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By about the 1920s, clinicians and researchers in the United States began to take an interest in the work of the Europeans who had been studying brain-behavior relationships and children and adults with learning difficulties. The U.S. researchers focused their efforts on language and reading disabilities and perceptual, perceptual-motor, and attention disabilities.

Language and Reading Disabilities

In the United States, there were several key figures from medicine, psychology, and education during this period who used the research of Hinshelwood and other Europeans as a springboard for their own work. Primary among these were Samuel Orton, Grace Fernald, Marion Monroe, and Samuel Kirk.

Samuel Orton. Samuel Orton was arguably the key figure in setting the stage for the study of reading disabilities in the United States. The primary professional society devoted to reading disabilities, the International Dyslexia Association, was originally named the Orton Dyslexia Society.

In January of 1925, Orton, then a neuropathologist at the State Psychopathic Hospital in Iowa City, set up a 2-week, mobile clinic in Greene County, Iowa. As a part of this “experiment,” local teachers were invited to refer students “who were considered defective or who were retarded or failing in their school work” (Orton, 1925, p. 582). Fourteen of the 88 students were referred primarily because they had great difficulty in learning to read. Orton highlighted the fact that many of these students scored in the near-average, average, or above-average range on the Stanford-Binet IQ test—one had an IQ of 122, four had IQs between 100 and 110, five had IQs between 90 and 100, one had an IQ of 85, and four had IQs between 70 and 80.

Hinshelwood had also noted that many of his cases of congenital word-blindness were intelligent, but with the advent of IQ tests Orton was able to lend a certain degree of objectivity to this notion. Furthermore, presaging later references to the Matthew effect, Orton speculated that the IQ score might not always reflect true intellectual ability in students with reading disabilities. In describing what he termed a typical case, a student with an IQ of 71, he stated: “I was strongly impressed with the feeling that this estimate did not do justice to the boy’s mental equipment, and that the low rating was to be explained by the fact that the test is inadequate to gage the equipment in a case of such a special disability” (Orton, 1925, p. 584).

After his seminal article in 1925, Orton continued to study children with reading disabilities over the next several years, with his work being summarized in his classic book, Reading, Writing, and Speech Problems in Children (Orton, 1937). Although he relied heavily on Hinshelwood’s prior work, Orton’s views differed from Hinshelwood’s in at least three important respects. First, Orton had a much more liberal view of the prevalence of reading disabilities. Whereas Hinshelwood had bristled at the notion that one per thousand of students in elementary schools might have “word-blindness,” Orton offered that “somewhat over 10 per cent of the total school population” (Orton, 1939, p. 59) had reading disabilities. He noted that Hinshelwood had argued for restricting the diagnosis of word-blindness to those cases in which there would be no question about whether there was pathology present. Orton argued, however, that Hinshelwood:

did not…offer any usable criterion as to how such a separation of the pathological cases could be made, and our experience in studying and retraining several hundred such cases over a period of years has convinced us that [they] cannot be so divided but rather that they form a graded series including all degrees of severity of handicap. (Orton, 1937, pp. 71–72)

Second, although they both thought reading disabilities were often inherited, Hinshelwood pointed to agenesis of the angular gyrus in the dominant hemisphere as the site of the problem. Although Orton considered the angular gyrus of the dominant hemisphere as “essential to maintaining a normal reading skill” (Orton, 1937, p. 39), he viewed reading as a complex activity that involved several areas of the brain. Rejecting the idea of defects in brain development, Orton focused instead on the inheritance of mixed cerebral dominance, or motor intergrading, as being behind many cases of reading disabilities.

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