Children who learn to read well before their peers and show a strong fascination with letters and numbers sometimes owe their exceptional abilities to a syndrome called hyperlexia. This is considered a possible sign of autism, Asperger’s or Williams-Beuren syndrome.
What is hyperlexia?
Hyperlexia, from the Greek “hyper” (over) and “lexis” (pronunciation, word), refers to a child’s strikingly well-developed ability to read. However, this is accompanied by difficulties in understanding and correctly using spoken language and difficulties with social interactions. The syndrome was first identified in 1967 by Norman and Margaret Silverberg, who defined it as precocious reading ability without prior practice, typically occurring before the child reaches the age of five. They noted that affected children have an aptitude in decoding words that far exceeds their reading comprehension. Many experts believe hyperlexia is an indication of autism. Others, such as Darold Treffert, distinguished different types of the syndrome, only some of which are related to autism and Asperger syndrome. These are neurologically unremarkable children who are very early readers (type 1), autistics who develop early reading ability as a special talent (type 2), and children who exhibit traits similar to autism that disappear with age (type 3).
Causes
The exact causes of hyperlexia are not known. It is believed that the syndrome results from overdevelopment of certain areas of the brain, while others remain underdeveloped. If the phenomenon occurs as a consequence of autism or Asperger’s, possible explanations can be found. Currently, different triggers of autism are being investigated. On the one hand, genetic factors may play a role. More than 100 genes and more than 40 gene loci have already been identified that are involved in the disease. The many possible combinations of genetic abnormalities account for the great diversity and breadth of the autism spectrum.
Symptoms, complaints, and signs
In 2004, researchers discovered signs of altered connectivity, the large-scale flow of information, in the brains of Asperger’s patients. Brain scans showed both areas of increased and decreased activity, as well as decreased synchronization of the activity patterns of different brain areas. In addition to global underconnectivity, i.e., reduced connectivity, local overconnectivity also frequently occurred. This is understood as an overspecialization of certain brain activities. The resulting peculiarities in the behavior of the patients, for example in the detection of connections between feelings, persons and things, can also be observed in hyperlexic children. Therefore, studying the triggers of autism and Asperger’s may shed light on the causes of hyperlexia syndrome.
Diagnosis and course of the disease
Children affected by hyperlexia usually have an average or slightly above average IQ. They have an exceptional talent for deciphering languages and therefore become very early readers. Up to the age of 18 to 24 months, they develop normally in most cases; only after that do the abnormalities become more frequent. If a child is able to spell long words before age 2 and read complete sentences before age 3, he or she may be affected by the syndrome. Other talents include rapid letter and syllable counting and reading backwards. At the same time, striking communication difficulties can often be observed in the children. Many of them learn to speak only through intensive repetition and have difficulty learning the rules of a language by example or trial and error. This often brings social problems, including the fact that hyperlexic children are less interested in playing or communicating with others. They rarely initiate conversations, and often develop specific and unusual fears. The children use echolalia, or the imitation of sentences and words, to develop their speech. They often have a large vocabulary and can name many objects, but do not understand how to use their language skills in an abstract way.Spontaneous expressions are absent and pragmatic language use is underdeveloped. Hyperlexic children often have problems answering questions about where, how and why. Affected children are often cognitively overtaxed by parents, educators or teachers who expect them to have special skills and performance in areas other than reading. In everyday life they need routines, as they meet difficulties with changes with ritualistic behavior.
Complications
Hyperlexia causes mainly psychological complaints that cannot be treated in every case. In many cases, special gifts or abilities occur in children, so that they learn reading or arithmetic at a relatively early age. In addition to these positive aspects, there are also limitations in other areas of life that can greatly complicate the daily lives of affected children. Furthermore, there may be communication difficulties, for example, which can lead to teasing or bullying, especially among children. Most children with hyperlexia also have no desire to play or talk with other children. It is not uncommon for them to develop fears about communication and contact with other people. If these fears are not treated in childhood, they may develop serious social problems in adulthood. The treatment itself does not lead to any particular complications and is usually carried out through various therapies. However, it cannot be predicted whether the therapies will be successful and lead to a positive course of the disease. It is not uncommon for parents to also suffer from psychological discomfort due to hyperlexia.
When should one go to the doctor?
If a child shows behavioral abnormalities in direct comparison with other children of the same age, these should be discussed with a doctor. If the child’s development is altered or not age-appropriate, there are often conditions that require treatment or the child needs special support for existing skills. Medical tests are performed to diagnose possible disorders or the level of development. If the affected person finds it difficult to establish contexts between people, things and feelings, this is considered unusual. If contexts cannot be grasped, a doctor should be consulted. If letters and words are learned at a very early age without the influence of adults, this observation should be followed up. If long words can be spelled at a very young age, consultation with a physician is recommended. If there are difficulties in the areas of communication, feelings or physical closeness, consultation with a doctor should be made. If the rules of the language cannot be grasped despite much practice, a doctor’s visit is advisable. For children who show little interest in social contact or playing with toys, a doctor should take a closer look at the behavior. If parents or caregivers of the child recognize that patterns to be learned are not being adopted by the child, a doctor should be asked for advice as a neutral observer.
Treatment and therapy
Hyperlexia can be treated if the condition is diagnosed early enough. This requires intensive speech therapy, which should begin early in the child’s development. This allows the child to acquire better language skills and develop social skills more easily. If he or she already has advanced reading skills, these should be used as the primary approach to speech therapy. It is important for experts, parents, educators and teachers to work together as a team. Applied Behavior Analysis (“ABA”), which is often used in the treatment of autism, can also lead to success in related hyperlexic syndrome. It is a holistic form of therapy that has included language skills instruction since the 1980s. The goal of these measures is to build social and communicative competence. The children’s existing skills are used as a foundation on which the therapy program is built. Parents are involved in treatment, and learning attempts and successes are reinforced as directly as possible.
Outlook and prognosis
The ability to learn letters and numbers before other children is not stopped or treated.It is the result of above-average intelligence of the child and in most cases indicates another existing disorder. For this reason, hyperlexia is not an independent disorder that is treated. It is the result of an existing underlying disorder that must be diagnosed and medically treated. In most cases, there is a brain disorder that leads to a reduction of possibilities in other areas of life despite the above-average ability to deal with numbers and letters. Often, it is not possible for the patient to lead an independent life. The patient’s need for treatment is not focused on hyperlexia and is therefore not given priority. Rather, remedial measures take place to ensure that the competencies of the hyperlexia are utilized and that the patient is not underchallenged in this area, which in turn can trigger new complications. The prospect of curing or minimizing hyperlexia can be considered constant for the reasons stated. In a speech or behavioral therapy existing cognitive possibilities are promoted and the handling of the ability is trained. This leads to an improvement in the emotional state of most patients and thus to a better sense of well-being.
Prevention
Because the causes of hyperlexia remain largely unexplored, no preventive measures can be recommended. In connection with autism, theories have repeatedly emerged in recent years that interpret the disorder as a possible consequence of vaccine damage. However, these theories have not yet been substantiated and, in the case of vaccines containing thiomersal, have even been disproved. Thus, refusal of vaccination most likely does not protect against autism and hyperlexia.
Follow-up
In most cases of hyperlexia, the measures of a follow-up are severely limited. Here, the affected person is primarily dependent on a quick diagnosis with subsequent treatment to prevent further symptoms or complications. This also prevents a further worsening of the symptoms. The disease does not really need to be treated by a doctor, but the children need a strong support in their life, so that they can exercise their abilities properly. Parents must recognize hyperlexia at an early stage and have it examined by a doctor. After that, the children are in need of special support. Behavioral therapy may also be necessary in some cases to alleviate the symptoms of this disorder. Care and support from one’s own family or from relatives and acquaintances can also help to alleviate or even prevent psychological upsets or depression. Parents must thereby inform themselves about this illness correctly and completely. Contact with other sufferers of hyperlexia can also be very useful in this regard, as this often leads to an exchange of information.
This is what you can do yourself
Parents of affected children should, in the first instance, arrange speech therapy for their child. If therapeutic treatment is started, language skills can be promoted and social limitations can be reduced. The therapy must be supported by the parents at home by reading and calculating a lot with the child. If the child already has advanced reading skills, the reading ability can be specifically improved. The child may be able to start school earlier and make full use of his or her intellectual abilities. Accompanying behavioral therapy is always indicated. Especially for children in whom hyperlexia occurs in conjunction with autism, early behavioral training is important. The parents or guardians should receive training for this and, if necessary, also talk to other parents. This will help find the best treatment for the child. If, despite everything, the child has difficulty integrating, further therapeutic counseling may be appropriate. The child may need to attend a special school or take medication to alleviate the accompanying symptoms of the underlying autism disorder. The pediatrician or a child psychologist can decide which measures to take in detail.