6 Chapter 1
recognize graphemes. The reader has letter reversals and/or does not perceive their shapes in a
meaningful way. Typical of this type of dyslexia is confusing “b” with “d” or “p” with “d.” Other
letters may have no meaning, and as a general rule, the more similar the shapes of the graphemes,
the more likely they are to be misperceived.
Another type of dyslexia involves loss of word meanings. This is typically seen in aphasic
patients (who have lost language due to a stroke or some other type of brain injury), but it can also
occur because of learning disabilities in children. The person with this type of dyslexia does not
recall the meaning of written words or confuses them with others. The condition is sometimes
called word blindness, but this term is misleading because the reading disorder is not a result of
visual impairment. It usually involves semantics and the patient’s impaired ability to decode writ-
ten language at the word level.
Dysgraphia is the inability to express oneself in writing. Although it may include prob lems
with legibility, it is not due to paralysis or paresis of the hand used for writing.
Dysgraphia can involve difficulty copying geometric forms, letters, words, and phrases.
Writing to dictation, as in taking lecture notes and composing legible, or ga nized papers, also pres-
ents prob lems that hinder academic per for mance in students with learning disabilities.
Reading and writing disorders may occur in de pen dently of each other, but they often are found
together. Thus, treatment usually involves objectives for both dyslexia and dysgraphia. In addition,
speech- language pathologists incorporate literacy training into all therapies, particularly those
involved with reading and writing.
Literacy Training and Language Disorder Syndrome
Recently, speech- language pathologists have made a more concerted effort to incorporate their
clients’ reading and writing educational goals into therapy objectives. (For more on literacy and
language, see Stone, Silliman, Ehren, and Apel, 2004.) Today these clinicians assume a primary role
in children’s literacy development. This is reasonable given their extensive knowledge and train-
ing in language development and disorders. These therapists bring knowledge and skills to the
classroom that enhance children’s literacy learning, and they are valuable educational resources.
Hearing Loss, Attentional Interactions, and Attention Deficits
Hearing is sometimes called the second sense after the primary sense of vision. However,
normal hearing and higher- level auditory pro cessing are primary in learning language. They are
essential to learning and appropriately using language symbols for speech, writing, and read-
ing. Consequently, a client’s hearing must be screened and, if warranted, thoroughly evaluated
before diagnosing language delay or disorders. In addition, although children may have normal
hearing, their pro cessing of auditory stimuli may be compromised by attention deficits. Westby
(1998) defines attentional interactions as the child’s capacity to attend to and discriminate among
stimuli. She notes that the be hav iors the infant uses to respond to and maintain stimulus inputs
can be manifested in several ways, such as visual tracking, smiling in response to a familiar per-
son, laughing, and orienting toward sound. Prob lems with sound orientation in the infant may be
one of the first indications of an auditory pro cessing disorder (APD). According to Martin and
Clark (2003, p. 209), “Auditory pro cessing disorders is [the term] often applied to children whose
recognition or use of language is not age- appropriate and/or is inconsistent with their level of
intelligence. Many of these children also have additional learning disabilities that prevent them
from progressing normally in their education.” More boys than girls have APDs, which affect the
acquisition and use of language. En glish (2002) lists early signs of APD, including inconsistent
responses to auditory stimuli, short attention span, distraction, frequent requests for repetition of
information, and prob lems with short- and long- term memory.