3 Dyslexia
Q
2 The policy
60. In May 2008, the Secretary of State for Children,
Schools and Families, the Rt Hon Ed Balls MP, asked Sir Jim Rose:
to make recommendations on the identification
and teaching of children with dyslexia, and on how best to take
forward the commitment in the Children's Plan to establish a pilot
scheme in which children with dyslexia will receive Reading Recovery
support or one-to-one tuition from specialist dyslexia teachers.[75]
61. Sir Jim Rose's report ("the Rose Report")
was published in June 2009. Sir Jim commented:
The Children's Plan made it clear that the Government
wants every child to succeed, and it hardly needs to be said that
the ability to read well is key to success in education and an
essential 'life skill'. Moreover, reading and writing are closely
related, and both are dependent on the development of children's
speaking and listening capabilities. As the review explains, responses
to overcoming dyslexia and other developmental difficulties of
language learning and cognition must be robust and set within
high quality provision for securing literacy for all children,
especially in primary schools.[76]
62. Sir Jim went on to make 19 recommendations that
required action by DCSF and a number of non-government bodies.
Those aimed at DCSF included suggestions that the Department should:
- fund a number of teachers to
undertake specialist training in teaching children with dyslexia
so that access to specialist expertise can be improved across
local authorities and schools will form partnerships to share
expertise;[77]
- cancel the pilot scheme in which children with
dyslexia will receive Reading Recovery support (see paras 78-79);[78]
and
- work with partners to develop additions to the
delivery of Every Child a Reader and other interventions, particularly
to make them more focussed on phonic work.[79]
63. The Government accepted and endorsed all of Sir
Jim's recommendations[80]
and made available £10 million to support their implementation,
including funding for the training of 4,000 specialist dyslexia
teachers.[81]
Our expectations of the evidence
base
64. Literacy difficulties are common and complex.
There are a range of reasons why a person may find it difficult
to read and write and many of these are claimed to be dyslexia.
Given that this is a matter of dispute, the first part of the
evidence base must be to define what is meant by dyslexia. What
should we expect of a definition of dyslexia? First and foremost,
the definition should make it possible to differentiate between
people who have dyslexia and people who do not; that is, make
diagnosis possible. A secondary consideration is contextual: dyslexia
has to be considered in an academic sense (the physiological causes
and cognitive manifestation of dyslexia as well as the tools that
can be used to manage it) and in a practical educational sense
(what difficulties the teacher will have to overcome in order
to teach a dyslexic child to teach, and following on from that,
what techniques a classroom teacher will employ to teach a child
to read). A good definition of dyslexia will take context into
account.
65. Following a definition, we are looking for an
evidence-base for how best to teach dyslexic children to read.
In terms of the kinds of evidence that we are looking for, it
is much the same as for general literacy interventions. The best
kind of trial design is the randomised controlled trial (RCT).
The best kind of data is standardised scores that have statistical
power and comparative value (see para 19). It is obvious but worth
saying that we are looking for trials specifically on teaching
dyslexic children to read, not just poor readers.
The Evidence Check
Defining dyslexia
66. Given the prevalence of people who have been
diagnosed as dyslexic, we expected that it had been well defined.
In fact, defining dyslexia has proved very difficult. A European
Union European Social Fund review of developmental dyslexia concluded
that "Dyslexia can be defined in more ways than one, but
each definition outlines a different concept".[82]
The authors went on to define seven different ways in which a
person might be described as dyslexic:
- Either people are 'dyslexic'
if they have alphabetic skills deficits (Seymour, 1986; Stanovich,
1996).
Or people are 'dyslexic' if they have severe
and persistent difficulty in acquiring alphabetic skills, even
though their difficulties might be attributable to moderate learning
difficulties or sensory impairments (British Psychological Society,
1999).
Or people are 'dyslexic' if they experience difficulty
in attaining fluency by automatising word-recognition skills,
so long as that difficulty can be attributed, at least in part,
to a constitutional factor (Gersons-Wolfensberger & Ruijssenaars,
1997).
Or people are 'dyslexic' if their difficulty
in acquiring alphabetic skills cannot be attributed to any more
probable explanation (such as moderate learning disability or
sensory impairment), especially if that explanation relates to
experience or opportunity; and this definition is 'exclusionary'
(World Federation of Neurology, 1968).
Or, with a difference of emphasis, people are
'dyslexic' if their difficulty in acquiring alphabetic skills
is accompanied by specific neurological impairments, no one of
which may be necessary or sufficient for diagnosis; and this definition
is 'inclusionary' (Miles, 1982).
Or people are 'dyslexic' if they show a characteristically
uneven pattern of facility and difficulty; this definition, too,
is inclusionary (Miles, 1983).
Or people are 'dyslexic' if they share a secondary
characteristic with others who have difficulty in acquiring alphabetic
skills, even if they do not experience this difficulty themselves
(Miles, Wheeler, & Haslum, 2003).
67. The Rose Report acknowledged these problems with
definitions and the Expert Advisory Group[83]
constructed a "working definition for the review that includes
key characteristics".[84]
- Dyslexia is a learning difficulty
that primarily affects the skills involved in accurate and fluent
word reading and spelling.
Characteristic features of dyslexia are difficulties
in phonological awareness, verbal memory and verbal processing
speed.
Dyslexia occurs across the range of intellectual
abilities.
It is best thought of as a continuum, not a distinct
category, and there are no clear cut-off points.
Co-occurring difficulties may be seen in aspects
of language, motor co-ordination, mental calculation, concentration
and personal organisation, but these are not, by themselves, markers
of dyslexia.
A good indication of the severity and persistence
of dyslexic difficulties can be gained by examining how the individual
responds or has responded to well-founded intervention.[85]
68. According to Dyslexia Action, a charity and provider
of educational services for people with dyslexia and learning
difficulties, this definition has received "universal acclaim
and agreement" and it has "been adopted by all the dyslexia
organisations".[86]
69. There is, however, a small group of people who
argue that the term 'dyslexia' is not useful. Professor Elliott
and Dr Gibbs have argued that "attempts to distinguish between
categories of 'dyslexia' and 'poor reader' or 'reading disabled'
are scientifically unsupportable [and] arbitrary".[87]
It is worth recounting the main thrust of their argument at length:
It is also perhaps something of a paradox that
determined advocates for the value of the label will readily agree
that the nature of the underlying difficulties experienced by
dyslexics can be highly diverse. The list of possible underlying
difficulties typically found in the dyslexia literature is lengthy
[…]: speech and language difficulties, poor short-term (or
working) memory, difficulties in ordering and sequencing, clumsiness,
a poor sense of rhythm, limited speed of information processing,
poor concentration, inconsistent hand preference, poor verbal
fluency, poor phonic skills, frequent use of letter reversals
(d for b, for example), a difficulty in undertaking mental calculations,
low self-image, and anxiety when being asked to read aloud.
The weakness of such lengthy lists is that they
routinely fail to offer meaningful differentiations. Similar items
to those listed above are often found in lists of signs of other
developmental conditions such as attention deficit hyperactivity
disorder or dyspraxia. […] Furthermore, many features seen
as indicative of dyslexia can be found in people who have no significant
literacy difficulties, and may be evident in poor readers who
are not considered to be dyslexic. Many difficulties that are
seen as typical of dyslexics are also found in younger normal
readers who read at the same age level […]. This suggests
that such problems are more characteristic of a certain stage
of reading development, than representing pathological features.[88]
70. In oral evidence, Professor Elliott argued that
Sir Jim's definition of dyslexia borders on tautology:
It is interesting you talk about the definition.
'Dyslexia is a learning difficulty that primarily affects the
skills involved in accurate and fluent word reading and spelling.'
Basically that is almost tautology because you could put those
words to 'reading difficulties' in there if you wanted to.[89]
71. The Rose Report's definition of dyslexia is
exceedingly broad and says that dyslexia is a continuum with no
clear cut-off points. The definition is so broad and blurred at
the edges that it is difficult to see how it could be useful in
any diagnostic sense.
DEFINING DYSLEXIA IN AN EDUCATIONAL
CONTEXT
72. Educationalists have long known that some people
struggle to read, even though all other aspects of their cognitive
abilities are normal. This phenomenon is what led researchers
to study this area and seek to identify and define dyslexia in
the first place. From an academic point of view it is interesting
as problems with phonological decoding, verbal memory and verbal
processing speed can occur across the full range of intellectual
abilities. It is worthy of research that the dyslexic continuum
exists with co-occurring difficulties—to use Sir Jim's definition—such
as motor coordination, mental calculation and concentration. Studies
on twins have shown that reading difficulties are heritable, and
molecular data point to a site on the short arm of chromosome
6, among other genetic loci.[90]
73. But we are specifically interested in the Government's
policy for diagnosing and managing dyslexia in the real world,
in schools. We therefore asked whether diagnosing a child with
dyslexia will have any impact on the educational support that
he or she receives. As we have noted, the Government has promised
"funding for around 4,000 teachers to train in appropriately
accredited specialist dyslexia teaching".[91]
We wanted to establish that the Government was planning to provide
a separate approach to teach dyslexic children, as opposed to
children with other kinds of reading difficulties, so we checked
with the Minister:
Dr Iddon: So the Government has a separate
policy for dyslexics once dyslexia is diagnosed?
Ms Johnson: One of the recommendations
out of the Sir Jim Rose report on dyslexia was around having specialist
dyslexia teachers to work with children who have been diagnosed
with dyslexia, so yes.[92]
74. We found a definition of 'specialist dyslexia
teaching' in the Rose Review, quoting Thomson (1990)[93]
who had identified the following features common to most specialist
teaching programmes:
Multisensory—by which is meant the active
and interactive integration of visual, auditory, kinaesthetic
and tactile elements of teaching and learning.
Cumulative.
Sequential.
Progressive.
Small steps.
Logical.
Over-learning (by which is meant the systematic
use of repetition, both within and between lessons, in the attempt
to ensure that newly acquired skills and material are automatised,
consolidated in memory, so that they can be readily applied or
recalled when needed, and will not be disrupted or confounded
by subsequent lesson material).[94]
75. We asked the experts from whom we took evidence
if there was anything in this definition that was not found in
teaching practices for all students who struggle with reading.
Shirley Cramer, CEO of Dyslexia Action, told us:
If you are talking about a six-year-old who is
struggling with literacy you will be doing the same. In fact,
we [Dyslexia Action] have programmes ourselves where we work with
mainstream education and we use our multi-sensory teaching techniques
and phonological awareness with all the children. We do not care
why they are struggling with reading.[95]
76. This brings us back to the problem of the definition.
As Professor Elliott put it:
The definition in this report is so amorphous
and so difficult to operationalise and to utilise that in a sense
when you are looking at it across countries it is not really much
of an issue for me. The question is: How useful is this differentiation
of the dyslexic as opposed to other youngsters who present with
reading problems?[96]
77. The answer we reached was that it is not useful
from an educational point of view. There is no convincing evidence
that if a child with dyslexia is not labelled as dyslexic, but
receives full support for his or her reading difficulty, that
the child will do any worse than a child who is labelled as dyslexic
and then receives specialist help. That is because the techniques
to teach a child diagnosed with dyslexia to read are exactly the
same as the techniques used to teach any other struggling reader.
There is a further danger that an overemphasis on dyslexia may
disadvantage other children with profound reading difficulties.
We conclude that 'specialist dyslexia teachers' could be renamed
'specialist literacy difficulty teachers'. There are a range of
reasons why people may struggle to learn to read and the Government's
focus on dyslexia risks obscuring the broader problem. The Government's
support for training teachers to become better at helping poor
readers is welcome and to be supported, but its specific focus
on 'specialist dyslexia teachers' is not evidence-based.
TEACHING DYSLEXIC CHILDREN TO READ
78. DCSF's 2007 Children's Plan set aside
funding for "a pilot scheme in which children with dyslexia
will receive Reading Recovery support or one-to-one tuition from
specialist dyslexia teachers".[97]
However, Dr Singleton has argued in his extensive 2009 review
that Reading Recovery was unlikely to be effective for the teaching
of dyslexics:
Literature searches failed to uncover any published
evaluations of Reading Recovery being used with dyslexic pupils.
To decide the question whether Reading Recovery actually works
for children with dyslexia therefore requires further research.
However, dyslexic children, by definition, have specific problems
in acquiring effective knowledge of letter-sound relationships
and of the rules that govern these, and in order to become independent
readers who can tackle unfamiliar words, they are likely to need
more rather than less intensive instruction in phonics. In consequence,
it is unlikely that Reading Recovery—in which the teaching
of phonics is less than systematic and which enables only a rather
small proportion of children taught by this method to tackle unfamiliar
words—would be an effective intervention for dyslexia.[98]
79. Following this advice, the Rose Report recommended
that the "dyslexia pilots proposed in the Children's Plan
should not go ahead",[99]
which the Government accepted.[100]
80. So what method should be used? Sir Jim Rose,
citing Dr Singleton's review of dyslexia interventions,[101]
concluded:
There is a well established evidence-base showing
that intervention programmes which systematically prioritise phonological
skills for reading and writing are effective for teaching reading
to children with dyslexia. […] Intervention sessions for
dyslexia therefore need to have a strong, systematic phonic structure.[102]
81. We have reservations about this conclusion, given
Dr Singleton's summary of the evidence in his report: "few
of the phonics-based interventions […] have been evaluated
specifically with children who have dyslexia".[103]
He also noted that "Few of the studies in this field conform
to methods that may be described as 'gold standard' (i.e. randomised
control trials)".[104]
We have already noted (para 78) that none of the Reading Recovery
studies looked at its impact specifically on children with dyslexia.[105]
82. We are left concerned that, as with the wider
issue of reading interventions, the trial qualities in this area
are not of a sufficiently high standard. Sir Jim's assessment
of the existing evidence base—namely that a systematic phonic
structure to teaching dyslexic children to read is the best approach—is
probably correct, but there is a clear need for properly constructed
trials, in which children who have been identified as dyslexic
are matched against proper control groups and subjected to a range
of different interventions. We recommend that future research
on the impact of literacy interventions on children with dyslexia
should be well designed randomised controlled trials, using appropriate
control groups (including children with other reading difficulties
and 'normal' children), and test a range of literacy interventions.
Policy drivers
83. When we asked the Minister why dyslexic children
receive a label that identifies their particular (in theory) problem,
but other children do not, she replied:
Clearly the dyslexia lobby has been very clear
that they wanted to have identified the particular concerns and
conditions of dyslexia and that is why the Government decided
to ask Sir Jim Rose to look particularly at dyslexia and to look
at the evidence.[106]
84. This is an interesting admission: that the Government
decided to spend time and money looking specifically at dyslexia
because of the strength of the dyslexia lobby, rather than because
of any pre-existing, well researched, well defined problem. We
have demonstrated the range of difficulties in this area: that
dyslexia is so broadly defined that it encompasses a continuum
of reading difficulties that have little if any relation to specific
literacy interventions; and that the research in this area is
not of the highest quality. The Minister's admission explains
why teachers who are being trained to help all children with reading
difficulties are labelled 'specialist dyslexia teachers'. We
recommend that the Government be more independently minded: it
should prioritise its efforts on the basis of research, rather
than commissioning research on the basis of the priorities of
lobby groups.
75 The Rose Report, 2009, p 8 Back
76
The Rose Report, 2009, p 1 Back
77
The Rose Report, 2009, p 23 Back
78
The Rose Report, 2009, p 26 Back
79
The Rose Report, 2009, pp 25-26 Back
80
HC Deb, 22 June 2009, col 41WS Back
81
Ev 101 Back
82
M. Rice & G. Brooks, Developmental dyslexia in adults:
a research review, European Union European Social Fund, 2004,
p 17 Back
83
The Expert Advisory Group to the Rose Review included Dr Singleton
and Professor Brooks, who gave oral evidence to the Committee,
as well as Professor Stuart who submitted a written memorandum. Back
84
The Rose Report, p 29 Back
85
The Rose Report, 2009, p 30 Back
86
Ev 22 [Dyslexia Action] para 1.7 Back
87
J.C. Elliott & S. Gibbs, "Does Dyslexia Exist?"
Journal of Philosophy of Education, Vol. 42 (2008), p 475 Back
88
J.C. Elliott & S. Gibbs, "Does Dyslexia Exist?"
Journal of Philosophy of Education, Vol. 42 (2008), p 483 Back
89
Q 78 Back
90
The Rose Report, p 37 Back
91
Ev 101 Back
92
Q 189 Back
93
M. Thomson, Developmental Dyslexia (3rd edition), 1990 Back
94
The Rose Report, pp 89-90 Back
95
Q 90 Back
96
Q 78 Back
97
DCSF, The Children's Plan: Building brighter futures, December
2007, p 9 Back
98
Chris Singleton, Intervention for Dyslexia, 2009, p 11 Back
99
The Rose Report, p 15 Back
100
Ev 101 Back
101
Chris Singleton, Intervention for Dyslexia, 2009 Back
102
The Rose Report, p 14 Back
103
Chris Singleton, Intervention for Dyslexia, 2009, p 120 Back
104
Chris Singleton, Intervention for Dyslexia, 2009, p 7 Back
105
Chris Singleton, Intervention for Dyslexia, 2009, p 118 Back
106
Q 195 Back
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