Kindergarten Training in Phonological Awareness: Fluency and Comprehension Gains Are Greatest for Readers at Risk in Grades 1 Through 9

Training in phonological awareness has brought about well-documented positive effects on learning to read in lower-primary grades. Less is known about long-term gains extending to upper-primary and junior high school. The few longitudinal studies covering at least 5 years suggest that gains in decoding are sustained, whereas effects on reading comprehension have either not been studied or produced equivocal results. The present study followed up the reading development of 209 Finland Swedish students from kindergarten until Grade 9, half of whom participated in an 8-month phonological intervention in kindergarten. The intervention group outperformed the control group in both word reading and reading comprehension in Grades 1 through 9. However, albeit statistically significant, the differences at the group level were small. The main result was a clear-cut difference in both skills among readers at risk belonging to the lowest 25% in foundational skills at the beginning of kindergarten. In Grade 6, altogether 60% of the nontrained readers at risk still belonged to the lowest quartile in reading comprehension as opposed to 24% of their peers in the intervention group. The pattern was repeated in Grade 9, with trained readers at risk performing at the level of nontrained mainstream readers.

Efficacy of a Supplemental Phonemic Awareness Curriculum to Instruct Preschoolers With Delays in Early Literacy Development

PURPOSE

Children who do not develop early literacy skills, especially phonological awareness (PA) and alphabet knowledge, prior to kindergarten are at risk for reading difficulties. We investigated a supplemental curriculum with children demonstrating delays in these skills.

METHOD

A cluster randomized design with 104 preschool-age children in 39 classrooms was used to determine the efficacy of a supplemental PA curriculum, PAth to Literacy. The curriculum consists of 36 daily scripted 10-min lessons with interactive games designed to teach PA and alphabet skills. A vocabulary intervention (Story Friends), which also uses a small-group format, served as the comparison condition.

RESULTS

Multilevel modeling indicated that children in the experimental condition demonstrated significantly greater gains on the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) First Sound Fluency (Dynamic Measurement Group, 2006) and Word Parts Fluency (Kaminski & Powell-Smith, 2011) measures. Educational relevance was evident: 82% of the children in the experimental condition met the kindergarten benchmark for First Sound Fluency compared with 34% of the children in the comparison condition. Teachers reported overall satisfaction with the lessons.

CONCLUSIONS

Results indicated that the vast majority of children demonstrating early literacy delays in preschool may benefit from a supplemental PA curriculum that has the potential to prevent reading difficulties as children transition to kindergarten.

Reading and language intervention for children at risk of dyslexia: a randomised controlled trial

BACKGROUND

Intervention studies for children at risk of dyslexia have typically been delivered preschool, and show short-term effects on letter knowledge and phoneme awareness, with little transfer to literacy.

METHODS

This randomised controlled trial evaluated the effectiveness of a reading and language intervention for 6-year-old children identified by research criteria as being at risk of dyslexia (n = 56), and their school-identified peers (n = 89). An Experimental group received two 9-week blocks of daily intervention delivered by trained teaching assistants; the Control group received 9 weeks of typical classroom instruction, followed by 9 weeks of intervention.

RESULTS

Following mixed effects regression models and path analyses, small-to-moderate effects were shown on letter knowledge, phoneme awareness and taught vocabulary. However, these were fragile and short lived, and there was no reliable effect on the primary outcome of word-level reading.

CONCLUSIONS

This new intervention was theoretically motivated and based on previous successful interventions, yet failed to show reliable effects on language and literacy measures following a rigorous evaluation. We suggest that the intervention may have been too short to yield improvements in oral language; and that literacy instruction in and beyond the classroom may have weakened training effects. We argue that reporting of null results makes an important contribution in terms of raising standards both of trial reporting and educational practice.

Predictors of reading in Urdu: does deep orthography have an impact?

The aim of this study was to establish the extent to which rapid automatized naming (RAN) and non-word repetition (NWR) tasks predict reading fluency and reading accuracy in Urdu. One hundred sixty (8-9 years) children attending two types of schools (Urdu and English medium schools) were distributed into two groups, a control and a reading disability group on the basis of teacher's report. The results confirmed the role of RAN in predicting reading fluency in both groups. The role of NWR as a predictor of accuracy was also confirmed, although the strength of the relationship was modulated by RAN in the reading disability group. There are no tests available to identify children with reading problems in Urdu. Our study supports the validity of NWR and RAN tasks for the purposes of screening for reading deficits. The performance results also confirm the original grouping based on teacher reports. The study further highlights the importance of medium of instruction and increased oral language input in learning to read.

Precursors of developmental dyslexia: an overview of the longitudinal Dutch Dyslexia Programme study

Converging evidence suggests that developmental dyslexia is a neurobiological disorder, characterized by deficits in the auditory, visual, and linguistic domains. In the longitudinal project of the Dutch Dyslexia Programme, 180 children with a familial risk of dyslexia (FR) and a comparison group of 120 children without FR (noFR) were followed from the age of 2 months up to 9 years. Children were assessed on (1) auditory, speech, and visual event-related potentials every half year between 2 and 41 months; (2) expressive and receptive language, motor development, behaviour problems, and home-literacy environment by questionnaires at the age of 2 and 3; (3) speech-language and cognitive development from 47 months onwards; and (4) preliteracy and subskills of reading, and reading development during kindergarten and Grades 2 and 3. With regard to precursors of reading disability, first analyses showed specific differences between FR and noFR children in neurophysiological, cognitive, and early language measures. Once reading tests administered from age 7 to 9 years were available, the children were divided into three groups: FR children with and without dyslexia, and controls. Analyses of the differences between reading groups yielded distinct profiles and developmental trajectories. On early speech and visual processing, and several cognitive measures, performance of the non-dyslexic FR group differed from the dyslexic FR group and controls, indicating continuity of the influence of familial risk. Parental reading and rapid naming skills appeared to indicate their offspring's degree of familial risk. Furthermore, on rapid naming and nonverbal IQ, the non-dyslexic FR group performed similarly to the controls, suggesting protective factors. There are indications of differences between the FR and control groups, irrespective of reading outcome. These results contribute to the distinction between the deficits correlated to dyslexia as a manifest reading disorder and deficits correlated to familial risk only.

Emergent literacy intervention for prekindergartners at risk for reading failure: years 2 and 3 of a multiyear study

This research examined the effectiveness of an emergent literacy intervention for prekindergarten children at risk for reading failure, to replicate and improve on significant findings from year 1 of the study. Data are reported for 266 children in 72 child care and preschool sites in year 2 of the study and for 374 children at 102 sites in year 3. The intervention consisted of eighteen 30-min lessons delivered twice weekly to small groups of children. Lessons targeted critical emergent literacy skills through explicit, developmentally appropriate activities for prekindergartners. Hierarchical linear models were used to nest children within center and measure treatment effects on phonological awareness, alphabet knowledge, and vocabulary skills. Results indicated significant treatment effects on multiple measures in years 2 and 3. This study replicated and strengthened findings from year 1 in demonstrating a positive impact of this intervention for prekindergarteners at risk for reading failure.

Predicting reading disability: early cognitive risk and protective factors

This longitudinal study examined early cognitive risk and protective factors for Grade 2 reading disability (RD). We first examined the reading outcome of 198 children in four developmental cognitive subgroups that were identified in our previous analysis: dysfluent trajectory, declining trajectory, unexpected trajectory and typical trajectory. We found that RD was unevenly distributed among the subgroups, although children with RD were found in all subgroups. A majority of the children with RD had familial risk for dyslexia. Second, we examined in what respect children with similar early cognitive development but different RD outcome differ from each other in cognitive skills, task-focused behaviour and print exposure. The comparison of the groups with high cognitive risk but different RD outcome showed significant differences in phonological skills, in the amount of shared reading and in task-focused behaviour. Children who ended up with RD despite low early cognitive risk had poorer cognitive skills, more task avoidance and they were reading less than children without RD and low cognitive risk. In summary, lack of task avoidance seemed to act as a protective factor, which underlines the importance of keeping children interested in school work and reading.

French immersion experience and reading skill development in at-risk readers

We tracked the developmental influences of exposure to French on developing English phonological awareness, decoding and reading comprehension of English-speaking at-risk readers from Grade 1 to Grade 3. Teacher-nominated at-risk readers were matched with not-at-risk readers in French immersion and English language programs. Exposure to spoken French phonetic and syllabic forms and to written French orthographic and morphological forms by children attending French immersion programs was expected to promote phonological, decoding and reading comprehension achievement. Growth in all outcomes was found, with children in immersion experiencing higher final status in phonological awareness and more rapid growth and higher final status in decoding, using multilevel modeling. At-risk readers in French immersion experienced faster growth and higher final status in reading comprehension. Benefits to reading of exposure to an additional language are discussed in relation to cross-language transfer, phonological grain size and enhanced executive control processes.

Accelerating chronically unresponsive children to tier 3 instruction: what level of data is necessary to ensure selection accuracy?

Response-to-intervention (RTI) approaches to disability identification are meant to put an end to the so-called wait-to-fail requirement associated with IQ discrepancy. However, in an unfortunate irony, there is a group of children who wait to fail in RTI frameworks. That is, they must fail both general classroom instruction (Tier 1) and small-group intervention (Tier 2) before becoming eligible for the most intensive intervention (Tier 3). The purpose of this article was to determine how to predict accurately which at-risk children will be unresponsive to Tiers 1 and 2, thereby allowing unresponsive children to move directly from Tier 1 to Tier 3. As part of an efficacy study of a multitier RTI approach to prevention and identification of reading disabilities (RD), 129 first-grade children who were unresponsive to classroom reading instruction were randomly assigned to 14 weeks of small-group, Tier 2 intervention. Nonresponders to this instruction (n = 33) were identified using local norms on first-grade word identification fluency growth linked to a distal outcome of RD at the end of second grade. Logistic regression models were used to predict membership in responder and nonresponder groups. Predictors were entered as blocks of data from least to most difficult to obtain: universal screening data, Tier 1 response data, norm referenced tests, and Tier 2 response data. Tier 2 response data were not necessary to classify students as responders and nonresponders to Tier 2 instruction, suggesting that some children can be accurately identified as eligible for Tier 3 intervention using only Tier 1 data, thereby avoiding prolonged periods of failure to instruction.

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.

Response to intervention with secondary school students with reading difficulties

The authors summarize evidence from a multiyear study with secondary students with reading difficulties on (a) the potential efficacy of primary-level (Tier 1), secondary-level (Tier 2), and tertiary-level (Tier 3) interventions in remediating reading difficulties with middle school students, (b) the likelihood of resolving reading disabilities with older students with intractable reading disabilities, (c) the reliability, validity, and use of screening and progress monitoring measures with middle school students, and (d) the implications of implementing response to intervention (RTI) practices at the middle school level. The authors provide guidance about prevailing questions about remediating reading difficulties with secondary students and discuss future directions for research using RTI frameworks for students at the secondary level.

The improvement of reading skills of L1 and ESL children using a Response to Intervention (RtI) Model

This study examined the development of literacy skills in children in a district that used a Response to Intervention (RTI) model. The district included children whose first language was English and children who were learning English as a second language (ESL). Tasks measuring phonological awareness, lexical access, and syntactic awareness were administered when the children entered school in kindergarten at age 5. Reading, phonological processing, syntactic awareness, memory, and spelling were administered in grade 7. When the children entered school, significant numbers of them were at risk for literacy difficulties. After systematic instruction and annual monitoring of skills, their reading abilities improved to the extent that only a very small percentage had reading difficulties. The results demonstrated that early identification and intervention and frequent monitoring of basic skills can significantly reduce the incidence of reading problems in both the ESL and language majority children.

Computer-assisted instruction to prevent early reading difficulties in students at risk for dyslexia: Outcomes from two instructional approaches

The relative effectiveness of two computer-assisted instructional programs designed to provide instruction and practice in foundational reading skills was examined. First-grade students at risk for reading disabilities received approximately 80 h of small-group instruction in four 50-min sessions per week from October through May. Approximately half of the instruction was delivered by specially trained teachers to prepare students for their work on the computer, and half was delivered by the computer programs. At the end of first grade, there were no differences in student reading performance between students assigned to the different intervention conditions, but the combined-intervention students performed significantly better than control students who had been exposed to their school's normal reading program. Significant differences were obtained for phonemic awareness, phonemic decoding, reading accuracy, rapid automatic naming, and reading comprehension. A follow-up test at the end of second grade showed a similar pattern of differences, although only differences in phonemic awareness, phonemic decoding, and rapid naming remained statistically reliable.

Emergent literacy intervention for prekindergarteners at risk for reading failure

This study examined the effectiveness of an assessment and intervention study targeting prekindergarten children at risk for reading failure. Across 38 child care sites, 220 children were identified as "at risk" for reading failure due to their performance on a screening measure of early literacy skills and randomly assigned to receive immediate or delayed intervention. The intervention consisted of eighteen 30-minute lessons delivered twice weekly for 9 weeks and focused on teaching critical emergent literacy skills within small groups. Hierarchical linear models were used to nest children within center and measure treatment and dosage effects for students' residualized gains in rhyming, alliteration, picture naming, and print and letter knowledge skills. Results indicated significant treatment effects on two of four outcome variables (rhyming and alliteration) and significant dosage effects on all four variables. The study demonstrated a significant positive impact of this intervention for prekindergartners at risk for reading failure.

Predictive validity of the get ready to read! Screener: concurrent and long-term relations with reading-related skills

This study examined concurrent and longitudinal relations for the Get Ready to Read! (GRTR) emergent literacy screener. This measure, within a battery of oral language, letter knowledge, decoding, and phonological awareness tests, was administered to 204 preschool children (mean age = 53.6, SD = 5.78; 55% male) from diverse socioeconomic backgrounds. Subgroups were reassessed at 6 months and 16 and 37 months later. Results indicate strong relations between the GRTR and the literacy and language assessments. Long-term follow-up indicated that the screener was significantly related to some reading-related measures, including decoding skills. These results support the utility of the GRTR as a brief, valid measure of children's emergent literacy skills. The GRTR holds promise as a tool useful for educators, parents, and others in regular contact with preschool children to help determine those who may be at risk for later reading difficulties and could benefit from intervention and focused instruction in emergent literacy.

Floor effects associated with universal screening and their impact on the early identification of reading disabilities

Response to intervention (RTI) holds great promise for the early identification and prevention of reading disabilities. The success of RTI rests in part on the accuracy of universal screening tools used within this framework. Despite advancements, screening instruments designed to identify children at risk for reading disabilities continue to have limited predictive validity. In this study, the authors examined a common screening instrument for the presence of floor effects and investigated the impact that these effects have on the predictive validity of the instrument. Longitudinal data (kindergarten to third grade) from a large cohort of children were used. These data included children's performance on five measures from the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) and two reading achievement outcome measures. The results showed that DIBELS measures were characterized by floor effects in their initial administrations and that these effects reduced the predictive validity of the measures. The implications of these findings for early identification are discussed.

Does early reading failure decrease children's reading motivation?

The authors used a pretest-posttest control group design with random assignment to evaluate whether early reading failure decreases children's motivation to practice reading. First, they investigated whether 60 first-grade children would report substantially different levels of interest in reading as a function of their relative success or failure in learning to read. Second, they evaluated whether increasing the word reading ability of 15 at-risk children would lead to gains in their motivation to read. Multivariate analyses of variance suggest marked differences in both motivation and reading practice between skilled and unskilled readers. However, bolstering at-risk children's word reading ability did not yield evidence of a causal relationship between early reading failure and decreased motivation to engage in reading activities. Instead, hierarchical regression analyses indicate a covarying relationship among early reading failure, poor motivation, and avoidance of reading.

Intensifying instruction: Does additional instructional time make a difference for the most at-risk first graders?

Research is clear on the benefit of early intervention efforts and the importance of intensive instructional supports; however, understanding which features to intensify is less clear. General intervention features of group size, instructional delivery, and time are areas schools can consider manipulating to intensify instruction. Also, each of these features can vary along a continuum making them easier or more challenging for schools to implement. What is unclear is if implementing very intensive interventions early in school (first grade), which require significantly more school resources, provides accordingly accelerated student learning. This article investigates the role of intensifying instructional time for the most at-risk first graders in schools implementing research-based instructional and assessment practices within multitiered instructional support systems. Results indicate that students receiving more intensive intervention made significantly more progress across a range of early reading measures. Intervention features, limitations, recommendations for practice, and implications for treatment resisters are discussed.

Indexing response to intervention: a longitudinal study of reading risk from kindergarten through third grade

In this study, response to intervention and stability of reading performance of 41 kindergarten children identified as at risk of reading difficulty were evaluated from kindergarten through third grade. All students were assessed in the fall of each academic year to evaluate need for intervention, and students who fell below the 30th percentile on criterion measures received small-group supplemental intervention. Measures included a combination of commercial normative referenced measures and specific skill and construct measures to assess growth or change in reading risk status relative to 30th percentile benchmarks. Results indicated that consistent with the findings of prior research involving students with comparable entry-level performance, the majority of children identified as at risk in the beginning of kindergarten responded early and positively to intervention. On average, absolute performance levels at the end of kindergarten positioned students for trajectories of later reading performance that exceeded the 50th percentile on the majority of measures. Moreover, changes in risk status that occurred early were generally sustained over time. Only oral reading fluency performance failed to exceed the 30th percentile for the majority of students.

Effects of small-group reading instruction and curriculum differences for students most at risk in kindergartenL: two-year results for secondary- and tertiary-level interventions

This article describes the implementation of small-group reading instruction as secondary- and tertiary-level components of a three-tier model of prevention and intervention. The study consisted of 83 students who were targeted in the winter of kindergarten as being at high risk for reading failure. Intervention consisted of evidence-based curriculum delivered in groups of one to six students during 30- to 40-min sessions a minimum of three times per week over a 2-year period. Outcome data were collected for early literacy skills, using the Dynamic Indicators of Basic Early Literacy Skills and Woodcock Reading Mastery Test, with comparisons across the different curricula. Results indicated that students in the more directed, explicit intervention groups generally out-performed students in the comparison group. Implications for future research and practice implementing schoolwide three-tier prevention models are discussed.

Response to varying amounts of time in reading intervention for students with low response to intervention

Two studies examined response to varying amounts of time in reading intervention for two cohorts of first-grade students demonstrating low levels of reading after previous intervention. Students were assigned to one of three groups that received (a) a single dose of intervention, (b) a double dose of intervention, or (c) no intervention. Examination of individual student response to intervention indicated that more students in the treatment groups demonstrated accelerated learning over time than students in the comparison condition. Students' responses to the single-dose and double-dose interventions were similar over time. Students in all conditions demonstrated particular difficulties with gains in reading fluency. Implications for future research and practice within response to intervention models are provided.

Longitudinal Effects of Phonological Awareness Intervention on Morphological Awareness in Children With Speech Impairment

Purpose

This study examined reading performance and morphological awareness development in 2 groups of children with speech impairment who had received differing types of intervention during their preschool years.

Method

The children were aged between 7;6 and 9;5 (years;months) at the time of the study. Group 1 ( n = 8) had received preschool intervention to facilitate phonological awareness and letter knowledge in addition to improving speech production. Group 2 ( n = 9) had received preschool intervention that focused solely on improving speech intelligibility. A third group of children with typical development (Group 3, n = 24) also participated in the study. Two reading tests were administered, one that assessed word recognition and another that assessed nonword decoding. Two tests of morphological awareness were also administered, one that tested the spelling of morphologically complex words and another that tested the oral generation of the base form of derived words.

Results

Children with a history of speech impairment who had received phonological awareness intervention (Group 1) performed significantly better on nonword decoding and on the spelling of morphologically complex words than did children with a history of speech impairment whose intervention focused on speech only (Group 2). The typically developing children (Group 3) were not significantly different from Group 1 on the spelling of morphologically complex words, and like Group 1, they outperformed Group 2 on this measure. However, Group 3 did not perform significantly better than Group 2 on nonword decoding, and both of these groups performed significantly more poorly than Group 1 on this measure. There were no group differences in the ability to orally generate base words.

Conclusion

Children with a history of speech impairment who had received phonological awareness intervention and who became proficient readers demonstrated an ability to use morphological awareness in the spelling process that was similar to that of their peers without speech impairment. These findings highlight the potential long-term benefits associated with early phonological awareness intervention.

Supporting nursing students with dyslexia in clinical practice

AIMS

To determine whether pre-registration nursing students with dyslexia experience specific problems in developing clinical competence, identify what strategies they use and how they may be supported in clinical practice.

METHOD

Qualitative case study methodology was used. Stage 1 involved semi-structured interviews with seven students, three support and eight teaching staff, postal questionnaires from nine mentors, in addition to a review of policy documentation. Stage 2 involved a two-year study of four students on their branch programme and included semi-structured interviews with seven mentors.

FINDINGS

The students' difficulties in clinical practice fell into three categories: dealing with information; performing the role; and administering drugs. Specific supporting measures included: informal and formal support networks; portable information technology equipment; and personal strategies, for example, rehearsing difficult tasks such as the handover report. The students' relationships with their mentors and the type of environment they were working in were key to the successful development of clinical competence.

CONCLUSION

Nursing students who have dyslexia have specific learning difficulties in practice. Their response to these difficulties is individual and support needs to be tailored to meet their specific needs.

A survey-based exploration of the impact of dyslexia on career progression of UK registered nurses

AIM

To explore the effects of dyslexia on the practice and career progression of UK registered nurses (RN).

BACKGROUND

Literature suggests dyslexia can have a negative impact in the workplace and may pose particular difficulties for nurses, where accuracy in information processing activities is essential for practice.

METHODS

A questionnaire was used to survey RNs with dyslexia (n = 116) and results analysed using content analysis.

FINDINGS

Dyslexia provided a challenge to the everyday work of RNs, which was often met successfully using a range of individualized strategies. Career progression was achievable but compared with peers, was perceived to take longer. Disclosure of dyslexia to work-colleagues was selective and dependent on the perceived benefits. Informal support mechanisms were commonly utilized with formal management support less well defined.

CONCLUSION

Dyslexia appears to have a negative impact on working practices and career progression, but remains a poorly understood and often hidden disability.

The disclosure of dyslexia in clinical practice: experiences of student nurses in the United Kingdom

Heightened awareness and increasingly sophisticated psychological tests have seen a dramatic rise in the numbers of people diagnosed with dyslexia. Accordingly, there is a reported increase in the numbers of students with dyslexia entering Higher Education (HE) in the United Kingdom (UK) [Singleton, C.H., Chair, 1999. Dyslexia in higher education: policy, provision and practice. Report of the national working party on dyslexia in higher education. University of Hull on behalf of the Higher Education Funding Councils of England and Scotland, Hull], [Higher Education Statistics Agency. HESA. Available from: <URL http://www.hesa.ac.uk> (accessed 21.12.05)]. Studies researching the effects of dyslexia on the clinical practice of nurses are almost non-existent. This paper reports part of a UK study exploring the clinical experiences of student nurses with dyslexia. In depth interviewing of 18 adult branch student nurses revealed a range of difficulties encountered and a variety of coping mechanisms to manage these. Other than in exceptional circumstances there is no legal requirement to disclose a dyslexia diagnosis. The decision to conceal or disclose their dyslexia was particularly prominent and contentious for these participants. This related to the attitudes of co-workers, concerns for patient safety, expectations of support, confidentiality issues and potential discrimination. Dyslexia continues to attract an unwarranted stigma and can adversely affect the learning experience. The need for disability awareness training in the workplace and improved education/service partnerships to support these students is considered crucial.

Evaluation of children with reading difficulties

Reading difficulties are common and are associated with poor long-term academic achievement. Evaluation of a child's developmental, educational, and family histories in conjunction with standardized screening tests (e.g., Ages and Stages Questionnaires, Parents' Evaluation of Developmental Status, Safety Word Inventory and Literacy Screener) can increase recognition of risk factors for reading difficulties. Validated, office-based, standardized screening tests and school-administered standardized achievement tests (e.g., California Achievement Tests, Iowa Tests of Basic Skills, Metropolitan Achievement Tests, Stanford Achievement Test) can be used to assess school-age children with reading difficulties. Reading difficulties in children often are caused by environmental and organic risk factors. However, many children have reading or learning disabilities and will have lifelong difficulties with reading despite adequate intervention. Children with substantial reading difficulties should receive a full educational assessment. There is good evidence that individualized instruction emphasizing increased phonologic awareness can have a favorable long-term effect on academic achievement.

Evidence-Based Practice, Response to Intervention, and the Prevention of Reading Difficulties

Purpose

This article provides an evidence-based perspective on what school communities can do to lower the prevalence of reading difficulties among their pupils through preventive interventions. It also delineates the roles that speech-language pathologists (SLPs) might play in these interventions.

Method

This article is organized to first provide a broad overview of current directions in research, practice, and policy in educational interventions, with an emphasis on how the three are increasingly integrated to respond to evidence showing that American school children are underperforming in reading. Next, the concept of response to intervention (RTI) is described. RTI is an educational policy and practice that is grounded in the accumulated literature that focuses on how schools might better organize themselves to deliver multitiered reading interventions to reduce children’s risk for reading disability. Last, this article provides three organizational principles that school-based professionals, including SLPs, might follow to deliver RTI interventions.

Implications

This article provides an important and timely description of key concepts in the prevention of reading difficulties through proactive multitiered interventions. SLPs can draw on the suggestions presented here to inform their local efforts in implementing preventive literacy programs that are consistent with an RTI paradigm.

Treatment integrity in a home-based pre-reading intervention programme

Treatment integrity is an underexposed issue in the phonological awareness intervention research. The current study assessed the integrity of treatment of the families (N = 32) participating in the experimental condition of a home-based pre-reading intervention study. The participating kindergartners were all genetically at risk for developing dyslexia. Two aspects of treatment integrity, the number of lessons completed (quantity) and the quality of the administration of the programme (observed in a videotaped session), were investigated. The level of treatment integrity turned out to be 66% when completion of all lessons was taken as quantitative criterion, and about 74% when quality of the parent-child interaction was assessed. The two measures could predict the pre-reading skills at the end of kindergarten. Together they accounted for 43% of the variance in this dependent variable. Together with pre-reading scores at the pre-test the total predicted variance was 87%. The number of lessons completed still contributed 12% to the prediction after controlling for pre-test scores. The results indicated that treatment integrity indeed appears to be an important aspect of treatment outcome and should therefore be included in intervention studies.

Paths to reading comprehension in at-risk second-grade readers

Two studies of second graders at risk for reading disability, which were guided by levels of language and functional reading system theory, focused on reading comprehension in this population. In Study 1 (n = 96), confirmatory factor analysis of five comprehension measures loaded on one factor in both fall and spring of second grade. Phonological decoding predicted accuracy of real-word reading; automatic letter naming predicted rate of real-word reading; accuracy and rate of both real-word reading (more so than decoding of pseudowords) and text reading predicted reading comprehension; and Verbal IQ also predicted reading comprehension. In Study 2 (n = 98), the treatment group (before/after school clubs receiving an integrated instructional approach that was supplementary to the general reading program) improved significantly more in phonological decoding and state standards for reading fluency than the control group (general reading program that had some code instruction but emphasized comprehension). The rate of phonological decoding explained 60.3% of real-word reading. Both treatment and control children improved significantly in reading comprehension, but controlling for pretreatment individual differences in oral vocabulary or in phonological decoding eliminated this effect. Taken together, the results of the two studies support two paths to reading comprehension: one from vocabulary and verbal reasoning, and one from written language that has multiple links between subskills: (a) alphabetic principle --> phonological decoding, (b) automatic phonological decoding --> accurate real-word reading, (c) automatic letter coding ---> automatic word reading, and (d) automatic word reading --> fluent text reading. Instructional implications of both paths and the links within the written language are discussed.

Effectiveness of Spanish intervention for first-grade English language learners at risk for reading difficulties

The effectiveness of an explicit, systematic reading intervention for first-grade students whose home language was Spanish and who were at risk for reading difficulties was examined. Participants were 69 students in 20 classrooms in 7 schools from 3 districts who initially did not pass the screening in Spanish and were randomly assigned within schools to a treatment or comparison group; after 7 months, 64 students remained in the study. The intervention matched the language of instruction of their core reading program (Spanish). Treatment groups of 3 to 5 students met daily for 50 min and were provided systematic and explicit instruction in oral language and reading by trained bilingual intervention teachers. Comparison students received the school's standard intervention for struggling readers. Observations during core reading instruction provided information about the reading instruction and language use of the teachers. There were no differences between the treatment and comparison groups in either Spanish or English on any measures at pretest, but there were significant posttest differences in favor of the treatment group for the following outcomes in Spanish: Letter-Sound Identification (d = 0.72), Phonological Awareness composite (d = 0.73), Woodcock Language Proficiency Battery-Revised Oral Language composite (d = 0.35), Word Attack (d = 0.85), Passage Comprehension (d = 0.55), and two measures of reading fluency (d = 0.58-0.75).

Predictive assessment of reading

Study 1 retrospectively analyzed neuropsychological and psychoeducational tests given to N=220 first graders, with follow-up assessments in third and eighth grade. Four predictor constructs were derived: (1) Phonemic Awareness, (2) Picture Vocabulary, (3) Rapid Naming, and (4) Single Word Reading. Together, these accounted for 88%, 76%, 69%, and 69% of the variance, respectively, in first, third, and eighth grade Woodcock Johnson Broad Reading and eighth grade Gates-MacGinitie. When Single Word Reading was excluded from the predictors, the remaining predictors still accounted for 71%, 65%, 61%, and 65% of variance in the respective outcomes. Secondary analyses of risk of low outcome showed sensitivities/specificities of 93.0/91.0, and 86.4/84.9, respectively, for predicting which students would be in the bottom 15% and 30% of actual first grade WJBR. Sensitivities/specificities were 84.8/83.3 and 80.2/81.3, respectively, for predicting the bottom 15% and 30% of actual third grade WJBR outcomes; eighth grade outcomes had sensitivities/specificities of 80.0/80.0 and 85.7/83.1, respectively, for the bottom 15% and 30% of actual eighth grade WJBR scores. Study 2 cross-validated the concurrent predictive validities in an N=500 geographically diverse sample of late kindergartners through third graders, whose ethnic and racial composition closely approximated the national early elementary school population. New tests of the same four predictor domains were used, together taking only 15 minutes to administer by teachers; the new Woodcock-Johnson III Broad Reading standard score was the concurrent criterion, whose testers were blind to the predictor results. This cross-validation showed 86% of the variance accounted for, using the same regression weights as used in Study 1. With these weights, sensitivity/specificity values for the 15% and 30% thresholds were, respectively, 91.3/88.0 and 94.1/89.1. These validities and accuracies are stronger than others reported for similar intervals in the literature.

The effects of varying group size on the reading recovery approach to preventive early intervention

The purpose of this study was to determine whether an early intervention program based on the Reading Recovery (RR) format could be developed for pairs of struggling readers that would allow them to make accelerated progress similar to that experienced in the 1-to-1 RR tutorial. A preliminary pilot study showed that the RR lesson format could be adapted for teaching pairs of struggling readers without compromising the integrity of the lesson content, provided that the average length of the lesson was increased to 41 min. An experimental study comparing the effectiveness of 1-to-1 RR instruction with RR instruction in pairs showed that although RR instruction in pairs required somewhat longer lessons (42 min vs. 33 min), there were no major differences between the two groups on any measures at discontinuation and at the end of the year, nor was there a significant difference between the groups in mean number of lessons to discontinuation. The results further indicated that by discontinuation, the children in the treatment groups were performing within the average range on all measures, and that these positive effects were maintained on end-of-year measures. Thus, by increasing instructional time by about a quarter, RR teachers can double the number of students served without making any sacrifices in outcomes.

A longitudinal study of the development of oral reading fluency in young children at risk for reading failure

The purpose of this study was to examine the development of oral reading fluency in a sample of first-grade children. Using growth curve analysis, models of growth were identified for a combined sample of at-risk (AR) and not-at-risk (NAR) children, and predictors of growth were identified for the longitudinal AR sample in first and second grade. Large and serious differences in reading fluency growth between the AR and NAR samples were apparent early, replicating other reports. Theories of sight-word learning and reading fluency were supported, in that letter-sound fluency was a uniquely significant predictor of first-grade reading fluency. The effects of phonological awareness and rapid automatized naming were mediated by the other variables in the model. Growth in first-grade oral reading fluency accounted for the most unique variance in second-grade growth and end-of-year performance. The results suggest that word reading fluency should be regarded as developing concomitantly with early word recognition rather than as a later-developing skill.

The effects of dyslexia on the work of nurses and healthcare assistants

AIM

To explore the effects of being dyslexic on the working lives of nurses and healthcare assistants (HCAs), and to identify what might be done to improve their working lives.

METHOD

A qualitative approach was taken comprising semi-structured interviews and interpretative data analysis. Seven nurses and HCAs took part in the study.

FINDINGS

Dyslexia affects each individual differently and may affect career choice and career progression. Appropriate support from colleagues and employers is important. The participants identified dyslexia-friendly practices and made suggestions for improvements.

CONCLUSION

Nurses and HCAs with dyslexia can make a major contribution to patient care, although dyslexia can affect their work in many different ways. Establishing a dyslexia-friendly workplace would help them to achieve their maximum potential.

Clinicians and dyslexia—a computer-based assessment of one of the key cognitive skills involved in drug administration

AIMS

This research investigates the relationship between dyslexia traits and nurse performance on a laboratory task designed to assess one of the key cognitive skills involved in drug administration. The potential moderating role of perceived performance control was also assessed, based on previous work demonstrating the importance of self-belief as a facilitator of vocational success.

BACKGROUND

Dyslexia within the health care professions has been the subject of wide and emotionally charged debate but has not yet been scientifically examined. Those who fear clinicians with dyslexia do so because of a presumed or potential risk to patient health and safety posed by dyslexia-induced performance error (e.g. problems with drug administration). DESIGN, SAMPLE AND METHODS: 46 nurses (40 student nurses and 6 qualified nurses) volunteered to complete a battery of computerised tasks assessing for dyslexia traits (using four accuracy tasks measuring different types of literacy skill), a paired association task designed to measure one of the key cognitive skills involved in drug administration) and a self-report questionnaire (Learning Styles Questionnaire, self-reported reading difficulty and a history of educational support, perceived control over performance). The performance criterion measure was constructed after detailed job analysis (involving analysis of official documentation, in-depth interviews and field observation across a variety of clinical settings) and involved matching drug names to patient names and vice versa.

RESULTS

The results showed that the dyslexia indicators (objective and self-report) were significantly correlated with performance on the paired association task. Contrary to expectation however, the perceived control variable was not associated with performance.

CONCLUSION

The findings provide tentative support for the idea that some tasks might be problematic for the clinician with dyslexia. Taken in isolation however, it would be inappropriate to conclude that this will necessarily translate into true performance errors without taking into consideration the entire performance context. Suggestions are made for replicating and extending the study to provide a more solid and constructive basis for intervention (e.g. support measures, a built-in checking process).

Male vulnerability to reading disability is not likely to be a myth: a call for new data

Whether boys are more vulnerable than girls to reading disabilities (RD) is controversial. We review studies that were designed to minimize ascertainment bias in the selection of individuals with RD. These include population-based studies that identified children with RD by objective, unbiased methods and studies that examined the gender ratios among the affected relatives of those diagnosed with RD. We conclude that even when ascertainment biases are minimized, there is still a significant preponderance of boys with RD, although the gender ratio of the affected relatives of those with RD manifests the weakest male bias. Furthermore, we demonstrate that potentially confounding factors such as attentional or neurological problems, race, IQ, and severity of RD cannot account for the observed gender bias. We end with a clarion call to future researchers to (a) consider analyzing gender differences by means of more than one definition of RD, (b) compare gender ratios when boys and girls are ranked against the performance of their own gender as opposed to an average across genders, and (c) report group differences in variability and effect sizes of obtained gender ratios.

Current status of treatments for dyslexia: critical review

The acquisition of reading is a complex neurobiologic process. Identifying the most effective instruction and remedial intervention methods for children at risk of developing reading problems and for those who are already struggling is equally complex. This article aims to provide the clinician with a review of more current findings on the prevention and remediation of reading problems in children, along with an approach to considering the diagnosis and treatment of a child with dyslexia. The first part of the review describes interventions targeted at preventing reading difficulties in the at-risk younger child. The second part of the review discusses the efficacy of approaches to treat the older, reading-disabled child ("intervention studies"). Factors that impact the response to treatment are also discussed, as are neuroimaging studies that offer insight into how the brain responds to treatment interventions. With appropriate instruction, at-risk readers can become both accurate and fluent readers. In contrast, although intensive, evidence-based remedial interventions can markedly improve reading accuracy in older, reading-disabled children, they have been significantly less effective in closing the fluency gap. Owing to the dynamic course of language development and the changes in language demands over time, even after a child has demonstrated a substantial response to treatment interventions, his or her subsequent progress should be carefully tracked to ensure optimal progress toward the development of functional reading and written language skills.

Embedded-Explicit Emergent Literacy Intervention I

This article, the first of a two-part series, provides background information and a general description of an emergent literacy intervention model for at-risk preschoolers and kindergartners. The embedded-explicit intervention model emphasizes the dual importance of providing young children with socially embedded opportunities for meaningful, naturalistic literacy experiences throughout the day, in addition to regular structured therapeutic interactions that explicitly target critical emergent literacy goals. The role of the speech-language pathologist (SLP) in the embedded-explicit model encompasses both indirect and direct service delivery: The SLP consults and collaborates with teachers and parents to ensure the highest quality and quantity of socially embedded literacy-focused experiences and serves as a direct provider of explicit interventions using structured curricula and/or lesson plans. The goal of this integrated model is to provide comprehensive emergent literacy interventions across a spectrum of early literacy skills to ensure the successful transition of at-risk children from prereaders to readers.

Embedded-Explicit Emergent Literacy Intervention II

This article, the second in a two-part series, provides guidance to speech-language pathologists (SLPs) for implementing the explicit component of the embedded-explicit emergent literacy intervention model for at risk preschool and kindergarten children. The explicit component refers to the provision of regular structured therapeutic interactions that intentionally target critical emergent literacy goals. This article describes fundamental principles of explicit literacy instruction, identifies literacy domains targeted as part of explicit literacy instruction, and presents examples of how early childhood classrooms can be organized to implement the embedded-explicit model.

21st Century Literacy for a Diverse World

Literacy demands in the 21st century require that proficient readers do more than 'read along the lines' or decode words and know their meaning. Proficient readers must be able to 'read between the lines', making relevant inferences to interpret, analyze, and synthesize information in texts; and 'read across the lines', applying these critical reading processes to multiple texts for purposes of problem-raising and problem-solving. This article will review literature on the cognitive and linguistic skills necessary for reading along the lines in a variety of scripts; the nature of the language and cognitive skills essential for the text comprehension necessary for reading between and across the lines, and the ways that culture and language influence text comprehension.

Predicting response to early reading intervention from verbal IQ, reading-related language abilities, attention ratings, and verbal IQ-word reading discrepancy: failure to validate discrepancy method

Additional analyses of a previously published study addressed three questions about growth in word reading during early reading intervention: (1) How well do Verbal IQ, reading-related language abilities (phonological, rapid naming, and orthographic), and attention ratings predict reading growth? (2) How well do language deficits predict reading growth? and (3) How well does Verbal IQ-word reading discrepancy predict reading growth? Univariate analyses showed that Verbal IQ, phonological skills, orthographic skills, rapid automatized naming (RAN), and attention ratings predicted the response to early intervention, but multivariate analyses based on a combination of predictors for real-word reading and pseudoword reading showed that Verbal IQ was not the best unique predictor. Students with double or triple deficits in language skills (RAN, phonological, and orthographic processing) responded more slowly to early intervention than students without language deficits. Verbal IQ-word reading discrepancy did not predict the response to early intervention in reading. Overall results supported the use of reading-related language and attention measures rather than IQ-achievement discrepancy in identifying candidates for early reading intervention.

The prevention and identification of reading disability

There is abundant evidence that intervention for the prevention of reading disability is effective in dramatically reducing the prevalence of reading disability. This article explores the current state of knowledge regarding the causation and prevalence of reading disability, along with evidence that the incidence of this condition can be dramatically reduced through quality intervention. Specifically, we (1) explore what is known about the nature and causes of reading disability, (2) examine how reading disability can best be identified, and (3) estimate the percentage of children that have severe reading difficulties that indicate the true presence of a disability.

Early elementary school intervention to reduce conduct problems: a randomized trial with Hispanic and non-Hispanic children

Children's aggressive behavior and reading difficulties during early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address both of these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems. European American (n = 116) and Hispanic (n = 168) children from 3 communities who were selected for aggressiveness or reading difficulties were randomly assigned to an intervention or no-intervention control condition. Intervention families received parent training, and their children received social behavior interventions and supplementary reading instruction over a 2-year period. At the end of intervention, playground observations showed that treated children displayed less negative social behavior than controls. At the end of a 1-year follow-up, treated children showed less teacher-rated internalizing and less parent-rated coercive and antisocial behavior than controls. The study's limitations and implications for prevention are discussed.

The child's route into reading and what can go wrong

Two strands of linguistic development critically important for successful reading acquisition are outlined. One of these ontogenetic roots concerns phonological development and projects onto word decoding. The other root concerns the development of vocabulary and syntax projecting onto reading comprehension. Language development starts very early in infancy when the child learns to categorize the speech sounds according to the pattern typical of the mother tongue. Equipped with these sound categories the child is ready to learn to understand and to use new words. The precise phonological representation of words will facilitate the important development of phonological awareness. The paper reviews some longitudinal research and training studies indicating the causal direction of the relation between phonological awareness and reading. Preventive implications are pointed out. The preventive power of the second strand of development is discussed with reference to vocabulary exposure in different social environments and to informal early literacy socialization. In particular, the benefits of the prototypical situation of reading aloud to children are discussed. Finally, the complexity of the causal relationships between different aspects of early language development and later reading is pointed out.