A Case of Congenital Word-Blindness Showing its Social Implications
- Author:
Charles K Ford
- Institute:
Ohio State Bureau of Juvenile Research
The matter of congenital word blindness lias been recognized since Dr Morgan first reported a case in 1896 and so named it because of its similarity to aphasic word blindness. Since this time many cases of reading disorders have been reported, some of which are included in the bibliography appended. Three main factors appear to be common to the congenitally word blind. (1) They cannot read words, although they can read other symbols as music and letters; (2) they have no other outstanding mental or physical defect, and (3) they can be taught to read when the correct method is found.
There has been no homogeneity in the diagnosis technique or teaching methods. For the most part, diagnosis is dependent upon the examiner’s subjective judgment as to the defect’s purity and the degree of disability. Many that are so diagnosed have a very simple reading vocabulary, others recognize no words. Objective data have rarely been reported to show the purity of the defect.
The condition is rare and yet Wallin reports that he found 4.1 per cent who could be so diagnosed out of 2,774 children examined who were not making satisfactory school progress. This is the highest estimate of its incidence we have found in the literature, but any who are familiar with school clinic examinations know that reading defects account for a sizeable number of retardates.
Even though the condition is well known and regularly found in school clinics, the school implications have not been the subject of any of the articles. Three main ideas are involved in presenting the following case. The first is to present a case study showing the conditions surrounding the case as a matter of history and measured results. The second is to give a technique in the examinations of the congenital word blind. The third is to show that the described condition is a cause of severe school and social maladjustment.
Paul was referred to the Bureau by one of the large juvenile courts of the state because he was guilty of lying, stealing from home and school, truancy and being a disturber in school. Test situations were not new to Paul as he had previously been given psychological examinations in May, 1922, and again in February, 1927. Excellent history was furnished in his case and an abstract follows:
Maternal Grandparents: Nothing known.
Paternal Grandparents: Born in Scotland and came to the United States twenty-five years ago. At that time, they settled in their present city and have never been known to be troublesome. They are described as capable and industrious people. They own their home which is described as clean, well painted, and comfortably furnished. Next door to the house is a lot which they also own. Six children were born to the union, including Paul’s father. Three are married and three live at home. The youngest, a boy fourteen years old, is in the sixth grade at school.
Father: Age thirty-one years. Born in Scotland, came to the United States when six years old and is now a citizen. He had one year of school in Scotland and finished either the fifth or sixth grade in the same school Paul now attends. He is said to have good health and does not use alcohol. He is a foreman in the machine shop of a steel mill and works nights. There were no domestic troubles between the father and Paul’s mother.
Mother: Died in 1921 of tuberculosis at the age of twenty-four or five. The illness followed an attack of influenza, lasted but three months and there was no coughing. She was of Irish descent but native-born. No history is available concerning her school and industrial competency, although all evidence seems to show she was of normal intelligence and thoroughly capable. She was reared, at least partially, in an orphanage. She had done some housework. She is also described as being fond of reading. Step-mother: About thirty-one years old; is native-born. Finished high school and attended business college. The father says that he “has the best wife you ever saw.” She is said to like Paul but is disappointed in him. Her own children are well cared for physically and are “taught to have good manners.” Half-siblings: Dorothy, aged four, and Gordon, aged three. No information concerning them is available.
Neighbourhoods: Described by the court as a good residential district, close to the car line, schools and churches. The step father disagrees in this judgment, however, and says he wouldn’t want to rear his children in the neighbourhood as there are many questionable children thereabout.
Economic Status: Nothing definite known but everything points to a sufficiency for adequate care. Expenses for Albert are furnished by the father.
Personal History: Paul was born August 8, 1916, in the same city where he now lives. He was the first and only child of the union. There were no previous miscarriages and no still births. The mother’s health during the term of pregnancy was said to be normal but she was lazy and indifferent. He was born at full term and it was a normal delivery. He was breast fed and was always a healthy baby.
When he was four and one half years old, his mother died and at the time of her death she requested the paternal grandmother to care for him. Following her death and prior to the father’s re-marriage, they lived at the paternal home. After the marriage, Paul lived with his father and step-mother for some time. In fact, he had started to school and gotten into difficulties before he was sent to live with his grandmother.
The court reports he was transferred because “he was not responding to the fine training he was receiving from his second mother.” His present teacher says, “I think Paul has been indulged too much by all members of his family. They buy him everything he wants and coax him. He needs firmer discipline. They are interested in his welfare, however, and try to cooperate. The father and step-mother handle him more wisely than the grandmother ” The step-mother says, “I tried to train Paul in the right way; sent him to Sunday School, and tried to interest him in Boy Scout work, sent him to camp, but he was sent home on account of breaking the rules. When he did wrong in Park School, we decided to change his schools and allow him to board with his father’s family.”
The grandmother’s home offers the possibility of many associates and Paul gets acquainted rather easily. He does not choose older boys for companions except his fourteen-year-old uncle, whose association is of doubtful value.
He seems to hold his grandparents and his home in high esteem and makes no complaint about the conditions. They are good to him, supply his wants and allow him much leisure time. He is particularly fond of his father. The other side of the story obtained through agencies is that the grandmother is weary of caring for him and feels he should be with the father. She may be a trifle indulgent with the lad in some respects but has allowed the idea that he is dumb, backward or lazy to grow up within the home.
He freely admits these charges and says he was sent here for lying, stealing, being bad and playing truant. He has been stealing at home and using the money to hire saddle horses for some time. He also admits much stealing from stores near his home. He takes particular delight in the out-of-doors and when truant, spends his time tramping in the woods and fields. After school and on Saturdays, he works on a small truck farm near his home and earns $1.25 a day. Above all else he is fond of horses and spends all his money to hire them for rides. His parents report the following factors that seem to hold a clinical interest. He is easy to manage and tries hard to please. He is often troublesome, starts fights but usually holds his own in them. He holds spite and is vindictive. He is not well-liked by children his own age and sex and is not kind to them. He does not enjoy group play; probably doesn’t know how to play with a group but does know how to play by himself. He lies to protect himself and when the truth would be better. He also steals and runs away from home frequently. He is interested in things which younger children find pleasure in. They also report him as shy, moody, easily led, indifferent to the affairs of life, poor in memory, and that it is hard to hold his attention for any length of time. Enuresis and masturbation are reported.
Paul is a lovable boy, attractive in appearance, orderly in his habits, and at least during his stay with us, he lias been thoroughly trustworthy. He is not overly phlegmatic and yet he is quiet and reticent. The whole impression of the lad rather leads one to feel that he is a lad of satisfactory intelligence equipment who has been made to feel inferior and is therefore rather afraid to let himself go. We have no evidence of his fighting, quarreling, masturbating nor bed wetting while here. School History: Started to kindergarten in Park School, at the age of 5 years, was examined mentally, found to have an I.Q. of 97, and entered the first grade at age of 6 years. Attended for about two years, but made no progress, so he was sent to live with his grandmother and transferred to X-Road School, kept in regular grade for one and one half years and then transferred to a “tutor class” where he had been for one and one half years. He has had a total of five years school and one year of kindergarten so far and has made very limited progress. In fact,’ he is still regarded as being of 1A grade. This despite the fact that he had presumably normal intelligence at the time of his entry in the first grade.
Some idea of the school’s attitude in his case may be had by answers to direct question put to his teacher and principal: Was he a problem to his teacher??”Always.”
“What did he do to make himself a problem??”Wouldn’t apply himself. Apparently made no progress. Would still be considered 1A. Interfered with others. Was rough with mates or those younger than himself. Lied. Later took things. Frequent fights in yard. Struck children in the building, own mates and others. Not continually, but at intervals.”
Does he attend school regularly??”As a rule.” Why is he absent ??’’ Truancy.’’
What grade is he now in??”Borderline?ranked as 1A.” What grades has he failed??”Has made no progress apparently.” In what subjects does he do his best??”Handwork. Oral language. ‘’ In what subjects does he do his poorest??”Reading, spelling.” Why do you think he failed the grades he did??”Laziness. Lack of attention, interest, memory.”
In an accompanying letter, the principal says, “There is something radically wrong with his mental attitude and ability. No one who has had him in school has been able to fathom the difficulty.’’
There can be no doubt that Paul has made himself a problem to the school. He admits this freely, but undoubtedly there were mitigating circumstances as normal boys leading normal lives and with average teachers are not serious problems. The problem then is to determine the cause of the maladjustment.
Previous Psychological Examinations:
5-19-22?Life age 5 years, 9 months. Stanford M.A. 5 years, 6 months. I.Q. 96. 2-16-27?Life age 10 years, 6 months. Stanford M.A. 9 years, 2 months. I.Q. 86. A note on the second examination reads “marked disability to read; cannot read even first grade work. Recognizes only short words. Should have careful examination of the eyes.” Recent Psychological Examination: When Paul was first called for any testing work he appeared to be phlegmatic, ill at ease and very easily distracted by outside noises. He was unable to take examinations of the questionnaire type as he could not read well enough to understand the questions asked.
12- 2-27. Performance tests. Witmer form board Trial 1?Time 21 seconds Trial 2?Time 22 seconds Trial 3?Time 19 seconds Median M.A. 9-10 years Knox Imitation test Median M.A. 19 years Healy Pic. Com. Board No. 2 .. .Median M.A. 7-8 years On this last test, three blocks scoring minus five were placed. In hole 3, block No. 31; hole 4, block 3; hole 8, block 37. 12- 2-27. Anthropological Data?Average physical measurement (Doll) 70th percentile Average psycho-motor measurement, 84th percentile. Average psycho-motor excess, plus 14.
12- 5-27. Stanford-Binet. Chron. Age 11 years, 4 months. Mental age 8 years, 5 months. I.Q. 74. Basal at 6 years, range through 12; failed names of days in year 7; passed similarities only at 8th year. Failed month, date, etc., and names of months at 9th year. Passed only absurdities, copying design and sentence repetition at 10 years and fables only at year 12. Failed all beyond this. His ball and field test was particularly poor. Digit memory span was 5 forward and 4 backward. Vocabulary 19 words. 12-12-27. Myers Mental Measure?Medial Mental age 9-10 years. 12-16-27. Herring-Revision of Binet test?Mental age 8 years, 4 months. On the latter test there was a marked handicap because of inability to read. He did very well on such tests as interpretation of pictures, detection of absurdities, similarities, etc. Digit memory span 5 forward, 4 backward. 1- 4-28. Goodenough’s Drawing Scale. Mental age 13 pins years. A rather detailed drawing bnt not artistically good. 1-14-28. Stanford-Binet, repeated. Chronological age 11 years, 5 months. Mental age 9 years, 5 months. I.Q. 83. Basal at 6 years. Range through 12; failed days of week and digits forward at 7; failed ball and field and comprehension at 8 years; failed day of month and year and names of months at 9 years; passed absurdities, design, repetition of digits and sentences at 10 years; passed fables, pictures, interpretations and similarities at 12; all failed beyond. Vocabulary score 25, digit memory span 6 forward, 4 backward. This retest was made as it seemed evident that he could do much better on the Stanford than previous performance because being new to the institution at that time, he was rather apprehensive. It will be noticed that the tests on which he did better the second time are not tests that lend themselves well to coaching. Kent-Rosanoff Association tests that have been given him showed nothing significant.
Medical Examination: Showed nothing abnormal. Visual sensitivity normal. Fundi normal. Examination of diplopia negative. Hearing normal. Both ear drums normal. Laboratory findings, including blood Wassermann and Kahn tests, were negative. The test results seem to show that Paul is a boy of nearly normal mental equipment if we make allowance for his lowered score because of reading difficulty and his rather general timidity. Examination of Reading Ability: The analysis of the reading difficulty started out with the Pressey “First Grade Readings” attainment scale. On word recognition his score was 21 out of possible 25. On sentence recognition it was 12 out of possible 15. Word recognition score gave him a grade rating of 1A plus, sentence recognition score, a grade rating of 1A minus. Such a score is clearly better than a guess, although in the sentence recognition phase in one line he said the sentence called for was not in the line and then circled the next line’s sentence in the line omitted. From here he went on correctly.
He was then given a printed directions test which is very simple but was apparently unable to read it. He was then asked to read it aloud and could not pronounce words more difficult than “in,” “it,” “the,” etc. Such words as “make,” “many,” “cross,” etc., he could not read, but he could name the letters that composed the word. Gray eheck list was then used with no success. He was unable to pronounce or understand the words. The Pressey test was then returned to and he was asked to read the words circled. He was able to read but one word. Turning to the sentences he could not read a single sentence he had circled. His performance on a series of tests of phonetic ability from Gates, “Improvement of Reading,” is interesting. Naming a standard alphabet of upper case letters took him 1 minute and he made the following errors: called Y Q; Y…. M; H…. N; J…. X; N…. M; G…. C; and Q…. 0. The standard time for children 7.1 years old is 30 seconds and errors are so infrequent as not to be tabulated. His performance on a standard lower case alphabet was similar. It again took him 1 minute and he made the following errors: called Y….Q; V Z; J G; Z C; and P… .Q. In giving the sound of 20 letters he succeeded in 14; of them and failed on p, w, g, h, v, and u. On this element he was up to the norms of 7 years old. In pronouncing two letters in combinations all of which are one consonant and one vowel, he failed completely. He would sound each letter individually and apparently couldn’t combine the sound although he could repeat the sound when given him.
His phonetic ability from auditory stimuli was equally poor. Giving letter equivalents of letter sounds, he succeeded at the 7.7 year level. He failed miserably on spelling words and nonsense syllables. In perception of difference of both words and digits he succeeded at the level of 7.6 years.
In pronouncing simple words such as OUT he would pronounce it O-O-T but could not apparently, even with that as a key, blend the sounds so as to produce a word. He can, however, recognize his own name whether written, printed or typed and pronounce it correctly. Some monosyllabic words were occasionally pronounced and missed at other times.
Repeated tests yielded results comparable to the first test of each type even to the matter of word recognition and inability to pronounce circled words. Repeated tests of reading the alphabet showed that he rather consistently missed the last letters of the alphabet but he was not consistent in what he called them. Tests with each eye independent of the other brought approximately the same results, although it took from 17 to 39 seconds longer to read the letters with one eye than with both. His audito-memory span was rather consistently five forward. For instance it is 5 digits, 5 letters, 5 disconnected monosyllabic words, and polysyllabic nonsense words of six syllables. “Writing from dictation was very poor. The letters were poorly formed and infantile in character. The spelling, although all words were very common primer words, was exceedingly poor. Copying Set 1, No. 1 of Gray’s check list was poor from the standpoint of penmanship, although, for the most part, his letters were correctly reproduced in script.
Oral arithmetic problems in change making were presented and satisfactory solutions were readily given. In solving these problems he had a peculiar mode of attack. In telling the coins that would be returned, he would start with the coin of highest value. Although not an expert in his number combinations, he knew them fairly well.
His oral language is spontaneous and accurate. His voice is a timid one and he never seems to raise it unless told to specifically. There is no speech defect and any sound can be reproduced accurately. He apparently has good motor coordination. Hand work such as coloring pictures, paper cutting and pasting is done unusually well.
Social Implications: The clinical picture here presented is one of a boy of normal or nearly normal intelligence who has had one year in kindergarten and five years in grade school, one and one-half years of which were in a tutor class, but still unable to read up to first grade attainment. His behavior is a matter of concern to both the school and his parents. Yet there is no objective evidence, other than behavior, of any instability. His behavior problems have apparently increased with each succeeding year in school. In kindergarten, so far as can be learned, his problems were nil. As soon as he entered the grades, he became an even greater problem. As his teacher indicated in a letter previously quoted, no teacher he has had has been able to fathom his difficulty. During his enrollment at Park School, he started truancy, but so far as we can learn, this was not until his second year in the first grade.
When transferred to X Road School his problems continued to increase. Stealing was added to his list as was gross lying. True, there was a different environment in his new home but this was made worse because he couldn’t read. He tells us that his uncle, who is 14 years old, calls him “dummy” because he doesn’t read, and he also says his playmates “kid” him about his difficulty. His teachers apparently are out of sympathy with him, his father and stepmother think he is deficient mentally, his grandmother is weary of caring for him. Small wonder then that Paul is maladjusted.
Discussion: In the light of published works it seems sound to diagnose this lad’s case as one of congenital word blindness. He has had long and regular schooling with consistent training in reading as may be seen from the following letter from his teacher: “Paul had his first reading lessons in a pre-primary class. It was sight reading from the black-board. It was very simple and was presented in a very attractive way.
His present teacher writes:
“In our school the Aldine was the basal reader. Last spring, he became familiar with nearly all of the first grade ‘families.’ He knew consonant sounds also and applied them fairly well. He could read from a set of cards that I have called ‘Play Briefs.’ The little play was dramatized by several pupils and Paul enjoyed them and learned to read them well. He became really interested, and at that time I could see some progress. “When he came back in September, I was unable to reach him as I did before. I tried to correlate his handwork, language, reading and spelling. He is fond of his dog. He made a dog house in school. That furnished a topic for simple compositions that he wrote. He worked with a will, building the house, but took very little interest in other subjects. I worked with him individually in spelling, arithmetic, reading and writing. I found that he does not retain what he learns.
His reading disability is marked to the extent of rarity. He has no difficulty naming objects when they are presented, he can read numbers and letters. He can interpret pictures.
Although he is not up to his age in other academic subjects such as arithmetic he can solve simple problems and is successful in making change. Since he has been retained in school and has not had access to essentials beyond his grade, there is little reason to expect a much higher ability than he shows. His oral language is good and his handwork is superior.
There is no known organic defect. Visual sensitivity and hearing are normal. The English language has always been spoken in his home. His parents and grandparents read for pleasure. Whether or not his intelligence is normal is a question if test results alone are considered. However, he has evidenced such thoroughly normal behavior while with us that we feel sure his level is at least as high or higher than test results would indicate. Test level, however, is sufficiently high to indicate he has enough intelligence to read. Throughout the entire period of examining, he was on the defensive. He was used to being considered dull and this has undoubtedly influenced his score as it surely did his behavior. Thus all the factors that have been included in a diagnosis of congenital word-blindness are met and yet there is an additional factor that, so far as we know, has not been considered in the literature. That is the matter of his ability to recognize words but not to be able to name or understand them. By doing this he has exhibited good judgment in being able to pick some cue to the word. This cue is not the first one or two letters as a series of words were presented where the initial letters of the required word were initial letters of other words in the list. There is some evidence that the last syllable is the cue.
We cannot help but feel more emphasis should be placed on the matter of congenital word-blindness and congenital dyslexia as an element in social maladjustment. Here is a rather clear case ?f, at least average home conditions, an approximately normal boy in level and function, where school and social maladjustment is the result of the condition. He has lost the sympathy and understanding of the home and school. He has been made to feel inferior by being held back in school and chided by his associates and his recourse is fighting, stealing, truancy, etc. None of these manifestations have been gross but they are irritating and serve only to make him appear even worse than he is.
That these statements of feelings of inferiority and its compensation are not pure hypothesis is shown by the fact that Paul was maladjusted at home where he was considered dull and he gets along well here where he is not considered dull. The lad is not inferior to the bulk of boys now about him. He is made to feel capable and he responds by being faithful to many trusts. He has caused no trouble in a group who are here because of troublesomeness, and who are trouble makers here. He has been in no fights; he has not lied and last of all he is keenly interested and alive to things about him.
One of the most hopeful elements in the matter of congenital word-blindness is that all reported cases have been taught to read. Reasoning by analogy we hope then Paul’s problems can be minimized, because he too can be taught to read if the proper method can be found and the proper encouragement maintained.
Bibliography
Bronner, A. F. The Psychology of Special Abilities and Disabilities. (1917) Burt, C. Mental and Scholastic Tests. (1923) Doll, E. A. Anthropometry as an Aid to Mental Diagnosis. (1916) Fildes, L. G. A Psychological Inquiry Into the Nature of the Condition Known as Congenital Word-Blindness; Brain (1921) Hinshelwood, James. Congenital Word-Blindness. (1917) Hollingsworth, Lita S. Special Talents and Defects. (1923) McCready, E. B. Congenital Word-Blindness as a Cause of Backwardness in School. Pennsylvania Medical Journal. (January, 1910.) Morgan, W. Pringle. Congenital Word-Blindness, British Medical Journal. (November, 1896.) Orton, Samuel T. Congenital Word-Blindness in Children. Archives of Neurology and Psychology. (June, 1925.) Schmitt, C. Developmental Alexia and Congenital Word-Blindness, or Inability to Learn to Bead. Elementary School Journal. (1918) Wallin, J. E. W. Clinical and Abnormal Psychology. (1927)
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.