ADD / ADHD, Dore Achievement Centres, Dyslexia, Science

Mind Hacks points to a good article on the current state of research into the effectiveness of biofeedback on ADHD. Its conclusion that biofeedback is a promising but unproven treatment is fair one.

What is interesting about the article is that it talks about what makes a good research study and delves into the problems of having a control group. In medication trials the control group takes a placebo pill, an inert sugar pill, whilst the study group takes the real medication. Both pills look the same and none of the medical staff handing out the pills know who is getting what. This minimises the confounding variables in the experiment.

In biofeedback studies, the problem is what to do you do with the control group. The treatment typically consists of 30 minutes a day using a computer and a biofeedback device. The control group needs to have a dummy treatment that is identical so that no one knows who is getting the real treatment but yet is guaranteed to have no effect. By its nature, biofeedback is an interactive process so the control group must have some sort of interactive experience. A device that just randomly responses to the the biofeedback would be quickly spotted.

This problem, when applied to a treatment such as the Dore program, becomes even more significant. Dore is series of exercises forming a 12 month program of twenty minutes a day. What activity could be used as a placebo that isn’t immediately recognised as the placebo? The only possibility would be to give one group the proper Dore exercises whilst the control group gets a random selection of exercises. But, the random exercises are too much like the real thing and there is a chance they help develop the cerebellum. Though they certainly would not be as effective it would introduce an unknown variable into an experimental set-up designed to remove unknowns.

A secondary problem is that children are assessed every six weeks under Dore using sensitive balance and eye-tracking devices. The child gets regular empirical evidence that the treatment is having an effect long before any improvements are seen in academic work. Obviously the users of the placebo should not see any improvement and this could have a significant effect on the child’s general confidence.

There is a way to conduct trials in these situation. You have two treatment groups, A and B plus a control, Group C. Group A gets the treatment whilst Group B gets a different activity, for example one-to-one help for 20 minutes a day. Group C gets no treatment. After Group A has received the treatment, the groups switch so Group B get the treatment and Group A gets the other activity. Once Group B has completed the treatment the experiment ends.

Both Groups A and B should of made more academic progress than the control Group C because of the one-to-one help they received and confounding variables such as the Placebo and Hawthorne effects. If the treatment worked better than the one-to-one help, then Group A would be expected to show academic improvements during the first period greater than Group B. This progress would slow down in the second period after the two groups switched roles and Group B would catch-up. If the treatment did not work, Group B would be ahead after the first period thanks to the one-to-one help and Group A would catch-up in during the second period.

There are some obviously difficulties in using this experimental design with Dore. Firstly it is a year long treatment. That means the whole experiment will last two years. To allow for people to move schools or drop out without having a major impact on the statistics, each group needs to be quiet large. Given that for the two treatment groups, there is a lot of investment of time in doing the exercises or taking children to the one-to-one sessions, the drop-out rate is likely to very high. Each group would probably need to start with about 50 people.

The cost of all this is significant. One-to-one teaching everyday for 50 people for year, twice, won’t be cheap. Nor will provision of the Dore treatment. Overheads in managing the experiment, tracking the academic performance of the children all add up. A gold standard experiment like this costs tens of thousands of pounds. Of course if Wynford Dore pays for the experiment then it won’t be an independent study but no one else will fund the experiment. The only dyslexia research body with that sort of funding is the department at York University. It is run by Professor Snowling who is rabidly opposed to Dore so its unlikely that any funding will come from there.

Another problem with an experiment on Dore is an ethical one. Asking a child to take part in a drug trial for four weeks is OK because if the treatment has no benefit then the child isn’t effected in anyway. For a Dore trial, the child has to spend twenty minutes a day for a year. If the treatment doesn’t work then the child has lost a huge amount of time and effort that could of been spent on more established therapies and the child would of fallen even further behind academically. This is major problem as the basis of any ethical experiment is that in no way, regardless of the experiment’s outcome, should the subjects experience any detrimental effects.

There are good reasons to criticise Dore’s scientific research and similar research by other alternative treatment but it has to be seen in context. The practicalities of an effective study that proves in one go the treatment works are both difficult and expensive. Dore and others are stuck in a catch-22 situation where if they pay for research there will be immediate accusation of bias but if they don’t pay for it, no one else will. Finally the ethical issues make the whole feasibility of an experiment doubtful.

Source: How Strong is the Research Support for Neurofeedback in Attention Deficits?

Dore Achievement Centres, Dyslexia, Dyslexia Treatment, Science

Myself and a reader going under the name of Tom, are having a discussion on the Dore Treatment. Tom is very much against Dore and has described it as a “con”. He has also accused me of promoting Dore for money and that I am lying about my treatment and subsequent improvement. You can read all this on iPhone Plays Guitar or via the Myomancy Forum.

One of the interesting points that has arisen out of this discussion is the idea that any improvement in my dyslexia has been caused by the placebo effect.

The placebo effect is defined as “…occur[ing] when a patient’s symptoms are altered in some way (i.e., alleviated or exacerbated) by an otherwise inert treatment, due to the individual expecting or believing that it will work. “. The two important elements are that the patient receives a totally inert treatment and that the patient’s symptoms really change.

The placebo effect is normally found in relation to physical medical problems ranging from common colds to cancer. Alternative medical treatments such as homeopathy and faith healing rely on the placebo effect for most of their benefits. It is also common practice in drug trials to give half the patients the real drug to be tested and the other half a sugar pill placebo. It is then possible to compare the results from the real drug to the placebo and work out how much more effective the real drug is. These drug trails regularly show 20%-30% of people on the placebo show an improvement of symptoms. In some cases, such as drugs designed to control pain, up to 75% of people on the placebo reported less pain. The placebo effect is very real and may be far more important to how effective drugs are than the big pharmaceutical companies would like you to know.

It is important to note that there is no evidence that the placebo effect actually cures anything. They can make you feel better by reducing pain or other symptoms and this can have a knock-on effect. A patient with less pain may be more positive and more active and this can help the bodies natural healing process. Another vital aspect of the placebo effect is that it wears off. A placebo only works because the patient believes it is going to work. After they have been taking a placebo for sometime the patient will begin to question why their illness hasn’t been cured. Once this loss of faith occurs the placebo loses its symptom reducing effects.

To apply this to dyslexia we have to identify the ‘disease’ and the ‘symptoms’. If the Dore Treatment is a placebo, the symptoms should reduces in intensity for a while but then return because the underlying problem or ‘disease’ still remains. Most dyslexia experts believe that dyslexia, the ‘disease’, is caused by a fundamental difference in the brain that cannot be changed. The ‘symptoms’ of this disease are reading problems, poor spelling, poor handwriting and poor short-term memory. Because the ‘disease’ is an unchangeable flaw, these symptoms can only be ameliorated. If a placebo works on dyslexia then we would expect one or more of those symptoms to show improvement and then return to its previous levels once the effect is lost.

A patient receiving a dyslexia treatment placebo might well do better in a spelling test than before because they believe they are being cured. This success would boast their confidence, helping them to learn new words and to make further progress in the next test. But if dyslexia is a lifelong condition that can only be ameliorated then this cycle of progress can only continue until the limits on the patient’s ability, placed on them by the underlying ‘disease’, are reached. Once this limit is reached the patient would lose faith in the placebo, the placebo effect would stop working, levels of confidence would drop and most of the improvements seen would disappear.

This does not appear to be the case. My own, other people’s anecdotal evidence, and research by Dore shows that the improvements gained whilst on the treatment remain and further improvements are seen after the treatment has stopped. Though the treatment has certainly not worked for some, no one has reported seeing significant improvements and then losing them once treatment stops.

This persistence of improvement is the clear sign that the Dore treatment is not working through a placebo effect but is making a permanent change in the brain.

None of this proves the underlying hypothesis of the Dore treatment that dyslexia is caused by an under-developed cerebellum or that the Dore treatment does anything but boast the patient’s confidence. But because the effects of the treatment are permanent it cannot be described as a placebo effect.

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Autism, Autism and Mercury, Autism Treatment, Dore Achievement Centres, Dyslexia

Are we too quick to medicate children?, a good round-up of the issue from the Las Angeles Times. Whilst The Guardian has a piece on the rise of students using brain boosting drugs such as Ritalin

The Spoof! has a short piece on PHADD (Pseudo Hyperactivity Attention Deficit Disorder)

Questionable Study Claims ADHD is Under-Diagnosed

Good Vibrations, a new, drug-free treatment for ADHD?

Understanding Chelation therapy, a brief round-up of this dubious autism therapy.

National Institutes of Health will intensify its efforts to find the causes of autism.

No explanation for ‘scary’ rise in autism in New Zealand

A Dore Program presentation at the Hallowell Center in Sudbury, MA.

Experts Demand End to Child Drugging in the US.

Shire reveals the effect size for it ADHD medication, Vyvanse.

Study on Concerta shows significant effect on ADHD sufferers.

Dore Achievement Centres, Dyslexia, Television

I predict a lot of publicity (good and bad) for Wynford Dore and his Dore Treatment Centres over the coming weeks. The ex-Rugby player who has been on the Dore program to treat his dyslexia is appearing on Strictly Come Dancing. Kenny Logan has spoke out about hows the Dore program changed everything on several occasions. Wynford Dore has stated that Kenny Logan (and fellow celeb Toya Wilcox) that they attended the program as ordinary customers and were not approached by Dore.

Source: Rugby Star Kenny Logan On Strictly Come Dancing

ADD / ADHD, Dore Achievement Centres, Dyslexia, Dyslexia Treatment

In the Journal of Pediatrics and Child Health, Professor Dorothy Bishop of the Department of Experimental Psychology at Oxford University has written an article questioning the validity of research done on the Dore Program.

Abstract: Dore Achievement Centres are springing up world-wide with a mission to cure cerebellar developmental delay, thought to be the cause of dyslexia, attention-deficit hyperactivity disorder, dyspraxia and Asperger’s syndrome. Remarkable success is claimed for an exercise-based treatment that is designed to accelerate cerebellar development. Unfortunately, the published studies are seriously flawed. On measures where control data are available, there is no credible evidence of significant gains in literacy associated with this intervention. There are no published studies on efficacy with the clinical groups for whom the programme is advocated. It is important that family practitioners and paediatricians are aware that the claims made for this expensive treatment are misleading.

This isn’t the first time the research has been questioned and most recently it lead to five people resigning from the Dyslexia Journal’s editorial board. Though there are questions about why only those five, out of twenty plus board members, resigned.

Professor Bishop has a long and notable history of research into dyslexia, ADHD and autism. This includes research relating to motor control, timing and language problems that did find that a genetic problem could cause both language and motor problems.

A timed peg-moving task was used to assess motor skill. Children with combined speech and language impairments obtained poorer peg-moving scores than unaffected children. Bivariate DeFries-Fulker analysis found significant shared genetic variance for impairments on peg-moving and on a test of nonword repetition. It is concluded that genes that put the child at risk for communicative problems also affect motor development, with the association being most evident when speech production is affected.

Without access to the full text of Professor Bishop’s article its impossible to say how fair her criticism of the Dore research is. There are certainly problems with the research relating to control groups and how the children’s progress was measured but all research has issue, especially when dealing with children and a treatment that takes 12 months to complete. Check out this recent research that showed that many medical research papers have miscalculation, poor study design or self-serving data analysis to gauge the difficulties in producing research that cannot be criticised. As ever we need more research before we can find the truth.

Sources:
Curing dyslexia and attention-deficit hyperactivity disorder by training motor co-ordination: Miracle or myth?Motor immaturity and specific speech and language impairment: Evidence for a common genetic basis

Dore Achievement Centres, Dyslexia

Remember those scientists who resigned over publication of research into the Dore Program? At the time it was odd that only five or the twenty or so experts on the Dyslexia Journal’s expert panel resigned. If the research was of such poor quality why didn’t all the experts resign? This suggested that there was something going on over and above a simple dispute about a scientific paper.

Now we have some more information. The five people who resigned are:

According to a Sunday Time article, they resigned because of “concerns over apparent conflicts of interest” and “[the paper’s author’s] working relationship with Angela Fawcett, editor of Dyslexia”. As these are the stated reasons I think it is worth examining the connections between the five rebels.

  • Professors Snowling and Hulme are married to each other
  • Snowling and Hulme (plus one other) jointly received a £1.26M research grant from the Wellcome Trust
  • Snowling, Hulme, and Hatcher all work in the same department in York University. In fact Snowling and Hulme (along with two others) run the department and control its budget
  • Rack is the Dyslexia Action’s Head of Assessment and Evaluation whilst Snowling is an Honorary Fellow
  • Rack works in Dyslexia Action’s York office which is based in York University close to Snowling’s, Hulme’s and Hatcher’s officers
  • On her department’s website, Uta Frith lists Snowling as a collaborator
  • All five have written and published papers with each other on numerous occasions including one attacking the Dore program

There is nothing unusual or wrong about these connections. Pick any five scientists working in the same field and you will find similar connections. This is how science works. What is wrong is for this gang of five to carry out a cheap stunt in order to criticise others for potential conflict of interests and close working relations when they themselves enjoy a similar situation.

The real reason behind the gang of five’s resignation is simply professional rivalry. All five have spent many years doing research into phonic based treatments of dyslexia so naturally they are against Dore’s approach that potentially invalidates their life’s work. Such rivalry is healthy and has characterised many of the great scientific debates but cheap stunts and newspaper articles should play no part in science.

Dore Achievement Centres, Dore Sport

Dore Sports has launched as training program for sportsmen. Its based on the Dore Program for dyslexia and ADHD and is a logical move for Wynford Dore’s company.

The original Dore training program focuses on the cerebellum, an area of the brain related to processing information and physical control. Through a series of exercises taking around 12 months, this area of the brain is improved. For a dyslexic or ADHD sufferer this brings the cerebellum up to normal ability levels allowing them to learn skills such as reading or self-control.

For sportsmen and women, who for the most part already have a good cerebellum, Dore Sports takes it to the next level. Just as a the right physical exercise program can allow a coach-potato to run a marathon, the right training program can turn an average athlete into a world-class athlete.

Dore Sports is aimed at professionals and those who want to become professional. There are no details given on the website about costs but its is likely to around the £3000 for a year’s treatment.

Dore Achievement Centres, Dyslexia, Dyslexia Treatment

Ever since I started Myomancy, I’ve been banging on about the cerebellum as the cause of dyslexia. Quite reasonably, many people asked why the cerebellum, an area of the brain linked that controls muscles, should have anything to do with dyslexia but I couldn’t give them a good answer.

Now I can, thanks to research found by BrainBlog

The paper looks at how the cerebellum is involved in speech and is based on clinical observations and fMRI data. Here is part of the abstract (emphasis added).

Recent functional imaging data point at a contribution of the right cerebellar hemisphere, concomitant with language-dominant dorsolateral and medial frontal areas, to the temporal organization of a prearticulatory verbal code (‘inner speech’), in terms of the sequencing of syllable strings at a speaker’s habitual speech rate. Besides motor control, this network also appears to be engaged in executive functions, e.g., subvocal rehearsal mechanisms of verbal working memory, and seems to be recruited during distinct speech perception tasks. Taken together, thus, a prearticulatory verbal code bound to reciprocal right cerebellar/left frontal interactions might represent a common platform for a variety of cerebellar engagements in cognitive functions. The distinct computational operation provided by cerebellar structures within this framework appears to be the concatenation of syllable strings into coarticulated sequences.

Translated, this mean that the cerebellum and speech / language areas of the brain are tightly connected in a cross lateral way. e.g. right side of the cerebellum links to left frontal lobe. This connection effects many aspects of speech and also the ability to decode what is being said by others.

Anyone who has a problem with this connection will have problems pronouncing words and differentiating between different but similar phonemes. e.g. ph / th / v / f. This is exactly the sort of problem many dyslexics have. The research didn’t look into how the cerebellum effects spelling but learning to speak and hear different phoneme is vital to learning to spell (hence the whole phonics movement).

This is only small step to proving how cerebellum exercise programs such as Dore tackle dyslexia but it is an important step. It clearly links the cerebellum to how we use and understand the sounds that make up our language.

Study Abstract: The contribution of the cerebellum to speech production and speech perception: Clinical and functional imaging data

Dore Achievement Centres, Web/Tech

Back in December 2006, I wrote that Dore needed to create a public forum to discuss their treatment.

By creating a public space that anyone can post to, Dore is saying to the world that they don’t need to sell the product because it is so good it sells itself. Those scientists and others who attack Dore for bad science or for being overly commercial will have to explain why so many customers are writing about how it helped them. By placing everything in the public domain, by allowing potential customers to decide for themselves, Dore could do away with his sales people, saving Dore hundreds of thousands a year, allowing him to reduce his prices and making the Dore Program even more popular.

In June, Dore launched a forum to do just this. Looking in on it today I can see that in the ten weeks since its launched, 29 people have posts 101 messages. This isn’t very many for a company with 25+ treatment centers around the world and a product that on other ADHD / Dyslexia forums, the very mention of it can produce 100’s of comments.

So what is wrong with the forums?

The front page is disaster. Rather than being about Dore its about the software running the forums. This is insane. Its like opening a brand new shop and leaving the windows full of adverts for the shop-fitters. This is going to confuse and put off first time visitors to the website and the forum cannot afford to do that because its getting so few visitors.

How do I know its getting few visitors? Because there are no links to the forums from anywhere, let alone Dore’s own websites. There is no link from Dore’s UK site, Dore’s Australian site, Dore’s US site or it’s New Zealand site. All these websites have ‘News’ sections and the launch of a public Dore forum is the perfect material to go in them. On top of that, on the front page of every single Dore site there should be link in big letters saying ‘Find out what people on the programme are saying in the Dore Talk forums’. Finally Dore should get in touch with blogs that cover ADHD and dyslexia. There are quite a number out there and many would link to the forums.

All these links will drive people to the forums and that will go a long way to making the forums what they need to be but it takes more that lots of visitors to make it a success. Over time, forums develop a sense of community and make them a place people visit to find out information but stay because they enjoy the company. You cannot create or buy a community spirit like that but you can encourage it. Dore staff should be posting something new everyday. Hints for getting the exercises done, success stories, personal observations from having watched 100’s of people do the programme. The forum has to look alive to entice people to stay.

It is early days for the forum but their future looks dim if Dore cannot get its act together enough to link its own websites to the forums.

Dore Achievement Centres, Dyslexia, Dyslexia Treatment

A documentary shown on BBC 2 in February about welsh rugby legend Scott Quinnell undertaking the Dore program is on Google Video. Quinnell’s Last Test follows him and his children through a year of treatment for dyslexia. Scott is severally dyslexic and his two children are both struggling with their school work.

Anyone thinking of doing the Dore Program should watch this 30 minute video. It shows exactly how the program works and highlights the effort and drive needed to do the exercises every day for a year. In one part, Scott talking is to Kenny Logan, himself a veteran of the Dore treatment and an international rugby player. They compare notes on their exercises and Kenny reveals the lengths he went to so he could hide his treatment from the his fellow players because he was afraid of ridicule.

Quinnell completes the treatment program and is moved to tears when talking about the program and the benefit it has had on his life.