Crossed Laterality

Arch Dis Child: first published as 10.1136/adc.28.140.247 on 1 August 1953. Downloaded from CROSSED LATERALITY A STUDY IN ITS SIGNIFICANCE AND TREATMElWNT IN ORDINARY SCHOOL LIFE BY ROBERT A. H. PEARCE From the China Inland Mission School, Kuling (RECEIVED FOR PUBLICATION JANUARY 20, 1953) All paired muscle systems are represented in the The work here recorded was planned to discover: brain by paired controlling centres. Dominance, or (1) Symptoms arising because of crossed laterality: leading control of the function, may be entirely left- (2) the effect of these symptoms on education; sided, in which case the organs controlled are (3) the mechanism whereby these symptoms are pro- dominant on the right side, or entirely right-sided. duced; (4) why some cases of crossed laterality were If some centres are on the left and some on the right asymptomatic; and (5) effective means whereby the side of the brain, the condition is called crossed handicap of crossed laterality might be overcome. laterality. Protected by copyright. The dominance may be fixed, and diagnostic The Symptoms methods give no variation in results. In some Reversal of units in a series was the most promi- children there is less fixity, one or the opposite nent and basic phenomenon observed. This was centre taking control according to whim or circum- found in any of the 'three R's' at any age. The child stance. was never conscious of the error until it had been These investigations were provoked by the obser- made. The symptoms to be described are not vation of educational problems arising in a school observed on every possible occasion. In different of 150 to 200 children of both sexes between the children they are present with varying frequency and ages of 6 and 16. The observations and investigations persistence, depending upon the nature and the were carried on over a period of four years. The fixity of the irregularity, and upon what com- examiner knew all the children intimately, and lived pensations the child has developed. Other factors among them continually. Thorough physical ex- which influence the appearance of symptoms are aminations were made at intervals of approximately emotional tension at the time of examination; the http://adc.bmj.com/ nine months. Intelligence was measured and re- type of teaching which the child has experienced, measured, using Terman and Merrill's tests, and and the associated mental stress; the intelligence; Raven's progressive matrices. The teaching staff of and the speed with which puberty is being attained. the school used to meet regularly and frequently No child will show all the symptoms observed, but for discussion of the progress, educational problems each type of 'crossing' is associated with certain and conduct of each child. In the capacity of School sets of symptoms. These symptoms do not occur Medical Officer I attended all such meetings. There in children without irregular dominance. Any child on September 29, 2021 by guest. were unrestricted opportunities for investigation of may make a mistake, and in the course of ordinary these problems. probability any particular mistake may be made. During the work report meetings it was noticed Those children who have these forms of irregular that some 40 % of the children, at one time or dominance show these symptoms frequently and another, presented some difficulty or failure in persistently. Further, they find difficulty in learning educational attainment. A further search revealed to correct the mistakes, for the error occurs uncon- that 70°' of these children had some type of crossed sciously. laterality. Viewed from another aspect it was known It is not at all uncommon for children who are that 4700 of the children in the school had crossed just learning to write to reverse letters, as b for d, laterality, and of these 8500 were in the group who or vice versa. Normal children learn the correct experienced difficulties in school work. form quickly and without difficulty. Children with 247 is 248 ARCHIVES OF DISEASE IN CHILDHOOD Arch Dis Child: first published as 10.1136/adc.28.140.247 on 1 August 1953. Downloaded from irregular dominance are slow to make the correction, upset commonly seen to follow the symptoms of not readily appreciating the error. They have a irregular dominance. marked tendency to repeat the error unconsciously. Children having complete left dominance show In older children the error may appear so that they some of these symptoms, but with characteristic seem to make careless mistakes in compositions and differences. Reversal mistakes in reading occur, but arithmetic. One can look upon a letter or figure as a not in listening. Some prefer to write along lines diagram. More complicated diagrams have been that are oblique to the body. The use of the writing prepared, and reversal of units of these may left hand above the line of script is only a means by frequently be found when these are reproduced by which what has been written may be seen, the hand children with irregular dominance. For example, not then obstructing the view. Not all children using this diagram (from Terman and Merrill's tests the left hand are completely left-handed; some have Form L 9 years) copied from visual memory may be crossed laterality, and show the symptoms noted reproduced with the corner units reversed thus: above. Attempts to force the child to use dominantly a function which is not naturally dominant will cause symptoms to arise from the induced crossing, and also certain other evidences of cerebral turmoil. -_1 - F EF Symptoms arising thus are minimal when the crossing is not fixed, and when intelligence is high. The When reading, reversal of the letters of a word most widely known symptom resulting from may make something unpronounceable and mean- attempts to change dominance is deranged speech. ingless, or occasionally a word that does not fit the This can vary from complete aphasia to varying sense. In the former instance, reading will be slow, degrees of stammering. Other signs of nervous upset and the child appears to stumble at small words. are also seen-not in themselves pathognomonic- Protected by copyright. In the latter case the wrong word is read, delaying such as enuresis and encopresis. the perception of content, or if read aloud, the child The emotional upsets that develop because of is embarrassed and appears to others to be stupid. these symptoms are not isolated events but grow as As an example, the child reading 'He saw a plum' the errors recur. The form which they take will may perceive and read 'He was a plum'. A similar depend upon factors such as age, development, fault is found in arithmetic, for the child reads or speed of growth and intelligence. The following copies the figures of a problem in reverse, as 54 for 45 story is typical: The little child learning to write has or 729 for 792. a very poor hand, and the teacher finds that efforts Perception by hearing leads to reversal symptoms to bring improvement meet with little success. less frequently than if perception is by vision, for Mistakes in reading recur so persistently that the the opportunity is less. I have known it to occur teacher naturally begins to suspect that the child's when a child looks for a hymn that has been mental capacity is not equal to the appointed tasks. announced during a service of worship if he cannot Should he read silently, the content is gained too http://adc.bmj.com/ see the hymn board. slowly: should he read aloud, errors are made over It is characteristic of children learning to write, small words, and he becomes a source of merriment who have crossed dominance of eye and hand, that to his fellows. In arithmetic the persistent mistakes if the accepted normal standards of writing- are labelled 'careless'. In consequence we find the position of person or paper and pencil-are rigidly child is frequently embarrassed in his class, and enforced, the resulting script is poor. If the children begins to echo his teacher's suspicion that he is are left alone to write as they please the script may mentally slow. He says, 'The harder I work, the on September 29, 2021 by guest. still be poor, but they will twist the paper or the worse I do.' It is easy, even reasonable, to cease to head. The children do not know why they do this, try hard and to drop into lazy habits. These children but all affirm that it is easier for them to write in are difficult and often exasperating. No child of high this 'awkward way', and a diagnosis of 'poor intelligence fails without suffering, for he is conscious muscular control' is frequent. of ability and rebels against the suggestion that he Children who use a left foot dominantly show no is 'dumb'. He either becomes lazy and difficult or closely related symptom, but may provoke a laugh embarrassingly nervous, failing to keep pace with from their fellows who consider the foot work others, in spite of what appears to be tremendous strange and awkward. But if the ability to kick well effort. with a left foot wins for such a child acceptance as How deeply this emotional trauma affects the having a special ability, he will avoid the emotional child depends upon inherited physical factors and Arch Dis Child: first published as 10.1136/adc.28.140.247 on 1 August 1953. Downloaded from CROSSED LATERALITY 249 upon intellectual capacity as well as upon the object of the test. It is a good plan, therefore, to environment.

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