Recently, I had a patient with some delayed cognitive development and a confirmed dyslexia diagnosis referred to me by one of our providers. According to the IEP, the student is receiving the Edmark Reading Program at their school. When asked why the school is using this specific program for this particular student, the parents informed me that this was all the school had to offer in terms of reading interventions. The student is showing progress with recognizing sight words using the Edmark Reading Program, but still struggles with reading and comprehension on their own. That being said, the parents are interested in getting a private tutor that offers Orton-Gillingham based services with the Wilson Reading Program.

My question is your professional opinion on utilizing multiple reading interventions. In this particular case, I know that the student isn't receiving multisensory interventions with the Edmark program at school. I, personally, have never had a family that wants to utilize two programs at once, but it piqued my curiosity. Say, hypothetically, that a student was using two separate Orton-Gillingham based programs simultaneously. In your experience, is there any detriment or positive to this? Is it too messy? Are there any articles or studies that have explored this topic and any effectiveness on its practice?

Dr. Pierson's Response: 

First, I’m surprised that a student with “delayed cognitive development” has a diagnosis of dyslexia. Dyslexia is a “...deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities…” (Lyon, Shaywitz, & Shaywitz, 2003, Annals of Dyslexia, p. 2). A student with a cognitive disorder who has challenges with reading would be identified with a reading disorder, not dyslexia. That said, the intervention for reading would be the same, but the student with the cognitive disorder would, most likely, also need spoken language intervention, which the student with dyslexia does not need as their language skills, particularly in comprehension, are intact. The fact that you wrote that the student still struggles with reading and comprehension tells me that this student may indeed need language therapy in addition to reading intervention.

I do not know of any research that answers your question about teaching two programs simultaneously. I do know that I would recommend that the student not be provided with Leveled Literacy Intervention (Fountas & Pinnell), as it is not suitable for the student with dyslexia and can actually produce negative effects for students with phonological and orthographic processing difficulties.

Here is a piece on Edmark. The authors concluded that the Edmark program promotes phonological awareness skills, which may have been the case in their small group (i.e., only 30 students). It appears, though, that the program focuses on whole words rather than letter-sound connections, which is what structured literacy programs emphasize and students with dyslexia need. It is true that students do need to learn the words that do not follow typical orthographic rules, but in many of the cases of “rule breakers” (e.g., the silent -e in have does not make the ‘a’ say its long sound, as would be the rule), we still teach rules when applicable. So, if a student spelled have “hav,” we would explicitly teach that words do not typically end with V in English; V at the end of a word needs a silent e. We have students learn a “memory hook” for unusual spellings (e.g., "Oh you lucky dog" for could, would, should).

I do have anecdotal evidence based on my experience working with students with dyslexia in my private clinical practice. A number of my clients see another practitioner (e.g., tutor, special education teacher) in addition to working with me. Some interventionists are trained in structured literacy and others are not. Many use a structured literacy-based program, such as the Wilson Reading System or Project Read. I do not use one specific program, but pull fom different ones depending on the student’s needs at any given time. Given that we know intensive intervention has the best outcomes for students with language-based learning disorders, the more we can give these kids the better, but that said, it does need to be the right programs/techniques. The International Dyslexia Association (IDA) has termed the intervention for students with dyslexia as structured literacy. For example, Orton-Gillingham is a structured literacy approach.

I think the key to using more than one program with a student is that all practitioners are using the same language and, as much as possible, targeting the same skills. I could see where it could be very confusing to a student if too much is being introduced and/or we are using different language to talk about concepts. With my clients who are also seeing someone else, we have regular email exchanges about what we are targeting. Sometimes, one person will focus on reading and the other writing; or one will target written language and the other spoken language. Regardless, we still need to coordinate the student's program and talk the same talk. Many times, I can ask my client, “Has your tutor talked about X?,” and get a pretty good idea whether the concept has been introduced or targeted. I also try to make connections with potential different words being used -- “So does your teacher call this Magic -e or Bossy -e?” when I am teaching silent -e. Again, I find that my students can answer those types of questions. So, all of this is to say that I think it is doable for different practitioners to use different programs to target reading and spelling. But, I think having everyone talking is key.