An Experimental Study of Scheduling and Duration of "Tier 2" First-Grade Reading Intervention

A meta-analysis of the effects of foundational skills and multicomponent reading interventions on reading comprehension for primary-grade students

This meta-analysis examined the effects on reading comprehension of foundational reading skills and multicomponent reading interventions provided to students with or at risk for reading difficulties or disabilities (students with RDs) in kindergarten through Grade 3. The meta-analysis included studies identified by Wanzek et al. (2016) and Wanzek et al. (2018), with an updated search through August of 2019, for a total of 47 included studies (m = 112; total student N = 7446). The weighted average effect on norm-referenced reading comprehension outcomes was estimated as g = 0.37, indicating that primary-grade interventions have an educationally meaningful effect on reading comprehension for students with RDs. Effects did not differ for interventions focused only on foundational reading skills and those that provided both foundational skills and comprehension instruction. Effects were significantly moderated by the measurement timepoint, with follow-up effect sizes being, on average, 0.16 smaller than immediate posttest effect sizes.

Cortical Thickness and Local Gyrification in Children with Developmental Dyslexia

Developmental dyslexia is frequently associated with atypical brain structure and function within regions of the left hemisphere reading network. To date, few studies have employed surface-based techniques to evaluate cortical thickness and local gyrification in dyslexia. Of the existing cortical thickness studies in children, many are limited by small sample size, variability in dyslexia identification, and the recruitment of prereaders who may or may not develop reading impairment. Further, no known study has assessed local gyrification index (LGI) in dyslexia, which may serve as a sensitive indicator of atypical neurodevelopment. In this study, children with dyslexia (n = 31) and typically decoding peers (n = 45) underwent structural magnetic resonance imaging to assess whole-brain vertex-wise cortical thickness and LGI. Children with dyslexia demonstrated reduced cortical thickness compared with controls within previously identified reading areas including bilateral occipitotemporal and occipitoparietal regions. Compared with controls, children with dyslexia also showed increased gyrification in left occipitotemporal and right superior frontal cortices. The convergence of thinner and more gyrified cortex within the left occipitotemporal region among children with dyslexia may reflect its early temporal role in processing word forms, and highlights the importance of the ventral stream for successful word reading.

Examining How Treatment Fidelity Is Supported, Measured, and Reported in K-3 Reading Intervention Research

Treatment fidelity data (descriptive and statistical) are critical to interpreting and generalizing outcomes of intervention research. Despite recommendations for treatment fidelity reporting from funding agencies and researchers, past syntheses have found treatment fidelity is frequently unreported (e.g., Swanson, The Journal of Special Education, 47, 3-13, 2011) in educational interventions and fidelity data are seldom used to analyze its relation to student outcomes (O'Donnell, Review of Educational Research, 78(1), 33-84, 2008). The purpose of this synthesis was to examine how treatment fidelity is supported, measured, and reported in reading intervention studies conducted with students at risk or with reading difficulties in grades K-3 from 1995 through 2015. All studies (k = 175) were coded to extract and classify information related to (a) the characteristics of the intervention study (e.g., publication year, research design); (b) treatment implementer training and support; (c) treatment fidelity data collection procedures, dimensions (i.e., adherence, quality, receipt, dosage, and differentiation), and levels of treatment fidelity data; and (d) the use of fidelity scores in the analysis of treatment effects. Results indicated that less than half (47%) of the reading intervention studies synthesized reported treatment fidelity data (numeric or narrative). Exploratory analyses showed that several study features were associated with the prevalence of fidelity reporting. Studies reporting treatment fidelity largely measured treatment adherence, and scores were, on average, high. Other dimensions of treatment fidelity (e.g., treatment differentiation), and analyses relating fidelity data to outcomes, were consistently absent from the corpus of reading intervention studies reviewed. Recommendations for enhancing how treatment fidelity data in intervention studies are collected and reported are presented.

White matter microstructure integrity in relation to reading proficiency☆

Components of reading proficiency such asaccuracy, fluency, and comprehension require the successful coordination of numerous, yet distinct, cortical regions. Underlying white matter tracts allow for communication among these regions. This study utilized unique residualized tract - based spatial statistics methodology to identify the relations of white matter microstructure integrity to three components of reading proficiency in 49 school - aged children with typically developing phonological decoding skills and 27 readers with poor decoders. Results indicated that measures of white matter integrity were differentially associated with components of reading proficiency. In both typical and poor decoders, reading comprehension correlated with measures of integrity of the right uncinate fasciculus; reading comprehension was also related to the left inferior longitudinal fasciculus in poor decoders. Also in poor decoders, word reading fluency was related to the right uncinate and left inferior fronto - occipital fasciculi. Word reading was unrelated to white matter integrity in either group. These findings expand our knowledge of the association between white matter integrity and different elements of reading proficiency.

White matter integrity of cerebellar-cortical tracts in reading impaired children: A probabilistic tractography study

Little is known about the white matter integrity of cerebellar-cortical pathways in individuals with dyslexia. Building on previous findings of decreased volume in the anterior lobe of the cerebellum, we utilized novel cerebellar segmentation procedures and probabilistic tractography to examine tracts that connect the anterior lobe of the cerebellum and cortical regions typically associated with reading: the temporoparietal (TP), occipitotemporal (OT), and inferior frontal (IF) regions. The sample included 29 reading impaired children and 27 typical readers. We found greater fractional anisotropy (FA) for the poor readers in tracts connecting the cerebellum with TP and IF regions relative to typical readers. In the OT region, FA was greater for the older poor readers, but smaller for the younger ones. This study provides evidence for discrete, regionally-bound functions of the cerebellum and suggests that projections from the anterior cerebellum appear to have a regulatory effect on cortical pathways important for reading.

Anxiety and Response to Reading Intervention among First Grade Students

BACKGROUND

For school-aged children with reading difficulties, an emerging and important area of investigation concerns determining predictors of intervention response. Previous studies have focused exclusively on cognitive and broadly defined behavioral variables. What has been missing, however, are studies examining anxiety, which is among the most commonly experienced difficulty for youth.

OBJECTIVE

The present study examined anxiety among children classified as typically achieving or showing inadequate/adequate response following an intervention for reading problems.

METHODS

Participants were 153 ethnically-diverse children (84 male, 69 female) evaluated in the winter and spring of their first-grade academic year. Children completed several standardized measures of reading achievement involving decoding and fluency along with a multidimensional anxiety rating scale.

RESULTS

Repeated measures ANOVA revealed significant main effects for time and scale and significant interactions for time*scale and group*scale. Logistic regression examined whether anxiety predicted response to intervention (Y/N) at the end of the school-year.

CONCLUSIONS

Results showed overall decreases in anxiety over time, with the exception of the harm avoidance area which increased and also interacted with group (children with decoding/fluency difficulties reported less harm avoidance than typically achieving children). The harm avoidance area was most pertinent across analyses highlighting the potential importance of targeting this area; however, none of the anxiety scales predicted response group at the end of the intervention. Ongoing research is needed in this area in order to identify characteristics of inadequate responders to reading intervention programs and/or inform interventions that incorporate these socioemotional factors.

Improving Clinical Practices for Children With Language and Learning Disorders

Purpose

This lead article of the Clinical Forum addresses some of the gaps that exist between clinical practice and current knowledge about instructional factors that influence learning and language development.

Method

Topics reviewed and discussed include principles of learning, generalization, treatment intensity, processing interventions, components of language therapy, grammar goals, and goal prioritization for students with language and learning difficulties.

Conclusion

The gaps that exist between current knowledge about learning, language development, and clinical practice often do not receive as much attention as the gaps in the evidence base that addresses the efficacy and effectiveness of language intervention practices and service delivery models. Fortunately, clinicians do not have to wait for future intervention studies to apply their knowledge of learning and language development to clinical practices.

AGREEMENT AND COVERAGE OF INDICATORS OF RESPONSE TO INTERVENTION: A MULTI-METHOD COMPARISON AND SIMULATION

PURPOSE

Agreement across methods for identifying students as inadequate responders or as learning disabled is often poor. We report (1) an empirical examination of final status (post-intervention benchmarks) and dual-discrepancy growth methods based on growth during the intervention and final status for assessing response to intervention; and (2) a statistical simulation of psychometric issues that may explain low agreement.

METHODS

After a Tier 2 intervention, final status benchmark criteria were used to identify 104 inadequate and 85 adequate responders to intervention, with comparisons of agreement and coverage for these methods and a dual-discrepancy method. Factors affecting agreement were investigated using computer simulation to manipulate reliability, the intercorrelation between measures, cut points, normative samples, and sample size.

RESULTS

Identification of inadequate responders based on individual measures showed that single measures tended not to identify many members of the pool of 104 inadequate responders. Poor to fair levels of agreement for identifying inadequate responders were apparent between pairs of measures In the simulation, comparisons across two simulated measures generated indices of agreement (kappa) that were generally low because of multiple psychometric issues inherent in any test.

CONCLUSIONS

Expecting excellent agreement between two correlated tests with even small amounts of unreliability may not be realistic. Assessing outcomes based on multiple measures, such as level of CBM performance and short norm-referenced assessments of fluency may improve the reliability of diagnostic decisions.

Effects of dose frequency of early communication intervention in young children with and without Down syndrome

Children with intellectual disability were randomly assigned to receive Milieu Communication Teaching (MCT) at one 1-hr session per week (low dose frequency, LDF) or five 1-hr sessions per week (high dose frequency, HDF) over 9 months ( Fey, Yoder, Warren, & Bredin-Oja, 2013 . Non-Down syndrome (NDS) and Down syndrome (DS) subgroups were matched on intelligence, mental age, and chronological age. The NDS group had significantly more growth in spoken vocabulary than the DS group. In the DS subgroup, the HDF group had more spoken vocabulary growth than the LDF group when IQ was controlled. In both etiological subgroups, the HDF group yielded greater vocabulary production outcomes than the LDF group for children who played functionally with a range of objects.

Learning Disabilities Research Studies: Findings from NICHD funded Projects

Advancements in prevention and treatment of learning disabilities hold the promise of improving the educational, health, social and civic lives of affected children, adolescents, adults, and their families. To meet this promise, a continued, concerted effort is needed to develop and refine intervention approaches targeting struggling or at-risk learners and those identified with a specific learning disability. These interventions will be delivered in diverse settings by practitioners representing a range of disciplines. We need intervention options that address the developmental range of learners from our youngest to older secondary learners and include a sufficient breadth of intervention approaches to be relevant along the prevention to remediation (e.g., general education classroom and special education services in schools) spectrum. This special issue aims to move us closer to that promise by focusing on projects designed to inform intervention development and test specific intervention models for young, struggling learners at risk for or identified with a reading disability.

Classification and identification of reading and math disabilities: the special case of comorbidity

Much of learning disabilities research relies on categorical classification frameworks that use psychometric tests and cut points to identify children with reading or math difficulties. However, there is increasing evidence that the attributes of reading and math learning disabilities are dimensional, representing correlated continua of severity. We discuss issues related to categorical and dimensional approaches to reading and math disabilities, and their comorbid associations, highlighting problems with the use of cut points and correlated assessments. Two simulations are provided in which the correlational structure of a set of cognitive and achievement data are simulated from a single population with no categorical structures. The simulations produce profiles remarkably similar to reported profile differences, suggesting that the patterns are a product of the cut point and the correlational structure of the data. If dimensional approaches better fit the attributes of learning disability, new conceptualizations and better methods to identification and intervention may emerge, especially for comorbid associations of reading and math difficulties.

Effects of Tier 3 Intervention for Students With Persistent Reading Difficulties and Characteristics of Inadequate Responders

This article describes a randomized controlled trial conducted to evaluate the effects of an intensive, individualized, Tier 3 reading intervention for second grade students who had previously experienced inadequate response to quality first grade classroom reading instruction (Tier 1) and supplemental small-group intervention (Tier 2). Also evaluated were cognitive characteristics of students with inadequate response to intensive Tier 3 intervention. Students were randomized to receive the research intervention (N = 47) or the instruction and intervention typically provided in their schools (N = 25). Results indicated that students who received the research intervention made significantly better growth than those who received typical school instruction on measures of word identification, phonemic decoding, and word reading fluency and on a measure of sentence- and paragraph-level reading comprehension. Treatment effects were smaller and not statistically significant on phonemic decoding efficiency, text reading fluency, and reading comprehension in extended text. Effect sizes for all outcomes except oral reading fluency met criteria for substantive importance; however, many of the students in the intervention continued to struggle. An evaluation of cognitive profiles of adequate and inadequate responders was consistent with a continuum of severity (as opposed to qualitative differences), showing greater language and reading impairment prior to the intervention in students who were inadequate responders.

Is more better? Milieu communication teaching in toddlers with intellectual disabilities

PURPOSE

The authors sought to determine whether a program of 5 weekly doses of milieu communication teaching (MCT) would yield improvements in children's communication and word use compared with a once-weekly delivery of the same treatment.

METHOD

Sixty-four children with intellectual and communication delay were randomly assigned to receive 60-min sessions of MCT either 1 time or 5 times per week over a 9-month treatment. Growth curves were fit to data collected at 5 points before, during, and after the MCT was delivered.

RESULTS

With groups collapsed, significant growth across the experimental period was observed on all measures, but this was not associated unconditionally with treatment intensity. Children who played with 9 or more objects during a standard play assessment, an empirically identified cut-point, benefited more from the high- than from the low-intensity treatment on lexical measures (Hedges's g range = .49 to .65).

CONCLUSIONS

More MCT is not always better for all children. Clinicians can expect that increasing the frequency of MCT sessions will yield moderate enhancement of outcomes if the child has high interest in objects.

Is more better? Milieu communication teaching in toddlers with intellectual disabilities

PURPOSE

The authors sought to determine whether a program of 5 weekly doses of milieu communication teaching (MCT) would yield improvements in children's communication and word use compared with a once-weekly delivery of the same treatment.

METHOD

Sixty-four children with intellectual and communication delay were randomly assigned to receive 60-min sessions of MCT either 1 time or 5 times per week over a 9-month treatment. Growth curves were fit to data collected at 5 points before, during, and after the MCT was delivered.

RESULTS

With groups collapsed, significant growth across the experimental period was observed on all measures, but this was not associated unconditionally with treatment intensity. Children who played with 9 or more objects during a standard play assessment, an empirically identified cut-point, benefited more from the high- than from the low-intensity treatment on lexical measures (Hedges's g range = .49 to .65).

CONCLUSIONS

More MCT is not always better for all children. Clinicians can expect that increasing the frequency of MCT sessions will yield moderate enhancement of outcomes if the child has high interest in objects.

Adequate versus inadequate response to reading intervention: an event-related potentials assessment

Three visual event-related potential components to the second of two sequentially presented words that rhymed or not discriminated children who improved (AR) from those who failed following (IR) reading intervention. Right hemisphere P100 amplitudes discriminated Typically Developing (TD) children from AR children but IR from AR children over left hemisphere sites. N200 amplitudes across hemispheres discriminated TD from IR children and AR from IR children. P300 hemisphere differences differentiated TD from AR and IR children. P300 amplitudes discriminated rhyming from non-rhyming words across children. Results extend prior work asserting that normalization and compensatory mechanisms are active during successful interventions.

Studying the impact of intensity is important but complicated

This commentary suggests that the most commonly studied aspect intensity (dose frequency) on overall rate of response to treatment may often be weak or conditional. To improve statistical power of tests of weak effects additive statistical models have typically been used. However, multiplicative models may be a more productive route to understanding dose frequency effects on children's speech and language development. To illustrate, recent findings are presented that dose frequency effects on vocabulary development varied by two child characteristics. Finally, it is suggested that spacing of teaching episodes within an intervention session be included as a variable in the multi-dimensional model of treatment intensity. Spacing teaching episodes may eventually prove to be one of the more powerful aspects of intensity.

Optimal intervention intensity in speech-language pathology: discoveries, challenges, and unchartered territories

This article is the final response in a scientific forum on the optimal intensity of intervention in speech-language pathology. It is a reflection on the state of knowledge offered by the 13 commentaries in this issue, addressing the areas of early communication and language impairment, speech sound disorders in children, emergent literacy, reading, aphasia, dysphagia, stuttering, motor speech disorders, voice disorders, and traumatic brain injury. Although more intense intervention can lead to better outcomes, the relationship between intensity and outcome is not always linear. More is not always better. Non-intense and intense schedules can yield similar outcomes. Intensity can also reach a point of diminishing return. The insights offered by the authors illustrate the challenges involved in studying this complex issue. To establish the optimal intensity of interventions in speech-language pathology our field needs to: identify active ingredients of interventions; better understand how principles of motor learning and neural plasticity facilitate learning; appreciate the contribution of individuals characteristics, values, and preferences; discover the effect of specific combinations of intensity (including dose, dose form, dose frequency, session duration, and total intervention duration) on treatment outcomes, and find practical solutions when disparities exist between research recommendations and workplace limitations.

Pharmacological dosage concepts: how useful are they for educators and speech-language pathologists?

The first part of this response to Baker (2012) examines studies that have attempted to determine the optimum treatment intensity of reading interventions associated with a Response to Intervention (RTI) model of service delivery. In general, the findings indicated that differences in broad measures of intensity (duration and scheduling) did not result in differences in reading outcomes. These non-significant findings and Baker's excellent discussion of all of the factors that impact treatment outcomes led me to question how useful pharmacological dosage concepts are for educators and speech-language pathologists (SLPs). This commentary concludes by acknowledging that the more information available about the active ingredients of treatment episodes, the better able one will be to design effective and efficient interventions to improve speech, language, and literacy.

Anxiety and inattention as predictors of achievement in early elementary school children

The objective of this study was to examine the relations among anxiety, inattention, and math/reading achievement, as well as the mediating/moderating role of inattention in the anxiety-achievement association both concurrently and longitudinally. Participants included 161 ethnically diverse children (aged 6-8) and their teachers. At the middle and end of first grade (approximately 5 months apart), students completed measures of anxiety and achievement while their teachers completed a measure of inattention. For the concurrent analyses, greater harm avoidance anxiety was associated with better attention, which was in turn related to better achievement. For the longitudinal analyses, mid-year inattention interacted with harm avoidance and separation anxiety to predict end of year reading fluency. For those rated as more attentive, greater separation anxiety symptoms were associated with decreased fluency performance while greater harm avoidance symptoms were associated with increased performance. Findings were discussed in terms of the importance of considering socioemotional variables in the study of children's academic achievement and the potential utility of early anxiety prevention/intervention programs, especially for children experiencing academic difficulties who also show internalizing behaviors.

Response to intervention for reading difficulties in the primary grades: some answers and lingering questions

The purpose of this article is to describe the current research base and identify research needs related to response to intervention (RTI) frameworks in primary-grade reading. Research is reviewed on early reading instruction and intervention, the implementation of multitiered reading interventions, and the determination of intervention responsiveness. Areas identified as in need of research include (a) the conditions under which early reading interventions are most effective in RTI contexts, (b) multitiered interventions for students with limited English proficiency, (c) reading instruction for students who make limited progress in Tier 3 intensive interventions, (d) criteria for determining intervention responsiveness, and (e) the effects of fully implemented RTI frameworks. Although RTI research may be expensive and difficult to implement, it may contribute to improved reading outcomes for many students who are otherwise at risk of serious negative life consequences.

Anxiety and reading difficulties in early elementary school: evidence for unidirectional- or bi-directional relations?

The present study examined competing models of the bi-directional influences of anxiety and reading achievement. Participants were 153 ethnically-diverse children (84 male, 69 female) from general education classes evaluated in the winter and spring of their first-grade academic year. Children completed standardized measures of reading achievement involving decoding and fluency along with an anxiety rating scale. Hierarchical linear regression analyses revealed that separation anxiety symptoms were negatively predicted by fluency performance and harm avoidance symptoms were positively predicted by decoding performance. Fluency performance was positively predicted by harm avoidance and total anxiety (for girls only) symptoms, while decoding was not predicted by any anxiety subscale.

Smart RTI: A Next-Generation Approach to Multilevel Prevention

During the past decade, responsiveness to intervention (RTI) has become popular among many practitioners as a means of transforming schooling into a multilevel prevention system. Popularity aside, its successful implementation requires ambitious intent, a comprehensive structure, and coordinated service delivery. An effective RTI also depends on building-based personnel with specialized expertise at all levels of the prevention system. Most agree on both its potential for strengthening schooling and its heavy demand on practitioners. In this article, we describe Smart RTI, which we define as making efficient use of school resources while maximizing students' opportunities for success. In light of findings from recent research, we discuss three important features of Smart RTI: (a) multistage screening to identify risk, (b) multistage assessment to determine appropriate levels of instruction, and (c) a role for special education that supports prevention.

Cognitive Correlates of Inadequate Response to Reading Intervention

The cognitive attributes of Grade 1 students who responded adequately and inadequately to a Tier 2 reading intervention were evaluated. The groups included inadequate responders based on decoding and fluency criteria (n = 29), only fluency criteria (n = 75), adequate responders (n = 85), and typically achieving students (n = 69). The cognitive measures included assessments of phonological awareness, rapid letter naming, oral language skills, processing speed, vocabulary, and nonverbal problem solving. Comparisons of all four groups identified phonological awareness as the most significant contributor to group differentiation. Measures of rapid letter naming, syntactic comprehension/working memory, and vocabulary also contributed uniquely to some comparisons of adequate and inadequate responders. In a series of regression analyses designed to evaluate the contributions of responder status to cognitive skills independently of variability in reading skills, only the model for rapid letter naming achieved statistical significance, accounting for a small (1%) increment in explained variance beyond that explained by models based only on reading levels. Altogether, these results do not suggest qualitative differences among the groups, but are consistent with a continuum of severity associated with the level of reading skills across the four groups.

A test of the cerebellar hypothesis of dyslexia in adequate and inadequate responders to reading intervention

The cerebellar hypothesis of dyslexia posits that cerebellar deficits are associated with reading disabilities and may explain why some individuals with reading disabilities fail to respond to reading interventions. We tested these hypotheses in a sample of children who participated in a grade 1 reading intervention study (n = 174) and a group of typically achieving children (n = 62). At posttest, children were classified as adequately responding to the intervention (n = 82), inadequately responding with decoding and fluency deficits (n = 36), or inadequately responding with only fluency deficits (n = 56). Based on the Bead Threading and Postural Stability subtests from the Dyslexia Screening Test-Junior, we found little evidence that assessments of cerebellar functions were associated with academic performance or responder status. In addition, we did not find evidence supporting the hypothesis that cerebellar deficits are more prominent for poor readers with "specific" reading disabilities (i.e., with discrepancies relative to IQ) than for poor readers with reading scores consistent with IQ. In contrast, measures of phonological awareness, rapid naming, and vocabulary were strongly associated with responder status and academic outcomes. These results add to accumulating evidence that fails to associate cerebellar functions with reading difficulties.