Pensioner Doug Vermeulen struggled at school and repeated Grade 12 twice, yet he knew he was bright. “Chatting with varsity students and adults, I always more than held my own and often contributed fresh perspectives, so I knew I wasn’t intellectually challenged.” His problem was that he battled when he wanted to recall a name or a piece of information. “It’s as though the hook I use to retrieve things from my memory has been straightened. It goes in, and there is information there to retrieve, but the hook can get nothing out.”
As a young adult, his own research of his difficulties led him to conclude that he had dyslexia. “When I write or type I repeat words, my tongue gets tangled when I speak, and sometimes strange words come out, to the amusement of family and friends. It’s as if my speech mechanisms can’t keep up with the speed at which my brain operates.” Doug loved doing research and dreamed of a career in academia, but after studying “every form of memory aid system available at the time” with little progress, he settled for jobs in sales. Then when Doug was 36, a remedial teacher friend told him about the “VAKT multisensory teaching method of recall”, using visual, auditory, kinaesthetic and tactile means to remember words. “I responded best to visual stimulus and developed my own form of hieroglyphics; drawing stick figures or simple scenes to remind me of a name or a bit of information.”
This was so successful that when a friend persuaded him to enter Bible College in his fifties, he not only coped with the studies, he averaged ninety percent on his exams. But it’s only since he retired in Durban two years ago at the age of 74 that Doug has discovered that, while he had a degree of dyslexia, “90 percent” of the problem was a separate, little-known condition called dysnomia. “If the information had just been available earlier, and my parents and I had been able to take (appropriate) steps, my life could have been different.”
More about dysnomia
Dysnomia is sometimes known as “anomic aphasia”, “naming-speed deficit” or “semantic dyslexia”, but while it is a learning disability like dyslexia, it is not a form of dyslexia, says Gauteng educational psychologist Melanie Hartgill. “Dyslexia is a language processing disorder that can hinder reading, writing, spelling, and sometimes even speaking, while dysnomia is linked to neurological and speech factors and the person cannot remember words correctly. The difficulty with word retrieval affects written output, as can dyslexia for some people.”
Learning disorders such as dysnomia appear to be on the rise, probably because parents are becoming more aware of them, and because medical advances today are helping more at-risk babies survive, says Durban educational psychologist Shireen Mohamed. “We also rely so much on visual media that children are developing fewer language and speech skills.”
The actual cause of dysnomia remains unclear. Current thinking is that it has a genetic element in some cases, and immature neuron development or brain injury in others. “There’s no history of it in my family, but I had a forceps delivery and believe an injury from that brought on my problem,” says Doug. Birth trauma causing lack of oxygen to the brain has been linked to learning difficulties, confirms Mohamed. But in some cases dysnomia can occur later in life as a result of a tumour or lesion in the language area of the brain, the left hemisphere, or a stroke.
Signs to look for
The main indication is a difficulty recalling names or words, which is shown as hesitation or strained speaking. Sufferers often use associated or similar-sounding words even when these make no sense, such as “churn” for “burn” or “gutter” for “butter”. Some also battle to use numbers and do simple calculations. They can have difficulty grasping concepts and principles, and may take longer to complete tests because of their problems with recalling information, says Mohamed. “But generally children with learning difficulties have average to above average intelligence.”
If your child shows any of the signs, it’s vital to have them checked out immediately by a multidisciplinary team that can include an educational psychologist, a remedial and speech and language therapist, and a neuro-developmental paediatrician, and to have their hearing tested to rule out hearing difficulties. Ignoring signs can compromise not only their academic future and careers, but their emotional health, as communication problems can lead to withdrawal, frustration and clinical depression, which Doug experienced “at certain very traumatic times in my life”.
Diagnosis can be tricky as the symptoms are not always clear, and it typically mimics normal language development as young children often use incorrect words, says Hartgill. “It becomes more evident in senior primary when it begins to affect their ability to function in academic and social environments.” Dysnomia can also overlap with other learning disorders such as dyslexia, or with attention deficit hyperactivity disorder (ADHD), which presents with similar word retrieval and naming difficulties, says Mohamed. It’s usually done with a psycho-neurological assessment and speech and language assessment that highlights areas of the brain affected and the associated deficit.
Treatment depends on the extent of the dysnomia. If it’s caused by a tumour or lesion, surgery may help, along with speech therapy. But where the cause is genetic or due to a head injury, treatment mostly deals with finding ways to remediate the problem or work around it. “The focus is on word-retrieval strategies such as picture identification and categorization, says Mohamed. “Special attention is given to reading skills when reading disability is involved.”
Sufferers learn to stay calm, speak slowly, and use props to get a message across, or to draw pictures. Speech therapy should be started as early as possible, and may include VAKT. “If I’d started using my hieroglyphics at school, I may have retired as a professor,” rues Doug. Even starting as late as he did, he has been able to write 16 books in the past three years, mostly on Christian ministry and governance.
New treatment options such as Melodic Intonation Therapy (MIT) are being explored. This is based on the theory that while it’s difficult for dysnomia sufferers to speak words or phrases, as it’s a left-brain activity, they can often sing or say them using different pitches and rhythms, as musicality is a right-brain activity. “Studies need to be made of the individual child to find out what particular intervention would work best,” says Doug. “I just wish I’d had that option.”
Other “dys-” types of learning difficulties
Dysgraphia: difficulty writing – suspect this if your child’s writing is illegible or they struggle to draw
Dyscalculia: difficulty doing certain maths, not counting accurately, reversing numbers
Dyspraxia: difficulty with motor skills – clumsiness and difficulty with tasks like writing or tying shoelaces
Dysarthria: difficulty speaking – a loss of control of facial muscles so speech is slow or slurred
Dysphagia: difficulty swallowing – there’s risk of swallowing food or drink into the lungs which can cause pneumonia
Word for word
Durban speech and language therapist Ingrid Robertson advises:
- Praise every effort at speech.
- Try to figure out the meaning of the words they make up.
- Speak slowly and distinctly.
- Use common words and simple sentences, but don’t talk down to them.
- Ask questions they can answer with a “yes” or “no”.
- Allow time for a reply; don’t second-guess or hurry them.
- Give phonetic cues, where you sound the first part of the word, if they get stuck.
- Get them to describe what they want to recall.
- Don’t speak for them or speak as if they aren’t there.