Abstract
Snowling, M. J., & Hulme, C. (2012). Interventions for children’s language and literacy difficulties. International Journal of Language and Communication Disorders, 47, 27–34.
ASHA’s (2010) position statement, “Roles and responsibilities of speech–language pathologists in schools” describes the ways in which SLPs can be involved with literacy in schools. Implementation of the Common Core State Standards (CCSS; Common Core State Standards Initiative, 2010) in 45 states and the District of Columbia is increasing SLPs participation in developing students’ literacy. The focus of the standards is on increasing students’ proficiency in reading and comprehending a variety of complex texts. SLPs’ role with the CCSS is to evaluate the language underpinnings students must have to meet the standards and to assist students in developing these underpinnings. SLPs must recognize that there are two broad aspects to proficiency in literacy—decoding the text and comprehending the text. Fluent decoding is essential but not sufficient for comprehension; and a focus on comprehension alone will not give students the skills they need to decode. The intervention strategies selected to promote students’ literacy skills must address the specific nature of the students’ reading difficulties.
Interventions to Promote Word-Level Decoding and Fluency
The main ingredients of a teaching approach to promote word-level decoding skills is one that combines training in phonological awareness with training in letter–sound knowledge, and in which these two skills are reinforced in the context of reading (Torgesen, 2005; Snowling & Hulme, 2011). Such an approach goes beyond an emphasis on systematic phonics by ensuring that children have adequate phonological awareness skills and by ensuring that what is taught is practiced in context, which in turn can provide a vital bootstrapping resource for children who have significant phonological difficulties.
Hatcher, Hulme, and Ellis (1994) were among the first researchers to assess the efficacy of different forms of intervention for readers with dyslexic profiles (difficulty with word-level decoding and fluency) using a controlled design. Children participating in this study had reading skills that fell within the bottom 10% of the population in terms of reading accuracy. The children were randomly assigned to one of four experimental conditions. In three conditions, the children received intervention, the fourth was a control group that received “business as usual.” The three intervention arms were based on reading theory and best practice at the time:
reading alone (R) in which children read from texts that were selected to be at the appropriate level and teachers reinforced effective reading strategies to hone the children’s skills;
phonology alone (P), which consisted of exercises training the development of oral phonological awareness at syllable, rhyme, and phoneme levels following the ideas of Bradley and Bryant (1983) but not involving letter work; and
reading with phonology (R + P), which combined the reading and phonology approaches. The children receiving this intervention where trained in phonological awareness and letter–sound knowledge, and were encouraged through the reading of texts at the easy and instructional levels to practice their emergent skills.
The interventions were delivered on a twice weekly basis by skilled teachers for 20 weeks. Children in the phonology group made the greatest gains in phonological skills (sound segmentation, blending, deletion), but only children in the R + P group made gains in reading.
These findings indicate that phonological deficits alone do not cause reading impairment, since it was only when phonological awareness was trained in the context of orthography that the impact on reading was significant. Although children who received the phonology alone (P) program were ahead of the others in phonological awareness at the end of the intervention, these gains did not generalized to their literacy skills. Thus, for phonological awareness programs to have an effect on literacy, they must be combined with strategies to promote print awareness and sound/symbol correspondence.
We know what places a child at risk of reading difficulties, and hence it seems there is no good reason to wait until a child has failed before implementing a remediation program. Bowyer-Crane et al. (2008) evaluated a 20-week intervention program using the principles of the R + P intervention or an oral language (OL) program for children who entered school with poor speech and language development. The R + P program comprised three components: letter–sound work, segmenting and blending, and reading together and reading independently. The intervention was implemented by trained teaching assistants. The OL program comprised vocabulary training, independent speaking, inferencing, listening skills, and narrative skills. The children in the R + P and OL groups were assessed before the intervention, mid-intervention after 10 weeks, and post-intervention after 20 weeks. To assess maintenance of gains, they were also seen 5 months after the intervention had finished. The outcomes for the children who had received the P + R intervention were significantly better than those in the OL group for prose reading accuracy, nonword reading, spelling, and segmenting and blending. In addition, gains for single-word reading were marginally significant. Children in the OL intervention made better gains in vocabulary and grammar skills. The effects of the interventions were maintained 5 months after they ceased. The children learned what they were taught. Only a focus on phonological skills and reading improved decoding abilities. OL intervention resulted in improved OL skills but did not affect decoding skills.
Interventions to Promote Comprehension
The cognitive profile associated with reading comprehension impairment contrasts with that associated with dyslexia or decoding difficulties. Whereas children with dyslexia have pervasive phonological deficits, phonological skills are typically normal in poor comprehenders (Nation, 2005). In contrast, reading comprehension impairment is associated with a wide range of language-processing difficulties, for example, with grammar and sentence structure, and for many of these children, vocabulary is poor.
Children with reading comprehension impairment experience a range of difficulties with aspects of text processing. In particular, they have difficulty making inferences that link sentences and make texts cohere (Cain, Oakhill, & Bryant, 2000), and they have difficulty in monitoring the sense of what they are reading and in using metacognitive strategies such as looking back on the text to resolve ambiguity. For this group of students, many intervention studies have targeted higher level text comprehension (TC) skills such as making inferences (Yuill & Oakhill, 1988) as well as incorporating the use of visual imagery to enhance the representation of text (Joffe, Cain, & Maric, 2007).
Clarke, Snowling, Truelove, and Hulme (2010) compared three intervention programs to promote reading comprehension skills that were specifically designed for poor comprehenders:
text-level training within the written language domain (TC);
metacognition strategies;
reciprocal teaching with text: Students clarify unknown words/phrases, discern global meaning of passage, predict missing information, guess what happens next;
different inferences types;
written narratives (structure, sequencing, character profiling);
training activities to promote vocabulary, figurative language, and listening comprehension skills (OL);
vocabulary using multiple context approach (Beck, McKeown, & Kucan, 2002);
reciprocal teaching with OL in responses to passages students listened to;
figurative language: idioms, riddles, jokes, similes, metaphors;
spoken narratives (structure, sequencing, character profiling); and
an integrated program that incorporated activities to improve OL and to enhance text-level processing. This intervention (combined [COM]) contained all of the activities in the TC and OL programs. Students spent 50% of their time with TC components and 50% with OL components.
Children with reading comprehension impairment were randomly assigned to one of four groups, either to receive one of the interventions or to participate as a waiting list control who would receive the intervention at the end of the trial. The three interventions were delivered by trained teaching assistants in three 30-min sessions each week. The children receiving the interventions, and the children in the waiting control group were assessed with several reading and vocabulary tests at pre-intervention, 10 weeks later, and 10 weeks later at the end of the intervention. The children were also followed for 11 months before they were reassessed to investigate maintenance of gains.
All three interventions brought about small but significant gains in TC compared with the control group. The children in the OL intervention made the greatest gains, and they exhibited continued growth at the 11-month follow-up. Statistical analysis indicated that vocabulary mediated reading comprehension, and students in the OL condition received the most instruction in vocabulary. (Because students’ time in the COM group was divided between text and oral activities, they received less time devoted to vocabulary compared with the OL group.) Growth in vocabulary increases an individual’s ability to understand not only single words but also sentences, and arguably increases resources that are available for making inferences across the text. An alternative explanation for the greater effects of the OL program might be that children who receive OL training become somehow more engaged with learning, and this accounts for the further gains that they made. This finding suggests that OL difficulties are a causal risk factor for reading comprehension impairment and perhaps more specifically vocabulary deficits may be a critical causal factor. This then is prima facie evidence to support the early implementation of programs that foster OL development in children with such difficulties. More generally, such difficulties will affect a child’s ability to listen in the classroom and to benefit from the education that they receive, much of which will be delivered initially through the spoken modality and later through written and textual materials.
The results of a number of studies on language and reading indicate that interventions for students with reading impairments need to be targeted to the nature of the impairment. Students with decoding deficits require explicit instruction in phonological awareness, phonics, and orthographic skills. Students with deficits in comprehension require broad-based language intervention with an emphasis on building vocabulary.