PEACFUL COEXISTENCE

Autism, Asperger's, Hyperlexia

by Lynn Richman

This article has been republished here from the American Hyperlexia Association Fall 1995
Newsletter.

Lynn Richmann is professor and directory of the division of pediatric psychology at the University of
Iowa College of Medicine. He directs the Pediatric Learning Disorders Clinic. This article is adapted
from his presentation at the conference on hyperlexia held in Oak Brook Illinois, October, 1996.

When you speak about hyperlexia, you must talk about language learning
disorder. When you talk about them both, you need to address autism. More
recently, when you talk about hyperlexia, you need to think about the nonverbal
learning disorders as well. When you talk about hyperlexia and nonverbal learning
disorders, you must talk about Asperger's syndrome. When you talk about all of
these, you always need to consider that Attention Deficit Disorder may be a
coexisting trait.

When talking about any of these learning functions, two spectrums are important.
First is the social perception spectrum, running from low to high awareness of
social cues and appropriate behaviors. Second is the cognitive balance spectrum,
measuring both performance (non-verbal) IQ and verbal IQ. Rather than being an
unrelated set of characteristics, hyperlexia is best understood in the context of
these spectrums and how the various disorders are expressed on these continuums.

Two Subtypes
In our work, we have identified two subtypes of hyperlexia. One group has a
language disorder, which is what you generally see in the literature. Another group
has a visual spatial motor disorder. In our group with language learning disorders,
we often found lower verbal IQ and higher performance IQ. We found superior
visual memory in almost al cases.

For the visual spatial motor type, we often found a lower performance or nonverbal IQ
and a higher verbal IQ. It seems unusual to talk about a higher verbal IQ in a child who
has a language disorder, but when you look at the nonverbal learning disordered kids or
Asperger's Syndrome, you see children who have relatively intact language in many
ways but have difficulty in the use of language pragmatically. This group had superior
auditory memory, but they had impaired cognitive organization. The language learning
disorder group had more phonics errors when they were reading, whereas the visual
spatial disordered type had very few phonics errors.

Hyperlexia Language Hyperlexic Visual-Spatial

Disorder Disorder
Expressivelanguagedeficit,despite Definition Visualspatialand/ormotordelayof
goodrotememoryskills.Languageis
delayed,echolalicandperserverative.
Problemsinunderstandingoverall
meaningbeyondroterecall.Autistic
likesymptoms.
Problemswithreading
comprehensionmaynotshowupin
theearlygradesbecauseofgood
memory.Maketangential
associations,whichproduceoffbeat
responses.Immature,unawareof
other'sreactions,doesnotconsider
consequencesofbehavior.
Distractibleandinpulsive,butthis
mayberelatedotalanguagedeficit.
Processingspeedisaproblem.
Autisticsymptomsdropoffas
languageimproves.
Needsintensivelanguagetherapy.As
languageimproves,integrate
languageandsocialskillstraining.
Allowmoretime;slowdownthe Remediation childtoanswerorallyortaperecord
speedoftests.Deemphasizeoral
readingabilityandworkonreading
formeaning.
disorder.Languagepragmaticdeficit
inexpressingandinterpreting
experientialaspectsoflanguageand
environment.Aspergerlike
symptoms.
Mayhaveletterandwordreversals
butreadingcomprehensiongood.
Difficultywithworksheetsand
copyingproblemsfromthe
Symptoms blackboardorbook.Unorganized
andinpulsive.Socialinperceptions,
problemsreadingnonverbalcues.
Doesnotlearnfromexperienceand
continuestomakesamemistakes.
Avoidpurelyvisualapproaches;use
strengthinverbalreading.Talk
throughperceptualtasks.Avoid
copyingfromblackboard.Allow
whenpossible.Usecongnitive
behaviormodificationtoreduce
impulsivity.Needssocialtrainingto
increasesocialperception.

Points on the Spectrum

Using language functionally, reading other people's intentions are areas where
language problems occur. Children with Asperger's Syndrome usually have a
deficity in nonverbal skills, and I would cal that a cognitive problem. There are
often problems in visual motor integration skills, visual spacial orientation and
spatial memory. Often these characteristics are not measured and therefore
missed. They need to be looked at.

We can view hyperlexia as an overlap between autism and language learning

disorder, or between Asperger's Syndrome and a nonverbal disorder. The
hyperlexic child in the language disorder category is more likely to have deficits in
language association, expressive language, reading comprehension and some social
difficulties. However, many of the children with language learning disorders do not
have major social perceptual problems. Those that do overlap with the autism
group.

Children with the nonverbal learning disorder type of hyperlexia overlap with
Asperger's kids, who have a very low social perception. The characteristics of the
nonverbal language disorder hyperlexia are deficits in visual spatial organization,
fine motor coordination and math. The children will have adequate to advanced
level of word recognition, good verbal learning and a high amound of verbal
output. However, social imperceptions and inappropriate affect are common.

Asperger's kids generally have better use of some aspects of language than
children with Autism. Asperger's kids often wish to be sociable but fail, and that is
a cardinal feature to look at. The child with autism has such difficulty socializing
that he does not even try. Cognitive symptoms and social symptoms need to be
looked at together as core features of both autism and Asperger's syndrome.

Coexisting Diagnoses
Rather than being a separate diagnosis, hyperlexia may be a coexisting diagnosis.
The hyperlexia child can fit into some categories that have already been
established.

Interest in hyperlexia is growing as we get more information out across the

country. We have the problem of fitting it into the context of current diagnostic
categories. Those diagnostic categories may not be valid for the hyperlexic child if
you simply use the checklist to see if a child qualifies for a diagnosis. If hyperlexia
becomes listed as a primary disorder, many children will be misdiagnosed, just as
other problems are misdiagnosed now. If you think about the content of verbal and
nonverbal skills and the level of social perception and don't jump to conclusions,
children with hyperlexia can be identified under a system of coexisting diagnoses.

Article originally appeared in the Winter 1997 AHA Newsletter

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