By Darold A. Treffert, MD

This Web site gets many "I have a son or daughter who..." questions, usually inquiring about the presence and implications of savant-like behaviors, often "splinter skills", in children, adolescents or adults. Occasionally these behaviors present as a rather startling precocious ability to read words in very young children, well beyond that expected at the child's chronological age, coupled with an intense fascination with letters or numbers. In spite of this intense preoccupation and ability with words, there are, correspondingly, significant problems in understanding verbal language. Comprehension of that which is masterfully read is often poor, and thinking is concrete and literal. There is difficulty with, and a paucity of, abstract thinking. There may be some autistic-like symptoms as well including echolalia (repeating rather than initiating conversation), pronoun reversals, intense need to keep routines (obsession with sameness), auditory or other sensory hypersensitivity, specific intense fears, strong auditory & visual memory, and selective listening with the appearance of deafness.

This combination of precocious reading skills accompanied by significant problems with learning & language, and impaired social skills is called Hyperlexia. A more complete description of this condition can be found at the American Hyperlexia Association Web site at http://www.hyperlexia.org. An excellent, even more detailed article by Phyllis Kupperman, Sally Bligh and Kathy Barouski, entitled "Hyperlexia," can be found at this Web site: http://www.hyperlexia.org/hyperlexia.html.

The literature on this topic is really quite scant, beginning to appear only as recently as 1967. These children, most of whom have learned to read before age 5 with little or no training, have this precocious reading ability combined with language difficulties (in spite of accelerated reading ability) and display significant difficulty in social relationships. As the authors above point out, these children come to their particular Speech and Language Disorders Clinic with a variety of diagnoses such as: "autism, behavior disorder, language disorder, gifted, precocious reading ability seen often as rote learning, a splinter skill or a savant idiosyncrasy."

Usually parents of hyperlexic children, when they inquire of this web site, have had their child go through numerous evaluations, with various confusing and contradictory diagnoses applied ranging from autism, to Pervasive Developmental Disorder, Asperger's Disorder, Attention Deficit Disorder or language disorder, for example. In other instances there is no diagnosis applied at all except for "precociousness." Controversy exists as to whether hyperlexia is a serious developmental disorder such as autism, or whether this is in fact a speech and language disorder of a distinct and separate type.

While the literature to date is not a great deal of help in making the distinction between hyperlexia being a autistic/PDD spectrum disorder, or a separate, distinct language disorder, it appears in either circumstance, the prognosis for improvement overall is quite good. Quoting the authors above, with respect to prognosis, they note that these children when first seen at age 2 or 2 ½ "are not able to understand language. They may use a few words but often they are echolalic. Their behavior looks autistic. However we have found that these children emerge out of that autism. Although they may retain some aloofness or antisocial and oppositional behaviors." They go on to note that the aloneness and self-stimulating behaviors decrease dramatically as language comprehension and expressive language improves. By the time many of the hyperlexic children are in first or second grade many of the 'autistic' behaviors have diminished and while remaining aloof, the children do begin to socialize more. In short, they emerge significantly from their 'autism', if in fact it was Autistic Disorder at all.

An article entitled "Reading Skills in Hyperlexia: A Developmental Perspective," by Kate Nation of York University is another source of information on this condition (Psychological Bulletin 125:338-355, 1999). This lengthy article is a comprehensive review of the literature to date. One section of the article examines the relationship of Hyperlexia to other Developmental Disorders, particularly autism. The author concludes that hyperlexia, while present in children with Autistic Disorder, is not specific to Autistic Disorder or confined to that condition. Instead, hyperlexia can be seen in non-autistic persons many of whom, however, do have autistic-like symptoms.

The literature is divided on the causes and different types of hyperlexia. From my reading of that literature it appears, however, that broadly speaking, there are at least three forms of "hyperlexia" in children who read precociously. First, there is a group of normal children with very precocious reading skills whose development was normal in all other respects (no autistic-like behaviors; adequate comprehension and no other language, communication or social deficits). These are normal children who simply have exceptional early reading skills.

Second is a group of children and adolescents who also have exceptional and advanced early reading (word recognition) skills coupled with pronounced difficulties in other language, reading comprehension, cognitive and social skills. Many also show autistic-like behaviors such as echolalia, obsessive-compulsive behaviors including obsession with sameness, specific intense fears, remarkable memory and impaired social and interactive skills, for example. But these children do not have Autistic Disorder as such. It is this group, in my view, that does represent a separate and specific speech and language disorder to whom the diagnosis of Hyperlexia is most properly applied. The prognosis or long-term outlook for this group, it appears, is really quite good.

Finally there is a third group of children and adolescents whose precocious reading ability, sometimes at a prodigious level, is in fact a savant splinter skill in individuals with either Autistic Disorder or some other form of Developmental Disorder. It is sometimes the "hyperlexia" that is first noted in these individuals, and sparks the 'savant' consideration. In these instances the hyperlexia is but one manifestation or symptom of a larger Autistic/Developmental Disability spectrum disorder, it seems to me, in contrast to Hyperlexia as a separate disorder as in the second group above.

All of this underscores the need for a comprehensive assessment by a knowledgeable person or team at a clinic or agency that is conversant with this disorder. The Kupperman, Bligh and Barouski article noted above, and available through the Hyperlexia Web site also noted above, outlines in excellent detail the parameters and considerations in such an evaluation.

The point in this posting on Hyperlexia on this Web site is not to exhaustively discuss the disorder. Rather it is to point out that when precocious reading ability and extraordinary fascination and ability with words presents itself in a young child, along with other language and social problems, hyperlexia should be in the differential diagnosis, and more importantly, a comprehensive speech and language evaluation should be part of a diagnostic workup. If the diagnosis, as a part of such an evaluation, turns out to be Hyperlexia, the specific principles and considerations in educational and treatment approaches to these children need to be carefully applied as well.

Several parents who had inquired on this site about their child with accelerated, savant-like precocious reading ability, obtained considerable relief and help when, in those particular instances, the diagnosis, and treatment approaches, consistent with Hyperlexia were applied. Feedback from these parents indicated such an evaluation, and specific treatment and educational follow-up, and information were both of a great deal of help in those particular circumstances. It is for that reason this information, and resources, on Hyperlexia appears here. Hopefully as the literature continues to evolve on this condition, there will be more clarification regarding classification of Hyperlexia with respect to its component sub-groups, and even more resources will emerge and be identified for comprehensive evaluation and then application of appropriate education and treatment principles to this group of individuals.


For more information, please contact:
Darold A. Treffert, MD
St. Agnes Hospital, Fond du Lac, Wisconsin
Clinical Professor, Department of Psychiatry
University of Wisconsin Medical School, Madison
Personal Web site: http://www.daroldtreffert.com
e-mail: savants@charter.net