Hyperlexia: Related to Vision and Language Problems
Rebecca Williamson Brown, OD
Many children love to read, and some even learn to read at a remarkably early age. However, in an unusual syndrome called hyperlexia, the ability to read at a very young age can be the key indicator of a problem. Children with hyperlexia have an extraordinary ability to read at a very young age. They also have an extreme fascination with symbols, letters, and numbers. Unfortunately this fascination with words is just a small portion of what may be a lifetime of struggles. These children also have to overcome language delays and social problems. Although little is known about the actual cause of the learning disorder, fortunately there is a lot that
can be done to help improve the performance socially and academically for the child with hyperlexia. A great network of physicians, therapists, and teachers is necessary for the child. Unfortunately, the optometrist is an often overlooked and underutilized link in the assessment and therapy of learning related disorders such as hyperlexia.
Hyperlexia has also been defined as "advanced word-recognition skills in individuals who otherwise have pronounced cognitive, social, and linguistic handicaps" (Nation, 1999). Often, a child with hyperlexia can be a very visual learner and has difficulty interacting socially. However they can also have a great deal of perceptual problems. Signs of hyperlexia usually do not begin to emerge until after 18 to 24 months of age (www.hyperlexia.org). A child has been developing normally until this point, but then begins to regress. It is almost as though the child misses the developmental step of learning the meaning
of language and thus, he learns to read words first, then later he learns what those words mean. Many children with hyperlexia tend to emerge as self-taught readers at an age below the norm. Also, they have a physical need for reading, a sort of obsession. This is quite similar to the variety of fixations that many other children with disorders experience. Usually the fixation does not define the disorder, but in this case it is a significant indicator that distinguishes the child from having other developmental disorders. If the child does not have books, he will try to decode signs or symbols. If he is given even less, he may form the shapes and symbols with his own fingers. But, he is not
learning language this way, nor is he learning any subject that he may be reading. He just has a need to read.
Hyperlexia is not a diagnosis in and of itself. It is often coupled with a broad spectrum of language related disabilities such as autism or nonverbal learning disorders such as Aspergerís syndrome; Attention Deficit Disorder may also co-exist with hyperlexia (Richman, 1997). Eventually, as the child develops and matures, it depends not directly on the hyperlexia whether that child will have trouble functioning in society but on the associated disorder. In many situations he maybe able to function normally in society, but there may always be the urge or need to read or decode things.
At this point, two forms of hyperlexia have been identified. Both exhibit superior visual memory. The first is more of a language disorder. These children have problems with expressive language because they cannot understand the overall meaning of words. At first, their reading comprehension may appear good because it has been masked by excellent memorization skills (1997). They tend to have a lower verbal IQ, making more phonetic errors when reading compared to the second form of hyperlexia (1997). These children with hyperlexia that show a language disorder highly resembling an autistic child, but this similarity diminishes over time secondary to
The second form of hyperlexia is a visual-spatial learning disorder. These children seem to have normal language, but have difficulty cognitively interpreting the language and expressions as they see or hear them. Therefore, they exhibit deficits in visual motor integration skills, visual spacial orientation skills, and spatial memory skills (1997).
For most learning disorders, there is a higher frequency of incidence in males versus females. However, for hyperlexia, there appear to be "no significant differences in the frequency of hyperlexia in girls compared with boys" (Grigorenko, 2002). So, even though hyperlexia coexists within a broad spectrum of learning disorders, it is not associated more with boys. This is interesting because Semrud-Clikeman and Hynd note that the maturation rate of the male and female brains differ. The male brain matures slower and with this comes more asymmetry between the two hemispheres of the brain. (Semrud-Clikeman and Hynd, 1990). The left hemisphere
is more language based, and the right hemisphere is more visual-spatial based. So, because of the differences between males and females, if the right or left brain was damaged or if development of the right or left hemisphere was disrupted in any way, males would be more greatly affected by this disturbance because of the asymmetry (1990). Usually, this would explain why males are affected more by learning disorders, but this is not so for hyperlexia and interestingly the reason remains unexplained.
Yet, the study of Semrud-Clikeman and Hynd can be applied to the two distinct types of hyperlexia. As previously stated, the right brain is more visual-spatial based. This fits with the second type of hyperlexia. If there is a deficiency in this hemisphere, visual perception is disturbed. Because this type of hyperlexia has an intact left hemisphere, language is normal, but the integration of information between the two hemispheres cannot occur as it normally should. Thus, they are able to phonetically pronounce words, giving the appearance of good language skills, but words on paper is about as far as they can go. They are unable to cognitively give
meaning to the world due to their perceptual disabilities resulting in the inability to express and interpret "experiential aspects of language and environment" (Richman, 1997). These children have no understanding of morphs, the meaningful units of words, and reading comprehension. Without coherence of language and perception this child with hyperlexia cannot function appropriately, creating social and academic problems. Furthermore, the language based left hemisphere explains the first type of hyperlexia. They have more of an inability to apply meaning to words, not knowing what the individual morphs mean, i.e. decreased reading comprehension. They can simply decode the phonemes to
pronounce the word as most readers would be able to do with any completely new word they come across that they do not yet have a definition for. However, they have less social perceptual problems (unless they fall into the category of autism).
In addition to the obvious visual perception disorders demonstrated by children with hyperlexia, a wide variety of other visual problems can occur depending on the associated learning disorder or syndrome. According to the College of Optometrists in Vision Development, any child with a suspected problem should be appropriately examined by an optometrist. The examination should include "visual acuity, eye tracking and fixations, depth perception, color vision, eye teaming and focusing, the presence of [ametropia], eye health and visual fields" (COVD, 20021). Depending on the disorder, further visual testing may be done such as a
general vision therapy work-up or perhaps a visual perceptual exam. These tests will help further determine the strengths and weaknesses of the affected child (or adult) so that a more rigid therapy program can be established. Vision therapy and visual perceptual therapy will help improve the childís visual efficiency and visual processing in order to allow them to be more responsive to educational instruction (COVD, 20022). But these therapies are just the beginning of available therapies for children with hyperlexia. Speech and language therapy as well as occupation therapy may be in order for a child with hyperlexia. Because of the many coexisting disorders, therapy for children with
hyperlexia is so varied and encompasses so many different techniques that it cannot be discussed here in great detail, only these few suggestions can be provided.
Unfortunately, not much is physiologically known about hyperlexia, especially at the neurological level it remains a mystery. This is partly because there is not as much research on hyperlexia as there is for many other "well-known" learning related disorders such as autism. Also, because learning disorders tend to coexist, there is often one or more learning disorders superimposed on the child with hyperlexia making it difficult to sort out the precise basis for hyperlexia. Fortunately there is hope for a child with hyperlexia. With proper understanding and therapy the child with hyperlexia may be able to acheive both socially and
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