s area and the right parietal cortex. In tests on volunteers both of these area s of the brain were activated when the person performed a finger movement, observed the finger movement in others or saw a picture of the finger movement. The findings support the theory that the brain learns through imitation (UniSci). The development of language has long been associated with Broca s area. The involvement of this area may explain why the development of children s ability to understand the intentions of other people also is generally associated with the development of conversation skills. (UniSci) This fact intrigues me because understanding intentions and conversation skills are both seriously lacking in the hyperlexic. This difficulty is happening at the same time that imitation is being used to learn written language.

The current brain research skirts around the syndrome of hyperlexia but provides some insight into closely related disorders. One does need to be careful, however, not to apply all the research on autism, PDD and NLD to a case of hyperlexia. Each of these learning disabilities must be examined separately.

CONCLUSION

Hyperlexia is still a bit confusing to me. I understand the symptoms although there are certainly varying degrees of hyperlexia. One type of hyperlexia is more language disordered and one type is more behaviors disordered. The more I read the more enlightened and confused I became.

Hyperlexia is not a remarkable reading ability without comprehension. The child can comprehend what he has read but he cannot apply the information to his life and the world around him. If I encountered a hyperlexic child in my career as a special educator I believe I would know how to help him educationally. I hope to continue my reading on hyperlexia. Ideally I will find out how the music connection to remediation would be beneficial.
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