A descriptive study of hyperlexia in a clinically referred sample of children with developmental delays

Enhanced interest in letters and numbers in autistic children

BACKGROUND

An intense and precocious interest in written material, together with a discrepancy between decoding and reading comprehension skills are defining criteria for hyperlexia, which is found in up to 20% of autistic individuals. It may represent the extreme end of a broader interest in written material in autism. This study examines the magnitude and nature of the interest in written material in a large population of autistic and non-autistic children.

METHODS

All 701 children (391 autistic, 310 non-autistic) under the age of 7 referred to an autism assessment clinic over a span of 4 years were included. Ordinal logistic regressions assessed the association between diagnosis and the level of interest in letters and numbers. A nested sample of parents of 138 autistic, 99 non-autistic clinical, and 76 typically developing (TD) children completed a detailed questionnaire. Cox proportional hazards models analyzed the age of emergence of these interests. Linear regressions evaluated the association between diagnosis and interest level. The frequency of each behaviour showing interest and competence with letters and numbers were compared.

RESULTS

In the two studies, 22 to 37% of autistic children had an intense or exclusive interest in letters. The odds of having a greater interest in letters was 2.78 times higher for autistic children than for non-autistic clinical children of the same age, and 3.49 times higher for the interest in numbers, even if 76% of autistic children were minimally or non-verbal. The age of emergence of these interests did not differ between autistic and TD children and did not depend on their level of oral language. Non-autistic children showed more interest in letters within a social context.

LIMITATIONS

The study holds limitations inherent to the use of a phone questionnaire with caregivers and missing sociodemographic information.

CONCLUSIONS

The emergence of the interest of autistic children toward written language is contemporaneous to the moment in their development where they display a strong deficit in oral language. Together with recent demonstrations of non-social development of oral language in some autistic children, precocious and intense interest in written material suggests that language acquisition in autism may follow an alternative developmental pathway.

The co-occurrence of neurodevelopmental problems in dyslexia

The primary aim of this study was to explore the overlaps between dyslexia and a range of neurodevelopmental disorders and problems (NDPs), specifically symptoms of attention-deficit/hyperactivity disorder, autism spectrum disorder, atypical sensory perception and developmental coordination disorder. Capitalizing on a population-based sample of twins, secondary aims included estimating the heritability of dyslexia and reporting on the measurement characteristics of the scale used to assess dyslexia. A telephone interview regarding symptoms of dyslexia and other NDPs was conducted with parents of 1,688 nine-year-old twins. The prevalence and the heritability of dyslexia were estimated at 8 and 52%, respectively. The boy: girl ratio was 1.5:1. Results revealed that there was more than an eight-fold increase in (diagnostic proxy) NDPs prevalence in the dyslexia group as compared to typical readers. Quantitatively measured symptoms of inattention, oral language problems and atypical sensory perception significantly predicted dyslexia status in a multivariate analysis. By contrast, ASD-related inflexibility was inversely associated with dyslexia in the multivariate model. In sum, dyslexia often overlaps with other NDPs. The current study provides new knowledge supporting the position to move beyond isolated diagnostic categories into behavioural profiles of co-occurring problems when trying to understand the pattern of strengths and needs in individuals with dyslexia.

Early Word Reading of Preschoolers with ASD, Both With and Without Hyperlexia, Compared to Typically Developing Preschoolers

A portion of children with Autism Spectrum Disorder (ASD) exhibit a strength in early word reading referred to as hyperlexia (HPL), yet it remains unclear what mechanisms underlie this strength. Typically developing children (TD) acquire phonological awareness, alphabet knowledge and language skills as precursors to word reading. We compared these skills across English-speaking preschoolers with ASD, both with and without hyperlexia, and TD preschoolers. Findings indicated that the group with both ASD and HPL (ASD + HPL) exhibited advanced word reading and letter naming skills as compared to the other two groups, but did not demonstrate commensurate phonological awareness, letter-sound correspondence, or language skills. Findings support an alternative, non-phonological approach to early word reading in preschoolers with ASD and hyperlexia.

Early Reading Comprehension Intervention for Preschoolers with Autism Spectrum Disorder and Hyperlexia

Children with autism spectrum disorder (ASD) and hyperlexia (HPL) have both advanced word reading skills and a reading comprehension disorder, alongside impaired oral language. We developed a unique, parent-supported, tablet-based intervention aiming to improve oral and reading comprehension at the word-, phrase- and sentence-level, for preschoolers with ASD and hyperlexia (ASD + HPL). English-speaking preschoolers (N = 30) with ASD + HPL (N = 8), ASD without HPL (N = 7) and typical development (N = 15) underwent a 6-week no-intervention period followed by a 6-week intervention period. Findings revealed a significant increase in reading comprehension scores for the group with ASD + HPL as compared to the TD group (p = .023). Gains were also found for receptive but not expressive language for all groups. Implications for early intervention for preschoolers with ASD + HPL are discussed.

Measuring the Emergence of Specific Abilities in Young Children with Autism Spectrum Disorders: The Example of Early Hyperlexic Traits

The presence of a restricted interest in written materials, including an early ability to name and recognize letters and numbers, is regularly reported in preschoolers with autism spectrum disorders (ASDs). There is, however, scarce information on this early ability akin to emerging hyperlexic traits in preschoolers with ASD younger than 3 years old. Here, we defined a measure of early naming and recognition of letters and numbers in 155 preschoolers with ASD using a sliding window approach combined with a 90th percentile threshold criterion, and subsequently compared the profiles of children with ASD with and without early hyperlexic traits. Using this measure, we found that 9% of children with ASD showed early hyperlexic traits. The early ability to name and recognize letters and numbers was associated with a higher level of restricted and repetitive behaviors yet more social-oriented behaviors at baseline and with better expressive and written communication at baseline and one year later. This study contributes to a better definition of the profile of children with ASD with an early ability in letters and numbers akin to emerging hyperlexic traits, a skill that is associated with promising social strengths and language abilities in this subgroup of children.

Predictors and Moderators of Spontaneous Pretend Play in Children with and without Autism Spectrum Disorder

Although pretend play has long been linked to children's normative cognitive development, inconsistent findings call for greater rigor in examining this relation (Lillard et al., 2013). Spontaneous pretend play is often impacted in atypical development, notably in autism spectrum disorder (ASD). Since ASD traits exist along a continuum in the general population, investigating how pretend play varies across the range of ASD symptoms by indexing variations in ASD traits in both typically developing and ASD populations may provide insight into how ASD symptoms may influence the relation between pretend play and associated processes in cognitive development. This study used rigorous observational methods to assess spontaneous pretend play. Specifically, 5-min free-play sessions with two discrete toy sets were double-coded by blinded coders (coder assignment counterbalanced). Key facets of pretense development [attribution of pretend properties (APP), object substitution (OS), imaginary objects] were examined. These facets of pretend play production were then analyzed in relation to ASD symptoms, as well as plausible, long-theorized correlates [theory of mind (ToM), verbal ability, familiarity, and interest in specific toys]. Forty children (M_age = 6;5, SD_age = 1.45; 29 males), six of whom met the threshold for ASD diagnosis via parent-reported ASD symptoms, participated in play sessions and completed measures of verbal IQ and ToM. Besides the measure of child ASD symptoms, parents completed a survey of their child's interest in and familiarity with the play session toys. Overall, greater ToM predicted more APP, and more interest in the toys presented predicted more OS. In terms of overall pretend play production, two results were counterintuitive. First, among children with more ASD symptoms, verbal ability marginally negatively predicted pretend play production. Second, among children with fewer ASD symptoms, ToM negatively predicted pretend play production. Further probing revealed that the negative effect of ASD symptoms on pretend play was simultaneously moderated by both variables: low ToM and high verbal ability both related to less pretend play production among children with more ASD symptoms. Implications for assessment and subsequent treatment for pretend ability among children with varying degrees of ASD symptoms, as well as for future research, are discussed.

Distinctive Role of Symbolic Number Sense in Mediating the Mathematical Abilities of Children with Autism

Despite reports of mathematical talent in autism spectrum disorders (ASD), little is known about basic number processing abilities in affected children. We investigated number sense, the ability to rapidly assess quantity information, in 36 children with ASD and 61 typically developing controls. Numerical acuity was assessed using symbolic (Arabic numerals) as well as non-symbolic (dot array) formats. We found significant impairments in non-symbolic acuity in children with ASD, but symbolic acuity was intact. Symbolic acuity mediated the relationship between non-symbolic acuity and mathematical abilities only in children with ASD, indicating a distinctive role for symbolic number sense in the acquisition of mathematical proficiency in this group. Our findings suggest that symbolic systems may help children with ASD organize imprecise information.

Reading and math achievement profiles and longitudinal growth trajectories of children with an autism spectrum disorder

This study examined the reading and math achievement profiles and longitudinal growth trajectories of a nationally representative sample of children ages 6 through 9 with an autism spectrum disorder. Four distinct achievement profiles were identified: higher-achieving (39%), hyperlexia (9%), hypercalculia (20%) and lower-achieving (32%). Children with hypercalculia and lower-achieving profiles were more likely to be from low socioeconomic families and had lower functional cognitive skills than the higher-achieving profile. All four profiles lost ground in passage comprehension over time. Slower improvement occurred for the higher-achieving group on letter–word identification, the hyperlexia group on conversation abilities and the hypercalculia group on calculation and functional cognitive skills relative to the lower-achieving group.

Excellent Word-Reading Ability in the Context of an Autism Spectrum Disorder: A Case Study of a Swedish-Speaking 7-Year-Old Boy

This case study seeks to extend our knowledge of the phenotype associated with excellent word reading in autism spectrum disorder by a detailed examination of psycholinguistic, neuropsychological/cognitive, and classroom/academic functioning of a Swedish-speaking 7-year-old boy (called “Jonas”). On age-referenced word reading-decoding assessment, Jonas scored among the top 7%. Reading comprehension status varied as a function of information source. Jonas’s phonological processing and phonological memory performance was found to be normal to strong. In contrast, he scored poorly on tests of oral semantic, syntactical, and narrative language. On the WISC-III, Jonas performed highly uneven across subtests from impaired to above average levels. On the Kaufman factors, Jonas had a peak in perceptual organization (IQ score 119), thus reflecting very strong visual attention skills, which together with normal to strong phonological abilities might underlie his excellent word reading. Finally, both his parents and teacher reported on other classroom-learning skills and difficulties.

Brain routes for reading in adults with and without autism: EMEG evidence

Reading utilises at least two neural pathways. The temporal lexical route visually maps whole words to their lexical entries, whilst the nonlexical route decodes words phonologically via parietal cortex. Readers typically employ the lexical route for familiar words, but poor comprehension plus precocity at mechanically 'sounding out' words suggests that differences might exist in autism. Combined MEG/EEG recordings of adults with autistic spectrum conditions (ASC) and controls while reading revealed preferential recruitment of temporal areas in controls and additional parietal recruitment in ASC. Furthermore, a lack of differences between semantic word categories was consistent with previous suggestion that people with ASC may lack a 'default' lexical-semantic processing mode. These results are discussed with reference to dual-route models of reading.

Lexical decision as an endophenotype for reading comprehension: an exploration of an association

Based on numerous suggestions in the literature, we evaluated lexical decision (LD) as a putative endophenotype for reading comprehension by investigating heritability estimates and segregation analyses parameter estimates for both of these phenotypes. Specifically, in a segregation analysis of a large sample of families, we established that there is little to no overlap between genes contributing to LD and reading comprehension and that the genetic mechanism behind LD derived from this analysis appears to be more complex than that for reading comprehension. We conclude that in our sample, LD is not a good candidate as an endophenotype for reading comprehension, despite previous suggestions from the literature. Based on this conclusion, we discuss the role and benefit of the endophenotype approach in studies of complex human cognitive functions.

Emergent Literacy in Children With Autism: An Exploration of Developmental and Contextual Dynamic Processes

Purpose

This investigation describes emergent literacy skills, print motivation, and home literacy environments in a linguistically diverse group of children with autism spectrum disorders (ASD).

Method

Emergent literacy skills were directly assessed in 41 children between the ages of 4 and 8 years. Parent report was solicited to provide additional information concerning the children’s emergent literacy skills, as well as their print motivation and home literacy environments. The achievements of children with differential language abilities were compared, and associations among the children’s language and emergent literacy abilities were explored.

Results

Narrowly, children with typical language achieved significantly higher scores on an emergent literacy composite than those with mild-to-moderate or severe language impairments; broadly, these scores were highly correlated (ρ = .56) with the children’s language. Skill performance was varied but was characterized by relative strengths in discrete skills, such as letter name identification, and weaknesses in more holistic skills, such as print functions. Parents generally described the children as being motivated by print materials and the home environments as offering high levels of parent–child engagement in literacy activities.

Conclusion

Profiles were associated with language and were illustrated by heterogeneity with potentially unequal achievements between code- and meaning-based skills. Implications for speech-language pathologists and other educators are provided.

Atypical neural specialization for social percepts in autism spectrum disorder

The social motivation hypothesis posits that aberrant neural response to human faces in autism is attributable to atypical social development and consequently reduced exposure to faces. The specificity of deficits in neural specialization remains unclear, and alternative theories suggest generalized processing difficulties. The current study contrasted neural specialization for social information versus nonsocial information in 36 individuals with autism and 18 typically developing individuals matched for age, race, sex, handedness, and cognitive ability. Event-related potentials elicited by faces, inverted faces, houses, letters, and pseudoletters were recorded. Groups were compared on an electrophysiological marker of neural specialization (N170), as well as behavioral performance on standardized measures of face recognition and word reading/decoding. Consistent with prior results, individuals with autism displayed slowed face processing and decreased sensitivity to face inversion; however, they showed comparable brain responses to letters, which were associated with behavioral performance in both groups. Results suggest that individuals with autism display atypical neural specialization for social information but intact specialization for nonsocial information. Findings concord with the notion of specific dysfunction in social brain systems rather than nonspecific information-processing difficulties in autism.

Teaching children with autism to read for meaning: challenges and possibilities

The purpose of this literature review is to examine what makes reading for understanding especially challenging for children on the autism spectrum, most of whom are skilled at decoding and less skilled at comprehension. This paper first summarizes the research on reading comprehension with a focus on the cognitive skills and processes that are involved in gaining meaning from text and then reviews studies of reading comprehension deficits in children on the spectrum. The paper concludes with a review of reading comprehension interventions for children on the spectrum. These children can especially benefit from interventions addressing particular cognitive processes, such as locating antecedent events, generating and answering questions, locating referents, and rereading to repair understanding.

Myth and Reality of the Word Caller: The Relation Between Teacher Nominations and Prevalence Among Elementary School Children

The purpose of the study was to investigate (a) the prevalence of word callers in elementary school, (b) the accuracy of teachers' word caller nominations, and (c) teachers' conceptualization of reading fluency and reading comprehension. To this end, 2 cross-sectional studies of second- and third- (N = 868) and of third- and fifth-grade (N = 202) children were conducted. Our findings suggest that word callers occur infrequently in the primary grades but that they are more prevalent in late elementary school. Regardless of grade level, teachers often overnominated children as word callers. Furthermore, a great deal of ambiguity and inconsistency seems to exist regarding teachers' understanding and use of the term. These findings suggest that the term should be used relatively rarely and that reading educators should be cautious about their identification of word callers in early elementary school.

Orthographic and phonological pathways in hyperlexic readers with Autism Spectrum Disorders

Children with Autism Spectrum Disorders (ASD) often present poor text comprehension relative to their ability to read individual words. Some of them have been considered hyperlexic because of their oustanding word-reading abilities. Although it has been suggested that these children access word reading in an atypical way, there is conflicting evidence on their use of phonological and orthograhic pathways. Fourteen adolescents with ASD with word reading to text comprehension discrepancy and 12 typically developing children, all matched on word reading and chronological age, were administered different lexical and sublexical tasks exploring semantic, orthographic, and phonological word representations and processes. No differences were found on any of the tasks between the children with ASD and the typically developing group. The children with ASD were further subdivided into two groups matched on word reading, one with outstanding word reading rela0tive to verbal IQ and another with word reading consistent with verbal IQ. The first group outperformed the second on tasks involving lexical orthographic and phonological representation. However, they were no different on sub-lexical phonological processing, on rapid naming or working, and short-term memory tasks.

The savant syndrome: an extraordinary condition. A synopsis: past, present, future

Savant syndrome is a rare, but extraordinary, condition in which persons with serious mental disabilities, including autistic disorder, have some 'island of genius' which stands in marked, incongruous contrast to overall handicap. As many as one in 10 persons with autistic disorder have such remarkable abilities in varying degrees, although savant syndrome occurs in other developmental disabilities or in other types of central nervous system injury or disease as well. Whatever the particular savant skill, it is always linked to massive memory. This paper presents a brief review of the phenomenology of savant skills, the history of the concept and implications for education and future research.

Promoting Literacy in Students With ASD: The Basics for the SLP

Purpose

This article provides a tutorial for speech-language pathologists (SLPs) concerning approaches for improving the reading skills of students with autism spectrum disorder (ASD). SLPs are encouraged to modify their role to include a literacy focus, not only because of inclusion and standardized reading tests, but also because SLPs offer skills to enrich the literacy skills of students with ASD.

Method

This article is organized to provide guidance on approaches associated with reading achievements in 3 stages of development: (a) emergent, (b) conventional, and (c) skilled reading. For each, we provide a brief overview of major achievements observed in students with typical development as well as a synopsis of what is currently known concerning the achievements of students with ASD. We then provide suggestions concerning specific approaches that can be used to further the reading and oral language skills of students with ASD within the particular stage.

Implications

This article suggests literacy interventions that target critical oral language and literacy skills that have been well documented as areas of need among many students with ASD. SLPs can draw on this information when designing and implementing transdiciplinary literacy interventions for this growing population of students whose literacy needs are currently underserved.

Treatment effects of Fast ForWord demonstrated by magnetoencephalography (MEG) in a child with developmental dyslexia

Treatment effects of Fast ForWord, hypothesized to ameliorate temporal processing deficits, were demonstrated by magnetoencephalography in a child with dyslexia using four paradigms: Word/Non-word Reading (NW), Grapheme-to-Phoneme Matching (GP), Verbal, and Spatial Working Memory (VWM, SWM). Shifts in brain activation from right inferior frontal and temporal to left frontal, bilateral supramarginal, and transverse temporal regions occurred during GP. During NW, shifts progressed from (1) right or bilateral anterior and superior to (2) left, inferior frontal, to (3) left, superior posterior temporoparietal, to (4) left, inferior, posterior temporooccipital regions. Reading and written language improvements were noted in passage comprehension and spelling.

Hyperlexia in children with autism spectrum disorders

We compared the reading-related skills of children with Autism Spectrum Disorders who have hyperlexia (ASD + HPL) with age-matched children with ASD without HPL (ASD - HPL) and with single-word reading-matched typically developing children (TYP). Children with ASD + HPL performed (1) better than did children with ASD - HPL on tasks of single-word reading and pseudoword decoding and (2) equivalently well compared to word-reading-matched TYP children on all reading-related tasks except reading comprehension. It appears that the general underlying model of single-word reading is the same in principle for "typical" and hyperlexic reading. Yet, the study revealed some dissimilarities between these two types of reading when more fine-grained cognitive and linguistic abilities were considered; these dissimilarities warrant further investigations.

Patterns of Reading Ability in Children with Autism Spectrum Disorder

This study investigated reading skills in 41 children with autism spectrum disorder. Four components of reading skill were assessed: word recognition, nonword decoding, text reading accuracy and text comprehension. Overall, levels of word and nonword reading and text reading accuracy fell within average range although reading comprehension was impaired. However, there was considerable variability across the sample with performance on most tests ranging from floor to ceiling levels. Some children read accurately but showed very poor comprehension, consistent with a hyperlexia reading profile; some children were poor at reading words and nonwords whereas others were unable to decode nonwords, despite a reasonable level of word reading skill. These findings demonstrate the heterogeneous nature of reading skills in children with ASD.

Literacy and mental disorders

PURPOSE OF REVIEW

This review examines recent evidence on the comorbidity between literacy problems and psychiatric disorder in childhood and discusses possible contributory factors.

RECENT FINDINGS

Recent studies confirm the substantial overlap of literacy problems with a range of emotional/behavioural difficulties in childhood. Literacy problems and inattention may share genetic influences, contributing to associations with attention deficit hyperactivity disorder. To an extent, links with conduct problems may be also mediated by attentional difficulties. In addition, findings suggest bidirectional influences whereby disruptive behaviours impede reading progress and reading failure exacerbates risk for behaviour problems. Associations between literacy problems and anxiety disorders are not entirely mediated by inattentiveness. Rather, comorbid anxiety disorders seem likely to arise from the stressors associated with reading failure. Findings in relation to depression are less consistent, but suggest that poor readers may be vulnerable to low mood. Children with autism seem more likely to face problems in reading comprehension than the decoding difficulties more prominent in other disorders.

SUMMARY

Literacy problems are associated with increased risks of both externalizing and internalizing disorders in childhood, with different mechanisms likely to be implicated in each case. When comorbid problems occur, each is likely to require separate treatment.

Disorders of attention or learning in neurodevelopmental disorders

Disorders of attention or learning commonly accompany neurodevelopmental disorders. The evaluation and diagnosis of these disorders is complex and does not always follow techniques used for typically developing children. These disorders are often underappreciated and inadequately addressed because they are overshadowed by the neurodevelopmental disorder. Nevertheless, failure to recognize, diagnose, and manage these disorders may result in unsuccessful community integration.

Family-based association study of DYX1C1 variants in autism

DYX1C1: was recently identified as a candidate gene for developmental dyslexia, which is characterized by an unexpected difficulty in learning to read and write despite adequate intelligence, motivation, and education. It will be important to clarify, whether the phenotype caused by DYX1C1 extends to other language-related or comorbid disorders. Impaired language development is one of the essential features in autism. Therefore, we analyzed the allelic distribution of the DYX1C1 gene by family-based association method in 100 Finnish autism families. No evidence for association was observed with any intragenic marker or with haplotypes constructed from alleles of several adjacent markers. No evidence for deviated allelic diversity was either observed: the frequency of expected dyslexia risk haplotype was comparable to its frequency in Finnish controls. Thus it seems unlikely that DYX1C1 gene would be involved in the genetic etiology of autism in Finnish patients.

Annotation: Hyperlexia: disability or superability?

BACKGROUND

Hyperlexia is the phenomenon of spontaneous and precocious mastery of single-word reading that has been of interest to clinicians and researchers since the beginning of the last century.

METHODS

An extensive search of publications on the subject of hyperlexia was undertaken and all available publications were reviewed.

RESULTS

The literature can be subdivided into discussions of the following issues: (1) whether hyperlexia is a phenomenon that is characteristic only of specific clinical populations (e.g., children with developmental delays) or whether it can also be observed in the general population; (2) whether hyperlexia is a distinct syndrome comorbid with a number of different disorders or whether it is a part of the spectrum of some other clinical condition(s); (3) whether hyperlexia should be defined through single-word reading superiority with regard to reading comprehension, vocabulary, general intelligence, any combination of the three, or all three characteristics; (4) whether there is a specific neuropsychological profile associated with hyperlexia; (5) whether hyperlexia is characterized by a particular developmental profile; and (6) whether hyperlexia should be viewed as a disability (deficit) or superability (talent).

CONCLUSIONS

We interpret the literature as supporting the view that hyperlexia is a superability demonstrated by a very specific group of individuals with developmental disorders (defined through unexpected single-word reading in the context of otherwise suppressed intellectual functioning) rather than as a disability exhibited by a portion of the general population (defined through a discrepancy between levels of single-word reading and comprehension). We simultaneously argue, however, that multifaceted and multi-methodological approaches to studying the phenomenon of hyperlexia, defined within the research framework of understanding single-word reading, are warranted and encouraged.

The enactive mind, or from actions to cognition: lessons from autism

Normative-IQ individuals with autism are capable of solving explicit social cognitive problems at a level that is not matched by their ability to meet the demands of everyday social situations. The magnitude of this discrepancy is now being documented through newer techniques such as eye tracking, which allows us to see and measure how individuals with autism search for meaning when presented with naturalistic social scenes. This paper offers an approach to social cognitive development intended to address the above discrepancy, which is considered a key element for any understanding of the pathophysiology of autism. This approach, called the enactive mind (EM), originates from the emerging work on 'embodied cognitive science', a neuroscience framework that views cognition as bodily experiences accrued as a result of an organism's adaptive actions upon salient aspects of the surrounding environment. The EM approach offers a developmental hypothesis of autism in which the process of acquisition of embodied social cognition is derailed early on, as a result of reduced salience of social stimuli and concomitant enactment of socially irrelevant aspects of the environment.