Developmental Dysgraphia as a Reading System and Transfer Problem: A Case Study

Abstract

This is a case study of an adolescent who had largely overcome his early difficulty in learning to read, but continued to have severe problems with spelling. He had no visual memory impairment, and his letter–sound knowledge and phonemic awareness were at adult levels. Testing revealed that his difficulties in both reading and spelling only manifested when processing unfamiliar words. He was slow and inaccurate when reading non-words, despite a sublexical system dominated by the use of grapheme–phoneme units. It is suggested that limitations in the processing of the reading system were responsible for the lack of an extensive set of induced position-sensitive sublexical representations (ISRs) that are contextually dependent. This would have serious consequences for transfer to spelling.

Full text

fpsyg-07-00149 February 20, 2016 Time: 18:28 # 1
ORIGINAL RESEARCH
published: 23 February 2016
doi: 10.3389/fpsyg.2016.00149
Edited by:
Tilo Strobach,
Medical School Hamburg, Germany
Reviewed by:
Robert Gaschler,
FernUniversität in Hagen, Germany
Jan-Henning Ehm,
German Institute for International
Educational Research, Germany
*Correspondence:
Claire M. Fletcher-Flinn
cm.fletcher-flinn@auckland.ac.nz
Specialty section:
This article was submitted to
Cognitive Science,
a section of the journal
Frontiers in Psychology
Received: 10 November 2015
Accepted: 27 January 2016
Published: 23 February 2016
Citation:
Fletcher-Flinn CM (2016)
Developmental Dysgraphia as
a Reading System and Transfer
Problem: A Case Study.
Front. Psychol. 7:149.
doi: 10.3389/fpsyg.2016.00149
Developmental Dysgraphia as a
Reading System and Transfer
Problem: A Case Study
Claire M. Fletcher-Flinn*
School of Psychology, The University of Auckland, Auckland, New Zealand
This is a case study of an adolescent who had largely overcome his early difficulty
in learning to read, but continued to have severe problems with spelling. He had no
visual memory impairment, and his letter–sound knowledge and phonemic awareness
were at adult levels. Testing revealed that his difficulties in both reading and spelling
only manifested when processing unfamiliar words. He was slow and inaccurate when
reading non-words, despite a sublexical system dominated by the use of grapheme–
phoneme units. It is suggested that limitations in the processing of the reading
system were responsible for the lack of an extensive set of induced position-sensitive
sublexical representations (ISRs) that are contextually dependent. This would have
serious consequences for transfer to spelling.
Keywords: dysgraphia, specific spelling disability, dyslexia, induced sublexical relations (ISRs), Knowledge
Sources theory
INTRODUCTION
Reading and writing are important skills learned during childhood. It is estimated that up to 10%
of children have difficulty learning to read (Snowling, 2013), and much research effort has focused
on understanding the cognitive deficits associated with developmental dyslexia. There has been
far less emphasis on spelling and writing, despite being at least as severe, if not worse, than the
reading difficulties experienced by dyslexics (Ellis, 1993), with poor spelling often persisting into
adulthood among compensated dyslexics (Critchley and Critchley, 1978;Miles, 1983;Bruck, 1990).
The purpose of this study was to examine a case of developmental dysgraphia from a learning
perspective, using Knowledge Sources theory (Thompson et al., 1996;Thompson and Fletcher-
Flinn, 2006) as an explanatory framework. Although formal generalization from case studies is not
warranted, well-chosen cases are useful for tests of falsification (Flyvbjerg, 2006), and for restricting
the range of theory application (Fletcher-Flinn, 2014).
Dysgraphia
Dysgraphia was originally included in the description of dyslexia (Deuel, 1995) but is now
differentiated as a component within the broad spectrum of writing disorders, referring specifically
to spelling, and illegible handwriting (Adi-Japha et al., 2007). Different strands of theoretical
research and proposed causal mechanisms for these two aspects of dysgraphia has separated the
field of enquiry further, and is responsible for some confusion in the use of the term (Nicolson and
Fawcett, 2011). Cognitive developmental researchers tend to use the term dysgraphia to apply only
to the cognitive aspects of spelling (e.g., Frith, 1980), while those interested in writing difficulties
(e.g., Deuel, 1995) use the term to refer to motor difficulties in handwriting. This paper focuses on
the former.
Frontiers in Psychology | www.frontiersin.org 1February 2016 | Volume 7 | Article 149

fpsyg-07-00149 February 20, 2016 Time: 18:28 # 2
Fletcher-Flinn Developmental Dysgraphia
Much of our knowledge of dysgraphia comes from studies
of adults who have suffered brain trauma through accident
or stroke. As these adults were literate prior to their injuries,
they are considered to have ‘acquired’ the impairments. Various
patterns of acquired dysgraphia have been described that parallel
the acquired dyslexic categories. Both are based on the dual-
route theory (Coltheart, 2005), which separates the reading
system into lexical (word) and non-lexical pathways. Familiar
words are recognized via the lexical route, and unfamiliar words
and non-words are pronounced through a grapheme–phoneme
(letter–sound) conversion system for reading and writing. Those
individuals with phonological dysgraphia can spell words, but
not non-words, and those with surface dysgraphia can spell non-
words and regular words but not irregular words. As might
be expected, acquired dysgraphia is usually concurrent with
acquired dyslexia, and similar errors in reading and writing are
reported (Ellis, 1993).
There have been several interesting adult cases, however,
in which there is an asymmetry between reading and writing.
One case has been reported in which reading was in the
normal range but spelling was below expectation. Miceli et al.
(1985) reported the case of an Italian adult, FV, with ‘pure
dysgraphia’ and no concomitant reading problems. FV had
suffered a cardiovascular accident but had recovered to the
extent that he could resume his law practice. However, his
writing continued to be problematic. On writing to dictation,
he made errors on 22% of the words, and 31% of the non-
words presented. FV seemed to be aware of his errors, and was
able to correct many of them. He also performed well on tests
of delayed copying of word and non-words. His difficulty was
thought to lie with refreshing the decaying item in the graphemic
buffer, which holds the representation of the spelling during the
act of writing. It was suggested that FV used the phoneme–
grapheme (P–G) conversion system to refresh the graphemic
buffer. The P–G conversion system works by transforming the
phonological form of the item held in a phoneme buffer to its
graphemic form. It was concluded that overreliance on the P–G
conversion system instead of a direct lexical representation
would result in errors even in a shallow orthography like
Italian.
Goulandris and Snowling (1991) described the case of JAS,
a university undergraduate student who had severe problems
with spelling. She was reported as being a (developmental)
surface dyslexic who had largely compensated for her reading
difficulties, which was within the normal range on standardized
tests. However, further testing showed that she had subtle
impairments in reading. She showed a ‘marginal’ regularization
effect on low frequency words, and had more difficulty than
expected with irregular words, making mainly regularization
errors. Her spelling strategies were considered unusual. When
presented with words to spell, she “sounded out” individual
letters in words before writing them, even when she knew how
to spell the item. This idiosyncratic sound based approach to
spelling was unreliable, with more errors made on irregular
words. Tests of visual processing showed that she had severe
deficits on visual memory tasks. It was concluded that these visual
memory impairments prevented JAS from establishing detailed
orthographic representations in her lexical system, having a
severe effect on her spelling.
Both of the adult cases of dysgraphia are similar in
that there appeared to be an overreliance on phonology
to spell and write words. The question remains as to
whether developmental cases of dysgraphia (without reading
impairment) have particular difficulty with either establishing
precise orthographic representations due to poor visual memory
as suggested for JAS, or having access to the representations, as
may have been the case for FV.
Developmental Dysgraphia
Starting with Hinshelwood (1917), many researchers have drawn
parallels between the difficulties of those children with specific
impairments in reading and writing, and brain-injured adult
dyslexics. The same cognitive neuropsychological approach has
been applied to developmental cases of dyslexia and dysgraphia
with regard to classification, terminology, and etiology for both
case (e.g., Temple and Marshall, 1983;Temple, 1985), and group
(e.g., Angelelli et al., 2004) studies.
Similar to acquired dyslexia, most children with reading
problems also struggle with spelling, as these aspects of literacy
share cognitive components and are usually well correlated
(e.g., Frith, 1980;Fletcher-Flinn et al., 2004). The difficulties
of both are also attributed to the same cognitive impairment
(e.g., Shankweiler et al., 1996;Angelelli et al., 2004;Caravolas
et al., 2005). For example, Angelelli et al. (2004) described the
writing characteristics of 18 Italian dyslexic children, ranging in
age from 10 years 8 months (10:8) to 13:1. They reported that
they were very slow readers compared with age-matched controls.
Their writing errors, mainly on ‘unpredictable’ words, mirrored
their reading errors, occurring for the most part on irregular
words. They concluded that the children suffered from surface
dysgraphia, and their errors were attributed to impairments in
lexical access resulting in an overreliance on grapheme–phoneme
rules.
Despite the similarities between acquired forms of dyslexia
and dysgraphia, and their developmental counterparts, strong
claims are problematic (Ellis, 1993). The developmental cases lack
known brain trauma, and have developing reading systems that
may be inefficient, but are not totally incapable in the way that the
acquired ones are. Dyslexic children are generally able to read and
write both familiar and unfamiliar words, but to a lesser degree
than those making normal progress. Their difficulties are situated
in the learning of these literacy skills and the establishment of
a reading system, rather than a disruption to a well-functioning
one. Although the cognitive neuropsychological approach has
provided some valuable insights into dyslexia and dysgraphia,
a developmental framework is better suited to understanding
deficits in learning to read and spell.
A Developmental Approach
Maul and Ehri (1991) claimed that it was primarily through
reading that spellings of words were learnt. The exposure to the
correct spellings of words was considered essential due to the
vagaries of English spellings making them difficult to predict.
Frontiers in Psychology | www.frontiersin.org 2February 2016 | Volume 7 | Article 149

fpsyg-07-00149 February 20, 2016 Time: 18:28 # 3
Fletcher-Flinn Developmental Dysgraphia
Through reading children retained word-specific information in
orthographic (lexical) memory that could be accessed for spelling.
Word representations take time to develop, as they require
print experience. According to Knowledge Sources theory
(Thompson and Fletcher-Flinn, 1993, pp. 32–33), word
representations are formed through a learning sequence in
which the letters and letter order of words become increasingly
complete as new representations are added, and further
discrimination is required. As the letters in words become
represented, alignments are made between their positional
coding, and the temporal coding of the matching phonological
component. These alignments are called induced sublexical
relations (ISRs), and are used to generate reading responses
to new words. They consist of small grapheme–phoneme
representations, as well as larger context-dependent sequences
of grapheme and corresponding phonological units (Thompson
et al., 1996;Thompson, 1999;Thompson and Fletcher-Flinn,
2006). For example, from the orthographic representations of
bat,sit,cat,went,get, the child would induce non-conciously that
the final orthographic component –t relates to /–t/.
When the orthographic representations provide sufficient
exemplars, more complex ISR associations are formed, such that
the ISR for the grapheme yin final position of words like baby
and happy is distinguished by position from the yin yes and you,
where it has a different sound, and contextually from by or my,
which has a different sound again. Some ISRs take account of the
influence of sequences of graphemes and associated phonemes
on the mapping of the preceding vowel (e.g., hold versus hot),
or following vowel (wand versus hand). As more representations
are added, so will the number of ISRs expand, creating a system
of interlinked representations. The product of this process, ISR
knowledge, although mainly implicit, can occasionally become
explicit and conscious for some relationships if attention is drawn
to them (Thompson, 1999;McKay et al., 2004;Thompson and
Fletcher-Flinn, 2006).
Although good readers and spellers are characterized by fast
and accurate recall from representations in the orthographic
lexicon, it is not necessarily the case that full representation
is required for a word to be recalled. In spelling, a detailed
representation is far more important for accuracy. This partially
explains the common finding in developmental studies of
beginning readers that spelling lags behind reading (for a
review, Fletcher-Flinn et al., 2004), and may be considerably
underdeveloped as shown by a very precocious 3-year-old reader
(Fletcher-Flinn and Thompson, 2000). If a word spelling is
not fully represented than the missing part must be filled-
in from other knowledge sources. According to Ehri (1986),
this can be achieved through applying knowledge of the
orthographic system, including producing a phonetic spelling,
or using a morphographic or analogy strategy. Although
orthographic knowledge is mostly implicit, these procedures
for filling-in would presumably involve some degree of explicit
knowledge gained through instruction, e.g., learning letter–sound
relationships.
If reading is critical for spelling, then some form of knowledge
transfer must occur from these implicitly formed word, and
ISR representations in reading to be available for spelling. Only
a few studies have directly examined learning and transfer in
developmental dysgraphia. Maul and Ehri (1991) compared the
performance of 34 pairs of dysgraphic adolescents (M14 years)
with a reading comprehension matched group making normal
progress. Fifteen words thought to be unfamiliar in meaning and
spelling, were chosen as targets. They found positive transfer for
the dysgraphic adolescents to the same extent as the comparison
group in both an isolated word condition in which the target
words were read aloud but not corrected, and in the silent reading
of continuous text. It was concluded that their source of difficulty
was in ‘remembering’ whole word spellings, which would result in
the filling-in of the missing letters by ‘ear.’ Based on their poorer
performance on a non-word reading test, and the pronunciations
of target words in the isolated reading condition, it was claimed
that the dysgraphics had weaker phonological recoding skill with
which to do this, and they did not have the knowledge of spelling
patterns, and morphophonemic rules to the same extent as the
normal spellers with which to generate better guesses.
In another study, Neser (2002, Unpublished) trained seven
adolescents (M13:10 years) with specific spelling disability on
40 words differing in regularity (20 high and 20 low). The
adolescents were reading-level matched with seven normal-
progress adolescents (M12:2). To ensure that the adolescents
were not already familiar with the training words, a reading and
spelling pretest was given of the entire word pool consisting of
141 matched training and control word pairs. Words that were
read incorrectly, as well those that were spelt correctly were
eliminated from the word pool along with the matched control
words for each participant. The adolescents read the 40 training
words in different sentences, with a total of four exposures for
each. The normal-progress spellers showed significant gains in
spelling, relative to the matching untrained control words, but
only on the highly regular words. The dysgraphics showed no
gains.
It was suggested that the gains for the normal spellers were
facilitated by the activation of existing stored ISRs comprising
phoneme–grapheme correspondences constrained by regularity
patterns. The small number of reading exposures may have been
insufficient for learning new phonological recoding relations for
the less regular words. As six of the seven adolescents who were
spelling disabled had difficulty learning to read, they may not
have had sufficient reading exposure to develop the associative
sublexical networks to facilitate transfer from reading to spelling
for even the highly regular words. In terms of a more general
transfer, as ISRs are position sensitive, the specificity of the
grapheme positions and sequences of graphemes of the training
words did not feature to the same extent in the control words,
and this specificity was suggested as contributing to the non-
significant gains on these words for both groups.
The two training studies contrast in outcome, and this is
most likely due to methodological differences. In the Maul and
Ehri (1991) study, the spelling posttest was given immediately
after the treatments, whereas there was a 3-day delay in the
Neser (2002, Unpublished) study. The number of participants,
training words, amount of exposures, use of untrained control
words, and checks on prior knowledge of target word spellings
also differed between studies. Nonetheless, their conclusions are
Frontiers in Psychology | www.frontiersin.org 3February 2016 | Volume 7 | Article 149

fpsyg-07-00149 February 20, 2016 Time: 18:28 # 4
Fletcher-Flinn Developmental Dysgraphia
similar, and align well with that of JAS, pointing to difficulty
in establishing orthographic (word) representations from their
reading experience, and/or sublexical components (ISRs) from
them to facilitate transfer from reading to spelling. Poor visual
memory was considered causally related to the difficulties JAS
experienced with spelling, but it was not directly tested in the
dysgraphic adolescents. However, those in the Maul and Ehri
(1991) study had good recall of double letters, which indicated
access to some visual information because they could not be
guessed at phonetically. The conclusions from these studies are in
contrast to a view of developmental dysgraphia as difficulty with
access to the representations.
The purpose of this study was to examine the cognitive
performance, visual memory, and the reading and spelling of
an adolescent referred for assessment due to poor spelling.
BT, the case reported in this study was in a state integrated
secondary school, and similar to JAS had normal reading
attainment but further specific testing revealed some deficits.
His performance was compared to normal adult readers,
and a sample of 12-year-old normal progress readers. These
reading level matches were used to examine the extent to
which his reading skills and processing differed from them.
The intention was to discuss BT’s reading and spelling from
a developmental, rather than a cognitive neuropsychological
point of view and to draw from it broader implications for
theories of developmental dysgraphia with regard to access
(Angelelli et al., 2004), or the establishment of orthographic
representations (Goulandris and Snowling, 1991;Maul and Ehri,
1991).
MATERIALS AND METHODS
Case History
BT was 15 years, 3 months (15:3) when testing began. He was in
Year 10 at a state-integrated high school for boys. As reported
by his mother, BT had a normal delivery at full term, and he
reached all of his developmental milestones on time, except
for his language. He was a late talker and there were concerns
about his hearing. From about 8 months, he suffered from ear
infections, and grommets were inserted at 3 years.
At 41/2years, he entered school in England, and the teacher
reported that he seemed ‘distracted,’ and didn’t always respond
to his name. He made poor progress in reading with phonics
instruction, which was supported at home with Jolly Phonics. At
6.5 years, he completed the National Curriculum assessments,
and scored above average for Mathematics and Science, but
below the grade norm for English. When BT was 7 years,
the family moved to New Zealand. According to his mother,
reading and writing seemed to get worse at first, but by
10 years, he was reading independently and avidly. It is not
surprising that BT had initial difficulty as the New Zealand
curriculum for reading is based on a text-centered approach,
which is supported through books with increasing levels of
difficulty (see, Thompson, 1993). This approach would have been
different to the phonics instruction that he had been receiving in
England.
It was noted that BT’s father had similar difficulty with
spelling, and his paternal grandfather was characterized as an
“underachiever” despite a high IQ. At school, BT struggled with
some ball sports, but he was able to enjoy rugby, swimming,
and cross-country, and continues to be involved with a fencing
club. He is a good runner and loves hiking and being outdoors.
Art is a challenge, although when he was nine, an inspired art
teacher encouraged him to use patterns of dabs of paint to imitate
Australian Aboriginal paintings. His painting was considered so
good that it was framed by the school and still hangs in the
Principal’s office. However, like his father, he still finds drawing
a problem, and his handwriting is hardly legible. Of the 10 Topic
tests for Year 9, BT only managed to finish half of them.
General Procedure
BT was administered a series of cognitive and literacy tasks over
a period of about 1 month, with two to three 1 h sessions per
week. The cognitive tasks were administered during the first
week, followed in the second week by the standard reading and
spelling tasks, and in the last 2 weeks, the experimental reading
and spelling tasks. Published data from 12-year-olds (Fletcher-
Flinn and Thompson, 2004) and two adult samples (Thompson
et al., 2009), as well as the Coltheart and Leahy (1992) samples
were used as comparison groups for the various experimental
tasks where appropriate. The 12-year-old sample was justified as
BT’s reading age on the WRAT4 was shown to be at that level.
Presentation was similar to that used for the comparison groups
for all of the experimental tasks.
ASSESSMENTS
Cognitive
BT was assessed with the Wechsler Intelligence Scale for
Children–Third Edition, Australian Version (WISC–3, Wechsler,
1992). His Verbal IQ was 127, Performance IQ was 113, and
his Full Scale IQ was 123. His Index Scores were: Verbal
Comprehension 123, Perceptual Organization 126, Freedom
from Distraction 129, and Perceptual Speed 83. He achieved
a standard score (SS) of 11 on Digit Span forward, and 9 on
Digit Span backward, putting him in the Average range for
auditory sequential memory. His receptive vocabulary of 110 on
the British Picture Vocabulary Scale (BPVS, Dunn et al., 1997)
was consistent with his expressive vocabulary on the WISC–3
(SS 12).
All of BT’s subtest scores on the Verbal and Performance
Scales of the WISC–3 were in the very superior to above
average range for his age. There was a significant disparity
between Perceptual Speed and the rest of the Index scores.
The combined score put him in the Low Average range.
Perceptual Speed is measured by performance on two subtests,
Symbol Search and Coding. In Symbol Search a decision
must be made about whether target symbols appear in a
row of symbols, whereas for Coding, a digit-symbol code
must be transcribed as quickly as possible. Both measures
involve skills in quick scanning and visual sequential short-
term memory, and speed of processing (psychomotor speed).
Frontiers in Psychology | www.frontiersin.org 4February 2016 | Volume 7 | Article 149

fpsyg-07-00149 February 20, 2016 Time: 18:28 # 5
Fletcher-Flinn Developmental Dysgraphia
BT performed at an average level on Symbol Search with
a SS of 10, but showed a severe deficit on the other
subtest (SS 3).
The difference in the subtests is their content, with Symbol
Search having figural content, and the Coding subtests having
symbolic content. The latter requires a strategy of associative
learning, forming paired associations between numbers and
shapes. It is sensitive to the ability to learn these associations,
and performance can be influenced by a weakness in short-
term visual memory of the learned associations. BT made no
errors, and it was noted that he performed this task by giving
names to the shapes. His poor performance was due to slow
processing.
He was also administered the Mazes supplementary subtest
from the WISC–3 to further examine his fine motor skills,
ability to manipulate a pencil, and planning ability. On this
subtest, scores are given for speed and accuracy. He made
no errors, and his speed was well within the maximum,
completing the two most difficult mazes having time limits
of 150 s, in 38 and 31 s. He achieved the maximum
SS of 17.
Considering BT’s overall cognitive performance was in the
superior range, his performance on the Coding subtest was
markedly discrepant, and his verbal mediation strategy was
consistent with a visual memory deficit and warranted additional
examination.
Visual Short-Term Memory
Visual sequential memory was assessed with the Illinois Test
of Psycholinguistic Abilities Revised (ITPA-R, Kirk et al., 1968).
It consists of a set of 17 tiles with arbitrary visual symbols
that must be arranged in the sequence shown in the test
booklet. For each item, a sequence is shown for 5 s then
removed and the participant is asked to place the tiles in
the same order. Two points are given for correct items on
the first trial, one point if correct on the second trial, and
none if both trials are failed. Testing is discontinued after two
consecutive items are failed. BT scored in the Average range
for his age (Heriot and Beale, 1996), and similar to the Coding
subtest on the WISC–3, this score was achieved using an oral
strategy.
The Recall of Designs subtest from the British Ability Scales
(BAS, Elliott et al., 1978) was administered to BT. In this subtest,
19 geometric designs have to be drawn from memory following
a 5 s study period. Points are given for accuracy and ranges from
2 to 0. BT achieved a raw score of 23/38, which is in the Average
range for his age (Centile Score 59).
Both visual memory tests are consistent in placing BT in the
average range. BT’s performance on visual sequential memory
is similar to his score on the WISC–3 Digit Span subtest which
measures auditory sequential memory. Although his oral strategy
on the sequential memory tests is suggestive of a visual memory
deficit, it would have been difficult to code verbally for the recall
of geometric designs, and he was not observed doing so. Given
his normal scores on the tests requiring visual analysis and visual
memory, it does not appear that BT suffers from a visual memory
deficit.
Standardized Tests of Reading and
Spelling
The Wide Range Achievement Test 4 (WRAT–4, Wilkinson and
Robertson, 2006) was used to test BT’s word reading and spelling
skills. For word reading (Combined Form), his SS was in the
Average range at 95. This is equivalent to a reading age of
approximately 121/2. Although it is an acceptable score in the
normal range for his age, it is inconsistent with his Superior
verbal ability. On the spelling subtest his SS was 82. This is
equivalent to an age score of approximately 9–91/2. His spelling
skills were in the Low Average range, and almost undecipherable.
This is in contrast to his excellent fine motor skills as shown
on the Mazes subtest of the WISC–3, and his drawing of
geometric designs on the BAS subtest. It is possible that his poor
handwriting is task dependent. Deuel (1995) refers to this as a
‘material-specific dyspraxia’.
These standardized scores on reading and spelling correspond
well to attainment on school-based assessments. BT’s reading
comprehension on the Assessment for Teaching and Learning
Test (e-Asttle, Ministry of Education, 2005) was one level higher
than the average student. On the Progressive Achievement
Test Listening Comprehension (PAT, New Zealand Council for
Educational Research, 2010), the participant listens to text read
by the teacher, and responds to comprehension questions. BT was
average (Stanine 6) on this test for his year level. On the Schonell
Spelling Test (Schonell, 1932) his spelling age was 9:1, which is
similar to his age level performance on the WRAT–4.
EXPERIMENTAL TASKS: READING
Phoneme and Grapho-Phonemic
Awareness
The extended Scarborough task (Thompson et al., 2009, Table 2)
was used for assessment and comparisons were made with two
adult samples, one from New Zealand who had not received
phonics instruction in childhood, and the other from Scotland
who had received such instruction. In the phoneme awareness
task 30 words were presented in aural form and the task was
to count the number of the “smallest sounds” in each word,
(e.g., four for socks). The same words from this task were used
in a grapho-phonemic task in which the words were presented
in print form. In this task, the participant must read the word,
note the number of sounds in the word (awareness score), and
underline the letter or letter sequence belonging to each sound
(identity score).
BT’s accuracy on the test of phoneme awareness at 60%
was close to the adult sample of university students (61%)
without phonics instruction. At 77%, he was 0.8 SD better than
the New Zealand sample for grapho-phonemic awareness (NZ
adults, 61%), and 1.85 SD better at 63% on grapho-phonemic
segmentation (NZ adults, 39%). Neither of these differences were
significant at the 0.05 level. His scores were all within 1 SD of
the adult sample from Scotland who similar to BT had received
phonics instruction in childhood. These scores indicated that his
performance was at an acceptable adult level.
Frontiers in Psychology | www.frontiersin.org 5February 2016 | Volume 7 | Article 149

fpsyg-07-00149 February 20, 2016 Time: 18:28 # 6
Fletcher-Flinn Developmental Dysgraphia
Letter Names and Sounds
The same three tasks as in Thompson et al. (2009, Table 2)
for giving letter names, letter sounds, and digraph sounds were
administered to BT on a computer with speeded instruction.
Comparisons were made with the two adult samples. The first
two sets comprised the 26 lower case alphabet letters, and the
last consisted of 29 digraphs, all presented in random order,
in the same session. BT was 100% accurate on the letter name
task. On providing phonic sounds to letters, he achieved 62%
accuracy, which was within 1 SD of the NZ adult sample (75%),
and on digraphs at 61% accuracy, he was within 1.2 SD of the
NZ adult sample (73%). He was significantly lower, p<0.05,
than the adult sample with phonics instruction on both giving the
phonics sounds for letters (87%), and digraphs (78%) by 2.13 SD,
and 2.78 SD, respectively. BT’s knowledge of phonic sounds for
letter names, sounds and digraphs was at acceptable adult levels
considering the teaching instruction that he had received since he
arrived in New Zealand.
Reading Non-Words
BT was administered the Coltheart and Leahy (1992, Task 2) non-
word task, which consisted of three sets of 20 items, Regular,
body-consistent; Regular, body-inconsistent; and Irregular, body-
consistent non-words presented in a randomized sequence. There
was only one correct regular response for the Regular Consistent
non-words, (e.g., dack,ving), and one correct irregular response
for the Irregular Consistent non-words (e.g., jook with –ook
pronounced as in “book”; vind with –ind pronounced as in
“kind”). Regular responses (e.g., jook with –ook pronounced
as in “spook”; vind with –ind pronounced as in “wind”) were
considered less correct, regularization errors. The Inconsistent
non-words were scored as correct for either a regular or irregular
pronunciation (e.g., nush with –ush pronounced as in “rush” or
“push”). The task was administered on a computer with speeded
instruction. Comparisons were made with the 12-year-old NZ
sample, the two adult samples (Thompson et al., 2009), and the
Coltheart and Leahy samples.
Overall, for the categories of correct regular responses to the
Regular Consistent and Inconsistent non-words, BT’s combined
accuracy was 67% (Table 1). He was within 1 SD of the 12-year-
olds who achieved 70% (SD 11%), but less than the Coltheart and
Leahy adults (Coltheart and Leahy, 1992, Table 3), and the NZ
adults, who averaged 93 and 92% (SD 4), respectively.
There is one interesting anomaly, BT performed poorly on the
Regular Consistent non-words compared to the other samples.
He was 2.57 SD below the 12-year-olds, which is a significant
difference, p<0.05. Of his nine errors, four were pronounced
as real words (e.g., rell as “real”; prile as “pride”), and the other
five responses were non-words (e.g., drace as “drance”; hane as
“han”). For the most part, the errors consisted of consonant
substitutions, or vowel/consonant additions (each 38%), and
vowel digraph/consonant blend reductions (25%). One response
seemed to be a combination of errors (“deal” for stell). A major
source of errors for the children in the Coltheart and Leahy
(1992, p. 727) study for Grades 1–3 was the failure to lengthen
the vowel for final enon-words (between 25 and 30%). Of the
TABLE 1 | Mean percentage of regular and irregular pronunciations for the
Coltheart and Leahy non-words varying in regularity and consistency of
body spelling for BT and normal-progress and adult readers.
Regular
consistent
Inconsistent Irregular
consistent
Regular pronunciations
BT 55 79 47
NZ 12-year-olds 82 (10.5) 57 (11.2) 33 (14.9)
NZ Adults 92 (4) 84 (7) 10 (9)
Irregular pronunciations
BT –a11 26
NZ 12-year-olds – 23 (10.5) 46 (13.9)
NZ adults – 10 (6) 63 (17)
aDashes indicate that regular pronunciations do not exist for regular consistent
non-words.
eight non-words of this type, BT made 6 errors (75%) errors.
However, there were also 6 final enon-words of a similar type
in the Inconsistent set, and BT pronounced all of these as correct
regular responses.
The pattern of accuracy results for BT on the Irregular
Consistent non-words was most similar to the adults in the
Coltheart and Leahy (1992) study. Unlike the NZ adults and 12-
year-olds, his responses to the Irregular Consistent non-words
were dominated by regularizations (45%), as were the Coltheart
and Leahy adults (49%). The number of correct responses to
the Irregular Consistent non-words (25%) was also similar to
that sample of adults (28%). As suggested (Fletcher-Flinn and
Thompson, 2004, 2007;Fletcher-Flinn, 2014), the large number
of regularizations may be a long-term result of early exposure to
phonics instruction.
BT’s response times were analyzed for those categories above
mean acceptable response rates of 33% or higher (Table 2). These
included only two categories, the regular responses for Regular
Consistent (Mean RT =1018 ms) and Inconsistent (Mean
RT =926 ms, SD =226) non-words. There were no outliers
(±3SDs), and a repeated measures analysis of variance (ANOVA)
by items (e.g., Fletcher-Flinn and Thompson, 2000, 2004, 2007;
Beland and Mimouni, 2001;Upton et al., 2003;Fletcher-Flinn,
2014) showed no difference in mean RTs, F>1.
TABLE 2 | Mean RTs (ms) of regular and irregular pronunciations for the
Coltheart and Leahy non-words varying in regularity and consistency of
body spelling for BT and normal-progress readers
Regular
consistent
Inconsistent Irregular
consistent
Regular pronunciations
BT 1018 (228) 926 (224) 1274 (392)
NZ 12-year-olds 1160 (375) 1064 (284) 1279 (623)
Irregular pronunciations
BT –a1019 (115) 1073 (285)
NZ 12-yearolds –a1111 (260) 1229 (466)
aDashes indicate that regular pronunciations do not exist for regular consistent
non-words.
Frontiers in Psychology | www.frontiersin.org 6February 2016 | Volume 7 | Article 149

fpsyg-07-00149 February 20, 2016 Time: 18:28 # 7
Fletcher-Flinn Developmental Dysgraphia
As response times were available for half of the 12-year-
olds, BT’s response time averaged over these two categories
of regular responses (Mean RT 972 ms, SD 226) was not
significantly different compared to this subsample (1220 ms, SD
499). However, it was 2.5 SD slower (p<0.05) than the New
Zealand adults who averaged 673 ms (SD =138).
Overall, BT’s accuracy and speed for reading non-words
was consistent with his reading age, and comparable to the
comparison group of 12-year-olds. The one exception was
his lower score for Regular Consistent non-words, which was
significantly below the comparison group.
Exemplar Word Reading
BT was administered the Coltheart and Leahy (1992), Tasks 3
and 4 on a computer with speeded instructions. These two tasks
consisted of four sets of 20 exemplar words (e.g., back, rush,
bush, walk) that contained the rimes from the non-words, and
a set of 20 fillers. BT’s mean accuracy was 95%. This was not
significantly better (1.4 SD) than the full sample of 12-year-olds
at 80% (SD 11). There was no difference for BT in response times
(repeated measures by items ANOVA) across these categories,
F(3,36) =0.40, p<1, and his average RT was 702 ms. (SD 94 ms).
His word reading was significantly faster (2.9 SD, p <0.05) than
his non-word reading, which is a normal finding (Ellis, 1993).
EXPERIMENTAL TASKS: SPELLING
Knowledge of Spelling Errors
According to Ehri (1986, p. 126), after a spelling is written, an
assessment can be made as to whether the word “looks right”
and has no errors. This validation process involves comparing the
spelling against any stored “visual alphabetic information.” To
ascertain if BT was visually aware of his errors, the two versions
of BT’s typed responses on the WRAT–4 spelling test were
printed, and BT was asked to tick the words that were correct. On
the Green Form, BT made 22 errors before he achieved the cut-off
point of 10 consecutive errors, and on the Blue form he made 12
errors before reaching the cut-off point. Of the 22 errors on the
Green form, BT thought five were correctly spelt words, and of
the 12 errors on the Blue form, he thought one item (i.e., belive)
was correct. It appeared that BT was to a large extent aware of his
errors.
Typing Words on Computer
To explore the possibility that BT’s poor handwriting might have
contributed to errors in letter formation (Deuel, 1995), or being
unrecognizable, penalized in the scoring, the spelling subtest of
the WRAT–4 was repeated. The automatic spell checker was
turned off but the procedure was exactly the same as for the
handwritten version of the test. The total number of spelling
errors on the written form (Blue and Green forms combined)
was 26, and on the computer it was 25. The correlation between
the hand written and computer version of the test was significant
for the Blue form, r(23) =0.65, p=0.001, and likewise for the
Green form, r(31) =0.81, p=0.0001. These results show that
BT’s errors were fairly consistent across modalities, and there was
no advantage in using the computer. This is compatible with a
study by Ouellette and Tims (2014) showing no modality effect
on orthographic learning. Any claimed advantage for computer
use is probably due to a working spell checker.
Error Analysis: Spelling
An error analysis was carried out on the computer version of the
WRAT–4 spelling subtest to explore the types of errors that were
made. Of BT’s total number of errors on both forms, 51% were
mainly attempts to spell words phonetically. On the Green form,
12 of the 22 were attempts to spell the words phonetically (e.g.,
explain as explane; kitchen as kichin; museum as mussium). This
strategy of spelling also occurred on the Blue Form. Six of the 12
items were phonetic attempts at spelling (e.g., correct as cerrect;
ruin as ruein; believe as belive).
All of the errors bore some relationship to the presented word
and could be classified as letter substitutions (e.g., correct as
cerrect), additions (e.g, brief as briefe), deletions (e.g., material
as materal), or a combination of these errors (e.g., circleas cural).
There were no transpositions. The largest number of errors was
of the mixed type (59%) and occurred on words of more than one
syllable. Of these, 38% were due to a letter(s) deletion resulting
in the missing of a full syllable, in addition to another error(s)
(e.g., reasonable as resnabal; initiative as inishive). A noticeable
consistent error was the lack of placing the letter u after q
(i.e., equipment as eqment; loquacious as lowqashus; quantity
as qwantity). BT also showed consistency in using the suffix –
al at the end of words (i.e., circle as cural; material as materal;
reasonable as resnabal; imperturbable as inperturbal). Other than
the misspelling of material, –al was used as a substitute for –le (as
in cural for circle). These consistent errors across words indicate
that BT lacked significant knowledge of standard orthographic
conventions for spelling.
GENERAL DISCUSSION
BT appears to be a compensated dyslexic with residual problems
in spelling. Both his visual memory for designs, and his visual
and auditory sequential memory were normal for his age, and
he was visually aware of his spelling errors. He performed at an
acceptable level on a standard test of isolated word reading, as
well as on school-based measures of text reading, and his accuracy
for reading single syllable words was age appropriate. His letter–
sound skills and phoneme awareness were consistent with adult
levels. Although BT’s spelling was in the low average range, his
scores on the two standardized spelling tests equated to an age
score of approximately 9–91/2years, far below what would be
expected given his IQ and reading age. Most of his errors were
phonological attempts to spell and occurred on words of more
than one syllable. There were some consistent errors, with the
most unexpected being the lack of placing a ufollowing the
letter q, which is a highly predictable orthographic regularity in
English.
Despite his normal standardized scores in reading,
BT showed some subtle deficits. His accuracy and speed
of processing non-words was less than expected for his
Frontiers in Psychology | www.frontiersin.org 7February 2016 | Volume 7 | Article 149

fpsyg-07-00149 February 20, 2016 Time: 18:28 # 8
Fletcher-Flinn Developmental Dysgraphia
chronological age but consistent with his reading age. His
pattern of responses for Irregular Consistent non-words was
similar to other samples with such instruction, showing a
strong regularization effect on pronunciation (Coltheart and
Leahy, 1992;Fletcher-Flinn and Thompson, 2007;Thompson
et al., 2009). This preponderance of regular responses on
these non-words having highly consistent irregular rimes
indicates the dominant use of grapheme–phoneme units for
processing, showing the long-term effects of early instruction in
phonics.
Considering his more than adequate knowledge of letter–
sound correspondences, and his phonological processing bias,
BT’s poor performance on Regular Consistent non-words was
surprising. His accuracy was significantly less than a sample of
normal-progress 12-year-olds. BT’s error responses consisted of
almost an equal number of real words and incorrect non-words,
resembling the performance of much younger children. It is not
immediately clear why BT made so many errors on this set
of non-words, with 67% occurring on non-words necessitating
the elongation of the vowel (rule of e). In contrast, he had
no trouble with this type of non-word for the Inconsistent
set, making no errors. The only notable difference between the
set of final enon-words were the medial vowels. The Regular
Consistent set were comprised of an equal number of the medial
vowels aand i(e.g., yane,prile), whereas the Inconsistent
set had medial vowel components of only o(e.g., brone).
These errors indicate a reading processing system inefficient at
forming context-dependent ISRs that consist of position sensitive
sequences of graphemes and matching phonology, including the
rime.
Although not directly tested, but based on BT’s consistent
spelling errors that failed to take advantage of orthographic
regularities, it seems reasonable to suggest that transfer from
reading to spelling was limited. It is likely that this is due
to his earlier reading difficulty, which for a significant period
of time would have constrained the size of the orthographic
lexicon due to insufficient print exposure. There is some evidence
that processing within a reading system reaches stability early,
as shown by a very precocious reader (Fletcher-Flinn, 2014).
If so, it may be that in BT’s case, the reading processing
system remained biased toward the formation of smaller ISR
units, consisting of simple grapheme–phoneme relationships.
This might have been exacerbated by early school instruction
in phonics, which draws attention to individual context-
free letters and sounds. The consequence for spelling is the
generation of a phonetic (sound–letter) spelling to fill the gaps
for partially represented words, which would result in many
inaccuracies.
To summarize, BT has no difficulty with access to his
orthographic lexicon in that he can read words that he knows
both quickly and accurately. This probably characterizes most
developmental cases. It is when BT has to generate a reading
response for unfamiliar words (non-words) that he is slower, and
far less accurate. This is consistent with his spelling performance.
He can spell words that he can access, as presumably they are
completely represented, but he has difficulty with those that
are not, in which case the missing letters must be provided.
In BT’s case, reading and spelling are limited by small unit
(ISR) activation and processing, which is adequate for reading
to a large extent, but does not work as well for spelling. The
difficulty experienced may not be in establishing orthographic
(word) representations due to poor visual memory as this was
in the normal range for BT. It would seem that the primary
difficulty is in the formation of context-dependent ISRs that
include the rime, and other regularities from the orthographic
representations. These, in a reciprocal manner, would support
the further establishment of orthographic representations, and
through interconnected activation facilitate word spellings. Some
ISR knowledge might also become available during the conscious
process of reflecting on incomplete word spellings, and this
information could also contribute to the generation of the
missing letters.
This case study raises issues with regard to contemporary
theories of developmental dysgraphia. Cognitive
neuropsychological explanations based on dual route theory
(Coltheart, 2005) have provided valuable insights, but learning
and the establishment of a reading system are not considered.
Viewed from a developmental perspective, learning to read and
spell is an overriding consideration. However, the picture appears
far more complex than is implied by propositions pertaining to
lack of access (Angelelli et al., 2004), or the failure to establish
(complete) orthographic representations due to poor visual
memory (Goulandris and Snowling, 1991), or ‘remembering’
the words (Maul and Ehri, 1991). The reading system comprises
sublexical representations (ISRs) that have a substantial role in
learning to read, and by the activation of associative networks,
facilitate transfer from reading to spelling. These ISRs are formed
from orthographic (word) representations and their matching
phonological components. If there is difficulty in learning to read
then both the orthographic representations and the resulting
ISRs will be limited, resulting in delay in both aspects of literacy
relative to those making normal progress.
In the case of BT, by adolescence his reading proficiency
was in the normal range but his spelling had not caught
up to the same extent. This asynchrony is similar to normal
progress beginning readers. Small position-sensitive ISRs are
formed initially and these would, to a large extent, typify those
available in the reading system of beginners, and similarly,
BT. What is lacking in both are complex ISRs that include
the rime and other orthographic regularities. For beginning
readers this is due to insufficient orthographic representations,
as reading experience is limited. BT, on the other hand, has
sufficient reading experience but his system of ISRs has remained
limited. Whether this is due to the early stability of the
reading system biasing ISR formation toward smaller units
as suggested, remains an open question, and warrants further
research with longitudinal case studies, and with larger samples
of developmental dysgraphics. As reading is essential for spelling,
then more studies carefully documenting the reading processes
of dysgraphics, and involving experimental tests of transfer are
needed.
Although a thorough review of educational support strategies
is beyond the scope of this paper, there are some implications
from this research that might be incorporated into current
Frontiers in Psychology | www.frontiersin.org 8February 2016 | Volume 7 | Article 149

fpsyg-07-00149 February 20, 2016 Time: 18:28 # 9
Fletcher-Flinn Developmental Dysgraphia
programs. Considerable practice in reading should be
encouraged, as it is through reading that orthographic knowledge
for spellings are learnt. As this knowledge is mainly implicit,
it might be useful to point out orthographic regularities and
patterns in words from learners’ reading vocabulary (McKay
et al., 2004). Management could include the use of word
processors, and untimed tests (Deuel, 1995). This ‘bypass’
method would make up for some of the adverse effects of
poor spelling and slow writing (as shown by BT’s school test
results) due to the mental effort required to generate correct
spellings.
AUTHOR CONTRIBUTIONS
The author confirms being the sole contributor of this work and
approved it for publication.
ACKNOWLEDGMENT
I thank BT for his cooperation and consent to publish his data,
and G. Brian Thompson for his helpful comments on an earlier
draft.
REFERENCES
Adi-Japha, E., Landau, Y. E., Frenkel, L., Teicher, M., and Gross-Tsur, V.
(2007). ADHD and dysgraphia. Cortex 43, 700–709. doi: 10.1016/S0010-
9452(08)70499-4
Angelelli, P., Judica, A., Spinelli, D., Zoccolotti, P., and Luzzatti, C.
(2004). Characteristics of writing disorders in Italian dyslexic children.
Cogn. Behav. Neurol. 17, 18–31. doi: 10.1097/00146965-200403000-0
0003
Beland, R., and Mimouni, Z. (2001). Deep dyslexia in the two languages of an
Arabic/French bilingual patient. Cognition 82, 77–126. doi: 10.1016/S0010-
0277(01)00148-2
Bruck, M. (1990). Word recognition skills of adults with childhood diagnoses of
dyslexia. Dev. Psychol. 26, 439–454. doi: 10.1037/0012-1649.26.3.439
Caravolas, M., Volin, J., and Hulme, C. (2005). Phoneme awareness is a
key component of alphabetic literacy skills in consistent and inconsistent
orthographies: evidence from Czech and English children. J. Exp. Child Psychol.
92, 107–139. doi: 10.1016/j.jecp.2005.04.003
Coltheart, M. (2005). “Modeling reading: the dual route approach,” in The Science
of Reading: a Handbook, eds M. J. Snowling and C. Hulme (Malden, MA:
Blackwell Publisher), 6–23.
Coltheart, V., and Leahy, J. (1992). Children’s and adults’ reading of non words:
Effects of regularity, and consistency. J. Exp. Psychol. Learn. Mem. Cogn. 18,
718–729. doi: 10.1037/0278-7393.18.4.718
Critchley, M., and Critchley, E. R. (1978). Dyslexia Defined. London: Heinemann.
Deuel, R. K. (1995). Developmental dysgraphia and motor skills disorders. J. Child
Neurol. 10, S6–S8. doi: 10.1177/08830738950100S103
Dunn, L. M., Dunn, L. M., Whetton, C., and Burley, J. (1997). British Picture
Vocabulary Scale, 2nd Edn. Windsor: NFER-Nelson.
Ehri, L. C. (1986). Sources of difficulty in learning to spell and read. Adv. Devel.
Behav. Pediat. 7, 121–195.
Elliott, C. D., Murray, D. J., and Pearson, L. S. (1978). British Ability Scales.
Windsor: National Foundation For Educational Research.
Ellis, A. W. (1993). Reading, Writing and Dyslexia: A Cognitive Analysis, 2nd Edn.
Hove: Lawrence Erlbaum Associates Ltd.
Fletcher-Flinn, C. M. (2014). Learning to read as the formation of a dynamic
system: evidence for dynamic stability in phonological recoding. Front. Psychol.
5:660. doi: 10.3389/fpsyg.2014.00660
Fletcher-Flinn, C. M., Shankweiler, D., and Frost, S. J. (2004). Coordination
of reading and spelling in early literacy development: an examination
of the discrepancy hypothesis. Read. Writ. 17, 617–644. doi:
10.1023/B:READ.0000044297.85675.f5
Fletcher-Flinn, C. M., and Thompson, G. B. (2000). Learning to read with
underdeveloped phonemic awareness but lexicalized recoding: a case study of a
three-year-old. Cognition 74, 177–208. doi: 10.1016/S0010-0277(99)00072-4
Fletcher-Flinn, C. M., and Thompson, G. B. (2004). A mechanism of implicit
lexicalized phonological recoding used concurrently with underdeveloped
explicit letter sound skills in both precocious and normal reading development.
Cognition 90, 303–335. doi: 10.1016/S0010-0277(03)00162-8
Fletcher-Flinn, C. M., and Thompson, G. B. (2007). Dissociation between deficits
in explicit procedures and implicit processes in the visual-spatial and the
phonological systems during reading acquisition. Cogn. Neuropsychol. 24, 471–
484. doi: 10.1080/02643290701423689
Flyvbjerg, B. (2006). Five misunderstandings about case-study research. Qual. Inq.
12, 219–245. doi: 10.1177/1077800405284363
Frith, U. (1980). “Unexpected spelling problems,” in Cognitive Processes in Spelling,
ed. U. Frith (London: Academic Press), 495–515.
Goulandris, N. K., and Snowling, M. (1991). Visual memory deficits: A plausible
cause of developmental dyslexia? Evidence from a single case study. Cogn.
Neuropsychol. 8, 127–154. doi: 10.1080/02643299108253369
Heriot, S., and Beale, I. (1996). New zealand norms for the visual sequential
memory test of the illinois test of psycholinguistic abilities–revised. New Zeal. J.
Psychol. 25, 1–7.
Hinshelwood, J. (1917). Congenital Word Blindness. London: HK Lewis.
Kirk, S. A., McCarthy, J. J., and Kirk, W. D. (1968). Illinois Test of Psycholinguistic
Abilities. Urbana, IL: University of Illinois Press.
Maul, B. D. K., and Ehri, L. C. (1991). “Memory for spellings in normal and
dysgraphic spellers,” in Written Language Disorders, ed. M. Joshi (Amsterdam:
Kluwer Academic Publishers), 25–42.
McKay, M. F., Fletcher-Flinn, C. M., and Thompson, G. B. (2004). New theory for
understanding reading and reading disability. Aust. J. Learn. Disabil. 9, 3–7. doi:
10.1080/19404150409546758
Miceli, G., Silveri, M. C., and Caramazza, A. (1985). Cognitive analysis of a case of
pure dysgraphia. Brain Lang. 25, 187–212. doi: 10.1016/0093-934X(85)90080-X
Miles, T. R. (1983). Dyslexia: the Pattern of Difficulties. Oxford: Blackwell.
Ministry of Education (2005). Assessment Tools for Teaching and Learning (e-
asTTle). Available at: http://e-asttle.tki.org.nz/
New Zealand Council for Educational Research (2010). Progressive Achievement
Tests: Listening Comprehension. Wellington, NZ: NZCER Press.
Nicolson, R. I., and Fawcett, A. J. (2011). Dyslexia, dysgraphia, procedural learning
and the cerebellum. Cortex 47, 117–127. doi: 10.1016/j.cortex.2009.08.016
Ouellette, G., and Tims, T. (2014). The write way to spell: printing vs. typing effects
on orthographic learning. Front. Psychol. 5:117. doi: 10.3389/fpsyg.2014.00117
Schonell, F. J. (1932). Schonell Spelling Test. Cheltenham. GB: Nelson Thornes
Ltd. Available at: http://www.academicedge.co.nz/download/schonell-spelling-
test.pdf?inline
Shankweiler, D., Lundquist, E., Dreyer, L. G., and Dickinson, C. C. (1996). Reading
and spelling difficulties in high school students: causes and consequences. Read.
Writ. 8, 267–294. doi: 10.1007/BF00420279
Snowling, M. J. (2013). Early identification and interventions for dyslexia: a
contemporary view. J. Res. Spec. Educ. Needs 13, 7–14. doi: 10.1111/j.1471-
3802.2012.01262.x
Temple, C. M. (1985). Developmental surface dysgraphia: a case report. Appl.
Psycholing. 6, 391–406. doi: 10.1017/S0142716400006329
Temple, C. M., and Marshall, J. C. (1983). A case study of developmental
phonological dyslexia. Br. J. Psychol. 74, 517–533. doi: 10.1111/j.2044-
8295.1983.tb01883.x
Thompson, G. B. (1993). “Reading instruction for the initial years in New Zealand
schools,” in Reading Acquisition Processes, eds G. B. Thompson, W. E. Tunmer,
and T. Nicholson (Clevedon: Multilingual Matters), 148–154.
Thompson, G. B. (1999). “The processes of learning to identify words,” in Learning
to Read: Beyond Phonics and Whole Language, eds G. B. Thompson and T.
Nicholson (New York, NY: Teachers College Press), 25–54.
Thompson, G. B., Connelly, V., Fletcher-Flinn, C. M., and Hodson, S. J. (2009).
The nature ofskilled adult reading varies with type of instruction in childhood.
Mem. Cogn. 37, 223–234. doi: 10.3758/MC.37.2.223
Frontiers in Psychology | www.frontiersin.org 9February 2016 | Volume 7 | Article 149

fpsyg-07-00149 February 20, 2016 Time: 18:28 # 10
Fletcher-Flinn Developmental Dysgraphia
Thompson, G. B., Cottrell, D. S., and Fletcher-Flinn, C. M. (1996). Sublexical
orthographic-phonological relations early in the acquisition of reading:
the knowledge sources account. J. Exp. Child Psychol. 62, 190–222. doi:
10.1006/jecp.1996.0028
Thompson, G. B., and Fletcher-Flinn, C. M. (1993). “A theory of knowledge sources
and procedures for reading acquisition,” in Reading Acquisition Processes, eds
G. B. Thompson, W. E. Tunmer, and T. Nicholson (Clevedon: Multilingual
Matters), 20–73.
Thompson, G. B., and Fletcher-Flinn, C. M. (2006). “Lexicalized implicit learning
in reading acquisition: the knowledge sources theory,” in Cognition and
Language: Perspectives from NewZealand, eds C. M. Fletcher-Flinn and G. M.
Haberman (BowenHills, QLD: Australian Academic Press), 141–156.
Upton, N. J., Hodgson, T. L., Plant, G. T., Wise, R. J. S., and Leff, A. P. (2003).
Bottom up and top down effects on reading saccades A case study. J. Neurol.
Neurosurg. Psychiatry 74, 1423–1428. doi: 10.1136/jnnp.74.10.1423
Wechsler, D. (1992). Wechsler Intelligence Scale for Children, 3rd Edn. Sydney:
Psychological Corporation.
Wilkinson, G. S., and Robertson, J. G. (2006). Wide Range Achievement Test 4.
Florida, FL: Psychological Assessment Resources, Inc.
Conflict of Interest Statement: The author declares that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
Copyright © 2016 Fletcher-Flinn. This is an open-access article distributed under the
terms of the Creative Commons Attribution License (CC BY). The use, distribution or
reproduction in other forums is permitted, provided the original author(s) or licensor
are credited and that the original publication in this journal is cited, in accordance
with accepted academic practice. No use, distribution or reproduction is permitted
which does not comply with these terms.
Frontiers in Psychology | www.frontiersin.org 10 February 2016 | Volume 7 | Article 149