The dyslexia debate continues
WHEN the dyslexia storm broke in September, I was not surprised that
one tactic employed by detractors was to put words in my mouth and then
attack them. I didn’t expect to find such an approach employed in The
Psychologist.
The programme (entitled ‘The Dyslexia Myth’, not ‘The Myth of
Dyslexia’) did not argue that dyslexia was a myth; it stated that ‘the
common understanding of dyslexia is a myth which hides the scale and
the scandal of true reading disability’. Indeed, as I (and others
associated with the programme) have repeatedly said, the question as to
whether dyslexia exists or not is essentially meaningless.
The fallacy of such a question becomes clears when one examines working
definitions such as that of a BPS working party report which
stated: ‘Dyslexia is evident when accurate and fluent word
reading and/or spelling develops very incompletely or with very great
difficulty. This focuses on literacy learning at the “word” level and
implies that the problem is severe and persistent despite appropriate
learning opportunities’ (BPS,1999, p.64). On this basis, how could one
question the existence of dyslexia? The more meaningful question is how
can this position be reconciled with the many
very different definitions (and symptoms) employed by others, and what relevance
do these varied conceptions have for clinical/educational intervention?
In this respect, I was pleased that Nicolson accepts the important
point that diagnosing dyslexia is not the objective process that many
are led to believe, neither does it point to appropriate forms of
treatment.
Nicolson mentions the heritability findings as if this were something
he was pointing out, but the heritability findings were highlighted in
the programme itself. He says ‘the fact that 50 per cent of the
variance in dyslexia is genetic means that dyslexia does have a clear
and distinct basis, and hence cannot be a “myth”.’ In fact, they show
that poor reading has a clear and distinct basis, not that dyslexia
as traditionally conceived (by reading/IQ discrepancy, visual reversals, etc.) has
a clear and distinct basis. He sets up the ‘straw man’ by saying: ‘No
one has ever suggested that children with generalised learning
difficulties can’t learn to read.’
But we were actually questioning whether children with dyslexia (as
traditionally defined) respond differently to intervention from those
with generalised learning problems. In rejecting this, we highlighted
the absence of clear evidence that there exists a particular teaching
approach that is more suitable for a dyslexic subgroup than for other
poor readers.
The programme did not sideswipe Nicolson's cerebellar deficit
hypothesis. It neither reported nor commented on any of the theories
about the underlying pathology which might explain the phonological
deficit (the immediate cause of reading problems) and the comorbidity
often associated with this deficit but not thought to be its cause. The
documentary did report criticism of the DDAT treatment for reading
problems, which claims to be based on the cerebellar deficit
hypothesis. It did so because the research Nicolson refers to as
supporting this complementary approach (which has been widely
publicised in the media) has been subjected to criticism by leading
researchers on both sides of the Atlantic (e.g. Snowling & Hulme,
2003; Stein, 2003).
While his point about the Code of Practice is true up to a point, I am
puzzled that Nicolson doesn’t recognise the more subtle ways that a
dyslexic diagnosis can influence both teachers and gatekeepers to
resources. Teachers are increasingly wary of litigation and may seek to
protect themselves against legal challenge. It would be naive to
underestimate the power of the label to access additional resources, a
point recently noted by school SEN coordinators (SENCO-Forum, 2005).
Finally, I am rather surprised by the simplistic distinction between
educational and ‘academic’ psychologists, finding this neither helpful
nor meaningful. Is he, in actuality, differentiating between the
diverse academic fields of cognitive and educational psychology? If so,
it might be helpful if he didn’t offer imprecise and inaccurate
accounts of the latter discipline. Certainly, there are areas in
educational psychology where ascertaining the causes of a problem (even
if this were possible) is not very helpful for guiding intervention.
Our knowledge of factors that underpin reading disability has massively
increased in recent years and it seems likely that brain function and
genetic studies offer much for the future. Hopefully, such work will
ultimately provide valuable guidance in developing increasingly
effective interventions. At the current time, however, splitting poor
readers into two groups – dyslexic sheep and ordinary poor-reading
goats – has little practical value for dealing with literacy problems.
Rather than pouring resources into dyslexic assessments, we would, at
the current time, be wiser to target all poor readers at an early age
for intervention. This is the main point that the programme set out to
make.
Julian Elliott
Durham University
British Psychological Society (1999). Dyslexia, literacy and
psychological assessment. Report of a working party of the Division of
Educational and Child Psychology. Leicester: Author.
SENCO-Forum (2005). Points from the SENCO-Forum: Is it dyslexia? British Journal of Special Education, 32(2), 165.
Snowling, M.J. & Hulme, C. (2003). A critique of claims from
Reynolds, Nicolson and Hambly (2003) that DDAT is an effective
treatment for reading problems – ‘Lies, damned lies and (inappropriate)
statistics?’ Dyslexia: An International Journal of Research and
Practice, 9, 1–7.
Stein, J.F. (2003). Evaluation of an exercise-based treatment for
children with reading difficulties. Dyslexia: An International Journal
of Research and Practice, 9, 124–126.
Having worked in the field of specific learning disability for
over 40 years, I am still greatly upset that my colleagues are trapped
in their thinking by medical titles, such as ‘dyslexia’, ‘dyscalculia’,
‘dysgraphia’, etc., which are merely descriptions of symptoms.
We should be looking instead for the causes of these problems.
Following research in Canada connecting such problems with metabolic
problems, an article in Scientific American (from memory, in the 1980s)
found the genetic link on the X chromosome. This explains the
four-to-one ratio of such problems in boys vs. girls.
I have found over the years that, when there is evidence of SLD in WISC
or WAIS subtest scatter, perceptual problems in visual or auditory
modalities, fine motor problems and of course reading and spelling or
calculation below the level expected from the intelligence level,
comprehensive tests of allergies and of vitamin and mineral trace
deficiencies almost invariably find the metabolic connection. The
results are so often spectacular, that teachers and parents are amazed
that the client is so greatly improved in concentration and ability to
learn, often in a few days.
Terms like ADD and ADHD are again merely descriptions of symptoms,
which are treated by the medical profession with drugs. This does not
get at the cause of the problem, and often leads to dependency.
John H. Jenkins
University College London
THERE are a number of issues here that highlight what appears to be
serious conceptual confusion in the field. These carve out an important
agenda both for research and practice.
In order to consider what is at stake, it is helpful first to refer to
the important theoretical framework proposed by Morton and Frith (1995;
see also Morton, 2004). According to this framework, it is important
when considering developmental disorders to separate the biological,
the cognitive and the behavioural levels of explanation. Importantly,
it is necessary to acknowledge that developmental disorders are dynamic
and there are environmental interactions at all levels. So the
behavioural manifestations of disorders, such as dyslexia, change with
time, and also in different contexts – for example we would see
different behaviours in a child taught to read in Italian or in one who
received early intervention.
The phonological deficit theory of dyslexia, featured in the
documentary, is a theory at the cognitive level. It explains a
constellation of behaviours that are normally associated with dyslexia
(short-term memory problems, word-finding difficulties, etc.). The
phonological deficit theory is a well-specified, falsifiable theory
that so far has not been refuted. What many respondents are upset about
is that certain behaviours often associated with dyslexia are not
explained by the theory – e.g. visual problems, problems of
organisation and of motor control. Of course, it is correct that these
behaviours often co-occur with dyslexia; they signal important
co-morbidities. Why they do is poorly understood. Next steps must
involve seeking both biological and cognitive explanations of these
associated disorders so that ultimately we can begin to unpick what is
dyslexia (the construct under threat), what is not dyslexia and why
these behaviours co-occur so frequently. But, to gather everything
under the umbrella of ‘dyslexia’ helps neither theory nor practice. As
for the call for ‘cut-off points’ for ‘dyslexia’, we can as a
profession agree criteria for extra time or a laptop computer, but it
is meaningless to imagine quantitative criteria defining a dynamic
developmental disorder.
Maggie Snowling
University of York
Morton, J. (2004). Understanding developmental disorders: A cognitive modelling approach. Oxford: Blackwell.
Morton, J. & Frith, U. (1995). Causal modelling. In D. Cicchetti
& D.J. Cohen (Eds.) Manual of developmental psychopathology. New
York: Wiley.
FOR some years I have been asking my university colleagues how they
determine that a student has dyslexia, and thereby grant them extra
time in examinations. None of the answers I have received are based on
specific criteria and cut-off points drawn from an epidemiologically
defined population, say a national sample of 18-year-olds. It would be
good to update an old reference (Yule et al., 1974). Obviously, if
anyone has such data it would help clarify if dyslexia exists.
James Thompson
Centre for Behavioural and Social Sciences in Medicine, University College London
Yule, W., Rutter, M., Berger, M. & Thompson, J. (1974). Over- and
under-achievement in reading. British Journal of Educational
Psychology, 44, 1–12.
In his introduction Professor Elliott was
dismissive of certain ideas that highlight particular aspects of the
subject. For instance he ridicules the idea of coloured lenses. This
refers to a small fraction of individuals who suffer from scotopic
sensitivity. They experience movement and distortion of black print on
a white background, and successful treatment is offered by the use of
tinted lenses or coloured overlays. Normally this is only one aspect of
an individual’s reading difficulties, but for some it can be a very
significant feature. Scotopic sensitivity is a form of visual dyslexia,
and it does exist. Specialists have highlighted its existence but no
one claims that it is a complete solution. Does total agreement as to
the nature or treatment of any human condition exist?
The same applies to coordination activities. Again they are not a
complete answer to dyslexia, but they can help children who suffer from
dyspraxia or coordination problems or dysgraphia (handwriting
difficulties). Both these latter conditions are often associated with
dyslexia and treating them appropriately can have a positive effect on
the development of the child’s literacy skills.
If the general public, as Elliott claims, falls for single therapies as
a complete answer to the very complex condition of dyslexia then that
is surely their fault. However, specialists in the area have never
claimed this. It may be true that certain sections of the population
are over-influenced by new ideas. But that is no reason to consign to
oblivion the term ‘dyslexia’, which has been a useful administrative
and legal term for many years.
Peter Congdon
21 Hampton Lane
Solihull
Professor Elliott’s message in the Dispatches programme
is supported by the two major reviews of the literature, by the BPS in
1999 and the Journal of Child Psychology and Psychiatry in 2004.
My experience as an LEA educational psychologist is that schools and
teachers feel ‘disabled’ by the messages about dyslexia being a
discrete set of difficulties – rather like a syndrome – that needs
expert diagnosis and specific learning difficulties trained teaching.
The ‘empowering’ message that this programme gives, and which is
supported scientifically by available evidence, is that there is no
discrete set of difficulties that allows a ‘diagnosis’ of dyslexia to
be made.
I personally do not like the term specific learning difficulties,
following recent private psychologist reports that claim that any
discrepancy in verbal/non-verbal/spatial abilities suggests SLDs. This
is diagnosed, even where children are scoring well within the average
range for reading and spelling. Any term that becomes so broad that it
becomes vague is clearly unhelpful.
A colleague and I recently attended a local Dyslexia Association
meeting. Those who are reluctant to accept that all children are
‘dyslexic’ who are not developing reading and spelling skills at the
expected rate have other reasons for not being able to accept the
programme’s definition. They agree with those of us that accept the
Dispatches message, that children need an individualised and structured
teaching programme, applied often, to develop skills until they become
more automatic and fluent. Where they disagree is in terms of politics.
The Dispatches message, although empowering to schools and teachers –
and ultimately parents and students, is a threat to them. It threatens
their livelihood, as often they are employed as private assessors and
tutors. It threatens the training courses that they attend to gain
their accreditation as SpLD teachers, and it threatens their view of
‘dyslexia’ as a disability.
Interestingly, a member of the local association expressed her concern
that children needed a ‘diagnosis’ of dyslexia to be able to access
their teaching programmes, adding ‘Are you suggesting that we allow any
child with a reading and spelling difficulty to access our help?’ …Now
there’s an idea!
Pat Kearney
23 White Lion Park
Malmesbury
Wiltshire
Professor Elliott said that ‘there is no consensus
about how it [dyslexia] should be defined or what diagnostic criteria
should be used’. The difficulty in using this type of argument to
dismiss dyslexia as a myth is that many, if not most, specific learning
difficulties, psychological conditions and medical conditions are
equally difficult and contentious to ‘diagnose’. Visual impairments,
epilepsy, autistic spectrum disorder and the like are not ‘discrete’
entities but range in their degree from mild to severe impairment, and
individuals are not uniform in the ways in which they are affected. If
Elliott’s logic is applied across the board then I assume that he is
also arguing that these disabilities do not exist?
Elliott said ‘a diagnosis of dyslexia tells us virtually nothing about
how best the individual can be helped to become a better reader’. For
many years the ACID profile of the WISC/WAIS IQ test together with WRAT
or WORD test have been used to diagnose individuals with dyslexia. The
ACID profile is unusual, and those with dyslexia usually have either a
full or partial profile, i.e. they are either dyslexic because of
auditory short-term memory weakness (as identified by a lower score for
digit span-D), visual short-term memory weakness (as identified by a
lower score for coding-C) or because they have weaknesses in both
domains. So rather than telling us ‘virtually nothing’ a diagnosis
demonstrates in exactly which areas the student has difficulty and by
implication how to support the individual’s learning.
In the programme much time was given to the impact of phonological
difficulties in reading and how to support them. I very much doubt
whether anybody would dispute that where phonological difficulties are
present, teaching strategies should be implemented. However there was a
failure to even acknowledge visual difficulties as a possible source
for reading or spelling difficulties. If there was not a visual route
of word recognition; then it would not be possible for ‘normal’ people
to differentiate between wear and where. We must acknowledge that
visually based, phonologically based or multisensory-based teaching
methods can be effective in supporting learning depending upon the
individual’s areas of weakness.
There was no coverage of the unusual, yet consistently reported, soft
signs of dyslexia (difficulty in learning to tell the time, telling
one’s left-hand side from one’s right-hand side, etc). Explanations
based purely on phonological weakness do not account for these types of
difficulty.
Phonological weakness alone also fails to explain difficulties in
spelling which persist in compensated dyslexic adults (including those
who have been taught using the phonological methods presented in the
programme). Spelling in such adults can be haphazard; for example
individuals are able to spell a word one day, but not the next.
The television programme made a comment to the effect that IQ drops in
those children who do not learn to read. It would be helpful to know
where this research has been published. As I understand it, an
artificial drop occurs for individuals with dyslexia when they are
tested on the post-16 WAIS scale purely because for the first time the
digit span subtest is included in the overall calculation of the IQ
score (this subtest is not used toward the full IQ score in the WISC).
I would be grateful if Professor Elliott could point to any literature
that documents a ‘real’ change in IQ during childhood of the type
outlined in the programme.
Jill F. Baird
Cardiff Centre for Lifelong Learning
Senghennydd Road, Cardiff
(Please note that some pictures may have been removed for copyright reasons)
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