Study doubts colored overlays for reading problems

NEW YORK (Reuters Health) - Special colored “overlays” for reading materials may not immediately improve reading skills in children with a controversial condition known as Irlen syndrome, a new study suggests.

Irlen syndrome is a diagnosis given to some children and adults with reading difficulties, though poor reading skills are not the only sign. Others may include general light sensitivity, visual distortions, headaches, concentration and attention problems and difficulty with depth perception.

Proponents say that close to half of people with dyslexia or other learning problems may have Irlen syndrome and could be helped by the treatment for it: colored overlays, or plastic sheets, placed over the printed page.

Irlen syndrome is said to reflect a problem in the way the brain processes visual information, and people with it appear to have difficulty with perceiving black print on a white background. The colored overlays are said to minimize visual distortions.

People with problems beyond reading -- like sensitivity to different kinds of light -- may also be prescribed glasses with “precision-tinted” lenses.

But the treatment -- and the very existence of Irlen syndrome -- are controversial. A 2009 review by the American Academy of Pediatrics, for example, said that studies on the condition have often been of poor quality.

“Irlen syndrome has been studied for a long time, but scientists and doctors are still unsure whether it exists or whether the symptoms usually attributed to it are best explained by other, more well-understood problems,” said Stuart Ritchie of the University of Edinburgh in the UK, the lead researcher on the new study.

For their study, published in the journal Pediatrics, Ritchie and his colleagues had an Irlen diagnostician -- someone certified in the specific Irlen method for assessing the condition -- test 61 schoolchildren with poor reading skills.

The Irlen testing method has children look at text and images through various colored overlays to see whether any specific colors seem to make the page clearer.

In this study, the diagnostician found 47 children -- or 77 percent of the group -- to have Irlen syndrome.

On a separate day, the children took reading tests under three conditions: with their prescribed Irlen overlay, with an overlay of a different color, or with a clear plastic sheet.

To limit the chances of a “placebo effect” -- in this case, seeing benefits because you expect them -- the children were not told of their diagnosis or what their prescribed overlay color was.

Overall, Ritchie’s team found, the type of overlay made no difference in the children’s reading test results.

An interesting finding, Ritchie told Reuters Health in an email, is that two children in the study did know what their prescribed color was. (Their parents had taken the children to an Irlen testing center after their assessment in the study, but before they took the reading tests. So when the children took the tests, they had actually been using overlays for “some days.”)

And those two, Ritchie said, “were the only children in the study who showed substantial effects of the overlays, suggesting that a large expectation effect is involved in this treatment.”

But Helen Irlen, the psychologist and educational therapist for whom the syndrome is named, took issue with the study methods -- most importantly, that it looked at immediate effects on reading.

“We don’t say, ‘You have poor reading skills, so we’ll slap on an overlay and you’ll be able to read well,’” said Irlen, who directs the Long Beach, California-based Irlen Institute.

“You would not expect an immediate effect,” she told Reuters Health in an interview. “Overlays are not going to make poor readers good readers overnight.”

Instead, Irlen said, the overlays are designed to relieve perception problems that are keeping children from developing good reading skills.

She pointed to a 2004 study where elementary school children diagnosed with Irlen syndrome were split into two groups. One used colored overlays and received help with their reading skills; the other group had reading help but did not receive overlays until three months into the study.

After the first three months, children using the overlays made gains in their reading achievement -- typically bringing them up to their grade level in reading skills. Children in the comparison group did not show those same gains until after they started using the overlays.

Another problem with the current study, Irlen said, is that 54 percent of the children diagnosed with Irlen syndrome had failed standard vision tests. She said they should have had their vision problems corrected (with glasses or contacts) before having reading tests with the colored overlays.

“This is a flawed study,” Irlen said. “It was designed to set up for failure.”

Ritchie acknowledged that the findings do not discount the possibility that some children with reading problems can benefit from colored overlays.

But he also noted that the 77 percent rate of Irlen syndrome in this study group suggests that Irlen practitioners may be “ready to diagnose” the condition in many children with poor reading skills.

“But that should not be taken to suggest that the syndrome has a clinical reality,” he said, “or that Irlen treatment will be successful.”

“We would advise parents to carefully consider the totality of the evidence before expending time, resources and hope on this controversial treatment,” Ritchie said.

Irlen agreed that parents should consider all the evidence -- which, she said, supports the effectiveness of colored overlays for some people with reading difficulties.

She also disputed the idea that colored overlays could be a drain on time and resources. She said people can go to the Irlen website for a free “self-test” -- in which you see whether different colored backgrounds make reading easier -- and then buy a colored overlay to find out if it helps with everyday reading. The overlays cost a few dollars apiece.

To get tinted glasses or contacts, though, you would have to go to an Irlen testing center (there are about 80 centers worldwide). That would end up costing several hundred in fees and the cost of the lenses.

SOURCE: Pediatrics, online September 19, 2011.