A Clinical Study of a Severe Case of Reading Disability in a Left-Handed Child who was Taught to Read by a Combined Graphomotor and Voco-Motor Method
- Author:
Richards, M.S.
Clinic Teacher, The Psychological Clinic, University of Pennsylvania The definite interest sliown recently in problems of handedness and particularly in those of the relationship, now generally accepted, between handedness and “eyedness” has motivated a further interest at the Psychological Clinic of the University of Pennsylvania m the orthogenic procedure that seems best adapted for those individuals whose disability in reading seemed etiologically to rest within the sphere of these problems. Studies by Orton1 and Monroe2 would indicate that there is a basis for the assumption that tendencies to mirror writing and reading in reverse fashion, i.e., from right to left, correlate to a definite extent with handedness.
These tendencies are more evident in left-handed than they are in right-handed individuals, and their incidence seems greatest in those cases where dominance of either right or left is not clear cut, particularly the type of child who has been “trained over” to the use of the right hand after a preference has been shown for the use of the left. A study3 of the problem by Lord, Carmichael, and Dearborn in 1925 suggested that the left-handed child who habitually relies upon kinaestlietic cues in learning to read might very possibly encounter difficulty when expected, as he is in the public schools, to conform to the dextrad pattern which holds throughout m a civilization composed largely of right-handed individuals.
Dearborn asserts in a more recent paper4 In writing and reading (in our language) the movements of the hand and eye are dextrad. It is this sequence from left to right which has to be followed to build up the correct visual and kinaesthetic images of words. This is the natural and easiest movement of the right-handed?away from the center of the ‘Orton, S. T., “Word-Blindness” in School Children. Arcii. of Neur. and Psyciiiat., 1925. Vol. XIV, pp. 581-615.
3 Monroe, Marion, Methods for Diagnosis and Treatment of Cases of Reading Disability. Genetic Psychol. Mono. Vol. IV. 1928, Nos. 4-5. “Lord, E. E., Carmichael, L., and Dearborn, W. F., Special Disabilities in Learning to Bead and Write. Harvard Mono, in Ed. Series I, Vol. II, No. 1. ?Dearborn, W. F., The Nature of Special Abilities and Disabilities. Sen. and Soc. Vol. XXXI, 1930, pp. 632-636. body. Left-handed and left-eyed children have a preference for the other direction, i.e., sinistrad… . Some of them even write a mirrored hand, and in reading confuse the reversible letters “b” and “d,” etc., or reverse the sequence of letters as in reading “god” for “dog” or “on” for “no”. ? ? ? There is uncertainty about the correct sequence of letters in words because of conflicting tendencies of hand and eye. The result is that faulty word images with letters interchanged are stored up in the mind which later make the prompt and precise recognition of words difficult or almost impossible. This viewpoint would suggest not only that the left-handed individual encounters at least a slight difficulty in first learning to read, but that this difficulty in the initial phase of the learning process should become greater in proportion to the greater dependence upon kinaesthesia. The individual whose imaginal endowment indicates a reliance largely upon the kinaesthetic cues and who is, in addition, left-handed, should learn to read only as the result of training which embraces these factors. With most of the teaching of reading in the public schools based on a visual method of presentation, or at best a combination of the visual and auditory, it is not to be wondered that such a child should be retarded in comparison with his classmates.
An illustration of this viewpoint was borne out rather strikingly in the case of a child who received about fifty-six hours of diagnostic teaching distributed over six weeks, in the Psychological Clinic during the summer school of 1930. The child, Louise, aged seven years, seven months at the time of her initial examination in May, 1930, was brought to the clinic because she was slow in her school work, and because of an evident disability in reading and in writing. The mother felt that this deficiency might be due to the fact that she was left-handed. The educational history shows that the child entered the first grade at the age of five, where she has remained for two years. Because the family moved a number of times the child has been entered in several schools, which might further add to her difficulty. The medical history suggests nothing of retardation. In spite of the fact that Louise is an only child her mother has described her at the time of the examination as being extremely useful about the house. She seemed to enjoy setting the table, drying dishes and making beds. Her relationships with other children indicate that she is socially well adjusted, and that she possesses qualities of leadership. Although she had had no training the child danced very well. Indeed, the most striking thing in the clinical picture was the extremely graceful bearing and poise that was always evident, suggesting an emotional maturity far in advance of the child’s age. She seemed to be left-handed in all types of movements, such as opening the door, catching an article thrown to her, handing articles to another person, and the finer ones, such as writing, etc.
In the psychological examination Louise’s work on performance tests approximated the median for six-year-old girls, while her discernment spans placed her, at the same age level, superior to 90 per cent for the audito-vocal span, and superior to 99 per cent in the visual and reverse spans. Her Intelligence Quotient on the Stanford Revision of the Binet-Simon Scale was 114. Her school proficiency was rated 1A in arithmetic and in writing, but she had practically no proficiency in reading.
The peculiarities in Louise’s reading are worthy of note. The tendency to read from right to left had been reported by the mother before the child was examined. It was noticed again in testing her for the visual discernment span. A horizontal row of digits was presented to the child, and it was found that her speed and accuracy in reading the digits were noticeably greater when she read from right to left than when she read from left to right. Very little difference was noticed when the same experiment was tried with rows of letters. Presented with large wooden letters she correctly placed H, V, W, A, (all laterally symmetrical) and G, but 3 and C were reversed. She was unable to read from a page of material printed mirror fashion, and when single short words were presented in printing on the blackboard both in mirror fashion and in the normal manner she showed more proficiency in reading the latter. When asked to write her name she wrote it correctly, with all letters correct and in the correct sequence, but short words sucli as dog and boy were spelled in correct sequence but with a mixture of correctly written and reversed letters. When asked to write the numbers from one to ten she wrote
dC8e It was clear that word recognition was the stumbling block in reading which factor was undoubtedly influenced by the facilitated right-to-left eye movements. Certainly the results of the examination did not suggest a “mirror-mindedness,” nor a consistent tendency to reversal. It was clear that poor habits of eye movements and analytical approach to the elements of words had been integrated into the reading situation. The obvious procedure was to determine what approach might best be used in establishing a correct habit-complex for this child who had been obviously immune to the teaching procedure common in the public schools. She was normal mentally, with her general competency estimated by the examiner, Dr Miles S. Murphy, as superior to 60 per cent and inferior to 20. A child with this native equipment should have been able after two years to assimilate enough from her teaching to give a better performance in reading than did Louise, if she were not hindered by a special deficiency or an anomalous capacity for learning. She was recommended to the clinic teacher for periodic observation, and was subsequently assigned to be taught by a student in the course in diagnostic education conducted by Dr Lightner Witmer.
The teaching procedure adopted for the case of Louise consisted at first in having her see the word printed and written, then in having her copy the word in writing, and finally, in having her write the word several times without looking at the original. She was gradually taught to analyze exactly what she was doing; taught to see that each letter was made in a certain fashion, and was placed in the word for a certain reason. An introduction to phonic analysis was thereby provided. From this point on it was relatively easy to change our kinaesthetic method to a kinaesthetic-auditory method. It was found that if the child were to say the word to herself, as a whole word or as a group of letter- and phonic-sounds it was easier for her to write it, and ultimately to read it. When confronted with a new word she would analyze its elements as best she could, write the word, say it, and finally be able to read it. We became gradually convinced that the most efficient way for this child to learn to read consisted in a method involving these steps:
(1) getting the grapho-motor image of the strange word by writing it or a voco-motor image by saying it, which led to (2) learning the sound of the word or of its elements, as associated with the kinaesthetic image, and finally (3) learning to interpret the visual symbol or symbols by association with the sounds they involved. This seems like an extremely laborious procedure, as, indeed, it proved to be for some time. Gradually, however, the child grew familiar with identical elements, contrasts and peculiarities of letREADING DISABILITY 289 tors and letter combinations, which proved to be valuable aids to her 111 analyzing words. The writing continued, for it seemed a constant aid to the child. She kept a notebook in which she faithfully copied all new words, and practiced writing them independently. Whenever she was puzzled in her daily reading and it seemed logical to do so she was referred to this notebook to work that she had done and which had by now become familiar ground. Louise was inclined to be self-corrective to a very fine degree. A tendency to make vertical jumps between lines?to lose her place?was always cause for her to say, as soon as she noticed her error, “My eye was here, and it should have been there.’’ This same self-reprimand soon made itself evident as she saw from the context of the reading matter that saw should have been ivcis and on, no. The whole emotional reaction of this child was interesting throughout. She was extremely self-possessed; her conversation was intelligent, her behavior always lady-like, her manners fine almost to the point of being exquisite. She seemed to regard her own problem as a matter which naturally involved much hard, patient work, and her appreciation for the value of the task at hand always motivated a splendid cooperation on her part. We could see nothing of the “sense of inferiority” in this child because of her handicap, unless it was indicated in the Probably compensatory social manner.
The independence from the necessity of copying new words increased each day, until by the end of the teaching period the child was able to glance at an entirely new word, analyze it for herself, and reproduce it correctly with very little in her overt reaction to suggest a kinaesthetic or an auditory process involved. She was able to read at the rate of about ninety-five words in five minutes, which, ?f course, is extremely slow for a child who has been in the first grade two years. It was, however, an enormous increase over her output six weeks previously. The tendency to reverse letters had almost disappeared by this time, although the numbers 6, 7, and 9 curiously offered difficulty. Throughout the teaching period she was allowed to use the preferred hand for all movements, and she chose her left for almost all. We felt this to be the wisest policy, in view of the fact that since the inadequate lateral dominance seemed to be an original cause for the condition, the confusion which might result from a “changing over” process, i.e., teaching her to write with her right hand, might further increase the imaginal confusion in a field wherein she had manifested great difficulty.
The prognosis for the case rests, we believe, on the fact that Louise will require thorough understanding on the part of her teacher. Not only must her weakness be understood, but her strength must be appreciated and utilized in teaching her to read. The enthusiasm ‘’ for visual education’’ will do more than leave Louise untouched; it will definitely retard her. She is definitely kinaesthetic, and this avenue of approach in teaching her in the elementary phases of reading must be used. The child is equipped to become a good independent reader, which she can only do if the specific problem in her case is understood and met accordingly.
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