Thursday, September 25, 2008

Hyperlexia Therapy Approach

I recently met with the mother of a little boy and asked her to think about what the next step might be for her son. She said she wanted to focus on reading and writing because her son was so easily engaged and interested when any activity included letters. Given how clearly she articulated her desire to use written language with her son, I got thinking about the Hyperlexia Framework for understanding children who love letters. Some people think of children who have a relative cognitive strength in the area of written language as having a distinct developmental disorder called Hyperlexia. I thought I would go check out some therapy ideas on a Hyperlexia website.

First, I read this set of guidelines from The Syndrome of Hyperlexia: Remediation Techniques by Philips Kupperman and Sally Bligh which are very good guidelines for almost any child that I see at my clinic and a good reminder of many important principles of intervention. But not ideas at the level of a recipe book for therapy games, which is what I wanted. So, I then read an article by Ann M. Osterling, MA, CCC-SLP/L called Facilitating Language Development in Children with Hyperlexia and this was a little more specific. But not yet quite what I had in mind. Rather than continuing to look, though, I started a translation process where I took the ideas that I was reading and tried to turn these ideas into games and activities. I thought perhaps this translation process might be interesting to some readers, so here is an example.

I took the set of intervention strategies that Ms. Osterling so generously offered (I copied three suggestions from her long list below so you can see) and I began to sort out therapy techniques from suggestions that were concrete enough to be worked into a therapy activity--like sorting out cooking techniques from the cooking ingredients in a cook book:

  • start where child is at (developmentally, interests), expand from there

  • written labels

  • be concrete when speaking

After sorting all the suggestions, I took one suggestion at a time and began to brainstorm therapy ideas. The first concrete therapy ingredient on the list was written labels. There are many easy ways to add written labels to games and activities that I already do. Here is a game that I modified (which was very successful, by-the-way) using written labels as a key ingredient.

This short video model is good for the purpose of explaining to a child (and a parent) the steps of a puzzle game using written labels. In real life, a much more complex activity was gradually created for our letter loving little guy. Here are some pictures of a Sign Puzzle activity that he did with his mother. Like many kids who enjoy words and letters, he has studied road signs and he liked this puzzle. He was interested in some of the names of the signs. As they played together, he chose what signs to put where on the page and mom traced each sign and wrote on each sign. He read things that she wrote, particularly when she would prompt him by spelling the word and then waiting as in S T O P spells _____. He would pipe in saying stop. He looked each time at what puzzle piece had already been copied and chose each new puzzle piece carefully to insure that all were eventually traced and written on. After doing this game with two puzzles that we brought out, he independently took another puzzle off the shelf and brought it over. His mom took this game home and was prepared and eager to trace and write on puzzle pieces together with her son as they had many inset puzzles at home that he had enjoyed when he was a bit younger. The one idea, written labels, can be turned into many more therapy ideas and since I did not find them online already, I will try to gets some video clips of the games we create around the idea of written labels and other Hyperlexia suggestions as well.

Note: Someone out there might wonder if I think Hyperlexia is a better diagnostic label than autism for some children. My answer is, no, even though, as a parent I would rather have my child called "extra good reader" instead of "self-absorbed person" which is what I think of with these two labels. But emotional preference aside, ASD (and all the variants) has won in the diagnostic label war at this time and it is the more common diagnostic label. In most places it will get a child more services. Most literature that is helpful is written using the diagnostic labels of Autism, Pervasive Developmental Disorder, Autism Spectrum Disorder, and Asperger Syndrome. I am in the business of getting children the services needed and getting parents the information needed. That said, I really like the approach to intervention described in the Hyperlexia literature and think many parents may want to know that this literature is out there.

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