The Battle Rages: Phonological Versus Visual Causes of LD and Dyslexia

I’m weighing in on the on-going and often heated debate about whether there’s justification to include Vision Training or Therapy in treating dyslexia.  There’s a fierce intellectual hubris and territorialism among those who diagnose and treat.   In addition, parents becomes victims and proponents of one side or the other.  There are others with a vested interest, notably those who sell products.

This territorialism that I refer takes on a black and white, rigid thinking that’s usually associated with fundamentalism in various forms, or political blogosphere.

Go ahead and search the internet for spirited discussions and articles addressing the possibility that visually-based therapies , such as developmental optometry or “Scotopic Sensitivity Syndrome” for example, (and the use of Irlen Lenses). You will start to drift deeper and deeper into a black hole of anecdotes,  poorly designed studies cited ( or done by the companies selling product), and some degree of name-calling.

I’ve certainly been guilty of some of that in the past.  People care passionately about their work with and care of children. I’ve been in the field of learning disabilities and behavioral health for more than twenty-five years.  As a parent who raised a child with LD, an Orton-Gillingham trained educator, an LD school director and more, I’ve been lucky enough to see and be part of advances in clinical practice, research, and brain-imaging techniques that have deepened our understanding of the intricacies of reading and spelling disabilities.  I know on a very deep level the importance of attending to the phonological and linguistic aspect of print disabilities. For many people who struggle with printed words and dense language, an Orton-based or other evidence-based systematic approach for instruction can be a life-saver and a huge piece of the puzzle and key to unlocking the world of reading and writing.

I also know the critical nature of mindset and developing a work ethic/resilience in the face of repeated frustration.

I must say I have also witnessed many many people who describe a visual aspect to their struggle with reading.

So here’s the thing and the point I’m getting to (hang in there it’s coming): Even though the preponderance of the scientific evidence points to the primacy of phonological weaknesses as a root cause of dyslexia and reading disabilities, there is a need for a crack to open in our collective expert phonological minds. Just open enough in order to allow that there may just be very important visual processing aspects to success in reading for some folks.

An insidious problem that leads us to a complete denial of the role of the visual aspect of reading for example, is the amount of overselling from “the other side.” There has been an irresponsible overstating of how conditions can be “cured” with all sorts of gimmicks and lenses, etc. What gets lost in all the hyperbole, is an open-mindedness to consider the degree to which our brains and sensory systems are indeed impacted, negatively and positively, by light, color, shape and size.

I’ve spent a considerable amount of professional time and energy defending the primacy of language-based and phonological issues in literacy development, and caution people all the time about needlessly investing time and money in unproven methods.  However, in the interests of kids and research, I believe we need to think more holistically at times. As much as I pin my profession on evidence-based approaches, double-blind studies, although rightfully the perceived pinnacle of evidence standards, are not the be all and end all. Absence of evidence is not proof that something doesn’t exist.

To all of the Orton- and code-based experts, myself included: We sometimes need to get off our high horses long enough to dig around in the weeds. Sometimes those weeds include asking kids themselves what they are experiencing. Sometimes we might learn something from people we disagree with, because even though they may overstate and over-promise and over generalize, we might at times throw out the baby for the bathwater.  I find no compelling evidence for example, that the Open Dyslexia font, which among other attributes, “weights” the bottoms of certain confusable letters (i.e. “b”s), works for lots of people. However I’ve had a few kids tell me they feel that it’s helpful to them. Hmm.

As for Vision Training: There’s little or no evidence that it is useful in treating dyslexia.  One of the most common myths is that people with dyslexia show poor visual tracking when reading.  This is called “saccadic eye movements.” The evidence shows that poor tracking is caused by the fact that the eyes of poor readers jump around because of their unfamiliarity and ease with the codes, phonological and morphological, of the words they’re looking at.  When a struggling reader looks at the word “predictable” they’re not processing the letters as pre dict able (syllables and suffix).  That’s what competent readers do because they’ve been taught or implicitly recognize those patterns.  When a struggling reader looks at a word without those guardrails, the eye will move around searching for meaning in a more haphazard way.

Light, sizing, color, and weighted fonts can all contribute.  And if there’s a true convergence or other visual processing condition, treat that too.

Let’s not use Congress, and the trolls in online comment sections, as our role models for educational and psychological solutions.


About Sanford

Learning Disabilities specialist and Educational Consultant
This entry was posted in Discussion Topics, Education Issues and Ideas, Social Issues and Ideas. Bookmark the permalink.

16 Responses to The Battle Rages: Phonological Versus Visual Causes of LD and Dyslexia

  1. pdw says:

    If a child has issues with phonological understanding/development, hearing, auditory processing, etc. then lenses are not going to help him.

    If a child has issues with vision, nearsightedness, eye teaming, visual processing, etc. then phonological training is not going to help him.

    If a child has both (and working memory issues, and distractibility, and slow processing speed, etc. etc.) then choosing only one method/therapy is not going to help. We need to be willing to use whatever therapy or combination of therapies will work best for each child.

  2. Richard says:

    I think Sanford’s point, pdw, is that one’s proclivity can color one’s perception of what’s needed. If one likes hammers, everything starts looking like a nail.

  3. Sanford says:

    True Richard. And were you punning? (“color one’s eyes)

    We all get so “right” we lose sight of reality. Language gets in the way of direct experience sometimes.

    Standing firm is one thing. Closing mind and heart is another.

  4. JD says:

    Curious who posted this. It’s super.

  5. Sanford says:

    Thanks. Glad you liked it. I posted it. Anything in particular speak to you?
    Sanford Shapiro

  6. Dr. Leonard Press says:

    Bravo, Sanford. My mentor, Dr. Harold Solan, was both an optometrist and educator who was one of the world’s leading researchers in the visual aspects of reading problems before he passed away. He was on the editorial review board of JLD. He championed the exact position you’re espousing.

  7. Sanford says:

    Dr. Press. As I mentioned, I’m a huge supporter of what works and mostly I use a phonetic linguistic approach. I just don’t like it when anything, including vision therapy is oversold and over-generalized. That said, we can all get a little closed off from listening some times.
    Thanks for your comments.

  8. Pingback: Getting Lost in Hyperbole | The VisionHelp Blog

  9. Raul Aldape says:

    As a former vision therapist turned teacher, I believe it should be the most important consideration when designing and implementing any type of activity (hands on or handout). Howard Gardner’s Musical-Rhythmical Intelligence Theory pretty much lends itself to the use of the metronome in lessons where a student must repeat a series of steps to solve math problems. This has been the primary focus for me when teaching process steps. I’ve been able to integrate other visual skills such as accommodation, fixation, saccades, and hand-eye coordination skills thru math lessons. I honestly believe that ALL teachers should have to take a training on understanding the visual skills in play in the learning environment that is the classroom.

  10. Sanford says:

    I’m afraid I don’t get all of what you’re saying. What do you think should be (your words)… “the most important consideration when designing and implementing any type of activity (hands on or handout).” ? Are you saying that Gardner’s theory should be the most important consideration?

    Just because Gardner’s postulated a theory of intelligence styles that includes a Musical one, why do you think a metronome is useful for many people with math? What if you’re not high musical?

    I’m interested to hear how you use a metronome and would you use it during, say, long division (remembering a series of steps)? Is that it?

    Besides, while I appreciate your experience, this thread is about the root causes of reading and spelling difficulties. Care to weigh in there?

    Thanks for writing in.

  11. Pingback: Dyslexia – Phonics or Learning Difference Debate | 3D Learner Blog

  12. Bea says:

    Once everyone gets down from their “high horses” then perhaps the visual processing component of reading will be addressed. Unfortunately I don’t see this happening anytime soon. This battle has been going on for decades and I am afraid it will continue because those in the “know” whose expertise is funded with big money will always get the recognition. Perhaps that is why the underdogs in this debate (those who believe in the visual connections) will be seen as quacks offering cures. I am a reading specialist who knows that most of my struggling readers do have phonological awareness issues. HOWEVER, there are those children for whom phonology is NOT the issue and whose issues are based on visual perceptual differences. For once and for all – we NEED TO GET BEYOND THE DEBATE and actually accept that there is no ALL (no generalization) that works with our struggling readers.

    • Sanford says:

      The problems and impediments are plentiful. There’s rigidity from all quarters. I introduced this with an admission that the rigidity exists on “both sides.” That said, a lot of the blame in my opinion is on folks who overstate the impact of visual processing on reading difficulties. There’s a lot of money involved to be sure again from all sides, but since the overwhelming indicators signify the weightiness of the language processing and phonological aspect, most attention should be there.

      I say let’s do away with the debate. It’s old news. There are visual aspects to learning and they can obviously be a help or a hindrance. Much of reading struggle is either language processing-based and phonological or “visual-to -verbal.” The last part, “visual to verbal” is crucial to this discussion. Dr. Martha Denckla from the Kennedy Krieger Institute, who along with Maryann Wolf from Tufts, created the Rapid Automatized Naming Test, articulates this very well. Besides the speech and language aspect, reading is “look-say” “look-say.” Even much of the visual component is not actually visual only…it’s the brain’s processing in nano seconds, and the movement from seeing the symbol on the page to instantaneously attaching a verbal or phonological label to it. People who struggle in this area have difficulty rapidly accessing the phonological information (like the names and sounds of letters) that may be already stored in a longer term memory bank. That’s fundamentally a dyslexic profile. When there’s also issues with phonemic awareness you have the infamous “double deficit.”

      Of course, if there are visual problems, and they do exist, statiscally they are in a minority when it comes to reading problems.

      The problems occur in the professional community, when over generalizations occur in contradiction to evidence. On both sides. Not every person who struggles with readng and spelling have dyslexia and phonological issues. Just most.

      Children are the casualties of the rigidity and avoidance of reading the research. Frankly these battles keep us from focusing on the other crucial area. How do we keep kids from feeling like they’re broken and only their deficits? We have to spend as much time letting them develop passions and strengths.

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