Phonological dyslexia and dysgraphia: cognitive mechanisms and neural substrates

To examine the validity of different theoretical assumptions about the neuropsychological mechanisms and lesion correlates of phonological dyslexia and dysgraphia, we studied written and spoken language performance in a large cohort of patients with focal damage to perisylvian cortical regions implicated in phonological processing. Despite considerable variation in accuracy for both words and non-words, the majority of participants demonstrated the increased lexicality effects in reading and spelling that are considered the hallmark features of phonological dyslexia and dysgraphia. Increased lexicality effects were also documented in spoken language tasks such as oral repetition, and patients performed poorly on a battery of phonological tests that did not involve an orthographic component. Furthermore, a composite measure of general phonological ability was strongly predictive of both reading and spelling accuracy, and we obtained evidence that the continuum of severity that characterized the written language disorder of our patients was attributable to an underlying continuum of phonological impairment. Although patients demonstrated qualitatively similar deficits across measures of written and spoken language processing, there were quantitative differences in levels of performance reflecting task difficulty effects. Spelling was more severely affected than reading by the reduction in phonological capacity and this differential vulnerability accounted for occasional disparities between patterns of impairment on the two written language tasks. Our findings suggest that phonological dyslexia and dysgraphia in patients with perisylvian lesions are manifestations of a central or modality-independent phonological deficit rather than the result of damage to cognitive components dedicated to reading or spelling. Our results also provide empirical support for shared-components models of written language processing, according to which the same central cognitive systems support both reading and spelling. Lesion-deficit correlations indicated that phonological dyslexia and dysgraphia may be produced by damage to a variety of perisylvian cortical regions, consistent with distributed network models of phonological processing.     

Dyslexic Children Show Atypical Cerebellar Activation and Cerebro-Cerebellar Functional Connectivity in Orthographic and Phonological Processing

Previous neuroimaging studies have found atypical cerebellar activation in individuals with dyslexia in either motor-related tasks or language tasks. However, studies investigating atypical cerebellar activation in individuals with dyslexia have mostly used tasks tapping phonological processing. A question that is yet unanswered is whether the cerebellum in individuals with dyslexia functions properly during orthographic processing of words, as growing evidence shows that the cerebellum is also involved in visual and spatial processing. Here, we investigated cerebellar activation and cerebro-cerebellar functional connectivity during word processing in dyslexic readers and typically developing readers using tasks that tap orthographic and phonological codes. In children with dyslexia, we observed an abnormally higher engagement of the bilateral cerebellum for the orthographic task, which was negatively correlated with literacy measures. The greater the reading impairment was for young dyslexic readers, the stronger the cerebellar activation was. This suggests a compensatory role of the cerebellum in reading for children with dyslexia. In addition, a tendency for higher cerebellar activation in dyslexic readers was found in the phonological task. Moreover, the functional connectivity was stronger for dyslexic readers relative to typically developing readers between the lobule VI of the right cerebellum and the left fusiform gyrus during the orthographic task and between the lobule VI of the left cerebellum and the left supramarginal gyrus during the phonological task. This pattern of results suggests that the cerebellum compensates for reading impairment through the connections with specific brain regions responsible for the ongoing reading task. These findings enhance our understanding of the cerebellum’s involvement in reading and reading impairment.     

Treatment of a case of phonological alexia with agraphia using the Auditory Discrimination in Depth (ADD) program.

Phonological alexia and agraphia are acquired disorders characterized by an impaired ability to convert graphemes to phonemes (alexia) or phonemes to graphemes (agraphia). These disorders result in phonological errors typified by adding, omitting, shifting, or repeating phonemes in words during reading or graphemes when spelling. In developmental dyslexia, similar phonological errors are believed to result from deficient phonological awareness, an oral language skill that manifests itself in the ability to notice, think about, or manipulate the individual sounds in words. The Auditory Discrimination in Depth (ADD) program has been reported to train phonological awareness in developmental dyslexia and dysgraphia. We used a multiple-probe design to evaluate the ADD program's effectiveness with a patient with a mild phonological alexia and mixed agraphia following a left hemisphere infarction. Large gains in phonological awareness, reading and spelling nonwords, and reading and spelling real words were demonstrated. A follow-up reassessment, 2 months posttreatment, found the patient had maintained treatment gains in phonological awareness and reading, and attained additional improvement in real word reading.     

Inflectional spelling deficits in developmental dyslexia

The goal of this study was to examine past-tense spelling deficits in developmental dyslexia and their relationship to phonological abilities, spoken morphological awareness and word specific orthographic memory. Three groups of children (28 9-year-old dyslexic, 28 chronological age-matched and 28 reading/spelling age-matched children) completed a battery of tests including spelling regularly inflected words (e.g., kissed) and matched one-morpheme words (e.g., wrist). They were also assessed on a range of tests of reading and spelling abilities and associated linguistic measures. Dyslexic children were impaired in relation to chronological age-matched controls on all measures. Furthermore, they were significantly poorer than younger reading and spelling age-matched controls at spelling inflected verbs, supporting the existence of a specific deficit in past-tense spelling in dyslexia. In addition to under-using the -ed spelling on inflected verbs, the dyslexic children were less likely to erroneously apply this spelling to one-morpheme words than younger controls. Dyslexics were also poorer than younger controls at using a consistent spelling for stems presented in isolation versus as part of an inflected word, indicating that they make less use of the morphological relations between words to support their spelling. In line with this interpretation, regression analyses revealed another qualitative difference between the spelling and reading age-matched group and the dyslexic group: while both spoken morphological awareness and orthographic word specific memory were significant predictors of the accuracy of past-tense spelling in the former group, only orthographic memory (irregular word reading and spelling) was a significant factor in the dyslexic group. Finally, we identified a subgroup of seven dyslexic children who were severely deficient in past-tense spelling. This subgroup was also significantly worse than other dyslexics and than younger controls on scores of orthographic memory. The implications of our findings for teaching and remediation strategies are discussed.     

Dyscravia: Voicing substitution dysgraphia

We report a new type of dysgraphia, which we term dyscravia. The main error type in dyscravia is substitution of the target letter with a letter that differs only with respect to the voicing feature, such as writing “coat” for “goat”, and “vagd” for “fact”. Two Hebrew-speaking individuals with acquired dyscravia are reported, TG, a man aged 31, and BG, a woman aged 66. Both had surface dysgraphia in addition to their dyscravia. To describe dyscravia in detail, and to explore the rate and types of errors made in spelling, we administered tests of writing to dictation, written naming, and oral spelling. In writing to dictation, TG made voicing errors on 38% of the words, and BG made 17% voicing errors. Voicing errors also occurred in nonword writing (43% for TG, 56% for BG). The writing performance and the variables that influenced the participants’ spelling, as well as the results of the auditory discrimination and repetition tasks indicated that their dyscravia did not result from a deficit in auditory processing, the graphemic buffer, the phonological output lexicon, the phonological output buffer, or the allographic stage. The locus of the deficit is the phoneme-to-grapheme conversion, in a function specialized in the conversion of phonemes’ voicing feature into graphemes. Because these participants had surface dysgraphia and were forced to write via the sublexical route, the deficit in voicing was evident in their writing of both words and nonwords. We further examined whether the participants also evinced parallel errors in reading. TG had a selective voicing deficit in writing, and did not show any voicing errors in reading, whereas BG had voicing errors also in the reading of nonwords (i.e., she had dyslegzia in addition to dyscravia). The dissociation TG demonstrated indicated that the voicing feature conversion is separate for reading and writing, and can be impaired selectively in writing. BG's dyslegzia indicates that the grapheme-to-phoneme conversion also includes a function that is sensitive to phonological features such as voicing. Thus the main conclusion of this study is that a separate function of voicing feature conversion exists in the phoneme-to-grapheme conversion route, which may be selectively impaired without deficits in other functions of the conversion route, and without a parallel deficit in reading.     

Dysgraphia in primary progressive aphasia: Characterisation of impairments and therapy options

Background: Spelling impairment is common in primary progressive aphasia (PPA). Although behavioural interventions tend to focus on spoken language, remediation of written language may be desirable, either because an individual’s regular use of writing makes it a priority or because writing is needed for communication in cases where it is better preserved than spoken language.

Aims: This paper has three aims: (1) to provide an up-to-date survey of spelling and handwriting impairments in each variant of PPA, (2) to provide guidance on characterisation of dysgraphia and identification of loci of impairment, and (3) to outline possible interventions. Because the number of studies which have specifically evaluated therapy for dysgraphia in PPA is small, this paper also reviews relevant studies of therapy in non-progressive dysgraphia.

Main Contribution: Review of the literature indicated that the most common pattern of spelling impairment in the semantic variant of PPA is surface dysgraphia (impairment in lexical spelling). The profile is more variable in the non-fluent and logopenic variants of PPA, but most commonly there is impairment in lexical spelling and in phoneme-to-grapheme conversion. Review of the literature on therapy for dysgraphia indicated that four main types of therapy have been evaluated and shown to improve spelling performance: (1) training of spelling of specific target words (used to ameliorate lexical and graphemic buffer impairments), (2) training of sound-to-spelling correspondence rules (used to treat impairment in assembled spelling), (3) training in segmentation of stimulus words into smaller chunks (to make them manageable for a damaged graphemic buffer, or as a first stage in applying sound-to-spelling correspondence rules), and (4) learning to identify and self-correct errors (used in treatment of graphemic buffer disorder).

Conclusions: It is likely that spelling impairment in PPA would be responsive to treatment, although this has only been demonstrated in the logopenic variant. Reported improvements following therapy for anomia demonstrate that relearning is possible in PPA, despite the progressive nature of the condition. This gives reason for optimism regarding a positive response to therapy for dysgraphia in all variants of PPA.     

Reading ability and phonological awareness in Japanese children with dyslexia

In alphabetic languages, the deficit of the phonological awareness is considered as the core deficit in developmental dyslexia. However, the role of phonological awareness in the acquisition of reading Japanese kana, the transparent, mora-based phonogram, has not been understood completely. We examine the abilities of Japanese dyslexic children on different types of Japanese phonological tasks, and discussed which tasks significantly account for each aspect of reading ability. METHODS: Fifteen dyslexic children (9.53+/-1.52 years old), and 15 children with normal reading ability (9.17+/-0.90 years old) participated in this study. They performed three types of phonological awareness tasks. The mora counting task and the mora reversal task of words require phonological awareness at the mora level. The letter rhyming task, which resembles the task in English language, requires phonological awareness at the phoneme level. We evaluated the reading ability by the reading speed, the reading errors, and the number of pauses while reading sentences aloud. RESULTS: The task performances of the dyslexic group on all three phonological awareness tasks were significantly lower than those of the control group. Stepwise multiple regression analysis revealed that the mora counting task and the rhyming letter task most significantly explained the reading speed and number of reading pauses. The mora reversal task of words, together with the antegraded digit span, significantly explained the reading errors. CONCLUSIONS: Japanese dyslexics showed deficits of phonological awareness both at the mora and the phoneme levels. Phonological awareness must be crucial for acquiring the ability of decoding phonograms, including Japanese kana.     

Reading disorders in a language with shallow orthography: A multiple single-case study in Italian

Background: This study aimed (i) to verify whether the classical word-naming models developed for English-speaking participants also account for the performance of patients who speak a shallow-orthography language such as Italian, and (ii) to study the effects of word frequency, concreteness, and grammatical class on word naming. Methods & Procedures: A total of 90 Italian aphasic patients participated in two reading tasks. The first task contained four sets of items: (i) concrete nouns (natural objects and artefacts), (ii) abstract nouns, (iii) function words, (iv) morphologically simple legal nonwords. The second task (trisyllabic words with unpredictable stress position) was designed to test reading ability along the lexical route (the position of the major word stress is the only opaque variable in the Italian reading system). The patients' performances on the two tasks were analysed for strong dissociations, and to test the effect of grammatical class, concreteness, word frequency, and item length. The effect of age of acquisition was tested in a subsequent analysis. Outcomes & Results: Reading scores were pathological for all patients. The present sample reflected the entire spectrum of reading impairments: phonological (49), surface (4), undifferentiated (32), and letter-by-letter (5) dyslexia, which is in line with data reported for English-speaking aphasic patients. Only one of the phonological dyslexic patients made semantic errors (a reading impairment compatible with the diagnosis of deep dyslexia). The vast majority of Broca's aphasic patients suffered from phonological dyslexia (76%), while fluent aphasic patients were distributed more evenly across dyslexia types; all four surface dyslexic patients belonged to the fluent aphasia group. Overall, grammatical class (concrete nouns vs function words) had a significant effect on 14 patients (15.6%), concreteness (concrete vs abstract nouns) on 15 (16.7%), and word frequency on 5 (5.6%). Grammatical class and concreteness affected the performance of phonological and undifferentiated dyslexic patients, and seemed not to influence the scores of the surface dyslexic patients. Age of acquisition turned out to have a highly significant effect and may account for most of the lexical effects emerging from the first analysis. Conclusions: The entire spectrum of reading impairments was observed in this group of Italian aphasic patients, thus confirming the validity of contemporary reading models also for shallow-orthography languages. Concreteness and grammatical class effects, present in deep dyslexia, also affected the performance of patients suffering from other types of dyslexia, although both phenomena might derive from a confounding effect of age of acquisition.     

Do deep dyslexia, dysphasia and dysgraphia share a common phonological impairment?

This study directly compared four patients who, to varying degrees, showed the characteristics of deep dyslexia, dysphasia and/or dysgraphia--i.e., they made semantic errors in oral reading, repetition and/or spelling to dictation. The "primary systems" hypothesis proposes that these different conditions result from severe impairment to a common phonological system, rather than damage to task-specific mechanisms (i.e. grapheme-phoneme conversion). By this view, deep dyslexic/dysphasic patients should show overlapping deficits but previous studies have not directly compared them. All four patients in the current study showed poor phonological production across different tasks, including repetition, reading aloud and spoken picture naming, in line with the primary systems hypothesis. They also showed severe deficits in tasks that required the manipulation of phonology, such as phoneme addition and deletion. Some of the characteristics of the deep syndromes - namely lexicality and imageability effects - were typically observed in all of the tasks, regardless of whether semantic errors occurred or not, suggesting that the patients' phonological deficits impacted on repetition, reading aloud and spelling to dictation in similar ways. Differences between the syndromes were accounted for by variation in other primary systems--particularly auditory processing. Deep dysphasic symptoms occurred when the impact of phonological input on spoken output was disrupted or reduced, either as a result of auditory/phonological impairment, or for patients with good phonological input analysis, when repetition was delayed. 'Deep' disorders of reading aloud, repetition and spelling can therefore be explained in terms of damage to interacting primary systems such as phonology, semantics and vision, with phonology playing a critical role.     

Impaired auditory frequency discrimination in dyslexia detected with mismatch evoked potentials

Deficits in phonological skills appear to be at the heart of reading disability; however, the nature of this impairment is not yet known. The hypothesis that dyslexic subjects are impaired in auditory frequency discrimination was tested by using an attention-independent auditory brain potential, termed mismatch negativity (MMN) while subjects performed a visual distractor task. In separate blocks, MMN responses to graded changes in tone frequency or tone duration were recorded in 10 dyslexic and matched control subjects. MMN potentials to changes in tone frequency but not to changes in tone duration were abnormal in dyslexic subjects. This physiological deficit was corroborated by a similarly specific impairment in discriminating tone frequency, but not tone duration, which was assessed separately. Furthermore, the pitch discrimination and MMN deficit was correlated with the degree of impairment in phonological skills, as reflected in reading errors of regular words and nonwords. It is possible that in dyslexia a persistent sensory deficit in monitoring the frequency of incoming sound may impair the feedback control necessary for the normal development of phonological skills.     

The nature and treatment of phonological text agraphia

Phonological alexia and agraphia are written language disorders characterised by disproportionate difficulty reading and spelling nonwords in comparison to real words. In phonological alexia, it has been shown that, despite relatively accurate reading of words in isolation, text-level reading deficits are often marked and persistent. Specifically, some individuals demonstrate difficulty reading functors and affixes in sentences, a profile referred to as phonological text alexia. In this paper, we demonstrate an analogous manifestation of the phonological impairment on text-level writing and suggest the term “phonological text agraphia”. We examined four individuals with phonological alexia/agraphia who also showed disproportionate difficulty writing well-formed sentences in comparison to their grammatical competence in spoken utterances. Implementation of a phonological treatment protocol resulted in significantly improved sublexical phonology skills as well as improvements in grammatical accuracy of written narratives. These findings support the notion of a common phonological impairment underlying nonword reading/spelling deficits and sentence-level difficulties.     

Classifying Chinese children with dyslexia by dual-route and triangle models of Chinese reading

This present study focuses on classifying developmental dyslexia by combining two famous models, the dual-route model and the triangle model of Chinese reading, re-examining validity of the subtypes, and observing the error types of word recognition for each subtype. Sixty-sixth graders with dyslexia in Chinese and 45 sixth graders who were matched by age and IQ with the dyslexic group were involved in the present study. Twelve (20%) sixth graders from the dyslexic group were classified as having phonological dyslexia, 11 (18.3%) were classified as surface dyslexia, 12 (20%) were classified as deep dyslexia, and five (8.3%) of them were classified as displaying more than one kind of deficit. Besides, still more than half (31; 51.7%) of the dyslexic group did not belong to any subtypes here. These subtypes had a good validity based on comparison of their phonological awareness, orthography, and semantics. Finally, for their error types of word recognition, both children with multiple-deficit dyslexia and children with non-subtype dyslexia showed a proportional pattern of six kinds of errors. Children with phonological dyslexia showed more phonetic errors and analogy errors, children with surface dyslexia showed more visual errors and analogy errors, and children with deep dyslexia showed more semantic errors and selective errors.     

ADHD and dysgraphia: underlying mechanisms

Multiple complaints in the domain of writing are common among children with Attention Deficit Hyperactivity Disorder (ADHD). In this work we sought to characterize the writing disorder by studying dysgraphia in twenty 6th grade boys with ADHD and normal reading skills matched to 20 healthy boys who served as a comparison group. Dysgraphia, defined as deficits in spelling and handwriting, was assessed according to neuropsychological explanatory processes within 3 primary domains: linguistic processing, motor programming and motor kinematics. Children with ADHD made significantly more spelling errors, but showed a unique pattern introducing letter insertions, substitutions, transpositions and omissions. This error type, also known as graphemic buffer errors, can be explained by impaired attention aspects needed for motor planning. Kinematic manifestations of writing deficits were fast, inaccurate and an inefficient written product accompanied by higher levels of axial pen pressure. These results suggest that the spelling errors and writing deficits seen in children with ADHD and normal reading skills stem primarily from non-linguistic deficits, while linguistic factors play a secondary role. Recommendations for remediation include educational interventions, use of word processing and judicious use of psychostimulants.     

Do phonologic and rapid automatized naming deficits differentially affect dyslexic children with and without a history of language delay? A study of Italian dyslexic children.

OBJECTIVE: The study aims to verify whether phonologic and rapid automatized naming (RAN) deficits are present and associated in Italian dyslexic children and whether they differentially affect dyslexics with and without a history of previous language delay (LD). BACKGROUND: According to the phonologic core deficit hypothesis, dyslexia may stem from impairment of the representation and manipulation of phonemes and may be closely associated with oral language deficits. However, deficits in tasks not requiring fine-grained phonologic representations, such as RAN, have also been described in dyslexic children. METHODS: Thirty-seven children were selected on the basis of a reading deficit and were assigned to 2 groups according to whether or not they had a history of early LD as determined retrospectively by parental report. A battery of reading and writing, verbal working memory, metaphonologic, RAN, and visual search tests were administered. RESULTS: RAN deficits were shared by most dyslexics (with and without a history of LD), whereas phonologic deficits were mainly associated with a previous LD. This last condition did not result in a more profound impairment of reading and writing decoding skills. CONCLUSION: In a shallow orthography such as Italian, RAN, not phonologic deficits, may represent the main cognitive marker of developmental dyslexia.     

Hyphenation can improve reading in acquired phonological dyslexia

Background: We describe JD, a person with severe phonological dyslexia. JD is good at reading words yet is extremely poor at reading nonwords. She shows no effect of word regularity on her reading performance. However, she has only a very mild general phonological deficit. Although it is known that teaching grapheme–phoneme correspondence rules and learning bigraph syllables can improve dyslexic reading, we investigate the possibility that segmenting the input string using hyphens can also improve reading.

Aims: We investigate the locus of JD's reading deficit and explore means of improving her reading. We examine the extent to which hyphenation can improve nonword reading.

Methods & Procedures: We use a battery of tasks in a single‐case study. We test oral reading, writing and spelling ability, and lexical and semantic knowledge. We assess phonological processing using tests of repetition and phonological awareness. We focus on blending and segmentation, and test whether hyphenating the letter string can improve reading.

Outcomes & Results: JD is very good at reading words (overall about 90%), but very poor at reading nonwords (overall about 10%). She makes no semantic errors and shows little effect of word regularity. JD has only a mild concomitant phonological deficit. She also has a very good digit span (8). JD can read affixes in isolation, and can also read nonwords made up of inappropriately affixed morphemes (e.g., “dismove”) if a hyphen is inserted at the affixation point (e.g., “dis‐move”). We found that hyphenation improves nonword reading in general, but particularly if it is the grapheme units that are separated by hyphens.

Conclusions: We discuss the possibility that JD's phonological dyslexia arises from impaired graphemic parsing, and that affixes have inherent meaning for her. Hyphenation may be a therapeutic tool worthy of wider consideration for improving reading performance in people with dyslexia.     

Disruption of posterior brain systems for reading in children with developmental dyslexia.

BACKGROUND: Converging evidence indicates a functional disruption in the neural systems for reading in adults with dyslexia. We examined brain activation patterns in dyslexic and nonimpaired children during pseudoword and real-word reading tasks that required phonologic analysis (i.e., tapped the problems experienced by dyslexic children in sounding out words). METHODS: We used functional magnetic resonance imaging (fMRI) to study 144 right-handed children, 70 dyslexic readers, and 74 nonimpaired readers as they read pseudowords and real words. RESULTS: Children with dyslexia demonstrated a disruption in neural systems for reading involving posterior brain regions, including parietotemporal sites and sites in the occipitotemporal area. Reading skill was positively correlated with the magnitude of activation in the left occipitotemporal region. Activation in the left and right inferior frontal gyri was greater in older compared with younger dyslexic children. CONCLUSIONS: These findings provide neurobiological evidence of an underlying disruption in the neural systems for reading in children with dyslexia and indicate that it is evident at a young age. The locus of the disruption places childhood dyslexia within the same neurobiological framework as dyslexia, and acquired alexia, occurring in adults.     

Inter-relationships among behavioral markers, genes, brain and treatment in dyslexia and dysgraphia

Cross-country, longitudinal twin studies provide strong evidence for both the biological and environmental basis of dyslexia, and the stability of genetic influences on reading and spelling, even when skills improve in response to instruction. Although DNA studies aimed at identifying gene candidates in dyslexia and related phenotypes (behavioral expression of underlying genotypes); and imaging studies of brain differences between individuals with and without dyslexia and the brain's response to instructional treatment are increasing, this review illustrates, with the findings of one multidisciplinary research center, an emerging trend to investigate the inter-relationships among genetic, brain and instructional treatment findings in the same sample, which are interpreted in reference to a working-memory architecture, for dyslexia (impaired decoding and spelling) and/or dysgraphia (impaired handwriting). General principles for diagnosis and treatment, based on research with children who failed to respond to the regular instructional program, are summarized for children meeting research criteria for having or being at risk for dyslexia or dysgraphia. Research documenting earlier emerging specific oral language impairment during preschool years associated with reading and writing disabilities during school years is also reviewed. Recent seminal advances and projected future trends are discussed for linking brain endophenotypes and gene candidates, identifying transchromosomal interactions, and exploring epigenetics (chemic al modifications of gene expression in response to developmental or environmental changes). Rather than providing final answers, this review highlights past, current and emerging issues in dyslexia research and practice.     

Computer assisted remediation of a homophone comprehension disorder in surface dyslexia

Abstract

An information processing model of reading was used to identify the locus of a reading and spelling disorder. The patient was found to exhibit the symptoms of surface dyslexia with surface dysgraphia, with a reliance on phonological decoding of the printed word to achieve comprehension. As a result, many errors were made in comprehending homophones. A remediation progrmmae presented on a microcomputer was implemented to retrain the recognition and comprehension of a set of written homophones. The patient improved in her ability to both recognise and comprehend homophones, but no generalization of the improvement to spelling of homophones took place.