Remedial interventions for developmental dyslexia: Comparing the rhythmic reading training to the “Abilmente” approach

Abstract

The possibility of using rhythmic auditory interventions for addressing dyslexia-related difficulties has been empirically explored by several investigations, with encouraging results. Such findings inspired the design of a novel rhythm-based intervention, Rhythmic Reading Training (RRT), specifically designed for students with developmental dyslexia (DD). To measure RRT efficacy, a clinical trial with an active-controlled design was carried out. More precisely, RRT combined with music games was contrasted with a personalized multi-componential treatment of DD of proven efficacy, namely, the Abilmente approach. Thirty-two children and preadolescents with DD received either one of the two interventions under the supervision of a specialized trainer. Immediate- and medium-term effects on reading skills did not differ between the two interventions. The analysis of the specific contribution of each methodology showed that the Abilmente approach was more effective in improving text reading, while RRT induced more consistent maintenance of all reading sub-processes 4 weeks after the end of the treatment. Consistent with previous research, the rhythmic intervention showed more consistent effects on reading speed. These results confirmed the efficacy of a unimodal process-based intervention such as RRT in inducing global reading effects comparable with those following a personalized multi-componential intervention.

Keywords

reading developmental dyslexia music rhythm intervention rehabiliation music therapy

Developmental dyslexia (DD) is the best known and most studied among specific learning disorders, especially in school populations (Snowling et al., 2020). Since its main behavioral manifestation is an impairment in the ability of reading (American Psychiatric Association, 2013), DD often hinders school learning, thus having negative consequences on academic achievement. Such adverse outcomes are typically associated with low self-efficacy (Lackaye & Margalit, 2006; Magenes et al., 2021) and frequently lead to emotional and behavioral problems (Capozzi et al., 2008).

Considering DD prevalence in Italian school population, which is estimated to range up to 4.75% (Cappa et al., 2015), it is crucial to deliver effective interventions targeting dyslexia-related difficulties, thus boosting students’ academic achievement, which, in turn, would act as a protective factor for mental health problems. However, standard training methods delivered in Italy for DD are often characterized by limitations, such as expensiveness, time commitment, the tediousness of the activities, and long practice required for trainers to master the techniques.

An alternative approach, which circumvents the mentioned limitations, is involving children with DD in musical activities. A line of research investigated the efficacy of auditory and musical interventions specifically devised for improving DD-related difficulties (Cancer & Antonietti, 2022). Significant beneficial effects on phonological abilities and reading were reported by most studies and were found to be comparable to those of standard language-based interventions, thus supporting the hypotheses of a transfer effect of musical/auditory training on phonological and literacy skills (e.g., Bhide et al., 2013; Cogo-Moreira et al., 2012; Flaugnacco et al., 2015; Gaab et al., 2007; Habib et al., 2016).

A specific musical approach for DD intervention was developed within the Temporal Sampling theoretical framework of DD (Goswami, 2011; Goswami et al., 2014), according to which the DD-related phonological deficit (Ramus et al., 2013) is linked to atypical neural entrainment of the auditory oscillatory networks to the rhythms of speech at low frequencies, responsible for an impairment in the perception of temporal acoustic components (Giraud & Ramus, 2013; Goswami, 2011). Such impaired rhythmic sensitivity would interfere with the development of the phonological skills crucial for language and reading acquisition. The hypothesis of a beneficial effect of a rhythmic auditory training for DD has been posited by a few researchers (Overy, 2003; Tallal & Gaab, 2006).

These findings inspired the design of a rhythm-based intervention, specifically designed for students with DD, called Rhythmic Reading Training (RRT; Cancer et al., 2016). More precisely, a software-based program comprising exercises in which decoding tasks are embedded into auditory-based exercises was devised to induce a more accurate entrainment to the spectral properties of auditory stimuli during reading, and consequentially boost reading fluency. Compared with standard interventions for improving reading, the rhythmical feature of RRT makes it—as reported by trainees and trainers involved in the previous implementations of the approach (Cancer et al., 2021, 2022)—more appealing and less tedious for participants, thus fostering compliance and motivation of children undertaking the remedial procedure.

The efficacy of RRT had already been investigated in several test-training-retest studies (Cancer & Antonietti, 2017). It has been demonstrated that RRT induces greater improvement in reading than that occurring thanks to natural development, as proven by comparison results against a no-treatment control group (Bonacina et al., 2015). Moreover, RRT is effectively applicable in both school and clinical rehabilitation settings (Cancer & Antonietti, 2017), in both presence and remote mode (Cancer et al., 2021), and all students with DD can benefit from it regardless of music expertise (Cancer & Antonietti, 2017). When compared with other interventions, RRT was as effective in enhancing reading as other validated multimodal approaches (Cancer & Antonietti, 2017; Cancer et al., 2020). Moreover, basic auditory abilities and verbal working memory were found to contribute to the efficacy of the reading intervention (Cancer et al., 2019), whereas no additional effect of the synchronized visual cue in RRT was found (Cancer et al., 2022).

In the attempt to confirm RRT’s efficacy as a remedial intervention for DD, a comparative study was carried out. In the present investigation, the effectiveness of RRT was compared with that of an intervention for DD of proven efficacy (Allamandri et al., 2007), namely, a personalized integrated treatment called the Abilmente (the Italian word for “skillfully”) approach (Brembati & Donini, 2009). The Abilmente approach comprises several validated treatments resulting in a proposal tailored to meet individual needs and features.

To compare the effects of the two interventions, a clinical trial with an active-controlled design was carried out. To confirm the medium-term efficacy of both interventions, maintenance of reading gains over time was measured and compared between conditions. Additionally, the study aimed to explore each intervention’s specific effect, in terms of duration (immediate and medium-term effect) and modulation of reading processes (lexical and sublexical reading speed and accuracy).

Method

Participants

Thirty-two Italian primary and junior-high-school students (from 4th to 8th grade) with a diagnosis of DD were enrolled in the study. Half of them were recruited in three different Neuropsychiatry Units in Milan, Italy. Eligible participants were selected among patients who were part of the waiting list for an intervention on reading. As for the second half, they were recruited among the patients of “Abilmente” private psychology center in Cassano d’Adda, Lombardy, Northern Italy, who were about to be enrolled in an intervention using the Abilmente approach. More precisely, patients of the Abilmente center were selected to create a comparative group matched for gender, IQ, school grade, and level of reading impairment (Table 1). Despite the different recruitment locations, patients of both rehabilitation institutions shared similar clinical management associated with DD. Namely, diagnostic procedures and treatment indications are the same in public and private centers dealing with learning disabilities. Furthermore, due to the lack of resources in Italian public neuropsychiatry services, together with the high demand for treatments of neurodevelopmental disorders, patients who are on a waiting list for neuropsychological rehabilitation have commonly to wait for several months before receiving the treatment. Therefore, many families decide to contact private centers, often making use of the economic aids provided by the regional government of Lombardy to support students with learning disabilities.

Table 1.

Participants’ Characteristics. Non-Parametric Comparisons of School Grade, Gender, Intellectual Functioning, and Baseline Reading Skills Between Participants Enrolled in the Two Experimental Conditions, Namely, RRT and the Abilmente Approach.

	RRTn = 16	Abilmenten = 16	Between-group comparisons
	Mdn	Mdn	Mann–Whitney test: U, p	χ², p
Primary school^a	5	6	–	0.14, .71
Junior high school^a	11	10	–	0.14, .71
Male^a	6	10	–	3.45, .06
Female^a	10	6	–	3.45, .06
FSIQ^b	98	102.50	107.5, .62	–
Global reading speed^c	–2,07	–2,15	120, .73	–
Global reading accuracy^c	–1,57	–1,02	103, .35	–

Note. RRT = Rhythmic Reading Training; FSIQ = Full Scale IQ.

Frequencies.

FSIQ composite score derived from the Wechsler Intelligence Scale for Children Third Edition (WISC-III).

Baseline global reading scores comprising text, word, and nonword, reported as z-scores (positive z-scores represent above-average performance, negative z-scores below-average performance).

Inclusion criteria comprised (a) previous diagnosis with DD (ICD-10 code: F81.0) based on standard inclusion and exclusion criteria (ICD-10: World Health Organization, 1992) of the diagnosis procedure followed in Italy (PARCC, 2011); (b) absence of comorbidity with other neuropsychiatric or psychopathological conditions, whereas comorbidity with other learning disabilities was allowed; and (c) no involvement in previous reading intervention programs for at least 1 year before the enrollment in the present study.

As for both groups, researchers contacted parents of the eligible participants, presented them the purpose and procedures of the study in detail, and finally obtained written informed consent of those who agreed to be involved (enrollment rate: 95%).

The study was approved by the Psychology Research Ethics Committee of the Catholic University of the Sacred Heart, Milan, Italy on the 22nd December 2015. The entire research process was conducted according to the standards of the Helsinki Declaration.

Interventions

Participants were assigned to one of two experimental conditions according to recruitment location. The patients of the Neuropsychiatry Units took part in an intervention using RRT in combination with specific auditory training, whereas patients of the private center received a training program following the Abilmente approach.

Rhythmic Reading Training

RRT (Cancer et al., 2016) is a computerized reading training program designed for students with DD. Its main feature is the synchronization between reading fluency and an isochronous acoustic rhythm. The tempo of the rhythm is gradually increased to improve reading fluency, along with the complexity of the verbal stimuli presented. The training program comprises three categories of exercises, each aimed at training a specific reading sub-component: “Syllables,” “Merging,” and “Words and Nonwords.” Participants are taught to read aloud the verbal stimuli presented on the screen (i.e., syllables, words, nonwords, phrases) synchronically with the acoustic stimulation. During the first presentation of each exercise, the stimulus that is meant to be read is highlighted by a visual cue synchronized with the acoustic stimulation, so to support the synchronized reading at a specific tempo. The software allows the trainer to modulate the tempo of the stimulation depending on each participant’s reading level.

To boost the attention and motivation of participants through providing a greater variation in activity plan, computer time was alternated with music games involving small musical instruments (e.g., bongo drums, xylophone, maracas). Music games involved synchronization tasks, thus addressing the same temporal processing mechanisms as RRT. Because of such a consistency between training activities, no specific hypothesis of an additional effect of music games to RRT was formulated. During each training session, participants were overall involved in each type of activity (i.e., computer exercise, music games) for approximately 30 min.

Abilmente approach

The Abilmente approach (Brembati & Donini, 2009) is an intervention for DD, which comprises several validated treatments resulting in a proposal tailored to meet individual needs and features. More precisely, this rehabilitation approach takes the specific characteristic of each participant into account to design a customized intervention. For doing so, the approach requires an initial assessment of reading abilities, prerequisite skills for reading (i.e., phonological awareness, visual discrimination, visual search, short-term memory, automatized naming), and reading comprehension. Moreover, emotional and motivational aspects (e.g., self-efficacy, attribution style) are assessed, to provide insights for tailoring the intervention further. After the preliminary assessment, several validated treatments are selected and combined to meet the needs of the participant.

Both paper-and-pencil and computerized activities are used. An example of activity targeting reading speed is making the user read the same passage comprising high-frequency words many times, alternating silent and aloud reading. An example of activity targeting reading accuracy, specifically when the child struggles in starting a new line, is making the user read the first and last words of each line. The activities do not focus only on reading speed and accuracy, but other reading-related abilities (e.g., phonological awareness, visual search, prosody during reading) are trained as well. Furthermore, metacognitive strategies are fostered throughout the intervention. The individualized intervention differs in length and procedure according to each user’s specific profile. Usually, the treatment is interrupted when rehabilitation goals, set specifically for each participant, are reached.

The efficacy of Abilmente approach has been shown by some test-training-retest studies (e.g., Allamandri et al., 2007; Brembati & Donini, 2009) involving Italian primary, junior high, and high school students with DD. The intervention induced significant improvements in both reading speed and accuracy. However, the largest effect was found on the latter, which tended toward normalization.

Procedure

The clinical trial was first registered at ClinicalTrials.gov (Clinical Trial ID: NCT03199092). As for RRT combined with music games (hereafter referred to as RRT), the intervention was delivered for 20 sessions, twice a week, of 60 min each. The Abilmente intervention period was tailored to individual needs and comprised a number of 60-min sessions, twice a week, ranging from 8 to 20 (M = 13; SD = 4.26). The sessions were individual and conducted by psychologists, who were expert in each methodology and neutral with respect to the hypothesis of the study.

RRT sessions took place in the Neuropsychiatry Unit where the participants were recruited, whereas the Abilmente approach was administered at the “Abilmente” center. As for both locations, treatments were delivered in a quiet room, with appropriate lightning conditions, shielded from visual and auditory distractors. Trainers from both institutions were selected so to guarantee similar training backgrounds and similar interaction styles with children.

Participants’ reading abilities were assessed before and after the intervention. Furthermore, a subgroup of 14 participants (RRT: n = 7; Abilmente approach: n = 7) were involved in a follow-up assessment up to 4 months after the end of the training period (M = 3; SD = 0.58; between-group comparison: U = 21, n.s.).

Assessment

Medical history, diagnosis, and intellectual functioning measures were collected from each participant’s clinical records. Reading abilities were assessed using an Italian battery of standardized tests providing accuracy and speed scores. Namely, the ability to read aloud age-normed texts was measured using the “New MT reading tests for junior high school” (Cornoldi & Colpo, 1995). Word reading (four lists of 28 words each characterized by different lengths and frequency of use) and nonword reading (two lists of 16 nonwords each characterized by different lengths) were measured using the “Assessment battery for Developmental Reading and Spelling Disorders-2” (Sartori & Job, 2007).

Statistical analyses

Given the small sample size and the count nature of the accuracy scores, assumptions of normality and homogeneity of error variance were not met for all the outcome variables. For this reason, non-parametric statistics have been computed.

To investigate within-group training effects, pre–post comparisons (Wilcoxon signed-rank test) have been conducted considering each intervention separately. Then, pre–post difference scores have been computed as an estimate of training effect and reading gains were compared between conditions (Mann–Whitney U-test).

For the subgroup of participants who were involved in the follow-up assessment (n = 14), preliminary within-group comparisons have been conducted for each intervention separately, to measure the medium-term improvement. Furthermore, pre-follow-up differences have been compared between conditions. For both within- and between-group comparisons, the effects were tested on global speed and accuracy reading measures (i.e., mean of word, nonword, and text reading) first; Then, post-hoc analyses have been computed to investigate training effects on each specific reading sub-measure (i.e., word, nonword, and text reading). Effect sizes have been reported as Pearson’s correlation coefficient r (values of ±.1 represent a small effect, ±.3 is a medium effect, and ±.5 is a large effect; see Rosenthal, 1991, p. 19).

Results

Within-group training immediate and medium-term effects on global reading scores

Pre versus post (n = 32) and pre versus follow-up (n = 14) within-group differences are reported in Figure 1. RRT induced an immediate significant effect on global reading speed, as showed by pre–post within group comparison, W = 3.00, p < .001, r = .58. The reading speed gain was also maintained at follow-up assessment, as shown by a significant difference between pre-training and follow-up scores, W = 0.00, p = .02, r = .65. Global reading accuracy did not improve immediately after intervention in the RRT group, W = 46.00, p = .27, r = .02. However, accuracy was significantly improved at follow-up, W = 0.00, p = .01, r = .77.

Figure 1.

(a) Pre–Post Global Reading Speed and Accuracy Gains in the Two Experimental Conditions. (b) Pre-Follow-Up Global Reading Speed and Accuracy Gains in the Two Experimental Conditions, in a Subgroup of Participants (N = 14). Higher Values Correspond to a Better Performance.

In children who received the Abilmente approach, a significantly improved global reading speed was measured immediately after training, W = 0.00, p < .001, r = .84, and at follow-up, W = 0.00, p = .02, r = .65. Improved global reading accuracy was also found after training, W = 4.00, p < .001, r = .41; however, the accuracy improvement was nonsignificant at follow-up in the Abilmente group, W = 3.00, p = .08, r = .33. Although this last finding is not clearly reflected in Figure 1, which shows pre, post, and follow-up mean scores for each group, this incongruence is explained by a significantly larger variance of the follow-up improvement scores in the Abilmente group, as compared with the RRT group, as revealed by the variance ratio test, F = 0.05, p < .002.

Post-hoc within-group training immediate and medium-term effects on reading sub-measures

Post-hoc analyses on individual sub-tests (i.e., word, nonword, text) are reported in Figure 2. In the RRT group, the pre versus post reading speed improvement was significant for word, W = 3, p = .001, r = .57, nonword, W = 2, p = .001, r = .55, and text, W = 7, p = .003, r = .42. No sub-test accuracy score was improved immediately after RRT (word: W = 37.00, p = .35, r = .30; nonword: W = 45.50, p < .25, r = .12; text: W = 47.00, p = .48, r = .08). As compared with baseline, follow-up reading performances of RRT’s participants were significantly improved for both speed (word: W = 0.00, p = .02, r = .72; nonword: W = 0.00, p = .02, r = .61; text: W = 0.00, p = .02, r = .53) and accuracy (word: W = 1.00, p = .03, r = .59; nonword: W = 0.00, p = .02, r = .57; text: W = 1.00, p = .03, r = .48) in all sub-tests.

Figure 2.

(a) Pre–Post Word, Nonword, and Text Reading Speed Gains in the Two Experimental Conditions. (b) Pre-Follow-Up Word, Nonword, and Text Reading Speed Gains in the Two Experimental Conditions, in a Subgroup of Participants (N = 14). (c) Pre–Post Word, Nonword, and Text Reading Accuracy Gains in the Two Experimental Conditions. (d) Pre-Follow-Up Word, Nonword, and Text Reading Accuracy Gains in the Two Experimental Conditions, in a Subgroup of Participants (N = 14). Higher Values Correspond to a Better Performance.

As for the Abilmente approach, speed scores in all sub-tests were higher immediately after the intervention (word: W = 0.00, p < .001, r = .78, nonword: W = 0.00, p = .001, r = .56; text: W = 0.00, p < .001, r = .87). Moreover, the Abilmente approach induced significant improvements in all reading accuracy sub-tests (word: W = 7.00, p = .01, r = .32; nonword: W = 4.50, p = .002, r = .49; text: W = 12.00, p = .007, r = .27). Significant pre versus follow-up differences occurred only for word speed (W = 1.00, p = .03, r = .58) and text speed (W = 0.00, p = .02, r = .76), but not for nonword speed (W = 3.00, p = .16, r = .47) nor for any sub-test accuracy score (word: W = 6.00, p = .22, r = .27; nonword: W = 1.50, p = .07, r = .42; text: W = 3.00, p = .14, r = .26). Similarly to the global accuracy measures, the nonsignificant pre versus follow-up accuracy differences are not reflected in Figure 2. Again, this result can be explained by the greater variability of accuracy improvement in the Abilmente group.

Training effects’ comparisons between interventions

Pre–post reading gains were then compared between conditions (see Table 2). No significant differences emerged in the global reading measures (speed: U = 84.00, p = .10, r = .32; accuracy: U = 88.00, p = .14, r = .28). Post-hoc analyses on individual reading sub-tests revealed that the Abilmente approach modulated text reading speed to a greater extent, relative to RRT (U = 46.5, p = .002, r = .51), whereas the difference between interventions did not reach statistical significance for any of the other measures (ps ranging between .09 and .57).

Table 2.

Between-Group Reading Gains Comparisons. Non-Parametric Comparisons of Pre–Post Reading Gains Between the Two Experimental Conditions, Namely, RRT and the Abilmente Approach.

	RRTn = 16	Abilmenten = 16	Btw-groupComparisons
	M (SD)	M (SD)	Mann–Whitney test:U, p, r
Text reading speed	0.44 (0.47)	0.87 (0.06)	46.5, .002, .51
Word reading speed	0.46 (0.33)	0.65 (0.25)	83, .09, .29
Nonword reading speed	0.52 (0.39)	0.45 (0.38)	113, .57, .09
Text reading accuracy	0.35 (2.16)	0.72 (1.26)	106.5, .43, .10
Word reading accuracy	0.54 (2.48)	1.52 (2.24)	104, .36, .21
Nonword reading accuracy	0.49 (1.94)	1.80 (1.60)	86.5, .12, .34

Note. Significant differences in bold. RRT = Rhythmic Reading Training.

Medium-term gains did not differ between groups, for either global reading speed (U = 20.00, p = .61, r = .23) or global reading accuracy (U = 24.00, p = 1.00, r = .11). Post hoc analyses revealed no difference between conditions in pre versus follow-up changes, in any individual sub-test (word speed: U = 21.0, p = .71, r = .14; nonword speed: U = 23.0, p = .90, r = .18; text speed: U = 16.0, p = .32, r = .24; word accuracy: U = 23.5, p = .95, r = .11; nonword accuracy: U = 22.0, p = .80, r = .24; text accuracy: U = 17.0, p = .38, r = .09).

Discussion

The efficacy of RRT in increasing reading skills of children with DD had been previously assessed (Bonacina et al., 2015; Cancer & Antonietti, 2017; Cancer et al., 2016, 2019, 2020). The same was true of the Abilmente approach (Brembati & Donini, 2009). Hence, there was no need to further compare each of the two treatments with a control group. Instead, it was interesting to compare RRT with other treatments to check whether the former produces similar, or even better, outcomes. If so, advantages associated to the fact that RRT is based on a specific etiological theory of DD (i.e., temporal processing deficit) and that the treatment is less demanding (in terms of requested professional expertise and costs) and more motivating could lead to recommend it as a valid remedial approach for DD.

Although we did not measure children’s motivation, we expect RRT to be engaging for children based on previous evidence on musical (Martin et al., 2015) and computer software (Villagrasa et al., 2014) interventions, which are known to ensure a playful environment. Furthermore, narrative experiential reports by children and practitioners involved in the current and previous RRT applications have confirmed this claim. Nonetheless, future research should study motivation and engagement, using self-report measures, to confirm this hypothesis.

The comparison of RRT effects with those of a multi-method approach did not show substantial differences in improving global reading speed and accuracy outcomes. However, the post-hoc analysis on specific reading sub-processes showed that the Abilmente approach was more effective in improving text reading speed. This effect is likely explained by the use of prose passages as reading materials in the Abilmente training sessions. RRT, instead, does not comprise a specific training of text reading, but its activities target a more basic decoding mechanism in the attempt to generalize the effects to all reading materials.

As for the maintenance of reading gains over time, both interventions induced improvements lasting up to 4 months after the end of the training period. Even though no difference emerged between interventions in terms of pre versus follow-up performance change, different patterns of within-training effects were observed. Improved speed scores immediately after training were found for word, nonword, and text reading tests in both groups. However, the nonword reading speed improvement was maintained at medium-term only in the RRT group. Reading accuracy was not immediately improved after training in the RRT group, whereas the Abilmente group showed accuracy improvements in all sub-tests. However, in the follow-up assessment significantly improved accuracy scores were measured in the RRT group, whereas the pre versus follow-up differences were nonsignificant in the Abilmente group. Such results suggest that reading improvement of children who received the Abilmente approach peaked immediately after the end of the training period, but the training effect was not as strong after a period of up to 4 weeks. On the contrary, participants of the RRT group showed an immediate training effect only for reading speed, but not accuracy. Nonetheless they consolidated reading gains in both speed and accuracy after 4 weeks, as showed by significant pre versus follow-up differences in all reading sub-measures. This pattern of results suggests that RRT induced more consistent medium-term gains, likely due to its unimodal and process-based approach. Differently, the personalized nature of the Abilmente method created variability in the medium-term fluctuations of the responses to intervention. Such variability indicates a lasting effect on reading which was less homogenous among participants. This finding can be explained by the diverse training protocol administered to each child, in term of activities, materials, and intervention duration.

Regarding the limitations of the present study, we are aware that assigning participants to each experimental condition based on recruitment location could potentially induce a bias in the results. However, participants’ individual characteristics (gender, IQ, school grade, and level of reading impairment), as potential confounding variables that are more likely to affect the training outcome, were stratified by site of recruitment. Furthermore, the locations shared similar characteristics, which we argue could reduce the confounding center-effect. Therefore, although we could not exclude the allocation bias, we suggest that the main outcome differences would be mostly accounted for by the different approaches employed by each methodology. Nonetheless, we cannot exclude a potential confounding effect of participants’ socio-economic status (SES), which was not controlled in the present study.

Although gender ratio was not statistically different between conditions, it is worth mentioning that more boys (10 vs 6) were assigned to the Abilmente intervention. Recent evidence showed a gender role in predicting treatment response in DD (Middleton et al., 2022), with males being better responders. Given that and the rather small sample size, we cannot exclude that a slightly greater number of boys in the Abilmente group contributed to better reading improvements.

It is also worth discussing that training duration varied between conditions. The treatment time difference is an effect of the personalized nature of the Abilmente approach, versus the standardized procedure of RRT. The aim of the study was to compare a process-based, unimodal, standardized training method to a less-controlled approach, in which training time is controlled by the trainer—in Abilmente, the sessions are interrupted when rehabilitation goals are reached. We are aware that this variability could have accounted for the outcome differences. However, we decided to conduct our study in a more ecological setting, by comparing a typical intervention practice (personalized, multi-method, variable in time) to a more standardized and controlled treatment, based on a specific cognitive process. In Italy, most DD interventions share the same multimodal, personalized, and uncontrolled characteristics of the Abilmente approach. Therefore, after comparing RRT in better-controlled trials in previous studies (Cancer & Antonietti, 2017; Cancer et al., 2020), we opted for a commonly administered and widespread procedure as the control condition to test RRT effect.

Finally, medium-term effects should be interpreted with caution, due to the small sample size of the group who took part in the follow-up assessment. Future studies with greater statistical power should confirm the improvement trends that emerged in the present investigation.

Conclusion

The present study aimed to compare the effectiveness of RRT with that of a multi-componential personalized intervention comprising several training methods, namely, the Abilmente approach. To provide a more entertaining rehabilitation setting for children and preadolescents, RRT intervention was combined with music games, which addressed the same synchronization processes as RRT. The results showed short- and medium-term effects on reading in both interventions. The analysis of the specific contribution of each methodology showed that the Abilmente approach was significantly more effective in improving text reading, while RRT induced more consistent maintenance of all reading sub-processes 4 weeks after the end of the treatment.

The main finding of the present study is that a unimodal process-based intervention such as RRT induced global reading effects, which did not substantially differ from those by an intervention involving several reading training materials specifically arranged to meet individual needs. RRT is a relatively standardized theory-based intervention, addressing a specific cognitive component—namely, rhythm processing—whereas Abilmente is an integrated, flexible, and multi-componential approach, which requires several ad-hoc materials and multiple traditional methods. The cost and preparation of such training materials, along with the planning of personalized activities in each session, should be considered when opting for the Abilmente approach. Although the settings of the RRT software (speed, selection of reading material) have to be adjusted to the child’s characteristics, the intervention protocol is rather standardized, thus leading to a reduction of the trainer effort and overall cost of the intervention. As for the music games, they can be easily reproduced without music instruments, by using finger tapping, stepping, and clapping exercises, since the games address the temporal—rather than melodic or timbrical—component of music.

In conclusion, these results confirmed RRT’s potential in improving reading, with more consistent effects on reading speed, in accordance with previous research (Bonacina et al., 2015; Cancer & Antonietti, 2017; Cancer et al., 2020). These findings can, therefore, broaden the dyslexia intervention options, by including a single process-based training whose effects do not differ substantially from a multi-modal training approach, which requires a broad spectrum of resources.

Future research should replicate these results on a larger sample, especially for the follow-up testing. Additionally, to test the long-term effect of RRT, at least 6-month follow-up measures should be collected. Finally, thanks to the new advances in the RRT online administration (Cancer et al., 2021), the possibility for children to alternate supervised in presence sessions with unsupervised at-home sessions should be explored. We suggest that such a hybrid training modality, applied to process-based approaches and engaging activities, is the recommended characteristic for future DD intervention, because of the reduced costs it implies. Furthermore, other traditional, in-presence reading activities should be renovated according to the findings of the present study. For instance, exercises in which students are asked to read aloud can be proposed, in both rehabilitation and educational settings, with a rhythmic/musical background so to boost entrainment processes, which may be beneficial for students who struggle with reading fluency.

Footnotes

Acknowledgements

The authors thank Chiara Pradella and Gaia Silibello who, as specialized trainers and research assistants, participated in the application of RRT treatment.

Author contributions

Conceptualization, A.C. and A.A.; methodology, A.C.; formal analysis, A.C.; investigation, G.S., G.P., A.Co., F.B., and R.D.; data curation, A.C., G.S., G.P., A.Co., F.B., and R.D.; writing—original draft preparation, A.C. and G.S.; writing—review and editing, A.C. and A.A.; supervision, A.A.; project administration, A.A., F.B., and R.D. All authors have read and agreed to the published version of the manuscript.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical approval

The study was approved by the Psychology Research Ethics Committee of the Catholic University of the Sacred Heart, Milan, Italy on 22 December 2015. The entire research process was conducted according to the standards of the Helsinki Declaration.

ORCID iD

Alice Cancer

Trial Registration

ClinicalTrials.gov NCT03199092.

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