Special Problems

an organic entity. It is not discovered until the age ofreading is commenced. The child is labelled backward or stupid. It should not be called 'word blindness', a bad term as the child is not blind but is unable to appreciate visual symbols. The features of congenital dyslexia are that there is a familial incidence, there is often a similar reading and spelling difficulty in a parent and a mixed dominance. The children are of normat or high intelligence and do not appear to have any neurological lesion. They are often ambidextrous or with a mixed dominance such as right hand and left eye and may confuse right and left, although this is not an uncommon trait in many. When writing they reverse letters and have a habit of mirror writing which Orton referred to as strephosymbolic. They mix up numbers and in words the order of the letters may be mixed, likewise their spelling is often bizarre. On the other hand they are often surprisingly good at arithmetic. They cannot translate into a written word what they hear and likewise they cannot translate into speech the written word. They have a very poor visual memory and, although short words can often be recalled, a word of numerous syllables is completely unintelligible. The result of these difficulties is that the child becomes emotionally disturbed, especially if the condition is not recognized and the diagnosis is missed. The fact that the child appears to develop normally in the days of the nursery school and the early years at the primary school prevents due notice being taken of the difficulties in reading and spelling until the school curriculum becomes more complicated. The child is then brought to the ophthalmologist or the otologist, usually both, to ascertain whether there is any visual or auditory defect. There are no signs of defects in the special senses or in mental development. A general examination of the child should include vision, hearing, intelligence and full examination by a neurologist. It is important to discuss with the parents any similar defect in the family and also have a resume of the child's education up to date. A diagnosis can often be made by careful questioning of the child: one should find out from him where the difficulty lies and get him to write his own name and spell a few simple words. He should be asked to write the alphabet, to tell the time and to indicate his right and left hand, and should be sent for the usual intelligence tests. The following are two typical cases of my own: