Effects of Combined Repeated Reading and Question ...daddcec.org/Portals/0/CEC/Autism_Disabilities/Research/...Effects of Combined Repeated Reading and Question Generation Intervention

Effects of Combined Repeated Reading and QuestionGeneration Intervention on Young Adults with Cognitive

Disabilities

Youjia Hua, William J. Therrien, Jo M. Hendrickson, Suzanne Woods-Groves,Pamela S. Ries, and Julia W. Shaw

The University of Iowa

Abstract: The combined repeated reading and question generation procedure is a reading intervention designedto target both fluency and comprehension for students with disabilities. Previous research has demonstrated theeffectiveness of the intervention for school age children with learning disabilities. This study extended theresearch by utilizing the program with three postsecondary learners with severe learning disability and mildmental retardation. In the context of a multiple baseline across participants design, the results indicate that theprogram may be an effective intervention to improve fluency and comprehension for young adults with cognitivedisabilities.

Reading is an area of primary academic skilldeficit for young adults with cognitive disabil-ities (NALLDC, 1999). Traditionally, postsec-ondary education programs for adults withdisabilities have an emphasis on functionalskills that prepare them for work and indepen-dent living without focusing on reading (Scan-lon & Lenz, 2002). As a result, the limitedreading proficiency for individuals with dis-abilities will persist throughout their adult-hood and affect all aspects of life (Vogel,1998). For example, individuals strugglingwith reading tend to have lower incomes andhigher rates of unemployment (Baydar,Brooks-Gunn, & Furstenberg, 1993). Limitedreading proficiency may also affect their qual-ity of life and general well-being (Chhabra &McCardle, 2004). Therefore, reading shouldbe an essential instructional goal of postsec-ondary education for adults with disabilities(National Adult Literacy Summit, 2000).

However, research in the area of reading atpostsecondary level is sparse and unable toguide practice (Scanlon & Lenz, 2002). Scan-

lon and Lenz’s survey of the adult literacyeducation directors in the United States indi-cates that reading instruction for learners withdisabilities at postsecondary level is predomi-nantly driven by prescribed curriculum, notteachers’ knowledge of effective practice. Inaddition, only a few of the reported interven-tions provided by adult literacy programs werevalidated by research. The results of the surveyhighlight the critical needs of research in thearea of reading for this population.

Researchers have developed a number ofreading interventions and materials forschool-age students, however, it may not beappropriate to implement these interventionswith learners at postsecondary level (Carnine,1993). On the other hand, there is some evi-dence that adults with disabilities learn to readthe same way that children learn and adultlearners may benefit from structured and in-tensive reading instruction that focuses onfundamental reading skills (e.g., Lyon, 1995;Scanlon & Lenz, 2002; Vogel, 1998).

For example, one defining characteristic ofpoor reading ability manifested by bothschool-age children and young adult learnersis the lack of reading fluency (NALLDC,1999). Reading fluency, the ability to readwith speed, accuracy, and proper expression,is one of the essential components of readinginstruction (National Institute of Child Health

Correspondence concerning this article shouldbe addressed to Youjia Hua, Department of Teach-ing and Learning, N256 Lindquist Center, The Uni-versity of Iowa, Iowa City, IA 52242. Email: [email protected]

Education and Training in Autism and Developmental Disabilities, 2012, 47(1), 72–83© Division on Autism and Developmental Disabilities

72 / Education and Training in Autism and Developmental Disabilities-March 2012

and Human Development, 2000). Readingfluency is considered a predictor of compre-hension achievement (Fuchs, Fuchs, & Hosp,2001). When reading without fluency, indi-viduals are likely to have difficulty with com-prehension because they have to use an ex-tensive amount of cognitive resources tofocus on decoding individual words, thus leav-ing not enough capacity to comprehension(Berg & Samuels, 1974). On the other hand,increase in reading fluency does not guaran-tee improvement in reading comprehension(e.g., Bryant et al., 2000; Homan, Klesius, &Hite, 1993; Rashotte & Torgesen, 1985).Therefore, researchers and educators mustaddress both fluency and comprehensionwhen designing reading intervention foryoung adults with cognitive disabilities (Vogel,1998).

The Reread-Adapt and Answer-Compre-hend (RAAC) is one such intervention thatmay be promising for learners with cognitivedisabilities at postsecondary level. The RAACprocedure is a reading intervention designedto target both fluency and comprehension forstudents with disabilities (Therrien, Wick-strom, & Jones, 2006). Several instructionalcomponents of the RAAC intervention areconsidered essential (Rosenshine, Meister, &Chapman, 1996; Therrien, 2004). First, theRAAC intervention addresses reading fluencyby having students repeatedly read instruc-tional level materials to a competent tutorwho corrects decoding errors. Second, theRAAC intervention targets comprehension byhaving students answer a series of comprehen-sion questions before and after reading.

Researchers demonstrated that the RAACintervention increased decoding fluencyand reading comprehension for school-agechildren with and without disabilities (Ther-rien, 2004). Hua, Hendrickson, and Therrien(2010) extended the research by utilizingthe RAAC intervention with three postsec-ondary learners with autism spectrumdisorder. The results indicate that theintervention improved fluency and compre-hension for all three participants. Fluencygains exceeded the ambitious levels of growthand transferred to unpracticed passages. Inaddition, all participants answered more fac-tual and inferential comprehension cor-rectly during intervention. While the utility

of the RAAC intervention has yet to beproven for young adults with cognitive dis-abilities, it seems to be a logical interventionfor this population.

The purpose of this study was to assess theeffectiveness of the RAAC intervention onreading fluency and comprehension of youngadults with cognitive disabilities. Specifically,we addressed the following two questions.(1) Does the RAAC program increase stu-dents’ reading fluency on intervention pas-sages? (2) How does RAAC impact factual andinferential comprehension?

Method

Participants and Setting

Three students diagnosed with mild mentalretardation and severe learning disability par-ticipated in the study. At the time of the study,all three participants were enrolled in a post-secondary education program for youngadults with learning and cognitive disabilitiesat a Midwestern university. The program pro-vided an integrated collegiate experience in-cluding academic enhancement, career devel-opment, student life, and community life. Theprogram academic coordinator referred thethree students for participation in the studybecause of their reading difficulties.

Before the study, we administered an oralreading fluency (ORF) curriculum-basedmeasurement (CBM) to determine individualstudent’s instructional reading level. The ini-tial CBM results indicated that using the read-ing placement criteria recommended byFuchs and Deno (1982) the highest instruc-tional reading level for Linda was 1st grade,2nd grade for Sam, and 6th grade for Paul.Table 1 presents a detailed description of eachstudent, including age, gender, ethnicity, dis-ability category, standardized test scores oncognitive ability, and instructional readinglevels.

Nine undergraduate students enrolled in aspecial education methods course partici-pated in the study as tutors. Tutors collectedbaseline data and implemented the interven-tion during the one-on-one sessions in threeoffices (3 m � 3 m). We conducted the exper-iment three times a week (i.e., Monday,

Combined Repeated Reading and Question Generation / 73

Wednesday, Friday) and each intervention ses-sion lasted for approximately 15 minutes.

Materials

We created 27 reading passages at grades 1, 2,and 6 using the procedures developed byTherrien et al. (2006). We controlled thelength of the individual passages so that stu-dents reading at the 50th percentile fluencylevel could finish reading the passages in1–1.25 minutes (Hasbrouck & Tindal, 1992).The average length of passages for 1st, 2nd,and 6th grade was 86, 113, and 161 wordsrespectively. We also developed eight readingcomprehension questions (four factual andfour inferential) using the definition by Daveyand McBride (1986):

Correct responses to factual questions canbe underlined directly in the text withoutrequiring the integration of informationfrom multiple sentences. Correct responsesto inferential questions either cannot belocated in the text (i.e., cannot be under-lined) or require integration of informationfrom multiple sentences (p. 257).

Procedure

In the baseline, the tutor asked the student toread a passage aloud. As soon as the studentstarted to read the first word of the passage,the tutor started the stopwatch. The tutor fol-lowed student reading on the tutor’s copy ofthe passage by recording errors with a slashthrough the incorrectly read word (includingsubstitution and omissions). If the studenthesitated or did not read a word within 3seconds the tutor told the student the word,and marked it as an error on the tutor’s copy.

After the student finished reading the lastword of the passage the tutor stopped thestopwatch and recorded the total time. Thetutor then removed the passage from the stu-dent and asked the reading comprehensionquestions. The tutor transcribed student’s re-sponses on the tutor’s copy while the studentanswered the reading comprehension ques-tions orally. Student responses to the compre-hension questions were graded by tutor ascorrect or incorrect using a key of list of ac-ceptable answers. At the end of each session,the tutor thanked the student and gave briefand generic praise (e.g., “Thank you. Goodjob!”).

During intervention, the tutor imple-mented the RAAC procedure using a checklistdeveloped by the researchers. The tutor firstgave the student a cue card that contained alist of four questions related to the structureof the narrative passages (see Table 2 for cuecard questions). The tutor asked the studentto read these questions with the followingstatement: “Before you read the story I wantyou to read these questions. Pay attention towhat you are reading as you will need to an-swer these questions (the tutor pointed to thequestions on the cue card).” The student thenread each question aloud.

TABLE 1

Description of Students

Student Information

Student Age Gender Ethnicity Disability IQ Reading Level

Linda 19 Female Caucasian Severe LD 92 1st GradeSam 21 Male Caucasian Mild MR 65 3rd GradePaul 20 Male Caucasian Mild MR 67 6th Grade

TABLE 2

Question Generation Prompts

How did the main character feel?Who is the main character?Where and when did the story take place?What did the main character do?How did the main character feel?


As soon as the student finished reading thequestions on the cue card, the tutor gave thestudent a reading passage and asked the stu-dent to read the passage aloud three timesusing the procedures identical to those de-scribed in baseline. After each reading, thetutor corrected all the decoding errors usingan explicit teaching procedure. The tutorpointed to the word that was incorrectly readand asked the student to read the word aftertutor modeling (e.g., “This word is ____. Whatword?”). After modeling all the incorrectlyread words in the passage, the tutor pointed tothese words and asked the student to read itindependently (e.g., “What is this word?”).This error correction procedure was repeateduntil the student read these words correctlywithout additional help. The student also re-ceived feedback on fluency, accuracy, andprosody from the tutor (see Table 3 for feed-back sheet).

After the student finished reading the pas-sage for the third time, the tutor asked thestudent to orally answer the generic narrativepassage questions on the cue card. If the stu-dent did not know the answer or answered thequestion incorrectly, the tutor provided addi-tional prompts using the following steps. Ini-tially, the tutor prompted the student to readthe passage and find the information (e.g.,“Can you find the answer in the passage?”). Ifthe prompt did not result in a correct answer,the tutor asked the student to read the sen-tence where the answer could be found orinferred (e.g., “Can you find the answer in thissentence?”). If the student could not answerthe question correctly after reading the sen-tence, the tutor provided the answer orallyand explained the reason. At the end of thesession, the tutor asked the student to answerthe passage specific comprehension questionsand transcribed and scored the student re-sponses using the same procedures as thosedescribed in baseline.

Tutor Training

We trained tutors to collect data and imple-ment RAAC intervention during the two3-hour class sessions using the explicit instruc-tion procedure. We task-analyzed the proce-dure and developed a 14-step checklist. Theresearchers then modeled each step. After

modeling, tutors practiced each step as agroup with researcher’s prompts and feed-back. Researchers checked individual’s mas-tery of the procedures during the one-on-onesimulated sessions. All tutors reached 100%accuracy on the procedural checklist by theend of the training sessions.

Experimental Design

We used a multiple-baseline across subjectsdesign to examine the effects of RAAC proce-dures on reading fluency and comprehension.This design allowed us to demonstrate theeffects of the academic intervention on a skillthat could not be reversed (Tawney & Gast,1984). The baseline period for Linda was 6sessions, for Sam the baseline was 12 sessions,and for Paul the baseline was 18 sessions. Wethen sequentially introduced the RAAC inter-

TABLE 3

Feedback Sheet Used by the Tutor

Level 4 □ I read most of the story in longmeaningful phrases.

□ I repeated or missed only a fewwords.

□ I emphasized important words orphrases

□ I read with expressionLevel 3 □ I read most of the story in 3- to

4-word phrases.□ I repeated or missed only a few

words.□ I emphasized important words or

phrases□ I read some of the story with

expressionLevel 2 □ I read most of the story in short

2-word phrases.□ I repeated or missed too many

words.□ I did not emphasize important

words or phrases□ I did not read with expression

Level 1 □ I read most of the story word byword.

□ I repeated or missed too manywords.

□ I did not emphasize importantwords or phrases

□ I did not read with expression


vention to individual students and measuredall three participants’ reading performancesconcurrently. Linda received 21 sessions ofRAAC intervention, 15 sessions for Sam, and 9sessions for Paul.

Dependent Variables

The primary dependent variable was correctwords per minute (CWPM). Correct words perminute was calculated by multiplying thenumber of words read correctly by 60 anddividing by the number of seconds taken toread the passage. We used CWPM from theterminal (i.e., third) reading of passagesduring intervention for comparison. We alsorecorded the number of words read incor-rectly and the number of comprehensionquestions answered correctly across the exper-imental conditions as secondary dependentvariables.

Reliability and Procedural Integrity

We checked both procedural integrity andinterobserver reliability during 25% of the ses-sions across baseline and intervention foreach participant. An independent observerevaluated tutor’s treatment integrity using aprocedural checklist identical to the scriptused by the tutor. Procedural integrity was100% across all tutors. The observer also in-dependently scored student ORF and readingcomprehension during the session. Interob-server agreement was calculated by total num-ber of agreements divided by agreements plusdisagreements multiplied by 100%. The meanagreement for CWPM was 92%; the meanagreement for reading comprehension was95%.

Results

Figure 1 presents participants’ CWPM duringbaseline and intervention. Table 4 presentsthe mean CWPM and slopes across the exper-imental conditions. All three participants im-proved their ORF immediately after they re-ceived RAAC intervention. Linda’s ORFincreased from a mean of 38 CWPM (range,24 to 47) in baseline to a mean of 84 CWPM(range, 61 to 108) in intervention. Sam im-proved his ORF from a mean of 65 CWPM

(range, 49 to 83) in baseline to a mean of 90CWPM (range, 74 to 105) in intervention.Paul’s ORF increased from a mean of 133CWPM (range, 102 to 154) in baseline to amean of 162 CWPM (range, 141 to 205) inintervention.

In addition to the level changes, students’ORF slopes changed between baseline andintervention as well. We calculated slopes inbaseline and intervention using ordinary least-squares regression between CWPM and ses-sions. During RAAC training, Linda reversedher decelerating slope of �2.00 in baseline toan accelerating slope of 1.01. Sam improvedhis fluency growth with a slope of .90 in com-parison to the baseline slope of .47. However,Paul’s ORF had a descending slope of �1.84in the intervention in comparison to his base-line slope of .56.

Based on the slope values, we calculatedCWPM growth per week to examine student’sprogress over time. We converted the slope toa weekly CWPM growth rate by multiplying by3.5 days as the slope value from the regressionrepresents the average change of CWPM forevery two calendar days (Fuchs & Fuchs,1992). We compared weekly CWPM growthwith normative realistic and ambitious gradelevel growth rates. In comparison to the nor-mative grade level ORF growth rate recom-mended by Fuchs, Fuchs, and Hamlett (1989),Linda and Sam exceeded the ambitious levelsof growth in intervention (see Table 5). Be-fore intervention, Linda read with a decreas-ing fluency at 7 words per week; Sam’s ORFgain was 1.65 words per week. During inter-vention, Linda increased ORF growth to 3.54words per week, representing .54 words abovethe ambitious growth rate. Similarly, Sam’sORF growth rate was 3.16 words per weekduring intervention, 1.16 words higher thanthe ambitious ORF growth rate. Paul’s weeklyORF growth rate, on the other hand, was 1.98CWPM in baseline and �6.42 CWPM in inter-vention.

Figure 2 presents total number of wordsread incorrectly per passage across the exper-imental conditions. All three students’ decod-ing errors decreased immediately after receiv-ing RAAC intervention. Linda’s decodingerrors decreased from an average of 16 to anaverage of 3.6 errors per passage in interven-tion. Sam’s decoding error was reduced from


an average of 8.72 in baseline to 2 errors perpassage in intervention. Paul’s average decod-ing errors decreased from 2.39 in baseline to

.2 errors per passage in intervention. Figure 3and Table 6 present total number of factualand inferential comprehension questions an-

Figure 1. Correct words per minute across experimental conditions.


swered correctly by students across the exper-imental conditions. In general, all participantsanswered more factual and inferential com-prehension questions correctly during inter-vention.

Discussion

Researchers suggest that the importance ofreading fluency extends beyond elementarylevel and it is essential to include effectivefluency intervention for struggling readers, re-gardless of their age (Rasinski et al., 2005).Furthermore, struggling adult readers alsoneed explicit comprehension instruction us-ing passages with controlled vocabulary anddifficulty level (NALLDC, 1999). The resultsof the study suggest that young adults withcognitive disabilities may benefit from system-atic and intensive instruction that focuses onfluency and comprehension. The RAAC inter-vention we implemented in the study ad-dressed both fluency and comprehensionneeds of this population. Similar to the find-ings from previous studies (e.g., Hua et al.,2010), all three participants showed gains in

oral reading fluency from reading the samepassage three times. Reading fluency of thetwo participants also exceeded the ambitiousORF growth rate. In addition, the interven-tion improved all three participants’ readingcomprehension on both factual and inferen-tial questions.

This study extended the research by utiliz-ing the RAAC intervention with learners whohave cognitive disabilities at postsecondarylevel. In comparison to the RAAC interventiondeveloped by Therrien and colleagues (2006),we modified the procedures in several ways.First, students read each passage three timeswithout using a performance criterion. Sec-ond, students read passages at their individualinstructional level throughout the interven-tion without varying passage difficulty. Resultsof the study indicate that repeated readingmay be an effective intervention for youngadults with cognitive disabilities. It enhancedreading fluency by increasing learners’ oppor-tunities to respond and practice (Skinner &Shapiro, 1989). In addition, anecdotal obser-vation and reports from the tutors in the studysuggest that two of the participants (Lindaand Sam) were motivated to read during in-tervention because they enjoyed knowing thatthey read faster after each reading. Therefore,the immediate and significant fluency gainsduring repeated reading may be reinforcingfor learners (Vallely & Shriver, 2003). Giventhe long history of difficulties in the area ofreading, motivation is an important factor thatcontributes to the successful acquisition ofnew skills for adults with disabilities (Deshler,Schumaker, & Lenz, 1984).

The other critical component of the RAAC

TABLE 4

Mean CWPM and Slopes During Baseline and Intervention

Experimental Conditions

Baseline Intervention

Student CWPM (SD) Slope (SEE) CWPM (SD) Slope (SEE)

Linda 38 (8.95) �1.99 (2.17) 84 (13.02) 1.01 (.42)Sam 65 (9.73) .47 (.84) 90 (8.83) .90 (.49)Paul 133 (15.22) .56 (.70) 162 (20.12) �1.84 (2.69)

TABLE 5

Correct Words Per Minute Weekly Growth

Actual Normative

Student Baseline Intervention Realistic Ambitious

Linda �6.99 3.54 2.00 3.00Sam 1.65 3.16 1.50 2.00Paul 1.98 -6.42 .30 .65


procedure we implemented in the study wasthe feedback from tutors. During interven-tion, tutors corrected all the decoding errorsand practiced these words with the learners.Research syntheses of repeated reading sug-

gest that when the intervention incorporatedcorrective feedback students made greatergains on reading fluency (e.g., Therrien,2004). Tutor’s feedback on fluency, accuracy,and prosody may have also increased learners’

Figure 2. Number of errors per passage across experimental conditions.


success and motivation because tutors can di-rectly and effectively address the immediateneeds of learners with disabilities (Deshler,Schumaker, Lenz, & Ellis, 1984).

We also focused on reading comprehensionin the RAAC intervention. Researchers sug-gest that struggling readers benefit from inter-ventions that help them activate prior knowl-

Figure 3. Number of comprehension questions answered correctly across experimental conditions.


edge and organize text (e.g., Mastropieri,Scruggs, & Graetz, 2003). Before each read-ing, we asked the students to read the ques-tions related to the structure of the narrativepassages (e.g., setting, characters, problem,solution and outcome). These questions notonly provided an outline of the narrativepassage but also helped students take noteof the relevant information, thus enhanc-ing comprehension monitoring duringreading (Gersten, Fuchs, Williams, & Baker,2001).

On the other hand, one student’s descend-ing ORF slope in intervention raised concernsregarding the efficacy of the RAAC interven-tion with this population. There are severalplausible explanations for Paul’s performanceduring program implementation. Among thethree students, Paul was the most proficientreader. He read 6th grade level passages withan average of 133 CWPM in baseline and 162CWPM in intervention. Some researchers(Kuhn & Stahl, 2003) speculate that fluencyintervention is most beneficial for studentsreading below 4th grade level. Second, Paulreceived the least amount of intervention ses-sions (9 sessions). Additional intervention ses-sions may have resulted in an increasingtrend. Last, Paul’s decreasing fluency duringrepeated reading may indicate that he wasbecoming less motivated to read because thetask was not challenging. Researchers foundthat boredom was one of the drawbacks ofrepeated reading and may become aversivefor older learners (Homan, et al., 1993; Rasin-ski, 1990).

Limitations and Future Research

The results of this study must be interpretedwithin the context of its limitations. First, wedid not assess the effects of the RAAC inter-vention on unpracticed passages. In order forthe acquired reading skill to be functional,learners must be able to generalize the skill tounpracticed passages (Vallely & Shriver,2003). It will be important to evaluate if theeffects of the intervention are transferrable totexts that are novel to learners as generaliza-tion of the skills to other contents and settingis an important goal of the literacy educationfor young adults with disabilities (Deshler,Schumaker, & Lenz, 1984).

Second, the modest improvement and ahigh degree of variability of the number ofcomprehension questions answered correctlyby students warrant further investigation ofthe effectiveness of the intervention on com-prehension. In the study, students had limitedopportunity (i.e., eight comprehension ques-tions) to demonstrate their comprehensiongrowth. Therefore, it is possible that students’performances of reading comprehensionwere limited by the ceiling effects. In addition,future research should use more sensitivemeasures to examine the effectiveness of theintervention on reading comprehension (e.g.,story retell- Fuchs & Fuchs, 1992).

Third, although the data of the studyshowed that the RAAC was an effective inter-vention to improve reading fluency and com-prehension for postsecondary students withcognitive disabilities, only three students par-ticipated in the study. Researchers found thatyoung adults with reading difficulties have

TABLE 6

Mean Number of Factual and Inferential Comprehension Questions Answered Correctly Per PassageDuring Baseline and Intervention

Experimental Conditions

Baseline Intervention

Student Factual Inferential Total Factual Inferential Total

Linda 3.83 2.83 6.67 3.86 3.62 7.48Sam 3.50 2.92 6.42 3.93 3.40 7.33Paul 2.44 2.61 5.06 3.33 2.67 6.00


large discrepancies of needs and proficiencylevels in critical reading skill areas (Vogel,1998). Thus, further research is warranted todetermine whether other individuals with cog-nitive disabilities would also benefit from theRAAC intervention.

Practical Implications

The emphasis of postsecondary education forindividuals with cognitive disabilities shoulddirectly contribute to meaningful outcome forthe adult. Evidence suggests that literacy pro-ficiency can enhance qualities of economicand social living for these individuals. There-fore, providing basic skills instruction usingresearch-based intervention should be a prior-ity for educators working with young adultswho struggle with reading. The results of thisstudy suggest that young adults with learningdisabilities and mild mental retardation canbenefit from an intensive reading programthat addresses both fluency and comprehen-sion (Zigmond, 1990). Teachers can improvefluency by providing students with opportuni-ties to read connected text repeatedly whilecorrecting decoding errors. Reviewing and an-swering comprehension questions related tothe structure of the story during reading canalso enhance reading comprehension.

The RAAC procedure we implemented inthe study included features identified by re-search as essential components of a dynamicintervention program (Deshler et al., 1984).First, we used CBM to progress monitor stu-dent reading fluency and comprehensionthroughout the intervention. Second, we col-lected procedural integrity data to check theactual implementation of the intervention.Third, we asked the tutors to write a reflectionpaper every week to keep us apprised of theconsumer satisfaction. This feedback loop en-sured that the intervention was dynamic andresponsive to the needs of the consumers ofthe program. Therefore, the RAAC interven-tion may be a promising basic literacy inter-vention model for young adults with cognitivedisabilities.

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Received: 19 October 2010Initial Acceptance: 21 December 2010Final Acceptance: 9 March 2011


Documents

Effects of Combined Repeated Reading and Question ...daddcec.org/Portals/0/CEC/Autism_Disabilities/Research/...Effects of Combined Repeated Reading and Question Generation Intervention