Abstract
Treffert, D. (2011). Hyperlexia III: Separating “autistic-like” behaviors from autistic disorder; Assessing children who read early or speak late. Wisconsin Medical Journal, 110, 281–287.
Speech-language pathologists serve a number of children who are hyperlexic. The term hyperlexia was first used in 1967 (Silberberg & Silberberg, 1967). Generally, these are children who have learned to read before age 5 with little or no training, and have this precocious reading ability combined with language difficulties (in spite of accelerated reading ability) and display significant difficulty in social relationships. These children come to speech and language disorder clinics with a variety of diagnoses such as autism, behavior disorder, language disorder, gifted, and precocious reading ability. Hyperlexia is often related to rote learning or splinter skills. Although hyperlexia is frequently associated with autism spectrum disorders (ASD), it is not necessarily a sign of autism. Treffer, in his article, differentiates three types of hyperlexia.
Hyperlexia I is precocious reading ability in young, neurotypical children who are early readers. These children, who are usually very bright, may be reading in the preschool years and exhibit no behavioral concerns. Often, their parents have read to them regularly. Initially, these children appear to “read” the book because they have memorized the words and pictures. Soon, however, they are actually reading and transfer their skills to other books. This type of hyperlexia is not a disorder and requires no treatment. In fact, Treffert hesitates to even use the term hyperlexia with this group of children for fear it will be considered a disorder. For these neurotypical children, hyperlexia can be predictive of future academic success.
Hyperlexia II is a splinter skill that is part of ASD. These children have other signs and symptoms of ASD, and the early reading is but one facet of that more pervasive disorder. Although they have remarkable memorization abilities, they frequently comprehend little of what they read. They may remember concrete facts from what they read, but do not generalize or make inferences about the material. Reading intervention and treatment in this group is directed toward developing language comprehension. The precocious decoding reading ability should not be disregarded, however; it can actually be used to support language and social development.
Hyperlexia III is a less recognized form of hyperlexia. It is not a part of ASD, and even though children with this type of hyperlexia show some autistic-like behaviors, these behaviors fade over time. In the preschool years, these children exhibit an intense fascination with letters or numbers, but they have significant problems in understanding verbal language. Like children with ASD, these children have poor comprehension of what they read, and their thinking is concrete and literal. They may also exhibit echolalia, pronoun reversals, intense need to keep routines (obsession with sameness), auditory or other sensory hypersensitivity, specific intense fears, strong auditory and visual memory, and selective listening with the appearance of suspected deafness. As these children develop language skills, their autistic-like behaviors disappear, and they become typically developing children.
Treffert recommends caution and observation of young children who exhibit hyperlexia and autistic-like behaviors, because hyperlexia is not always linked to ASD. He believes that the diagnosis of autism may be prematurely and erroneously applied to children with hyperlexia III. Hyperlexia III can only be diagnosed over time, as the disorder separates from hyperlexia II. These children should receive speech and language treatment to deal with the speech and comprehension problems, occupational therapy to deal with some of the sensory and social isolation issues, and behavioral interventions to deal with some of the ritual issues.