Evaluating the efficacy of remediation for struggling readers in high school

Reading Interventions for Students in Grades 3-12 With Significant Word Reading Difficulties

Most students with reading difficulties struggle to read words. We examined intervention effects for students with significant word reading difficulties (SWRD; standard score of 80 on at least one pretest measure of word reading), which includes individuals with or at risk for dyslexia. We investigated: (a) What are the effects of reading interventions for students in Grades 3-12 with SWRD? and (b) What intervention features (i.e., instructional components and elements of dosage) are related to improved reading outcomes for the target population? A meta-analysis of 22 studies and 208 effect sizes revealed a statistically significant, positive, mean effect (g = 0.14, standard error [SE] = 0.04, p = .01, 95% confidence interval [CI]: [0.04, 0.23]) of interventions for the target population. Subset analyses revealed positive, statistically significant intervention effects on measures of pseudoword reading (g = 0.38, SE = 0.07, p = .0003, 95% CI [0.21, 0.54]) and pseudoword reading fluency (g = 0.29, SE = 0.09, p = .010, 95% CI [0.09, 0.49]). Moderator analyses yielded statistically significant, positive effects associated with increased total hours of intervention, β = 0.003, SE = 0.0009, t(8.31) = 3.58, p = .007. Overall, findings indicate a need for interventions that improve generalized real-world reading for the target population.

Empowering Schools to Implement Effective Research-Based Reading Remediation Delivers Long-Lasting Improvements to Children's Reading Trajectories

There is a wide gap between what research evidence identifies as effective reading intervention and what is currently offered in schools. This effectiveness study reports the results of a long-term research/school system partnership that is implementing reading intervention for children with reading difficulties in community schools. In Study 1, growth-curve analyses revealed significant long-term shifts in the reading trajectories of children (n = 731) from Kindergarten to Grade 5 as a function of receiving the Empower™ Reading: Decoding and Spelling intervention. Long-term outcomes were higher in children who received intervention in Grade 2 than in Grade 3, supporting the benefit of earlier intervention. In Study 2, we compare reading outcomes before and after children participated in school system-led intervention (Empower™ Reading, n = 341) to results from previously reported researcher-led intervention and business-as-usual controls. Children in both school system-led and researcher-led interventions showed greater improvement than controls on standardized measures of decoding and reading comprehension. Among school system participants, greater gains were seen for those with stronger reading skills at pre-test. Findings demonstrate successful school system implementation of research-originated and validated reading intervention. Researcher/school system partnerships may be integral in closing the research-practice gap.

Identification of brain cell types underlying genetic association with word reading and correlated traits

Neuroimaging studies implicate multiple cortical regions in reading ability/disability. However, the neural cell types integral to the reading process are unknown. To contribute to this gap in knowledge, we integrated genetic results from genome-wide association studies for word reading (n = 5054) with gene expression datasets from adult/fetal human brain. Linkage disequilibrium score regression (LDSC) suggested that variants associated with word reading were enriched in genes expressed in adult excitatory neurons, specifically layer 5 and 6 FEZF2 expressing neurons and intratelencephalic (IT) neurons, which express the marker genes LINC00507, THEMIS, or RORB. Inhibitory neurons (VIP, SST, and PVALB) were also found. This finding was interesting as neurometabolite studies previously implicated excitatory-inhibitory imbalances in the etiology of reading disabilities (RD). We also tested traits that shared genetic etiology with word reading (previously determined by polygenic risk scores): attention-deficit/hyperactivity disorder (ADHD), educational attainment, and cognitive ability. For ADHD, we identified enrichment in L4 IT adult excitatory neurons. For educational attainment and cognitive ability, we confirmed previous studies identifying multiple subclasses of adult cortical excitatory and inhibitory neurons, as well as astrocytes and oligodendrocytes. For educational attainment and cognitive ability, we also identified enrichment in multiple fetal cortical excitatory and inhibitory neurons, intermediate progenitor cells, and radial glial cells. In summary, this study supports a role of excitatory and inhibitory neurons in reading and excitatory neurons in ADHD and contributes new information on fetal cell types enriched in educational attainment and cognitive ability, thereby improving our understanding of the neurobiological basis of reading/correlated traits.

Response to intervention for high school students: examining baseline word reading skills and reading comprehension outcomes

The purpose of this post hoc analysis was to analyze if pre-intervention word reading skills contributed to intervention response on reading comprehension outcomes. High school students with reading difficulties were randomized to a business as usual (BaU) or treatment condition that provided 2 years of an intensive, multicomponent word reading and reading comprehension intervention. Participants were assessed on measures of word reading and reading comprehension for pretest and reading comprehension only for posttest. Findings revealed no statistically significant differences with word-level fluency modeled as a continuous variable between treatment and control on reading comprehension. Regardless of assignment to condition, higher word-level fluency scores predicted higher posttest outcomes on years 1 and 2 reading comprehension scores.

Patterns of Adults with Low Literacy Skills Interacting with an Intelligent Tutoring System

A common goal of Intelligent Tutoring Systems (ITS) is to provide learning environments that adapt to the varying abilities and characteristics of users. This type of adaptivity is possible only if the ITS has information that characterizes the learning behaviors of its users and can adjust its pedagogy accordingly. This study investigated an intelligent tutoring system with computer agents (AutoTutor) designed to improve comprehension skills in adults with low reading literacy. One goal of this study was to classify adults into different clusters based on their behavioral patterns (accuracy and response time to answer questions) while they interacted with AutoTutor to help them improve their reading comprehension skills. A second goal was to investigate whether adults’ behaviors were associated with different reading components. A third goal was to assess improvements in reading comprehension skills, based on psychometric tests, of different clusters of readers. Performance on AutoTutor was collected in a targeted 100-hour hybrid intervention for adult readers (n = 252) that included both human teachers and the AutoTutor system. The adults’ average accuracy and response time in AutoTutor were used to cluster the adults into four categories: higher performers (comparatively fast and accurate), conscientious readers (slow but accurate), under-engaged readers (fast at the expense of somewhat lower accuracy) and struggling readers (slow and inaccurate). Two psychometric tests of comprehension were used to assess comprehension. Gains in comprehension scores were highest for conscientious readers, lowest for struggling readers, with higher performing readers and under-engaged readers in between. The results provide guidance to enhance the adaptivity of AutoTutor.

Developing an evidence-based reading intervention for early brain injury rehabilitation

Introduction:

Providing evidence-based services in areas with emerging or low-level evidence is a challenge for many clinicians. The aim of the current study was to apply a newly designed novel methodology to develop and describe a new intervention for cognitive-communication reading comprehension deficits in early acquired brain injury rehabilitation.

Methods:

An emergent multi-phase mixed methods design allowed phases of different research activity to build an evidence base of quantitative and qualitative data. A pragmatic clinical framework was developed to combine these traditional research findings with principles from knowledge translation and implementation science, evidence-based practice and intervention development models, clinical contextual practice guidelines and the Medical Research Council’s guidelines for developing and evaluating complex interventions, to create an evidence-based contextually driven clinical intervention.

Results:

The resulting reading comprehension intervention and service delivery model is presented and involves a multiple-strategy intervention across increasing level of reading comprehension complexity. In areas where traditional methodologies provide low-level evidence, this method provides an alternate way to conduct evidence-based clinical research.

Strategy-based reading comprehension therapy during early acquired brain injury rehabilitation: preliminary results

Introduction: An evidence-based intervention and service delivery model for early acquired brain injury reading comprehension rehabilitation (involving multiple-strategy, hierarchical reading) was investigated with 3 clients <3 m post onset as part of their brain injury rehabilitation program.Materials and methods: A multiple-baseline single case experimental design was used for each participant, with data analysed using Tau-U. Assessments of reading comprehension (impairment and activity level) were performed pre/post intervention, and at follow-up (3-6 months post-treatment). Participants' perceptions of the intervention and service delivery model were captured via semi-structured interviews.Results: All participants demonstrated improved reading comprehension post-intervention on all formal measures. At follow-up, reading comprehension was grossly maintained by 2 participants. The single case experimental design results (Tau-U) showed moderate-large intervention effect sizes for factual and inferential reading comprehension, two participants had significant (p = 0.01) changes. Participants reported overall positive experiences with the intervention.Conclusion: The intervention and service delivery model were successfully implemented in clinical practice, and preliminary results show the intervention has clinical promise with an early acquired brain injury population.IMPLICATIONS FOR REHABILITATIONCognitive communication reading comprehension deficits occur following acquired brain injury and impact participation during rehabilitation and in the community.An evidence-based intervention for the early rehabilitation of cognitive communication reading comprehension deficits following acquired brain injury has been developed and trialled in clinical practice with adults <3 months post-acquired brain injury, via a series of single-case experimental designs.Improvements in reading comprehension skill and activity/participation occurred for all participants post-intervention; statistically significant changes occurred for 2 of 3 clients.Early rehabilitation of cognitive communication reading comprehension deficits can be successfully implemented as a component of a multidisciplinary rehabilitation program.

Phonics training for English-speaking poor readers

BACKGROUND

The reading skills of 16% of children fall below the mean range for their age, and 5% of children have significant and severe reading problems. Phonics training is one of the most common reading treatments used with poor readers, particularly children.

OBJECTIVES

To measure the effect of phonics training and explore the impact of various factors, such as training duration and training group size, that might moderate the effect of phonics training on literacy-related skills in English-speaking poor readers.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 12 other databases, and three trials registers up to May 2018. We also searched reference lists of included studies and contacted experts in the field to identify additional studies.

SELECTION CRITERIA

We included studies that used randomisation, quasi-randomisation, or minimisation to allocate participants to a phonics intervention group (phonics training only or phonics training plus one other literacy-related skill) or a control group (no training or non-literacy training). Participants were English-speaking poor readers with word reading one standard deviation below the appropriate level for their age (children, adolescents, and adults) or one grade or year below the appropriate level (children only), for no known reason. Participants had no known comorbid developmental disorder, or physical, neurological, or emotional problem.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included 14 studies with 923 participants in this review. Studies took place in Australia, Canada, the UK, and the USA. Six of the 14 included studies were funded by government agencies and one was funded by a university grant. The rest were funded by charitable foundations or trusts. Each study compared phonics training alone, or in conjunction with one other reading-related skill, to either no training (i.e. treatment as usual) or alterative training (e.g. maths). Participants were English-speaking children or adolescents, of low and middle socioeconomic status, whose reading was one year, one grade, or one standard deviation below the level expected for their age or grade for no known reason. Phonics training varied between studies in intensity (up to four hours per week), duration (up to seven months), training group size (individual and small groups), and delivery (human and computer). We measured the effect of phonics training on seven primary outcomes (mixed/regular word reading accuracy, non-word reading accuracy, irregular word reading accuracy, mixed/regular word reading fluency, non-word reading fluency, reading comprehension, and spelling). We judged all studies to be at low risk of bias for most risk criteria, and used the GRADE approach to assess the quality of the evidence.There was low-quality evidence that phonics training may have improved poor readers' accuracy for reading real and novel words that follow the letter-sound rules (standardised mean difference (SMD) 0.51, 95% confidence interval (CI) 0.13 to 0.90; 11 studies, 701 participants), and their accuracy for reading words that did not follow these rules (SMD 0.67, 95% CI 0.26 to 1.07; 10 studies, 682 participants). There was moderate-quality evidence that phonics training probably improved English-speaking poor readers' fluency for reading words that followed the letter-sounds rules (SMD 0.45, 95% CI 0.19 to 0.72; 4 studies, 224 participants), and non-word reading fluency (SMD 0.39, 95% CI 0.10 to 0.68; 3 studies, 188 participants), as well as their accuracy for reading words that did not follow these rules (SMD 0.84, 95% CI 0.30 to 1.39; 4 studies, 294 participants). In addition, there was low-quality evidence that phonics training may have improved poor readers' spelling (SMD 0.47, 95% CI -0.07 to 1.01; 3 studies, 158 participants), but only slightly improve their reading comprehension (SMD 0.28, 95% CI -0.07 to 0.62; 5 studies, 343 participants).

AUTHORS' CONCLUSIONS

Phonics training appears to be effective for improving literacy-related skills, particularly reading fluency of words and non-words, and accuracy of reading irregular words. More studies are needed to improve the precision of outcomes, including word and non-word reading accuracy, reading comprehension, spelling, letter-sound knowledge, and phonological output. More data are also needed to determine if phonics training in English-speaking poor readers is moderated by factors such as training type, intensity, duration, group size, or administrator.

Literacy promotion by health care professionals: A comprehensive biomedical and psychosocial approach

Literacy is the ability to read, write and understand print. Proficiency in literacy is fundamental to social inclusion and strongly linked to health outcomes. Thus, improving literacy is important for lifelong health promotion. Poverty, inadequate hearing, speech and vision and learning disabilities may challenge literacy development. In our review, we explore these topics and suggest recommendations to: Mitigate the Effects of Poverty, Access Comprehensive Medical Assessments, Promote Early Childhood Education and Advocate for Early Intervention and Remediation Programs.

A Century of Progress: Reading Interventions for Students in Grades 4-12, 1914-2014

The history of research on interventions for struggling readers in Grades 4 through 12 dates back to 19th-century case studies of seemingly intelligent children who were unable to learn to read. Physicians, psychologists, educators, and others were determined to help them. In the process, they launched a century of research on a wide variety of approaches to reading intervention. As shown in this systematic narrative review, much has changed over time in the conceptualization of reading interventions and the methods used to determine their efficacy in improving outcomes for struggling readers. Building on the knowledge gathered over the past 100 years, researchers and practitioners are well-poised to continue to make progress in developing and testing reading interventions over the next 100 years.

The Effects of a Comprehensive Reading Program on Reading Outcomes for Middle School Students With Disabilities

Reading achievement scores for adolescents with disabilities are markedly lower than the scores of adolescents without disabilities. For example, 62% of students with disabilities read below the basic level on the NAEP Reading assessment, compared to 19% of their nondisabled peers. This achievement gap has been a continuing challenge for more than 35 years. In this article, we report on the promise of a comprehensive 2-year reading program called Fusion Reading. Fusion Reading is designed to significantly narrow the reading achievement gap of middle school students with reading disabilities. Using a quasi-experimental design with matched groups of middle school students with reading disabilities, statistically significant differences were found between the experimental and comparison conditions on multiple measures of reading achievement with scores favoring the experimental condition. The effect size of the differences were Hedges's g = 1.66 to g = 1.04 on standardized measures of reading achievement.

Discourse level reading comprehension interventions following acquired brain injury: a systematic review

Purpose Reading comprehension can change following acquired brain injury (ABI), impacting independence and participation. This review aims to identify and evaluate the interventions used for rehabilitation of discourse level reading in adults with ABI. Methods A systematic review was conducted of published journal articles. Methodological quality of studies was reviewed using formal and informal rating scales. Inclusion criteria involved adults with non-progressive ABI who experienced discourse level reading deficits related to aphasia or cognitive-communication disorders. Results A total of 23 studies were identified; these included randomized controlled trials, cohort and case studies. Six different types of reading interventions were found, overall results of these interventions were mixed. Reading deficits were reportedly related to language (aphasia) and/or cognitive deficits, with assessment processes varying. Questions arose regarding comparability of assessment methods and diagnostic issues across the studies. Conclusions Interventions for discourse level reading comprehension can make positive changes to reading function. However, no intervention was identified as a gold standard. A trend toward strategy-based reading was found, with these offering a potential for (comparatively) cost-effective lower-dosage reading treatments with positive-trend results. Cognitive and language features should be considered for assessment and intervention planning for discourse reading in ABI. Implications for Rehabilitation Six different types of discourse reading comprehension interventions for people with ABI were identified, with mixed evidence for each intervention. Clinicians need to consider both the linguistic and cognitive features of reading for assessment and intervention planning for discourse level reading. There is a research trend toward strategy-based reading interventions, which use a lower treatment dosage.

A Meta-Analysis of Interventions for Struggling Readers in Grades 4-12: 1980-2011

This meta-analysis synthesizes the literature on interventions for struggling readers in Grades 4 through 12 published between 1980 and 2011. It updates Scammacca et al.'s analysis of studies published between 1980 and 2004. The combined corpus of 82 study-wise effect sizes was meta-analyzed to determine (a) the overall effectiveness of reading interventions studied over the past 30 years, (b) how the magnitude of the effect varies based on student, intervention, and research design characteristics, and (c) what differences in effectiveness exist between more recent interventions and older ones. The analysis yielded a mean effect of 0.49, considerably smaller than the 0.95 mean effect reported in 2007. The mean effect for standardized measures was 0.21, also much smaller than the 0.42 mean effect reported in 2007. The mean effects for reading comprehension measures were similarly diminished. Results indicated that the mean effects for the 1980-2004 and 2005-2011 groups of studies were different to a statistically significant degree. The decline in effect sizes over time is attributed at least in part to increased use of standardized measures, more rigorous and complex research designs, differences in participant characteristics, and improvements in the school's "business-as-usual" instruction that often serves as the comparison condition in intervention studies.