Developmental Reading Disorders in Japan— Prevalence, Proﬁles, and Possible Mechanisms

Home , He (kana), Ka (kana)

Top Lang Disorders Vol. 34, No. 2, pp. 121–132 Copyright c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Developmental Reading Disorders in Japan— Prevalence, Proﬁles, and Possible Mechanisms

Yumiko Tanaka Welty, Lise Menn, and Noriko Oishi

Japan has been considered dyslexia-free because of the nature of the orthography, which con- sists of the visually simple kana syllabary and some thousands of visually complex, logographic kanji characters. It is true that few children struggle with learning kana, which provide consistent mappings between symbols and their pronunciation. Indeed, most children can read most of the kana by age 6. However, many Japanese children struggle with reading the kanji, which represent most of the content words in a text; in addition to their visual complexity and impoverished or nonexistent phonological information, kanji are difficult because they typically have several pronunciations and multiple meanings, depending on the context. Because kanji must be learned semantically rather than phonologically, many people believe that Japanese dyslexia is due to visuospatial rather than phonological processing impairments. We sketch the complex psycholinguistic demands of retrieving the correct pronunciations for kanji, especially in kanji compound words. Some individuals have extreme difficulty in learning the correspondences between these symbols and their sounds; whether these difficulties are visual, phonological, or both is an urgent topic for further research. After introducing Japanese orthography, we present 2 case studies. The first is a profile of a boy we observed from ages 7 to 20 years with difficulties in learning both kana and kanji. The second is a case study of using an interactive reading intervention for a fifth- grade boy with dyslexia. This program was designed to reduce decoding and fluency problems by teaching the meanings and pronunciations in phrasal context rather than in vocabulary lists. We propose that some of the dyslexias in Japanese may not be the same as any type of dyslexia that has been reported for learners of alphabetic writing systems. In addition, we emphasize the need for SLPs in Japan to establish new policies that support collaborative relationships with teachers and other professionals so that they can work in schools to identify and help children with spoken and written language problems. Key words: dyslexia, interactive reading intervention, Japanese orthography, phonological awareness

HIS STUDY surveys the research on the ing system seems to foster some difficulties T incidence and nature of reading disorders that have not yet been described for alpha- and dyslexia in Japan. Japanese reading dis- betic writing systems. Similar problems may orders may be interesting to an international exist, however, and even may be prevalent, audience because the complex Japanese writ- outside of Japanese if researchers start to look for them. We define dyslexia as problems with decoding written text. We note that the Author Affiliations: Osaka University of Arts, Japan (Dr Tanaka Welty); University of Colorado, broad category of “reading disorders” in- Boulder (Dr Menn); and Tama-Hokubu Medical cludes dyslexia, as well as other difficulties in Center, Japan (Dr Oishi). comprehending written materials, such as dif- The authors have indicated that they have no financial ficulty accessing the mental lexicon and other and no nonfinancial relationships to disclose. problems in getting meaning from text. Read- Corresponding Author: Yumiko Tanaka Welty, PhD, Osaka University of Arts, 4-1-103-1206 Oji-cyo Abeno- ing disorders, in turn, may be considered a ku, Osaka, Japan 545-0023 ([email protected]). subtype of language disorder, and they often DOI: 10.1097/TLD.0000000000000014 co-occur with other language problems. 121

On the basis of the report of Makita (1968), vantage held by children in Japan decreased Japan was considered free of reading disor- as the number of required kanji increased. By ders, including dyslexia, until the work of the fifth grade, children in America performed Stevenson, Stigler, William Lucker, and Lee just as well as the children in Japan and China. (1982). Makita had reported the prevalence Stevenson et al. concluded that their findings of dyslexia as only 0.98%, which was 10 times offered no support for the claim that dyslexia lower than that in Western countries. This and RD are absent among children in Japan. was based on a questionnaire asking Japanese Large-scale studies of children between first teachers to estimate the number of children and sixth grades that used standardized tests with difficulty reading in their classes. Makita (Shiba & Ishida, 2012; Uno, Wydell, Haruhara, attributed this extremely low rate of dyslexia Kaneko, & Shinya, 2009) reported that the in- to the ease of learning the Japanese orthogra- cidence of dyslexia was 1% based on kana phy by using the kana syllabary, which pro- decoding, but about 3%–7% based on kanji. vides consistent mappings between symbols As Haynes et al. (2000) pointed out after ask- and their pronunciation. For example, is ing classroom teachers for their estimates of always /ka/ and is always /ma/. The kana dyslexia prevalence, it is likely that the preva- syllabary should be easier to learn than the al- lence of RD was affected by the measurement. phabetic system of English, not only because That is, researchers who measured Japanese it is (almost completely) consistent, but also children’s reading skills directly (Hirose & because the name of each kana is the same as Hatta, 1988; Yamada & Banks, 1994) found the sound it represents. In addition, the unit a higher percentage (6%–7%) than the preva- size is probably easier for children to grasp. lence based on the teachers’ reports. That is, the unit is always a consonant-vowel It now appears that there are a few children sequence or a vowel (with the exception of with dyslexia/RD in each classroom and that three “special kana,” including syllable-final the difficulties appear in kanji rather than kana n). Although the kana system is called a syl- learning, but there is disagreement about the labary, the unit of representation is properly mechanisms that might underlie such difficul- called a mora, because some Japanese sylla- ties. Because kanji are more complex in shape bles, like ka+iorda+n, contain two moras than kana, it has been claimed that dyslexia and are written with two kana. is due to visuospatial rather than phonologi- On the contrary, the Japanese orthography cal processing impairments (Uno et al., 2009; contains thousands of kanji. These are non- Wydell & Butterworth, 1999). A related claim phonetic, logographic characters that have is that children who struggle mainly with several pronunciations, which must be memo- kanji may be referred to as having “visual rized and sometimes represent multiple mean- dyslexia” or “decreased visual processing abil- ings depending on whether they are used ities” (Morinaga, Konno, Akimoto, Ogata, & alone or in compound words (see below for Yoda, 1998). fuller explanation). Kanji are introduced grad- On the contrary, phonological involvement ually and start to be used heavily around has been suggested in Japanese reading (see fourth grade. Amano, 1989, for a review; Hara, 1998; Stevenson et al. (1982) compared read- Kobayashi, Haynes, Hook, & Kato, 2005; ing achievement of first- through fifth-grade Oishi, 1998). Mann (1986) examined relation- children in Chinese, Japanese, and English ships between phonological analysis and read- by assessing vocabulary, reading of text, and ing ability of kana among Japanese children comprehension. They found that many chil- and found that mora and phoneme counting dren struggle with reading kanji. Like Makita ability significantly predicted speed and er- (1968), they found that first-grade children in rors in oral reading of kana words. Japanese Japan were better at reading text than first- children with RD typically display decreased grade children in America. However, the ad- phonological awareness (PA) skills (Kato,

Oishi, Hara, & Kuru, 1998; Morinaga et al., section. Thus, there are several possible symp- 1998; Oishi, 1998). Poor skills in phonologi- tomatologies for dyslexia in Japanese, and cal analysis also have been found using kanji- detailed examination of a number of indi- compound reading tasks in children with vidual cases is needed to understand them. dyslexia in fourth to sixth grades (Shiba & This study attempts to describe what dyslexia Ishida, 2012). The high psycholinguistic de- looks like in a case study of one Japanese child, mands involved in reading kanji compounds and then reports a clinical trial of a reading in- will become apparent in the “How Japanese tervention to further delineate the nature of Orthography Evolved: History and Impact” Japanese dyslexia/RD. section given later. Another explanation for poor reading was JAPANESE ORTHOGRAPHY suggested by Tanaka Welty, Hyodo, Oishi, Wise, and Snyder (2006), who studied PA, decoding skills, and reading comprehension How Japanese orthography evolved: of five Japanese children with RD between History and impact first and fifth grades. They found that all To understand reading difficulties in any five children had low scores on PA, and that language, one must understand its writing sys- the older children had significant problems tem. Japanese has a particularly complex writ- with reading comprehension rather than de- ing system because of the influence of the coding. On the basis of the simple view of Chinese language and its writing system on reading (Gough & Tunmer, 1986), Bishop the Japanese language and writing system. and Snowling (2004) suggested that there The magnitude of this influence is compa- are at least two types of reading disorder: rable with that of Latin, Greek, and French (1) dyslexia, a specific difficulty with decod- on Anglo-Saxon English. However, it created ing print caused by the phonological pos- even more complexity in the writing sys- sessing deficits, and (2) reading comprehen- tem than the contact of English with other sion impairment, a specific difficulty with languages, because the Chinese writing sys- text comprehension, caused by a wide range tem is word-based rather than phonetically of language-processing difficulties. Tanaka based. Some Chinese characters are simple, Welty et al. hypothesized that relatively few like “mountain,” but about more than 80%, children have kana decoding difficulty, but like “ocean,” are complex. That is, they that many children have reading comprehen- are composed of two to four or so parts, sion problems due to general language prob- called radicals. One part is usually a pho- lems. This may reflect the “Matthew effect” netic radical, which is a simple character on poor reading of kanji (Stanovich, 1986). that sounds roughly like the complex one of This refers to the possibility that those who whichitisapart.Theothersaresemantic have general language difficulties understand radicals. That is, they are components that, less of what they read, learn fewer words and when used alone, denote a word with some concepts from their reading, and fall even fur- semantic relation to the meaning of the com- ther behind typically developing readers in plex one. For example, the semantic radical their language abilities as they age. Similarly, in ocean means water and the semantic rad- those who have kanji-reading difficulties un- ical in bridge means tree. Semantic radicals derstand less, learn less, and also fall behind are rarely iconic, so “neither the semantic nor their peers. the phonetic components . . . provide an ex- To summarize, there are multiple possible act indication of meaning or sound, but only explanations for dyslexia and reading difficul- give a vague approximation” (Mair 1996). In ties in Japanese, perhaps more than in other other words, both meaning and sound must languages, because the Japanese writing sys- be memorized; the character gives mnemonic temissocomplex,asweexplaininthenext hints, at best.

More complexity was created by the fact The only easy part of this adaptation was us- that Japanese and Chinese are unrelated lan- ing Chinese characters to represent the words guages that differ in virtually every linguistic borrowed from Chinese. Chinese characters aspect. At the phonological level, Japanese also were used to represent Japanese words has fewer vowels and consonants than Chi- that had direct equivalents in Chinese (e.g., nese and has a pitch-accent system, whereas woman, sun, mountain). But when these Chinese is a tone language. Also, Japanese were used to represent Japanese words, of morphemes can be quite long. In fact, words course they were pronounced entirely differ- consisting of a single three-syllable morpheme ently; for example, mountain is/ʃan/in Chi- are common, whereas each Chinese mor- nese, but /jama/ (yama) in Japanese. The pro- pheme is exactly one syllable. nunciation hints contained in the phonetic Japanese morphology (word-formation) radicals of some of the characters were thus of and grammar are also very different from Chi- no use for recalling these native Japanese pro- nese. Chinese has no inflectional endings; for nunciations. Furthermore, no Chinese char- example, Chinese uses independent words acters correspond to the word endings essen- to indicate verb tense when necessary and tial to Japanese, because Chinese has no such makes new words by compounding existing endings, or to the Japanese case-marking parti- ones. Most modern Chinese words are two- cles, which are not present in Chinese (Smith, morpheme compounds (cf. English “book- 1996). case,” “football,” “(to) babysit”). Japanese Eventually, some Chinese characters were uses compounding, too, but in addition, it adapted to represent the sounds of these has morphological word endings that are grammatical morphemes, and of many other used to indicate verb tenses, to make nega- words that had no Chinese equivalents. tive forms, to convert adjectives into corre- Greatly simplified in shape, these symbols sponding nouns (cf. English “–ness”), and so developed into the kana system, which is forth. Furthermore, Japanese has case parti- now the highly regular syllabary (ka, ki, ko, cles, such as those that mark subject and ob- ke, ku, . . . ) that makes up the easily learned, ject, which Chinese does not have. purely phonological part of the modern writ- Intense cultural contact occurred between ing system. Modern kana exist in two parallel China and Japan for several hundred years systems, with about 50 basic symbols each. starting around 600 CE. At the time, China had Hiragana is used for native Japanese words, a fully developed writing system and rich tech- including the grammatical morphemes, while nologies; meanwhile, the Japanese language katakana is used for writing borrowed words, was essentially unwritten, and the relative iso- roughly like the way English uses italics for lation of Japan meant that it was technolog- Latin ad infinitum or French savoir-faire ically behind China. Japan learned from all but much more widely, and also for ono- branches of Chinese literature, religion, gov- matopoeia and exclamations. ernment, and technology, importing the rel- As already indicated, kanji present multiple evant vocabulary along with this knowledge. problems to the Japanese student learning to The Chinese-based vocabulary thus became read. Because words were introduced from the basis of Japanese scientific and scholarly different Chinese dialects and at different vocabulary, just as the Latin and Greek roots, times, many of kanji characters acquired sev- often transmitted through French, became the eral different Chinese-based pronunciations basis of English scientific and scholarly vocab- in Japan. Therefore, in most cases, a kanji ulary. Japanese officials and scholars read and character has a native Japanese pronunci- wrote Chinese; officials and courtiers (includ- ation and several Chinese-based pronuncia- ing the world’s first novelist, Lady Murasaki) tions, all of which must be memorized. The gradually adapted the Chinese writing system Chinese-based readings usually resemble one to handle the Japanese language. another phonologically, but not always. For

example, for the character meaning per- morphemes such as nouns and the roots of son, the two Chinese-based readings are pro- verbs and adjectives (seed, shoot, put out)are nounced /nin/ and in/; the Japanese-based written in kanji; word endings and case parti- reading is /hito/). Note that the number of cles (possessive marker, topic marker, object kanji characters in a word is not related to the marker, and past-tense ending) are written in number of sounds in it. hiragana, and loan word nouns like “cosmos” Which pronunciation is to be used depends are written in katakana. on whether the kanji is used in a compound word, and if so, which compound. One can The phonetic scripts: Kana get an idea of the challenge by imagining that As mentioned, each kana character repre- in English the symbol “*” is used to symbolize sents one syllable, or more precisely, one the meaning star, but that a reader has to mora. Some syllables, like [kai], are two moras learn that when it is by itself it is pronounced long and require two kana, /ka/ and /i/. /star/; when it is followed by the characters A few combination kana are written with two meaning law,orsailor, it is pronounced kana characters, such as chyo and kyu astro (as in astronomy, astronaut). In ; these count as one mora in length be- addition, the reader must learn that when it cause they represent complexity in the initial is followed by the letters “ar” or occurs in the consonant blend rather than in the rhyme. Fi- letter string con*ation it is pronounced stell. nally, the few “special moras,” including the Consider also that this kind of information has glottal stop/long consonant marker ( ), the to be memorized for thousands of symbols, long vowel marker (—), and the postvocalic with only a vague indication of pronunciation nasal, do not contain vowels. for perhaps a quarter of the words, and that The relationship between orthography and the pronunciation information holds only for phonology in kana is highly regular and trans- their academic (i.e., Chinese-based) uses, not parent: each kana always represents the same for their daily meanings. mora of spoken Japanese (with just one very common exception: the kana that is usually How the three scripts are used in pronounced /ha/ is pronounced /wa/ when connected text it is used as the topic marker). All together, there are 104 kana characters to be learned. Reading Japanese requires integrating the Sentence A, given previously, can also be logographic kanji and the two syllabic written phonetically in all hiragana, as in Sen- scripts, hiragana and katakana, as shown in tence B. Sentence A. B. A. kosumosu-no tane-ga me-o dashi-ta. kosumosu-no tane-ga me-o dashi-ta. cosmos- seed- shoot- put out- katakana- kanji- kanji- kanji- Possessive topic object past hiragana hiragana hiragana hiragana marker marker cosmos- seed- shoot- put out- The cosmos seed put up a shoot. Possessive topic object past marker marker Children’s books are written with hiragana only; katakana are introduced in the first year The cosmos seed put up a shoot. of elementary school. Five-year-old children In Sentence A, kanji are (seed), (shoot already can name 70% of the kana (Takahashi, or bud), (the root form of the verb, put 2001), and by age 6, when they enter ele- up), hiragana are , , (case particles) and mentary school, the majority of children have , inflectional ending of the verb, ,and learned to read hiragana. Accordingly, those katakana is (cosmos). Thus, lexical children with dyslexia who have difficulty in

learning to read kana can be easily identified Phonological involvement in reading at the first grade. They have particular diffi- kanji culty in processing kana in connected writ- Thanks to history, as we have emphasized, ing, because Japanese does not write breaks each Japanese kanji typically has two or more between words: Sentence B would actually pronunciations; the native Japanese pronun- look like this: . ciations are called the “KUN”-readings and Yamada and Banks (1994) reported that 6% of the Chinese-based ones are called the “ON”- 125 fourth graders still showed this difficulty. readings. The KUN-reading is usually used when a single kanji occurs in isolation or followed by kana and is also used for a small set of Kanji and their multiple pronunciations multi-kanji words. An ON-reading is used for As they progress through school, children most kanji compounds and, rarely, for a single are exposed to text containing more kanji. kanji word (Smith, 1996). Because each kanji The number of kanji is quite large; one needs compound has only one correct pronuncia- to know as many as 3000 kanji to read news- tion, when there are several ON-readings for papers and ordinary texts. Furthermore, many each component character, the right pronun- kanji characters are visually complex. Some ciation must be retrieved for each of them (re- words are represented by a single kanji, but member the hypothetical English examples the majority of lexical items are made up of *naut = astronaut, con*ation = constella- of two or more kanji characters. For exam- tion, etc.). It is true that the meaning of the ple, the meaning of Sentence A can also kanji may be guessed without the pronunci- be expressed with multi-kanji compounds as ation (because it remains relatively constant shown in Sentence C; this type of sentence is across contexts), but the child who does not found in textbooks starting in 4th grade. remember the pronunciation will obviously be unable to recognize the word when it is C. used in classroom discussions or elsewhere. Kanji compounds learned in school contain kosumosu-no syushi-ga hatsuga-shita. the single kanji learned earlier. In Sentence C, the kanji (seed) is combined with another cosmos- shoot- sprout- kanji (child) and (shoot) with (start). Possessive topic did As we said previously, these previously marker learned kanji are pronounced in different ways when they are used in such combina- The cosmos seed sprouted a shoot. tions. The kanji is read as /tane/ in Sentence A (its KUN-reading) but as /syu/ in Sentence The compound kanji (syushi) has basi- C (its ON reading); and is read as /me/ in cally the same meaning as the noun (tane) A, but /ga/ in C. These two sentences are re- in sentence A. The word hatsuga) is a peated in the box later for ease of comparison: noun meaning “sprout”; this noun is combined with the past tense form of the verb A. “do,” , to make a verb (“sprouted”) that kosumosu-no tane-ga me-o dashi-ta. is equivalent to the phrase (putting up a shoot). Children in Japan are required katakana- kanji- kanji- kanji- to learn 1006 single kanji by the sixth grade, hiragana hiragana hiragana hiragana but the kanji compounds, whose meanings are only partially transparent, effectively triple cosmos- seed- shoot- put out- Possessive topic object past the number of sound–meaning correspon- marker marker dences that have to be memorized, because of their multiple pronunciations. The cosmos seed put up a shoot.

C. ratani (2012) looked at the scores on PA tasks and reading speed of single nonwords written kosumosu-no syushi-ga hatsuga-shita. in kana for 10 children with RD (first to sixth cosmos- shoot- sprout- graders). Seven of 10 children with RD had z- Possessive topic did scores poorer than −3onPAtasks,andtheir marker PA scores were equal to those of normally The cosmos seed sprouted a shoot. developed 4- or 5-year-old children. Because of studies such as these, Japanese speech– Given the phonological processing and cog- language pathologists are now aware that nitive demand in reading kanji compounds, dyslexia is a language disorder with phono- it is predictable that some children with logical involvement. dyslexia who are able to deal with kana because of their high transparency will have A JAPANESE CASE STUDY: ICHIRO problems in reading kanji compounds as they are introduced around the middle of the 4th To show the effects of this complex writing year of elementary school. system on an individual, we describe a longitudinal study of Japanese dyslexia by profiling PHONOLOGICAL INVOLVEMENT IN a boy with severe decoding problems. We fol- JAPANESE DYSLEXIA lowed “Ichiro” from 7 to 20 years old. Ichiro’s early speech and language were Makita (1968), the first researcher to study apparently developing normally. When he Japanese children with dyslexia, defined started first grade; however, he had difficulties dyslexia as a disorder manifested by difficulty in learning kana and could not read his own in learning to read despite conventional in- name written in kana. On his teacher’s advice, struction, adequate IQ, and sociocultural op- his family took him to an education consulta- portunity. This definition has been applied tion center, where he was given the Wechsler in identifying children with dyslexia for clin- Intelligence Scale for Children–III; his Verbal ical practice and research in Japan. Several IQ was 94 and Performance IQ was 111. The studies have shown that Japanese children center’s pediatric neurologist diagnosed him with RD typically display poor PA skills (Kato as having a reading disability, so Ichiro started et al., 1998; Morinaga et al., 1998; Morita, to receive reading treatment from the third Nakayama, Sato, & Maekawa, 1997; Oishi, author, who was the center’s SLP. 1998). For instance, difficulties in segment- ing kana words into moras were found in Disability in PA and kana learning 6- and 7-year-old children who were poor The first evaluation of PA in first grade readers (Morita et al., 1997), and low per- showed Ichiro’s developmental age to be 4.5 formance in reversing the sequence of moras years, a 3-year delay. Ichiro could not mem- in kana words was reported among middle- orize the sound of individual kana such as school children with RD (Oishi, 1998). In a (/a/ in hiragana), even after many repetitions. more systematic study, Tanaka Welty et al. Therefore, the key word teaching method (2006) obtained scores on PA, reading, writ- for preschoolers was adopted: a key word ing, and reading comprehension tasks from [e.g., (/ari/,ant)for /a/] is assigned 5 children with RD between first and fifth to each kana and the pronunciation of the grades. On phonological tasks such as syllable kana is evoked by its key word. It still took reversal and deletion, all five children with RD a year for him to learn to decode 60 kana had low z-scores (between −1.3 and −4.5 be- with this method. Even after learning how low the average of children with normal read- to sound out each kana, Ichiro spent sev- ing achievement), indicating that they all had eral months learning how to sound out even severe problems with PA. Oishi, Hara, and Hi- two-mora words. Some errors in reading kana

words appeared to be caused by visual similar- correspondence between a symbol and a lin- ity; (/miro/, nonword) for (/michi/, guistic unit. Only a study analyzing the nature “road”); other errors were caused by phono- of his errors and confusions would be able to logical complexity; (/kite/, ‘come’) for tell whether this was a visuospatial problem (/kitte/, ‘stamp’). Note that we have ob- or a new kind of cognitive symbol-processing served that the “special morae,” such as glot- disorder, but unfortunately, such data are not tal stop/long consonant , long vowel (—), available. and syllabic nasal, tend to be omitted in writing by other Japanese people with dyslexia as A PRELIMINARY STUDY OF AN well. INTERACTIVE INTERVENTION FOR Difficulties in kanji learning JAPANESE RD Learning kanji was much more difficult Any intervention should target the nature for Ichiro than learning kana. Kanji are con- of the impairment. Based on the simple ventionally mastered through rote memoriza- view of reading (Bishop and Snowling, 2004), tion (i.e., repeatedly saying aloud and writing Snowling and Hulme (2012) emphasized rely- down kanji that are extracted out of context). ing on a causal theory to develop intervention; However, this learning method was not ef- it should reinforce emergent skills to be ef- fective for Ichiro and apparently put a strain fective for dyslexic readers. Poor comprehen- on him, because he started to refuse to learn ders require training in oral language skills, kanji. in particular vocabulary and narrative. At the Learning the multiple readings for kanji was same time, they pointed out that many chil- very difficult; therefore, Ichiro was taught dren have problems with both decoding and only one reading per kanji and was taught comprehension. This is especially the case for only limited numbers of high-frequency kanji older children. They also emphasized that it is (e.g., /jama/, mountain; /kawa/, river). He good practice to ensure that interventions are mastered 250 kanji in the 6 years of elemen- systematic, well structured, and multisensory. tary school, which would be appropriate for On the basis of their work, we have developed second grade. By age 18, Ichiro had learned a structured reading–language intervention the sounds for most of the fifth-grade-level approach, called the Top-down Structured kanji. Reading Language Intervention (TSRLI) pro- His failure to learn kanji hindered his read- gram (Tanaka Welty & Iriyama, 2010; Tanaka ing comprehension, because, as noted pre- Welty, 2012). We implemented it with an 11- viously, content words-–the words that take year-old boy with dyslexia the central role in conveying the meaning The subject of this second case study was of the sentence—are mostly represented by “Shin,” a fifth-grade boy with no family history kanji. Not being able to read kanji meant that of language or reading disorder. His fourth- the concepts represented by these kanji could grade classroom teacher noted that Shin could not be learned from textbooks. Ichiro’s grades not read the textbooks at his age level de- were mostly 2 on a 5-point scale throughout spite his good cognitive functioning. Shin’s elementary school, junior high school, and difficulties were mainly inability to choose high school. His PA score on kana words the correct pronunciation for kanji. For ex- improved over time, but it was still at the ample, he had difficulty knowing whether to level of early elementary school at the age read the simple kanji as “kata”, “ho,” or of 20 years, indicating that his phonological “po” based on the context. This kind of prob- impairment was severe. However, his problem is neither visuospatial nor phonological; lem went far beyond the kana decoding dif- it seems similar to that of English-speaking ficulty; his problems with the kanji indicated children with RD who cannot use context that he was barely able to learn any kind of decide whether “teer” or “tare” is the right

pronunciation (and associated meaning) for was promoted at the phrase or sentence level the letter sequence t-e-a-r. Such decisions re- rather than at the word level. For example, quire both retrieving the possible sounds of Shin repeated a phrase or sentence that the the word (i.e., bottom-up processing) and teacher or clinician read to him so that he using meaning to choose the correct one could get a sense of reading fluency, which (i.e., top-down processing). Shin’s reading many dyslexic children do not have. We note problem had not been diagnosed in his first that the intervention did not include activi- three school years, because he could decode ties of PA to promote word-level decoding, kana. because at this point, Shin did not have prob- Shin was referred to a resource room where lems with kana. the special education teachers provide tradi- A teacher in the resource room, who was tional intervention (i.e., repetitive practice in trained by the first author regarding the nature reading texts and writing kanji three times per of dyslexia and the language-based reading ap- week for 45 min). However, he failed to re- proach, implemented the TSRLI program for spond to this intervention and refused to par- Shin 20 min daily for 12 individual sessions ticipate in the therapy. He also lost his inter- (2.5 weeks), including pre- and postassess- est in classroom learning. His WISC-R scores ments. were low average but within normal limits: As the pre- and postmeasurement scores, Verbal IQ 82, Performance IQ 92, and Full Shin’s reading fluency was measured in de- Scale IQ 85, but his academic achievements coding speed while reading a section of the in language and math were very low. Clini- textbook, plus a short untrained passage to cally, he was diagnosed as having a learning see generalization. Shin’s reading speed was disability, specifically dyslexia. dramatically shortened for both the textbook The TSRLI program was then introduced to (383 letters) and the short passage (280 let- Shin. Because the purpose of reading is to get ters); his reading speed for the textbook at the meaning out of text, one of the main tar- pretest was 682 s and 162 s at posttest. His gets of the TSRLI program is to promote the reading speed for the untrained passage was child’s top-down strategy, which is a metacog- 314 s at pretest and 143 s at posttest. We nitive strategy involved in sentence and text obtained the reading speed of eight normal comprehension processing to infer and grasp fifth graders and found that the average read- the gist. The implementation started with in- ing speed was 103.9 s (SD = 21.1) for the ferencing on the basis of the pictures about textbook and 60.0 s (SD = 12.8) for the un- the content of the text that the child is about trained passage. The increase of Shin’s read- to read, retelling of what the teacher read for ing skill also was measured by the number of him or her, followed by completing a visual errors in reading. The average number of er- map to denote the content. The rich verbal rors in reading by the eight fifth graders was interaction between the child and the adult 2.8 words (SD = 1.8 words) for the textbook. was intended to enhance such oral language Shin misread 10 words at the pretest. After skills as listening comprehension, narratives, the intervention, the error in reading was one and vocabulary. word. Recall that content words are mostly rep- His classroom teacher was the first per- resented by kanji, and that difficulties in son who noted Shin’s changes in reading flu- character-to-sound association can occur with ency and in his attitude toward comprehend- kanji, especially kanji compounds. Therefore, ing meaning in spoken and written texts, be- vocabulary was enhanced by explicitly teach- cause, after the first few sessions, he began ing the pronunciations and meaning of kanji asking her questions about the meanings of compounds, so that the child could pro- words in her instructions. As the interven- nounce them and understand their meaning tion proceeded, he gained the confidence at the same time. This training of fluency to read and understand texts and voluntarily

expanded his reading repertoire to other text- resource room at schools and have no ac- books, such as biology and social studies texts. cess to SLPs. A few such children, like Ichiro, Although his reading speed at the postassess- go to education centers or hospitals and re- ment was still −2SD below the mean of the ceive treatment from SLPs by decision of their fifth graders, Shin’s engagement toward read- parents. ing and classroom attendance were also mo- tivated well beyond our expectation. Thus, CONCLUSION administering the TSRLI program with the e-textbook for 20 min/day for just 2.5 weeks Orthographies differ in many ways (Zeigler seemed to have good effects even on an older & Goswami, 2005), and the nature of the re- student with RD. lationships between sounds and symbols af- fects the incidence and possibly the nature of dyslexia. Japanese is often described as a IMPLICATIONS FOR POLICY shallow script with rare dyslexia, but this is DEVELOPMENT FOR SLPs IN JAPAN true only for the kana system; the kanji system may be the deepest orthography in the world There are not enough children identified (Morton, Sasanuma, Patterson, & Sakuma, as having dyslexia to form an affected group 1992). for a comparative study to fully delineate the Although Japanese people with dyslexia nature of dyslexia for Japanese. Few teachers who have difficulties with kana learning might are even aware of the concept of dyslexia/RD be rare, they do show severe delay in PA devel- in Japan. Our studies indicated, however, that opment, indicating their underlying phono- children with dyslexia do exist in classrooms. logical processing deficits. Other dyslexia pro- Some of them may struggle with kana learning files can occur in recovering the sounds and from an early age. Most of them face difficul- meanings of words written with kanji, espe- ties around the third year of school in reading cially kanji compounds. The profile for Shin, kanji compounds that have multiple readings, who had a specific difficulty in choosing the probably because of underlying phonological contextually correct pronunciation for a given processing deficits. Given these dyslexia pro- kanji from among its several possible pronun- files, SLPs need to establish collaborative rela- ciations, was treated as a language-based dis- tionships with teachers and other profession- order (RD). Even though we do not know the als, and to play facilitative roles in assisting extent to which phonology was involved, it them to identify literacy problems of young might, in fact, be a decoding problem, in the and older children in classrooms. Speech– sense of being a specific problem with using language pathologists can play critical roles a written symbol to get to the corresponding in promoting preliteracy and literacy devel- lexical item. If Shin indeed has a decoding opment of children with language disorders, problem, it may not be the same as any type who are at great risk for reading problems. of dyslexia that has been reported for learners Language delayed preschool children can be of alphabetic writing systems. assessed in terms of preliteracy skills such as Because kanji represent the core mean- PA and print knowledge. ing of content words, failing in decoding Most SLPs in Japan, however, work in hos- kanji seriously hinders reading comprehen- pitals and treat adult patients under the doc- sion. Therefore, children with RD have prob- tors’ orders. Those SLPs specializing in chil- lems in both decoding and comprehension. dren mainly treat language delay in preschool Hence, a specific intervention that mixes read- ages. There is no official system for SLPs ing for decoding and language for comprehen- to work in schools, nor are there any read- sion in a structured way can be helpful. Writ- ing specialists. Generally, school-aged chil- ten language problems require a collaborative dren with RD receive education through a approach with other professionals, and new

policy developments in both teacher and SLP to carry out further studies on both accurate education are necessary for SLPs to be inte- identiﬁcation and the efﬁcacy of intervention grated into Japanese schools. To demonstrate using evidence-based practices for Japanese the need for such innovations, it is necessary children with RD.

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