Visuoperceptual deficits in letter-by-letter reading?

A longstanding and controversial issue concerns the underlying mechanisms that give rise to letter-by-letter (LBL) reading: while some researchers propose a prelexical, perceptual basis for the disorder, others postulate a postlexical, linguistic source for the problem. To examine the nature of the deficit underlying LBL reading, in three experiments, we compare the performance of seven LBL readers, matched control participants and one brain-damaged patient, OL, with no reading impairment. Experiment 1 revealed that the LBL patients were impaired, relative to the controls and to OL, on a same/different matching task using checkerboards of black and white squares. Given that the perceptual impairment extends beyond abnormalities with alphanumeric stimuli, the findings are suggestive of a more general visual processing deficit. This interpretation was confirmed in Experiments 2 (matching words and symbol strings) and 3 (visual search of letter and symbol targets), which compared the processing of linguistic and non-linguistic written stimuli, matched for visual complexity. In both experiments, the LBL patients displayed qualitatively similar effects of length and left-to-right sequential ordering on linguistic and non-linguistic stimuli. Moreover, there was a clear association between the perceptual impairments on these tasks and the slope of the reading latency function for the LBL patients. Taken together, these findings are consistent with a significant visuoperceptual impairment in LBL that adversely affects reading performance as well as performance on other non-reading tasks.