Re: What are the characteristics and treatment for Agraphia in children

Apologies for the delay, but your question involves a bit of semantics.



Alexia: "a" = "without" "lexia" = "reading" in the sense of failure
to recognize words.  The "proper" term is visual verbal agnosia
where "gnosia" comes from "knowledge."  Basically, the person can see the
letters and words and cannot understand the meaning.


Based on your question, this usually does not affect children. 
Nevertheless, I will discuss it first.  For true alexia to occur, the
person must suffer from lesions of the brain--usually strokes.  The "basic
organization" of the brain involves what are known as "primary" cortices or
areas the handle the stimulus.  Thus, we have a primary visual cortices at
the back of the occipital lobes [Back of head.--Ed.] known as "Brodman's
Area 17."  These communicate with "secondary" regions which also
communicate with further regions.  Basically, you have to see the letters,
you have to recognize the letters as a coherent thing, you then have to
attach a meaning to this coherence.  People with alexia lack this ability
to process at this level.


An interesting syndrome that demonstrates the processing of vision and
language is alexia without agraphia.  "Agraphia" means "without
writing."  A person with this syndrome can write--he can even take
dictation--but he cannot read.  He cannot read as he writes.


This results from damage that effectively isolates the secondary visual
cortices from the areas that interpret language.  The areas that interpret
language remain connected to the areas that produce language.  Thus, the
person can still produce language.  If you tell him what to write, he can
understand it and send it to the area to produce writing.  He simply cannot
send what he sees to the areas that interpret it.


Dyslexia:  Right, since your question refers to children, I suspect
you refer to those
who suffer from Developmental Dyslexia or Congenital Word
Blindness.  Back to semantics, the "dys" means a "disfunction of" which
more properly describes the problem.


First described in 1896 by Hinshelwood, the problem becomes known in an
older child who lackes the ability to understand the meaning of printed
words.  My primary reference lists a number of papers--which I list after
it--that discuss the finer detail of the syndrome.


"The main problem is an inability to read words and also to spell and to
write them, despite the ability to see and recognize letters.  There is no
loss of the ability to recognize the meanings of objects, pictures, and
diagrams." (Adams & Victor).


Children appear to lack the awareness that words may be broken down into
individual units of sound, or "phonemic unawareness." (Shaywitz, Adams &
Victor).  Some also have a failure in sequencing, cognitive processing, and
breaking words into individual phonemes.  A "phoneme" is the smallest part
of a word that can convey meaning.


The primary reference notes:


"Often, before the child enters school, reading failure can be anticipated
by a delay in attending to spoken words, difficulty with rhyming games, and
speech that is characterized by frequent mispronounciations and pucntuated
by hesitations and dysfluency, or there may be a delay in learning to speak
or in attaining clear articulation." (Adams & Victor).


While I find the discussion of the mechanisms fascinating, it does not
address your primary question with regards to treatments.  I refer readers
to the Adams and Victor reference which is a great source for neurologic
problems.  With reference to therapy, they do note:


"Lesser degrees of dyslexia are more common than the servere ones and are
found in a large segment of the school population.  Some 10 percent of
schoolchildren have some degree of this disability, but the problem is
complex because the condition is unquestionably influenced by the way
reading is taught.  This disorder is stable and persistent; however, as a
result of effective methods of training, only a few children are unable to
read at all after many years in school."


They continue that with steady drilling of many hours per week, a
cooperative and motivated child can slowly overcome the handicap and read
at grade level.  They recommend the "Orton phonologic method" as one of the
most successful--described in the Rosenberger reference.


I, myself, do not treat this condition in children.  If you have difficulty
obtaining the reference for therapy, please do not hesitate to contact me
through the Mad Scientists and I will see if I can find some
specialists who can help you.


--Doctor X


References:
Victor M, Ropper AH.  Adams and Victor's Principles of Neurology,
7th Ed.  New York.  McGraw-Hill, 2001  ISBN:0-07-067497-3 (US) 0-07-116333-6


Orton ST.  Reading, Writing and Speech Problems in Children.  New
York.  Norton, 1937


Critchley M, Critchley EA.  Dyslexia Defined.  Springfield, Il. 
Charles C. Thomas, 1978.


Kinsbourne M.  "Disorders of Mental Development," in Menkes JH ed. 
Textbook of Child Neurology, 5th. Ed.  Baltimore, Williams &
Wilkins, 1995.


Rutter M, Martin JAM.  Clinics in Developmental Medicine. No. 43. 
The Child with Delayed Speech.  London.  Heineman, 1972.


Shaywitz SE.  "Dyslexia," N Engl J Med 338:307, 1998.


Rosenberger PB.  "Learning Disorders," in Berg B, Ed. Principles of
Child Neurology.  New York, McGraw-Hill, 1996.