BRAIN AND LANGUAGE 17, l-23 (1982)

A Study of Hyperlexia
JANE M. HEALY
Hathaway Brown School
DOROTHY M. ARAM AND SAMUEL J. HORWITZ
Rainbow Babies and Childrens Hospital and Case Western Reserve University
AND
JANE W. KESSLER
Case Western Reserve University
Twelve children with early intense reading and superior word recognition skills
coupled with disordered language and cognitive behavior are described. Cog-
nitive, linguistic, and reading measures evidenced a generalized cognitive deficit
in forming superordinate schemata which was not specific to visual or auditory
modalities. Positive family histories for reading problems were present for 11
of the 12 children, suggesting a relationship between hyperlexia and dyslexia.
INTRODUCTION
Children with remarkably advanced word reading ability despite pro-
nounced cognitive and language deficits have been recognized for some
time. This unusual developmental disorder, termed hyperlexia by Sil-
berberg and Silberberg (1967), was noted in early reports of idiot savants
(Parker, 1917; Phillips, 1930), and in case studies of psychotic children
(Cain, 1969; Goodman, 1972).
A few recent studies have described circumscribed aspects of the
functioning of groups of hyperlexic children. In their initial report on
hyperlexia, Silberberg and Silberberg (1967) summarized a group of 28
children whose ability to recognize words was notably higher than either
comprehension of material read or overall verbal functioning. Other than
Address reprint requests to Dorothy M. Aram, Department of Pediatrics, Rainbow Babies
and Childrens Hospital, 2101 Adelbert Road, Cleveland, OH 44106.
1
0093-934x/82/050001-23$02.00/0
Copyright 0 1982 by Academic Press. Inc.
All rights of reproduction in any form reserved.
2 HEALY ET AL.
commenting upon the reading and verbal behavior and reporting that
intellectual functioning ranged from mental defective to bright normal
(IQs from nontestable to 126), the authors presented little information
about specific aspects of development. More than half of the group had
been diagnosed as retarded, autistic, or exhibiting behavior suggestive
of neurological impairment.
In subsequent reports Silberberg and Silberberg (1968, 1971) described
more fully six of these hyperlexic children. Although a wide variation
in perceptual and linguistic skills was reported among subjects, specific
findings or testing instruments used to evaluate these skills were not
delineated. The authors suggested that difficulty in integrating language
was implicit in this condition.
Twelve disordered children who began to read words spontaneously
before age 5 were described by Mehegan and Dreifus (1972). Expressive
language skills were notably lacking in these youngsters, although oral
reading of complex words was proficient. This skill was especially sur-
prising since only 2 of the 12 had effective spontaneous speech, mental
abilities were well below average, and little comprehension was evi-
denced for material read. Disorders of prosody and articulation were
common in the group, and the word reading was compulsive in nature.
Repetitive physical movements and other behavioral stereotypies were
noted.
Huttenlocher and Huttenlocher (1973) studied three hyperlexic children
in whom reading developed before age 5 despite language and behavioral
disorders. All three were considered intellectually slow and unresponsive
to people. Speech was characterized by echolalia, idioglossia, and pro-
noun reversals. Piagetian tasks showed that none of the three had attained
concrete operations as measured by number and liquid conservation
tests. Strengths were found in rote memory and recall of past events,
as well as for mathematical problems not requiring a grasp of underlying
concepts. Finding that performance was almost identical in response to
both oral and written commands, the authors suggested that these chil-
dren were able to extract only a limited amount of meaning from verbal
material in either auditory or visual modes.
One child described as hyperlexic by Elliott and Needleman (1976)
had shown interest in words at 15 months and, although she remained
mute, learned to communicate with typewriter and sentence cards. She
was also able to match pictures and words, leading these authors to
conclude that some comprehension was present. They questioned label-
ing hyperlexia as a disorder, seeing it rather as an accellerated cognitive
ability.
Most recently Richman and Kitchell (1981) described 10 children who
read words at least 2 years above age level, but presented a range of
developmental disorders including hyperactivity, language delay, atten-
HYPERLEXIA 3
tional deficits and autistic-like characteristics. Nine of the ten had Full-
Range WISC IQs within the average range. The authors documented
superior visual and auditory memory skills coupled with impaired as-
sociative language abilities.
Beyond descriptions of hyperlexic children, numerous theories have
been advanced to explain this condition. Explanations have ranged from
those holding that the condition represents a difference in degree from
normal functioning (Silberberg & Silberberg, 1968, 1971; Rawson, 1971)
to those who see it as a manifestation of a qualitative, neurological
dysfunction (Mehegan & Dreifus, 1972; Huttenlocker & Huftenlocker,
1973). Others (deHirsch, 1971; Elliot & Needleman, 1976) have suggested
that specific gifts in the form of superior skills in word recognition or
faculties for remembering words by sight underlie the phenomenon. Rich-
man and Kitchell (1981) have postulated that hyperlexia may represent
a primary deficit in language association skills. Along with Benton and
Pearl (1978) and deHirsch (1971), these investigators suggest that hy-
perlexia may be one particular variant of dyslexia. Psychodynamic ex-
planations such as those advanced by Cain (1969) or Goodman (1972)
have suggested that hyperlexia represents a volitional escape into a non-
personal, systematic world.
While most descriptions of such children have emphasized their un-
usually early development of word reading, the Richman and Kitchell
(1981) study did not report on this aspect of the condition. It designated
as hyperlexic children whose word reading was at least two years ad-
vanced over expectation. Other than this work, no systematic description
of hyperlexics cognitive, linguistic, and reading abilities has appeared.
Consequently many issues related to hyperlexia remain equivocal.
Among those addressed in the present study are the following: Does
hyperlexia exist as a syndrome with characteristic features? Are any
developmental or familial variables consistently related to the condition?
What cognitive, linguistic, and reading patterns exist for these children?
Are their abilities specific to auditory or visual input modalities?
METHOD
Subjects
Twelve children, eleven boys and one girl, between the ages of 5 and 11 years served
as subjects for this study. These children were drawn from three northern Ohio counties
and represented a wide cross section of socioeconomic groups, with parents occupations
ranging from professionals to welfare clients. Seven were white and five were black.
Referrals were obtained from school psychologists, a pediatric neurologist, a language
pathologist, and a diagnostic pre-school center. Subjects comprised all children referred
during the period of 1 year who met the following criteria: (1) intense early interest in
graphic symbols; (2) onset of word recognition prior to age 5; (3) disordered linguistic or
cognitive functioning; (4) level of word recognition superior to other linguistic or cognitive
abilities.
HEALY ET AL.
Instruments
Following subject identification, an extensive parent interview was conducted by the
first author at each childs home. This interview explored the childs medical, develop-
mental, and reading history, as well as familial learning patterns. Each child was then seen
individually for 8 to 10 hours of testing.
The test battery developed for this study explored cognitive, linguistic, and reading
competencies. Cognitive and linguistic tests were selected for the mental, rather than the
chronological, ages of the subjects, as it was anticipated that they might not be able to
perform at chronological age expectations.
To explore the question of modality-specific deficits in these hyperlexic children, alternate
written forms of specific auditory subtests were prepared and administered at a testing
session after standard administration. Alternate forms consisted of the test questions typed
on 3 x 5 cards which the child read. Table 1 summarizes the testing instruments included
in this battery.
TABLE 1
SUMMARY OF TESTING INSTRUMENTS
COGNITIVE TASKS
McCarthy Scales of Childrens Abilities
Verbal scale Performance scale Quantitative scale
Pictorial memory
Word knowledge I
Word knowledge II
Verbal memory I
Verbal memory II
Verbal fluency
Opposite analogies
Block building
Puzzle solving
Tapping sequence
Draw-a-design
Draw-a-child
Conceptual grouping
Number questions
Numerical memory I
Numerical memory II
Counting and sorting
Piagetian tasks
Detroit Tests of
Learning Aptitude
Object permanence
Seriation
Number conservation
Liquid conservation
Picture absurdities
Oral commissions
LANGUAGE TASKS
Test of Language Development
Comprehension Meaningful production
Repetition
Picture vocabulary
Grammatic understanding
Oral vocabulary
Grammatic completion
READING TASKS
Sentence imitation
Wide Range Achievement Test: Reading
Goldman Fristoe Woodcook: Reading of Symbols
Stanford Diagnostic Reading Test Level B: Comprehension
Reading Miscue inventory
u Denotes presentation of both oral and alternate written form of test items.
HYPERLEXIA 5
Cognitive tests selected for use in this study included the McCarthy Scales ofchildrens
Abilities (McCarthy, 1972), Piagetian tasks, and the test of Pictorial Absurdities and Oral
Commissions from the Detroit Tests of Learning Aptitude (Baker & Leland, 1959). The
McCarthy is a standardized test of mental abilities, similar in construction to the Wechsler
Intelligence Scales for Children. It yields a general cognitive index which is derived from
tests in three subscales: Verbal, Perceptual-Performance, and Quantitative. Piagetian tasks
included object permanence (Uzgiris & Hunt, 197.5) seriation, number and liquid conser-
vation. Seriation required the child first to copy a stairway of graduated wooden blocks,
and then to insert additional blocks into the construction (Elkind, 1968). A number con-
servation test with modified verbal requirements (Miller, 1976) was used with chocolate
M&Ms serving as the stimulus items. The child was asked, Which row has more-which
would you like to eat? A standard liquid conservation test was used (Bruner, 1966).
Pictorial Absurdities required the child to tell or indicate in some manner the absurdity
in each of a series of pictures of common situations, such as a tree bearing several different
kinds of fruit, or a child pushing an adult in a baby carriage.
The Oral Commissions subtest from the Detroit Tests of Learning Aptitude was also
administered in both oral and written forms, with the two modes alternated in each of two
testing sessions. Commissions consisted of eight sets of directions, ranging from one to
four parts each, for example: Walk to the window; then put this book on a chair.
Language Tests likewise were planned to explore auditory and visual receptive mo-
dalities, with verbal and nonverbal response alternatives. Subtests of the Test ofLanguage
Development TOLD, (Newcomer & Hammill, 1977), shown in Table 1, tapped syntactic
and semantic skills through both picture recognition and expressive language tasks. Again,
selected subtests were administered at a subsequent testing session with the stimulus
questions typed for the child to read. In Picture Vocabulary and Grammatic Understanding,
the child was asked to point to or place the word or sentence he had just read on the
appropriate one of four pictures. Oral Vocabulary required a definition of single words
(such as bird or old), while Grammatic Completion tests required completion of a
sentence with a syntactically correct word.
Reading Tests included tests both of word recognition and comprehension. The word
reading section of the Wide Range Achievement Test WRAT (Jastak & Jastak, 1965),
yielded a score for single word recognition, and the Reading of Symbols from the Goldman
Fristoe Woodcock Auditory Skills Test Battery GFW (Goldman, F&toe, & Woodcock,
1974) was used to test mastery of phonological principles in nonsense words. The Stanford
Diagnostic Reading Test Level B: Comprehension SDRT (Karlsen, Madden, & Gardner,
1976) included both sentence and paragraph meaning. The former required a picture choice
response to a single sentence, while the latter involved choosing words to complete related
sentences in a modified cloze procedure. In the Reading Miscue Inventory RMI (Goodman
& Burke, 1972), the child read a passage in which oral reading errors were tabulated and
evaluated. The child then was asked to retell the story as an index of comprehension.
RESULTS
Histories
Historical information obtained from the families supported distinct
commonality of development in all twelve subjects (Table 2). While gross
motor milestones were normal, patterned actions such as tying shoes,
buttoning, zippering, and even opening doors were uniformly delayed.
Behavioral problems, particularly those associated with autism, were
frequently cited, and all 12 subjects were described as difficult or puzzling
T
A
B
L
E

2

S
U
M
M
A
R
Y

O
F
D
A
T
A

F
R
O
M

F
A
M
I
L
Y

I
N
T
E
R
V
I
E
W

(
x

=

y
e
s
)

K
B

D
M

S
C

G
T

A
g
e

S
e
x

R
a
c
e

D
e
v
e
l
o
p
m
e
n
t
a
l

m
i
l
e
s
t
o
n
e
s

W
a
l
k

(
m
o
n
t
h
s
)

T
i
e

s
h
o
e
s

(
y
e
a
r
s
)

L
a
t
e

b
o
w
e
l

c
o
n
t
r
o
l

B
e
h
a
v
i
o
r

P
h
y
s
i
c
a
l

s
t
e
r
e
o
t
v
o
i
e
s

L
a
c
k

o
f

i
n
t
e
r
e
s
t
-
i
n

P
e
e
r

p
r
o
b
l
e
m
s

S
p
e
e
c
h

h
i
s
t
o
r
y

O
n
e

w
o
r
d

(
y
e
a
r
s
)

S
e
n
t
e
n
c
e
s

(
y
e
a
r
s
)

E
c
h
o
l
a
l
i
a

S
p
e
e
c
h

p
r
o
b
l
e
m
s

R
e
a
d
i
n
g

t
o
y
s

A
g
e

f
i
r
s
t

o
b
s
e
r
v
e
d

(
y
e
a
r
s
)

W
a
t
c
h
e
d

S
e
s
a
m
e

S
t
r
e
e
t

P
r
e
o
c
c
u
p
i
e
d

w
i
t
h

r
e
a
d
i
n
g

E
n
j
o
y
e
d

b
e
i
n
g

r
e
a
d

t
o

C
u
r
r
e
n
t

s
c
h
o
o
l

p
l
a
c
e
m
e
n
t

S
p
e
c
i
a
l

c
l
a
s
s

E
M
R

L
D

M
a
i
n
s
t
r
e
a
m
e
d

R
e
g
u
l
a
r

c
l
a
s
s

H
a
n
d
e
d
n
e
s
s

C
h
i
l
d

M
o
t
h
e
r

F
a
t
h
e
r

S
-
6

M

W

1
2

N
o

X

X

X

1
4

4

X

3

X

X

X

X

a
m

R

a
m

6
-
5

M

B

1
1

N
o

X

X

X

X

1

5
4

X

X

2
4

X

X

X

a
m

R

R

S
M

C
B

K
F

D
H

B
F

C
D

M
G

7
-
l

M

W

1
1

N
o

X

X

X

X

1

5

X

X

3

X

X

X

X

R

R

R

7
-
5

M

W

1
2

N
o

X

X

X

X

2

4
1

X

X

3
9

X

X

X

L

R

R

7
-
5

M

W

1
5

7

X

X

X

X

1

4
f

X

2
1

X

X

X

R
b

R

R

8
-
2

M

B

1
0

N
o

X

X

X

3

4

X

X

3
1

X

X

L
b

R

a
m

8
-
2

M

B

1
2

N
o

X

X

1
4

2

X

3

X

X

X

X

L

R

R

8
-
9

M

W

1
2

I

X

X

X

3

4

X

X

3

X

X

X

X

R

R

L

8
-
1
0

M

B

9
-
7

M

W

1
0
-
3

M

W

l
@

1
1

1
3

8

6

1
0

X

X

X

X

X

X

2
1

5

X

X

2
1

X

X

X

X

R
b

R

R

X

X

X

3
t

6

X

X

3
f

X

X

X

1
0

m
o

4

X

X

3

X

X

X

X

R

R

a
m

D
B

Q
\

1
0
-
7

F

B

1
2

I

X

X

X

5

E

8

X

5

m

X

c
l

4

F

X

X

X

R

R

L

0

S
t
o
p
p
e
d
.

D
E
x
a
m
i
n
e
r

o
b
s
e
r
v
e
d

a
m
b
i
d
e
x
t
r
o
u
s

h
o
h
s
l
v
i
n
r

HYPERLEXIA 7
children. Physical stereotypies such as hand flapping, spinning, or rocking
were common, and all but one child had shown a notable absence of
interest in toys. All had problems relating to peers and were described
as inflexible and intent on activities of their own choice. Speech histories
showed a common pattern of delay with echolalia often noted. All of
these youngsters had been referred to professional services for behavioral
anomalies and/or language delay. Most had been classified as retarded
by at least one professional. Only one was currently being educated full-
time in a regular classroom, although earlier he had special developmental
classes.
While all of the mothers were right-handed, two fathers were left-
handed and four were ambidextrous. Two of the subjects were clearly
left-handed, and two ambidextrous. Four had been reported by the fam-
ilies as either right or left-handed, but were observed to use both hands
for tasks usually performed by the dominant hand.
In dramatic contrast to other development, reading histories, also
shown in Table 2, illustrate unusually precocious acquisition of word
reading skills, most commonly noted first around age 3. Each family was
uniformly shocked at this development, and none had taught the child
to read. Some of these children actually began to read words before they
talked meaningfully, demonstrating word recognition by pointing or spell-
ing with magnetic letters. All were preoccupied, almost compulsively,
with letters and words, and spent hours studying books, labels, and
catalogs. In a typical account, one mother described her child as lying
in his playpen at age 24, studying books and ignoring his toys. All but
two had intently watched Sesame Street. Reading appeared to have
replaced other developmentally appropriate activities for all of these
children, and most were reported to have continued their fascination
with word-reading until the skill was highly developed. Families uni-
formly agreed, however, that the children had great difficulty under-
standing what they read.
An unexpected pattern that emerged from these interviews was one
of reading disorders on the paternal side of 11 out of 12 of these families.
Table 3 summarizes data relevant to these findings.
While 9 mothers reported that they enjoyed reading, only 1 father was
so described. This is not surprising, since 8 of the 12 fathers had sig-
nificant reading problems, and one other, who had dropped out of school
in Italy, had never learned to read English. These cases were charac-
terized by delayed acquisition of reading, poor comprehension, or adult
dyslexia. The fact that several of these men had gone on to finish high
school, college, or even a medical degree suggests that intellectual re-
tardation was not the primary factor in much of this reading pathology.
It is also notable that seven families reported male and female siblings
with some form of language-learning disorder, ranging from severe mental
T
A
B
L
E

3

S
U
M
M
A
R
Y

O
F
F
A
M
I
L
I
A
L
R
E
A
D
I
N
G
P
R
O
B
L
E
M
S

K
B

D
M

S
C

G
T

S
M

C
B

K
F

D
H

B
G

C
D

M
G

D
B

E
n
j
o
y
s

r
e
a
d
i
n
g

M
o
t
h
e
r

X

X

X

X

X

X

X

X

X

F
a
t
h
e
r

X

Y
e
a
r
s

o
f

s
c
h
o
o
l

C
o
m
p
l
e
t
e
d

i
i

M
o
t
h
e
r

1
2

1
3

1
2

6

1
2

1
2

1
2

B
A

1
3

B
S

B
A

1
2

F
a
t
h
e
r

1
3

1
2

B
A

d
.
0
.

1
1

d
.
o
.

d
.
o
.

M
D

1
5

B
A

M
S

1
2

5

3

R
e
a
d
i
n
g

p
r
o
b
l
e
m
s

M
o
t
h
e
r

X

F

F
a
t
h
e
r

X

X

?

X

X

X

X

X

X

S
i
b
l
i
n
g
s

X

X

X

X

X

X

X

P
a
t
e
r
n
a
l

r
e
l
a
t
i
v
e
s

X

X

X

X

X

X

?

M
a
t
e
r
n
a
l

r
e
l
a
t
i
v
e
s

X

X

x

=

Y
e
s
.

d
.
o
.

D
r
o
p
p
e
d

o
u
t

o
f

s
c
h
o
o
l
.

?

I
n
f
o
r
m
a
t
i
o
n

n
o
t

a
v
a
i
l
a
b
l
e
.

HYPERLEXIA 9
retardation to documented reading deficits. One older male sibling had
been hyperlexic and was now in high-school EMR classes. In two other
families, younger brothers had not yet acquired language at age 3, al-
though one was reported to be reading words at nursery school.
Test Findings
Table 4 summarizes test scores for all individual subjects in this study.
It should be noted that subtest scores on the Test of Language Devel-
opment and the Detroit Test of Learning Aptitudes are reported in age
level scores, while the three reading tests are scored by grade levels
(a typical 7-year-old, for example, would score at grade level 2.0). Ex-
amination of this table reveals notable discrepancies between perfor-
mance on cognitive and linguistic tests and on the two tests of word
recognition ( WRAT and GFW). The SDRT comprehension scores, how-
ever, in all but one case, reflect depressed ability even on this picture
and single-word measure designed for children in Grade 2.
Tests of Cognitive Abilities: McCarthy Scales
In Table 4 it may be seen that the ratio of mental to chronological age
on the total battery ranged from .47 to .91. Table 5 shows a group profile
on all McCarthy subtests in z, scores, which are calculated by subtracting
the mean score for age from each subjects score and dividing by the
SD in the normative sample for each subtest. Thus, each z score rep-
resents a comparison with normal functioning: e.g., a score of + 1
is one SD higher than the norm, -2 is two SD lower, etc. The Chart
of Extremes in Table 5 shows only those scores outside I-C 1 SD, so a
group profile of strengths and weaknesses may be seen. Group mean z
scores and SDs are also reported for each subtest.
Scores reveal relative group strengths on Verbal Fluency, where four
children were above one standard deviation and only two were below.
In this test, subjects are asked to name as many items in a category,
such as food, that they can think of in 20 sec. These items elicited such
a rapid series of associations from many of the children that it was
necessary to review tapes of each session for accurate scoring.
Relative strength was also found on Numerical Memory I and II (digits
forward and backward). Performance on the latter test, however, was
variable, as it was on Pictorial Memory.
Although only one child scored below expectation on the Block Build-
ing subtest, these constructions are extremely easy for children over 6
years; scores on this subtest probably should not be viewed as repre-
senting a particular group strength. Tapping Sequence, a repetition mem-
ory task where the child is asked to play a sequence on a toy xylophone
after demonstration by the examiner, was also high for the group.
Several subtests were uniformly difficult for most children in this study.
Only one child scored within one standard deviation of the mean on
T
A
B
L
E

4

S
U
M
M
A
R
Y

O
F

T
E
S
T

R
E
S
U
L
T
S
:

I
N
D
I
V
I
D
U
A
L

S
U
B
J
E
C
T
S
(
A
G
E
-
G
R
A
D
E

L
E
V
E
L

S
C
O
R
E
S
)

S
u
b
j
e
c
t

C
A

M
c
C
a
r
t
h
y

M
A
/
C
A

P
i
c
t
u
r
e

v
o
c
.

T
O
L
D

D
T
L
A

W
R
A
T

G
F
W

G
r
a
m
m
a
t
i
c

-

-

S
D
R
T

O
r
a
l

U
n
d
e
r
-

S
e
n
t
e
n
c
e

G
r
a
m
m
a
t
i
c

P
i
c
t
u
r
e

O
r
a
l

W
o
r
d

R
d
g
.

-

v
o
c
.

s
t
a
n
d
i
n
g

I
m
i
t
.

C
o
m
p
l
e
t
i
o
n

A
b
s
.

C
o
m
m
.

R
e
c
o
g
.

S
y
m
b
.

C
o
m
p
.

A
g
e

S
c
o
r
e
s

A
g
e

S
c
o
r
e
s

G
r
a
d
e

S
c
o
r
e
s

K
B

5
-
6

D
M

6
-
5

S
C

7
-
l

G
T

7
-
5

S
M

7
-
5

C
B

8
-
2

K
F

8
-
2

D
H

8
-
9

B
F

8
-
1
0

C
D

9
-
7

M
G

1
0
-
3

D
B

1
0
-
7

.
9
1

4
-
9

4
-
4

4

4

4

<
3

4
-
9

3
.
8

2
.
4

1
.
8

.
4
7

4

4
-
4

4

4

4

X

3
-
3

4
.
1

4
.
1

X

.
7
1

4

4
-
4

4

4

4

5

5
-
6

7
.
1

7
.
5

2
.
1

.
7
5

4
-
3

4

4

4

4

<
3

5
-
6

4
.
4

5
.
4

1
.
9

.
8
8

4

4
-
4

4

S
-
1
1

5
-
3

3
-
3

8
-
O

9
.
3

1
2
.
4

2
.
2

.
8
6

8
-
6

6
-
9

7
-
3

4
-
9

5
-
l

5
-
3

7
-
6

4
.
5

3
.
8

2
.
5

.
8
6

8

6
-
3

5
-
6

4

4

5
-
o

6
-
3

4
.
2

4
.
3

2
.
4

.
7
4

8
-
3

4
-
4

5
-
6

4
-
4

6
-
6

4
-
9

6
-
9

3
.
9

2
.
5

3
.
1

.
7
4

4
-
3

5
-
7

4
-
6

4

4

4
-
6

7
-
3

8
.
7

1
2
.
9

2
.
3

.
6
8

4
-
9

4
-
4

4

4

4

5
-
6

6
-
9

4
.
7

3
.
8

2
.
0

.
7
3

8
-
1
1

7
-
9

7
-
3

8
-
1
1

7
-
5

5
-
o

7
-
3

1
1
.
3

1
2
.
9

2
.
7

.
6
2

4

4
-
4

5
-
9

6
-
3

4

3
-
9

7
-
6

4
.
8

4
.
2

2
.
0

a

X

=

U
n
a
b
l
e
.

T
A
B
L
E

5

S
U
M
M
A
R
Y

C
H
A
R
T

O
F

E
X
T
R
E
M
E

z

S
C
O
R
E
S
:
M
C
C
A
R
T
H
Y

S
U
B
T
E
S
T
S

N
u
m
b
e
r

o
f

s
c
o
r
e
s

S
u
b
t
e
s
t

V
e
r
b
a
l

f
l
u
e
n
c
y

N
u
m
e
r
.

m
e
m
.

I

N
u
m
e
r
.

m
e
m
.

I
I

B
l
o
c
k

b
u
i
l
d
i
n
g

T
a
p
p
i
n
g

s
e
q
u
e
n
c
e

D
r
a
w
-
a
-
d
e
s
i
g
n

P
i
c
t
o
r
i
a
l

m
e
m
o
r
y

D
r
a
w
-
a
-
c
h
i
l
d

O
p
p
o
s
i
t
e

a
n
a
l
o
g
i
e
s

C
o
n
c
e
p
t
u
a
l

g
r
o
u
p
i
n
g

P
u
z
z
l
e

s
o
l
v
i
n
g

N
u
m
b
e
r

q
u
e
s
t
i
o
n
s

V
e
r
b
a
l

m
e
m
o
r
y

I
I

W
o
r
d

k
n
o
w
l
e
d
g
e

V
e
r
b
a
l

m
e
m
o
r
y

I

C
o
u
n
t
i
n
g

a
n
d

s
o
r
t
i
n
g

R
a
n
g
e

+
1
.
4

t
o

-
3
.
6

+
1
.
4

t
o

-
1
.
8

+
3

t
o

-
2
.
1

+

.
3

t
o

-
7
.
3

+
2
.
1

t
o

-
2
.
1

+

.
9

t
o

-
2
.
7

+
1
.
3

t
o

-
3
.
3

+
1
.
1

t
o

-
3
.
5

+

.
7

t
o

-
3
.
0

+

.
S
t
o
-
2
.
4

+
1
.
4

t
o

-
4
.
8

+

.
4

t
o

-
3
.
3

+

.
9

t
o

-
4
.
6

-

.
4

t
o

-
3
.
6

+

.
9

t
o

-
5
.
0

+

3

t
o

-

1
4
.
5

G
r
e
a
t
e
r

B
e
t
w
e
e
n

B
e
t
w
e
e
n

t
h
a
n

+
1

-
1
6
2

-
2

-
2

&

-
3

4

1

4

3

2

3

1

2

3

3

2

1

4

2

4

1

3

6

3

4

1

1

1

1

1

2

2

1

1

4

2

5

2

1

L
o
w
e
r

T
o
t
a
l

t
h
a
n

-
3

b
e
l
o
w

-

1

G
r
o
u
p

m
e
a
n

S
D

1

I

2

-

.
O
l

3

-

.
O
l

4

-

3
9

1

-

.
1
3

3

-

.
2
1

4

-

.
4
6

5

-

.
4
9

5

-

.
6
0

5

-

.
9
1

5

-

1
.
0
2

6

-
1
.
2
2

1
1

-

1
.
7
6

8

-

1
.
7
7

1
0

-

1
.
9
1

8

-
2
.
0
5

9

-
2
.
4
5

1
.
5
8

1
.
1
2

1
.
5
4

3

1
.
2
8

g

1
.
2
3

.
I
9

F

1
.
6
3

x

1
.
2
9

s

1
.
1
8

.
8
5

1
.
7
7

.
9
4

1
.
7
3

.
9
7

1
.
8
2

1
.
9
6

12 HEALY ET AL.
Number Questions. While computation was generally accurate, items
requiring numerical reasoning were commonly missed.
Other group weaknesses were shown in Verbal Memory I and II. In
the former, subjects generally performed well in repeating strings of
unrelated words, but were unable to retain meaningful sentences, thus
depressing the entire subtest score. Verbal Memory II required the child
to tell back a short story which was read to him. All but three of the
subjects were unable to retell even the simplest details of the story,
although they had given the appearance of attending when it was read.
Word Knowledge was also a common weak area; the only two scores
within the normal range were below the mean. Formulating a definition
for even a concrete noun was uniformly difficult, although the child often
was obviously familiar with the term and referent in question. Responses
were almost exclusively associative, tending toward personal sensori-
motor experiences (door: I close), syntagmatic relationships (bird:
tweet, tweet), or echolalic associations, often from television. Very
few responses earned full credit.
Counting and Sorting produced nine scores lower than one standard
deviation below the mean, with seven of these falling outside of three
standard deviations. On this subtest, failure to respond correctly to ques-
tions involving ordinal numeration accounted in part for these extreme
scores, as very few children above age 7 in the normative population
missed these items.
Overall difficulty was experienced by all children on subtests which
required organization of relationships or patterns for any type of incoming
stimuli (Table 6). This difficulty extended not only to items requiring
verbal organization, such as in Word Knowledge and Verbal Memory
II, but to numerical concepts, as in Number Questions, and manipulative,
visual-motor tasks such as Puzzle Solving and Conceptual Grouping.
The Puzzle Solving subtest was particularly notable in this regard.
Typically these youngsters worked exclusively by matching small inner
details rather than by forming the broad outline of the figure. Although
each child could name the picture puzzle before assembly, this task was
extraordinarily difficult for many.
Items in Conceptual Grouping required the child to abstract properties
of color, shape, and size, mentally and visually organizing plastic blocks
to ascertain missing or inappropriately placed members of a set. These
tasks were also notably difficult for the children in this study.
In dramatic contrast, subtests requiring repetition memory skills were
areas of strength, as has been noted (Table 6). Subtests in the McCarthy
requiring these abilities are Pictorial Memory, Tapping Sequence, Verbal
Memory I (part I), and Numerical Memory I and II. Although Numerical
Memory II requires the child mentally to reorganize a schema to repeat
the numbers backward, it was performed by these subjects as a repetition
HYPERLEXIA
13
TABLE 6
SUMMARY: EXTREME 2 SCORES, MCCARTHY SUBTESTS TESTS OF ORGANIZATIONAL
RELATIONSHIPS AND REPETITION MEMORY
Tests requiring organiza-
tional relationships
Puzzle solving
Word knowledge
Number questions
Verbal memory II
Conceptual grouping
Total
Tests of repetition
memory
Pictorial memory
Tapping sequence
Verbal memory I
Numerical memory I
Numerical memory II
Total
+1 -1 to -2 -2to-3 -3
1 3 1 2
0 4 5 1
0 3 4 1
0 3 2 3
0 4 1 0
1 17 13 7
3 2 2 1
1 2 1 0
0 1 2 5
4 3 0 0
2 3 1 0
10 11 6 6
x
- 1.22
- 1.91
-1.76
-1.77
-1.02
- .49
- .21
-2.05
- .Ol
- .09
Note. t = 2.51, p = < .05.
task. In some cases the children were observed to point to imaginary
numerals on the table or in the air as if actually reading them back from
a visual icon.
The difference between these two groups of scores was analyzed using
a one-tailed paired comparison t test. There was a significant difference
between the subjects scores on the five tests of organizational relation-
ships and the five tests of repetition memory (t = 2.51, df = 11, p <
.05).
Piagetian Tasks
While the method of administration used in this study corresponds to
standard Piagetian test procedures, these results are presented only as
general indications of cognitive development because of a lack of quan-
tifiable normative data or age-matched controls. All subjects but one
passed the test of object permanence; this one failure was attributable
to an inability to follow any organized search strategy in a series of
successive hidings. Simple seriation was attained by 10 of the children,
but when they were required to insert blocks in the stairway, complete
bafflement was the common response. Even when it was demonstrated
that blocks could be pulled apart to insert others, 10 were unable to alter
the previous construction.
Five passed the test of number conservation; correct answers were
achieved by counting the M&Ms. In several cases children selected the
group closest together as having more, despite a smaller amount. It
14 HEALY ET AL.
appeared to the examiner that they were responding to the density of
the array rather than length or number. No child in the study had attained
conservation of liquids; only one (MG) could be led to the correct answer,
but he failed the same test 2 weeks later. No child in the study had
achieved an age-appropriate level in these Piagetian tasks.
Detroit Tests of Learning Aptitude
Picture Absurdities produced uniformly low performance levels from
all subjects, as can be seen by examining age scores in Table 4. Converted
into z scores, they ranged from -3.02 to -7.53 with a mean of -5.04
and a SD of 1.58. The inability did not appear to center on verbal
expression of the absurdity, as children generally were able to describe
adequately what was happening and often picked out and described
details in the picture. Rather, they appeared not to evidence compre-
hension of the meaning of the situation pictured.
z Scores for auditory administration of items on the Oral Commissions
subtest were also low, ranging from - 1.01 to -7.05 with a mean of
- 2.62 and a SD of 2.16. The children responded to isolated words, but
seemed unable to apprehend relationships of words in the commands.
Bizzare responses resulted. When asked to Put this pencil on the table;
then open the door; then fold your hands behind you, two children
attempted to push the pencil under the door, looking baffled when it did
not fit. Similar responses were the rule, with complete confusion resulting
from an apparent inability to integrate the commands into any meaningful
framework. Sequential auditory memory, per se, seemed to be intact,
for the children often correctly repeated the commands. Alternate written
presentation of test items elicited similar responses and comparable
scores as will be seen later.
Tests of Language (TOLD)
Table 4 details individual age scores on TOLD subtests, and Table 7
summarizes group performance in z scores. Language performance was
highly discrepant from chronological age, with most subscores falling
below one standard deviation from mean for age and none above 1 SD.
This test is normed only through age 8-11, so scores for the three oldest
subjects were computed against these norms rather than comparable to
actual CA at time of testing. Even including these scores, only four
subscores in the entire test fell above mean for age; two on Picture
Vocabulary and two on Sentence Imitation.
Because of the extreme low scores on many tests, group means must
be interpreted with caution. As a group, subjects did best on Picture
Vocabulary, Sentence Imitation, and Oral Vocabulary and worst on
Grammatic Completion and Grammatic Understanding. It is important
to note that Grammatic Understanding is a test with a recognition re-
T
A
B
L
E

J

S
U
M
M
A
R
Y

C
H
A
R
T
O
F
E
X
T
R
E
M
E

z

S
C
O
R
E
S
:

T
O
L
D

S
U
B
T
E
S
T
S

N
u
m
b
e
r

o
f

s
c
o
r
e
s

S
u
b
t
e
s
t

R
a
n
g
e

B
e
t
w
e
e
n

-
I
&

-
2

B
e
t
w
e
e
n

-
2

&

-
3

T
o
t
a
l

b
e
l
o
w

-
1

G
r
o
u
p

m
e
a
n

S
D

P
i
c
t
u
r
e

v
o
c
a
b
u
l
a
r
y

+

1
.
0

t
o

-
3
.
0

1

6

7

-

1
.
3
0

1
.
3
7

S
e
n
t
e
n
c
e

i
m
i
t
a
t
i
o
n

+

1
.
0

t
o

-
2
.
7

5

5

1
0

-

1
.
5
5

.
8
J

O
r
a
l

v
o
c
a
b
u
l
a
r
y

-

.
3

t
o

-
3
.
0

6

4

1
0

-
1
.
5
8

.
J
9

G
r
a
m
m
a
t
i
c

c
o
m
p
l
e
t
i
o
n

-

.
J

t
o

-
2
.
1

3

8

1
1

-
1
.
8
5

.
9
2

G
r
a
m
m
a
t
i
c

u
n
d
e
r
s
t
a
n
d
i
n
g

-

.
3

t
o

-
3
.
0

4

7

1
1

-

1
.
9
1

.
7
9

T
A
B
L
E

8

S
U
M
M
A
R
Y

C
H
A
R
T

O
F

E
X
T
R
E
M
E

z

S
C
O
R
E
S
:

R
E
A
D
I
N
G

T
E
S
T
S

N
u
m
b
e
r

o
f

s
c
o
r
e
s

T
e
s
t

R
a
n
g
e

W
R
A
T
:

R
e
a
d
i
n
g

+
4
.
7
2

t
o

-

.
2
6

G
F
W
:

R
e
a
d
i
n
g

o
f

S
y
m
b
o
l
s

+
2
.
1

t
o

-

.
7

S
D
R
T
:

C
o
m
p
r
e
h
e
n
s
i
o
n

+

.
0
5

t
o

-
1
.
0

B
e
t
w
e
e
n

B
e
t
w
e
e
n

G
r
e
a
t
e
r

t
h
a
n

T
o
t
a
l

a
b
o
v
e

+
I
&

+
2

+
2

&

+
3

+
3

+
1

G
r
o
u
p

m
e
a
n

S
D

2

2

3

J

+

1
.
7
6

1
.
5
6

4

2

1

7

+

1
.
0
5

1
.
0
7

0

0

0

0

-

.
3
7

.
3
4

_
_
_
_
_

_
_
_
_
_
_

G

16 HEALY ET AL.
sponse of pointing to a picture in response to a spoken sentence; low
scores on this subtest would seem to indicate difficulty processing the
syntax and meaning of the sentence and/or the picture, rather than re-
flecting expressive language difficulties.
Responses on Oral Vocabulary, a test of defining words similar to the
McCarthy subtest, resulted in associative responses. Because scoring on
this test allows credit to be given for two such responses, many scores
were obtained which do not reflect a conceptual definition. The children
were frequently fluent in their associations, but responses overall were
limited to echolalic associations, to properties, or to sensorimotor con-
nections with the word.
Sentence Imitation was characterized by a rote quality. No paraphras-
ing of the sentences occurred and frequently meaning was completely
changed in the response, even when certain key words were retained.
Grammatic Completion revealed a lack of expressive syntactic struc-
tures commonly mastered by children of these ages. Responses to this
sentence completion task also showed, in many cases, a lack of under-
standing of the semantic intent of the stimulus sentence; words added
might be irrelevant or contradictory to intended meaning.
Tests of Reading
Individual scores for reading-related measures in this study are pre-
sented in Table 4, and group summary scores in Table 8. These tests
produced strikingly different results from other measures. Overall, the
childrens response was positive when these tasks were presented; in
many cases they seized the materials and began reading out loud before
asked to. Attentional problems, although present, were less apparent
than with other tasks. Articulation tended to be more precise in oral
reading than in speaking, and inflection and phrasing were often more
prosodic in the reading condition.
z Scores on the WRAT word recognition subtest ranged from - .26
to +4.72. Seven subjects scored higher than one standard deviation
above mean for age, and only one below the mean. In many cases difficult
words were sounded out successfully, and syllabic stress was often ac-
curate. In other cases, credit could not be given because the child pro-
nounced the phonemes correctly, but inflected incorrectly.
Results of the Goldman Fristoe Woodcock Reading of Symbols support
these findings. Reading of these nonsense words required use of phon-
ological word-attack skills for completely unfamiliar word configurations.
Six children scored at greater than one standard deviation above mean
for age, and six within -C 1 standard deviation. On the test of reading
comprehension, the Stanford Diagnostic Reading Test, all scores fell
below mean for age but within one standard deviation.
Oral reading for the Reading Miscue Inventory showed considerable
HYPERLEXIA 17
variation among this group in ability to read prosodically with observation
of phrasing and punctuation. While two of the subjects (MG and SM)
read fluently and with expression which suggested linguistic anticipation
of the text, the others read with varying degrees of prosody. One child
(DM) was unable to read text, although he was proficient with word
lists, and the youngest subjects connected speech (KB) was unintelli-
gible. While the remaining children successfully pronounced the words
of the text in order, intonation and phrasing were frequently absent, and
punctuation was often not observed. Nevertheless, a tendency to self-
correct errors was apparent, with corrections occurring immediately after
the mispronounciation rather than at the end of the phrase. This fact,
as well as the finding that the overwhelming majority of errors occurred
from close graphic and sound correspondences, suggests that these read-
ers are uniquely responsive to the perceptual attributes of the text rather
than to the meaning. Most readers reread and self-correct after they
reach the end of a phrase, realizing that they are not making sense;
such was not the case with these children.
Not only was the pattern of self-correction in these children divergent
from normal readers, but their number of errors was so limited as to
make scoring of the Reading Miscue Inventory questionable. The most
striking finding, however, was that not one of these youngsters, having
correctly pronounced almost all of the words in the text, could retell,
summarize, or even relate any information from the story. Isolated words
and phrases were sometimes recalled, and often the title was repeated
in response to the question, What was the story about? Most fre-
quently, responses were unrelated to the textual meaning, and, on at
least one occasion, drawn from a story read 1 month earlier. Even the
two most fluent readers failed to meaningfully retell or answer questions
about the story. It appeared that these children were not struggling with
verbal expression, rather that they had not grasped the overall meaning
of what they had read. Further discussion of reading test results of these
subjects may be found in Healy (1982).
Comparison of Performance in Auditory and Visual Input Modalities
Tables 9 and 10 show results of the statistical analysis of the selected
subtests which were administered in both auditory and visual (written)
forms. Subtests of the McCarthy and TOLD selected for this treatment
were first administered in the auditory mode for standard scoring in the
initial test administration. In sessions at least 1 week later, the identical
items were presented with the child reading the item from a prepared
card. All children could readily read the sentences presented.
Despite a possible training effect and previous suggestions that these
children might be more successful with written than with oral material,
there were no significant differences or directions in the scores of the
18 HEALY ET AL.
TABLE 9
COMPARISON OF AUDITORY AND VISUAL INPUT MODALITIES ON SUBTESTS ASSESSED BY PAIRED
COMPARISON 1 TEST (TWO-TAILED)
Subtest
Auditory Visual
32 SD x SD t
P
Opposite analo-
gies (McC)
Oral vocabulary
(TOLD)
Grammatic under-
standing
(TOLD)
Grammatic com-
pletion (TOLD)
Oral Commissions
5.8 1.9 5.6 2.5 .54 NS
5.7 3.8 5.6 4.9 .08 NS
11.1 4.8 11.8 4.9 - .83 NS
9.5 7.6 11.3 8.4 -2.80 < .02
12.6 5.1 11.6 4.8 1.73 NS
TABLE 10
COMPARISON OF AUDITORY AND VISUAL INPUT MODALITIES ON SUBTESTS ASSESSED BY
WILCOXIN MATCHED PAIRS SIGNED RANK TEST (TWO-TAILED)
Subtest
Oral vocabulary II (McC)
Verbal memory I (McC)
Picture vocabulary (TOLD)
No. of No. where
Pairs Vis. > Aud. S
P
10 7 12.5 NS
8 4 15.5 NS
8 4 16.5 NS
two administrations except on the subtest of Grammatic Completion.
The mean score on auditory was higher than on visual in three subtests:
Opposite Analogies, Oral Vocabulary (TOLD), and Oral Commissions;
the same in two: Verbal Memory I and Picture Vocabulary; and lower
on three: Grammatic Understanding, Grammatic Completion, and Oral
Vocabulary (McC).
DISCUSSION
Existence of a Syndrome of Hyperlexia
The childrens histories and test results support the existence of a
specific and identifiable syndrome of hyperlexia.
Support from Histories
All children presented developmental histories common in the follow-
ing respects. All read words before 5 years of age, and most around 34
years. None had been taught to read, although television may have
encouraged development of reading for most. The children pursued read-
HYPERLEXIA 19
ing intensely and with a preoccupation which typically substituted for
more usual preschool activities. Severely disordered language compre-
hension and expression were present for all of these children. Behavioral
patterns were similarly disordered, although assuming different forms in
different subjects. While autistic characteristics were frequently con-
comitant with the syndrome, they did not invariably appear, and degree
of severity varied considerably among children. Behavioral patterns com-
mon to all these hyperlexic children included a distortion of symbolic
play, a desire to focus intently on an activity of the childs own choice,
difficulty in mastery of many appropriate behaviors in both personal and
interpersonal situations, and problems with peer relationships. No con-
sistent pattern of pre-, peri-, or postnatal events was identified.
Commonality in familial patterns was found in the existence of lan-
guage-learning deficits on the paternal side. Eleven out of twelve families
reported close paternal relatives with disordered reading development,
and the remaining one was unclear because of the fathers early with-
drawal from school. Furthermore, one younger male sibling showed early
indications of hyperlexia, and one older male sibling had documented
hyperlexia. That 11 of the 12 children studied were male, coupled with
the paternal history of language learning problems, suggests that the
disorder may be genetically transmitted and its expression may be sex-
limited. Other investigators have similarly reported a preponderance of
males. Richman and Kitchells (1981) study included 8 boys and 2 girls,
while Mehegan and Dreifuss (1972) reported findings for 11 boys and 1
girl. All three children described by Huttenlocher and Huttenlocher
(1973) were boys, although Elliott and Needlemans (1976) case study
concerned a girl. None of these studies, however, investigated familial
history for language or reading disorders. Benton and Pearl (1978),
deHirsch (1971), and Richman and Kitchell (1981) have speculated that
hyperlexia may actually represent a subgroup of dyslexia. The family
histories reported in this study provide data supportive of this possible
relationship.
Support from Testing Results: Abilities Associated with Hyperlexia
Support for a common profile of abilities was found in cognitive, lin-
guistic, and reading tests. Profiles were uniformly divergent from patterns
of normal development in each area.
Cognitive abilities. While overall cognitive functioning was well below
age norms, relative skills in repetition memory tasks and concrete cate-
gorization were apparent in the testing results. Verbal and numerical
memory, particularly for nonmeaningful strings, were strengths. Some
categorization skills were evidenced by fluent associative naming as on
the Verbal Fluency Test of the McCarthy. These children were most
successful when organization was determined by the nature of the stim-
20 HEALY ET AL.
ulus and when immediate sensory cues were available. When they were
required to create organizational patterns, or to utilize relational or ab-
stract thinking, performance faltered. Failure to develop age-appropriate
Piagetian operations substantiate their general inability to free themselves
from the perceptual constraints of incoming stimuli and is consistent
with findings reported by Huttenlocher and Huttenlocher (1973). The
fact that this inability extended to nonverbal as well as verbal stimuli
suggests that a generalized cognitive deficit may underlie the syndrome
of hyperlexia.
Linguistic abilities. Language testing confirmed a pattern of disordered
and/or severely delayed development, which would appear to be an
invariable concomitant of the syndrome. Syntactic and semantic skills
were depressed in all subjects. Performance on tests involving units of
language was better than on those requiring conceptual integration of
word groups, rules, and relationships.
Relative strengths were found in recognition of Picture Vocabulary for
isolated concrete words, and in sensitivity to syntactic structures at a
recognition level. This latter ability may be consonant with abilities noted
in repetition memory, as these children frequently evidenced an almost
rote command of the structure of word groups even when unable to
demonstrate comprehension of the given syntactic or semantic relation-
ships. Ability to read orally, often with phrasing and expression, was
in dramatic contrast to the syntactic structures produced in formulated
language. Disordered syntactic and semantic abilities were found in both
comprehension and production tasks. While not directly tested, it was
also observed that pragmatic functioning of language was similarly dis-
ordered. Demonstrated problems with social use of language, both with
adults and in peer groups, was reported for all. In sum, these children
appeared to have achieved a high degree of phonological and syntactic
automaticity in reading and repetition tasks but were severely limited
in their ability to understand or generate meaningful language.
Reading abilities. Reading competencies likewise support some dis-
tinct commonalities among this group of hyperlexics. All were word-
calling at a level considerably in excess of expectation based on cognitive
or linguistic functioning. All exhibited comprehension of single words
when read, and all who could attend to connected prose evidenced com-
prehension of short literal sentences associated with a pictorial stimulus.
None, however, evidenced comparable comprehension of units larger
than single sentences without picture response alternatives. All had suc-
ceeded in generalizing phonological principles, and in integrating auditory
and visual, phoneme-grapheme correspondences.
While degrees of fluent oral reading with correction of miscues at a
perceptual, and possibly a syntactic level were observed, participation
HYPERLEXIA 21
in meaning was severely depressed when it was necessary for the child
to organize textual meaning beyond a concrete single-sentence level.
Important differences in reading abilities were also found among the
group. Despite almost identical early histories of reading behavior, the
course of development varied among subjects. At the time testing, in
fact, two distinct subgroups could be identified on the basis of decoding
ability. Seven subjects were extraordinary in their ability to decode both
familiar and unfamiliar word forms, while five were only superior in
relationship to their other cognitive and linguistic abilities.
Quantifying the parental attitude toward and encouragement of pre-
cocious word reading behaviors was not undertaken in this study. Most
parents tended to encourage the habit of word reading and looked on
it as a positive sign of development in children suspected of retardation.
The one mother who had viewed it with alarm, recognizing its abnormal
nature, had the only child in the study whose word reading and com-
prehension were roughly comparable. The importance of this point is
emphasized by the finding that reading had replaced normal preschool
play for these children, who evidenced a paucity of cognitive schemata
commonly acquired during sensorimotor and preoperational periods from
common childhood experiences. The implications here for redirection
of children exhibiting early hyperlexic behaviors into enactive activities
which increase participation in meaning would appear to be clear.
Auditory versus Visual Modality Strength
Results of this study support Huttenlocher and Huttenlochers (1973)
findings that hyperlexics deficits are not modality-specific. The only task
performed significantly better when read was the Grammatic Completion
subtest of the TOLD. Reading the stimulus items may have forced greater
attention and thus improved the score. Furthermore, as demonstrated
on the Reading Miscue Inventory, some of the children did anticipate
syntactic structures when reading. Reading with the additional visual
clues may have provided more ready access to rotely acquired syntactic
skills. The design, necessitated by scoring procedures of subsequent
administration of visual to auditory portions of the McCarthy and TOLD
tasks, makes conclusions from these subtests very tentative.
The Oral Commissions test, on the other hand, was administered in
a parallel-item, crossed design so that subjects responded to both auditory
and visual input at the first session, then to the same items with reversed
modality at the second. The nonsignificant results from this comparison
may be viewed with more assurance. It is notable that, despite focus of
attention by means of the visual stimuli, the children did better in the
auditory mode. Likewise, while a slightly better mean response on all
tests was obtained with nonverbal or motor tasks, none of these differ-
ences were significant.
22 HEALY ET AL.
Once more, it would appear that any effort to circumscribe the dis-
abilities inherent in hyperlexia in any narrow modality-specific manner
would be erroneous. Indications from this study support the view of a
generalized cognitive deficit underlying modality-specific processing
limitations.
Issues of Definition
The preceding discussion raises questions regarding the precise defi-
nition of hyperlexia. Is early reading behavior the hallmark of the con-
dition, or must the child continue to word-call at an extraordinary level
in order to be so designated? How extraordinary must this word rec-
ognition be?
Several investigators have described children less cognitively impaired
than the children in the present study. While the 10 studied by Richman
and Kitchell (198 1) presented associated language disorders, all achieved
Full Scale WISC IQs of 92 or above. Further, no mention was made
by these investigators of intense, early, untutored onset of reading. Their
criteria for identification as hyperlexic followed Silberberg and Silber-
bergs practice of specification of word recognition on the WRAT at least
2 years above expected achievement level. While a continuum in im-
pairment may well exist in hyperlexia, basing identification solely upon
accelerated word recognition surely would include many normally de-
veloping children. Just such definitional confusion exists in the literature.
For example, Niensted (1968) identified 26 out of 45 public-school chil-
dren as hyperlexic because their word list reading was at least 1 year
higher than their silent comprehension. Hypothesizing that overemphasis
on teaching of word-calling skills created this condition, she remedied
the hyperlexics by in-service teacher training and remedial instruction.
Although this study would seem to misinterpret the clinical problem of
hyperlexia, it does point up the need for definitional clarification.
We suggest that the term hyperlexia be reserved for reference to
the syndrome characterized by spontaneous and intense early interest
in letters and words which results in the development of extensive word
recognition prior to age 5, coupled with significantly disordered language
and cognitive development. Children exhibiting early hyperlexic behav-
iors may or may not continue to develop phenomenal word-calling abil-
ities, although word recognition remains considerably advanced over
other cognitive and linguistic abilities.
One final issue of definition concerns the relationship of this syndrome
to dyslexia. While not the focus of this paper, it must be noted that
disordered symbolic relationships considered to be integral to the dys-
lexic condition are also significantly present in hyperlexia. The existence
of common familial patterns, moreover, hints at more than a peripheral
relationship between these two language learning disorders.
HYPERLEXIA 23
REFERENCES
Baker, H. J., & Leland, B. 1959. Detroit tests of learning aptitude. Indianapolis:
Bobbs-Merrill Co., Inc.
Benton, A. L., & Pearl, D. P. (Eds.), 1978. Dyslexia. New York: Oxford Univ. Press.
Bruner, J. S., Oliver, R. R., & Greenfield, T. M. 1966. Studies in cognitive growth. New
York: Wiley.
Cain, A. C. 1969. Special isolated abilities in severely psychotic young children. Psy-
chiatry, 32, 137-149.
deHirsch, K. 1971. Are hyperlexics dyslexics? Journal ofSpecial Education, S(3), 243-246.
Elkind, D. 1968. Discrimination, seriation and numeration of size and dimensional differ-
ences in young children. In I. E. Sigel & F. H. Hooper (Eds.), Logical thinking in
children. New York: Holt Rinehart & Winston.
Elliott, D. E., & Needleman, R. M. 1976. The syndrome of hyperlexia. Bruin und Lun-
guuge, 3, 339-349.
Goldman, R., Fristoe, M., & Woodcock, R. W. 1974. Goldman Fristoe Woodcock Auditory
Skills Test Buttery. Circle Pines, MN: American Guidance Services, Inc.
Goodman, J. 1972. A case study of an autistic savant: Mental function in the psychotic
child with markedly discrepant abilities. Journal of Child Psycho/ogy, Psychiatry, 13,
267-273.
Goodman, Y. A., & Burke, C. L. 1972. Reading miscue inventory. New York: MacMillan.
Healy, J. M. 1982. The enigma of hyperlexia. Reading Research Quarter/y, in press.
Huttenlocher, R. R., & Huttenlocher, J. 1973. A study of children with hyperlexia. Neu-
rology, 23, 1107-l 116.
Jastak, J., & Jastak, S. 1965. Wide range achievemenf test manual. Wilmington: Guidance
Associates.
Karlsen, B., Madden, R., & Gardner, E. F. 1976. Stanford diagnostic reading test. New
York: Harcourt Brace Jovanovich.
McCarthy, D. 1972. McCarthy scales of childrens abilities. New York: The Psychological
Corp.
Mehegan, C. C., & Dreifus, R. E. 1972. Hyperlexia-exceptional reading ability in brain
damaged children. Neurology, 22, 1105-l Ill.
Miller, S. A. 1976. Nonverbal assessment of Piagetian concepts. Psychological Bulletin.
Newcomer, P. L., & Hammill, D. 0. 1977. The test of language development. Austin,
TX: Empiric Press.
Niensted, S. M. 1968. Hyperlexia: An educational disease? Exceptional Children, 35(2),
162-163.
Parker, S. W. 1917. Pseudo-talent for words. Psychology Clinics, 11, 1-7.
Phillips, A. 1930. Talented imbeciles. Psychology Clinics, 18, 246-265.
Rawson, M. B. 1971. Lets shoot for eulexia-not at hyperlexia. Journal of Special Ed-
ucation, 5(3), 247-252.
Richman, L. C., & Kitchell, M. M. 1981. Hyperlexia as a variant of developmental language
disorder. Bruin and Language, 12, 203-212.
Silberberg, N., & Silberberg, M. 1967. Hyperlexia: Specific word recognition skills in
young children. Exceptional Children, 34, 41-42.
Silberberg, N., & Silberberg, M. 1968. Case histories in hyperlexia. Journal of School
Psychology, 7, 3-7.
Silberberg, N., & Silberberg, M. 1971. Hyperlexia: The other end of the continuum. Journal
of Special Education, S(3), 233-242.
Uzgiris, I. C., & Hunt, J. McV. 1975. Assessment in infancy. Urbana: Univ. of Illinois
Press.