What Should Families Actually Spend Their Money On? A Guide to Prioritizing Support for Dyslexic Children
A family sits across from me with a recommendation from a neuropsychologist: get a comprehensive audiology evaluation. Over the years, I've seen other families arrive with different recommendations — pursue elaborate visual processing testing, consider genetic testing, dig through medical histories looking for evidence of ear infections or adenoid issues that might have contributed to their child's dyslexia. And then one family explained their budget constraint: ten thousand dollars for the next several months. That's all they have for dyslexia-related concerns. So the question became urgent and practical: given limited resources, what will provide the most effective, immediate, and long-lasting benefit?
The answer, supported by decades of research, is simultaneous multisensory structured literacy instruction. This is the evidence-based intervention for dyslexia — regardless of cause. Whether a child's reading difficulties stem from genetic predisposition, early ear infections, adenoid hypertrophy, tongue tie, or some combination of all of these, the intervention remains the same. The cause does not change what the child needs to learn to read. Simultaneous multisensory structured literacy instruction, grounded in Orton-Gillingham methodology, is what moves the child forward. It works because dyslexic children do not have broken brains — they have different brains, brains that process phonological information through different neural pathways, and simultaneous multisensory instruction is specifically designed to work with those pathways rather than against them.
Nevertheless, families want to understand what physiological issues may have contributed to their child's dyslexia and how each condition affects their child's specific profile. That desire is valid. However, this search can become a labyrinth. In some cases, the evidence needed to identify the cause is no longer present. In others, one cause may be identified while others remain hidden or undetectable. The search can become an endless quest for knowledge that doesn't ultimately bring comprehensive resolution. And furthermore, in virtually every situation, the answer remains the same: simultaneous multisensory structured literacy instruction is what's needed.
It's also worth noting that cause and dyslexic profile are rarely simple. Even children with a genetic predisposition to dyslexia may have concurrent physiological issues — ear infections during the critical developmental window, enlarged adenoids, restricted tongue movement — which layer on top of that predisposition and exacerbate the dyslexia they were already genetically inclined toward. Understanding those concurrent conditions can help explain why one dyslexic child's profile looks different from another's. But again, it does not change the intervention.
That said, understanding what can contribute to dyslexia — and how — is genuinely interesting and useful. This post introduces a series to explore exactly that. Parents don't need to know the precise cause of their child's dyslexia to get started with appropriate instruction. But for those who want to understand the landscape — why some children develop phonological processing differences when others don't, what role ear infections, adenoid hypertrophy, tongue tie, or genetic predisposition may have played, and how each of those conditions leaves its particular fingerprint on a child's learning profile — this series is for them. It is also for the professionals who work alongside these families: teachers, interventionists, pediatricians, neuropsychologists, and speech-language pathologists who want a fuller picture of the terrain they're navigating together.
Pediatricians and neuropsychologists approach these families from frameworks that make sense within their professions. Medicine investigates thoroughly, rules out causes, and builds a complete clinical picture. Neuropsychology assesses comprehensively and recommends further evaluation when questions remain unanswered. These are not unreasonable instincts. But both professions should consider whether their recommendations truly serve the child's best and most immediate interest when family resources are limited. Every month of delay is a month the child spends in a classroom not designed for how their brain works — struggling, often quietly, and in many cases concluding that the difficulty they're experiencing is a reflection of their own intelligence or worth. That conclusion, once formed, is not easily undone.
A more helpful hierarchy would place simultaneous multisensory structured literacy instruction at the top of every recommendation list. Until the day when kindergarten classrooms universally integrate this instruction from the start, pediatricians and neuropsychologists have an important role to play: directing families to identify a practitioner trained in an IMSLEC-accredited program — the International Multisensory Structured Language Education Council, whose accreditation ensures that practitioners have received rigorous, evidence-based training in this methodology. Further diagnostic testing can always be reserved for children who do not respond to well-implemented intervention.
The professional organizations that represent these fields — those institutional bodies that speak collectively for pediatricians, neuropsychologists, and related specialists — have an opportunity and a responsibility that extends beyond individual recommendations. They should be using their collective voice to advocate for school districts to incorporate simultaneous multisensory structured literacy instruction into classrooms from kindergarten forward. They should be pressing teacher training programs to reform their curricula so that future teachers graduate understanding not just phonics, but the neuroscience of reading and the methods that work for children whose brains process language differently.
And that brings us to the educators themselves. Classroom teachers, special education teachers, building administrators, and special education administrators need to move beyond surface-level interpretations of the science of reading. Adding a higher dose of phonics is not the same as understanding why simultaneous multisensory instruction works, what it actually looks like in practice, and why it matters that all sensory channels are engaged at the same time rather than sequentially. That deeper understanding requires real professional development, genuine commitment, and institutional support.
Structured Literacy Education is not a one-size-fits-all approach – by design it is customized to the student. A child can have strong language comprehension and weak decoding skills — and look like a poor reader when the real problem is narrow. Or they can decode well but lack the vocabulary and background knowledge to make sense of what they've decoded. The intervention in each case looks different. Knowing which strand is weak is not a diagnostic nicety. It's the difference between targeting the right skill and working on the wrong one.
The field of remediation could be reduced to a fraction of its current size if appropriate instruction were introduced in elementary school from the very beginning. Intelligent children are being pigeonholed into remedial categories for reasons that could have been addressed at the outset — not years later, after the damage to confidence and identity has already been done, after the child has spent years wondering why reading, which seems effortless for everyone around them, feels so impossibly hard for them alone. All of us who work in this space — doctors, neuropsychologists, teachers, interventionists, administrators — share a responsibility to push for the reforms in curriculum, practice, and teacher training that will empower teachers to provide appropriate instruction to every student in their classroom, from the very first day. The children who are sitting in those classrooms right now cannot wait for a perfect system. But we can build one for the children who come after them.