The Dore Programme: evaluation
1 like2,277 views
The document critically evaluates the Dore Programme, an exercise-based treatment claimed to cure dyslexia and ADHD by addressing cerebellar developmental delay. It highlights the lack of credible evidence supporting the program's efficacy, with identified flaws in published studies and misleading claims. The conclusion emphasizes that family practitioners should be cautious of the Dore Programme's assertions, which are not substantiated by rigorous scientific research.
![2
The Dore Programme
Conditions such as developmental dyslexia, ADHD, dyspraxia and Asperger’s disorder
are of considerable clinical importance: they are relatively common neurodevelopmental
disorders, which cause misery to children and their parents. Although there are
recognised approaches to treatment, more severe forms of disorder are not easy to
remediate [1] and many affected children will have life-long problems. According to
Wynford Dore, a businessman who started the Dore Achievement Centres, this need not
be so [2]. He maintains that he has not only identified the root cause of many learning
difficulties – Cerebellar Developmental Delay – but has also found a way to cure it.
Demand for the Dore Programme, a series of exercises done for around 10 minutes twice
a day, escalated after it was featured on UK national prime-time TV early in 2002, and
there are now 17 Dore Achievement Centres in Australia. Although most of the
promotion of the treatment is based on personal testimonials, these are backed up by
research. Dore [2] pointed to a study showing that treatment led to a nearly five-fold
improvement in comprehension, a three-fold improvement in reading age, and a 17-fold
improvement in writing. The programme costs around $A4000, but as Dore pointed out:
“Compare it to the price of braces for teeth, breast implants, a family holiday or
upgrading your car. Surely it is a price worth paying in the attempt to transform the life of
your child?” [2, p. 171].
Cerebellar basis of neurodevelopmental disorders
The notion that the cerebellum might be implicated in some children’s learning
difficulties is not unreasonable: both post-mortem and imaging studies have reported
cerebellar abnormalities [3]. Furthermore, some studies have reported behavioural
deficits involving balance and automatisation of motor skills in a subset of people with
dyslexia, consistent with a cerebellar deficit hypothesis. However, it is premature to
conclude that abnormal cerebellar development is the cause of dyslexia, rather than an
associated feature. Many people with dyslexia do not show any evidence of motor or
balance problems [4, 5]. Furthermore, the cerebellum is a plastic structure which can be
modified by training [6], raising the possibility that cerebellar abnormalities might be a
consequence of limited experience in hand-writing in those with poor literacy.
Dore, however, claims that “Cerebellar Developmental Delay” is the cause of
children’s problems, and that training skills mediated by the cerebellum will lead to
improvement in other domains (e.g. reading, social skills). Even Dore’s supporters note
that this requires “something of a leap of faith” [7, p. 52], given that the cerebellum
consists of many autonomous regions. Studies showing that cerebellar function can be
modified by training typically focus on improvement in the specifically trained skill. The
gaping hole in the rationale for the Dore Programme is a lack of evidence that training on
motor-coordination can have any influence on higher-level skills mediated by the
cerebellum. If training eye-hand co-ordination, motor skill and balance caused](https://image.slidesharecdn.com/doreannotationpdf-121027195029-phpapp01/85/The-Dore-Programme-evaluation-2-320.jpg)
![3
generalized cerebellar development, then one should find a low rate of dyslexia and
ADHD in children who are good at skateboarding, gymnastics or juggling. Yet several of
the celebrity endorsements of the Dore programme come from professional sportspeople.
Efficacy of the Dore Programme: the published research evidence
The journal Dyslexia has published two papers describing consecutive phases of a
research project conducted at a UK primary school [7, 8]. The first paper was followed
by nine critical commentaries, with one commentator resigning from the journal’s
Editorial Board. The second evoked an even stronger reaction, with five more
resignations. To understand the strength of this reaction, one needs to appreciate the
mismatch between what the data showed and what was claimed.
Children were selected for inclusion in the study because they had significant risk
scores on the Dyslexia Screening Test [9]. The design of the study was a randomized
controlled trial, with one group receiving the Dore Programme and the other receiving no
treatment. Although a placebo treatment would have been methodologically tighter, the
no-treatment group does control for important confounds, in particular the tendency of
children to improve with maturation, and with practice on the tests, and the possible
impact of other intervention they may be receiving. Testing of children before and after
the treatment phase was done blind to group status. Unfortunately, despite these
strengths, the study had some fatal weaknesses, the most serious of which was that the
control group was largely ignored when analyzing results and drawing conclusions from
the study. The only tests given to all children as part of the study were from the Dyslexia
Screening Test, a brief assessment intended to screen for children at risk of literacy
problems rather than providing a sensitive measure of individual differences. Because its
authors embrace a cerebellar theory of dyslexia, measures of bead-threading and balance
are included along with more conventional literacy tests in the criteria for identifying risk
for dyslexia. As shown in Figure 1, the data on literacy tests did not provide convincing
evidence for the efficacy of the Dore Programme; gains were common in the control
group as well as in the trained group, presumably reflecting practice effects.
Furthermore, despite random assignment, children in the treated group had lower initial
scores than those in the control group [10]. The only literacy test showing a significantly
larger gain in the treated group was a word reading test (‘one minute reading’), on which
the treated group had a lower score to start with and so more room for improvement. At
delayed follow-up, after the control group had received 6 months of treatment, their mean
score on this subtest fell relative to their pre-treatment percentile, failing to replicate the
2003 results [8].
The authors presented other relevant data from achievement tests given to the whole
school as part of regular educational assessments. However, the timing of these tests was
not synchronized with the study. This meant that there were no data corresponding to a
time when the treatment group had had intervention and the control group had not –
because the control group had embarked on treatment at the end of the first phase.
Accordingly, the authors presented the data only from the treated group. Although one of
the school measures came from a standardized reading test with good psychometric](https://image.slidesharecdn.com/doreannotationpdf-121027195029-phpapp01/85/The-Dore-Programme-evaluation-3-320.jpg)
![4
properties, the others were taken from Standard Assessment Tasks (SATS), which are
blunt instruments involving some subjective judgement by teachers [11]. On these
measures there were no control data, and the authors made the dubious assumption that
they could assess treatment effects by dividing the gain seen in the year after treatment
with gain seen in the year before treatment. It is from these analyses that the remarkable
claim comes that there is a 17-fold increase in writing skills after treatment: this is the
figure one ends up when comparing mean SATS scores of 2.53 (July 2000), 2.56 (July
2001) and 2.95 (July 2002) using the method described above. Without control data it is
impossible to tell whether such changes are meaningful, especially since the SATS were
administered by different teachers in different years. In the 2007 paper [8] the authors
present further reading test data, and mention a parental checklist of attention-deficit
symptoms which decline after treatment. Again, there are no control data, so we cannot
know whether this is age-related change. After all, children’s shoe size will have
increased during the study, yet we would not conclude that the intervention made their
feet grow. There is nothing here to justify the claims made that the Dore Programme is
more effective than state-of-the-art medication for ADHD [2], especially in view of the
fact that only one child in the study had an ADHD diagnosis.
The data in Figure 1 emphasise another odd feature of this study. The Dore
programme is marketed as a cure for dyslexia, a condition that is usually diagnosed by
demonstrating a significant mismatch between general ability and literacy skills. One
would expect a child with this diagnosis to have marked problems on literacy measures
(typically one SD or more below age level, corresponding to 16th percentile). The mean
scores of the children in this study were better than this, consistent with the fact that only
a minority of them had diagnoses of specific learning difficulties.
The 2003 paper also reported data on the vestibular and postural tests used at Dore
Achievement Centres to diagnose cerebellar problems and determine treatment.
However, the authors noted that there were no norms for children on these tests. One is
left wondering how these measures can be interpreted in a diagnostic setting.
Overall, family doctors and paediatricians need to be aware that the published
evidence does not support the claims of a “Miracle Cure”: on the contrary, the data from
comparisons of treated and control groups lead to considerable scepticism that the
intervention improves anything other than those skills that are trained in the exercises.](https://image.slidesharecdn.com/doreannotationpdf-121027195029-phpapp01/85/The-Dore-Programme-evaluation-4-320.jpg)
![6
Figure legend
Figure 1
Mean percentile scores on literacy measures from Dyslexia Screening Test for treated and
control children from Reynolds et al [7]. Standard errors were not provided by the
authors. Significant interactions between group and pre-post test were found only for
word reading, where Treated group had lower scores on pre-test.
Treated Control
Word reading Word reading
Spelling Spelling
pre-test pre-test
Writing Writing
post-test post-test
Nonword Nonword
reading reading
Phoneme Phoneme
segmentation segmentation
0 20 40 60 80 0 20 40 60 80
mean percentile mean percentile](https://image.slidesharecdn.com/doreannotationpdf-121027195029-phpapp01/85/The-Dore-Programme-evaluation-6-320.jpg)
The Dore Programme: evaluation
- 1. 1 Preprint of: Bishop, D. V. M. (2007). Curing dyslexia and attention-deficit hyperactivity disorder by training motor co-ordination: Miracle or myth? Journal of Paediatrics and Child Health, 43, 653-655. doi: 10.1111/j.1440- 1754.2007.01225.x Annotation: Curing dyslexia and ADHD by training motor co-ordination: Miracle or myth? D. V. M. Bishop Abstract Dore Achievement Centres are springing up worldwide with a mission to cure Cerebellar Developmental Delay (CDD), thought to be the cause of dyslexia, attention-deficit hyperactivity disorder (ADHD), 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. Keywords: Dyslexia, Attention Deficit Hyperactivity Disorder, Cerebellum, Treatment, Exercise
- 2. 2 The Dore Programme Conditions such as developmental dyslexia, ADHD, dyspraxia and Asperger’s disorder are of considerable clinical importance: they are relatively common neurodevelopmental disorders, which cause misery to children and their parents. Although there are recognised approaches to treatment, more severe forms of disorder are not easy to remediate [1] and many affected children will have life-long problems. According to Wynford Dore, a businessman who started the Dore Achievement Centres, this need not be so [2]. He maintains that he has not only identified the root cause of many learning difficulties – Cerebellar Developmental Delay – but has also found a way to cure it. Demand for the Dore Programme, a series of exercises done for around 10 minutes twice a day, escalated after it was featured on UK national prime-time TV early in 2002, and there are now 17 Dore Achievement Centres in Australia. Although most of the promotion of the treatment is based on personal testimonials, these are backed up by research. Dore [2] pointed to a study showing that treatment led to a nearly five-fold improvement in comprehension, a three-fold improvement in reading age, and a 17-fold improvement in writing. The programme costs around $A4000, but as Dore pointed out: “Compare it to the price of braces for teeth, breast implants, a family holiday or upgrading your car. Surely it is a price worth paying in the attempt to transform the life of your child?” [2, p. 171]. Cerebellar basis of neurodevelopmental disorders The notion that the cerebellum might be implicated in some children’s learning difficulties is not unreasonable: both post-mortem and imaging studies have reported cerebellar abnormalities [3]. Furthermore, some studies have reported behavioural deficits involving balance and automatisation of motor skills in a subset of people with dyslexia, consistent with a cerebellar deficit hypothesis. However, it is premature to conclude that abnormal cerebellar development is the cause of dyslexia, rather than an associated feature. Many people with dyslexia do not show any evidence of motor or balance problems [4, 5]. Furthermore, the cerebellum is a plastic structure which can be modified by training [6], raising the possibility that cerebellar abnormalities might be a consequence of limited experience in hand-writing in those with poor literacy. Dore, however, claims that “Cerebellar Developmental Delay” is the cause of children’s problems, and that training skills mediated by the cerebellum will lead to improvement in other domains (e.g. reading, social skills). Even Dore’s supporters note that this requires “something of a leap of faith” [7, p. 52], given that the cerebellum consists of many autonomous regions. Studies showing that cerebellar function can be modified by training typically focus on improvement in the specifically trained skill. The gaping hole in the rationale for the Dore Programme is a lack of evidence that training on motor-coordination can have any influence on higher-level skills mediated by the cerebellum. If training eye-hand co-ordination, motor skill and balance caused
- 3. 3 generalized cerebellar development, then one should find a low rate of dyslexia and ADHD in children who are good at skateboarding, gymnastics or juggling. Yet several of the celebrity endorsements of the Dore programme come from professional sportspeople. Efficacy of the Dore Programme: the published research evidence The journal Dyslexia has published two papers describing consecutive phases of a research project conducted at a UK primary school [7, 8]. The first paper was followed by nine critical commentaries, with one commentator resigning from the journal’s Editorial Board. The second evoked an even stronger reaction, with five more resignations. To understand the strength of this reaction, one needs to appreciate the mismatch between what the data showed and what was claimed. Children were selected for inclusion in the study because they had significant risk scores on the Dyslexia Screening Test [9]. The design of the study was a randomized controlled trial, with one group receiving the Dore Programme and the other receiving no treatment. Although a placebo treatment would have been methodologically tighter, the no-treatment group does control for important confounds, in particular the tendency of children to improve with maturation, and with practice on the tests, and the possible impact of other intervention they may be receiving. Testing of children before and after the treatment phase was done blind to group status. Unfortunately, despite these strengths, the study had some fatal weaknesses, the most serious of which was that the control group was largely ignored when analyzing results and drawing conclusions from the study. The only tests given to all children as part of the study were from the Dyslexia Screening Test, a brief assessment intended to screen for children at risk of literacy problems rather than providing a sensitive measure of individual differences. Because its authors embrace a cerebellar theory of dyslexia, measures of bead-threading and balance are included along with more conventional literacy tests in the criteria for identifying risk for dyslexia. As shown in Figure 1, the data on literacy tests did not provide convincing evidence for the efficacy of the Dore Programme; gains were common in the control group as well as in the trained group, presumably reflecting practice effects. Furthermore, despite random assignment, children in the treated group had lower initial scores than those in the control group [10]. The only literacy test showing a significantly larger gain in the treated group was a word reading test (‘one minute reading’), on which the treated group had a lower score to start with and so more room for improvement. At delayed follow-up, after the control group had received 6 months of treatment, their mean score on this subtest fell relative to their pre-treatment percentile, failing to replicate the 2003 results [8]. The authors presented other relevant data from achievement tests given to the whole school as part of regular educational assessments. However, the timing of these tests was not synchronized with the study. This meant that there were no data corresponding to a time when the treatment group had had intervention and the control group had not – because the control group had embarked on treatment at the end of the first phase. Accordingly, the authors presented the data only from the treated group. Although one of the school measures came from a standardized reading test with good psychometric
- 4. 4 properties, the others were taken from Standard Assessment Tasks (SATS), which are blunt instruments involving some subjective judgement by teachers [11]. On these measures there were no control data, and the authors made the dubious assumption that they could assess treatment effects by dividing the gain seen in the year after treatment with gain seen in the year before treatment. It is from these analyses that the remarkable claim comes that there is a 17-fold increase in writing skills after treatment: this is the figure one ends up when comparing mean SATS scores of 2.53 (July 2000), 2.56 (July 2001) and 2.95 (July 2002) using the method described above. Without control data it is impossible to tell whether such changes are meaningful, especially since the SATS were administered by different teachers in different years. In the 2007 paper [8] the authors present further reading test data, and mention a parental checklist of attention-deficit symptoms which decline after treatment. Again, there are no control data, so we cannot know whether this is age-related change. After all, children’s shoe size will have increased during the study, yet we would not conclude that the intervention made their feet grow. There is nothing here to justify the claims made that the Dore Programme is more effective than state-of-the-art medication for ADHD [2], especially in view of the fact that only one child in the study had an ADHD diagnosis. The data in Figure 1 emphasise another odd feature of this study. The Dore programme is marketed as a cure for dyslexia, a condition that is usually diagnosed by demonstrating a significant mismatch between general ability and literacy skills. One would expect a child with this diagnosis to have marked problems on literacy measures (typically one SD or more below age level, corresponding to 16th percentile). The mean scores of the children in this study were better than this, consistent with the fact that only a minority of them had diagnoses of specific learning difficulties. The 2003 paper also reported data on the vestibular and postural tests used at Dore Achievement Centres to diagnose cerebellar problems and determine treatment. However, the authors noted that there were no norms for children on these tests. One is left wondering how these measures can be interpreted in a diagnostic setting. Overall, family doctors and paediatricians need to be aware that the published evidence does not support the claims of a “Miracle Cure”: on the contrary, the data from comparisons of treated and control groups lead to considerable scepticism that the intervention improves anything other than those skills that are trained in the exercises.
- 5. 5 References 1. Torgesen JK. Individual differences in response to early interventions in reading: The lingering problem of treatment resisters. Learning Disabilities Research and Practice 2000;15:55-64. 2. Dore W. Dyslexia: the miracle cure. London: John Blake Publishing, 2006. 3. Bishop DVM. Cerebellar abnormalities in developmental dyslexia: cause, correlate or consequence? Cortex 2002;38:491-498. 4. Rochelle KSH, Talcott JB. Impaired balance in developmental dyslexia? A meta- analysis of the contending evidence. Journal of Child Psychology and Psychiatry 2006;47:1159-1166. 5. Savage R. Motor skills, automaticity, and developmental dyslexia: a review of the research literature. Reading and Writing 2004;17:301-324. 6. Black JE, Isaacs KR, Anderson BJ, Alcantara AA, Greenough WT. Learning causes synaptogenesis, whereas motor activity causes angiogenesis, in cerebellar cortex of adult rats. Proceedings of the National Academy of Sciences 1990;87:5568-5572. 7. Reynolds D, Nicolson RI, Hambly H. Evaluation of an exercise-based treatment for children with reading difficulties. Dyslexia 2003;9:48-71. 8. Reynolds D, Nicolson RI. Follow-up of an exercise-based treatment for children with reading difficulties. Dyslexia 2007; 13, 78-96. 9. Fawcett AJ, Nicolson RI. The Dyslexia Screening Test. London: The Psychological Corporation, 1996. 10. Snowling MJ, Hulme C. A critique of claims from Reynolds, Nicolson & Hambly (2003) that DDAT is an effective treatment for children with reading difficulties - 'lies, damned lies and (inappropriate) statistics?'. Dyslexia 2003;9:127-133. 11. Singleton C, Stuart M. Measurement mischief: a critique of Reynolds, Nicolson and Hambly (2003). Dyslexia 2003;9:151-160.
- 6. 6 Figure legend Figure 1 Mean percentile scores on literacy measures from Dyslexia Screening Test for treated and control children from Reynolds et al [7]. Standard errors were not provided by the authors. Significant interactions between group and pre-post test were found only for word reading, where Treated group had lower scores on pre-test. Treated Control Word reading Word reading Spelling Spelling pre-test pre-test Writing Writing post-test post-test Nonword Nonword reading reading Phoneme Phoneme segmentation segmentation 0 20 40 60 80 0 20 40 60 80 mean percentile mean percentile