3.3 Cognitive approaches
Cognitive approaches to therapy involve interventions that focus on addressing aspects of cognitive processing. For example, cognitive therapy is frequently used to treat stress, depression or phobia, and involves working with a therapist who highlights maladaptive beliefs that an individual may have about their situation. The individual is retrained to monitor their own thoughts, recognise when their thoughts are based on emotion rather than reality, reject biased cognitions and learn to change whatever beliefs have caused them to distort their interpretation of reality. Another approach, referred to as cognitive behaviour therapy (CBT) involves observing the therapist ‘modelling’ the desired behavioural response to a situation, and the individual trying to copy that response and receiving feedback on their attempt. This behavioural rehearsal is repeated until the behaviour has been mastered. It is claimed that this process, whereby the person realises that they can now do something that they had previously been unable to, leads to the development of a sense of self-efficacy, will also encourage the person to cope with new situations.
Interventions that directly address the cognitive deficits of a condition (i.e. rather than emotional difficulties) through training may also be thought of as ‘cognitive therapy’. As the primary difficulty for people with dyslexia is with acquiring literacy, the most common approach to remediation is to develop programmes that teach reading and writing in a way that addresses the cognitive deficits associated with dyslexia. The difficulty shown in acquiring alphabetic and phonological awareness has led to the development of phonic teaching programmes. Phonic approaches to reading teach students how to break words down into their composite sounds, e.g. “cat”=/k/ /a/ /t/ (phonic analysis) and how to blend individual sounds together to form words (phonic synthesis).
At the time of writing, all English and Welsh children are routinely taught phonic strategies as part of the National Literacy Strategy. Phonic strategies are also included in reading programmes in other countries in Europe and in America. Earlier we noted that phonic strategies should not be taught to the exclusion of other approaches if they are to be successful, and they rarely are although they are an especially important technique for children with dyslexia to focus on due to their difficulties in achieving ‘alphabetic’ reading. Moreover, phonic strategies alone are not enough to improve dyslexic symptoms if they are taught in normal classroom contexts – so the way that they are taught to students with dyslexia is an important feature of remedial programmes. One approach known as the Reading Recovery System, developed by Marie Clay in New Zealand, emphasises the need for regular periods of one-to-one tuition that focuses on the types of error each child typically makes. There is evidence that this level of individual support is effective in bringing poor readers up to age-appropriate levels of performance, especially when combined with tuition in phonics (see Iversen and Tunmer, 1993), but such programmes are expensive to maintain. They also lack thorough evaluation of the long-term performance of children after the intervention period has finished. Other projects have found that parental tuition and peer-support (where more able friends teach struggling readers) can also be effective, although specific guidance on how to support the student must be given to the tutors.
Clearly, one-to-one tuition is not always a practical option. The more common approach to teaching phonics is known as multisensory teaching. The origins of this idea appear to be with Hinshelwood (1917) who recommended that when teaching reading to dyslexic children, the teacher should simultaneously provide input to verbal, visual, motor and tactile memory centres. This sensory integration is intended to maximise the child's ability to make associations between visual and verbal information by linking them via the other available senses. However, this idea is more widely credited to Samuel Orton who, along with Anna Gillingham, developed the Orton-Gillingham Technique. This involved ‘… the constant use of associations of all of the following: how a letter or word looks, how it sounds and how the speech organs or the hand in writing feels when producing it’ (Gillingham and Stillman, 1956, p. 17).
A wide variety of multisensory teaching strategies have been developed based on this principle (e.g. the Hickey Multisensory Language Course in the UK, or the Wilson Reading System in the US). Studies have shown the multisensory technique to be especially effective in helping students with dyslexia and it has also been applied to the teaching of mathematics (Kibel, 1992).