Exploring issues of identification and treatment of children with lateemerging reading disabilities

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Exploring issues of identification and treatment
of children with late-emerging reading
disabilities from an RTI perspective.

• Donald Compton
• Vanderbilt University
• This research was supported in part by Grant
  H324U010004 from the U.S. Department of
  Education (OSEP), Grant R324G060036 from the
  U.S. Department of Education (IES), and Core
  Grant HD15052 from the National Institute of
  Child Health and Human Development to Vanderbilt
  University. Statements do not reflect the
  position or policy of these agencies, and no
  official endorsement by them should be inferred.

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Overview

• Very short introduction on response-to-interventio
  n (RTI)
• Study 1 Results of a 1st grade universal
  screening study
• Study 2 Exploring serious challenges to early
  screening procedures Children with late-emerging
  reading disabilities (LERD)
• Study 3 Results from a study investigating the
  use of a multicomponent reading intervention
  program for struggling readers in late elementary
  school.

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Typical RTI Procedures

• All children in a class, school, district are
  tested once in the fall to identify students at
  risk for long-term difficulties.
• The response of at-risk students to GE (Tier1) is
  monitored to determine whose needs are not met
  and therefore require more intensive tutoring
  (Tier 2).
• For at-risk students, research-validated Tier 2
  tutoring is implemented. Student progress is
  monitored throughout intervention.
• Those who do not respond to the validated
  tutoring are identified and further evaluated by
  a multi-disciplinary team evaluation for possible
  LD designation and special education placement.

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RTI Three Tiers

• Tier 1 General education
• Research-based program
• Faithfully implemented
• Works for vast majority of students
• Screening for at-risk pupils, with monitoring of
  at-risk response to general education
• Tier 2 Small-group preventative tutoring
• Monitoring of at-risk response to tier 2
  intervention
• Tier 3 Special education

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Tertiary Prevention Specialized
Individualized Systems for Students with
Intensive Needs
CONTINUUM OF SCHOOL-WIDE SUPPORT
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Secondary Prevention Specialized Group Systems
for Students with At-Risk Behavior
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Primary Prevention School-/Classroom- Wide
Systems for All Students, Staff, Settings
80 of Students
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Advantages of RTI

• A stronger focus on prevention
• Earlier identification of children with
  disabilities
• An assessment process with clearer implications
  for academic programming
• The end of a wait-to-fail model of identification

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Questions Remaining Regarding Implementation of
RTI

• Who should enter the RTI process?
• What should effective tier-2 instruction look
  like?
• How should one determine whether effective
  secondary prevention has been conducted?
• What is a valid and practical method of
  monitoring responsiveness to secondary
  prevention?
• What is a defensible definition of
  nonresponsiveness (i.e., RD) in terms of key
  reading skills?
• How should tertiary prevention be conceptualized?

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Study 1 Using Universal Screening to Identify
1st Grade Children at Risk for RD
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The First Step in RTI Screening

• RTI success depends on accurate specification of
  this risk pool.
• Perfect screening would result in 100 accurate
  identification of True Positives (those who
  will develop RD) who will go into Tier 2
  interventions and True Negatives (those who
  will not develop RD) who will be excluded from
  Tier 2 intervention.

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Two Types of Screening Errors

• Two types of errors challenge the accuracy of
  procedures for determining risk.
• False positives
• Children who eventually become good readers score
  below the screening cut score and are falsely
  identified as at risk.
• Undermine RTIs prevention purpose by increasing
  the number of children identified at risk and
  thereby stressing school resources to provide
  intervention to an inflated percentage of the
  population.
• False negatives
• Children who later exhibit reading problems score
  above the cut score and are falsely identified as
  not at risk.
• Diminish the utility of RTI prevention by failing
  to provide intervention to children who will
  eventually develop RD.

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Previous Attempts

• The vast majority of early identification studies
  have reported classification accuracies outside
  the acceptable range for RTI to work
• False positives ranging from 20 to 60
• False negative rates ranging from 10 to 50

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Identifying Children Who Are Responders (not at
risk for RD) and Nonresponders (at risk for RD)
to Tier 1 InstructionHypothetical Case Studies
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Sarahs Progress on Words Read Correctly
Sarah Smith
Reading 2
Words Read Correctly
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
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Jessicas Progress on Words Read Correctly
Jessica Jones
Reading 2
Words Read Correctly
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
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Do we have evidence that we can accurately
identify children in the fall of first grade who
are at high risk for becoming RD (Jessica) while
limiting false-positives (Sarah) ?
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Compton et al. (2006) Study

• Explored issues affecting development of decision
  rules for selecting 1st graders for tier-2
  intervention within an RTI model of LD
  identification.
• What is the added predictive utility of including
  initial word identification fluency (WIF) or 5
  weeks of WIF PM to a multivariate screening
  battery (that already includes phonemic
  awareness, rapid naming skill, and oral
  vocabulary)?
• Can we develop screening procedures which are
  accurate enough to work within an RTI framework?

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Example of a WIF Probe
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Overview of Study Methods

• In 42 classes in 16 middle-TN schools, identified
  low study entry 1st graders.
• The 6 lowest students per class on one or both
  measures, also judged as such by the teacher,
  were designated low study entry (n 252).
• At end of grade 2, a total of 206 were
  found/tested (attrition rate of 18 over 2
  years).
• In October, administered a multivariate screening
  battery initial WIF, phonemic awareness, rapid
  naming, oral vocabulary.
• Monitored progress with WIF, each week for 5
  weeks calculated 5-week slope and level.
• At end of grade 2 classified children as
  RD/non-RD based on a composite score of reading.
• Applied logistic regression to classify RD/non-RD
  at end of grade 2, using 1st-grade prediction
  battery and short-term PM as predictors.
• Evaluated differences in classification accuracy
  using sensitivity, specificity, and area under
  ROC curve.

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Results
TN/FN/TP/FP HR Sens Spec AUC Initial
Screen 145/5/15/41 77.7 75.0 80.0 .863 Sound
Matching Rapid Digits Vocabulary Add Initial
WIF 150/3/17/36 81.1 85.0 80.6 .904 Add 5-Week
PM 154/2/18/32 83.4 90.0 82.7 .912 Classification
Tree Analysis 174/0/20/12 96.8 100.0 93.5 .982

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Conclusions Study 1

• Using the 6 screening variables and logistic
  regression we are able to accurately identify 90
  true positives and 85 of true negatives
  correctly!
• These results have been replicated on a more
  representative sample.
• Seems to me we should stop here, pat ourselves on
  the back, and proclaim mission accomplished!
• Hmmm, maybe there are children who develop RD
  after the end of second or third grade and we
  miss them via early screening?

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Study 2 Exploring Subtypes, Prevalence Rates,
and Early Identification of Children Exhibiting
Late-Emerging Reading Disability
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Who are we missing using early identification
procedures focusing on word ID skills?

• Are there student who do not display reading
  deficits until later in elementary school (i.e.,
  late-emerging RD LERD)?
• Can we identify separate subtypes of LERD and
  what is the prevalence of each subtype?
• Can we identify variables that distinguish LERD
  from typically developing (TD) readers in
  kindergarten or 1st grade?
• What is the effect of early intervention on LERD
  identification?

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Literature on the Existence of Late-Emerging RD

• Children with LERD undermine the intent of early
  prevention by depriving at-risk children of the
  early intervention they require (i.e., false
  negatives in early grades).
• Estimates suggest that the prevalence of children
  with late-emerging RD range from 20 to 46 of
  those identified with RD during elementary school
  
• Several studies have identified students who were
  not identified until fourth grade (Catts Hogan,
  2002 Compton et al., 2008 Leach et al., 2003
  Lipka et al., 2006)
• Previously these high prevalence rates had been
  attributed to flaws in the identification process
  (due to high intelligence, good behavior, or
  compensatory strategies).

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Conceptualizing Subtypes of LERD using the Simple
View of Reading

• Goughs simple view of reading postulates that
  two general types of skill are required for good
  reading comprehension
• accurate words identification
• general language comprehension ability
• Evidence suggesting partial independence of word
  ID and comprehension skills allowing 3 major
  subtypes
• Specific deficits in word-reading (LERD-W)
• Specific deficit in comprehension (LERD-C)
• Deficits in word-reading and comprehension
  (LERD-CW).

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Prevalence of LERD

• Catts Compton (2008) employed mixture latent
  transition modeling (i.e., mover-stayer model),
  to examine the stability of classes associated
  with RD across time (grades 2-10) and to identify
  the prevalence of the three LERD subtypes.
• 493 children were followed longitudinally as part
  of an epidemiologic study (Tomblin et al., 1997).
  
• 5 standardized reading measures (2 word
  reading/decoding and 3 requiring passage reading
  and question answering) were used to estimate
  latent class membership in grades 2, 4, 8, 10.

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What is Latent Transition Analysis?

• LTA, an extension of latent class analysis,
  allows modeling of the movement of individuals
  across latent classes as a function of time
• Because LTA relies on latent variable analyses,
  classes are not directly observable, but rather
  are inferred from a combination of manifest
  indicators
• LTA produces parameter estimates corresponding to
  the proportion of individuals in each latent
  class initially (RD and TD), as well as the
  probability of individuals changing classes with
  time.

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LTA Model
Four Classes Time 1 ? Time 2 TD ? TD RD ?
RD TD ? RD RD ? TD
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Catts Compton
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LERD Subtype Prevalence
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Summary of LTA Modeling

• Overall, 82 of the sample remained in the same
  class (i.e., stable) across grades 2-10 (69
  typically developing 13 RD)
• Approximately, 13 of the population transitioned
  from the typically developing class to one of the
  LERD classes
• Comprehension deficits (LERD-C LERD-CW) made up
  the largest transitioning group (8.5 of the
  population)
• The vast majority of transitions took place
  between grades 2-4
• Once children transitioned into a class they
  tended to stay in that class

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Can We Identify Late-Emerging RD Before the
Problem Emerges?

• We attempted to identify late-emerging RD
  subtypes using kindergarten variables
• Oral Vocabulary (CELF)
• Receptive Vocabulary (PPVT)
• Grammatic Understanding (CELF)
• Grammatic Completion (CELF)
• Sentence Imitation (CELF)
• Narrative Comprehension (CELF)
• Narrative Recall (CELF)
• Phoneme Deletion
• Letter ID
• IQ

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Kindergarten Predictors of LERD
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Conclusions Study 2

• RD and TD latent classes are fairly stable across
  time
• Our findings indicate the existence of LERD
  children who fall into 3 major subtypes (LERD-W,
  LERD-C, LERD-CW)
• Clear differences exist between TD and EIRD
  across all 10 kindergarten measures
• LERD subtypes with comprehension deficits (LERD-C
  and LERD-CW) resembled the EIRD subtype scoring
  poorly on early language measures but exhibited
  elevated performance on letter ID measures
• Compared to LERD-C, the LERD-CW subgroup tended
  to score lower on all measures except letter ID
• LERD-W subtype mirrored the EIRD subtype profile
  across kindergarten with deficits being almost
  half as severe as EIRD

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Study 3 What Can We Do Instructionally For Poor
Comprehenders?
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What Skills Are Needed for Skilled Reading
Comprehension?

• Comprehending written material requires the
  coordination of a complex set of skills
• Accurate and fluent identify the words
• General language comprehension ability
• Background/domain knowledge
• Application of specific reading strategies
• Inference making
• Monitor comprehension processes
• Deficits in any one of these areas can contribute
  to comprehension failure

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What Should We Do?

• Design instruction to address the diverse set of
  literacy skills
• Effective reading programs designed to improve
  struggling readers comprehension skills must
  provide integrated work across (Pressley, 2000)
• Decoding and word recognition
• Reading fluency
• Vocabulary
• Knowledge development
• Reading comprehension strategy

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Can We Do This and Does it Work?

• Consensus reports suggest that teachers have
  difficulties integrating multiple instructional
  components in an effective manner to teach
  reading to struggling readers (NICHD, 2000 RAND,
  2002 Snow, Burns, Griffin, 1998).
• Few studies have systematically studied the
  effects of multicomponent reading programs on the
  reading skills of struggling readers
• Our long-term research objective is to develop
  multicomponent reading programs to address the
  diverse needs of late elementary school students
  who are struggling readers

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What Have We Done Thus Far?

• We have been examining the effects of in-text
  reading activities, embedded within
  multicomponent reading programs, to promote
  vocabulary and knowledge learning from text
• Our primary objective in this study was to
  develop instructional dialogues, strategies, and
  materials that increased the probability that
  struggling readers would derive and retain
  vocabulary and declarative knowledge while
  reading text
• I present efficacy data from two studies
  evaluating the efficacy of a multicomponent
  instructional program for students in grades 3-5
  who are struggling readers
• Study 1 We isolated the effects of metacognitive
  strategy instruction on the retention of
  knowledge
• Study 2 We examined the effects of text-level
  instructional program designed to increase
  vocabulary and declarative knowledge acquisition
  during reading in expository text

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Study 1 Research Questions

• What are the benefits of including a
  metacognitive strategy component to comprehension
  instruction on the retention of declarative
  knowledge in children who are poor readers
• Where do the effects come from?

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Study 1 - Procedure

• Groups of struggling 3rd and 4th grade readers
  consisting of 2 3 children were randomly
  assigned to one of three interventions
• Instruction was provided by trained RAs
• Instruction was provided outside the general
  education classroom
• Groups received either 30 minutes or 60 minutes
  of instruction per lesson depending on the
  treatment group assigned.
• Groups met 3 4 times per week for approximately
  10 weeks.
• Groups received a total of 25 lessons

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Interventions

• Decoding Only Decoding Fluency (30
  minutes/lesson)
• Decoding Traditional Comprehension Decoding
  Fluency (30 minutes/lesson) Comprehension (30
  minutes/lesson)
• Decoding Reciprocal Teaching Decoding
  Fluency (30 minutes/lesson) Comprehension
  Metacognition (60 minutes/lesson)

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Decoding Only

• Word Identification Strategies
• (WIST Gaskin et al., 1986
• Lovett et al., 2000).
• WIST teaches children to recognize larger subword
  units by applying four different decoding
  strategies including Compare and Contrast (rime
  unit), Peeling-Off affixes, Vowel Variation, and
  Seek the Part You Know. Approximately 25 minutes
  per lesson.
• QuickReads (Hiebert, 2003)
• QuickReads feature short, high-interest,
  nonfiction texts designed to be read quickly
  (multiple times) and meaningfully. Approximately
  5 minutes per lesson

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Decoding Traditional Comprehension

• WIST QuickReads (30 minutes)
• Reading Expository Text Orally (30 minutes)
• Each group read 3 books (50 pages/book)
• Book Titles Chasing Tornadoes, Young Pioneers,
  Rain Forests
• Children took turns reading text aloud
• Comprehension Instruction
• After each paragraph/passage the teacher directed
  children to
• Answer or generate a question about the
  paragraph/passage
• Summarize the paragraph/passage
• Make predictions
• Provide clarification if needed

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Decoding Reciprocal Teaching

• WIST QuickReads (30 minutes)
• Reading Expository Text Orally (30 minutes)
• Each group read 3 books (50 pages/book)
• Book Titles Chasing Tornadoes, Young Pioneers,
  Rain Forests
• Children took turns reading text aloud
• Comprehension Instruction
• Teacher modeled the metacognitive dialogue for
  question generating, summarizing, predicting, and
  clarifying
• After each paragraph/passage the children would
• Generate a question about the paragraph/passage
• Summarize the paragraph/passage
• Make predictions
• Seek clarification
• Before proceeding to the next paragraph the group
  had to come to agreement that the question,
  summary, and prediction were of high quality
• Children gradually assumed responsibility for
  comprehension instruction

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Effects of Text Instruction
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Why is RT Superior?

• Increased Opportunities to Respond and Listen to
  Others Respond?

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Increased Opportunities to Respond

• RT Dialogue
• Lesson 6
• Taylor (reads text in book) There were a number
  of trails the pioneers could take. Most people
  used the Oregon Trail, which was the best-known
  route. The trail ran fro 2,400 miles over prairie
  grass, mountain rocks, and desert sand. After
  passing through the Rocky Mountains, the pioneers
  came to the halfway point. Here the trail
  divided. The northern part continued into Oregon.
  The southern part went into California.
• Teacher Thats good. So Taylor, can you give us
  a summary?
• Taylor Hmmmm.
• Teacher Brucker and Allie, I want both of you
  guys to look to answer that.
• Taylor A summary?
• Teacher From the paragraph. (waits) What trail
  did they take?
• Taylor The Oregon Trail.
• Teacher Very good. What happened to that trail?
• Taylor They came to the halfway point and they
  divided the northern part
• Teacher Where did the other part go?
• Taylor Southern.

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Increased Opportunities to Respond

• RT Dialogue
• Lesson 24
• Allie (reads text in book) Weather satellites
  travel high above the earth. They take pictures
  of the atmosphere below. They show where the
  thickest clouds are. This is where storms are
  most likely to develop.
• Allie This is aboutThis paragraph is about a
  satellite, a satellite in space taking pictures
  of the earth.
• Brucker That is what I was going to say.
• Taylor I like it.
• Brucker I like it too, but this is what I was
  going to say. This paragraph is about a
  satellite from space that is taking pictures of
  the earths atmosphere and these where the
  thickest clouds are.
• Taylor Thats good.
• Allie Im not saying it is bad Brucker, but it
  could be a little too long. I dont know how to
  shorten it but
• Taylor You could put both of yours together
  somehow but make it short. Like you and Brucker
  both said taking pictures.
• Allie Are you saying maybe we should do like.
  ..This is about satellite in space taking
  pictures of earth...
• Taylor Say where the storm is going to hit
  next.
• Brucker Yea. What do you think?
• Taylor Yea, thats good.
• Allie Why did Who took What takes pictures?
• Taylor You could just say satellite.
• Brucker I got one. How do we know where a storm
  is?

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Increased Opportunities to Respond

• Traditional Dialogue
• Lesson 24
• Trevor (reads text in book) Weather satellites
  travel high above the earth. They take pictures
  of the atmosphere below. They show where the
  thickest clouds are. This is where storms are
  most likely to develop.
• Teacher You are really doing a great job. All
  right, summary?
• Trevor I read about what weather satellites
  that they travel high above the earth.
• Teacher They do. Weather satellites travel high
  above the earth. But what do they do high above
  the earth? They take...
• Trevor Pictures.
• Teacher Good, weather satellites take pictures
  of the atmosphere to show where a storm might
  start. Courtney, what do weather satellites do?
• Courtney The weather people probably have this
  little TV and monitor and they can look from
  the space ...I forgot the name of it...
• Teacher Satellites
• Courtney Satellites and if they take a picture
  of it making a funnel they can probably see it
  and when it is coming back on they can say there
  is going to be a tornado and can tell people to
  get covered.

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Study 2 - Research Questions

• What are the effects of text-level instruction
  aimed at increasing vocabulary and declarative
  knowledge acquisition during reading in
  expository text?
• Are there trade-offs between vocabulary learning
  and declarative knowledge acquisition based on
  the type of text-level instruction provided to
  children during reading in expository text?

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Procedure

• Groups consisting of 2 4 struggling readers
  grades 2 - 5 were assigned to one of three
  interventions.
• Instruction is provided by trained RAs.
• Instruction is provided at Vanderbilt University
  after school hours.
• Groups receive 90 minutes of instruction per
  lesson.
• Groups met 2 times per week.
• Groups receive a total of 24 lessons for a total
  of 36 hours of instruction.

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Outcome Measures

• Experimenter created vocabulary measure
• 40 multiple choice items made up the vocabulary
  assessment.
• Questions were generated directly from the books.
• To control for reading ability all items were
  read to the children at pre- and posttest.
• Experimenter created declarative knowledge
  measure
• 30 multiple choice items made up the assessment.
• Questions were generated directly from the books.
• To control for reading ability all items were
  read to the children at pre- and posttest.

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Interventions

• Word Identification Strategies (30 min)
• WIST (Lovett et al., 2000) teaches children to
  recognize larger subword units by applying four
  different decoding strategies (Approximately 20
  minutes per lesson).
• QuickReads (10 min)
• QuickReads (Hiebert, 2003) feature short,
  high-interest, nonfiction texts designed to be
  read quickly (multiple times) and meaningfully
  (approximately 10 minutes per lesson)
• Reading Expository Text Orally (50 min)
• Each group reads 3 books (50 pages/book,
  Chasing Tornadoes, Young Pioneers, Rain Forests)
  with children taking turns reading text aloud.
• Text-level Instruction
• During text reading children were instructed in
  one of 3 text-level instructional strategies
  (Vocabulary, Reciprocal Teaching, or Traditional
  Instruction).

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Traditional Instruction(Control Condition)

• After reading all of the days passages students
  completed a work sheet that required answering
  questions regarding key concepts read during the
  day.
• Students are allowed to look back at the text to
  answer questions and the teacher helps guide
  students in finding the relevant information.
• Care was taking in constructing the worksheets
  that there was no overlap between vocabulary and
  declarative knowledge covered on the worksheet
  and that targeted on during VOC and RT training.

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Traditional Instruction Worksheet
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Reciprocal Teaching

• Strategies Taught to the RT Condition (Same as
  Study 1)
• Questioning
• Prediction
• Clarifying
• Summarizing
• Metacognitive Dialogue

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Example of RT Instruction
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Vocabulary Instruction

• Strategies Taught to the Vocabulary Condition
• Word Analysis
• Word Parts
• Parts of Speech
• Context Clues
• Inference Making
• Finding Signal Words to Identify Definitions,
  Synonyms, Antonyms, or Examples
• Look-up
• Metacognitive Dialogue

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Vocabulary Instruction

• Instructional Procedure for Vocabulary Condition
• Teacher modeled the metacognitive dialogue for
  word analysis, contextual clues, and look-up
• After each paragraph/passage the children use the
  vocabulary strategies to ascertain the meaning of
  a predetermined word in text.
• Children gradually assumed responsibility for
  vocabulary instruction.

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Vocabulary Strategy Chart
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Contextual Signal Words
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Contextual Signal Words
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Example of a Look-up
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Example of Vocabulary Instruction
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(No Transcript)
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Conclusions Study 3

• Across groups reading instruction had a positive
  effect on vocabulary learning, declarative
  knowledge acquisition.
• Results tend to suggest devoting significant time
  to vocabulary learning while reading text does
  not negatively affect declarative knowledge
  acquisition while allowing more vocabulary
  learning.
• There is more to worksheets than meets the eye.

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Conclusion Across the Three Studies

• We can identifying accurately a group of children
  who will experience early onset on RD
• However we should be prepared to continue
  screening children to identify children with
  late-emerging RD.
• We need to continue to develop effective
  interventions to address the diverse needs of
  children with poor comprehension skills due to
  language and metacognitive deficits.

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Thank you!