Orton linked mixed dominance to the major symptoms he frequently observed in the clinic: (a) reversals of letters such as p and q and b and d; (b) confusion of palindromes such as was and saw; (c) reading from right to left, manifested by reversals of paired letters, syllables within words, or whole words within sentences; and (d) a propensity to “mirror read and/or write.” He theorized that the nondominant hemisphere of the brain stored mirror engrams of the engrams recorded in the dominant hemisphere. For example, in reading the word was, the dominant hemisphere would store was in the dominant hemisphere while at the same time storing saw in the nondominant hemisphere. In those who have complete hemispheric dominance, the dominant hemisphere controls language and, therefore, the mirrored engrams are suppressed. In the case of mixed dominance, however, the mirrored engrams often emerge causing the child to reverse letters or words.
Third, Orton’s emphasis on cerebral dominance and reversals led him to propose a different term than word-blindness to describe the children whom he was seeing in his clinic:
The term “congenital word-blindness” because of its association with the acquired condition and the implications therefrom, does not seem to be properly descriptive of this disability, and I would therefore like to offer the term “strephosymbolia” from the Greek words, [strepho], twist, and [symbolon], symbol…. The prefix “strepho” has been chosen to indicate the turning or reversals…. “Symbolon” is used in its original meaning of “word,” “sign” or “token,”…. Strephosymbolia thus seems nicely suited to our cases in which our analysis points to confusion, because of reversals, in the memory images of symbols resulting in a failure of association between the visually presented stimulus and its concept. (Orton, 1925, p. 610)
Ironically, neither term—word-blindness, strephosymbolia—fared well historically, the former primarily because of its focus on the visual aspect of reading, the latter primarily because of its emphasis on mixed cerebral dominance and reversals. Although few subscribe to Orton’s views on cerebral dominance and reversals today, he has had an enduring influence in the realm of remediation techniques in at least two respects. First, he was one of the first to advocate focusing on phonics instruction with students with reading disabilities. He criticized the then-current “look and say” or “sight reading” method of reading instruction for the general population and proposed that:
logical training for these children [those with strephosymbolia] would be that of extremely thorough repetitive drill on the fundamentals of phonic association with letter forms, both visually presented and reproduced in writing, until the correct associations were built up and the permanent elision of the reversed images and reversals in direction were assured. (Orton, 1925, p. 614)
Orton later emphasized that teaching letter sounds was not enough, that there was a need for sound blending:
We have repeatedly seen children referred to us as reading disability cases with the statement that the phonetic method had been tried but had failed. In these cases examination has revealed the fact that while the teaching of the phonetic equivalents may have been fairly complete, the next step, that of teaching the blending of the letter sounds in the exact sequence in which they occur in the word, had not been attempted or had been poorly carried out. It is this process of synthesizing the word as a spoken unit from its component sounds that often makes much more difficulty for the strephosymbolic child than do the static reversals and letter confusions. (Orton, 1937, p. 162)
Second, Orton was one of the first to introduce the idea of multisensory training. In particular, he stressed the use of the kinesthetic function by having students trace letters while sounding them out (Orton, 1937). And Orton’s ideas served as a stimulus for the work of Anna Gillingham and Bessie Stillman, whose book, Remedial Work for Reading, Spelling, and Penmanship (1936) emphasized building the following linkages: visual-auditory, auditory-visual, auditory-kinesthetic, and kinesthetic-visual. Gillingham and Stillman believed “it is essential to establish each linkage with patient care, even into the thousandth repetition” (Gillingham & Stillman, 1936, p. 36).