The nature and treatment of phonological text agraphia

ABSTRACT

Phonological alexia and agraphia are written language disorders characterised by disproportionate difficulty reading and spelling nonwords in comparison to real words. In phonological alexia, it has been shown that, despite relatively accurate reading of words in isolation, text-level reading deficits are often marked and persistent. Specifically, some individuals demonstrate difficulty reading functors and affixes in sentences, a profile referred to as phonological text alexia. In this paper, we demonstrate an analogous manifestation of the phonological impairment on text-level writing and suggest the term “phonological text agraphia”. We examined four individuals with phonological alexia/agraphia who also showed disproportionate difficulty writing well-formed sentences in comparison to their grammatical competence in spoken utterances. Implementation of a phonological treatment protocol resulted in significantly improved sublexical phonology skills as well as improvements in grammatical accuracy of written narratives. These findings support the notion of a common phonological impairment underlying nonword reading/spelling deficits and sentence-level difficulties.

KEYWORDS:

• Agraphia
• alexia
• aphasia
• phonological text alexia
• writing
• spelling

Acknowledgements

We acknowledge the assistance of Erin Northrop, Esther Kim, Christine Shultz, Chelsea Bayley, and Mara Goodman with various aspects of this research, including data collection from control participants.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 The integrity of the sublexical pathway is also required to eliminate potential semantic errors arising from exclusive reliance on the lexical-semantic procedure for reading and spelling. Although patients who produced semantic errors were previously classified as “deep” rather than phonological alexia/agraphia, there is much evidence that the difference between these written language disorders are quantitative rather than qualitative. Acknowledging this overlap, we use the term phonological agraphia to refer to both entities in this paper.

Additional information

Funding

This work was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health under award [2R01DC007646] to PMB.