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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.

Please.