Leading dyslexia treatment isn’t a magic bullet, studies find, while other options show promise

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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 solution 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 involves very expensive teacher training, she said, which many schools cannot afford. McHale-Small experienced the costs first hand when she was superintendent of the Saucon Valley school district in Pennsylvania and participated in a pilot study of Orton-Gillingham 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.

One of the trickiest things about studying dyslexia is defining it and determining who has it. Experts disagree. Some insist it is a genetic condition, but there is no genetic test. Others say a child’s environment can cause it. Others believe it is neurobiological, but it is difficult to determine whether a reading difficulty is neurological in origin. The belief that children with dyslexia see letters backwards is a debunked myth of the past, but there is little agreement on what it is exactly.

When I interviewed the researchers behind the 2022 meta-analysis on reading interventions, they explained to me that dyslexia, or word reading difficulty, falls along a continuum. “People think of dyslexia like a broken leg, you either have it or you don’t,” said Hall. “But dyslexia and word reading difficulties are more like high blood pressure. It still needs to be addressed, but it’s a different way of thinking about it.”

In the 2021 and 2022 studies, researchers defined dyslexia as having “word-level reading difficulties.” Some children were formally diagnosed with dyslexia and others hadn’t been diagnosed, but they scored in the bottom 25 percent in basic word recognition, reading fluency and spelling. Dyslexia is generally distinguished from comprehension difficulties, but there is often overlap. Some children with word reading difficulties have excellent comprehension.

Both McHale-Small at the Learning Disabilities Association and Wolf at UCLA believe that there are various types of dyslexia and each may need different interventions. Not every child diagnosed with dyslexia struggles to sound out words, for example.  “The minute you see reading fluency problems, that is beyond phonics,” said Wolf. “Over time, some of those kids just don’t need that decoding emphasis.”

“We need more research,” said McHale-Small. “We know a lot about dyslexia but we need to know a lot more.”

Millions of children and their parents are waiting for an answer.