Acquired Dyslexia in a Turkish-English Speaker Ilhan Raman Middlesex University, United Kingdom Brendan S. Weekes University of Sussex, United Kingdom The Turkish script is characterised by completely transparent bidirectional mappings between orthography and phonology. To date, there has been no reported evidence of acquired dyslexia in Turkish speakers leading to the nai've view that reading and writing problems in Turkish are probably rare. We examined the extent to which phonological impairment and orthographic transparency influence reading disorders in a native Turkish speaker. BRB is a bilingual Turkish-English speaker with deep dysphasia accompanied by acquired dyslexia in both languages. The main findings are an effect of imageability on reading in Turkish coincident with surface dyslexia in English and preserved nonword reading. BRB's acquired dyslexia suggests that damage to phonological representations might have a consequence for learning to read in Turkish. We argue that BRB's acquired dyslexia has a common locus in chronic underactivation of phonological representations in Turkish and English. Despite a common locus, reading problems manifest themselves differently according to properties of the script and the type of task. Key Words: Acquired dyslexia, orthographic transparency, phonological deficit, Turkish-English bilingual and biscriptal reader Annals of Dyslexia, Vol. 55, No.l, 2005 Copyright ©2005 by The International Dyslexia Association® ISSN 0736-9387 79 80 RAMAN AND WEEKES INTRODUCTION Research investigating the effects of orthographic transparency on reading and writing has flourished in recent years. However, the study of individuals with acquired reading and writing impairments has ignored the effects of orthographic transparency. This is regrettable since cognitive neuropsychological studies of patients with acquired dyslexia can reveal much about the functioning of the normal reading system as well as how impairments to the normal system can lead to developmental dyslexia (see Coltheart, Rastle, Perry, Langdon, & Ziegler, 2001 for a discussion). Current theories of reading do not commit to a view about effects of orthographic transparency on reading and writing impairments. However, in our view, case studies of acquired dyslexia can contribute to understanding patterns of developmental dyslexia seen in languages other than English. We know that problems processing the phonological properties of a word are a precursor to dyslexia in several languages (Goswami, 2003; Goswami, Ziegler, Dalton, & Schneider, 2003; Ramus, 2003; Snowling, 2000; Wagner & Torgesen, 1987; Ziegler, Perry, Ma-Wyatt, Ladner, & Shulte-K6rne, 2003). These problems include difficulties on verbal short-term memory tasks including n o n w o r d repetition and rapid naming, as well as meta-linguistic tasks such as phonological awareness and phonological recoding, leading to the phonological deficit hypothesis, which is now supported by numerous studies. A coherent account of dyslexia must explain how these phonological i m p a i r m e n t s lead to reading and writing problems across scripts, although clearly, the unique features of a script must constrain the phenotype of dyslexia that is observed in any given language (Yin & Weekes, 2003). There is an emerging view that phonological problems observed in children with reading and writing problems may be independent of language and hence type of script (Goswami, 2003; Goswami et al., 2003; Ziegler et al., 2003). Type of script can be characterised in terms of the predictability of the mappings between orthography and phonology (O->P). In English, O->P mappings are relatively unpredictable and thus can be called opaque. In other languages such as German, Greek, Italian, and Spanish, O->P mappings are relatively predictable and, therefore, transparent. English orthography is opaque as it is characterised by irregularity and inconsistency, and these variables are highly correlated (see Henderson, 1982 for a review; Venezky, 1970; Wijk, 1966, for an account of spelling-sound rules in English). ACQUIRED DYSLEXIA IN A TURKISH-ENGLISH SPEAKER 81 Word regularity refers to whether a word conforms to grapheme to phoneme rule knowledge, whereas consistency refers to whether subword units such as the rime can be pronounced in more than one way (e.g.,/ead/). Both regularity and consistency have an effect on reading in English although their relative importance is still being debated (see Cortese & Simpson, 2000). It is not clear how phonological impairments would manifest in a script such as Turkish in which O->P (and P->O) mappings are entirely predictable (Raman, 2003). One hypothesis is that phonological impairments lead to reading and writing problems in any language regardless of the predictability of the script. There is growing evidence to support this from studies of dyslexia in languages ranging from Chinese to Slovakian (see Smythe, Everatt, & Salter, 2004). A different hypothesis is that predictability--or more precisely grain size--of the script is critical to whether or not phonological impairments will manifest as reading and writing impairments (Wydell & Butterworth, 1999). Turkish was omitted from the Smythe et al. review of dyslexia across languages despite reports of dyslexia in transp a r e n t o r t h o g r a p h i e s (Finnish, Italian, P o r t u g u e s e , a n d Spanish). This must not be taken as support for the view that dyslexia is not present in Turkish speakers. Rather, we believe that reading and writing problems can be observed in Turkish if the critical features of the language are considered when tests for dyslexia are administered. M O D E L S OF R E A D I N G Orthographic transparency has a central role in models of oral reading in English (e.g., Coltheart, 1978; Coltheart, Curtis, Atkins, & Haller, 1993; Coltheart et al., 2001; Plaut, McClelland, Seidenberg, & Patterson, 1996) and also in German (Perry & Ziegler, 2000; Ziegler, Perry, & Coltheart, 2000). The dual-route computational (DRC) model assumes that independent pathways are used to convert print to sound for reading in English (see figure 1). One route is lexical (route A) where stored information about words is retrieved from the mental lexicon. Presentation of a word results in cascaded activation across feature, letter, and word levels, which spread to whole word nodes in the phonological output lexicon, and then to the phonemic buffer and speech. The other route is nonlexical (route D) where phonology is generated using grapheme to phoneme translation rules. This route translates print into a phonological code 82 RAMANAND WEEKES via the assembly of sublexical spelling-sound correspondences. O u t p u t activates the p h o n e m i c buffer and speech. Although lexical and nonlexical routes are assumed to operate simultaneously, they may not necessarily deliver output at the same time. This is because different factors influence their operation. For example, word frequency has an impact on route A but not on route D (e.g., Baluch & Besner, 1991; McCann & Besner, 1987), while n u m b e r of letters has an impact on route D but not on route A (Weekes, 1997). In the extended, three-route model (see Besner, 1999), an additional lexical-semantic route (route B-C) is a d d e d to accommodate the effects of rated w o r d imageability on r e a d i n g in English (e.g., Strain, Patterson, & Seidenberg, 1995). Rated imageability refers to the ease with which a word arouses an image (e.g., apple is a high imageability word and justice is a low imageability word). Imageability is correlated with word class (i.e., nouns are more imageable than verbs). Print o Speech Figure 1: Dual-route model of reading aloud, adapted from Besner (1999). ACQUIRED DYSLEXIA IN A TURKISH-ENGLISHSPEAKER 83 The DRC model can explain the effects of orthographic transparency (O->P) on reading whereby less predictable words are read more slowly than predictable words (be they irregular or inconsistent). This is because less predictable words generate c o m p e t i n g o u t p u t from the lexical and nonlexical routes whereas predictable words do not. Also, the DRC model can explain different effects of grain size on reading across orthographies (Ziegler, Perry, Jacobs, & Braun, 2001). However, to date, there has been little attempt to apply the DRC model to acquired disorders of reading in languages other than English. The DRC model can explain all of the acquired reading disorders reported in English. Phonological dyslexia is characterized by poor reading of nonwords and spared ability to read w o r d s (e.g., Beauvois & Derouesne, 1979; W a r r i n g t o n & Shallice, 1979). Phonological dyslexia is due to impairment in route D, which fails to generate phonology from novel print (Funnell, 1983) while route A is intact. Deep dyslexia is an acquired reading impairment that involves production of semantic errors and the inability to read nonwords. Patients with deep dyslexia are assumed to have multiple damage including the components of routes A and D, leading to reliance on reading via route B-C (though see Weekes, Coltheart, & Gordon, 1997; Coltheart, 2000 for a different view). In surface dyslexia, reading of irregular words (e.g., yacht) is poor and typically accompanied by regularization errors while reading of nonwords and regular words is preserved (Coltheart, Masterson, Byng, Prior, & Riddoch, 1983; M a r s h a l l & N e w c o m b e , 1973). Surface dyslexia results from reliance on route D because one or more parts of the lexical reading system is damaged. Surface dyslexia could result from damage to route A, including damage to the orthographic input lexicon or the phonological output lexicon or damage to route B-C, including the semantic system itself. A related idea is the summation hypothesis, which assumes that surface dyslexia is the product of output from a partially preserved semantic route and a partially preserved nonlexical route (Hillis & Caramazza, 1991, 1995). Surface dyslexia can result from damage at more than one locus according to figure I including direct access to the phonological output lexicon from orthographic input, the phonological input lexicon or semantics; impaired semantic system damage; and damage to the phonological output lexicon itself. Weekes and Coltheart (1996) reported patient NW who displayed surface dyslexia, which they showed was the result of damage located at or around the orthographic input lexicon. 84 RAMAN AND WEEKES Damage to the orthographic lexicon is seen on tests of homophone definition since precise orthographic knowledge is required to perform this type of task. Several other studies report that damage to the semantic system is associated with surface dyslexia (Breedin, Saffran, & Coslett 1994; Graham, Hodges, & Patterson, 1994; Patterson & Hodges, 1992; Patterson, Graham, & Hodges, 1994; Plaut et al., 1996) although some patients with semantic memory problems do not show surface dyslexia (Lambon-Ralph, Ellis, & Sage, 1998). Damage to the semantic system is revealed by poor performance on matching tasks such as word-picture matching tasks and synonym judgment tasks. Watt, Jokel, and Behrmann (1997) argued that damage to the mappings between semantics and phonological output (route C) leads to surface dyslexia although damage to route C does not n e c e s s a r i l y lead to surface dyslexia (see Weekes & Robinson, 1997). Deep dysphasic patients who show poor word and n o n w o r d repetition performance also display surface dyslexia in reading (Majerus, Lekeu, Van der Linden, & Salmon, 2001; Valdois, Carbonnel, David, Rousset, & Pellat, 1995). Thus damage to the phonological lexicon--as revealed by poor repetition in deep dysphasia--is also associated with surface dyslexia. Surface dyslexia has most often been reported in languages with opaque, nonalphabetic scripts such as Chinese (Law & Or, 2001; Weekes & Chen, 1999), and Japanese (Patterson, Suzuki, Wydell, & Sasanuma, 1995), but has also been reported in languages with transparent scripts including Dutch (Diesfeldt, 1992), Italian (Miceli & Caramazza, 1993), and Spanish (Cuetos & Labos, 2001; Iribarren, Jarema, & Lecours, 1999). There also are reports of parallels between the impaired lexical reading of brain damaged patients and developmental reading and writing disorders in Italian (Angelelli, Judica, Spinelli, Zoccolotti, & Luzzatti, 2004) and Spanish (see Weekes, 2005). Although Italian and Spanish have relatively predictable O->P mappings and are thus transparent, they are not completely transparent. It is, therefore, of interest to examine reading and writing impairments in languages in which phonology is entirely predictable from orthography. C H A R A C T E R I S T I C S OF T U R K I S H Turkish is an extreme case of a transparent orthography as it has completely predictable one-to-one mappings between orthography and phonology. Thus, regularity and consistency are ACQUIRED DYSLEXIA IN A TURKISH-ENGLISHSPEAKER 85 not relevant to reading in Turkish. Modern Turkish (Tfirkge) belongs to the Turkic languages cluster and is currently the official language of several nations (Turkey, Azarbaijan, Turkmenistan, Uzbekistan, and northern Cyprus). The modern Turkish orthography consists of 29 Roman letters (8 vowels and 21 consonants) and was designed to embody sounds in the spoken language in a totally transparent manner. Each letter in the alphabet directly corresponds to a single phoneme and each phoneme is represented by a single letter. Turkish is, therefore, characterised by total bidirectional transparency in reading (feed-forward) and spelling (feedback). In addition, a high number of vowels allows transparency. There are no silent letters in Turkish. Unlike Italian, stress is not required for monosyllabic and bisyllabic words; and unlike Spanish, stress is always assigned on the penultimate syllable of multisyllabic words. Hence, the salient aspect of Turkish is the computation of nonlexical phonology in an entirely reliable and context independent manner. It thus allows derivation of correct pronunciation from print without any lexical information and is learned with a minimal amount of training. A further remarkable linguistic property of Turkish is its morphology. Languages can be classified into one of three types: isolating or noninflective (e.g., Chinese), agglutinating (e.g., Turkish), and inflecting (e.g., English). The hallmark of ag= glutinative languages is multisyllabic words composed of linear sequences of morphemes. For example, from the root KAL (meaning stay), KAL-MI-YOR (meaning he or she is not staying), and KAL-MI-YOR-LAR (meaning they are not staying) are typical derivations by adding tense and person suffixes. Thus Turkish orthography is also predictable at the morpheme level with clearly defined syllable boundaries. We report the oral reading of a biscriptal (Turkish-English) patient (BRB) who has previously been diagnosed with deep dysphasia in Turkish (Raman & Weekes, 2003). Our motivation for testing BRB's oral reading was twofold. First, we wished to know if BRB's reading in English was surface dyslexic. We expected it was, given the evidence from other deep dysphasic patients showing that poor repetition is associated with surface dyslexia (Majerus et al., 2001; Valdois et al., 1995). Second, we wanted to know whether damage to lexical reading would have any impact on oral reading in a transparent script. This was motivated by our assumption that biscriptal reading relies on components in figure 1 that are shared for the two languages (see also Dijkstra & Van Heuven, 1998; Jared & Kroll, 2001). There have been no reports to date of acquired dyslexia in Turkish 86 RAMAN AND WEEKES speakers although according to figure 1, damage to a lexical reading system could result in acquired dyslexia in Turkish. CASE DESCRIPTION BRB is a right-handed male who was 67 years of age at the time of testing. Although he is a native speaker of Turkish, BRB's secondary and tertiary education was in English (conducted between the ages of 11 and 21). He is a retired senior civil servant from Cyprus where Turkish is a co-official language. BRB used both languages daily in his working life. Cyprus was a British colony until 1960 and civil servants were highly proficient bilinguals (Turkish-English or Greek-English) in speaking, reading, and writing prior to employment. BRB's premorbid IQ was estimated in the average range based on previous education and work history. BRB was hospitalized in 1999 following an acute CVA to the left parietal-occipital region. BRB's speech was severely reduced after the stroke and he presented with deep dysphasia (i.e., profound repetition impairment in both languages) (Raman & Weekes, 2003). BRB's repetition was severely impaired for words and nonwords, and he had marked shortterm auditory-verbal memory problems; for example, he displayed very poor performance on the Digit Span (repeating digits) in Turkish = 1 forward and 1 backward, and English = 1 forward and 1 backward. He produced circumlocutory errors on tests of confrontation naming. BRB's close relatives reported no premorbid difficulties with vision, hearing, or language. TESTS OF LANGUAGE IMPAIRMENT IN ENGLISH AND TURKISH We first assessed BRB's language problems in English using the Psycholinguistic Assessment of L a n g u a g e Processing and Aphasia (PALPA) battery (Kay, Lesser, & Coltheart, 1992). Test results are summarized in table I. BRB completed the written-word picture matching task and the spoken word picture matching test from PALPA with only two errors (no worse than controls), demonstrating that he could recognize objects and that he understood the meaning of printed and spoken words. BRB's auditory lexical decision with high frequency words was also perfect. His knowledge of written synonyms for high imageability words (e.g., start--beginning) was excellent but there was impairment with knowledge of some low imageability words (e.g., detection--discovery). ACQUIRED DYSLEXIA IN A TURKISH-ENGLISH SPEAKER 87 Table I. N u m b e r and percentage correct on PALPA tests for BRB. Task Number % correct Spoken word-picture matching Written word-picture matching Auditory lexical decision Written synonym judgement High imageability Low imageability Repetition English Turkish Speaking picture names English Turkish Writing picture names English Turkish 38/40 38/40 40/40 95 95 100 30/30 23/30 100 76 26/40 33/40 65 82 29/40 32/40 72 80 31/40 33/40 77 82 BRB's performance on the PALPA homophone definition task revealed that he could comprehend the meaning of print although he often produced the correct definition in Turkish. This is a feature of biscriptal reading reported in other case studies (e.g., Eng & Obler, 2002; Masterson, Coltheart, & Meara, 1985). Subsequent tests were conducted in English and Turkish (on separate occasions). Word and nonword repetition was poor in both languages suggesting damage to the phonological output lexicon. BRB's performance on the PALPA test of picture naming was poor in both English and Turkish (control subjects made no more than I error on this task) and he tended to make semantic intrusion errors (e.g., t h u m b ba~parmak as finger parmak) although phonological errors were also observed (e.g., rabbit--raffit). His writing of picture names was impaired in both languages. BRB's performance can be summarized with reference to figure 1. There is evidence that BRB is able to understand spoken words, suggesting the phonological input lexicon is intact; he can define printed homophones, suggesting the orthographic input lexicon is intact; and he knows word meanings, so the semantic system is intact. However, BRB is unable to repeat words and name pictures, suggesting damage to the phonological output lexicon or connections to this system (route C). Thus, 88 RAMAN AND WEEKES according to our reasoning above about deep dysphasic patients, BRB might show surface dyslexia in English. EXPERIMENTAL INVESTIGATIONS Our first hypothesis was that impaired access to the phonological output lexicon (route C) would result in surface dyslexia. If BRB's lexical reading system is impaired, then effects of predictability on reading should be observed but nonword reading should be intact (via route D). It is not possible to test for effects of predictability on reading in a transparent script (Coltheart, 1984). However, in order to test lexical reading in Turkish, we devised tests that we assumed involved at least some lexical knowledge. Our second hypothesis was that BRB's impairments might lead to an effect of imageability on reading in Turkish. We tested for effects of imageability on reading since it is universally assumed that imageability effects reflect reading via the lexical-semantic system (route B-C). We also tested for effects of word class (nouns versus verbs and verbal nouns) on reading since patients who produce semantic errors--and hence rely on lexical-semantic reading--show effects of word class on reading (Coltheart, 1980a, 1980b). Finally, we predicted that impaired lexical reading in Turkish would cause BRB to have difficulty translating Turkish print into English spoken words, a task we assumed is performed via lexical knowledge (cf., Jared & Kroll, 2001; Kroll & Stewart, 1994). TESTS OF READING We tested the first hypothesis by examining BRB's reading of 40 consistent and 40 inconsistent English words using items from Monaghan and Ellis (2002) matched for word frequency, length, neighborhood size, and age of acquisition (AoA), and reading of irregular words and nonwords taken from the PALPA battery. Results are summarized in table II. There was an effect of consistency on BRB's reading with consistent words read better than inconsistent words (note some items are abstract words such as death) t(39) = 9.2, p <.01]. Irregular words from the PALPA were read poorly and nonwords read perfectly. We tested the second hypothesis by examining BRB's reading of words rated high and low in imageability. We used four sets of experimental trials, 20 in each condition, matched on initial letter, number of syllables, and number of letters. Statistics for each set are reported in Appendix A. Note that low values ACQUIRED DYSLEXIA IN A TURKISH-ENGLISH SPEAKER 89 Table II. Number and percentage correct on tests of reading in English for BRB. Task Consistent words (written words with consistent OP mappings [e.g., drill]) Inconsistent words (written words with inconsistent OP mappings [e.g., dough]) Irregular words taken from PALPA Nonwords taken from PALPA Number % correct 31/40 77 19/40 47 17/40 40/40 42 100 indicate low frequency but are rated high imageability. Word imageability and word frequency norms were from Raman and Baluch (2001). The following are examples of four types of stimuli: high i m a g e a b i l i t y - h i g h f r e q u e n c y (YATAK bed); high imageability-low frequency (YOKU~ uphill); low imageability -high frequency (YEMIN vow); and low imageability-low frequency (YORUM interpretation). BRB was asked to read each word from the experimental list printed in Arial typeface, size 14. Stimuli and data are presented in table III. There was a reliable effect of Imageability X2 (1) = 3.8, p < 0.05. Errors were phoneme substitutions (e.g., in balkon balcony - 1 was substituted with r leading to barkon). BRB shows the classic dissociation of poor reading of unpredictable words with intact nonword reading that is the hallmark of surface dyslexia in English, and there is evidence that he is reading via the lexical-semantic reading pathway (route B-C) in Turkish. Thus, although the lexical reading pathway is used for reading in Turkish, he is surface dyslexic. TESTS OF W O R D C L A S S O N R E A D I N G Test results are summarized in table IV. We presented 34 nouns, 34 verbs, and 34 verbal (derived) nouns for oral reading in Turkish. Given the results from Experiment 2, stimuli were matched for rated word imageabili~. There was no significant effect of word class on performance (F<I). This suggests that morphological complexity has little impact on BRB's oral reading. READING TRANSLATION Our observation that BRB spontaneously defined irregular and inconsistent words in English (e.g., break, colonel, bear, heir, suite, prophet) from the PALPA by producing phonological out- High FrequencyHigh Imageability anne ate~ bardak bahqe ~i~ek dfinya g6z gfine~ insan kan karde~ kilit kitap mavi para sat sigara tava tarak yatak t=r Correct 19/20 (95%) High FrequencyLow Imageability artlk aylp bencil biqim n w ~6zfim duygu nw gizli gfi~ inat kaylt n w kibar lisan mantlk n w onur 6nlem sanat tarih tasa nw yalan nw yemin 14/20 (70%) Low FrequencyHigh Imageability ayran arpa balkon l=r baston ~ilek dfi~ne gaz gitar incir kaygan kukla kumar kfip maske pete saz sevin~ tepe tfirbe yoku~ 19/20 (95%) 14/20 (70%) Low FrequencyLow Imageability ablak ayar bellek buhran n w ~i~ir n w doyum g6~ g6nfil ilim kavram kislr Iasan menzil oru~ n w i~l~ek n w sfirgtin tekel nw t/ire n w yazgi yorum Nonwords ahf apuk ab aj aruy apran bikaf botkan banim berzik cava cuto ~iren ~ifre dopul deset eknez evsol s=z fIran fazur gep gaj gicar genzit hosu hesel inser ircin kof kenyip kitel kti~ meyu merki m=k pese pepi sef sfip teley tapul Correct 38/40 (95%) Table III. Number and percentage correct on tests of reading words and nonwords in Turkish for BRB in Experiment I (note errors are in bold; nw = nonword; phoneme substitutions are in bold and denoted). ACQUIRED DYSLEXIA IN A TURKISH-ENGLISH SPEAKER 97l Table IV. N u m b e r and percentage correct on tests of reading n o u n s , verbs and derived n o u n s for BRB in Turkish (Note errors are in bold). Nouns Verbs aday anne a~a~ ate~ ayakkabi ayna bah~e bahk balkon bardak bebek ~ocuk ~i~ek defter deniz doktor dfinya ekmek erkek gazete gece asmak a~mak akmak atmak aldatmak anmak bi~mek b61mek basmak bilmek bo~nak qarpmak ~izmek d/~vmek dolmak delmek do~mak ezmek e~mek gegmek gezmek gitmek giilmek ha~lamak inmek kirmak kazmak olmak parlamak satmak sermek tatrnak ta~mak yakmak 30/34 (88%) giysi gfine~ haber insan kitap karde~ okul para sabah sigara tarak toplum yatak Correct 33/34 (97%) Derived Nouns asma a~ma akma atma aldatma anma bi~me b61me basma bilme bo~na ~arpma ~izme d6vme dolma delme dogma ezme e~me geqme gezme gitme gfilme ha~lama inme kirma kazma olma parlama satma serme tatma ta~ma yakma 33/34 (97%) 92 RAMAN AND WEEKES put in Turkish, suggested that the lexical reading routes m a y be shared by the two languages supporting "visual translation" of print in one language to phonological output in another. It has been k n o w n for some time that biscriptal readers can produce o r a l r e a d i n g r e s p o n s e s in t h e n o n t a r g e t l a n g u a g e (e.g., Masterson et al., 1985). However, the results m a y apply to concrete nouns only. Therefore, we w a n t e d to k n o w if there was an effect of w o r d class on visual translation performance for BRB. Test results are s u m m a r i z e d in tables Va and Vb. We pres e n t e d the p r i n t e d w o r d s d e s c r i b e d in Section 2 (hence the w o r d s w e r e m a t c h e d for r a t e d i m a g e a b i l i t y a n d w o r d frequency), and asked BRB to read them aloud in English. He was better at t r a n s l a t i n g n o u n s (31/34, 91%) t h a n verbs (18/34, 53%), and could not translate verbal nouns at all (0/34, 0%). The most c o m m o n error was semantic (e.g., ate~ fire was translated to burn; tarak comb to brush; biqmek reap to harvest), suggesting that he translated p r i n t e d Turkish w o r d s via the lexicalsemantic reading route (route B-C). BRB's poor performance with verbal nouns is not due to imageability nor to phonological complexity as verbal nouns were often shorter than verbs. His performance could be either due to difficulties processing polysemous words, which have an effect on w o r d recognition (Hino & Lupker, 1996), or to a morphological effect as the morphological structure of verbal nouns in Turkish is quite complex. We favor the latter possibility as his performance was poor with nearly identical words (i.e., verbs and verbal nouns) that were, nevertheless, m o r e complex in morphology w h e n presented as derived forms. DISCUSSION BRB is the first reported case of acquired dyslexia in Turkish. Although BRB's reading of m a n y Turkish words was preserved, he was unable to read some low imageability w o r d s including words that were high in frequency. This pattern of reading impairment shows that dyslexia can be observed in a transparent o r t h o g r a p h y , M o r e v e r , BRB's p r e s e r v e d n o n w o r d r e a d i n g shows dyslexia in Turkish can be selective (i.e., the nonlexical route can remain intact if lexical reading becomes impaired). BRB's pattern of acquired dyslexia in Turkish is reminiscent of surface dyslexia in Italian and Spanish, which is attributed to loss of lexical k n o w l e d g e (e.g., Iribarren et al., 1999; Miceli & Caramazza, 1993). We believe that the effect of imageability on ACQUIRED DYSLEXIA IN A TURKISH-ENGLISH SPEAKER 93 T a b l e Va: N u m b e r a n d p e r c e n t a g e correct o n tests of t r a n s l a t i n g n o u n s a n d v e r b s for BRB f r o m T u r k i s h to E n g l i s h i n E x p e r i m e n t 3 ( N o t e errors are i n b o l d ; n w = n o n w o r d ; s e m = s e m a n t i c error a n d nr = n o r e s p o n s e ) . Nouns Visual Translation aday anne a~aq ate~ fire ayakkabi ayna bahqe bahk balkon bardak glass bebek ~ocuk qiqek defter excercise book deniz doktor diinya ekmek erkek gazete gece giysi giine~ haber news insan kitap karde~ okul para sabah morning sigara tarak comb toplum community yatak candidate mother tree burn sem shoe mirror garden fish balcony glass baby child flower copybook sea doctor globe bread male gazette night clothes sun new human book brother school money morning cigarette brush sem people bed 31/34 (91%) Verbs asmak aqmak akmak flow atmak aldatmak cheat anmak biqmek reap b61mek basmak bilmek bogrnak suffocate qarpmak qizmek draw d6vmek dolmak fill delmek pierce, drill dogmak born ezmek e~mek light digging geqmek gezmek stoll gitmek g~ilmek laugh ha~lamak boil inmek climb down klrmak break kazmak dig olmak parlamak shine satmak sell sermek spread tatmak ta~mak yakmak Visual Translation hang open current sere throw lie s e m remember harvest sem separate press know choke sem multiply line sem beat nr hole sem create s e m crush equal pass picnic sem go smile sem nr inside break d u g {past t e n s e ) be shine sale sem nr taste carry burn 18/34 (53%) 94 RAMAN AND WEEKES T a b l e V b : N u m b e r a n d p e r c e n t a g e correct o n t e s t s o f t r a n s l a t i n g d e r i v e d n o u n s for B R B f r o m T u r k i s h to E n g l i s h i n E x p e r i m e n t 3. ( N o t e errors are i n b o l d ; n w = n o n w o r d ; s e m = s e m a n t i c error a n d nr = n o r e s p o n s e ) . Derived Nouns Visual Translation a s m a vine, suspension grape sem a ~ m a opening open sem a k m a flowing current sem/spell. a t m a throwing Throw sem a l d a t m a adultery lie s e m a n m a memorial memory/remember blame reaping b61me division b a s m a printed cloth b i l m e knowing b o ~ ' n a suffocating ~ a r p m a multiplication ~izme drawing, boots d 6 v m e beating, tatoo d o l m a filling, dolmades d e l m e piercing d o ~ n a birth e z m e crushed food e~me digging g e q m e passage, passing g e z m e stoll g i t m e going g f i l m e laugh h a ~ l a m a boiled i n m e climbing down k l r m a pleat, breaking k a z m a digging, hoe o l m a being p a r l a m a shining s a t m a sale s e r m e , hanging on line t a t m a tasting ta~ma ovelflow y a k m a burning scorriah nw separate sem nr know sem choke sem multiply sem line sem beat sem nr nr nr crush sem equal phono pass sem picnic sere go sem smile sem inside nr break sem dug sem be sem shine sere buy sem nr taste sem carry sem burn sem 0 / 3 4 (0%) sem ACQUIRED DYSLEXIA IN A TURKISH-ENGLISHSPEAKER 95 BRB's reading in Turkish is the result of damage to the lexicalsemantic reading route (route B-C) in figure 1. The data from BRB make a contribution to understanding dyslexia in Turkish. BRB's dyslexia in Turkish was observed in the context of deep dysphasia. BRB's poor repetition and confrontation naming suggest damage to phonological representations. A correlation between poor repetition and lexical reading impairments has been reported for French speaking deep dysphasic patients (Majerus et al., 2001; Valdois et al., 1995). Raman and Weekes (2003) argued BRB's repetition and naming disorders were the result of abnormally rapid decay of activation in the phonological word form system as in the computational model of Martin, Saffran, and Dell (1996). BRB's results show that phonological damage is correlated with acquired dyslexia in Turkish. One inference is that the poor repetition observed in some children with dyslexia may also be observed in Turkish speakers. Also, repetition problems may be associated with poor reading of low imageability words in particular. We also noted that late acquired words tend to be less imageable when compared to early acquired words. The association between BRB's phonological impairments and his reading can be explained by the lexicalization hypothesis proposed by Newton and Barry (1997). They argued that imageability effects on reading result from "lexicalization," which describes how a semantic representation selects the appropriate word (lexeme) in the phonological output lexicon for production. Semantic representations drive word production according to concreteness, which is correlated with the rated imageability of a word. The normal lexicalization process is sensitive to imageability (i.e., high imageable, concrete concepts are easier to lexicalize than low imageability, abstract concepts). Concrete concepts have a high degree of specificity in lexicalization so that high imageability printed words activate only a few related concepts. Therefore, high imageabitity words will easily and uniquely access their corresponding lexemes. The semantic representations of abstract concepts have less specificity and there is more spreading activation to related concepts. Therefore, it will be more difficult to access the corresponding lexeme. According to Newton and Barry (1997), these processes would not necessarily be revealed in skilled reading. However, an effect of imageability may be revealed after brain damage and in reading under speeded naming conditions (Strain et al., 1995). Our interpretation of imageability effects on BRB's oral reading is controversial. An effect of imageability is typically 96 RAMAN AND WEEK,S thought to reflect a semantic deficit for abstract words and to be a signature of deep dyslexia. BRB has no semantic deficit that we could detect and he does not exhibit deep dyslexia (he reads n o n w o r d s well). We believe that an effect of imageability on oral reading in Turkish can be observed without a semantic impairment if route C alone is d a m a g e d or phonological activation is poor. Note that Watt et al. (1997) offered a similar account of poor reading of abstract, irregular words in surface dyslexia in English. BRB is the first reported case of a biscriptal reader with acquired reading impairments in English and Turkish. The data f r o m BRB m a k e a c o n t r i b u t i o n to u n d e r s t a n d i n g a c q u i r e d dyslexia in biscriptal readers. We assumed that the same archit e c t u r e is a v a i l a b l e for oral r e a d i n g T u r k i s h a n d English. However, the lexical route (route A) is not necessary for reading in Turkish. We also assume one potential locus for BRB's surface dyslexia is the lexical-semantic reading route (route B-C). Thus, a d a m a g e d lexical-semantic reading route m a y be sufficient to explain BRB's surface dyslexia in English as well as impaired reading in Turkish. This w o u l d be the most parsimonious account since a c o m m o n locus of d a m a g e can lead to surface dyslexia and imageability effects in Turkish. This m a y be a consequence of abnormally rapid decay of lexemes in the phonological output lexicon. If our view is correct, it should be possible to find a biscriptal Turkish-English speaker w h o has d e e p dyslexia in Turkish but retains the ability to read irregular words in English. This point illustrates the value of cognitive neuropsychological studies of patients with acquired dyslexia as novel predictions can be generated on the basis of each n e w patient. It is p o s s i b l e , h o w e v e r , t h a t BRB's s u r f a c e d y s l e x i a in English results from damage to the lexical route alone. Indeed, according to Coltheart et al. (2001), surface dyslexia is independent of d a m a g e to the semantic system. Damage to the lexical r e a d i n g r o u t e is best m e a s u r e d w i t h tests of o r t h o g r a p h i c knowledge. This part of our assessment of BRB was weak. We found some evidence of orthographic d a m a g e on a h o m o p h o n e definition task though he did produce correct spoken words (in Turkish). W h a t the results do s h o w is that semantic support from reading via the lexical-semantic p a t h w a y is not sufficient to support reading of unpredictable words in English, at least in a biscriptal reader. Thus, we w o u l d not exclude the possibility that BRB's surface dyslexia results from d a m a g e to the lexical route alone, nor w o u l d we d e n y the need for a lexical route to read in English. ACQUIREDDYSLEXIA IN A TURKISH-ENGUSH SPEAKER 97 The extent to which models of reading can be applied to reading in other writing systems is now debated (Beland & Mimouni, 2001; Eng & Obler, 2002; Perry & Ziegler, 2000; Yin & Weekes, 2003; Ziegler et al., 2001). The strength of any model depends on its ability to explain a range of phenomena including biscriptal reading. This is important for theoretical as well as practical reasons (e.g., the design of specialized tests of reading and writing problems in biscriptal readers and the rehabilitation of reading impairments). Reading in scripts that have an unpredictable orthography such as English encourages the development of a lexical route. However, reading in transparent scripts such as Turkish may not require the development of such a route. The key evidence for a lexical route in English comes from patients who can read irregular words but who cannot access their meaning (e.g., Franklin, Turner, LambonRalph, & Morris, 1996; Lambon-Ralph, Ellis, & Sage, 1998; Schwartz, Marin, & Saffran, 1979; Shallice, Warrington, & McCarthy, 1983). It is impossible to find this type of patient in Turkish. However, it may be possible to find a patient who reads Turkish words but does not know their meaning. If the same patient cannot read nonwords, this would be evidence for a lexical route in Turkish. Thus, the need for separate lexical and lexical-semantic routes for reading in Turkish is moot. This issue was discussed in relation to developing strategies in attentional control in reading Turkish, and regular versus irregular orthographies (Raman, Baluch, & Besner, 2004). Yin and Weekes (2003) made a similar case to ours about oral reading in Chinese, which is a relatively opaque script. The claim made by them was the converse of the one made here (i.e., reading cannot be nonlexical in Chinese because each of the components of a character is lexical and thus a nonlexical route [route D] is unnecessary) (see also Coltheart, 1984). Note that the question of whether a lexical route (route A) is necessary for reading in English is still a matter for debate (cf., Hillis & Caramazza, 1991, 1995). What is the relevance of BRB's data to understanding the impact of type of script on dyslexia? We know already that culture has an effect on reading disability. Paulesu and colleagues (2001) found that Italian dyslexics read more accurately than English and French dyslexics, although all groups read slowly and had phonological impairments, suggesting that orthographic transparency has an effect on the p h e n o t y p e of dyslexia in different languages. In a study of Chinese dyslexia, Siok, Perfetti, Jin, and Tan (2004) found that script affects the 98 RAMAN AND WEEKES neurobiological abnormality leading to impaired reading. BRB shows that dyslexia is possible in a completely transparent orthography~ This is of interest because it seems counterintuitive (i.e., literate speakers learn such scripts quickly). We also found evidence of morphological constraints on translation, suggesting that damage to the lexical reading system may manifest itself differently according to the morphological complexity of the language. Morphological effects may be restricted to translation tasks resulting from weak lexicalization of the lexemes in a second language for morphologically dense words. However, it may be fruitful to examine morphological effects on dyslexia in Turkish. Children with dyslexia are known to have more difficulties writing the regular (-ed) than the irregular past tense of verbs in English (Egan & Pring, 2004; Leong & Parkinson, 1995). Turkish is a highly inflected language with many morphologically complex words that do not have a single, addressable lexeme, but are assembled on the basis of inflections (Durguno~u, 2002). Given that we found a link between phonological impairment and dyslexia, one suggestion for future research is to investigate morphological processing in c h i l d r e n and adults w i t h r e a d i n g and writing difficulties. This phenomenon also could be explored in other cases of acquired reading and writing impairments in Turkish. CONCLUSION BRB's data suggest that lexical reading problems in Turkish follow phonological impairments. Thus the naive view that developmental dyslexia does not exist in Turkish can be rejected. 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Final version accepted January 31, 2005. 1.51 Mean = 1.77 SD = .51 SD = .38 1.96 3.04 2.20 1.32 1.32 1.62 1.52 2.58 1.54 1.28 1.32 1.64 1.54 1.72 1.26 2.26 1.76 1.92 2.04 1.92 1.42 2.25 1.35 1.54 2.60 Mean = 1.67 bed yatak 2.49 cigarette sigara frying pan hair sa~ comb money para tava blue mavi tarak 1.68 book kitap 2.35 1.44 1.56 1.33 1.38 1.50 lock giine~ brother sun g6z 1.29 kilit eye diinya 1.44 karde~ earth ~i~ek 1.70 human flower bah~e 1.88 blood garden bardak 1.12 1.48 kan glass ate~ insan mother fire anne yoku~ tiirbe tepe sevin~ saz pete maske k6p kumar kukla kaygan incir gitar gaz dLi~ne ~ilek baston balkon arpa ayran uphill monument hill joy musical inst. veil mask water butt gamble puppet slippery fig guitar gas button strawberry walking stick balcony barley yoghurt drink SD = .39 Mean = 2.04 1.80 2.44 2.38 1.78 2.22 2.46 1.50 1.47 2.14 2.34 2.56 2.00 1.24 1.98 2.35 2.40 1.60 2.00 1.70 2.46 SD = .68 Mean = 4.09 3.80 4.76 3.04 2.60 4.30 5.44 4.22 4.06 3.64 4.38 3.53 4.22 3.76 3.99 3.84 3.90 4.56 3.74 5.28 4.84 Imageability and frequency norms of the Turkish words used in Experiment 1, and their corresponding translations in English. Translation Translation HFHI in English Imageability Frequency LFHI in English Imageability Frequency APPENDIX A pr~ pr~ pr~ ¢3 Vr~ ¢3 K3 5.77 selfish shape solution emotion secret power/difficult 4.98 5.14 shame stubborn register polite language logic honor prevention art history anxiety lie vow ayip bencil bi~im ~6ziim duygu gizli giiq inat kayit kibar lisan mantik onur 6nlem sanat tarih tasa yalan yemin 2.20 Mean = 2.23 SD = .40 5.21 SD = .48 2.04 1.90 2.14 2.22 1.76 2.53 1.88 2.79 2.22 2.88 1.96 2.02 2.12 1.60 2.14 3.16 2.60 1.89 2.56 Frequency Mean = 5.09 5.20 5.94 4.58 5.88 5.13 4.93 5.06 4.19 5.24 5.40 5.71 5.00 4.37 4.60 4.90 4.74 leftover artik Imageability Translation in English HFLI yorum yazgi t6re tekel sfirgfin 61qek oru~ menzil lasan klsir kavram ilim g6nfil g6~ doyum ~t~ir buhran bellek ayar LFLI ablak interpretation destiny custom monopoly exile scale fasting firing range seedling infertile concept science heart/mind migration content era depression memory timing dull person Translation in English SD = .64 Mean = 4.53 4.78 6.42 4.31 5.09 4.52 4.32 4.84 4.72 3.90 4.95 3.98 4.16 4.35 4.92 4.44 3.20 3.70 4.59 4.73 4.78 3.87 4.65 3.94 4.10 4.49 3.92 3.64 5.04 6.23 4.30 4.32 3.63 3.50 2.03 3.90 5.00 5.51 4.29 3.50 6.29 Frequency SD = .98 Mean = 4.31 Imageability