Unlocking the nature of the phonological-deep dyslexia continuum: the keys to reading aloud are in phonology and semantics

It has been argued that normal reading and acquired dyslexias reflect the role of three underlying primary systems (phonology, semantics, and vision) rather than neural mechanisms dedicated to reading. This proposal is potentially consistent with the suggestion that phonological and deep dyslexia represent variants of a single reading disorder rather than two separate entities. The current study explored this possibility, the nature of any continuum between the disorders, and the possible underlying bases of it. A case series of patients were given an assessment battery to test for the characteristics of phonological and deep dyslexia. The status of their underlying phonological and semantic systems was also investigated. The majority of participants exhibited many of the symptoms associated with deep dyslexia whether or not they made semantic errors. Despite wide variation in word and nonword reading accuracy, there was considerable symptom overlap across the cohort and, thus, no sensible dividing line to separate the participants into distinct groups. The patient data indicated that the deep-phonological continuum might best be characterized according to the severity of the individual's reading impairment rather than in terms of a strict symptom succession. Assessments of phonological and semantic impairments suggested that the integrity of these primary systems underpinned the patients' reading performance. This proposal was supported by eliciting the symptoms of deep-phonological dyslexia in nonreading tasks.