Dore (dyslexia treatment)

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The Dore programme, previously known as DDAT (Dyslexia Dyspraxia Attention Treatment) is a drug-free course of treatment for dyslexia and other learning difficulties which has aroused controversy among researchers and doctors in Britain and elsewhere. It consists of a series of exercises designed to develop the functions of the cerebellum. Dore was developed on the principle that the cerebellum coordinates brain functions and therefore plays an essential role in the learning process.

In May 2008 Dore Australia went into voluntary administration;[2][3][4] later in the same month Dore closed all their UK centres due to financial problems.[5][6]

Contents

[edit] Introduction

The development of DDAT was initiated by businessman Wynford Dore. It is reported that when his daughter was diagnosed with severe dyslexia and he saw the negative impact the condition had on her life he decided to invest in research to try to find an effective drug-free treatment.

According to Dore, conditions such as dyslexia, dyspraxia, ADD, Aspergers Syndrome and ADHD were linked to Cerebellar Developmental Delay (CDD)[7], a condition in which neural pathways between the cerebrum and cerebellum do not develop fully, leading to an impairment of the brain’s ability to coordinate nerve impulses. Dore states that he believed that it could be possible to treat some learning difficulties by developing these neural pathways, and that he hired specialists to develop a programme of practical exercises targeted towards cerebellar development.

[edit] The Dore method

The theory behind the Dore method is that skills such as reading and writing become automatic because the learning process eventually leads to the development of neural pathways specifically for these tasks. Its proponents argue that research suggests that while the cerebellum becomes less active once a skill has been learned, it nonetheless retains much of its neural plasticity i.e. the ability to develop new synaptic connections and neural pathways. They claim to be able to stimulate the development of the pathways affected by CDD and to strengthen the connections between the cerebrum and cerebellum.

The programme consists of a series of balance and coordination exercises which are carried out twice a day, typically for around twelve months. The programme is individually designed for each patient based on interpretation of the results of tests of cerebellar function. These tests are designed to measure balance (posturography) and eye tracking (Electronystagmography). Changes in the patient's abilities are charted by repeating these tests regularly throughout the program.

[edit] Effectiveness

No studies on efficacy with the target clinical groups have been published in a peer-reviewed medical journal, and where control data are available there is no credible evidence of significant gains in literacy associated with the Dore programme.[1]

[edit] Criticism

[edit] Of the treatment

The treatment has been much criticized, for two main reasons:

First, Dore's research[2] was poorly conducted. For example, it did not make effective use of its control group. There is also no independent rigorous research. This means that there is no reliable evidence about the effectiveness of the Dore method. A number of papers published in the British Dyslexia Association's journal have found the only piece of apparently independent academic research Dore initially offered in support of their treatment to be poorly designed and unreliable. According to an article published in the Times Educational Supplement in 2004, many of Britain's foremost academics maintain that the results are inconclusive. Critics have also pointed out that the research was carried out by a previous director of another Wynford Dore company, and so may not be independent. Several bodies, including the Dyslexia Action, have recommended that the exercises in DDAT be shared so that they can be tested objectively in a clinical-type trial with proper sample quality and control groups.

Second, there is no evidence that motor training influences higher-level skills; for example, if training coordination, balance, and motor skill had the hypothesized effect, then children good at sports like skateboarding should have a low rate of dyslexia and ADHD, an effect that has not been observed. One reviewer concluded, "It is important that family practitioners and paediatricians are aware that the claims made for this expensive treatment are misleading."[1]

The cost involved in following the Dore programme has also been criticised.[3]

[edit] Of misleading claims

Claims were made and widely publicised that the Dore method used physical training methods for astronauts used by the US National Aeronautics and Space Administration (NASA)[8]. NASA responded to that claim, saying that they were not conducting research into dyslexia, and had no evidence that any of their interventions might be effective in treating dyslexia[9].

The UK's Independent Television Commission and Ofcom upheld complaints made about a 2002 news item on British television in which Sir Trevor McDonald hailed DDAT as a "breakthrough in the treatment of dyslexia". It repeated this decision about a later item on Richard and Judy, and found a television commercial made by DDAT to be in breach of Advertising Standards Code Rules for creating a false impression of the medical evidence, and implying that professional medical advice and support would be part of the treatment. In all these cases, however, they stated that: "the ITC does not express, nor does it seek to express, any view whatsoever on DDAT as an organisation or the relative efficacy of its treatment for dyslexia, neither of which was the subject of this finding."[4] The complaints were mainly about claims that this was new and pioneering research when many elements date back to at least 30 years before the DDAT was founded.[5]

After the British journal Dyslexia published one paper about the Dore program in 2003,[6] the paper was followed by ten critical commentaries[7] and one commentator resigned from Dyslexia's editorial board.[1] In 2006, five members of the board of directors resigned in protest of the publication of a followup article highly favorable of Dore, citing concerns about the methodology used in the study and financial conflicts of interest due to Dore's involvement in funding the research.[8] The editor of Dyslexia defended the decision to publish.[9]

A very detailed criticism of the Dore treatment and publicity was published by Ben Goldacre[10].

[edit] References

[edit] Notes

  1. ^ a b c Bishop DV (2007). "Curing dyslexia and attention-deficit hyperactivity disorder by training motor co-ordination: miracle or myth?". J Paediatr Child Health 43 (10): 653–5. doi:10.1111/j.1440-1754.2007.01225.x. PMID 17854448. 
  2. ^ Reynolds D, Nicolson RI, Hambly H (2003). "Evaluation of an exercise-based treatment for children with reading difficulties" (PDF). Dyslexia 9 (1): 48–71. doi:10.1002/dys.235. PMID 12625376. 
  3. ^ "UK company claims breakthrough ADHD treatment", ABC, 08-01-06. 
  4. ^ Chris Tregenza. "TV Complaints Upheld About DDAT", Myomancy, 06-07-2004. 
  5. ^ "[1] Balancing act]", The Guardian, 07-16-02. 
  6. ^ Reynolds D, Nicolson RI, Hambly H (2003). "Evaluation of an exercise-based treatment for children with reading difficulties" (PDF). Dyslexia 9 (1): 48–71. doi:10.1002/dys.235. PMID 12625376. 
  7. ^ Critical commentaries of Reynolds et al. 2003:
  8. ^ Swinford S. "Scientists quit in dyslexia ‘cure‘ row", Sunday Times, 2006-11-26. Retrieved on 2008-04-10. 
  9. ^ EL(3)-09-07 : Paper 2 : Evidence to the Committee on Dyslexia Support in Wales - Professor Angela Fawcett - Director of the Centre for Child Research, Swansea University

[edit] External links