Estrategias

International Journal of Disability, Development and EducationVol. 58, No. 1, March 2011, 47–59

ISSN 1034-912X print/ISSN 1465-346X online© 2011 Taylor & FrancisDOI: 10.1080/1034912X.2011.547349http://www.informaworld.com

Examining the Efficacy of an Intervention to Improve Fluency and Reading Comprehension in Spanish Children with Reading Disabilities

Manuel Sorianoa*, Ana Mirandaa, Emilia Sorianob, Francisco Nievasc and Vicente Félixa

aDepartamento de Psicología Evolutiva y de la Educación, Universidad de Valencia, Valencia, Spain; bConsellería de Educación, Generalitat Valenciana, Valencia, Spain; cDepartamento de Psicología Evolutiva y de la Educación, Universidad de Almeria, Almeria, SpainTaylor and Francis LtdCIJD_A_547349.sgm10.1080/1034912X.2011.547349International Journal of Disability, Development and Education1034-912X (print)/1465-346X (online)Original Article2011Taylor & Francis581000000March [email protected] The main goal of the present study was to examine the efficacy of a multi-component

programme to improve reading fluency and text comprehension in Spanish childrenwith reading disabilities (RD). Special needs teachers were trained in the application ofthe programme, which included repeated reading plus phonological awareness trainingand grapheme–phoneme decoding training. Instruction was delivered one to one.Participants were 22 students with RD, aged 10–13, distributed in two groups: one with12 children who received the intervention (experimental group), and the other with 10children who received no intervention (comparison group). The effects of the trainingprogramme were evaluated using gains in scores on word and pseudo-word reading andtext reading fluency, as well as on a text comprehension test. Results of analyses ofcovariance comparing the two groups with age as a covariate showed that children whoparticipated in the intervention obtained statistically significant gains on the readingmeasures used, with the exception of text comprehension. Results are discussed withregard to effective interventions for students with reading disabilities. Reflections onthe study’s limitations provide a basis for recommending future lines of research.

Keywords: intervention; multi-component training; phonological awareness training; reading comprehension; reading disabilities; reading fluency; repeated reading; transparent orthography

Introduction

Reading proficiency is an academic skill that plays an essential role in school success.However, even though reading is a basic objective of the curriculum, many students havesevere problems with this foundational skill. Therefore, it is not surprising that there is agreat deal of interest in studying the factors involved in reading acquisition difficulties.The currently most widespread interpretation is that reading disorders are caused by inef-fective phonological processing. In fact, the results of several studies have indicated thatstudents with reading disabilities (RD) exhibit significant difficulties in grapheme-to-phoneme decoding, empirically supporting the view that ineffective phonological process-ing is a core deficit underlying RD (Herman, Matyas, & Pratt, 2006; Rack, Snowling, &Olson, 1992). Along the same lines, various studies carried out in Spain have also found adeficit in phonological awareness in children with specific reading disabilities who exhibitpoor reading fluency rather than mere inaccuracy. Typically, their reading is characterisedas being dysfluent and inaccurate, suggesting that RD in Spanish, a language with a trans-parent orthography, represents a severe and complex deficit in lexical access (Jimenez &

*Corresponding author. Email: [email protected]

48 M. Soriano et al.

Hernández, 2000; Jiménez, Rodríguez, & Ramírez, 2009; Serrano & Defior, 2008; Soriano& Miranda, 2010). Consequently, phonological training has become the basis for themajority of remediation programmes for students with reading disabilities.

Cumulative findings from intervention studies have shown that phonologically-basedinterventions can significantly increase young children’s reading skills, with the gains moreconsistent and robust when phonological awareness is taught together with letter-soundcorrespondence (Bus & van Ijzendoorn, 1999). In contrast, the results obtained with thistraining approach do not seem to be equally effective in older children with RD (Hernández-Valle & Jiménez, 2001; Kerstholt, van Bon, & Schreuder, 1994; Rueda & Sánchez, 1996).In sum, it seems that although phonological awareness plus letter–sound correspondencemay be a necessary training component, it is not sufficient to improve reading skills, partic-ularly in the case of older students with RD. Moreover, phonological awareness training byitself does not seem to be effective in increasing word reading fluency and comprehension,skills that gradually become more important throughout the reading development process(Torgesen, Rashotte, & Alexander, 2001). The ability to read involves a close connectionbetween decoding, fluency and comprehension, so that a fluent reader has “automated”many of the decoding processes and is able to devote their full attention to the meaning ofthe text. In contrast, readers who are not fluent in reading are less motivated to practice,struggle more in learning academic content, and have a poor understanding of what theyread (Kuhn & Stahl, 2003).

The above-mentioned considerations explain why reading fluency, defined as the abilityto read with speed and accuracy (Samuels, 1979), has become a crucial goal in the treatmentof children with RD, even though it is one of the reading dimensions where remediation isnot easy (Kamps & Greenwood, 2005; Lovett & Steinbach, 1997; O’Connor et al., 2002;Rasinski, Rikli, & Johnston, 2009). The most commonly used method for enhancing readingfluency has been the repeated reading of words or passages, which has been shown to havepositive effects on students’ reading achievement (e.g., accuracy, rate, prosody, or compre-hension) (Chard, Vaughn, & Tyler, 2002; Hintikka, Landerl, Aro, & Lyytinen, 2008; Kuhn& Stahl, 2003; Meyer & Felton, 1999; National Reading Panel, 2000; Therrien, 2004).Nevertheless, when this type of training has been directed specifically toward readers withsevere problems, transfer effects to untrained materials have generally been fairly small(Berends & Reitsma, 2006; Therrien, 2004).

One possible explanation for the limited transfer of repeated reading procedures is thatpositive effects of the training on speed and accuracy could be due to an increased specifi-cation of the orthographic representation of a word in the mental lexicon. In other words,the more specified this representation is, the easier it is to read the word fluently. Recentresearch has provided a theoretical framework for the word-specific training effect ofrepeated exposure. The Share (2004) self-teaching hypothesis indicates that every successfuldecoding event will improve the future reading of a particular word. That this effect is theresult of decoding instead of pure visual exposure is demonstrated by the fact that minimisingphonological processing during presentation significantly diminishes the orthographiclearning effect. Furthermore, the self-teaching hypothesis also proposes that training effectsare item based. The repeated reading training effects are expected to be word specific, andgeneralisation to untrained words is, therefore, unlikely. Within this framework, it makessense to provide training in sub-lexical units, due to its possible positive influence on gener-alisation. Syllables are the most consistent sub-lexical units in regular orthographies likeSpanish (Carreiras & Grainger, 2004). Thus, facilitating visual identification of syllablescould help individuals with RD to build up orthographic representations of recurrent sylla-bles, achieving faster automatic direct word recognition (Tresoldi, Vio, & Iozzino, 2007).

Intervention to Improve Fluency and Reading Comprehension 49

Therefore, training designed to make the participant familiar with syllables repeated indifferent words will help him or her to read other words containing the same syllables. Thus,systematic phonological awareness training at the syllabic and phonemic level is one of thecomponents of the reading fluency programme being tested in this study.

In another vein, various studies have found that decoding practice alone, althougheffective in improving word recognition, does not necessarily improve reading rate (Meyer& Felton, 1999; Torgesen, Wagner, & Rashotte, 1997). In addition, quick recognition ofwords in lists has also produced inconsistent findings for fluency in context (Levy, Abello,& Lysynchuk, 1997). Thus, in order to improve their reading rate, students probably needto dedicate a large amount of time to repeatedly reading texts within programmes designedto teach reading fluency.

One last matter of great educational interest involves the contribution of fluency toreading comprehension, the final goal of learning to read. Fluency is undoubtedly an impor-tant factor in the reading process. Poor readers have to dedicate a large portion of theircognitive resources to decoding words, which impedes flow of thought and interferes withcomprehension. In contrast, fluent readers decode words accurately and quickly, conserv-ing many resources that they can use for comprehension. A recent meta-analysis indicatedthat repeated reading has a moderate impact on students’ comprehension (Therrien, 2004).Along the same lines, in their excellent review, Kuhn and Stahl (2003, p. 9) concluded that,with few exceptions, the results for comprehension mirror those for fluency: “generally,where an increase in fluency was found, there was also an increase in comprehension”.

Study Purpose

The main purpose of this study was to extend the research in reading fluency training toSpanish, an orthographically transparent language. More specifically, our first objectivewas to use indicators of reading accuracy and speed to evaluate the efficacy of a multi-component programme consisting of repeated reading plus phonological awareness train-ing and grapheme–phoneme decoding, designed to improve reading fluency in Spanishchildren with RD.

The second objective of this study was to examine whether the application of the multi-component programme, which provided no instruction in the meanings of words or texts,produced a generalised improvement in comprehension. We expected to find moderate-to-strong correlations between reading fluency and reading comprehension, and our programmewas designed according to critical instructional variables shown to optimise the efficacy ofreading fluency intervention (see meta-analysis by Therrien, 2004). Thus, the training wascarried out during an extended period of time, and the material in each session was workedon until the performance criterion was reached. The instruction was individualised. Thestudent received continuous performance feedback and the intervention was performed byan expert adult who modelled appropriate prosodic marking to divide sentences in therepeated reading of the texts.

Method

Participants

In this study, 22 primary and secondary school students with reading disabilities fromdifferent schools in Valencia, Spain participated. They had low–middle socio-economicstatus, but no cultural or environmental disadvantages. All the participants were Caucasianor South American and used Spanish as their first oral language. They ranged in age from


10 to 13 years (mean age = 11 years, 7 months, standard deviation [SD] = 1 year, 1 month).The sample comprised 17 boys and five girls.

All the children, as stipulated in the regulations currently in force in Spain for studentswith learning disabilities, attended special education classes (i.e., resource rooms) threehours a week in their respective schools. They were classified into two different groups: theintervention group (IG), which was made up of 12 students with RD (mean age = 12 years,5 months, SD = 0.67; nine male and three female); and the untrained comparison group(CG), which was composed of 10 children with RD (mean age = 10 years, 7 months, SD =0.43; eight male, two female). Due to the distance between the different schools, the partic-ipants were not randomly assigned to the treatment regimen and the comparison regimen.The intervention group was made up of students who attended schools near each other, sothat the first author could maintain fortnightly contact with the teachers responsible forimplementing the intervention. This arrangement was designed to promote the fidelity ofthe intervention; that is, the application of the treatment by the teachers was in exactly theway it had been designed.

The presence of RD was confirmed using an adaptation of the multifaceted approachdeveloped by Pereira-Laird, Deane, and Bunnell (1999). The requirements followed in theassessment were: poor academic performance in reading, according to a teacher’s ratingreport, and average achievement in other academic areas (e.g., arithmetic); scores of 80 orhigher on an intelligence test (Cattell & Cattell, 1950/1989), in order to exclude studentswith intellectual disability; no evidence or history of neurological damage, environmentaldisadvantage, emotional disturbance, hearing or vision impairments, or any other majorhandicapping condition, in accordance with the conventional exclusion criteria for learningdisabilities (LD); and the achievement criteria in reading adopted in this study have beencommonly used in the LD literature. Specifically, RD was determined using a score corre-sponding to the 25th percentile or less on the word-reading subtest from the standardisedReading Test PROLEC-SE (Ramos & Cuetos, 2003).

Results of analyses of variance (ANOVAs) showed no significant differences betweenthe two groups in: IQ, F(1,20) = 0.008, η2 = 0.000, p = 0.929; naming speed, F(1,20) = 0.162,η2 = 0.008, p = 0.692; verbal working memory, F(1,20) = 0.875, η2 = 0.042, p = 0.361; orphonemic awareness, F(1,20) = 1.24, η2 = 0.059, p = 0.278, prior to training. However, therewere significant differences between the groups in age, F(1, 20) = 57.52, η2 = 0.74, p =0.001. Table 1 shows the means and SDs for age, IQ, naming speed, verbal workingmemory and phonemic awareness by group.

Children in the study learned to read with a focus on spelling–sound mapping, corre-sponding to the syllable. The children were taught to pronounce consonants associated withvowels in simple consonant–vowel syllables (e.g., ma, me, mi, mo, mu). The teachingbuilds on the pronunciation of these simple syllables by showing the children how the sylla-bles can be combined to construct words (e.g., mama [mother]). These lessons were thenextended to other sets of syllables through the association of different consonants with thesame vowels (e.g., pa, pe, pi, po, pu). Further teaching extended to more complex syllables(e.g., cos, a consonant–vowel–consonant syllable) and later to constructing words fromthese syllables.

The informed consent of the parents of the students who received the treatment wasobtained, once they had been informed about the participation requirements (e.g., contentand number of sessions, place and anticipated length). Furthermore, permission to evaluatethe reading performance of the children in the comparison group was obtained from theirparents, with the first author promising to personally provide them with an extensive reporton the results found.


Measures and Procedure

Various reading and reading-related cognitive tests were used to select and compare the twogroups of children with RD and examine the efficacy of the intervention programme. Allthe tests were applied individually in a quiet room, and the same experimenter administeredall of them. The test presentation order was randomised and took place in various sessions,in order to avoid fatigue effects in the children.

Tasks Given only as Pre-tests

Culture Fair Intelligence Test (Scale 2, Form A). This test (Cattell & Cattell, 1950/1989)measures general mental capacity without the interference of cultural basis. The authorsused the “two halves” method to calculate reliability, and they reported a correlation coef-ficient of 0.86. For validity, they used criteria scores on the Test of Scholar Aptitudes (TEATest: Seisdedos, De la Cruz, Cordero, & González, 1991). A correlation coefficient of 0.68was found between the g factor measure and results on the TEA test, which measuredverbal, reasoning, and numerical aptitudes.

Phonemic awareness. We administered the Test of Phonemic Awareness (Jiménez,1995). This test evaluates the participant’s ability to manipulate the sounds or phonemes inspoken words, and consists of four tasks containing 15 items each. On the isolation task,the child listened to a word (e.g., lana [wool]) and had to say its beginning sound, /l/. Onthe segmentation task, the child listened to a word (e.g., rana [frog]) and then had to say itsconstituent sounds, phoneme by phoneme (e.g. /r//a//n//a/). A correct response consisted ofpronouncing the sounds or saying the names of the letters. On the deletion task, the childlistened to a word (e.g., blusa [blouse]) and then had to delete its initial sound and say theremaining sounds (e.g., lusa). On the blending task, the child listened to a sequence ofphonemes (e.g., /m//e//s//a/) and had to say the whole word (e.g., mesa [table]). The totalscore was calculated by adding the correct responses on the four tasks. Each task had aCronbach’s alpha ranging between 0.75 and 0.86.

Table 1. Descriptive data for the intervention group and the comparison group.

IG (n = 12) CG (n = 10) F p η2

Age Mean 12.57 10.71 57.52 0.001 0.742SD 0.67 0.43

IQ Mean 106.58 106.20 0.008 0.929 0.000SD 10.1 9.8

Naming speed Mean 40.50 39.50 0.162 0.692 0.008SD 6.28 5.14

Verbal working memory Mean 3.33 3.70 0.875 0.361 0.042SD 0.98 0.82

Phonemic awareness Mean 38 36.92 1.24 0.278 0.059SD 2 2.46

Gender Male 9 8Female 3 2

Note: IG = intervention group; CG = comparison group.


Naming speed. The colour naming subtest from the Stroop Test (Golden, 1994) wasadministered. The child was told to name the colour, as rapidly as possible, of five rows of“xxxx” written in three basic colours (red, green and blue). The test–retest reliability of thistest was 0.85.

Verbal working memory. To assess the children’s working memory, we administered thetask used by Siegel and Ryan (1989). The child heard sentences with the final wordmissing. The task required him or her to provide the missing word and then repeat all themissing words from the set. There were three trials at each level or set size (two, three, fouror five words). For each trial, the score was one point (three per set) when the childperformed the task successfully, and the score was zero when the child failed to completethe task. Task administration was stopped when the child failed all the trials at one level.

Tasks Given as Pre-tests and Post-tests

Word reading fluency (PROLEC-SE; Ramos & Cuetos, 2003). This test requires the correctidentification of 40 words that vary in frequency, length and linguistic structure (CCV, CVV,CVC, CCVC, CVVC and VC, where C = consonant and V = vowel). The child’s scoreconsisted of an accuracy score divided by the reading speed, measured as the time taken tocomplete the task, and then multiplied by 100.

Pseudo-word fluency reading (PROLEC-SE; Ramos & Cuetos, 2003). This test consistsof 40 pseudo-words (e.g., erpisa), which were constructed by changing or adding one or twoletters for each of the 40 words on the reading test. In this case, the combined pseudo-wordreading score was also based on an accuracy score divided by the reading speed, and thenmultiplied by 100.

Oral text reading fluency. Children had to read aloud an appropriate 165-word text takenfrom the TALE-2000 Reading Battery (Toro, Cervera, & Urío, 2002). Two combined oralreading scores were taken: text reading speed and text reading accuracy. The former scorewas calculated by dividing the number of words read correctly by the total time in secondsto read the passage, multiplied by 60 (Parker, Hasbrouck, & Tindal, 1992). Text readingaccuracy was calculated by dividing the number of words read correctly by the totalnumbers of words read and multiplying this result by 100 (Parker et al., 1992).

Reading comprehension (PROLEC-SE; Ramos & Cuetos, 2003). On this test, the chil-dren had to read a descriptive text “Los esquimales” [The Eskimo] only once and thenanswer 10 open-ended literal and inferential questions about the text. The reading batteryhas been found to have an internal consistency of Cronbach’s α = 0.84. Teachers’ ratingsof reading ability were used as validity criteria. Teachers were asked to rate reading abilityon a 10-point scale ranging from low (one) to high (10). Correlations between readingmeasures and teachers’ ratings were statistically significant (p < 0.0001).

The test presentation order was randomised in the pre-test evaluation, alternating theadministration of the cognitive tests (intelligence, phonemic awareness, naming speedand verbal working memory) with the administration of the reading performance tests(word reading fluency, pseudo-word fluency, oral text reading fluency and readingcomprehension). This presentation order was used in order to avoid fatigue effects in the


children, because the reading tests are less motivating for students with RD than thecognitive tests.

Intervention Programme

The intervention programme consisted of 40 training sessions held three times a week,which corresponded to the timing of the special education services the participants werereceiving in their schools. The programme was carried out throughout the second quarterof the school year, from January to April. The sessions lasted 45 minutes each, and instruc-tion was delivered one to one. In each training session, the children were trained in onespecific phoneme (a, b, c, ch, d, e, f, g, h, i, j, k, l, ll, m, n, ñ, o, p, q, r, s, t, u, v, w, y, z) orconsonant blend (br, bl, cl, cr, pr, pl, gr, gl, fl, fr, dr, tr). Material included: simple andcombined syllables composed of the phoneme or consonant blend; words with thephoneme or blend in the initial, middle and, when possible, final position; sentences withvarious words containing these phonemes or blends; and passages and texts of 100–200words in length.

This supplemental programme was designed to include instructional components fromthe repeated reading and phonological awareness training and grapheme–phoneme decod-ing. Thus, the intervention consisted of the following instructional components: repeatedreadings, and phonological awareness training and grapheme–phoneme decoding. Withrespect to the repeated readings, in each session, the student read and reread all the materialfrom the session (syllables, words, sentences and passages/texts) following four steps: thestudent read the material aloud; the teacher provided a prosodic reading as a model of fluentreading; the student reread the material four times (silent reading); and the student read thematerial from the session aloud again. The teacher provided corrective feedback on readingerrors. Error correction entailed saying the item(s) and asking the student to repeat it/them.Feedback was provided on gains in speed or accuracy from the first to the last readings ofthe material. With respect to the phonological awareness training and grapheme–phonemedecoding, the teacher prompted the students to phonologically segment the words on whichthey had made reading errors. Students applied the following steps in reading each word(adapted from Bhattacharya & Ehri, 2004): students read the word aloud, with help if neces-sary; students orally divided the word’s pronunciation into its syllables with the visualsupport of letters; students orally divided the word’s pronunciation into its phonemes withthe visual support of letters (phoneme–grapheme correspondence); students reread theword three times and, finally, read the word aloud; and students blended the phonemes tosay the whole word. If incorrect, they were told the word and had to repeat it. The childrenwere given enough help to be able to resolve the task successfully and this help wasgradually reduced.

Special needs teachers participated in two two-hour training sessions about how toapply the programme. The first session introduced the teachers to the instructional proce-dures and the intervention plan. The second session focused on modelling the use ofrepeated readings and the phonological awareness training and grapheme–phoneme decod-ing with the materials.

The untrained comparison group completed pre-tests and post-tests, but they receivedno special instruction from the research staff. They remained in their classrooms and alsocontinued to receive the typical reading instruction provided by the school in the specialeducation classroom three days a week. The programme they followed had a moregeneral academic content and focused less on reading than the programme followed bythe intervention group.


Analysis and Results

Gain scores were calculated comparing the pre-intervention levels for word and pseudo-word reading skills, oral text reading speed and accuracy, and text comprehension for thetwo groups of children who participated in the study.

The comparison of the intervention group with the untrained comparison group on thereading variables studied was compromised by the fact that the untrained comparison grouphad a lower mean age than the intervention group. To control for this difference, we carriedout a multivariate analysis of covariance (MANCOVA) using age as a covariate. After-wards, analyses of covariance (ANCOVAs) were performed for each indicator of the read-ing skills evaluated: word and pseudo-word reading, text reading speed, text readingaccuracy, and text comprehension.

In addition to the results of the MANCOVA and ANCOVAs, we also provide the partialeta squared statistic (η2), which estimates the proportion of total variance accounted for bythe independent variables. For this statistic, values between 0.01 and 0.10 are considered asmall effect size, values between 0.10 and 0.30 are regarded as a medium effect size, andthose above 0.30 are considered a large effect size.

The MANCOVA performed on the gain scores at the post-intervention phase revealedthat there were significant main group effects (Wilks’ Lambda (Λ) = 0.286, F(5, 15) = 7.482,η2 = 0.71, p = 0.001) with large effect sizes. The results obtained from comparing the twogroups of children with and without treatment (see Table 2) revealed significant differencesin word reading skill gains, F(1, 19) = 13.620, η2 = 0.41, p = 0.002, pseudo-word readingskill gains, F(1, 19) = 15.954, η2 = 0.45, p = 0.001, text reading speed gains, F(1, 19) =24.072, η2 = 0.55, p = 0.001, and text reading accuracy, F(1, 19) = 12.320, η2 = 0.39, p =0.002, with large effect sizes in all variables. In contrast, there were no differences betweenthe groups in comprehension gains, F(1, 19) = 0.458, η2 = 0.024, p = 0.507, at the post-inter-vention phase.

Thus, students in the intervention group obtained statistically significant gains on themajority of the reading measures, except comprehension. As expected, the children withreading disabilities in the treatment condition showed greater gains in word and pseudo-word reading skills and on text reading measures (speed and accuracy) than the untreatedgroup of children with reading disabilities.

Table 2. Means and standard deviations of pre-test, post-test and gain scores of reading fluency and comprehension measures for the intervention group and the comparison group.

Intervention group (n = 12) Comparison group (n = 10)

Pre-test Post-test Gain Pre-test Post-test Gain

Word reading fluency Mean 32.41 52.82 20.41 31.81 34.39 2.5SD 2.59 8.71 7.9 2.68 3.32 1.72

Pseudo-word reading fluency Mean 25.08 35.30 10.22 26.03 28 1.96SD 1.03 2.42 2.76 2.67 2.61 4.45

Text reading speed Mean 69.34 114.28 34.59 69.15 71.99 3.74SD 9.74 14.41 9.79 10.70 16.60 3.93

Text reading accuracy Mean 79.49 89.49 10 77.59 77.72 0.132SD 1.96 4.21 3.66 3.9 7.32 4.19

Text comprehension Mean 4.08 4.25 0.17 4 4.4 0.40SD 1.37 1.28 0.38 1.05 1.07 0.51


Discussion

This study examined the effectiveness of a multi-component programme that combinedempirically-supported intervention components—that is, repeated readings plus phonolog-ical awareness training and grapheme–phoneme decoding—on fluency and readingcomprehension skills in Spanish children with reading disabilities.

The findings demonstrate that the children in the intervention group showed large gainsin word and pseudo-word reading skills [(accuracy/speed) x 100]. Despite the frequentlyreported difficulty of improving the reading rate of very poor readers (Lovett & Steinbach,1997), the students in the intervention condition made improvements in reading rate andaccuracy of isolated words and pseudo-words.

Recent proposals about the growth in children’s word recognition suggest that, after theinitial phases of reading acquisition, the learning effects in reading are mainly based onthe accumulation of knowledge about individual words or word representations, and thespecific problem of children with RD lies not so much in gaining orthographic access towhole words as in computing sub-lexical phonology (Ziegler & Goswami, 2005). In thestudy by Hintikka et al. (2008), a generalisation effect from the sub-lexical level to wordreading was found. Overall, the results of the present intervention study suggest that facil-itating the visual identification of syllables could enhance a rapid phonological recodingstrategy, pseudo-word reading skills. However, gains in the pseudo-word reading skillcould also be due to greater knowledge about the rules of grapheme–phoneme conversion,as shown in studies focused on phonemic instruction with visual support of letters (NationalReading Panel, 2000; Torgesen, 2002; Torgesen et al., 1997).

In addition, the children in the intervention group showed significant gains on the twomeasures of oral text reading fluency, speed and accuracy. Studies in which studentslearned to quickly recognise words in lists have produced inconsistent findings regardingfluency in context (Levy et al., 1997). In fact, the results of a recent study by Chard, Ketter-lin-Geller, Baker, Doabler, and Apichatabutra (2009), which examined research focused ondetermining the efficacy of repeated reading approaches for improving the reading fluencyof students with or at risk for learning disabilities, suggested that repeated reading was notsupported by rigorous research according to the quality indicators used.

Therefore, there may be several reasons for the positive outcomes in our study. The firstis the fact that the students in the intervention group practiced repeated reading with aconnected text. Repeated practice of the words in context, in passage reading, seemed tohave enhanced their orthographic representation. However, another possible reason for themagnitude of the fluency gains could be related to the intensity of the intervention (40sessions), which included twice the number of sessions normally used in studies dealingwith this topic (Chard et al., 2002; Kuhn & Stahl, 2003; Meyer & Felton, 1999; NationalReading Panel, 2000; Therrien, 2004). It should also be pointed out that the implementationof the repeated reading procedure in our study took place in optimal instructional condi-tions: modelling by the teacher, provision of a prosodic reading as a model of fluentreading, along with continuous and immediate corrective feedback.

Regarding the second objective of our study, the results indicated that the multi-component programme did not produce significant gains in reading comprehension.Several studies have reported that an increase in fluency is also accompanied by anincrease in comprehension (see Kuhn & Stahl, 2003; Schwanenflugel et al., 2009;Therrien, 2004). But such positive effects on comprehension are not always achieved withfluency training, especially with secondary school students who are required to read andcomprehend more complex and elaborated texts. In general, the relationship between


fluency and comprehension is weaker in older children than that usually found in youngerones (Silberglitt, Burns, Madyum, & Lail, 2006). Supporting this idea, a recent synthesisstudy carried out by Wexler, Vaughn, Edmonds, and Reutebuch (2008) on fluency inter-ventions for struggling secondary school readers concluded that the improvementsobtained on reading rate were not necessarily generalised to word reading accuracy orcomprehension. These findings, which coincide with ours, fit the idea that comprehensiondepends on skills other than just speed in recognising words. Fluent reading may improvethe reader’s micro-comprehension processes without directly affecting macro-comprehen-sion processes, which are influenced by prior knowledge and more global comprehensionstrategies that depend on the executive system. In such a case, it would be advisable tocomplement fluency training with instruction in cognitive and meta-cognitive readingcomprehension strategies, an approach that has been shown to be quite effective instudents with RD (Berkeley, Marshak, Mastropieri, & Scruggs, 2010; Gajria, Jitendra,Sood, & Sacks, 2007). It must be kept in mind that reading comprehension is a powerfullearning instrument. Consequently, special attention should be paid to instruction incomprehension strategies to awaken the motivation of the students to grasp the meaningof the text, from the initial phase of learning to read. As shown in a recent study byDenton et al. (2010), the intervention programmes implemented with children at risk ofhaving learning disabilities led to gains in comprehension when they combined explicitinstruction in phonics skills and text-reading strategies with modelling and instructionalscaffolding.

Moreover, general comprehension measures (e.g., the standardised achievement testsused in this study) may be less able to detect change than other assessment procedures, assome studies have found that fluency training produced better performance on literal andreferential reading comprehension tasks designed by the authors (Alber-Morgan, Ramp,Anderson, & Martin, 2007; O’Connor, White, & Swanson, 2007).

In summary, results from the implementation of this multi-component interventionprogramme suggest that explicit and structured instruction targeting core skills, such asorthographic representation and phonological processing, is quite promising in the treat-ment of children with RD. The availability of a familiar phonological pattern is certainly abasic pillar in enabling children with RD to perform the orthographic learning that willprovide them with direct and rapid access to the mental lexicon. Likewise, in this study,repeated passage reading is confirmed as an effective and valuable method for increasingword reading fluency and improving connected reading, although it does not necessarilyproduce direct effects on comprehension.

Limitations and Future Research

Several limitations are evident here, including the small sample size along with the greaternumber of male participants, which limit the possibility of generalising the results. Anotherlimitation of our study is the significant difference that exists in the age variable betweenthe treatment group and the comparison group. An analysis of covariance was used tocontrol for the possible effect of this variable on the treatment, but the best option forexperimental control would have been to match the two groups on age by pairs.

Furthermore, as this intervention was carried out one to one, future research shouldexplore how to best produce fluency gains in students with RD through small group instruc-tion, which is less costly in terms of human resources. In addition, the intervention took placein the resource room and was delivered by teachers specially prepared to instruct studentswith LD. Therefore, the results cannot be generalised to the regular classroom where the


instructional conditions provide fewer opportunities for scaffolding or accommodations.Another limitation of our study is a lack of information about both the receivers (thestudents) and the direct agents of the programme (the teachers) that could support its socialvalidity. This issue is quite important, given that monotony and fatigue, characteristics ofrepeated readings, could increase substantially when sub-lexical training is added, in whichcase it would be necessary to weigh up the advantages and disadvantages of this interventioncomponent. Finally, another question for future studies involves the programme’s possibleeffects on long-term reading comprehension. A constant level of practice over a moreprolonged period of time might help students with RD to become aware of the importanceof directing their cognitive resources more to text comprehension than to speed and accu-racy. Determining the impact of a multi-component programme at all levels of readingperformance would require a long-term study.

Acknowledgements

The findings reported here are based on research conducted as part of the project,“Efficacy of a Multicomponent Programme for the Treatment of Developmental Dyslexia.Variables that Predict Treatment Response” under Grant No. EDU2009-08082 fromMinisterio de Ciencia e Innovación, and no restrictions have been imposed on free accessto, or publication of, the research data. The content of this publication does not necessar-ily reflect the views or policies of Ministerio de Ciencia e Innovación, nor does mentionof trade names, commercial products, or organisations imply endorsement by Ministeriode Ciencia e Innovación. Opinions reflect those of the author(s) and do not necessarilyreflect those of the funding agency(ies). The author(s) had no financial or other conflictsof interest.

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