SPECIAL READING

Learning of Disabled Children and Their Environment

Masanori Hanada, MD

It has been pointed out that cases of reading disability are rare in Japan due to the specificity of the language structure. Fifty children with learning disabilities were examined both neurologically and psychologically, and they were classified into three groups; the first group had alexia and agraphia (2 cases), 30 cases showing signs of minimal brain dysfunction with choreiform move­ments of the eyeballs comprised the second group and 18 cases with a history of asphyxia at birth and/or severe jaundice and clumsiness without choreiform movements of the eyeballs formed the third group. The children belonging to the second and third groups showed that the character­istic features of reading disability are related to their circumstances. The results showed that suitable dynamic guidance including their environment was necessary for them.

Hanada M. Learning of disabled children and their environment.

In Japan, formal education commences at the age of six and the daily school attendance per­centage is very high. The six-year olds are taught 48 phonetic symbols called Kana and then the more complicated ideographic symbols called Kanji are taught throughout their educa­tion. It has been pointed out that cases of reading disability in Japan are rare (0.98% ac­cording to Makita (I]) due to the specificity of the language structure. In contrast, a re­view of the literature indicates that in other countries the reported rates are relatively high and range from 5 to 25%, e.g. 10-25% in Argen­tina [2],10% in Australia [3],5% in China [4], 10-15% in Denmar~ [5] , 14.8% in Finland [6] , 6.6% in Germany [7] and 11 % in Norway [8] .

Recently, even in Japan, teachers and

From the Department of Neuropsychiatry, Kinki University School of Medicine, Osaka.

Received for publication: February 23, 1984. Accepted for publication: Match 10, 1986.

Key words: Learning disability, hyperkinetic, minimal brain dysfunction, attention deficit disorder. Correspondence address: Dr. Masanori Hanada, De­partment of Neuropsychiatry, Kinki University School of Medicine, Sayama-cho, Minamikawachi-gun, Osaka 589, Japan.

Brain Dev 1986;8:547-51

parents have begun to direct their attention to children with normal IQs who have reading disabilities. There are many factors involved in reading, such as emotional stability, linguistic ability, educational opportunities, visual and auditory perception, etc. Since there are few such cases in the strict sense (congenital word blindness), children with learning disabilities who show hyperkinetic tendencies or clumsi­ness are attracting interest. To child psychiat­rists these cases are interesting and thOUght provoking.

Since the concepts of minimal brain dys­function and attention deficit disorders have become widely accepted, the risk of misun­derstanding these children's problems has increased. Consequently, the purpose of this study was to offer a therapeutically valid classification of learning disabilities and to demonstrate the need for a dynamically ori­ented method of treatment.

Subjects

Fifty children (42 boys and 8 girls, 6 to 15 years old) were enrolled in this study. They had learning disabilities without any signs of sensory or emotional disturbance but showed severe motor dysfunction. Their socioeconomic

status was middle class.

Methods

Each child was examined by a child psychiatrist and information was compiled as to the follow­ing:

1. Case history 2. Neurological examination 3. Electroencephalography 4. Intelligence test 5. Bender-Gestalt test 6. Left-right orientation 7. Reaction to drugs (methylphenidate, etc)

According to the findings, the children were divided into three groups.

The first group was defined as having "word blindness" according to Morgan [9] . Interviews with all immediate family members also reveal­ed "word blindness" in many of them who exhibited similar symptoms. The second group generally exhibited "choreiform movements of the eyeballs", so that the characteristic forms of dyslexia were apparent. These dyslexic symptoms were due to disturbances of the optic function. These cases showed poor results for the Bender-Gestalt test. The third group was defined as having "low practognostic func­tion". These cases exhibited left-right disori­entation and clumsiness, but there was no hereditary tendency in the families.

Results and Discussion

Only two cases fell into the first group. They were two boys, 7 and 12 years old, respectively. Tendencies toward alexia and agraphia were also observed in their family members. Fig 1 shows the familial tendencies for case 1. Among three generations of his family, the paternal grandmother and the father also showed alexia and agraphia.

Many psychiatrists have investigated the genetic properties of reading disability and concluded that developmental dysplexia has a monohybrid autosomal dominant mode of in­heritance [10].

The characteristic symptoms of alexia and agraphia became evident in this first group when the child in question was able to read Kana characters one by one, but when given a phrase or sentence written in Kana he was unable to integrate the combinations nor could

548 Brain & Development, Vol 8, No 5, 1986

)2f % )Zf ¢ R R R R

I T 0 B

0 0

L L

Wi ~

~

-,

0

R

o f\.

o @] L L

Alexia and agraphia

R Right handedness

L Left handedness

Fig 1 Familial tendencies in case 1.'

be conceptualize them. Errors in spontane writing and writing on dictation were re( nized as evidence of agraphia. On the contn he could easily read Kanji,the inference bE that Kanji have lineaments similar to hiero, phics and there is only a slight chance tJ meaning being confused, if there are no turbances in the Gestalt function.

In contrast, a Kana character is a sin structured phonetic sign, so more com plica Gestalt functions are required.

There were 30 cases (26 boys and 4 girls the second group. There was a high incide of choreiform movements and signs of mini! brain dysfunction. The obstetrical histo showed asphyxia at birth and/or febrile c vulsions in infancy, borderline or slightly normal findings on electroencephalography; evidence of other problems during infancy almost all the cases.

The children were examined for choreifc symptoms by having them stand still with tI feet together and their heads upright, al outstretched, palms down and eyes clos for twenty seconds. A nystagmogram was' ployed to verify observations of choreifc movements and to determine the influence these movements on the reading ability.

Two plate electrodes were placed on temples one cm behind from the corners of eyes and one plate electrode in the center the forehead secured with adherent. The am tude of the nystagmograph was 5 mm/200 I

_-, 200J,lV 1 sec

Fig 2 Nystagmograph a/a normal healthy i5-year­old boy.

the time constant 1.5 and the paper speed 0.75 em/sec. Fig 2 shows a nystagmogram for a normal healthy 15-year-old boy. When read­ing sentences written horizontally, the rising patterns of the center line of the nystagmogram coincided with his starting to read a new line.

Fig 3 shows the results for a ten-year-old dyslexic boy with choreiform movements. There are large sharp patterns on the nystag­mogram and the rising patterns of the center line coinciding with each new line of words are obscured.

The dyslexic symptoms in the second group were indicated by the errors in reading both Kana and Kanji. It is striking that these chil­dren read words other than those written and had their own concepts of the sentence contents prepared before reading. Sentences were reread or lines were skipped. Repeated reading of the same sentences showed the same errors.

Eighteen cases (14 boys and 4 girls) com­prised the third group. Almost all cases had a history of asphyxia at birth and/or severe jaundice, etc. In the electroencephalogram, paroxysmal slow activity patterns were seen in some cases. These children exhibited clumsiness and made numerous mistakes in the maze test. Additionally, they were unable to draw a cube, and also left-right disorientation, hyperkinetic behavior, dystractabilities, short attention span and ambidexterity were present concomitantly in some cases.

Orton [11] has done much to solve the problems of cerebral dominance. Many others have proposed the existence of inadequate cere­bral and split laterality in cases of reading dis­ability . It is well known that immature cerebral functions are related to reading and writing disability.

The alexia and agraphia in the third group was apparent when the children were given

_ _ J 200J,lV 1 sec

Fig 3 Nystagmograph 0/ a i O-y ear-old dyslexic boy.

instructions to correctly copy Kanji and/or Kana. None of the children displayed difficulty when allowed to write Kanji and/or Kana of their own choosing.

Judging from these results, one of their characteristic disturbances was due to their clumsiness that influenced their out-put func­tion_ Therefore, these cases have expressive linguistic problems compared with the cases belonging to the second group whose core problem is disturbances of in-put function (choreiform movements of the eyeballs)_ As­sessment of the reaction to drugs such as methylphenidate, carbamazepine and minor tranquilizers indicated the effectiveness in some cases in the third group.

In Japan, special education for emotionally disturbed or mentally retarded children has been discussed. However, there have been few investigations concerning the methodology for handling such children. There are no specific modes of education nor specially trained teach­ers to assist these children.

Cases of "word blindness" as in the first group are rare in Japan, and the symptoms are not influenced by the situations. In con­trast, the cases belonging to the second and third groups show a diversity of symptoms according to the diversity of individual situa­tions. The symptoms in these cases showed improvement when a stable relation between the child and the outer-world was created and maintained. On the contrary, the symptoms again became manifest when the stable relation ceased. For instance, in one case of a child having a reading disability due to choreiform movements of the eyes, the movements lessen­ed and the reading difficulties improved when the child was given books which were of interest to him. The results were confirmed objectively by nystagmography_ Fig 4 shows the findings on nystagmography when a 12-year-old boy

Hanada: Learning desabilities 549

(Sound of metronome) --'--_--'-------''---- .t ... ___ ~ __ , __ ,_" _ , _ , __ " - ' - '-

(1)

(Tapping) (Stead y pattern)

200J.lV 1 sec (2 )

Fig 4 Nystagmograph of a 12-year-old boy with read- - ' --- - ' • , , ing difficulties. (10 y boy with reading disability)

_ 200J.lV 1 sec

Fig 5 Nystagmograph of the same boy as in Fig 4. Recorded when he was reading a book which inter­ested him.

with reading difficulties and choreiform move­ments of the eyes read a textbook. The nystag­mogram shows very irregular patterns with sporadic big sharp waves. However , when he read from books which were of interest to him, the nystagmogram showed more normal patterns as shown in Fig 5.

It was understood that the choreiform move­ments in this case were movements directed by the mode of subjectivity of the child . In the cases of dyspractognosia, the relation between the symptoms and situations was examined by the same procedure_ Namely, it was confirmed that the Gastalt-cognition showed variation (Funktions-wandel) over a period of time and with changing situations. According to Werner [12], "an analogous process will improve the cognition and symptoms of these children."

We also examined the different responses of a child in accordance with the changes in the meter of a metronome controlled by the examiner. The subjects were instructed to tap a steady beat (60 taps per minute) on one key with the index finger of the preferred hand for each click of the metronome. After thirty seconds the meter was gradually changed to 120 beats per minute which was continued for 20/30 seconds.

Fig 6 shows the results of the finger tapping test. The first result obtained for a lO-year-old with no reading disability shows steady tapping

550 Brain & Development, Vol 8, No 5, 1986

to , ~ _!. __ , _,_ , (J)

--'---_--'--__ , __ , ___ _ J-_ ~ _--'-----''-------'-_

(The same case: after 1 0 trials)

(4)

- --' -----'------''------.:.. - --± ---'----~~ __ ~I_''----

(The same case: under special conditions)

Fig 6 Results of the finger tapping test.

without reactions to the meter change of metronome.

The second record shows the results another 1 O-year-old boy with reading disa ity. When the meter of the metronome 1

changed, his beat changed accordingly. The third record shows the results on

peating the test ten times. From the sec( testing there was gradual improvement u; his responses were the same as those 0

normal child. On interrupting the child while watch

an interesting TV program and again giv the tapping test, the results reflected th of the first test. -

If the child was interrupted, while watch an interesting TV program, the results of re-testing of finger tapping returned to th of his first trial.

In conclusion, analysis of the characteri~ symptoms of reading disabilities mentioI above, especially those in the second and th groups seems to contribute greatly to understanding of these children_ Therefore cognizing and accepting these children's prj lems as a well-defined syndrome would lead exploration and evolution of suitable dynaI guidance for them, though Pavlidis [13] s that there did not seem to be any relationsl to their environment.

References 1. Makita K. The rarity of reading disability in

Japanese children. Am J Orthopsychiatry 1968; 38:599-614.

2. Gorriti C, Muniz A. Learning problems in Argentina. In: Tarnopol L, ed. Reading disabil­ities. Baltimore: University Park Press, 1976: 27-37.

3. White J, White M. Perceptual and psycholin­guistic factors in treated and advanced levels of reading and spelling skills. Brisbane: Univ of Queensland, 1972.

4. Butler S. Reading problems of Chinese children. In : Tarnopol L, ed. Reading disabilities. Balti­more : University Park Press, 1976 :115-30.

5. Jansen M, Soegard A, Hansen M, Glaesel B. Special education in Denmark . In: Tarnopol L, ed . Reading disabilities. Baltimore: University Park Press, 1976:155-74.

6. Syviilahti R. Reading-writing disabilities in Fin­land. In : Tarnopol L , ed. Reading disabilities. Baltimore: University Park Press, 1976: 175-8.

7. Klasen E. Learning disabilities: the German per­spective. In : Tarnopol L, ed. Reading disabilities. Baltimore: University Park Press, 1976:179-91.

8. Vik G. Reading disabilities in Norwegian ele­mentary grades. In: Tarnopol L, ed. Reading dis­abilities. Baltimore: University Park Press, 1976: 249-64.

9. Morgan WP. A case of congenital word blindness. BrMedJ 1896;2:1378.

10. Hallgren B. Specific dyslexia. Acta Psychiatr Neurol Scand (Suppl) 1950;65:1-287.

11. Orton S. Reading. writing and speech problems in children. London: Chapman and Hall, 1937 .

12. Werner H. Comparative psychology of mental development. New York: Science Editions, 1961.

13. Pavlidis GT. How can dyslexia de objectively diagnosed? Reading 1979;13:3-15.

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