5 Incorrect Labels for Dyslexia

Helpful Tips for Homework Time (10)If your child is diagnosed or shows signs of dyslexia, there is a huge possibility that you will hear terms that are completely incorrect to describe your child’s disorder. You may even be confused by round-about diagnostic terms given to hide a diagnosis of dyslexia like a Specific Learning Disorder. If you are misinformed, it could affect the kind of treatment he or she receives in school– which could be detrimental to early intervention.  Though there is research being done looking into subtypes of dyslexia, there is only one official form.

Directional dyslexia/ spacial dyslexia/ geographic dyslexia: This refers to the issue some dyslexics experience with telling left from right. Though, this is simply something that comes along with dyslexia and is not a separate condition.

Visual Dyslexia: This term suggests that dyslexia is a visual problem, which is completely incorrect. This theory suggests that dyslexia can be improved through eye exercises or tinted lenses– and the only thing that helps dyslexia is structured literacy therapy. Countless neuroscience studies have proven dyslexia is not a vision condition. Experts do not endorse vision therapy as a treatment for dyslexia and never use this term to describe dyslexia.

13584535514_c2bb726231Math Dyslexia: This is an inaccurate name for dyscalculia– which is a brain-based math learning issue. Dyscalculia is not a form of dyslexia, but it isn’t unusual for kids to have both dyscalculia and dyslexia.

Dyslexia is a widespread issue with many nuances, but there is only one official type. If you see your child is showing any symptoms of dyslexia, take our free online screener. Early intervention is crucial to your child’s success.

What Your Pediatrician Says About Vision Therapy

Untitled designPediatricians Caution Parents Not to Waste Money on Vision Therapy

Beginning about 5 years ago pediatricians started cautioning parents of kids with reading disorders to avoid ineffective and costly treatments such as vision therapy and to look instead for  “proven education and language-based interventions”.

 

This year Pediatrics journal published another study that supports this advice. In research based on thousands of children aged 7 to 9, no evidence was found for an association between specific learning disorders with impairment in reading (dyslexia) and vision abnormalities.  The researchers concluded that there is no evidence that vision-based treatments would be helpful for children with severe reading impairments.

Pediatric ophthalmologists explain: “Children with dyslexia often lose their place while reading because they struggle to decode a letter or word combination and/or because of lack of comprehension, not because of a “tracking abnormality.’ ” (Vision Therapy, American Association for Pediatric Ophthalmology and Strabismus website)

Especially when you are worried about your child it is not hard to be fooled by “pseudo-scientific” jargon! IDA_Logo_Brand_Guide1
The International Dyslexia Association (IDA)  has
a fact sheet designed to help parents “critically evaluate programs, avoid scams, and move forward toward providing instruction that will truly help…”.  Lexercise is a corporate member of IDA and Lexercise therapy meets and exceeds IDA standards.  

If you are worried about your child’s reading, spelling and/or writing the free, online Lexercise Dyslexia Screener is a good place to start. If your child struggles to read the single, large-font words on this screener you can be pretty sure it is not due to their vision!

Dyslexia Treatment – What’s the Truth?

Following our posts of “Five Ways Not to Treat Dyslexia,” parts 1 and 2, we received a number of comments from individuals who disagree with my statements and advocate the use of the systems and treatments refuted in the articles. In “Five Ways” I discussed vision therapy (VT), Irlen lenses, ChromaGen lenses, low-plus reading glasses, and omega-3 fatty acids.

In this somewhat lengthy post, I would like to recap the comments, take a further look at the evidence for these therapies and offer some suggestions to help parents be more critical in their evaluations of dyslexia treatments.

Thank you to all of our readers and to those who wrote in reply to “Five Ways Not to Treat Dyslexia.”

Summarizing the comments

We heard from Leonard Press, O.D., a vision therapist who opines that the information I presented in “Five Ways” is “biased and distorted.” He says that my presentation “skews the issues to sell a phonics-based program.”

Dr. Press has elsewhere been an ardent critic of the 2009 American Academy of Pediatrics (AAP) Joint Policy Statement, Learning Disabilities, Dyslexia, and Vision, which I strongly endorse and to which I refer in “Five Ways.”

Dr. Press is a co-author of the American Optometric Association’s policy statement Vision, Learning, and Dyslexia. (Note: the optometrists label theirs a “joint” policy statement, which might cause it to be confused with the AAP Joint policy statement. However, whereas the AAP policy statement reflects an agreement between pediatricians, ophthalmologists, and pediatric ophthalmologists, the American Optometric Association/American Academy of Optometry “joint” statement reflects an agreement between the optometrists and…the optometrists.) As I noted in “Five Ways,” the optometric policy statement correctly says, “Vision therapy does not directly treat learning disabilities or dyslexia.” Dr. Press and his colleagues would have done well to stop there, but they go on to say that vision therapy improves “visual efficiency and visual processing, thereby allowing the person to be more responsive to educational instruction.” As I noted in “Five Ways,” those statements on their face sound reasonable if you buy the optometrists’ assumption that “visual efficiency” problems and “visual processing” problems play a major role in dyslexia. The problem is that there is no valid evidence that they do, and on the contrary, there is valid evidence that dyslexic readers have neither more nor fewer eye or vision disorders than nondyslexic readers.

Dyslexia Facts

Here are the facts. Dyslexia is a language processing problem, not a vision problem. Vision therapy does no direct harm to the child, but it does waste the parents’ money, which would be put to much better use by pursuing language therapy of the sort recommended by the International Dyslexia Association (IDA). And more importantly, by wasting valuable time, vision therapy does harm the child if, as is too often the case, the parents pursue vision therapy instead of the valid, language-processing therapy the child needs. Finally, regarding Dr. Press’s assertion that I “skew(ed) the issues to sell a phonics-based program,” please be aware that I have no financial interest in Lexercise nor in any other dyslexia diagnosis or remediation method, program, or company.

I appreciate Dr. Press’s interest in our blog, but I could not disagree with him more, and the evidence supports my position as stated in “Five Ways” and in the AAP Joint Policy Statement, not his. I stand by the facts as presented in “Five Ways.”

Among proponents of Irlen lenses, we heard from Helen Irlen, MA, who originated the still-unproven concept of “Scotopic Sensitivity Syndrome” (now known as “Irlen Syndrome”), for which her Irlen lenses are the supposed treatment. Ms. Irlen felt there were flaws in the very recent Pediatrics article I cited (which showed no benefit of Irlen lenses for reading disorders) and by way of rebuttal cited a flawed study that claims to show a benefit of her lenses.

(Note that Irlen International newsletters also credit Irlen lenses with helping people suffering from visual symptoms associated with head injuries, concussions, whiplash, perceptual problems, neurologic impairment, memory loss, language deficits, headaches, autoimmune disease, fibromyalgia, macular degeneration, cataracts, retinitis pigmentosa, complications from refractive surgery, depression, anxiety, schizophrenia, multiple sclerosis, and Asperger syndrome, among others.)

Ms. Irlen also cited SPECT scans as evidence of the effectiveness and validity of her syndrome and her lenses. I have searched without success for objective information regarding SPECT scans; I find them referred to only on sites of Irlen clinics and related facilities. I would be happy to review any objective information Ms. Irlen has regarding SPECT scans themselves, and any peer-reviewed evidence regarding their validity in diagnosing or treating dyslexia. I have been unable to find any. You can read Ms. Irlen’s comment in the section below the original post.

We heard from an occupational therapist who believes a) in vision therapy and b) that I am insufficiently educated because if I were sufficiently educated, I would believe in vision therapy, too.

We also heard from John Hayes, a representative (perhaps the inventor; I’m not sure) of See Right Dyslexia Glasses, who felt that not only was I wrong for saying that dyslexia is a language processing problem and not a vision problem, but that the vision therapy, Irlen and ChromaGen people have it wrong too, and that his glasses are the real treatment for dyslexia.

 

Reviewing the Evidence

Let’s look quickly at the evidence regarding each of the vision-based treatments.

Vision Therapy (VT)

There is no randomized controlled trial of vision therapy for dyslexia. However, in 2000 and again in 2008, the UK College of Optometrists reviewed the evidence regarding the effectiveness of VT for several conditions, including learning disabilities, and found insufficient evidence of effectiveness to recommend VT for learning disabilities. (SeeA critical evaluation of the evidence supporting the practice of behavioural vision therapy.” Ophthalmic Physiol Opt. 2009 Jan;29(1):4-25.)

 

Irlen lenses/filters

Please see the Pediatrics article referenced in the first half of “Five Ways”, which is the most recent of several well-designed studies that show the lack of legitimate effectiveness of these tinted lenses/filters for dyslexia. (You will note that under Responses to this article, Helen Irlen offered a rebuttal very similar to her reaction to my post, and the authors, Stuart J. Ritchie, et al, replied at length defending their research.)

The single best study of tinted lenses is “Do tinted lenses improve the reading performance of dyslexic children?” by Sheryl J. Menacker, Michael E. Breton, Mary L. Breton, Jerilynn Radcliffe, and Glen A. Gole in Archives of Ophthalmology, 1993, 111(2): 213-218. An abstract is available here.

A recent paper that is particularly strong in assessing the flaws in studies that claim to support the use of tinted lenses is “A review of three controversial educational practices: perceptual motor programs, sensory integration, and tinted lenses” by Keith J. Hyatt, Jennifer Stephenson and Mark Carter, in Education and Treatment of Children, May 1, 2009. The authors know the research methodology very well and can detect flaws in design and interpretation that most people (including me) might miss. Furthermore, they have no eye care connection, so they have no ax to grind on either side of the optometry/ophthalmology battles.

 

ChromaGen lenses

As cited in Part 2 of “Five Ways,” the only two studies claiming effectiveness are by the inventor, who obviously has a financial interest.

 

Low-plus reading glasses

Numerous non-optometric studies have shown no effect for these glasses, but perhaps the most convincing evidence is again from the UK College of Optometrists, who in their 2000 assessment of vision therapy techniques (cited above) reviewed critically the optometric literature regarding low-plus readers, evaluating the quality of the studies’ design to assess the strength of the studies’ conclusions. They found no convincing evidence that low-plus readers have any benefit.

 

Omega-3 fatty acids

Please see my comments in “Five Ways” part 2.

 

The Parents’ Dilemma

We know that parents are faced with hard decisions and persuasive voices as they choose among therapies. In fact, they may have to make a choice between views that are exact opposites of one another, and certainly, opposite views cannot both be right!

As a parent, how are you supposed to decide what’s right — and what’s right for your child? It’s almost overwhelmingly tempting to rely on anecdotes and testimonials from individuals promoting a method or from friends. But if you are able to assess the evidence for yourself, if you learn how to find the flaws in studies and claims, you won’t have to take anyone’s word — including mine — and you’re much more likely to make the right decision for your child.

 

Questioning the Evidence

There are levels of evidence in science and medicine ranging from randomized trials to anecdotes. The lower the level of evidence, the less reliable it is.

The lowest level of evidence is the anecdote or testimonial. That’s also the type of evidence we’re most familiar with. (Example: your best friend took a new cold remedy and her cold got better. She tells you it’s the greatest thing since sliced bread. It seems like a no-brainer that it would be worth trying the same remedy if/when you get a cold; after all, it “worked” for her.) It is almost impossible for any of us — myself included — not to be persuaded by anecdotal evidence: it’s right there in front of us, and we don’t have to do a bit of work to interpret it. She had a cold, she took the remedy and the cold got better. How much clearer can it get? (Note: just because something is anecdotal does not mean it’s false — it’s just the least likely to be true of all the forms of evidence.)

All of the study types listed on the graphic above are more likely to produce true results than anecdotal evidence; the higher you go on the list, the more reliable the results will be. However, unless you’re a researcher yourself, you almost certainly won’t be able to figure out whether the study you’re trying to read is a correlational study, comparison group, or a randomized controlled trial. But let me give you some general guidelines that you as a parent might find useful as you try to assess claims regarding therapies for struggling readers. Each of these is phrased as a question you might pose when you’re considering a claim.

 

Where’s the control group?

Consider a study in which 1000 people with colds were given a cold remedy and the cold got better in all 1000. The author claims a 100% success rate for the remedy, and we are tempted to believe that this remedy really works — after all, it has a 100% success rate! But wait a minute — was it the cold remedy that made them get better? No, they were going to get better anyway, because that’s what colds do! So what’s missing in this “study” is a control group: another group of about 1000 people (as similar to the first 1000 as possible) who had a cold and who did not get the cold remedy. Because colds get better, the study would now show 100% cure in both groups, which means that the remedy had no effect whatsoever on the cure rate.

So in any study that claims effectiveness for a therapy, always look for the control group. If you look only at the summary — “100% cure rate!” — you will be misled.

 

How was the condition defined, and who made the diagnosis?

In the cold remedy study, what if some of the people in the study had colds, but others had allergies and others had a sinus infection? That would really muddy the results. This is especially pertinent in studies of remedies for reading disorders. You need to look for how the research defined reading disorders (for example, did the subjects all have developmental dyslexia or did some have that and others have secondary dyslexia, due to inadequate IQ or inadequate instruction and did some have bad ADHD that made them unable to pay attention long enough to read, etc.), and who made that diagnosis. Only then can you know whether the remedy being reported is even treating the condition the authors say it’s treating.

 

How were success and failure defined in the study, and how was that determination made?

In the case of reading remedies, was success defined as an improvement in the rate of reading? Fluency? Comprehension? Something else? How much improvement was considered a success? 1%? 10%? 50%? Was the person making the assessment qualified to make the assessment? Did the subjects and/or the evaluators know which treatment they were getting? Subjects who know (or believe) they are receiving treatment will perform differently, and an evaluator’s assessment of the outcome will unavoidably be biased if he or she knows what treatment the subject received. Ideally, both the subject and the evaluator are “blind” to the treatment, meaning that neither knows whether the subject received the ‘real’ treatment.

 

Were the people in the study receiving any therapy other than the therapy that is being studied?

In a study of new cancer treatment — call it Treatment X — if the patients are getting Treatment Y at the same time they’re getting Treatment X, then how can you know whether the effect was due to Treatment X (as the authors of the study may claim) or Treatment Y? You can’t. If a group of children with dyslexia is given vision therapy and also given specific reading instruction, and after six months they read better, the authors may claim that the study shows that vision therapy helped their reading, when in fact it may have been the reading instruction itself that accounted for the improvement.

 

Does the author of the study have a financial interest in the outcome?

If the author has a financial interest in the outcome, it does not prove that the study is invalid — there could certainly be very valid studies, rigorously designed and conducted, that produce absolutely unbiased results. However, if the author has a financial interest, you have to interpret the claims of the study with even greater caution than usual, looking for evidence of bias, because now it matters to the author which way the study turns out.

 

To summarize (and thanks for your patience!):

  1. Don’t take someone else’s word that therapy works; learn to look critically at the evidence yourself.
  2. Resist the urge to rely on anecdotal evidence (testimonials); hold out for stronger evidence.
  3. Determine how the authors defined successful treatment, and how success or failure were established.
  4. In assessing studies regarding remedies for reading disorders, always ask: a) Where’s the control group? b) How did they define “reading disorder,” and who diagnosed it? c) Were the children in the study receiving any other treatment (such as reading instruction) besides the vision therapy, tinted lens, etc. and d) Did the author(s) have a financial interest in the outcome of the study?

Finally, keep this in mind: the burden of proof is not on those of us who would advise against controversial therapies such as those listed in “Five Ways.” Instead, the burden of proof is on those who would have parents pursue those therapies. As I have tried to demonstrate, the proof is not there.

I hope you find this helpful, and I hope this information prepares you to ask better questions as you’re considering your options for addressing your child’s struggle with reading, writing, and spelling.

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Dr. Young has no financial interest in any dyslexia evaluation or remediation program, method, or company, including Lexercise.

Five Ways Not to Treat Dyslexia | Part 2

This is the second in a two-part guest post by Dr. William O. Young. To read the first part, click here.

 

Dyslexia Treatment Myths (continued)

3. ChromaGen lenses

This is another twist on the tinted lens/overlay theme, though ChromaGen stresses that their lenses, which are various shades of gray and which may be different shades for the two eyes, are not the same as Irlen lenses/filters. ChromaGen lenses were developed 25 years ago as an attempt to treat colorblindness. More recently interest has developed in their use with struggling readers, and as was the case with Irlen lenses, the media have helped spread the word, including a very favorable (and uncritical) piece on ABC News: “Color-Filtering Lenses: Better Reading for Dyslexics?” November 30, 2011. (For a more objective review, see “The Healthy Skeptic: Promise of ChromaGen lenses for dyslexia a bit blurry,” in Los Angeles Times, November 28, 2011.)

Like the Irlen Institute, ChromaGen claims that their lenses help dyslexia by treating visual distortions, by altering the wavelength of light reaching the eye, and that about half of dyslexics could benefit from these tinted lenses (www.ireadbetternow.com).

Optometrists become ChromaGen certified providers by taking one hour (!) of online training and paying $1500 for a kit of lenses. After a $150 screening exam, a pair of ChromaGen lenses cost the patient $750 to $1200; ChromaGen tinted contact lenses are somewhat less expensive.

No one other than the inventor of the lenses, who obviously has a financial interest in the outcome, has published a study supporting their effectiveness for reading disorders. Nevertheless, just as there are people who swear by VT and Irlen lenses, there are people who feel ChromaGen lenses have helped them, and who have provided glowing testimonials. It is these testimonials that have driven ChromaGen sales, despite the lack of objective evidence that they work. The ABC story reports, “With such testimonials, ChromaGen’s Edwards downplayed the need for scientific studies to establish the lenses’ effectiveness.” Enough said. The placebo effect is a powerful thing.

 

4. Low-plus reading glasses

These are very weak reading glasses prescribed by optometrists for struggling readers on the basis that focusing on reading material, at a reading distance, causes “near point stress” which is relieved by the reading glasses, thus allowing the child to read better. This concept of near-point stress has been a part of optometric training since the 1920s, again without valid objective evidence.

There’s no way to explain why this therapy is bogus without some numbers. When we focus on things “at near” we have to accommodate, meaning crank in focusing power, to make things up-close clear. (When we turn 40 we can no longer accommodate enough to see clearly at reading distance, so we need reading glasses.) Glasses prescriptions and accommodation are both measured in units called diopters. Assuming we are not farsighted, we don’t have to accommodate at all to see things very far away, but to see things up close (at book-reading distance) we have to accommodate about 3 diopters. If a child is, say, 1 diopter farsighted to begin with, she has to accommodate 3 + 1 = 4 diopters at near. But a child at, say, age 10 is able to accommodate about 14 diopters and can sustain half of that accommodation (about 7 diopters). This means that this child is not even breaking a sweat to accommodate the 4 diopters needed to see at near: she has 14 – 4 = 10 diopters in reserve that she’s not even using!

And how much help do these low-plus readers provide? 0.5 diopters, typically (though I’ve seen them even weaker)! So the farsighted child reading with 0.5 diopter readers only has to accommodate 3.5 diopters at near, instead of the 4 diopters she requires without the readers—meaning that with readers she has 10.5 diopters in reserve, instead of the 10 she has in reserve without the readers. This is a truly insignificant difference, and again, any “effect” is a placebo effect.

(Note, by the way, that these children who supposedly can’t read because of near point stress are able to play video games—without their “reading glasses”—for long periods at a time without difficulty…)

 

5. Omega 3 fatty acids

Omega 3 fatty acids are advocated by John Stein, one of the major proponents of the “magnocellular theory,” for treating reading problems (along with yellow and blue lenses). The magnocellular theory proposes that a certain type of cell in the retina of the eye fails to suppress the image of the letters you’re looking at now when you shift fixation to the next set of letters as you read so that a “visual trace” of the last group interferes with the group of letters you’re trying to read now. A magnocellular deficit is believed by some proponents of Irlen lenses and ChromaGen lenses to be the reason for their lenses’ “effectiveness.”

The evidence for the magnocellular theory is debatable at best; my best interpretation of the current evidence is that even if some people do have a magnocellular deficit—a big “if”—it is unrelated to any reading difficulty they may have. (See “Visual Search Deficits are Independent of Magnocellular Deficits in Dyslexia” in Annals of Dyslexia.)

And as for the omega 3 fatty acids, the evidence for their effectiveness in dyslexia is….? (I’m not aware of any.) Look, omega 3 fatty acids are great: I take them myself because there’s evidence of cardiovascular benefit, and I recommend them to my patients with blocked oil glands in the eyelids (a common problem that causes red bumps in the eyelids called chalazia). They cause no harm that I’m aware of, they’re relatively inexpensive, and unlike the remedies discussed above, they may actually do some good (though not specifically for dyslexia). So if I had to pick one dyslexia “remedy” from this list of five, I’d pick omega 3 fatty acids, hands down!

 

Here’s the bottom line.

It seems very reasonable and logical to think that the eyes cause or contribute to dyslexia. It’s reasonable, logical, and almost always wrong! Dyslexia is a language processing problem, not a vision problem, and the valid remedy for dyslexia is targeted language therapy with daily practice, not eye exercises, tinted lenses, or reading glasses. There is simply no valid vision-based shortcut to treating dyslexia.

We are all, myself included, susceptible to being persuaded by anecdotal evidence: our friend down the street says something helped their child, so (we think) maybe it’ll help ours! As a parent, you are motivated by your desperate desire to help your struggling child, whatever it costs.

I urge you to hold out for objective evidence from an impartial source and instead put your money toward valid language-based therapy that will actually help your struggling reader. Unfortunately, there simply is no quick fix for dyslexia.

For a comprehensive overview of the subject of the role of the eyes in reading and learning disorders, please see Learning Disabilities, Dyslexia, and Vision: a joint policy statement by the American Academy of Pediatrics, the American Academy of Ophthalmology, and the American Association for Pediatric Ophthalmology and Strabismus. It’s 32 pages and will take you a while, but is well worth the time.

For another objective review of controversial vision-oriented therapies for dyslexia, see the excellent article in the Winter 2011 edition of the International Dyslexia Association’s publication Perspectives on Language, entitled Vision Efficiency Interventions and Reading Disability,” by a well-known dyslexia researcher and a pediatric optometrist.

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Dr. Young has no financial interest in any dyslexia evaluation or remediation program, method, or company, including Lexercise.

If you have questions or need a referral to a qualified clinician, contact us at Info@Lexercise.com or 1-919-747-4557.