Little Bookworms (Hyperlexia)

(C) PopCap.

Who has played Bookworm on PC or Game Boy? I do. Anyway…

Bookworms, especially children, are becoming rare (because of game app on tablets). But there are little children who reads materials (books or ebooks) for advanced readers like encyclopedia, dictionaries, and high school and college text books. Parents may feel “blessed” because they have gifted children; what they don’t know that reading too advanced for a child might be a sign of a neurodevelopmental disorder, called hyperlexia.

Hyperlexia?

You read it right. Hyperlexia. Hyperlexia is a syndrome that is characterized by a child’s precocious ability to read (far above what would be expected at their age), significant difficulty in understanding and using verbal language (or a profound nonverbal learning disability) and significant problems during social interactions.[1] It means a child’s advanced reading skills, i.e., a 2-year-old reading books (or ebooks), internet articles, and encyclopedias suitable for adolescents and adults. Summary: a child reading prodigy or bookworm.

Hyperlexia was first named and scientifically described in 1967[2][3] by Silberberg and Silberberg (1967), who defined it as the precocious ability to read words without prior training in learning to read typically before the age of 5.[2]

Image courtesy of wiseGEEK. Hypeerlexia is characterized by reading books with advanced vocabularies without understanding the meaning of them.

What are the characteristics of hyperlexia?

A youngster with the condition will often display a high interest in letters or numbers, and have trouble interacting with others. The condition is usually diagnosed when a child is 18- to 24-months old and shares traits with autism, behavior disorders, emotional disorders, and attention deficit disorder.[4] Hyperlexic children are characterized by having average or above average IQs and word-reading ability well above what would be expected given their age.[2][5] It can be viewed as a superability in which word recognition ability goes far above expected levels of skill.[2][6]

Hyperlexic children are often fascinated by letters or numbers. They are extremely good at decoding language and thus often become very early readers. Some hyperlexic children learn to spell long words (such as elephant) before they are two years old and learn to read whole sentences before they turn three. An fMRI study of a single child showed that hyperlexia may be the neurological opposite of dyslexia.^[7]

Despite hyperlexic children’s precocious reading ability, they may struggle to communicate. Often, hyperlexic children will have a precocious ability to read but will learn to speak only by rote and heavy repetition, and may also have difficulty learning the rules of language from examples or from trial and error, which may result in social problems. Their language may develop using echolalia, often repeating words and sentences. Often, the child has a large vocabulary and can identify many objects and pictures, but cannot put their language skills to good use. Spontaneous language is lacking and their pragmatic speech is delayed. Hyperlexic children often struggle with Who? What? Where? Why? and How? questions. Between the ages of 4 and 5 years old, many children make great strides in communicating.[2]

The social skills of a child with hyperlexia often lag tremendously. Hyperlexic children often have far less interest in playing with other children than do their peers.[2]

Are there types of hyperlexia?

Yes, hyperlexia have types, depending on the presenting symptoms. Here they are:

Darold Treffert Types[8]:

• Type 1: Neurotypical children that are very early readers.
• Type 2: Children on the autism spectrum that demonstrate very early reading as a splinter skill.
• Type 3: Very early readers who are not on the autism spectrum though there are some “autistic-like” traits and behaviours which gradually fade as the child gets older.

Rebecca Williamson Brown Types[9]:

• Type 1: Hyperlexia marked by an accompanying language disorder.
• Type 2: Hyperlexia marked by an accompanying visual spatial motor disorder.

What causes hyperlexia?

Nothing is known what causes hyperlexia. According to the Center for Speech and Language Disorders (CSLD), “the presence of hyperlexia within the context of another developmental disorder reflects a difference in the neurological organization of the brain. While a cause is not yet known, research in genetics and functional MRI studies may provide some information in the future.”[1]

Maybe hyperlexia is autism?

Some experts say hyperlexia is similar to autism, but others may classify hyperlexia as a separate disorder co-occurring with other neurodiverse conditions.

Another quote from CSLD tells that hyperlexia is present in a lot of autism children and have persistent pragmatic language and social difficulties:

 In working with a large number of children with hyperlexia, we have seen a spectrum of outcomes. Some children, though they may be excellent readers, may exhibit severe and persistent symptoms of autism. Other children have great difficulties developing verbal expressive language, though their written expressive language may exceed their verbal abilities. Some children may do well academically, but may have difficulties socially. It is hard to predict what a child with hyperlexia will be like as a young adult; however, we do know that using writing to supplement their learning leads to better progress.[1]

What are the symptoms of hyperlexia?

According to About Parenting, hyperlexia symptoms go like this[10]:

Hyperlexic children memorize phrases, sentences or entire conversations. To express an idea, the children must be able to dissect what they have memorized to create original expressions.

Hyperlexic children have excellent visual and auditory memories, which means they easily remember what they see and hear. They use their memory to help them learn language. They will often exhibit echolalia, which is the repetition of phrases and sentences without understanding the meaning.

Given their difficulty with spoken language, hyperlexic children rarely initiate conversations.[10]

Hyperlexia is considered to be part of the autism spectrum of disorders and like autistic children, children with hyperlexia have problems socializing and behaving appropriately. They also exhibit other characteristics of autism:

• Self-stimulatory behavior
• Ritualistic behavior
• Concrete and literally thinking
• Difficulty with abstract concepts
• Normal development until 18-24 months, followed by regression
• Need to keep routines
• Difficulty transitioning from one activity to another

Additional characteristics of autism include the following:

• Sensitivity to sounds, smells, and touch
• Unusual fears
• Selective listening (may appear to be deaf)

Image courtesy of Wikipedia/William Adolphe Bouguereau-The Difficult Lesson (1884).

According to the UK’s Special Needs Education (SEN), hyperlexia symptoms are summarized below[11]:

• A precocious ability to read words, far above what would be expected at their chronological age or an intense fascination with letters or numbers.
• Significant difficulty in understanding verbal language
• Abnormal social skills, difficulty in socialising and interacting appropriately with people
• Learn expressive language in a peculiar way, echo or memorize the sentence structure without understanding the meaning (Echolalia), reverse pronouns.
• Rarely initiate conversations.
• An intense need to keep routines, difficulty with transitions, ritualistic behaviour.
• Auditory, olfactory and / or tactile sensitivity.
• Self-stimulatory behaviour.
• Specific, unusual fears.
• Normal development until 18-24 months, then regression.
• Strong auditory and visual memory.
• Difficulty answering “Wh–” questions, such as “what,” “where,” “who,” and “why”.
• Think in concrete and literal terms, difficulty with abstract concepts.
• Listen selectively, appear to be deaf.

Can hyperlexia be cured?

No. Hyperlexia cannot be corrected since this is innate to the child. She is born with hyperlexia. Instead, co-existing deevelopmental disorders are managed and therapies are used to improve a child’s communication skill as well as social skills (for management of autism spectrum disorder, click here; see also my articles about stuttering and specific language impairment).

Hyperlexia isn’t necessarily a disorder though research may or may not label this as such. Neurotypical children do also have this (hyperlexia type 1).

For hyperlexia associated with autism and other developmental disorders: thorough psychological evaluation by a psychologist who is familiar with the syndrome of hyperlexia is a crucial first step. Hearing, neurological, psychiatric, blood chemistry, speech and language and genetic evaluations can be performed to rule out other disorders but are not needed to identify hyperlexia.[11]

Intensive speech and language therapy and early intervention programs can help achieve this objective. The child’s reading skills should be used as a primary means of developing language.[11]

It is important to teach the child appropriate social skills. Providing opportunities for the child to interact with children whose behavior is more socially appropriate is one way to accomplish this. Parents, teachers and other professionals should work together to develop programs for each child to reach his /her fullest potential.[11]

Image courtesy of thepaintedlily.blogspot.com. Addicted to books and complicated academic material is not so bad at all. It is actually good that it expands your scope of knowledge.

The only problem hyperlexia may have is its association with “nerds” or “geeks” or maybe too much reading can cause nearsightedness.

(C) Giant Microbes. Do bookworms have hyperlexia?

O too much reading can turn you into bookworms…

Nevertheless, precocious reading can be a good sign as this can make a child smarter.

Reference:

1. http://www.csld.org/HyperlexiaDefinition.htm
2. https://en.wikipedia.org/?title=Hyperlexia
3. “Hyperlexia–specific word recognition skills in young children”. Exceptional Children 34 (1): 41–2. 1967. PMID 6066378.
4. http://www.wisegeek.com/what-is-hyperlexia.htm
5. Tina M. Newman Æ Donna Macomber Adam J. Naples Æ Tammy Babitz Æ Fred Volkmar Æ Elena L. Grigorenko. (2007). Hyperlexia in Children with Autism Spectrum Disorders. 37:760-774-2. J Autism Dev Disord
6. Grigorenko EL, Klin A, Volkmar F (2003). “Annotation: Hyperlexia: disability or superability?”. J Child Psychol Psychiatry 44 (8): 1079–91. doi:10.1111/1469-7610.00193. PMID 14626452.
7. Turkeltaub PE, Flowers DL, Verbalis A, Miranda M, Gareau L, Eden GF (2004). “The neural basis of hyperlexic reading: an FMRI case study”. Neuron 41 (1): 11–25. doi:10.1016/S0896-6273(03)00803-1. PMID 14715131.
8. Treffert, MD, Darold A (2011). “Hyperlexia: Reading Precociousness or Savant Skill? Distinguishing autistic-like behaviors from Autistic Disorder”. Retrieved 2013-01-22. (WebCite archive of 2013-01-22).
9. http://www.nldline.com/hyperlexia.htm
10. http://giftedkids.about.com/od/glossary/g/hyperlexia_def.htm
11. http://www.specialeducationalneeds.co.uk/hyperlexia.html

Further Reading:

1. https://www.wisconsinmedicalsociety.org/professional/savant-syndrome/resources/articles/hyperlexia-reading-precociousness-or-savant-skill/
2. http://blogs.scientificamerican.com/mind-guest-blog/oops-when-autism-isnt-autistic-disorder-hyperlexia-and-einstein-syndrome/
3. http://www.k12academics.com/disorders-disabilities/hyperlexia#.VYULyPk_PIU

Can’t Control – The Anatomy of Tourette Syndrome

We can control movement by our own free will. But not all of us can do that. Some people cannot control their movements – and even speech – voluntarily. This doesn’t necessarily mean they’re crazy. It’s beyond their control. This condition is called Tourette Syndrome.

What is Tourette Syndrome?

Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman.[1] TS does characteristically wax and wane, can be suppressed temporarily, and are preceded by a premonitory urge. Tourette’s is defined as part of a spectrum of tic disorders, which includes provisional, transient and persistent (chronic) tics.[2] Usually, the tics can manifest right away then slowly disappears and then appears again. Sometimes, Tourette Syndrome is called the swearing disease[3] because some people with TS involuntarily blurts out inappropriate comments and/or curse words. TS does not affect intelligence or life expectancy.

How common is Tourette Syndrome?

Tourette Syndrome is not as rare as it presents, though uncommon, with mild symptoms to some people. Males are about three to four times more likely than females to develop Tourette syndrome.[4] Between 0.4% and 3.8% of children ages 5 to 18 may have Tourette’s[2][5];the prevalence of other tic disorders in school-age children is higher, with the more common tics of eye blinking, coughing, throat clearing, sniffing, and facial movements.[2]

What causes Tourette Syndrome?

Genetics and environment may play a role in the development of TS, but the exact cause is unknown.[2] Experts don’t know the exact cause of TS, but some research points to changes in the brain and problems with how nerve cells communicate. A disturbance in the balance of neurotransmitters — chemicals in the brain that carry nerve signals from cell to cell — might play a role.[6] Tics are believed to result from dysfunction in cortical and subcortical regions, the thalamus, basal ganglia and frontal cortex. Neuroanatomic models implicate failures in circuits connecting the brain’s cortex and subcortex, and imaging techniques implicate the basal ganglia and frontal cortex.[7]

What are the symptoms of Tourette Syndrome?

The main symptoms of TS are motor tics (sudden, apparently uncontrollable movements like exaggerated blinking of the eyes) or vocal tics (apparently uncontrollable uttered sounds such as throat clearing, grunting, or sniffing).[6] When under stress, the tics usually exacerbate. It can be prolonged or changed.

Tics are classified as either simple or complex. Simple motor tics usually involve just one group of muscles. Some examples are eye blinking and grimacing. In contrast, complex motor tics usually involve more muscle groups and might look like a series of movements.[6] Simple vocal tics can be throat clearing, sniffing, or humming, whereas complex vocal tics can involve repeating other people’s words (a condition called echolalia) or involuntary swearing (called coprolalia).[6]

Motor tics involve movement. They include[8]:

Arm or head jerking
Blinking
Making a face
Mouth twitching
Shoulder shrugging

Vocal tics include[8]:

Barking or yelping
Clearing your throat
Coughing
Grunting
Repeating what someone else says
Shouting
Sniffing
Swearing

Before a motor tic happens, a person with TS may get a sensation that can feel like a tingle or tension. The movement makes the sensation go away.[8]

Symptoms usually subside as the child grows up and tics can become minimal when they become adolescents and adults.

Some people can control tic symptoms. But tension builds, and it eventually has to be released as a tic.[6] Since controlling a tic requires much effort, they usually cannot concentrate in other activities (i.e. classroom or work).

This is an illustration of how Tourette Syndrome is presented.[7]

How is Tourette Syndrome diagnosed?

For Tourette Syndrome to be diagnosed, the patient is referred to a neurologist. There he or shecwill be tested and asked by the neurologist about how TS presents. The following are the usual questions asked[8]:

-What did you notice that brought you here today?
-Do you often move your body in a way you can’t control? How long has that been happening?
-Do you ever say things or make sounds without meaning to? When did it start?
-Does anything make your symptoms better? What makes them worse?
-Do you feel anxious or have trouble focusing?
-Does anyone else in your family have these kinds of symptoms?

Testing includes[8]:

MRI. It uses powerful magnets and radio waves to make pictures of organs and structures inside your body.
CT scan. It’s a powerful X-ray that makes detailed images of your insides.

How is Tourette Syndrome treated?

There is no cure for TS. But there are strategies used to manage and/or control its symptoms[9]:

Habit reversal therapy – involves monitoring the pattern and frequency of the tics and identifying any sensations that trigger them. The next stage is to find an alternative, less noticeable method of relieving the sensations that cause a tic (known as premonitory sensations). This is known as a competing response.[9]

Exposure with response prevention (ERP) –involves increasing exposure to the urge to tic in order to suppress the tic response for longer. This works on the theory that you get used to the feeling of needing to tic until the urge, and any related anxiety, decreases in strength.[9]

Medications can also help if the symptoms are more frequent and severe like alpha2-adrenergic agonists, muscle relaxants and dopamine antagonists[9] to relax muscles or control nerve impulses in tics.

Antidepressants and anxiolytics can help when the patient has depression and/or anxiety.

What is the prognosis for Tourette Syndrome?

The symptoms usually improve in two-thirds of TS cases after 10 years. The tics may diminish a lot and may even disappear. Medications and therapy are not necessarily needed. However, the symptoms continue in the remaining one-third of cases and medications will be continued. Nevertheless, TS symptoms get milder as the patient ages.

The cycle of Tourette Syndrome.[10]

What happens if Tourette Syndrome is not diagnosed?

If not identified right away, complications may arise. The patient may lose concentration in classes or work. They may even become subjects of ridicule and discrimination and he or she will have low self-esteem, anxiety, and depression.

Can someone with Tourette Syndrome be successful?

Yes. A person with TS can become successful in many areas of life given he or she has awareness, acceptance, and/or therapy or medicine. The most important factor is, that he or she will be given support and understanding instead of discrimination.

Below are some famous people with diagnosed or suspected TS[11]:

Jim Eisenreich, professional baseball player
Mahmoud Abdul-Rauf, professional basketball player
Samuel Johnson, British writer who penned the Dictionary of the English Language and the Lives of Poets
Wolfgang Amadeus Mozart (huh? Mozart again? He also had suspected ADHD and/or autism)
Tim Howard, soccer player[12]
Howard Hughes, one of the richest men in history[12]
Dan Ackroyd, actor[12] (he also had Aspergers)
David Beckham[12]
Michael Wolff, jazz musician and actor[12]
Dash Mihok, actor[12]

Image courtesy of njcts.org

So, people with TS should be treated equally with us instead of laughing at them. Who knows, the one with involuntary tics may become more successful than you!

Image courtesy of njcts.org

This concludes the description of the conditions nder the umbrella of neurodiversity. There are more conditions aside from dyslexia, ADHD, autism, dyspraxia, dyscalculia, and Tourette Syndrome, but I will discuss them in my following blog posts.

References:
1. http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm
2. http://en.m.wikipedia.org/wiki/Tourette_syndrome
3. http://www.reviewjournal.com/life/health/tourette-syndrome-challenges-patients-doctors-alike
4. http://www.mayoclinic.org/diseases-conditions/tourette-syndrome/basics/definition/con-20043570
5. Robertson MM. “Gilles de la Tourette syndrome: the complexities of phenotype and treatment”. Br J Hosp Med (Lond). 2011 Feb;72(2):100–7. PMID 21378617 
6. http://kidshealth.org/parent/medical/brain/tourette.html
7. http://www.medz.website/2014/12/tourette-syndrome-tourette-s-disorder.html
8. http://www.webmd.com/brain/tourettes-syndrome
9. http://www.nhs.uk/conditions/Tourette-syndrome/Pages/Introduction.aspx
10. http://www.netterimages.com/images/vpv/000/000/006/6082-0550×0475.jpg
11. https://faculty.washington.edu/chudler/ts.html#fp
12. http://www.disabled-world.com/artman/publish/tourettes-famous.shtml

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