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Reading difficulties: Research and
treatment
Associate Professor Genevieve McArthur
ARC Australian Research Fellow
(Macquarie Centre for Cognitive Science)
ARC Centre for Cognition and its Disorders
Making evidence-based decisions about the diagnosis and
treatment of dyslexia
Outline
The importance of reviewing the scientific evidence: Data collection
The diagnosis of dyslexia
different ways to diagnosis of dyslexia
myths about dyslexia
how to make an evidence-based diagnosis of dyslexia
Treatments for dyslexia
how to make an evidence-based decision about treatment
“causal” treatments
reading treatments
The importance of reviewing the scientific evidence: The Results
The importance of scientific evidence
Which of these statements – commonly made in the media – are supported by the weight of scientific evidence? True = 1 False = 2
1.You should floss your teeth to reduce tooth decay and gum disease
2.You should take a regular dose of vitamin C to prevent colds
3.You should get a flu shot
4.You should reduce your salt intake to improve your blood pressure
5.You should eat a high-fibre diet to prevent colon cancer
6.You should take gingko to prevent dementia
7.You should drink at least eight glasses of water per day (tea and coffee does not count)
8.You should drink red wine - but not white wine or beer
9.You should stretch before or after exercise to prevent muscle soreness
Outline
The importance of scientific evidence: Data collection
The diagnosis of dyslexia
different ways to diagnosis of dyslexia
myths about dyslexia
how to make an evidence-based diagnosis of dyslexia
Treatments for dyslexia
how to make an evidence-based decision about treatment
“causal” treatments
reading treatments
The importance of scientific evidence: The Results
✓
Research DSM4 Response to Intervention
Descriptive
What is impaired?
Reading ReadingSensation ~AcademiaEveryday reading
ReadingResponse to intervention
Reading
What is unimpaired?
NVIQSensationEducationNeurologyLanguage ~
IQEducation
Diagnostic tests
ReadingNVIQHearingVisionEducation historyLanguage ~
ReadingIQHearingVisionAcademiaEveryday readingEducation history
ReadingResponse to intervention
Reading
Different ways to diagnose dyslexia
Myths about dyslexia
More boys than girls have dyslexia
If you reverse letters (d for b or p) then you have dyslexia
People with dyslexia are more likely to be left-handed
People with dyslexia are unusually intelligent
People with dyslexia are unusually artistic
So … how are you supposed to diagnose dyslexia?
Use an evidence-based model of reading
regular words:
BOOTSee word
‘boot’Spoken word production
Letter identification 1
8007BOOT
P D D LB O O TLetter identification 2
B-O-O-TB-OO-TParsing
‘p’ ‘u’ ‘b’‘b’ ‘oo’ ‘t’Letter-sounds
‘b’ ‘oot’‘boot’Blending
‘fruit’‘boot’Spoken word planning
irregular words:
BOOKSee word
“book”Spoken word production
Letter identification 1
BOOK
B O O KLetter identification 2
B-OO-KParsing
’b oo kLetter-sounds
’ ‘book’Blending
‘book’Spoken word planning
“book”
BOOK Written word rep
‘book’
‘book’ Spoken word rep
Meaning
See word
Spoken word production
Letter identification 1
Letter identification 2
Parsing
Letter-sounds
Blending
Spoken word planning
Written word rep
Spoken word rep
Word meaning
Lexic
al
Sig
ht-
word N
onle
xica
lPhonics
to read regular and irregular words you need:two reading routesthat work at the same timethat work equally well
See word
Spoken word production
Letter identification 1
Letter identification 2
Parsing
Letter-sounds
Blending
Spoken word planning
Written word rep
Spoken word rep
Word meaning
Lexic
al
Sig
ht-
word N
onle
xica
lPhonics
but sometimes they don’t:
but bad at phonics reading (nonlexical) =
phonological dyslexia
some good at sight-word reading (lexical)
but bad at sight-word reading (lexical)=
surface dyslexia
some good at phonics reading (nonlexical)
many bad at sight-word reading (lexical)
and bad at phonics reading (nonlexical)=
mixed dyslexia
See word
Spoken word production
Letter identification 1
Letter identification 2
Parsing
Letter-sounds
Blending
Spoken word planning
Written word rep
Spoken word rep
Word meaning
Lexic
al
Sig
ht-
word N
onle
xica
lPhonics
Irregular-word
Reading CC2
Non-word
Reading CC2
need to assess:two reading routes
CC2 www.motif.org.aueach component
✗✗✗
Outline
The importance of scientific evidence: Data collection
The diagnosis of dyslexia
different ways to diagnosis of dyslexia
myths about dyslexia
how to make an evidence-based diagnosis of dyslexia
Treatments for dyslexia
“causal” and reading treatments
how to make an evidence-based decision about treatment
an evaluation of “causal” and reading treatments
The importance of scientific evidence: The Results
✓
✓
Commercial treatments for dyslexia
“Causal” treatments Reading treatments
Dorothy Bishop
dystalk.com/talks/60-evaluating-alternative-solutions-for-dyslexia
Introductions to evidence-based decisions about treatment
Ben Goldacre
http://www.youtube.com/watch?v=O1Q3jZw4FGs
Step 1: Find a systematic review
Review of all properly controlled studies of a treatment
Done by an independent expert
not a journalist
not a private company
not connected with the company (e.g., Rod Nicolson and Dore)
Some sources
Cochrane Reviews
Google Scholar
What Works Clearinghouse ~
MUSEC Briefings
Step 2: DIY systematic review
Coltheart, M., & McArthur, G. M. (In Press). Neuroscience, education and educational efficacy research. In M. Anderson and S. D.Sala (Eds.), Education in Neuroscience Oxford, UK: Oxford University Press.http://deevybee.blogspot.com/2010/08/three-ways-to-improve-cognitive-test.html
no control group
control group
Significantly bigger reading gains in
treated group than control group
No difference in reading gains in
treated and control groups
Large gains in reading scores in the
treated group
Small gains in reading scores in the
treated group
Step 3: Use indirect evidence
e.g. Eye Q > reading
Evidence that the same type of treatment (other brand) improves
reading
Evidence that the treatment itself (Eye Q) improves a factor (fatty
acids) that has been scientifically proven to improve reading
Evidence that the same type of treatment (other brand) improves
a factor (fatty acids) that has been scientifically proven to
improve reading
Coltheart, M., & McArthur, G. M. (In Press). Neuroscience, education and educational efficacy research. In M. Anderson and S. D.Sala (Eds.), Education in Neuroscience Oxford, UK: Oxford University Press.
Step 4: Ignore brain data
Brain data cannot tell us if an educational treatment works or not
Focus on the behavioural evidence (i.e., reading behaviour)
If a program did not improve reading but did change the brain, would you pay good money to buy it?
If a program did improve reading but did not change the brain, would you not buy it?
Coltheart, M., & McArthur, G. M. (In Press). Neuroscience, education and educational efficacy research. In M. Anderson and S. D.Sala (Eds.), Education in Neuroscience Oxford, UK: Oxford University Press.
Step 5: Ignore anecdotes
Biased sample
Subjective data
Cognitive dissonance
Coltheart, M., & McArthur, G. M. (In Press). Neuroscience, education and educational efficacy research. In M. Anderson and S. D.Sala (Eds.), Education in Neuroscience Oxford, UK: Oxford University Press.
Commercial treatments for dyslexia
“Causal” treatments Reading treatments
Program 1. Systematic review
2. DIY review 3. Indirect evidence
NA 2 studiesReading not tested
The effect of PA on reading contentious
Strong et al. 2010~ 10 studiesNo effect
Hyatt et al. 2009A few studiesNo effect
Bishop 2007A few studiesNo effect
NA NA Working memory can be trained but its effect on reading unknown
Hyatt 2007A few studiesNo effect
Program 1. Systematic review
2. DIY review 3. Indirect evidence
NA NA Phonics has small to moderate effect on dyslexia
NA NA Phonics has small to moderate effect on dyslexia
WWCA few studiesSmall effect
NA NA Phonics has small to moderate effect on dyslexia
NA NA Phonics has small to moderate effect on dyslexia
Outline
The importance of scientific evidence: Data collection
The diagnosis of dyslexia
different ways to diagnosis of dyslexia
myths about dyslexia
how to make an evidence-based diagnosis of dyslexia
Treatments for dyslexia
how to make an evidence-based decision about treatment
“causal” treatments
reading treatments
The importance of scientific evidence: The Results
✓
✓
✓
Which of these statements – commonly made by the media – are supported by the weight of scientific evidence? True = 1 False = 2
1. You should floss your teeth to reduce tooth decay and gum disease
2. You should take a regular dose of vitamin C to prevent colds
3. You should get a flu shot
4. You should reduce your salt intake to improve your blood pressure
5. You should eat a high-fibre diet to prevent colon cancer
6. You should take gingko to prevent dementia
7. You should drink at least eight glasses of water per day (tea and coffee does not count)
8. You should drink red wine - but not white wine or beer
9. You should stretch before or after exercise to prevent muscle soreness
The importance of evidence: The evidence
✗✗
✗
✗✗
✗
✗✗
✗
This above all: to the scientific evidence be true,
and it must follow, as the night the day,
thou are less likely to be false to any man (or woman or child)
(Shakespeare … kind of)
Thank you