Integration of lexical and sublexical processing in the spelling of regular words: a multiple single-case study in Italian patients

In this study we investigated 12 cases of "mixed dysgraphia", a spelling impairment where regular words are spelt better than either ambiguous words or regular non-words. Two explanations of mixed dysgraphia were formerly offered by Luzzatti et al. (1998): (i) a double functional lesion of the orthographic output lexicon (or damage to its access) and of the acoustic-to-phonological conversion; and (ii) some kind of interaction/summation between lexical and sublexical spelling routes when processing regular words. We first analysed whether a double functional lesion was sufficient to explain the mixed dysgraphia, checking acoustic-to-phonological conversion by means of the repetition of words and non-words: the answer was positive in five cases and uncertain in three. We tested the remaining four cases to see if there was an interaction between lexical and sublexical processing of regular words, quantifying for each patient, on a probabilistic basis, the separate contribution of the residual lexical and sublexical resources. We investigated whether the processing along these routes was simultaneous but independent ("independent cooperation") or if instead there was "interaction", i.e., the simultaneous activity led to an added increase of efficiency over and above the mere combination of separate success probabilities. For one case the processing along the two routes was independent, in the other three cases an interaction resulted. Following the same approach, we found that for the five cases with a double functional lesion, the observed success on regular word spelling was higher than that expected on a probabilistic basis, but the interpretation of this finding was different.