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

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

The Effects of ADHD Treatment and Reading Intervention on the Fluency and Comprehension of Children with ADHD and Word Reading Difficulties: A Randomized Clinical Trial.

Many students with reading difficulties and disabilities (RD) also have Attention Deficit/Hyperactivity Disorder (ADHD). This randomized clinical trial compared the effects of ADHD treatment alone (medication, parent training), intensive reading intervention alone, and their combination on the reading fluency and comprehension of students with both disorders. Students with ADHD and RD were randomly assigned to receive (a) Reading Intervention only (n=74), (b) ADHD Treatment only (n=78), or (c) simultaneous Combined ADHD and RD Treatment (n=70). For phonemic decoding fluency, the Reading Intervention group and the Combined Treatment group both had significantly better outcomes than the ADHD Treatment group, but did not differ from one another. For passage comprehension, the ADHD Treatment group had significantly better outcomes than the Reading Intervention group, while the other groups did not differ from one another. ADHD treatment may support passage comprehension in this population, while fluent decoding is best supported through intensive reading intervention.

The Impact of Intensive Reading Intervention on Level of Attention in Middle School Students.

The purpose of the study was to estimate the impact of reading intervention on ratings of student attention over time. We used extant data from a longitudinal randomized study of a response-based reading intervention to fit a multiple-indicator, multilevel growth model. The sample at randomization was 54% male, 18% limited English proficient, 85% eligible for free or reduced-price lunch, 58% African American, and 32% Hispanic. Reading ability was measured by using the Woodcock-Johnson III Tests of Achievement. Attention was measured by using the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale. Findings indicate that intensive, response-based reading intervention over 3 years improved reading achievement and behavioral attention in middle school struggling readers, with treatment directly affecting reading, which in turn influenced attention. In the business-as-usual condition, there was no relation between improved reading and attention. The results are consistent with a correlated liabilities model of comorbidity. The results do not align with the inattention-as-cause hypothesis, which predicts that reading intervention should not affect attention. The findings do not support, but do not necessarily preclude, the phenocopy hypothesis. The results are especially pertinent for older students who may be inattentive partly because of years of struggling with reading.

Reaction time variability associated with reading skills in poor readers with ADHD.

Linkages between neuropsychological functioning (i.e., response inhibition, processing speed, reaction time variability) and word reading have been documented among children with attention-deficit/hyperactivity disorder (ADHD) and children with Reading Disorders. However, associations between neuropsychological functioning and other aspects of reading (i.e., fluency, comprehension) have not been well-documented among children with comorbid ADHD and Reading Disorder. Children with ADHD and poor word reading (i.e., ≤25th percentile) completed a stop signal task (SST) and tests of word reading, reading fluency, and reading comprehension. Multivariate multiple regression was conducted predicting the reading skills from SST variables [i.e., mean reaction time (MRT), reaction time standard deviation (SDRT), and stop signal reaction time (SSRT)]. SDRT predicted word reading, reading fluency, and reading comprehension. MRT and SSRT were not associated with any reading skill. After including word reading in models predicting reading fluency and reading comprehension, the effects of SDRT were minimized. Reaction time variability (i.e., SDRT) reflects impairments in information processing and failure to maintain executive control. The pattern of results from this study suggest SDRT exerts its effects on reading fluency and reading comprehension through its effect on word reading (i.e., decoding) and that this relation may be related to observed deficits in higher-level elements of reading.

The construction of visual-spatial situation models in children's reading and their relation to reading comprehension.

Readers construct mental models of situations described by text to comprehend what they read, updating these situation models based on explicitly described and inferred information about causal, temporal, and spatial relations. Fluent adult readers update their situation models while reading narrative text based in part on spatial location information that is consistent with the perspective of the protagonist. The current study investigated whether children update spatial situation models in a similar way, whether there are age-related changes in children's formation of spatial situation models during reading, and whether measures of the ability to construct and update spatial situation models are predictive of reading comprehension. Typically developing children from 9 to 16 years of age (N=81) were familiarized with a physical model of a marketplace. Then the model was covered, and children read stories that described the movement of a protagonist through the marketplace and were administered items requiring memory for both explicitly stated and inferred information about the character's movements. Accuracy of responses and response times were evaluated. Results indicated that (a) location and object information during reading appeared to be activated and updated not simply from explicit text-based information but from a mental model of the real-world situation described by the text; (b) this pattern showed no age-related differences; and (c) the ability to update the situation model of the text based on inferred information, but not explicitly stated information, was uniquely predictive of reading comprehension after accounting for word decoding.

Resonance Frequency Analysis Identifies Implant- and Host-Related Factors Associated With Bone-Anchored Hearing Implant Stability.

HYPOTHESIS: Resonance frequency analysis (RFA) is a reliable, noninvasive method to assess the stability of bone-anchored hearing implants (BAHIs), although surgical-, implant-, and host-related factors can affect its outcome. BACKGROUND: BAHI plays an important role in restoring hearing function. However, implant- and host-related factors contribute to premature implant extrusion. To mitigate this, noninvasive methods to assess implant stability, along with a better understanding of factors contributing to BAHI failure, are needed. METHODS: We evaluated the utility of RFA to quantify implant stability in sawbone (bone mimicking material), 29 human cadaveric samples, and a prospective cohort of 29 pediatric and 27 adult participants, and identified factors associated with implant stability. To validate the use of RFA in BAHI, we compared RFA-derived implant stability quotient (ISQ) estimates to peak loads obtained from mechanical push-out testing. RESULTS: ISQ and peak loads were significantly correlated (Spearman rho = 0.48, p = 0.0088), and ISQ reliably predicted peak load up to 1 kN. We then showed that in cadaveric samples, abutment length, internal table bone volume, and donor age were significantly associated with implant stability. We validated findings in our prospective patient cohort and showed that minimally invasive Ponto surgery (MIPS; versus linear incision), longer implantation durations (>16 wk), older age (>25 yr), and shorter abutment lengths (≤10 mm) were associated with better implant stability. Finally, we characterized the short-term reproducibility of ISQ measurements in sawbone and patient implants. CONCLUSIONS: Together, our findings support the use of ISQ as a measure of implant stability and emphasize important considerations that impact implant stability, including surgical method, implant duration, age, and abutment lengths.

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

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

The elimination/challenge diet.

Elimination diets can be both a diagnostic tool and a therapeutic intervention for people with a suspected food sensitivity or allergy. They are clinically relevant not only for patients with functional gastrointestinal disorders but also for those with conditions where symptoms are refractory and a diagnosis is elusive. Elimination diets can help a physician make a diagnosis or identify an underlying cause of symptoms. The physician and team treating the patient can then use that information to recommend appropriate dietary and lifestyle changes as well as judicious drug therapy. This article describes the elimination/challenge diet approach and explains the rationale for undertaking it.

The Relations Among Oral and Silent Reading Fluency and Comprehension in Middle School: Implications for Identification and Instruction of Students With Reading Difficulties.

The purpose of this study was to investigate the relations among oral and silent reading fluency and reading comprehension for students in Grades 6 to 8 (n = 1,421) and the use of fluency scores to identify middle school students who are at risk for failure on a high-stakes reading test. Results indicated moderate positive relations between measures of fluency and comprehension. Oral reading fluency (ORF) on passages was more strongly related to reading comprehension than ORF on word lists. A group-administered silent reading sentence verification test approximated the classification accuracy of individually administered ORF passages. The correlation between a maze task and comprehension was weaker than has been reported for elementary students. The best predictor of a high-stakes reading comprehension test was the previous year's administration of the grade-appropriate test; fluency and verbal knowledge measures accounted for only small amounts of unique variance beyond that accounted for by the previous year's administration.

Effects of Individualized and Standardized Interventions on Middle School Students With Reading Disabilities.

This study reports the effectiveness of a year-long, small-group, tertiary (Tier 3) intervention that examined 2 empirically derived but conceptually different treatments and a comparison condition. The researchers had randomly assigned all students to treatment or comparison conditions. The participants were seventh- and eighth-grade students from the previous year who received an intervention and did not meet exit criteria. The researchers assigned them to one of two treatments: standardized (n = 69) or individualized (n = 71) for 50 min a day, in group sizes of 5, for the entire school year. Comparison students received no researcher-provided intervention (n = 42). The researchers used multigroup modeling with nested comparisons to evaluate the statistical significance of Time 3 estimates. Students in both treatments outperformed the comparison students on assessments of decoding, fluency, and comprehension. Intervention type did not moderate the pattern of effects, although students in the standardized treatment had a small advantage over individualized students on word attack. This study provides a framework from which to refine further interventions for older students with reading disabilities.

Cognitive Correlates of Inadequate Response to Reading Intervention.

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

Trajectories of Response to Treatments in Children with ADHD and Word Reading Difficulties.

This study investigated patterns of response to intervention in children with co-occurring attention-deficit/hyperactivity disorder (ADHD) and reading difficulties (RD), who participated in a randomized clinical trial examining the efficacy of reading intervention, ADHD treatment, or combined treatments. Growth Mixture Modeling (GMM) was used to investigate trajectories of parent and teacher academic impairment ratings and child oral reading fluency, and whether trajectories were predicted by pre-treatment covariates (ADHD severity, reading achievement, phonemic awareness, rapid letter naming, anxiety, oppositional defiant disorder), for 216 children with ADHD/RD in 2nd-5th grade (61.1% male; 72.2% African American; 8.8 ± 1.3 years of age). GMM revealed three trajectories for academic impairment (6.9-24.2% stable, 23.7-78.7% moderately improving, and 14.1-52.1% steeply improving) and oral reading fluency (20.8% low improving, 42.1% moderate improving, and 37.1% high improving). Children in the reading intervention were more likely to be in the stable or moderately improving trajectory than those in the ADHD and combined treatments, who were more likely to be in the steeply improving trajectory for academic impairment. Relative to the ADHD intervention, children in the reading intervention were more likely to be in the high improving trajectory than the moderate or low improving trajectory for oral reading fluency. Children without comorbid anxiety and with better reading skills showed a more positive treatment response for teacher-rated academic progress and oral reading fluency. Results highlight the importance of examining individual differences in response to reading and ADHD interventions. Intervention modality predicted differences in parent/teacher ratings of academic progress as well as reading fluency.

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

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

Response to Intervention for Middle School Students With Reading Difficulties: Effects of a Primary and Secondary Intervention.

This study examined the effectiveness of a yearlong, researcher-provided, Tier 2 (secondary) intervention with a group of sixth-graders. The intervention emphasized word recognition, vocabulary, fluency, and comprehension, Participants scored below a proficiency level on their slate accountability test and were compared to a similar group of struggling readers receiving school-provided instruction. All students received the benefits of content area teachers who participated in researcher-provided professional development designed to integrate vocabulary and comprehension practices throughout the school day (Tier 1). Students who participated in the Tier 2 intervention showed gains on measures of decoding, fluency, and comprehension, but differences relative to students in the comparison group were small (median d = +0.16). Students who received the re searcher-provided intervention scored significantly higher than students who received comparison intervention on measures of word attack, spelling, the state accountability measure, passage comprehension, and phonemic decoding efficiency, although most often in particular subgroups.

Fluid reasoning and reading difficulties among children with ADHD.

Background: Children with attention-deficit/hyperactivity disorder (ADHD) commonly experience difficulties in reading and in fluid reasoning (Gf). According to Cattell's Investment Theory (1987), Gf is a causal factor in the development of crystallized knowledge (Gc) and academic skills; therefore, the co-occurrence of reading and Gf difficulties within ADHD may not be coincidental. Methods: In the present study with children with both ADHD and reading difficulties (n = 187; 61% male; Mage = 9.2), we utilized mediation analyses to test direct and indirect (through Gc, phonemic awareness, and rapid automatized naming [RAN]) effects of Gf on four basic reading skills: untimed word recognition, untimed phonemic decoding, word reading efficiency, and phonemic decoding efficiency. Results: The direct effect of Gf on all reading skills was nonsignificant; however, significant indirect effects were observed. Specifically, Gf exerted an effect indirectly onto all reading skills through a serial and joint mechanism comprised of Gc and phonemic awareness (i.e., Gf → Gc → phonemic awareness → reading achievement). Gf also exerted an effect indirectly onto untimed word recognition and phonemic decoding through phonemic awareness (i.e., Gf → phonemic awareness → untimed word recognition/untimed phonemic decoding). Conclusion: Results build upon Cattell's Investment Theory by linking Gf with reading difficulties among children with ADHD, suggesting that such difficulties may arise from weaknesses in Gf and insufficient investment of Gf into reading through Gc and phonemic awareness.

Response to Intervention with Older Students with Reading Difficulties.

Addressing the literacy needs of secondary school students involves efforts to raise the achievement levels of all students and to address specifically the needs of struggling readers. One approach to this problem is to consider the application of a Response to Intervention (RTI) model with older students. We describe an approach to enhanced literacy instruction for middle school students that includes the essential components of any RTI model: universal screening, progress monitoring, and multi-tiered instructional service delivery. We use screening and progress-monitoring tools specifically tied to state accountability tests and a multi-tiered instructional framework that addresses the literacy needs of all middle school students, including struggling readers. Presently a large-scale, multi-site randomized trial is under way to evaluate the feasibility and effectiveness of this RTI model for middle school students.

Agreement among response to intervention criteria for identifying responder status.

In order to better understand the extent to which operationalizations of response to intervention (RTI) overlap and agree in identifying adequate and inadequate responders, an existing database of 399 first grade students was evaluated in relation to cut-points, measures, and methods frequently cited for the identification of inadequate responders to instruction. A series of 543 2x2 measures of association (808 total comparisons) were computed to address the agreement of different operationalizations of RTI. The results indicate that agreement is generally poor and that different methods tend to identify different students as inadequate responders, although agreement for identifying adequate responders is higher. Approaches to the assessment of responder status must use multiple criteria and avoid formulaic decision making.

Early reading skill profiles in typically developing and at-risk first grade readers to inform targeted early reading instruction.

This study identified distinct, homogeneous latent profiles of at-risk (n = 141) and not at-risk (n = 149) first grade readers. Separate latent profile analyses were conducted with each subgroup using measures of phonological awareness, decoding, linguistic comprehension, and oral reading fluency. This study also examined which measures best differentiated the latent profiles. Finally, we examined differences on two measures of reading comprehension as a function of profile membership. Results showed two latent profiles of at-risk students and three latent profiles of not at-risk students. Latent profiles were generally rank ordered with regard to achievement across measures. However, the higher performing at-risk profile and the lowest performing not at-risk profile were nearly identical across measures. Phonological awareness and decoding measures were best at differentiating latent profiles, but linguistic comprehension was also important for the lowest performing students. Oral reading fluency was limited to distinguishing the highest achieving students from the other profiles, and did not perform well with the lower achieving profiles. Most of the pairwise comparisons of reading comprehension scores were consistent across measures, but the nearly identical profiles showed a significant difference on only one reading comprehension measure. Implications for identifying at-risk first grade readers and designing targeted early reading interventions for at-risk students are discussed.

Altering the brain circuits for reading through intervention: a magnetic source imaging study.

Intervention-related changes in spatiotemporal profiles of regional brain activation were examined by whole-head magnetoencephalography in 15 children with severe reading difficulties who had failed to show adequate progress to quality reading instruction during Grade 1. Intensive intervention initially focused on phonological decoding skills (for 8 weeks) and, during the subsequent 8 weeks, on rapid word recognition ability. Clinically significant improvement in reading skills was noted in 8 children who showed "normalizing" changes in their spatiotemporal profiles of regional brain activity (increased duration of activity in the left temporoparietal region and a shift in the relative timing of activity in temporoparietal and inferior frontal regions). Seven children who demonstrated "compensatory" changes in brain activity (increased duration of activity in the right temporoparietal region and frontal areas, bilaterally) did not show adequate response to intervention. Nonimpaired readers did not show systematic changes in brain activity across visits.

Intensive instruction affects brain magnetic activity associated with oral word reading in children with persistent reading disabilities.

Fifteen children ages 7 to 9 years who had persistent reading difficulties despite adequate instruction were provided with intensive tutorial interventions. The interventions targeted deficient phonological processing and decoding skills for 8 weeks (2 hours per day) followed by an 8-week, 1-hour-per-day intervention that focused on the development of reading fluency skills. Spatiotemporal brain activation profiles were obtained at baseline and after each 8-week intervention program using magnetoencephalography during the performance of an oral sight-word reading task. Changes in brain activity were found in the posterior part of the middle temporal gyrus (Brodmann's Area [BA] 21: increased degree of activity and reduced onset latency), the lateral occipitotemporal region (BA 19/37: decreased onset latency of activation), and the premotor cortex (increased onset latency). Overall changes associated with the intervention were primarily normalizing, as indicated by (a) increased activity in a region that is typically involved in lexical--semantic processing (BA 21) and (b) a shift in the relative timing of regional activity in temporal and frontal cortices to a pattern typically seen in unimpaired readers. These findings extend previous results in demonstrating significant changes in the spatiotemporal profile of activation associated with word reading in response to reading remediation.