How Promising is the New Dyslexia Treatment?

In 2019, a grassroots campaign led by parents succeeded in passing a wave of dyslexia treatment legislation. Many states mandated hallmarks of the Orton-Gillingham method, specifically calling for “multisensory” instruction, to help students with dyslexia read and write better.* In New York, the city spends upwards of $300 million a year in taxpayer funds on private school tuition for children with disabilities. Much of it goes to pay for private schools that specialize in the Orton-Gillingham dyslexia treatment, which families insist are necessary to teach their children with dyslexia to read.

But two recent academic papers, synthesizing dozens of reading studies, are raising questions about the effectiveness of these expensive education policies. A review of 24 studies on the Orton-Gillingham method, published in the July 2021 issue of the peer-reviewed journal Exceptional Children, found no statistically significant benefit for children with dyslexia. Instead, suggesting a way forward, a review of 53 reading studies, led by University of Virginia researcher Colby Hall and published online September 2022 in Reading Research Quarterly, found that much cheaper reading interventions for children with a variety of reading difficulties were also quite effective for children with dyslexia.

There’s no litmus test for dyslexia and education experts say the diagnosis covers a range of reading problems. Orton-Gillingham is one of the oldest approaches to help struggling readers, dating back to the 1930s, and it explicitly teaches letters and sounds, and breaks words down into letter patterns. It also emphasizes multisensory instruction. For example, students might learn the letter “p” by seeing it, saying its name, and sounding it out while tracing it in shaving cream.

“We have this approach that’s so deeply rooted in legislation and in policy and practice, but we don’t have the evidence base to support it,” said Elizabeth Stevens, an assistant professor at Georgia State University, and the lead author of the 2021 Orton-Gillingham study. “The thinking is that Orton-Gillingham is the magic bullet, the thing that these students need. But Colby’s paper says, ‘No, these other reading interventions that explicitly teach these foundational skills significantly improve reading outcomes.’ These students can benefit from other interventions.”

The implication is that maybe children diagnosed with dyslexia don’t need something that is substantially different from children with other reading struggles. This theory still needs to be tested. No well-designed research study has compared a dyslexia treatment such as Orton-Gillingham head-to-head with more general interventions for children who struggle in reading.

More than 2 million children, nearly 3 out of 10 who receive special education services in the United States, have been diagnosed with dyslexia or a closely related reading disability. Getting the dyslexia treatment right is important, not only to help these children read and write, but to spend taxpayer funds on helping them efficiently. Monica McHale-Small, director of education at the Learning Disabilities Association of America, and previously with the International Dyslexia Association, said there’s a “growing consensus” that Orton-Gillingham approaches aren’t necessarily what all children with dyslexia need. “The research is there,” she said. “You can’t deny the findings of multiple studies.”

Many dyslexia advocates remain loyal to Orton-Gillingham, McHale-Small said, because so many parents have kids whom they believe were helped by Orton-Gillingham tutors. Meanwhile, it remains out of reach for many low-income families. Orton-Gillingham dyslexia treatment involves very expensive teacher training, she said, which many schools cannot afford. McHale-Small experienced the costs firsthand when she was superintendent of the Saucon Valley school district in Pennsylvania and participated in a pilot study in 2016-17. The American Institutes for Research, a nonprofit research group, found no statistical benefits for these multisensory interventions in a 2018 report.

“Science evolves. Science has to be taken seriously,” said Maryanne Wolf, director of the Center for Dyslexia, Diverse Learners and Social Justice at UCLA and author of Proust and the Squid, a book about how the brain learns to read. “We don’t need emphasis on ‘multisensory’; we need emphasis on being explicit, systematic and after all of the components of language in our interventions.”

The researchers in both the 2021 and 2022 studies all cautioned that the jury is still out on Orton-Gillingham. Better quality studies may still prove the method to be effective with children with dyslexia. Stevens had to throw out more than 100 of the studies she found; many were poorly designed, didn’t compare children who didn’t receive the treatment and didn’t measure outcomes well. In the end, she reviewed only 24 of the better Orton-Gillingham studies and just 16 had enough numbers to include in her calculations. Several of these were rather small, as few as 10 or 12 participants. That’s such a small number of children that it makes it hard to derive any meaningful conclusion from them.

“The corpus of studies included in our meta-analysis were not very high quality,” said Stevens. “We need to do more high-quality research to fully understand the effects of that approach on the reading outcomes for students with dyslexia.” The larger 2022 analysis of 53 reading interventions had a higher bar for study quality and only one Orton-Gillingham study made the cut. Several of the reading interventions that marketed themselves as “multisensory” also made the cut, but the researchers didn’t detect any extra benefits from them. “They weren’t more effective than the ones that didn’t market themselves as multisensory,” said Hall.

The good news is that most of the 53 reading interventions were effective and they had more similarities than differences. They were administered to children as either one-to-one tutoring sessions or in small groups. And they tended to provide direct, explicit step-by-step reading and writing instruction which includes not just traditional phonics but practice with clusters of letters, tricky vowel patterns and sounds. This is in sharp contrast with a teaching approach based on the belief that children can learn to read naturally if they are surrounded by books at their reading level and get lots of independent reading and writing time.

“Systematic instruction works for kids,” said Emily Solari, a prominent reading expert and a professor at the University of Virginia, who was part of the 12-member research team on the 2022 study. “That is what we need to do for kids with dyslexia and for word reading difficulties.” Researchers noticed good outcomes for several commercial interventions, such as Lexia Core5, Sound Partners, and Rave-O. Many non-commercial interventions were effective too, including Sharon Vaughn’s Proactive Reading intervention and Jessica Toste’s Multisyllabic Word Reading Intervention + Motivational Belief Training. Toste’s method isn’t sold commercially, but the University of Texas associate professor gives it away free to teachers upon request.

In the meta-analysis, there were hints that spelling instruction may be especially beneficial to students with dyslexia. Frequency appeared to matter too. “There’s been decades of research to show that we actually need to do really intensive intervention with these kids, not just two days a week for 20 minutes,” said Solari. “They need evidence-based core instruction, and then they need more. And often it’s a lot more.” The researchers could not ascertain a minimum threshold or dosage for effectiveness. That still needs to be studied.

Allison Green
Boston Tutoring Services