DIAGNOSING THE PROBLEM:

When a person of any age has difficulty reading and spelling individual words and that difficulty is unexpected in relationship to their other abilities and the amount and quality of instruction they have had, the problem is almost always due to a neurolinguistic processing disorder. A word processing disorder (sometimes lumped under the much more general term, auditory processing disorder) can occur in people of all ages and all backgrounds.  Word processing disorders are neurobiological in origin. They are often genetic and are not caused by bad speech models or bad teaching. People with neurolinguistic disorders have a physiologically limited capacity to process some types of linguistic information.      

 DIAGNOSIS in HEALTH CARE: People with neurolinguistic disorders may be diagnosed by a professional with training in language science. This may be a speech-language pathologist, psychologist or a clinical educator.  Depending on the results from formal testing, the clinician may apply one or more of the following health care diagnostic codes:

• 315.00- Reading disorder, unspecified
• 315.01-Alexia
• 315.02-Developmental dyslexia
• 315.09-Other specific developmental reading disorder
• 315.20-Other specific developmental learning difficulties

-Includes disorders of written expression

-Excludes:  (315.10), (315.00-315.09)

• 315.30-Developmental Disorder of Speech-Language 
• 315.31-Expressive Language Disorder
• 315.32-Receptive-Expressive Language Disorder-Mixed

-Includes (central) auditory processing disorder;

-Excludes: acquired auditory processing disorder (388.45)

• 315.34-Speech and language developmental delay due to hearing loss
• 315.39- Developmental Articulation Disorder
• 315.90-Unspecified delay in development

Conditions characterized by a significant discrepancy between an individual's perceived level of intellect and their ability to acquire new language and other cognitive skills.

• 784.30- Dysnomia (lexical access or word-finding disorder)
• 784.61-Alexia and dyslexia; Alexia (with agraphia)
• 784.69 -Other Symbolic Dysfunction (e.g., acalculia, agnosia, agraphia NOS, apraxia)

-Loss of the ability to distinguish the significance of stimuli; may be auditory, visual, olfactory, tactile, or gustatory.

-Inability to recognize, understand or interpret sensory stimuli in the absence of sensory defects.

-Includes word retrieval issues

Audiologists may use a health care code for (central) auditory processing disorder (CAPD or APD): 

      388.40-Other abnormal Auditory Perception

QUALIFICATION for USA PUBLIC SCHOOL SERVICES: In order for students to qualify for additional help through his/her public school a formal procedure, administered through the school's Exceptional Children’s Services, is required. This does not result in a diagnosis per se. Rather, the goal is identification of a learning problem and qualification for certain school services and/or accommodations. In the U.S., different states use different guidelines for qualifying public school children for Exceptional Children's Services. Some states require the child to have a "significant discrepancy" (difference) between his/her aptitude ("IQ") and his/her academic achievement.  Other states have moved to a system of qualification called "Response-to-Intervention" (R-t-I) that does not involve comparing IQ and achievement but instead looks at the child's response to specialized teaching methods. A public school child with a neurolinguistic disorder will usually be grouped, along with children with a variety of other learning problems, as “Learning Disabled” (LD).  LD is not a diagnosis but a service-delivery category.  By definition, school involves mostly group learning, with a lot of listening and talking and reading and writing in groups. Children with neurolinguistic disorders typically become quite fatigued when they have to use language for long periods. Fatigue and/or frustration causes inattention, so these children may be mis-diagnosed as having a primary inattentive disorder (i.e., Attention Deficit Hyperactivity Disorder or ADHD).

THERAPY for NEUROLINGUISTIC DISORDERS:

People with neurolinguistic disorders can attain functional and even upper-level literacy skills if they have intensive, linguistically informed intervention. (Torgensen, et al., 1997).

Intensive has typically been defined in terms of an amount of time spent practicing (e.g., 60 – 90 min.) each day (e.g., 5 days a week). How much actual practice is needed for any individual per day in terms of the number of responses (e.g., number of words attempted) is not as clear. In order to determine if the practice intensity is adequate to remediate the disorder the child’s accuracy and fluency will need to be monitored on an ongoing basis.  

Linguistically informed intervention is typically defined as an approach with these elements:

1)      Explicit: Each linguistic element is clearly and unambiguously defined. Clients practice conscious identification of each linguistic element with attention to accuracy and fluency. This means that the clinician must know a lot about English word structure (e.g., consonants, vowels, onsets, rimes, syllables, grammatical endings, meaning parts and how context impacts the use of sound-letter symbols).   

2)      Systematic & Sequential: All the linguistic elements and concepts needed for reading and spelling words are introduced, beginning with the most basic building blocks (syllables, vowel and consonant sounds, specific sound-letter symbols) to the most complex, context-related elements (syllable types and morphemes).

3)      Cumulative: Word structure is taught in a cumulative manner so that the words that a client can read and spell become structurally more and more complex as linguistic elements are mastered.

 The cost of therapy  through a health care clinician (e.g., a speech-language pathologist, psychologist or clinical educator) may be paid privately, by the client/family and/or their Health Savings Account, and/or through the client/family’s medical insurance plan (if that plan covers the service).  Each insurance policy has different requirements and coverage so families should consult with the clinician to determine if the service is covered, to what extent and under what conditions.

More and more, technologies like Lexercise are helping clinicians provide intensive, linguistically informed and cost-effective practice.