Intensive Remedial Instruction

for Children with Severe

Reading Disabilities:
Immediate and Long-term Outcomes From
Two Instructional Approaches

Joseph K. Torgesen, Ann W. Alexander, Richard K. Wagner, Carol A. Rashotte,

Kytja K. S. Voeller, and Tim Conway

Sixty children with severe reading disabilities were randomly assigned to two instructional programs that incorporated principles of
effective instruction but differed in depth and extent of instruction in phonemic awareness and phonemic decoding skills. All children
received 67.5 hours of one-to-one instruction in two 50-minute sessions per day for 8 weeks. Both instructional programs produced very
large improvements in generalized reading skills that were stable over a 2-year follow-up period. When compared to the growth in broad
reading ability that the participants made during their previous 16 months in learning disabilities resource rooms, their growth during
the intervention produced effect sizes of 4.4 for one of the interventions and 3.9 for the other. Although the children’s average scores on
reading accuracy and comprehension were in the average range at the end of the follow-up period, measures of reading rate showed
continued severe impairment for most of the children. Within 1 year following the intervention, 40% of the children were found to be no
longer in need of special education services. The two methods of instruction were not differentially effective for children who entered
the study with different levels of phonological ability, and the best overall predictors of long-term growth were resource room teacher
ratings of attention/behavior, general verbal ability, and prior levels of component reading skills.

ne of the most daunting and ades for research on reading, reading dren should be to discover interven-
~ clearly defined current chal- development, and the nature of read- tions that accomplish the task of reme-
lenges for both researchers and ing disabilities in children and adults. diation. When this goal is achieved, the
practicing educators is to develop, dis- One of the goals of this research, as de- next set of questions might concern
seminate, and implement methods for fined by the National Institute of Child methods for implementing these inter-
teaching reading that will help all chil- Health and Human Development (Lyon, ventions in the schools. The research
dren acquire adequate reading skills. Alexander, & Yaffee, 1997), is to inves- reported in this article is designed to
Clearly, the demands for literacy in our tigate the conditions that need to be in answer three questions related to the

society are increasing very rapidly place for all children to acquire ade- remediation of reading difficulties:
(Snow, Burns, & Griffin, 1998), and quate reading skills in school.
statelegislatures and other governing The present study was designed to 1. Can either of two carefully de-
bodies are instituting accountability contribute information about the con- signed instructional approaches
standards in literacy that reflect those ditions that need to be in place to re- accelerate reading growth suffi-
increasing demands. In recognition of mediate the reading difficulties of chil- ciently to bring the reading skills
this trend, and of the broad and serious dren with serious learning disabilities of children with severe reading
consequences of reading failure for (LD). We acknowledge at the outset disabilities into the average
children’s overall development, orga- that the interventions examined in this range?
nizations such as the National Insti- study may not be immediately practi- 2. Are there significant differences
tutes of Health and the U.S. Office of cal for broad-scale implementation in in the effectiveness of two instruc-
Education, along with a number of pri- public schools. However, we agree tional approaches, both of which
vate foundations, have provided sub- with Schulte (1996) that the first goal of contain many elements of effective
stantial funds over the past two dec- intervention research with older chil- instruction but differ broadly in the
34

specific instructional activities they mond, 1996) reached much the same though one might argue that contin-
emphasize? conclusion as has been reported for ued application of the successful in-
3. Are the two methods differentially widely used resource room, or pull- structional techniques from this study
effective for children with different out, models of intervention. Across would eventually produce complete
cognitive, linguistic, and demo- three different intervention sites (Zig- remediation of these children’s reading
graphic characteristics? mond et al., 1995), children with LD, as disabilities, in the absence of direct evi-
a whole, experienced little movement dence we simply do not know if this
Existing knowledge related to each of in reading ability relative to non-LD assumption is correct.
these questions will be considered children in their classrooms. Although Swanson (1999) recently reported a
briefly in turn. they kept pace with normal reading comprehensive meta-analysis of inter-
There is evidence from a variety of growth during the interventions, they vention research with children with
sources that typical public school in- did not significantly close the reading LD that found average effect sizes, us-
terventions for children with reading gap that got them identified as learn- ing standardized reading measures, of
disabilities can most accurately be ing disabled in the first place. .62 for word recognition and .45 for
characterized as stabilizing their de- These data indicate that although the reading comprehension. These data
gree of reading failure rather than re- reading instruction provided by spe- are valuable because they show that

mediating, or normalizing, their read- cial education is more effective than gen- we understand many of the elements

ing skills (Kavale, 1988; Schumaker, eral education classroom instruction of effective instruction for children
Deshler, & Ellis, 1986). For example, for children with reading disabilities, with reading disabilities, but they are
in acarefully controlled longitudinal current instruction in many special edu- also misleading in that they do not pro-
study, McKinney (1990) found that re- cation placements is not sufficient to vide information about the rate of nor-
source room placements for children accelerate reading growth so that there malization of reading skills. Instead,
with reading disabilities produced no is reasonable hope for these children to they describe the advantage in reading
gains in word-level reading skills rela- achieve average-level skills in a reason- growth for children in an experimental
tive to nondisabled readers during a 3- able period of time. Furthermore, most condition relative to a control condition.
year period in elementary school. The well-controlled intervention studies do They demonstrate that some instruc-
children with reading disabilities were not fully address questions about the tional techniques are more effective
placed in special education with an conditions that need to be in place to than others, but they do not provide
average standard scoreof 92, and after remediate reading disabilities, because information about the extent to which
3 years of special instruction, their the interventions are not powerful the reading skills of the children in the
standard score for word-level skills enough to produce large effects on the most effective condition approached
was 90. The children actually experi- reading skills of the children being normal levels at the end of the inter-
enced a significant relative decline in studied. For example, one excellent vention or follow-up period.
their standing on a test of reading com- and widely cited study (Lovett, Bor- In the present study, we have de-
prehension, falling from an average den, Lacerenza, Benson, & Brackstone, scribed the reading growth of children
score of 94 to a standard score of 88 1994) examined the relative effective- in our sample in terms of changes in
three years later. ness of several carefully contrasted in- their standard scores on a variety of
Recently, Hanushek, Kain, and Riv- terventions. Although the study pro- reading and nonreading measures.
kin (1998), using a very large sample duced useful information about critical These data indicate the extent to which
from the Texas Schools Microdata elements of reading instruction for the children have changed positions
Panel, showed that typical special edu- children with severe reading disabili- within the distribution of reading abil-
cation placements during the fourth- ties and showed that core reading ity of a large normative sample, and
and fifth-grade years of elementary deficits were amenable to improve- they also provide evidence about the
school accelerated reading growth by ment through direct instruction, at the extent to which their reading skills dif-
only .04 standard deviations over the conclusion of the study, the children’s fer from average readers at the conclu-
rate the children had been achieving reading skills still fell in the severely sion of the study. Several other studies
in their general education classroom disabled range. The children in the two have taken a similar approach, and
placements. Although this represents a strongest interventions began the they have begun to produce evidence
positive accomplishment for special study with an average standard score that with the right instructional condi-
education, it is hardly sufficient to nor- (M 100, SD 15) on a measure of
= =
tions, it is possible to produce very
malize the reading skills of children word-reading ability of 64.0, and at the large effects on the reading skills even
with severe reading disabilities in any conclusion of the study their score was of children who have experienced sev-
reasonable period of time. 69.5, with pre- and posttest scores on a eral years of reading failure as a result
A discussion of recently developed measure of reading comprehension of severe reading disabilities (Alexan-
inclusion models of intervention (Zig- being 66.4 and 70.8, respectively. Al- der, Anderson, Heilman, Voeller, & Tor-
 35

gesen, 1991; McGuinnes, McGuinnes, Thus, a primary limitation in skilled are many ways to accomplish this aim,
& McGuinnes, 1996; Truch, 1994; Wise, use of the alphabetic principle to de- and there is little consensus about the
Ring, & Olson, 1999). code unfamiliar words has been re- nature and balance of specific instruc-
Our current understanding of the ferred to as a &dquo;core characteristic&dquo; of tional activities for children with se-
most common form of reading disabil- the most common type of reading dis- vere reading disabilities. In this study,

ity suggests that for children with read- ability (Siegel, 1989; Stanovich, 1988). we contrasted two instructional ap-

ing disabilities to achieve adequate Although some children may have proaches, both of which were phonem-
reading skills, they must receive more problems in acquiring a sight vocab- ically explicit and systematic but var-
intensive, explicit, and systematic in- ulary that are relatively independent of ied in method of instruction and in
struction in word-level skills than is their limited phonemic decoding skills depth and extent of phonemic decod-
typically provided in schools (Clark & (Bowers, Golden, Kennedy, & Young, ing practice. The Auditory Discrimi-
Uhry, 1995; Foorman, Francis, Fletcher, 1994; Olson, Wise, Johnson, & Ring, nation in Depth (ADD; Lindamood &
Schatschneider, & Mehta, 1998; Torge- 1997), early difficulties in phonemic Lindamood, 1984) program was de-
sen, 1998a; Vellutino
et al., 1996). For decoding consistently account for a signed to directly attack the phonemic
example, there is now overwhelming substantial proportion of the variance awareness problems of children with

evidence that most children with read- among children in the growth of their reading disabilities by helping them
ing disabilities experience a major bot- fluent word recognition skills (Wagner discover articulatory cues to the num-
tleneck to reading growth in the area of et al.,1997). Reading comprehension is ber, identity, and order of phonemes in
skilled word identification (Share & often limited in children with reading words. It emphasizes instructional ac-
Stanovich, 1995; Torgesen, 1999). Com- disabilities because of difficulties with tivities that teach children to &dquo;feel,&dquo; as
pared to nondisabled readers, these accurate and fluent word recognition, well as hear, the individual sounds in
children exhibit two kinds of word- and because they have missed oppor- words. As implemented in this study,
level reading problems when they are tunities to acquire reading comprehen- the vast majority of time in this pro-
reading text. First, when they en- sion strategies (Brown, Palincsar, & Pur- gram was spent building phonemic/
counter a word they are not familiar cell, 1986). articulatory awareness and applying
with, they tend to place too much re- Another major discovery from the this awareness to solving decoding
liance on guessing the word based on research on reading within the last problems with individual words. In
the context of the passage (Briggs, two decades has been that the word- contrast, the Embedded Phonics (EP)
Austin, & Underwood, 1984; Simpson, reading difficulties of children with program, as developed for and im-
Lorsbach, & Whitehouse, 1983), which reading disabilities are caused primar- plemented in this study, provided ex-
produces a high rate of word-level er- ily by weaknesses in their ability to plicit instruction in phonemic decod-
rors in their reading. Their phonemic process the phonological features of ing strategies (letter-sound knowledge
analysis skill, or ability to use phonics language (Liberman, Shankweiler, & and blending) within a direct instruc-
to assist in the word-identification pro- Liberman, 1989). These weaknesses tion framework. Phonemic awareness

cess, is usually severely impaired (Bruck, have been demonstrated on a variety was stimulated during spelling and
1990; Siegel, 1989). Second, children of nonreading tasks, including mea- writing activities, and word identifica-
with reading disabilities encounter sures of phonological awareness, ver- tion strategies were practiced exten-
many more words in grade-level texts bal short-term memory, speed of access sively while the participants read text.
that they cannot read &dquo;by sight&dquo; thanto phonological information in long- The EP program provided much more
do average readers. Compared to chil- term memory, and some forms of practice than the ADD program in
dren of the same age who are learning speech perception (Stanovich & Siegel, reading and comprehending meaning-
to read normally, the number of words 1994; Torgesen, 1995). In particular, in- ful text, while the ADD program pro-
that children with reading disabilities dividual differences in phonological vided more explicit (down to the artic-
can recognize fluently and easily as or- awareness and rapid automatic nam- ulatory level) and extended practice on
thographic units is usually quite lim- ing ability have been shown to exercise phonemic awareness and phonemic
ited (Manis, Custodio, & Szeszulski, unique causal influences on the rate decoding skills than the EP program.
1993). at which children acquire important Both of the programs incorporated
Current theories about the growth of early word-reading skills (Wagner et al., principles of instruction that have
word-reading ability (Ehri, 1998; Share 1997). generally been found to be successful
& Stanovich, 1995) suggest that pho- The phonological weaknesses of with children who have LD (Swanson,
nemic decoding skills play a critical children with the most common form 1999). That is, both programs provided
supporting role as children begin to ac- of reading disability require that they ample opportunities for guided prac-
quire the orthographic reading skills receive reading instruction that is more tice of new concepts, were taught us-
that enable relatively fluent and effort- phonemically explicit and systematic ing one-to-one tutoring methods, pro-
less identification of words in text. than other children’s. However, there vided systematic cuing of appropriate
36

strategies, and taught children to seg- comes than the less explicit instruc- phonemic awareness, with level of
ment and blend the sounds in words. tional conditions for the entire sample,general intelligence uniquely predict-
In some discussions of preliminary but it was particularly beneficial for ing growth on one of the two measures
reports of this study (Allington & children with pronounced weaknesses of real-word recognition used in the
Woodside-Jiron, 1999; Swanson, 1999), in phonological processing. Another study. As in the study reported by Tor-
the EP condition has been mistakenly study of the prevention of reading dis- gesen, Wagner, Rashotte, Rose, et al.
considered to be an instructional con- abilities (Torgesen, Wagner, Rashotte, (1999), the study by Wise and her col-
trol to test the advantages of explicit Rose, et al., 1999) found reading growth leagues did not find a clear pattern of
and systematic instruction in word- to be significantly and uniquely pre- interactions between the entering apti-
level skills (as implemented in the dicted by entering levels of phonolog- tudes, or abilities, of the students and
ADD condition) for children with ical ability, classroom teacher ratings of their response to the different instruc-
reading disabilities. The EP condition attention and behavior, and socioeco- tional methods.
does provide a control group that can nomic status (SES). In the latter study, _

help determine whether instruction at no significant interactions were found

the articulatory level is necessary for between child and treatment char-
Method ~. &dquo;
’

children with severe reading disabili- acteristics, perhaps because the treat-
ties to improve their phonemic aware- ments were more similar to one an- &dquo; ’

ness and grow in reading ability, but it other than in the study by Foorman Participants
is not a control for explicit word-level et al., or because the sample size lim- Sixty children between the ages of 8
instruction per se. ited power to detect significant apti- and 10 who were previously identified
Rather, this study contrasted two the- tude by treatment interactions. as learning disabled were recruited for

oretically viable instructional strate- Consistent with the two previously participation in the study. In this age
gies for children with severe reading described prevention studies, Vellu- range, the state of Florida requires that
disabilities. The goal was to determine tino et al. (1996) found phonological children who qualify for special edu-
whether two approaches that both variables, but not general verbal abil- cation as learning disabled must dem-
contain explicit instruction in word- ity, to be significant predictors of onstrate a discrepancy of at least 1 stan-
level skills but vary systematically in growth in word-level reading skills. dard deviation between their scores on
their depth of instruction in phonemic This finding is consistent with an a standardized test of reading and their
awareness and extent of practice in de- emerging consensus that discrepancy full scale score on an intelligence test.
contextualized phonemic decoding between level of general intelligence This criterion allows a wide range of
skills would affect specific reading and word-level reading skills should variation in levels of intelligence.
skills in different ways. The methods’ not be used as one of the core defining Each year for 3 years, we selected
overall effectiveness was assessed by characteristics of children with reading from LD classes in three elementary
contrasting the children’s progress disabilities (Fletcher et al., 1994; Lyon, schools a sample of 20 children who
during the study with their progress in 1995). That is, children with similar met the following criteria:
special education placements before levels of phonological ability seem to
the experimental instruction began. respond similarly to explicit instruc- (a) They were identified by their
The last question we will address tion in word-level reading skills, re- teachers as having serious diffi-
concerns individual differences in the of in
gardless variability general intel- culty acquiring word-level read-
way that children in our sample re- ligence within the normal range. ing skills;
sponded to the two interventions. We Thus far, only one intervention study (b) their average standard score on
will be concerned not only with identi- (Wise et al., 1999) has reported results two measures of word-level read-
fying child characteristics that predict that are somewhat inconsistent with ing (Word Attack and Word Iden-
stronger and weaker growth during this conclusion. That study contained tification from the Woodcock
and following the interventions, but instructional contrasts that varied Reading Mastery Test-Revised
also whether these characteristics are along some of the same dimensions as [Woodcock, 1987] was at least
differentially important, depending on those used in the present study, and 1.5 SDs below average for their
the nature of the intervention. For ex- Wise et al. found that individual differ- age;
ample, Foorman et al. (1998) showed ences in growth on measures of word- (c) their estimated verbal intelligence
that the most phonemically explicit of level reading skills were significantly was above 75; and

several interventions was particularly predicted by age, general intelligence, (d) they performed below minimum
beneficial for children who began the and initial levels of phoneme aware- required levels for their grade on
study with the lowest levels of pho- ness. When the predictors were com- a measure of
phonological aware-
nemic awareness. The most explicit bined into a single multiple regression, ness (the Lindamood Auditory
condition produced better reading out- the strongest predictors were age and Conceptualization Test), as de-
 37

scribed in the test manual (Lin- thus would have simply been a third child apply the skills learned in the in-
damood & Lindamood, 1979). treatment group. tensive training to tasks in the LD
We completed training for 10 partic- class. It also allowed the LD teacher to
We excluded children from our sample ipants a year in each of the two treat- learn how to assist the child further by
who were adopted; who showed evi- ment groups, so that a total of 30 chil- becoming acquainted with his or her
dence of an acquired neurologic dis- dren received training in each of the new reading skills. Children who con-

ease ; who had experienced a perinatal groups. Because a limited number of cluded their intensive training close to
encephalopathic event; who had sen- experienced educational therapists the end of the school year had this
sory deficits (hearing loss greater than were available to deliver the training, follow-up training extended into the
20 dB, visual acuity of at least 20/40 in it was necessary to aggregate the sam- first several weeks of the next school
the better eye); who showed evidence ple over a period of several years. All year.
of chronic medical illness; who showed training took place in a room provided The teachers who administered each
some form of severe psychopathology; on school grounds. Treatment was pro- program all had at least 1 year’s expe-
or for whom English was a second vided on a 1:1 basis in two 50-minute rience teaching children with reading
language. We allowed variables such sessions (separated by a brief break) disabilities using that method or one
as SES, race, gender, and co-morbidity each day of the week. This training very similar to it. The teachers who
of ADHD to vary in a manner consis- substituted for the time the children taught the ADD program were all
tent with the larger population from would normally have spent in their drawn from those working at a clinic
which the sample was selected. learning disabilities resource room. where the program had been used
Training was provided over a period of for the previous 5 years. Teachers who
Materials and Procedure
8 to 9 weeks, until 67.5 hours of in- taught the EP program were drawn ei-
struction were accomplished. ther from the same clinic (one staff
Children identified aseligible for the At the conclusion of the intensive member had several years’ experience
study were randomly assigned to one phase of training, each child received with the Reading Recovery method) or
of two groups. One of these groups generalization training for the next from a pool of individuals working in
(ADD) received the Auditory Discrim- 8 weeks. The teacher who worked with other private clinics who had experi-
ination in Depth Program, and the the child during the intensive phase ence using direct and synthetic phon-
other group (EP) received an instruc- went into the LD class for one 50- ics approaches in teaching children
tional program we developed called minute session each week and worked with reading disabilities. One teacher
Embedded Phonics. Characteristics of with the child using classroom mate- was trained in both methods and

the children in the two instructional rials. The work done during this phase served as a substitute, or backup,
conditions are provided in Table 1. We of training focused on helping the teacher when the a child’s primary
employed a two-group design for sev-
eral reasons. First, we did not use a
normal intervention control group be- ’

TABLE 1
cause we were able to establish base-
Participant Characteristics
line, or preintervention rates of growth,
for these children from assessments
made previously by the schools. A nor-
mal intervention, or no-treatment, con-
trol group actually has little meaning
in a study such as this because of the
extremely high intensity of interven-
tion we were able to provide. We also
did not employ a treatment, or atten-
tional, control group in this study be-
cause it would have been unethical to
consume such a large part of the chil-

dren’s day with an intervention that

was not focused on their primary read-

ing difficulty. Any treatment control

condition involving reading instruc-
tion would have to provide instruction
with a reasonable probability of suc- Note. LAC Lindamood Auditory Conceptualization Test.
=

cessfully affecting reading growth and asubtests from the Woodcock Reading Mastery Test-Revised.
38

teacher was not available. Those teach- Achievement (Kaufman & Kauf- tests also administered at 1- and
were

ing the EP program received 10 hours man, 1985) and the Calculation 2-year intervals following the posttest
of preservice training in the particular subtest from the Woodcock- in order to monitor growth in reading
sequence of instructional activities Johnson Psychoeducational and language skills for an extended
used in the Embedded Phonics pro- Battery-Revised (Woodcock & period following the intensive instruc-
gram employed in this study. Separate Johnson, 1989); tion.
weekly staff meetings were held for 6. measures of expressive and
teachers in each instructional program receptive language skills from the
to discuss any instructional issues that Clinical Evaluation of Language Description of the
needed clarification, and also to pro- Fundamentals-Third Edition. Interventions
vide consultation about any behav- (Semel, Wiig, & Secord, 1995);
ioral problems that occurred. Over the 7. a full scale IQ test-the Wechsler As mentioned in the introduction, both
3 years in which interventions were IntelligenceScale for Children- of the interventions in this study pro-
provided, five different teachers taught Revised (Wechsler, 1974)-if one vided explicit and systematic instruc-
the ADD curriculum and five teachers had not been given by the school tion in word-level reading skills, but
taught the EP curriculum. district within the last year; differed in their methods of teaching
Pretesting of all children took place 8. three teacher checklists to and in the relative amounts of time
during the 2 to 3 weeks prior to the be- measure behaviors associated
spent on various types of instructional
ginning of treatment. The pretest bat- with attention deficit, filled out activities. The ADD curriculum stimu-
tery included by the child’s LD resource room lated phonemic awareness via articula-
teacher-the Multigrade Inven-
tory cues and spent almost all the in-
1. two measures of phonological tory for Teachers (Agronin, Hola- structional time building phonemic/
awareness-Phoneme Elision han, Shaywitz, & Shaywitz, 1992), articulatory awareness and individual
from the Comprehensive Test of The IOWA Conners Teacher Rat-
word-reading skills. In contrast, the EP
~
Phonological Processes (CTOPP; ing Scale (Loney & Milich, 1982), program stimulated phonemic aware-
Wagner, Torgesen, & Rashotte, and the Swanson, Nolan, and Pel- ness through writing and spelling
1999) and the Lindamood Audi- ham (SNAP) rating scales (Atkins, activities, taught phonemic decoding
tory Conceptualization Test; Pelham, & Licht, 1985); and spent a much
strategies directly,
2. two measures of phonological 9. two questionnaires that were
greater percentage of instructional
coding in working memory- filled out by parents to assess time in reading and writing connected
Nonword Repetition and Memory home reading environment, fam- text. Each program will be described
for Digits from the CTOPP; ily SES, and medical history; and in turn.
3. two measures of rate of access to 10. a physical/neurological examina-
phonological information in long- tion that included assessment of
term memory-Rapid Digit Nam- fine-motor functions. Auditory Discrimination
in Depth
ing and Rapid Letter Naming
from the CTOPP; The last two sets of measures (9 and 10) It should be noted here that this pro-
4. eight measures of reading skills- were administered during the year in gram has recently been revised and
Word Attack, Word Identification, which training occurred. In addition, is now called The Lindamood Pho-
and Passage Comprehension from we consulted school records to obtain neme Sequencing Program for Read-
the Woodcock Reading Mastery information about performance on in- ing, Spelling, and Speech (Lindamood
Test-Revised (Woodcock, 1987); dividually administered standardized & Lindamood, 1998). The new pro-
Phonemic Decoding Efficiency tests of reading that had been previ- gram is not significantly different from
and Sight Word Efficiency from ously administered to each child. (The the ADD curriculum, which was the
the Test of Word Reading Effi- instruments used in the pretest are de- one used in this study. As outlined in

ciency (TOWRE; Torgesen, Wag- scribed in detail in an appendix avail- the instructor’s manual (Lindamood &
ner, & Rashotte, 1999); and Read- able from the first author.) Lindamood, 1984), the ADD program
ing Accuracy, Reading Rate, and All children were administered the has three major goals. The first is to
Reading Comprehension mea- same measures of phonological aware- provide a basis for accurate discrimi-
sures from the Gray Oral Reading ness, phonological short-term memory, nations among phonemes by teaching
Test-III (Wiederholt & Bryant, rapid naming, reading, other academic the distinctive kinesthetic, auditory,
1992); skills, and expressive and receptive and visual (mouth form) features asso-
5. two measures of other academic language during the 2- to 3-week pe- ciated with all of the common pho-
skills-the Spelling subtest from riod immediately following the end of nemes of the English
language. Kines-
the Kaufman Test of Educational the intensive training period. The same thetic and visual features are taught to
 39

help make the phoneme more con- and tongue position. Following these words &dquo;don’t play fair,&dquo; so that parts of
crete, and to allow children to both initial discovery and labeling activities them simply have to be memorized. At
&dquo;hear&dquo; and &dquo;feel&dquo; phonemic contrasts with individual phonemes, the chil- the same time that children were build-
and identities in spoken patterns. dren engaged in an extensive series of ing facility at spelling and reading reg-
The second goal of the program is to problem-solving exercises that in- ular words of increasing complexity,
teach children to use their knowledge volved representing sequences of pho- they also received instruction and
of the distinctive features of phonemes nemes with either mouth-form pic- practice in reading words that occur
to monitor and represent sequences of tures or colored blocks. The purpose of with high frequency in printed English
sounds in spoken syllables. This is this training was to help the children (Fry, Kress, & Fountoukidis, 1993).
done by engaging them in a series of learn to focus on mouth movements as Typically, the children were asked first
problem-solving activities that allow an additional cue to the identity, num- to sound out words from this list and
the children to use concrete objects ber, and sequence of sounds in sylla- then were shown the parts of the
(mouth-form pictures and/or colored bles ; it also enabled them to learn to words that needed to be pronounced
blocks) to represent sound sequences. represent these sequences with con- differently. They then saw these words
A third important goal using these crete visual objects. repeatedly in word drills until they
problem-solving activities is to teach As they learned to label each pho- could recognize them fluently. The
children self-monitoring skills. The neme with a descriptive name, the par- children spent about 10% of their in-
teacher is encouraged to use tech- ticipants were also taught to associate structional time on sight word practice.
niques (socratic questioning, proleptic specific letters with each phoneme. Once The children were also taught a
exchanges) that allow children to dis- they became facile at representing number of simple phonics rules to help
cover methods by which they can cor- sequences of sound with concrete them deal with print conventions in
rect themselves on these activities. objects, it was a natural transition to reading and spelling, and they were
Children are then taught to transfer begin to represent them with letters. taught specific strategies for deal-
these same self-monitoring and self- Children learned first to encode (spell) ing with multisyllable words. About
correcting strategies to the spelling and syllables with letters using small plas- 95% of the instructional time in this
reading of individual words. tic tiles and then learned to decode condition was spent in stimulating
Because a &dquo;language&dquo; for talking (read) syllables by blending the sepa- phonemic/articulatory awareness and
about phonemes is taught in this pro- rate phonemes together. Much of this in building skill at decoding and en-
gram, all children began at the be- beginning work with spelling and de- coding individual words. The other 5%
ginning, regardless of differences in coding simple patterns (CV, VC, CVC of the time was spent reading from the
reading skill or skill with phonics. In- combinations) included the use of non- Poppin Readers (Smith, 1992) and the
struction began with teacher-student words, in order to reinforce the habit of Early Literacy Series (Hannah, 1993),
exchanges designed to help children &dquo;feeling&dquo; and &dquo;hearing&dquo; the individual which have been specially produced to
become aware of the specific mouth sounds in words. Activities in which provide decodable text as children
movements associated with each pho- words were spelled or read in chains progress through the ADD program.
neme. As part of this instruction, they were used extensively to illustrate the When reading text, the children were
also learned labels for each phoneme ways in which words can change when cued through appropriate questioning
that are descriptive of place and man- only one phoneme is different. For ex- to use their skills at &dquo;feeling&dquo; the
ner of articulation (e.g., &dquo;lip popper,&dquo; ample, the child might be asked to sounds in words to check that the
&dquo;tip tapper&dquo;), and they learned to as- show what needed to change in order words they pronounced matched those
sociate each sound with a picture to make &dquo;pop&dquo; from &dquo;pot,&dquo; and then on the printed page.

showing the mouth making the sound change &dquo;pop&dquo; to &dquo;top.&dquo;

(mouth-form pictures). The children The children continued to be intro-
Embedded Phonics
worked initially with a group of 10 con- duced to additional consonant and
sonants that were divided into 5 vowel phonemes, with an emphasis on This program was designed to provide
&dquo;brother pairs&dquo; that had the same ar- acquiring awareness of the articulatory direct, explicit instruction in word-
ticulatory gestures but differed in voic- gestures that are uniquely associated level reading skills while providing ex-
ing (e.g., /p/ and /b/ or /t/ and /d/). with each phoneme, until all 44 En- tensive opportunities to read and write
When children had achieved reason- glish consonant and vowel phonemes meaningful text. Children were ini-
able mastery of these consonant were introduced. The ADD program tially given an informal assessment of
sounds, they began learning to distin- provided extensive practice in reading their knowledge of letter-sound corre-
guish vowel sounds around a &dquo;vowel and spelling individual words and spondences, blending skills, and sight
circle&dquo; that represented differences nonwords that followed regular pat- word vocabulary. The content of in-
among vowel sounds in terms of terns. However, children were also ex- struction was then tailored to each in-
mouth shape (smiling, open, or round) plicitly taught the principle that some dividual child’s needs, but the time
40

spent on each kind of instructional ac- They were taught the most common paragraph, and asking them to predict
tivity wasroughly the same for all chil- spelling variations of all the consonant what might happen next.
dren. Because a standard pattern of in- phonemes and all the vowel pho- The second 50-minute daily session
structional activities was followed for nemes. In addition, children who re- contained the following activities.
all children in this condition, it will quired received direct help and mod-
it
serve as the basis for description of the eling in the skill of blending sounds Ten Minutes-Sight Word Practice.
treatment. together to form words. They were also Sometimes practice was provided on
Instruction was divided into two 50- taught a small number of phonetic rules / small groups of words that were just
minute sessions each day. In the first patterns (e.g., signal e, r-controlled introduced, and other times it involved
session, the following sequence of ac- vowels, inflected endings, and syllable larger, cumulative samples of all words
tivities took place. patterns) that are helpful in decoding that had been taught. A combination
real words. Participants were able to of word-card drills and word games
Ten Minutes-Introduction and Prac- practice these basic phonemic decod- was used.
tice in Reading Sight Words. Words ing skills by using word chains in a
were selected from the same list that manner similar to the ADD program.
Five Minutes-Spelling. Children
was used for children in the ADD pro-

gram. As words were introduced for Fifteen Minutes-Oral Reading in practiced spelling both sight words
and words that could be spelled pho-
the first time, the child attempted to Trade Book or Basal. Depending on
decode them, and both the parts that the level of the children’s phonemic nemically.
fair&dquo; and those that did not
&dquo;played decoding skill and the extent of their
were identified. A phonemic guide to sight vocabulary, they practiced read- Twenty Minutes-Reading in Basal
or Trade Book. This activity was sim-
the pronunciation of each word ap- ing in either a graded series of trade
ilar to that in the first session, although
peared below the word to aid in iden- books or a basal series that had a
sometimes it varied, with the child first
tification, and this guide was gradually highly controlled vocabulary (the HBJ
faded as the child acquired facility in Bookmark Series). While reading the reading the passage silently while
identifying each word. Words were text, the children were encouraged to noting and discussing difficult words,
then reading it orally for fluency
practiced repeatedly until children read words accurately while focusing
could pronounce them correctly within on meaning. Word-level errors were
and accuracy. ,,
,

1 second over 3 successive days. corrected in two ways: If the error in-
volved a phonemic decoding principle Fifteen Minutes-Writing Activi-
Five Minutes-Spelling Newly In- that had been taught, the children were ties Using Sight Words. Children
troduced Sight Words. This activity cued to correct their error through a se- were asked to compose and write

was designed to draw attention to the ries of leading questions, asking them meaningful sentences containing words
spelling patterns within new words to notice the specific way the pho- from their practice list of sight words.
and to stimulate phonemic awareness nemes in the word they said differed Here, the emphasis was on the mean-
through a questioning strategy that en- from the word on the page, if the error ing of the words, proper use in the sen-
couraged children to &dquo;stretch&dquo; words involved an obvious violation of the tence, and correct spelling.
and listen for all their sounds as context of the passage, the children From these descriptions, it is clear
they were spelled. In the case of words were asked to think about whether the that the two instructional methods
that involved irregularities in sound- word they said made sense in the sen- were different in a number of impor-

symbol correspondences, the irregular tence. They were then encouraged to tant ways. First, the amount of time
parts were pointed out as parts of the sound out as much of the word as spent on reading and writing con-
word that just needed to be memo- possible and then find a word that nected text varied substantially be-
rized. &dquo;sounded like that and made sense in tween the two conditions. The ADD
the sentence.&dquo; The error-correction group spent only 5% of their time ap-
Ten Minutes-Word Games for Flu- procedures used while the children plying their word-level skills to read-
ency with Sight Words. A variety of read text were designed to build their ing and comprehending text. In con-
games was used to provide repeated skills in using cues from both the let- trast, the EP group spent 50% of their
practice in correctly identifying words ters on the page and the meaning in the time in meaningful activities with con-
from the sight word list. passage in identifying words. As the nected text. The ADD group spent 85%
passages and stories were read, the of their time learning and practicing
Ten Minutes-Phonics Minilesson. teachers consistently emphasized mean- phonemic decoding skills with indi-
During this time, children were di- ing by asking the children specific vidual words whereas the EP group, in
rectly taught the information required questions, asking them to summarize the phonics minilessons and spelling
for phonemic decoding and spelling. what was just read in a sentence or practice, spent 20% of their time prac-
 41

ticing on broadlysimilar activities. Forexample, 81% of the ADD group 4.4, measures from the Gray Oral
Whereas the ADD group spent 10% of was diagnosed with either attention- Reading Test-III. The time x treatment
their instructional time on learning deficit disorder or attention-deficit/ interaction for the Comprehension
and practicing recognition of high- hyperactivity disorder, while 71% of score from the GORT-III just failed to

frequency sight words, the EP group the EP group had similar diagnoses. reach the .05 probability level, F(1, 47)
spent 30% of their time on this activity. These diagnostic judgments were =
3.6, p .06. In all of these cases, chil-
=

Finally, the ADD group received in- made by Dr. Alexander and Dr. Voeller, dren in the ADD condition improved
struction in phonemic awareness that both highly experienced clinicians, on more than those in the EP condition.

taught children to use both kinesthetic the basis of observations during pre- Growth during the follow-up period
and auditory cues for the identity of testing and information from the was examined using 2 (ADD vs. EP)

phonemes in words, whereas the EP teacher survey forms. Of the children x 3 (posttest vs. 1-year vs. 2-year)
group received only indirect training diagnosed with attention-deficit dis- repeated-measures ANOVAs. During
in phonemic awareness through in- order, approximately half received the follow-up period, the groups showed
struction in &dquo;phonics&dquo; and phonemic some form of stimulant medication a decline in standard scores on one test,

spelling. during the course of the intervention gains in standard scores on three tests,
Although the complexity of each or follow-up. However, medication and stable performance on four others.
instructional program precludes hy- condition during pre- and posttesting The children lost ground relative to
potheses attributing instructional ef- was not carefully controlled in this normal growth on the Word Attack test
fects to single variables, the overall study, nor was medication consistent (this means not that their actual skills
differences between the programs pro- over the course of the treatment. Thus, declined but, rather, that they did not
vide a contrast between one approach medication must be regarded in this keep pace with normal growth during
that placed primary instructional em- study as a variable that may have in- this period), F(2, 94) = 6.6, p < .01, with
phasis on building skills in phonemic troduced error variance, rather than most of this decline being shown by
awareness and phonemic decoding one whose effects were systematically children in the ADD group. On the
(ADD) and another approach that examined. other measure of phonemic decoding
taught those skills while placing more Table 2 reports pre-, post-, and skill (Phonemic Decoding Efficiency),
emphasis on their application while follow-up testing on all the reading the children’s performance was stable
reading meaningful text (EP). Again, variables for children in both condi- during the follow-up period. In con-
we were interested primarily in ques- tions. As can be seen from this table, trast to their decoding skills, the chil-
tions about the ultimate level of read- the effects of intervention were both dren’s standard scores on measures of
ing skill attained by children in both substantial and stable over the course sight word vocabulary increased dur-
programs, the relative effectiveness of of the 2-year follow-up period, and ing the 2 years following intervention.
one approach versus the other, and the outcomes were very similar for both Changes on both the Word Identifi-
predictability of individual children’s instructional methods. We analyzed cation, F(2, 94) =
9.1, and the Sight
responses to the interventions based growth during the intensive treatment Word Efficiency, F(2, 94) 27.9, test
=

on their entering characteristics. period, separately from growth during were statistically reliable, p < .01. The

the follow-up period in order to isolate children’s standard scores for the Pas-
specific effects of the treatment versus sage Comprehension test from the
Results long-term outcomes and maintenance WRMT-R also increased significantly
of instructional gains. during the follow-up period, F(2, 94) =
Although 60 children received reme- During the treatment period, a series 8.6. Standard scores on the GORT-III
dial instruction, 10 of them moved to of 2 (ADD vs. EP) x 2 (pre- vs. posttest) Accuracy, Rate, and Comprehension
another community before they re- repeated-measures ANOVAs showed measures did not show significant
ceived the 2-year follow-up test. Six that growth in standard scores was sta- change during the follow-up period.
children were lost from the EP condi- tistically significant (p < .01) for all the For none of the reading variables was
tion and four from the ADD group. The reading measures, with Fs(l, 47) rang- there a significant treatment x time in-
remaining sample was not signifi- ing from a high of 309.2 for Word teraction, nor were the two groups sig-
cantly different from the original sam- Attack to a low of 7.6 for rate on the nificantly different from one another
ple on any of the major pretest or de- GORT-III. The only measures for which on any of the measures during the

mographic variables. The findings to the two treatment groups showed dif- follow-up period.
be reported here are based on the ferent rates of growth from pre- to One of the most striking findings
50 children (26 ADD, 24 EP) for whom postest were Word Attack from the from the data in Table 2 was the large
complete data were available. Within Woodcock Reading Mastery Test- difference between gains on measures
this sample, there was a high degree of Revised, F(1, 47) 8.4, and the Rate
= of word-reading accuracy and compre-
comorbid attention-deficit disorder. F(1, 47) 4.2, and Accuracy, F(1, 47) =
= hension and those on the rate mea-
42

TABLE 2
Outcomes for Reading Measures at All Measurement Points

Note. Preliminary reports on the immediate posttest and 1-year follow-up for some of these measures were presented in earlier discussions of this study that
appeared as part of a special issue in Learning Disabilities: An Interdisciplinary Journal (see Torgesen, Wagner, Rashotte, Alexander, & Conway, 1997), and in
book chapters in Word Recognition in Beginning Reading (see Torgesen & Burgess, 1998), Specific Reading Disability: A View of the Spectrum (Torgesen, 1998a),
Language Basis of Reading Disabilities (Torgesen, 1998b), and Perspectives on Learning Disabilities (Torgesen, 1999).
aTo be consistent with the other measures, standard scores from the Gray Oral Reading Tests-III (Wiederholt & Bryant, 1992) were transformed to have a mean of
100 and standard deviation of 15.

sures. On the rate measure from the their rate changed from 42 to 104 WRMT-R. We obtained scores prior to
GORT III, which was our only measure words per minute, with a drop in er- the treatment from school records,
for text processing rate, the children rors from six to one. Thus, for passages with the average period elapsed be-
showed almost no change in their that had a constant level of difficulty, tween the school tests and our pretest

standing relative to average readers. the children’s reading rate more than being 16.6 months. During this 16-
They began the study almost 2 stan- doubled from pretest to end of the month time period, the children re-
dard deviations below average, and follow-up period. ceived remedial reading instruction in
they were at roughly the same point at To establish that the reading growth resource room settings. Although a va-
the conclusion of the follow-up period. attained during the intervention pe- riety of specific instructional methods
It must be emphasized, however, that riod for these children was signifi- were used in the children’s resource

this does not mean that they did not be- cantly different from that of the prein- rooms, they could all be characterized
come more fluent readers. To illustrate tervention period, we used standard as providing direct instruction in basic

the absolute level of gains in fluency, scores on the Broad Reading Cluster reading skills, including phonics, sight
we calculated a words-per-minute from the Woodcock-Johnson Psycho- word vocabulary, and comprehension.
score on the two most difficult pas- Educational Battery-Revised (Wood- The teacher-to-student ratio in these
resource rooms ranged between 1:8
sages they read at the pretest and com- cock & Johnson, 1989) that were ob-
pared this to their rate for passages of tained before, during, and following and 1:18.
the same level of difficulty at the 2-year the intervention period. The Broad Standard scores for the Broad Read-
follow-up test. For the most difficult Reading Cluster is composed of scores ing Cluster for each group are plotted
passage at pretest, rate changed from on the Word Identification and Passage in Figure 1, and it is obvious from this
38 to 101 words per minute, with a cor- Comprehension subtests of the WJP-R, figure that both treatments had a
responding drop in errors from 10 to 2. which are similar but not identical powerful effect on the rate of reading
On the next most difficult passage, to the corresponding subtests of the growth of children in the sample.
 43

Growth slopes were calculated for

each child by dividing the change in
standard score within a given period
by the number of months intervening
between measurement points, and
these slopes were analyzed in two
planned contrasts. The first contrast
compared growth during the preinter-
vention period with that occurring
during intervention and found that
these slopes were significantly differ-
ent, F(1, 47) 35.3, p < .01. The second
=

contrast found that the rate of growth

during the preintervention period was
not significantly different from the rate
following the intervention. Effect sizes
for the two interventions were calcu-
lated by dividing the difference be-
tween the slope during treatment and
the slope prior to treatment by the
pooled variability of the preinterven-
tion slopes. The effect size for the
Broad Reading Cluster, using the &dquo;reg- FIGURE 1. Standard scores on the broad reading cluster before, during, and fol-
ular resource room intervention&dquo; as lowing the intensive intervention.
the control group, was 4.4 for the ADD
group and 3.9 for the EP group.
Performance on nonreading mea- with the ADD group improving the =
26.3, but univariate effects were reli-
sures of language, phonological pro- most on this measure. During’ them able only for the nonword repetition
cessing, and other academic skills is follow-up period, there was, again, a measure, F(1, 47) = 41.2, p < .01. The
presented in Table 3. These data were significant time x treatment interaction same pattern was true for the follow-
analyzed in a manner similar to the F(2, 92) 8.0, with the ADD group’s
=
up period, with significant overall im-
reading variables, and the first set of scores declining, whereas the scores for provement on the memory measures,

analyses showed that children in both the EP group increased. Post hoc con- Wilk’s Lambda = 4.2, but reliable im-
groups improved significantly during trasts showed that the groups were not provement on only the measure of
the treatment phase in their expressive reliably different from one another on nonword repetition. For neither of
and receptive language skills, Fs(2, 94) the LAC test 2 years following inter- these measures was there a significant
= 30.4 and 42.2, respectively. Although vention. time x treatment interaction.
the children’s standard scores on these Because the two naming tasks were There was no effect of the interven-
language measures continued to im- very similar to one another, and the tion on the calculation subtest, which
prove during the follow-up period, the two memory tasks were also similar to indicates that the intervention did not
change was not statistically reliable. each other, these measures were have a generalized impact on academic
The phonemic awareness measures analyzed with multivariate repeated- performance; rather, its impact was
were analyzed separately, as standard measures analyses. For the naming restricted to the reading/language do-
scores were reported for one of the measures, there was a significant mul- main. Finally, slightly different outcomes
measures (Elision), and raw scores for tivariate effect of the intervention, were obtained for the two spelling
the other (LAC). For the Elision mea- Wilk’s Lambda 8.9, p < .01, and uni-
= measures. Standard scores on the

sure, there was a significant and variate treatment effects for both mea- Kaufman spelling test improved dur-
roughly equal effect of both interven- sures were also statistically reliable, ing the treatment phase, F(1, 47) 12.7, =

tions F(1, 47) = 42.5, with no significant Fs(l, 47) = 8.3 and 16.6 for digits and p < .01, but this improvement was
changes in standard scores during the letters,respectively. No change was qualified by a significant time x treat-
follow-up period. Scores on the LAC seen on the rapid naming measures ment interaction, F(1, 47) =
4.2, p < .05.
test also improved significantly during during the follow-up period. The pho- Follow-up analyses indicated that only
the intervention, F(1, 47) = 245.3, but nological memory measures also the EP group improved their spelling
there was also a significant time x showed a significant multivariate ef- scores. However, this effect was lost
treatment interaction, F( 1, 47) =
14.7, fect of the intervention, Wilk’s Lambda during the follow-up period, as the
44

TABLE 3
Outcomes for Nonreading Measures at All Measurement Points

Note. CELF =Clinical Evaluation of Language Fundamentals (Semel, Wiig, & Secord, 1995); LAC Lindamood Auditory Conceptualization Test (Lindamood &
=

Lindamood, 1979); Phoneme Elision, Digit Memory, Nonword Repetition, RAN Digits, and RAN Letters are all subtests of the Comprehensive Test of Phonological
Processes (Wagner, Torgesen, & Rashotte, 1999). Kauf. Spelling Spelling subtest from the Kaufman Test of Educational Achievement (Kaufman & Kaufman,
=

1985). With the exception of the LAC test, for which raw scores are reported, all scores are standard scores based on a distribution with a mean of 100 and
standard deviation of 15. -

children’s growth in spelling skill

did in thisstudy for children with severe recognition fell slightly below the aver-
not keep pace with that of the stan- reading disabilities vary both across age range at the end of the follow-up
dardization sample, and the decline in types of reading skill and across indi- period.
growth rate was particularly pro- vidual children. If we take a standard Apart from the remaining general
nounced for the EP group, F(2, 94) = score of 90 as the lower bound of the deficiency in reading rate, the inter-
4.5, p < .05. For the measure of phono- average range of reading ability, then ventions were clearly not sufficient for

logical spelling, there was also a sig- the sample as a whole remained clearly a significant proportion of the children.
nificant effect of the intensive inter- deficient in reading rate both at the end Table 4 reports the percentage of chil-
vention, F(1, 47) 14.0, but this effect
= of the intensive intervention and at the dren who attained standard scores
was similar for both groups. During end of the 2-year follow-up period. In below 90 at the pretest, posttest, and
the follow-up period, the students con- contrast, the accuracy of their phone- 2-year follow-up points. A little over
tinued to increase their raw scores on mic decoding skills, word reading in one third of the sample were still per-
this measure, F(2, 92) 16.0, but the
=
text, and reading comprehension for forming below the average range on
rate of growth for the ADD group was short passages (WRMT-R) fell within phonemic decoding skills and ability to
stronger than for the EP group, F(2, 92) the average range at the end of the read words accurately in text, whereas
= 3.3, P < .05. 2-year follow-up period. Comprehen- substantially more than half were still
Findings about the remedial suffi- sion performance on longer passages below average in their ability to iden-
ciency of the instructional conditions (GORT-III) and untimed single word tify real words without the aid of con-
 45

action between time and group was

TABLE 4
significant for all during the
measures
Percentage of Children in Each Instructional Group with Standard Scores Below 90
follow-up period, Fs(6, 90) 9.6, 5.7,
=

6.3, and 7.3 for Word Attack, Word

Identification, Comprehension, and
Rate, respectively.
The sample in this study was too
small for satisfactory analyses of indi-
vidual growth curves using hierarchi-
cal linear modeling, as we did in an
earlier study (Torgesen et al.,1999). We
had originally taken measures of word-
level reading skills and phonological
variables at a midpoint during treat-
ment in order to calculate the linear
component of growth for each partici-
pant in the study. However, the relia-
bility with which the slope parameter
could be estimated was unsatisfactory
(reliabilities ranged from .32 to .65)
text. Thus, interms of the word-level hension measure can be considered to during both the treatment and the
reading difficulties that are a core char- be successfully remediated. At the end follow-up period. As an alternative to
acteristic of children with severe read- of the follow-up period, 66% of the estimating the slope using hierarchical
ing disabilities, the interventions in children obtained scores on the Pas- linear modeling, we calculated the reli-
this study were sufficiently powerful sage Comprehension subtest within or ability of gain scores for our reading
to &dquo;normalize&dquo; the skills of approxi- above 1 standard error of measure- measures and found them to be sub-

mately one half to two thirds of the ment of their Receptive Language stantially higher. The average reliabil-
children, depending on the measure score, while the corresponding figure ity of the gain scores for our reading
being considered. for the GORT-III comprehension mea- measures from pre- to posttest was .76
Outcomes for the of read-
measures sure was 53%.
(range .68 to .86), and for the follow-
=

ing comprehension slightly better

were To communicate the general growth up period (posttest to Year 2 follow-up)
than for the word-level measures. On trajectories for children who showed it was .81 (range .70 to .89). For econ-
=

the Passage Comprehension subtest of different levels of reading skill at the omy of presentation, we will present
the WRMT-R, about 80% to 85% of the end of the follow-up period, the sam- the growth analysis for only four of our
children performed within the average ple was divided into four groups, de- eight reading measures (Word Attack
range, while the corresponding per- pending on their standard score on and Word Identification from the
centage for the comprehension mea- each of several reading measures. The WRMT-R, Comprehension and Rate
sure from the GORT-III was about 50%. Low, Mid-, Mid+, and High groups from the GORT-III). Results for the
Another way to evaluate comprehen- each contained approximately 25% of other measures do not depart in mean-
sion outcomes is to compare the chil- the children. Figure 2 reports stan- ingful ways from the results that are
dren’s performance on a measure of dard scores at pre-, post-, 1-year, and presented here.
general language comprehension with 2-year follow-up tests for children in The results presented in Table 5 ad-
their performance on the reading com- each of these four groups on the Word dress the question of which variables
prehension measures. Our most cur- Attack and Word Identification mea- predicted growth on the four reading
rent measure of general verbal ability sures from the WRMT-R, and on the measures during the treatment and
at the end of the follow-up period was Comprehension and Rate measures follow-up periods. For each predictor
the receptive language measure from from the GORT-III. It is obvious from variable, the beginning point on the
the CELF-R. If we assume that a goal of these graphs that the strongest diver- outcome variable (referred to as the
remedial reading instruction for chil- gence in growth rate among the groups autoregressor) was entered first into the
dren with severe reading disabilities is took place during the follow-up equation, so the regression coefficients
to help them acquire reading compre- period. For example, there was a sig- reported in Table 5 describe the degree
hension skills that are consistent with nificant time x group interaction, F(3, to which a given variable predicted
their general language ability, then 45) 3.6, p < .05, only for the Word
=
growth in the outcome measure with
children who score at or above their Identification measure during the beginning performance level con-
language ability on a reading compre- treatment period. However, the inter- trolled. This was done to avoid spuri-
46

nated as a factor in all these analyses,

as standard scores were used for all

reading, phonological, and cognitive

variables. The naming measure repre-
sented an average of naming rates for
digits and letters, and the memory
variable was an average of the two
measures of phonological memory.

Phonological awareness was repre-

sented by scores on the Elision test. The
attention/behavior variable was con-

structed from the attention and activity

categories of the Multigrade Inventory
for Teachers and the attention items
from the IOWA Connors Teacher Rat-
ing Scale. Average scores on each of
these scales were transformed to
within-sample z scores, and a unit
weighted composite formed. For this
variable, the higher the score, the
greater the incidence of rated attention/
behavior problems. The SES variable
was derived from father’s and moth-
er’s education and occupations and
was scored according to criteria de-
scribed in Hollingshead (1975). Gen-
eral verbal ability was represented by
the Receptive Language score from the
CELF-R, as it was the most current
measure of verbal ability available and
showed the most consistent pattern of
relationships with the outcome vari-
ables. We also used reading scores as
predictor variables in cases where a
given score (e.g., Word Attack) could
reasonably be construed as a compo-
nent skill that might contribute to
growth on another reading skill (e.g.
Word Identification or Comprehen-
sion).
Although not reported in Table 5, the
children’s gender and race were not
significantly related to growth on any
of the variables. The values in Table 5
are standardized regression coeffi-
FIGURE 2. Growth on Word Attack, Word Identification, Comprehension, and Rate cients, so that it is meaningful to com-
measures for children who fell within different quartiles on final outcomes for those
pare values both across predictor vari-
measures. ables and across gain scores. The
overall pattern of relationships indi-
cates that other than the autoregres-
ous relationships between predictor used as for the treatment
predictors sors, the predictor variables most reli-
and outcome variables in cases where period weretaken from the pretest, ably associated with growth were
the predictor variables were highly whereas those used to predict growth teacher ratings of attention, receptive
correlated with the beginning score on during the follow-up period were language scores, and measures of other
the outcome variable. The variables taken from the posttest. Age is elimi- reading skills. There were very strong
 47

TABLE 5
Prediction of Gain Scores During the Intervention Period and During the Two-Year Follow-Up period

Note. PA phonological awareness; SES

= = socio-economic status; Nonword Effic. = nonword efficiency; Sight Word Effic. =
sight word efficiency.
*p < .05. **p < .01.

negative relationships between enter- individual relationship to growth was ratings, and, in the case of the rate mea-
ing score on a given variable and rate entered, to preclude the presence of too sure, sight word efficiency.
of growth on that variable, particularly many predictors in the equation that Although the children’s reading
during the intervention period for the were highly correlated with one an- skills at the beginning of the treatment
Word Attack and Comprehension mea- other. The outcomes from these analy- and follow-up periods tended to be
sures. This means that children who ses are reported in Table 6. The stan- negatively related to the amount of
began the study (and the follow-up pe- dardized coefficient for each variable growth they experienced during each
riod) with the lowest scores showed within the simultaneous regression is period, these beginning scores were
the highest rate of growth on most of provided, along with the total percent- positively related to the skill levels that
the reading variables. When we tested age of variance accounted for by the re- were ultimately attained. That is, chil-
for interactions between predictor gression equation. During the inter- dren who came into the study with
variables and treatment groups, we vention period, growth was uniquely higher reading skills tended to have
found no cases in which the variables predicted only by the autoregressor higher reading skills at the end of the
reliably predicted growth differen- and measures of lower level reading study. Furthermore, variables that
tially across groups. skills. For example, both strengths on most reliably predicted rate of growth
To determine the degree to which in- the Word Attack test and relative (particularly attention and receptive
dividual differences on the predictor weaknesses on the Word Identification language scores) were also those that
variables could explain variance in test predicted growth in word identifi- tended to best predict the ultimate skill
growth on the outcome measures, we cation. For the rate and comprehension level the children attained. Table 7 re-
conducted a series of analyses in which measures, growth was uniquely and ports standardized regression coeffi-
the variables significantly related to positively related to measures of real- cients estimating the relationship be-
growth (including the autoregressor, word reading ability, in addition to tween the same predictive variables
regardless of whether it was signifi- being negatively related to the autore- used in the previous analyses and
cantly related to growth) were entered gressor. For the follow-up period in treatment outcomes for the intensive
simultaneously into the regression which a broader range of variables pre- instructional and follow-up periods.
analyses. The one exception to this en- dicted growth in the individual analy- These coefficients index the strength of
try rule applied to the reading mea- ses, the only variables that contributed relationships between the predictor
sures used as predictors. Only the read- uniquely to the prediction of growth and outcome variables with no other
ing predictor variable with the highest were the autoregressors, attentional variables in the prediction equation.
48

TABLE 6
Simultaneous Prediction of Growth During Intervention and Follow-Up Periods

*p < .05. **p < .01.

Notable here are the significant rela- reports the results from multiple re- posttest was the best predictor of read-
tionships between individual differ- gressions that included all the signifi- ing rate at the end of the 2-year follow-
ences in phonemic awareness at the be- cant predictors from the bivariate up period.
ginning of each period (treatment and analyses in Table 7. As was the case for Although we could find no evidence
follow-up), and both word-level and the growth analysis, the only measures in the correlational analysis that chil-
comprehension outcomes. In contrast, that contributed uniquely to the pre- dren with different entering character-
the rapid naming tests were related to diction of outcomes during the inter- istics responded differently to the two
individual differences in reading rate vention period were initial status on interventions, the sample size in this
at the end of the intervention period the outcome in question (autoregres- study did not provide sufficient power
but were not related to individual dif- sor) and component reading skills in for a reasonably sensitive test of this
ferences on the rest of the reading out- word attack and sight word identifica- possibility. Because of the specific pos-
comes. Performance on the Receptive tion. Although phonological aware- sibility that the ADD intervention,
Language measure was also a robust ness and receptive language skills pre- with its focus on phonemic awareness
predictor of ultimate reading levels dicted outcomes reliably when entered at the articulatory level and its exten-

during both the treatment and the by themselves, when considered si- sive practice in phonemic decoding,
follow-up period. And as might be ex- multaneously with the autoregressor may have been particularly helpful for
pected, beginning scores on compo- and component reading skills, they did children who entered the study with
nent reading skills were also strongly not contribute uniquely to the predic- the most severe phonological disabili-
predictive of the scores on the outcome tion of outcomes at the end of the in- ties (Wise et al., 1999), this hypothesis
measures at the end of each measure- tervention period. For the follow-up was tested in an extreme groups analy-
ment As with the gain scores,
period. period, the most consistent predictors sis. Pretest standard scores on the Word
when the correlations in Table 7 were of ultimate outcomes were the initial Attack and Elision tests were combined
calculated for each group separately, status variables (autoregressors). At- into an index of phonological weak-
no significant patterns of difference ex- tentional behaviors explained addi- ness, and children who fell within the
isted for the two treatments. tional unique variance for the compre- bottom and top 20% on this index
In a manner similar to the analyses hension and rate measures, and the within each treatment group were in-
conducted for the gain scores, Table 8 sight word efficiency measure at cluded in the analysis. Figure 3 shows
.

1*
 49

TABLE 7
Prediction of Posttest and Two-year Follow-Up Scores from Measures Taken at the Beginning of the
Treatment and Follow-Up Periods

Note. PA phonological
=
awareness; SES = socio-economic status; Nonword Effic. = nonword efficiency; Sight Word Effic. =
sight word efficiency.
*p < .05. **p < .01.

TABLE 8
Simultaneous Prediction of Outcomes at the End of the Intervention and Follow-Up Periods

*p < .05. **p < .01.

50

ments over a similar period of time. A

higher proportion of children from the
ADD group (46%) than from the EP
group (33)% were removed from spe-
cial education, although this difference
is not statistically reliable. Table 9 re-
ports the characteristics and selected
reading scores of children who were
removed from special education as
opposed to those who were not. From
the information in this table, we can
determine that the children who were
returned to the general education
classroom following our intervention
tended to be older, have less severe
attentional/behavior problems, have
stronger general verbal abilities, and
come from homes of higher socioeco-

nomic status. In addition, children re-

leased from special education were
better readers both before and after the
intensive intervention, and their ad-
vantage in reading skill increased dur-
ing the follow-up period. During the
intervention period, the groups did not
show differential growth on any of the
reading measures. In contrast, during
the follow-up period, significant in-
teractions were found between time
and group for all of the measures,
Fs(2, 92) = 4.2,14.2, 9.9, and 12.1 for the
Word Attack, Word Identification, Com-
prehension, and Rate measures, re-
spectively. At pretest, the groups were
reliably different from one another on
only the Word Identification test, but at
the end of the follow-up period they
were reliably different on all measures.

The divergence of growth in reading

skills between the groups during the
FIGURE 3. Reading growth of children who fell in the lowest and highest 20% in follow-up period cannot be attributed
awareness and phonemic decoding ability at pretest. to better reading instruction in the gen-
phonological
eral education classroom environment,
as no specific instruction in reading is
scores at all measurement points for special education services and were provided in the upper elementary and
the Word Attack, Word Identification, returned full-time to the general edu- middle school grades in this school
and Passage Comprehension measures cation classroom within the first year district. __ ,

from the WRMT-R. It is clear from this following the end of the intervention.
figure that there was not a striking ad- Reports from the school district in
vantage for the ADD intervention with which this study was conducted in- Discussion
children who entered the study with dicated that this rate was substan-
particularly weak phonemic aware- tially higher than the normal 5% rate of Perhaps the most striking finding from
ness and phonemic decoding skills. similar-aged children who were re- this study was the size of the gains in
Approximately 40% of the children turned to the general education class- reading achievement made by this
were judged to be no longer in need of room from learning disabilities place- sample of severely disabled readers, as
 51

TABLE 9
Characteristics and Reading Outcomes for Children Who Were/Were Not Staffed Out of Special Education
in Year Following Intensive Intervention

*This score was significantly (p < .05) higher than the corresponding score for the children who remained in special education.
aTo be consistent with the other measures, standard scores from the Gray Oral Reading Test-III (Wiederholt & Bryant, 1992) were transformed to have a mean of
100 and standard deviation of 15. bFor purposes of presentation in this table, the z scores for this variable were transformed to have a mean of 100 and a standard
deviation of 15. High scores represent more attention/behavior problems.

well as the stability of those gains over growth in accuracy of phonemic de- the two methods were much more sim-
the 2-year follow-up period. Both in- coding skills during the intervention, ilar than different.
structional methods produced very large these differences were not maintained How do the growth rates obtained in
alterations in the children’s growth during the follow-up period. The this study compare with those re-
rates for broad reading ability when ADD group also showed significantly ported by other investigators? Mc-
compared with the rate they had greater growth during treatment in the Guinnes et al. (1996) suggested a pos-
been growing during the previous accuracy and fluency of word reading sible metric for reporting the effects of
16 months’ instruction in learning dis- in text (GORT-III), but these differences intensive interventions in terms of
ability resource rooms. A direct com- were not large and did not maintain the number of standard score points
parison of growth rates on a measure during the period following the inter- gained per hour of instruction. Of
of broad reading ability during the pe- vention. The goal of any intensive in- course, this metric depends on the
riod before the intervention with those tervention with children with reading common use across studies of stan-

during the intervention produced ef- disability is to produce large changes dardized measures that have the same
fect sizes for the slopes of 4.4 for the in reading ability that maintain over standard deviation, but a number of
ADD condition and 3.9 for the EP group. time, and the clear conclusion from this studies have used measures similar
We conclude that the ADD and research is that the EP and ADD con- enough to allow rough comparisons.
EP instructional methods provided ditions were equally successful in In Table 10, we present values for this
equally effective instruction for this achieving this goal. Although the ADD metric for measures of phonemic de-
sample of children because no differ- program produced slightly greater coding (word attack), context-free word
ences existed between the groups on growth three of our eight reading
on reading (word identification), and
any of the important reading outcomes outcome measures during the inter- reading comprehension (passage com-
at the end of the 2-year follow-up vention period, the overall pattern of prehension). The studies by Wise et al.
period. Although the ADD condition growth in the treatment and follow-up (1999), Lovett et al. (1994), Alexander,
did produce substantially stronger periods indicates that the outcomes for et al. (1991), and Truch (1994) all taught
52

TABLE 10
Gains in Standard Score Points Per Hour of Instruction for Three Measures of Reading Skill

Note. ADD =
Auditory Discrimination in Depth; EP = Embedded Phonics.

children similar to those selected for and teacher skill, it is possible to obtain of their time on reading and writing ac-
the present study, whereas McGuiness these rates of growth via a variety of tivities involving meaningful text. Fur-
et al. (1994) and Rashotte, MacPhee, approaches to direct instruction in thermore, the ADD condition involved
and Torgesen (2000) worked with chil- reading. We might even suggest that extensive instruction to build a basic
dren of similar ages who were less se- these rates could serve as a benchmark and powerful level of phonemic aware-
verely impaired. It is apparent from for &dquo;reasonable progress&dquo; in reading ness at the articulatory level, whereas

Table 10 that the rates of growth we ob- for students receiving remedial in- the EP condition directed children’s at-
tained in this study for phonemic de- struction in both public and private tention to phonemes at the auditory
coding skills, word-reading ability, and settings. As such, they are clearly much level as they engaged in reading and
reading comprehension are very simi- higher than is typically achieved in writing activities. Given these large
lar to other studies of children with se- most current special education settings. differences in instructional emphases
vere reading disabilities. The fact that Only one study reported growth rate between the two approaches, the simi-
we obtained larger overall gains than values that were clearly out of range larities in outcome between them are
several other studies can be attributed with the others (McGuiness et al., 1994) remarkable, and they stand in contrast
to the number of hours the interven- which suggests that the findings bear to more substantial differences be-
tions lasted, not to substantial differ- replication by other investigators. tween similar instructional methods
ences in the rate of growth among Although the ADD and EP condi- that were employed in an earlier study
studies. The consistency in rate of gain tions both provided systematic and ex- of the prevention of reading difficulties
across the first five studies in Table 7 plicit instruction in the knowledge and (Torgesen et al., 1999). In the latter
seems remarkable, and it suggests that strategies required for reading words study, children in the ADD condition
the high rates of growth obtained in accurately in print, the instructional ac- obtained consistently higher scores on
our study should be generalizable to tivities and emphases within each pro- measures of phonemic decoding and

other settings, with other teachers gram were substantially different. The word identification during the inter-
implementing the interventions. Al- children in the ADD condition spent vention, and those scores that have re-
though it is true that the studies re- 85% of their time on activities designed mained stable over a 2-year follow-up
ported by Wise, Alexander, and Truch to stimulate phonemic awareness and period (Torgesen, Wagner, & Rashotte,
all used some variant of the Auditory build phonemic decoding skills using 2000).
Discrimination in Depth Program, the activities that did not involve con- There number of possible ex-
are a

similarities in growth rate of the ADD nected text. In contrast, children in the planations for the differences in find-
and EP conditions in our study suggest EP group spent only 20% of their time ings between these two studies, but the
that given the right level of intensity on broadly similar activities and 50% most likely one involves differences in
 53

levels of skill of the teachers in both build awareness of phonemes at the ar- children add sight words to their lexi-
studies. Whereas the present study em- ticulatory level. This is not to say that con primarily through reading them
ployed highly skilled teachers who all approaches such as Auditory Discrim- accurately in text a number of times
had a number of years’ experience ination in Depth are not extremely ef- (Ehri, 1998), this lack of word-reading
teaching children with reading disabil- fective with children who have reading practice places severe limits on the rate
ities, the prevention study employed disabilities. Rather, the conclusion is at which children with reading disabil-
inexperienced teachers who were that there is more than one way to ities acquire the sight word representa-
specifically trained for the study. In the build phonemic awareness and word- tions that are the basis of fluent read-
present study, the teachers in the EP level skills in these children. ing. Given the very low scores of the
condition were able to make signifi- Another striking finding from this children in this study on the word iden-
cant refinements to the children’s pho- study was the substantial difference in tification and sight word efficiency
nemic awareness and word-reading growth of reading accuracy as opposed measures at the beginning of the study,

strategies in the context of meaningful to reading rate. One way to under- it is clear that the range of their sight
reading and writing activities. Their stand this difference comes from con- word vocabulary was very limited
success in this area is most likely at- sidering of the factors that contribute compared to average readers’. To ex-
tributable to their expertise in error to reading fluency differences on mea- pect these children to entirely close the
correction routines that guided chil- sures such as the GORT-R. Perhaps the sight word gap either during the in-
dren’s attention to appropriate cues to most important of these factors is the tensive intervention or in the 2 years
word identity while reading, and to proportion of words in any given pas- following it is probably overly opti-
proper spelling strategies while writ- sage that can be read fluently as sight mistic, particularly as normal readers
ing. These error correction routines, or words. If too many words in a passage are continuing to practice reading and
&dquo;scaffolded interactions,&dquo; have been must be identified through phonemic thus are adding to their own sight
shown in other research (Juel, 1996) to analyses or guessed from context, word vocabularies at a high rate. In
be particularly important in stimulat- reading rate will suffer. The children in other words, the size of normally
ing growth of word-reading ability in our sample were able to improve their achieving children’s sight word vocab-
children with reading disabilities. accuracy scores on the GORT-R be- ularies is a rapidly moving target dur-
Although the similarities in outcome cause of their increased ability to apply ing the late elementary and middle
between the ADD and EP conditions in phonemic analysis skills and other school years. To close the gap in read-
this study were inconsistent with our word-reading strategies while process- ing fluency during these years, our
earlier prevention study (Torgesen et al., ing text. However, their reading rates children would have to add sight
1999), they are entirely consistent with remained severely limited because as words to their lexicons at a faster rate
other remedial research that has exam- the difficulty of the passages increased, than nondisabled children, and that
ined whether instruction at the articu- they encountered an increasing per- implies that they would be practicing
latory level is necessary for stimulating centage of words they could not recog- reading more than their normally read-
phonemic awareness and building nize fluently as familiar orthographic ing peers. To engineer conditions in
phonemic decoding skills in children units. This did not have a serious im- which children for whom reading is
with severe reading disabilities. Wise pact on their accuracy scores because still somewhat more difficult than av-
et al. (1999) recently reported an inves- they were able to decode these words erage are willing to read more than av-
tigation in which the presence or ab- using analytic strategies, but it did erage over an extended period of time
sence of instruction at the articulatory have a severe impact on their fluency is clearly a daunting task.
level was manipulated across methods scores because of the extra time it takes One piece of evidence that is consis-
that were carefully controlled on other to analytically decode words rather tent with a &dquo;practice&dquo; explanation of
important instructional dimensions. than recognize them at a single glance the fluency difficulties observed in this
They found no significant differences as sight words. study is that we did not obtain the
in important reading outcomes across This explanation highlights the chal- same disparity between growth of ac-
their methods that could be attributed lenge we face in helping older children curacy and rate of text reading in our
to whether or not stimulation of ar- who have been very poor readers for studies of the prevention of reading
ticulatory awareness was part of the several years to &dquo;close the gap&dquo; in disabilities. In one study, in which
method. Thus, one conclusion that ap- reading fluency with their normally highly at-risk children received pre-
pears to emerge from both this and reading peers. During the time they are ventive instruction from kindergarten
other research is that skillful instruc- allowed to remain poor readers, they through second grade (Torgesen et al.,
tion in phonemic awareness and phon- miss out on an enormous amount of 1999), and in another study, in which
ics at the auditory level can be just as text exposure and word-reading prac- at-risk children received intensive in-
effective in building word-level read- tice compared to average readers struction during first grade (Torgesen,
ing skills as methods that work to (Nagy & Anderson, 1984). Because Wagner, Rashotte, & Herron, 2000),
54

only very small differences in standard processing rate for some of the chil- receptive and expressive language do-
scores were found for accuracy versus dren. Consistent with this explanation mains. Although growth in these skills
rate measures, either at the end of the are the recurrent associations between was not as impressive during the
intervention or at the end of a 1- or measures of rapid automatic naming follow-up period, the fact that growth
2-year follow-up period. Apparently, if and measures of reading rate reported slightly exceeded the normal growth
the word-reading skills of children at in the literature on reading disabilities rate might be attributed to a change in
risk for reading failure can be main- (Wolf & Bowers, 1999), as well as their reading habits of many of the children
tained at normal levels during elemen- relationships in this study. For exam- in the sample. Longitudinal studies
tary school, their sight word vocabu- ple, the concurrent correlations be- generally indicate that children with
laries expand at normal rates and they tween naming measures and reading reading disabilities tend to show a rela-
do not develop serious discrepancies rate measures at immediate posttest tive decline, rather than an increase, in
between reading accuracy and reading for the sight word efficiency and Gort- their verbal skills during the elemen-
fluency. III rate measures were .52 and .18, re- tary and middle school period (Cun-
Another factor that may have lim- spectively, whereas analogous rela- ningham & Stanovich, 1998).
ited reading rate particularly on the tionships at the 2-year follow-up point A final point about group-level ef-
GORT-R test was the emphasis both in- were .44 and .28. That naming mea- fects involves the finding that the inter-
structional methods placed on accu- sures were more highly correlated with ventions produced significant changes
racy of word identification as a prior- single-word-reading rate than text- in standard scoresfor the measures of
ity during reading. Given also the fact reading rate suggests that reading rate phonological memory and rapid auto-
that the children knew they would be on the GORT-III reflected a more com- matic naming. We are not aware of
asked comprehension questions after plex combination of factors than sim- other studies in which significant im-
reading the paragraphs, they may have ple processing rate for individual provements on these more basic mea-
artificially slowed their word-reading words. sures of phonological ability have been
rates in order to maximize accuracy of Another notable effect of the inter- shown to occur in the context of read-
both word reading and comprehen- ventions was the growth they pro- ing instruction that does not involve
sion. In contrast, on the Sight Word Ef- duced in receptive and expressive lan- specific training in these areas. Al-
ficiency subtest of the TOWRE, on guage skills. The children began the though the children received fluency
which the children obtained higher study with very low scores on these practice for recognizing sight words,
fluency standard scores than in the measures (average Total Language neither of the interventions contained
GORT-R, the children were specifically score =
78.6), but by the end of the fluency-oriented practice at the phone-
instructed to read as many words as 2-year follow-up period, their scores mic level. At present, the most obvious
they could during the time allotted. were very close to the average range explanation for the improvement on
Thus, the difference in rate scores for (89.8). Most of this growth took place these measures involves either in-
the two types of measures may have during the intervention, but there was creased ability to focus and sustain at-
arisen partially because instructions also positive change in standard scores tention, or the development of more
for the two tasks led children to make on both expressive and receptive mea- precise or distinctive representations
different choices in the trade-off be- sures during the follow-up period. The for phonemic elements in speech (Met-
tween speed and accuracy in word most likely explanation for the im- sala & Walley, 1998). If the quality of
identification. provement during the intervention children’s phonemic representations
A third potential explanation of the was the density of language stimula- developed as a result of the interven-
difference between outcomes for rate tion occurring during teacher-student tions, this could conceivably make it
versus accuracy measures can be interactions. Both methods involved easier to access names of numbers and
found in the comparison of final levels extensive teacher-student discussions, letters from long-term memory on the
of performance on measures of phone- which frequently required the student naming tasks and to remember digits
mic awareness (an accuracy measure) to justify or explain answers to ques- and sequences of phonemes on the
and rapid automatic naming (a rate tions. Although the focus and content phonological memory tasks. The fact
measure) at the end of the intervention of these interactions were different that children improved more on the
period. The average standard score for between methods, they both were de- nonword repetition task, on which
the measure of phonemic awareness signed to increase students’ awareness they were required to repeat novel se-
(Elision) was 99.4, whereas that for the and control of their own cognitive pro- quences of phonemes, than on the digit
rate measures was 91.8, with an effect cessing during reading. The richness of span task is consistent with this ex-
size of .65. Thus, one factor that may the language interchange during this planation. That the changes in per-
have contributed to the enduring dif- kind of instruction had a powerful, formance were stable over the 2-year
ferences between accuracy and rate of and unanticipated, effect on the chil- follow-up period argues in favor of a
word reading in the children in this dren’s ability to think about and re- fundamental change in the quality of
study was fundamental limitations in spond to questions in the more general phonemic representation rather than a
 55

perhaps more transitory change in at- mately 30% of the variance in growth show stronger growth on the word
tentional habits. on the reading comprehension mea- identification and rate measures dur-
An analysis of individual differences sure during the follow-up period was ing the follow-up period, and stronger
in response to the interventions used in accounted for by the children’s posttest outcomes on these measures during
this study indicated that they were in- scores on the comprehension and word both the intervention and the follow-
sufficient to &dquo;normalize&dquo; the reading identification measures, along with up period. Although general verbal
accuracy of approximately one third to their verbal ability and behavior rat- ability (receptive language) did not
one half the children in the sample, de- ings. These same predictors, plus level contribute uniquely to the prediction
pending on the specific outcome mea- of phonemic awareness at immediate of growth on either comprehension or
sure being used. So, even in the context posttest, accounted for fully half of the word-level skills during the follow-up
of very large average gains for the variance in children’s ultimate scores period, this was due to its significant
group as a whole, substantial numbers on the comprehension measure at the relationships with other predictor vari-
of the children with severe disabilities end of the follow-up period. ables in the simultaneous regressions,
in this sample remained poor readers A much smaller range of variables particularly with the autoregressors.
following the intervention. Because the predicted growth and outcomes dur- Thus, we would argue that this study
children in this study fell within the ing the intervention period than dur- is consistent with other research with
bottom 2% of all children in terms of ing the follow-up period. This was at older children (Wise et al., 1999) in sug-
reading ability, we can estimate that if least partially due to the smaller vari- gesting that general verbal ability does
the interventions used in this study ability among children in their growth contribute to the ease with which chil-
were available to all children with during the intervention period; how- dren who have been instructed well in
reading disabilities, only about 1 % of ever, for two of the outcome measures basic phonemic decoding skills can
children would remain severely im- (word attack and comprehension) it add words to their sight vocabularies.
paired in reading accuracy upon leav- was also related to the strong negative Another way in which the findings
ing elementary school. relationship between entering level of from this study are consistent with
The growth trajectories presented in skill and growth. For these measures, those from Wise et al. (1999) is in the
Figure 2 suggest that the ultimate out- children who entered the study with lack of differential outcomes across the
comes from the intervention depended the weakest skills tended to show the two instructional conditions for chil-
more on what happened during the largest gains in their standard scores. dren with different entering levels of
2-year follow-up period than during One way to think about this outcome is phonemic awareness and phonemic
the intensive intervention itself. That in terms of the quality of instruction decoding skills. In other words, neither
is, those children who ended up with prior to entry into the study. Children study found that an instructional
the lowest scores at the end of the who showed very large gains from pre- method involving stimulation of pho-
follow-up period showed substantially to posttest may have been those who nemic awareness at the articulatory
different growth rates during the received particularly weak instruction level was particularly beneficial to chil-
follow-up period than those who in basic reading skills, or for some rea- dren with the weakest phonemic de-
ended up with the highest scores, son were not able to profit from in- coding skills. Although our sample
while the growth rates for these groups struction in group settings. When ex- size provided limited power to detect
during the treatment period were posed to the powerful one-to-one significant aptitude/treatment interac-
much more similar. Unfortunately, we instruction in this study, they were able tions by traditional methods, there was
were not able to closely monitor the to particularly profit from the instruc- not even a reasonable suggestion of
children’s reading instruction or prac- tion. At the same time, however, the such effects in the extreme group
tice once they finished the intensive in- positive relationships between pretest analyses described in Figure 3. Al-
tervention, so it is not possible to spec- and posttest scores on these measures though the ADD condition produced
ify all the factors associated with the indicate that the instruction we pro- stronger overall effects on phonemic
differences in growth rate during the vided was not sufficient to eliminate decoding skills than the EP condition,
follow-up period. However, our analy- the overall advantage in reading skill the advantages of the former were sim-
sis of growth using predictors from the enjoyed by those who entered the ilar for children entering the study
pretest and immediate posttest shed a study with the strongest skills. with the strongest and weakest skills in
small amount of light on this question. The broad influence of general re- this area.
During the follow-up period, the most ceptive language skills on growth and Our findings concerning the factors
consistent predictors of growth were outcomes in reading was expected for related to growth in reading were also
the children’s attentional/behavior reading comprehension but not for inconsistent with those reported by
ratings by resource room teachers, word-level reading skills. However, Wise et al. (1999) in one important way:
their general verbal ability, and the lev- the data in Tables 5 and 7 indicate that Whereas Wise et al. found that
els they had attained on component children with higher scores on the re- younger children showed stronger
reading skills. For example, approxi- ceptive language measure did tend to gains than older children, we found no
56

important outcome differences among ical community served by our schools ever, the ADD and EP approaches
our children that were related to dif- must also become involved to iden- varied substantially in their depths of
ferences in age. The one significant re- tify the additional resources that are instruction in phonemic awareness
lationship between growth and age needed. However, the finding that 40% and in their emphases on various in-
reported in Table 5 indicates that the of the children were returned full time structional activities. The fact that out-
older children tended to improve more to the general education classroom comes were so similar for the two
in reading rate during the follow-up within 1 year following the interven- methods suggests that within explicit
period than the younger children. The tion suggests that there may actually &dquo;structured language&dquo; approaches that
children in Wise et al.’s study covered be some significant economies associ- follow sound instructional principles,
a slightly larger age range than those in ated with increased quality and inten- there may be considerable latitude for
the present study (second through fifth sity of instruction for these children. arranging components of instruction
grade vs. third through fifth grade), The fact that reading rate remained according to teacher and student pref-
and they were also about two thirds of so impaired in most of the children erences.
a standard deviation less impaired on suggests the need for further experi- What neither interventionapproach
word-level reading skills than the chil- mentation to develop interventions in contained was a systematic approach
dren we studied. Thus, as Wise and her this area, aswell as the need to focus to teaching reading comprehension
colleagues suggested, because many of resources on the prevention of reading strategies. Because other research (Mas-
the older children in the study were difficulties. If future studies, as well as tropieri & Scruggs, 1997; Swanson,
reading above the third-grade level, longer term follow-up of early inter- 1999) has consistently shown that large
the phonemically explicit instruction ventions, verify that reading rate prob- gains in comprehension result from
those authors provided may have been lems can be eliminated for almost all such instruction, our next intensive in-
better matched to the instructional children via preventive instruction tervention study will include a sub-
needs of the younger than the older (Torgesen et al., 1999), this would stantial amount of instruction spe-
children. Other remedial studies that clearly be another powerful argument cifically focused on helping children
have found no differences in growth in support of more extensive preven- acquire and utilize effective compre-
related to age and covered a similar tive efforts with young children. How- hension strategies. Our hope is that
age range of children were reported by ever, it may also be possible to improve this additional instruction will help
Lovett and Steinbach (1997) and by fluency outcomes in future studies, even those children who remained rel-
Rashotte et al. (2000). through more careful fluency-oriented atively weak in their word-reading
training and practice than was pro- skill to improve their comprehension
vided in this study. We, and others, are more substantially than in the present
trying to address some of these ques- study.
Summary and Implications tions in the next round of intervention
studies.
The most significant outcome of this Another extremely important find- ABOUT THE AUTHORS
study was the demonstration of large, ing from this study was the fact that K. Torgesen, PhD, is a distinguished
generalized, and stable changes in the two quite different intensive instruc- Joseph
research professor of psychology and education
reading ability of a sample of children tional interventions produced essen-
at Florida State University. Ann W. Alexan-
selected because they had been unable tially the same long-term outcomes for der, MD, is a developmental pediatrician and
to acquire adequate word-reading abil- the children. It is important to empha- director of the Morris Child Development Cen-
ity through instruction received in size that both of these interventions ter in Gainesville, Florida. Richard K. Wagner,
both general and special education incorporated principles of instruction PhD, is the Alfred Binet Professor of Psychol-
classrooms. About half the children that have been shown to be partic- ogy at Florida State University, and Carol A.
in our sample attained average-level ularly important for children with Rashotte, PhD, is a senior research associate in
reading skills by the end of the follow- severe reading disabilities. That is, the Department of Psychology at the same in-
stitution. Elaine Rose, MS, is an academic spe-
up period. Given this demonstration of they both involved explicit instruction
the power of intensive instruction, we in phonemic awareness, phonemic de- cialist and director of the Rose and Speech and
would assert that one major task for Academic Center in Tallahassee, Florida. Kytja
coding, and sight word recognition K. S. Voeller, MD, is a professor of neurology
the educational establishment is to find skills. They also included mastery-
in psychiatry at the University of Florida, and
ways to deliver both the quality and oriented progressions through es-
Tim Conway, MS, is a PhD candidate in clin-
the intensity of instruction that many sential skills, extensively scaffolded ical psychology at the University of Florida. Ad-
children seem to require. This task error-correction routines to establish dress : Joseph K. Torgesen, Psychology Depart-
clearly extends beyond the educators appropriate word identification strate- ment, Florida State University, Tallahassee,
who are charged with providing direct gies, and many opportunities to prac- FL 32306-1270 (e-mail: torgesen@psyfsu.
instructional services. The larger polit- tice with appropriate materials. How- eduAbstract).
 57

AUTHORS’ NOTE Ehri, L. C. (1998). Grapheme-phoneme know- Lindamood, C. H., & Lindamood, P. C.
ledge is essential for learning to read (1984). Auditory discrimination in depth.
The research reported in this manuscript was
words in English. In J. Metsala & L. Ehri Austin, TX: PRO-ED.
supported by Grant No. HD30988 from the Na- (Eds.), Word recognition in beginning read- Lindamood, P., & Lindamood, P. (1998). The
tional Institute of Child Health and Human De-
ing (pp. 3-40). Hillsdale, NJ: Erlbaum. Lindamood phoneme sequencing program for
velopment, and by grants from the National
Center for Learning Disabilities and the Donald
Fletcher, J. M., Shaywitz, S. E., Shankweiler, reading, spelling, and speech, Austin, TX:
D. P., Katz, L., Liberman, I. Y., Stuebing, PRO-ED.
D. Hammill Foundation.
K. K., Francis, D. J., Fowler, A. E., & Shay- Loney, J., & Milich, R. (1982). Hyperactivity,
witz, B. A. (1994). Cognitive profiles of inattention, and aggression in clinical
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