Dore (dyslexia treatment)

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 the medical establishment in Britain. 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.

Introduction
The development of DDAT was initiated by successful businessman Wynford Dore. 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), 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 believed that it could be possible to treat some learning difficulties by developing these neural pathways. He hired specialists to develop a programme of practical exercises targeted towards cerebellar development.

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.

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. In 2006, the Daily Telegraph reported that in an unpublished trial (funded by Wynford Dore) of the programme on inmates at Stafford prison, 87% reported improvements in reading, writing, memory, concentration and co-ordination. However, these results are yet to be appear in a peer reviewed journal and as such, should be interpreted with a considerable degree of caution.

Criticism
The treatment has been widely criticized by the scientific community, for two main reasons. First, the Dore research was poorly conducted (for example, it did not make effective use of its control group) and there is no independent rigorous research. Second, Dore's suggested mechanism of action is not credible, as there is no evidence that motor training influences higher-level skills; for example, if training 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."

A number of papers published in the British Dyslexia Association's journal, have found the only piece of 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 wholly independent after all. The only other evidence for the effectiveness of the programme comes mainly from tabloid newspaper testimonials, featuring minor celebrities among other non-experts. Several bodies, including the Dyslexia Institute, 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.

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." 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.

In 2006, five members of the board of directors of the British Journal Dyslexia resigned in protest of the publication of subsequent research article following the progress of children treated with the Dore program, again citing concerns about the methodology used in the studies and financial conflicts of interest due to Dore's involvement in funding the research. . However some questions have been raised about the motivation of these five scientists as all five are involved in a rival theory relating to phonics.

The cost involved in following the DORE programme has been criticised although Wynford Dore argues that he has personally subsidised the research and development of the treatment and continues to do so.