The indomitable dinosaur builder – and how she overcame her phonological deficit and learned to read instructions, and other things – Statistical Data Included
Barbara W. Wise
K. C. is an 11-year-old girl who had a deficit in phonological awareness without difficulties in naming speed. After 18 months of linguistically sound, phonologically grounded therapy, she progressed from being a nonreader to being an at least grade-level reader midway through her fourth-grade year. Her therapy started after she had experienced 3 years of failure in school, despite 1 year of pull-out remedial reading support and 4 months of after-school remedial help. An extremely important component of her therapy was the dedication of her mother, who served as her coach, guided by me, the therapist-author. K. C. and her mother practiced daily for 30 to 60 minutes, using techniques learned in our weekly 1-hour sessions. They also both learned how to attend to positive behavior and how to teach with positive hinting. Seven months after completing her therapy, K. C. has maintained her gains and has gained another grade level in reading as she readies herself for entering fifth grade.
K. C., a frustrated girl who could not read, dreaded her upcoming repetition of third grade. Two summers later, she had become a confident reader excitedly tearing through her fourth Harry Potter book, Harry Potter and the Goblet of Fire (Rowling, 2000), 7 months after completing about a year and a half of intensive remediation. This article tells her story, partly to see whether her progress matches the predictions of a recent theory, the “double-deficit hypothesis.” That theory aims to clarify the definition of reading disabilities and to refine their clinical diagnosis and treatment. However, describing the girl’s history also has a larger purpose: to illustrate to teachers and researchers what is possible, with appropriate intensive work, for a feisty, strong-minded child with a severe deficit in phonological awareness and decoding. Readers may also be interested in the kind of therapeutic work she did and in the fact that the bulk of the practice was with her mother, with support and guidance from me, the therapist-author. Before describing the girl’s journey, I begin by considering some of the strengths and some of the limitations of the theory.
Considering the Double-Deficit Hypothesis
The double-deficit hypothesis groups children with reading difficulties into three categories: having a single deficit in phonology, a single deficit in naming speed, or a double deficit in both kinds of processes. Deeney, Wolf, and Goldberg O’Rourke succinctly present the rationale for the hypothesis and its predictions in this issue, and other recent articles present further background and significance (Wolf, 1997, 1999; Wolf & Bowers, 1999). The hypothesis offers practical strengths, even though categorizing children has drawbacks. Sometimes the use of artificially discrete categories can facilitate discussion and comparison of children. It may offer experimentalists a way of combining results and debating their implications, and it can give therapists and teachers a simplified model for understanding variations in patterns of abilities.
However, distinct categories oversimplify the picture of reading disabilities. Most cognitive deficits are not discrete, but vary on continuous dimensions that all interact to influence behavior (Olson, Wise, Rack, Conners, & Fulker, 1989). Children do not fall into neat groups with or without phonological and naming abilities; these abilities actually vary normally and continuously among children. Each child’s reading behavior depends on where he or she scores on both dimensions, as well as on other abilities and experiences. In the articles in this issue, the children’s extreme deficits or strengths in phonological awareness and decoding, or in naming speed, illustrate the categories of the double-deficit hypothesis.
In this categorization, the single phonological deficit includes problems in “phonological awareness”–the ability to identify and manipulate sounds in spoken syllables–and in “phonological decoding”–the ability to translate print into speech, or the sounding-out part of reading. This view likely considers “phonological encoding,” the reverse operation of translating speech into print for spelling, as also part of a single phonological deficit. Twenty years of research confirms that deficits in these phonological processes underlie most cases of specific reading disability where children have been identified as reading below expected grade level, despite normal intelligence, emotional and educational background, and sensory abilities (Rack, Snowling, & Olson, 1992; see Lyon, 1995, for a review). In contrast, the “naming speed” deficit involves slowness in the ability to name repeated familiar objects accurately. As Deeney et al. (this issue) acknowledge, “the underlying processes indexed by naming speed tasks have not yet been clearly differentiated.” Many would argue that naming speed is in large part also phonological, in that it involves retrieving and pronouncing words (Brady, 1998; Scarborough & Domgaard, 1998). Brady, Scarborough, and Domgaard encourage psychologists to devise experiments to refine the understanding of exactly what naming speed tests measure–word access, retrieval, or speech rate, or a combination of these and other cognitive processes, including attention and motor processes?
Despite these caveats, the double-deficit view predicts independent variance in reading behavior (Goldberg, Wolf, Cirino, Lovett, & Morris, 1998), and it groups children in ways that help predict their responses to instructional treatments (Felton & Wood, 1992; Lovett, Steinbach, & Fritjers, 2000; Wise, Ring, & Olson, 2000; Wolf & Bowers, 1999; Wood & Felton, 1994). Children with significant deficits in naming speed but relatively intact phonological awareness and decoding often learn to read accurately but slowly. According to Wolf and Bowers, they may also show problems in reading comprehension. Children with severe deficits in phonological awareness and decoding, but without deficits in naming speed, may at first be locked out of reading and writing. However, they appear to be able to achieve high levels of reading when given structured, intensive, theoretically grounded remediation aimed at improving underlying processes and applying the new skills to reading and writing (Alexander, Anderson, Heilman, Voeller, & Torgesen, 1991; Torgesen, Wagner, Rashotte, Alexander, & Conway, 1997; Uhry, 1997). Children with double deficits on both kinds of measures seem to have the hardest time achieving grade-level reading performance, even with intensive remediation (Felton, this issue; Uhry, 1997; Wood & Felton, 1994). Wolf and Bowers proposed that knowing a child’s naming speed will sharpen diagnostic focus, helping therapists understand, diagnose, make a reasonable prognosis for, and design appropriate educational programs for children with reading problems. The three case studies in this issue have been chosen to represent the three categories.
Case Study
Within this double-deficit view, K. C. presents as a child with a single, rather severe phonological deficit, with average to above-average performance in naming speed. This case study has three goals: to describe one child with a severe phonological deficit and her bleak pretherapy school experience; to demonstrate how a motivated parent can learn to implement and support theoretically grounded training; and to verify that a nonreader, even after third grade, can become an independent and eager reader, whose skills and confidence continue to grow at least 7 months after completing therapy.
About K. C.
K. C. is an energetic and athletic Caucasian girl who attends a bilingual elementary school in Colorado, successfully learning Spanish as a second language. According to school reports, K. C.’s mother’s pregnancy, labor, and delivery were normal, and K. C. achieved developmental milestones normally. She has had no significant surgeries, hospitalizations, or illnesses. Her family history includes bipolar illness in her father, from whom her mother was divorced when K. C. was 6 years old. Her mother reports that K. C. still sees her father about once a month, if her mother sets up the contact. K. C.’s family situation changed in second grade to include a stepfather and new baby sister, to whom she adjusted well.
During kindergarten, K. C. experienced enough difficulty with literacy and readiness activities that her mother asked her teacher about dyslexia. K. C.’s teachers that year and the next told her mother not to worry, that children develop at different rates and that she would be fine the following year. Finally, K. C.’s second-grade teacher noticed that she was not performing up to her intellectual capacity, especially in reading and writing, and she recommended testing for learning disabilities.
Early Testing
K. C.’s testing in late second grade included the Wechsler Intelligence Scale for Children-Third Edition (WISC III; Wechsler, 1991), which indicated at least average intelligence, with a Verbal IQ of 100 and Performance IQ of 90. However, the school psychologist noted what all subsequent testers also reported: K. C.’s performance and test-taking behavior were inconsistent. She responded quickly, often without thinking or checking. Besides being impulsive and very active, she started to act silly when she became frustrated, and she quickly said “I don’t know” when faced with a question she thought might be difficult. The school psychologist stated that the test results probably underestimated K. C.’s true cognitive ability. K. C.’s strongest verbal performance was on abstract verbal reasoning (75th percentile), with other verbal measures in the average range. Her highest performance measures were on tests measuring alertness to visual detail and visual processing speed (all 75th percentile), with weak performance in visual–motor coordination (16th percentile). This visual–motor difficulty matches K. C.’s persistently poor handwriting, with ill-formed letters of inconsistent size, with irregular spacing, and with variable slant. The psychologist noted K. C.’s strengths to be her strong interest in science, her creativity, and her talent learning Spanish as a second language.
A speech–language evaluation reported that all language development was well within the average range, with particular strengths in use of receptive and expressive grammar. The report also mentioned that the test scores may have slightly underestimated K. C.’s abilities, due to her tendency toward silliness and giving up if she thought material was becoming difficult.
The special education teacher tested K. C. with the Woodcock-Johnson Psycho-Educational Battery–Revised (Woodcock & Johnson, 1990) and reported her great difficulty with reading and writing. Despite having good sound–symbol knowledge for consonants, K. C. was ineffective at using phonetic strategies for reading and in the late second grade scored at a low-first-grade equivalent in word reading (13th percentile), although her spoken vocabulary was at least average (see Table 1). Her ability to use phonological cues was so minimal that even using context plus initial sound was ineffective. K. C. tried to construct meaning from print, and she was able to do so fairly well using picture cues; however, she struggled and gave up quickly if the passage contained no pictures (21st percentile Passage Comprehension). She scored late first grade on written language (21st percentile, discounting spelling accuracy), with writing fluency only at the 5th percentile. According to the tester, K. C.’s spoken sentences were much more elaborate than her written attempts.
Despite her low-first-grade–level reading skills, K. C. did not qualify for special education services. Her grade level and average IQ kept her from qualifying for services according to the discrepancy criteria in use at the time, even though the psychologist had said her IQ test underestimated her intellectual ability. K. C. was instead assigned to Title 1 small-group reading support.
As K. C.’s mother described it: “All this testing was the start of a long and frustrating road for all of us.” While the schools labeled K. C. a slow learner, an independent psychologist diagnosed her with attention-deficit disorder, even though no teachers reported seeing attention problems (except for the wiggliness and silliness, especially in testing situations when she thought something might be difficult). K. C. received some counseling related to stress about school failure. About half-way through third grade, she began working in a private after-school remedial program. Even with daily Title 1 support and 4 months of after-school remediation, she could not read independently at a first-grade level at the end of third grade. Reviewing her slow progress, the after-school therapist recommended that K. C. come and see me for therapy. Her parents decided to do that and decided also to have K. C. repeat third grade, hoping that intensive remediation would help her succeed where she had failed before. Although K. C. grieved the loss of her classmates and standing, her mother reported that she had friends among the class going into third grade the next year.
Further Pretesting
When I met K. C. in late July, before her second try at third grade, she was discouraged and defensive about her reading problem. She said she hated reading, and that she also hated being wrong. We discussed how there are many reasons for having difficulty in reading, and that I wanted to look further at her reading, spelling, and language to see how best to help her.
This pretesting included the Wide Range Achievement Test of Reading and Spelling (WRAT; Jastak, Bijou, & Jastak, 1976). The WRAT norms overestimate grade-equivalent levels compared to the WRAT 3 (Wilkinson, 1993), as can be seen by comparing K. C.’s WRAT scores and those on three posttests that were given a few weeks apart for comparison (see the Results section). However, I used WRAT at the time for its abundance of items. I chose it not for grade equivalence but for stable measures of progress. K. C. also took two tests of phonological awareness–the Lindamood Test of Auditory Conceptualization (LAC; Lindamood & Lindamood, 1971) and the Test of Auditory Analysis Skills (TAAS; Rosner, 1995)–and an informal reading and dictation sample, using the Specific Skills Series (Boning, 1990).
At this point, even after a year of Title 1 Reading and 4 months of after-school remedial reading with phonics, K. C. scored very poorly in phonological awareness: with “skills adequate for success in beginning first grade” on the LAC and “adequate for success in early second grade” on the TAAS. Neither of these tests yields standardized scores. As an example of her phoneme manipulation skills, K. C. scored correctly on no items more difficult than “If that says /ip/, show me /pi/” on the LAC, where children manipulate colored blocks to indicate sound changes in syllables they hear. She could do no items harder than “Say `clap’ without the /k/” on the TAAS, where children delete sounds in spoken words. On the “optimistically grade-leveled” WRAT, K. C. scored a 2.5 grade equivalent in reading. However, she made errors on very simple words (e.g., dip for deep, splash for spell, try for tray, flit for felt, and cuff for cliff), showing the typical pattern for phonological dyslexia of omissions, reversals, and guessing from initial sounds. She scored a grade equivalent of 2.0 in the WRAT test of spelling production. On most of her spellings, K. C. tried a phonetic strategy but misspelled vowels (e.g., cot for cut), added sounds (e.g., rjeche for reach), omitted sounds (e.g., spris for surprise), and had difficulty with conventional spelling patterns (e.g., wil for will).
The Specific Skills Series contains picture cues at a first-grade level. On an informal reading inventory at this level, K. C. read said for see, take for talk (self-corrected), pidge for Peg, and least for last. Nevertheless, she answered both main idea questions correctly, probably from picture cues, and she seemed cheerful, so we went on to attempt second-grade passages. Here she read build for bring (self-corrected) but did not self-correct their for they, or bones for bodies, and said she did not know wind, out, or sometimes. Needless to say, her comprehension of these pictureless passages was poor. I scored her as “instructional” at the first-grade level and “frustrated” at the second-grade level.
K. C.’s short dictation sample seemed stronger than her reading. She rendered “How do birds stay warm in winter?” as “hou do brdse stae wrm in witer,” showing problems with vowel sounds and omitting sounds. On all these tests, except perhaps the end of the second-grade-level reading passages, K. C. put forth substantial effort and seemed to be trying her best.
At follow-up testing, K. C. took the Comprehensive Test of Phonological Processing (CTOPP; Wagner, Torgesen, & Rashotte, 1999). Most studies find little change in children’s standard scores on rapid naming over time (Uhry, 1997). Even Deeney et al.’s (this issue) student, who received training specifically aimed at improving naming speed, made gains in his raw scores but not in his standard scores in naming speed, reflecting no change in his standing relative to peers or expected growth over the time of training. Thus, it seemed reasonable to use the standard score ranking from K. C.’s later test as an estimate of her pretraining ranking relative to her peers. K. C. scored a standard score of 112 (79th percentile) in rapid naming of letters and digits–well above average. Her standard score for objects and colors combined was an impressive 121, or 92nd percentile. Interestingly, her single standard score for letters (10, or 50th percentile) was by far her lowest, as is frequently true for children with dyslexia. The other CTOPP scores will be reported as part of follow-up testing.
The Therapy
Theoretical Background. Converging research with trained comparison groups suggests that 30 to 88 hours of well-structured remediation in phonological awareness and decoding improves later reading for children with phonological deficits, over and above intensive remediation without an explicit phonological focus (Hatcher, Hulme, & Ellis, 1994; Lovett, et al., 1994; Torgesen, Wagner, & Rashotte, 1997; Wise & Olson, 1995; Wise, Ring, & Olson, 1999, 2000). An important question that lingers from this research is, What will help these gains transfer to similarly higher independent fluent reading and writing long after training is completed? Certainly this is the goal of all educational therapy. Common sense and theory both suggest that transfer will be enhanced by training improved processes to speeded, automatic levels and by practicing them extensively in reading and writing in context (Meyer & Felton, 1999; Samuels, 1985).
Bruner (1977) wrote extensively and persuasively about the problem of transfer in education in general, and his ideas are also relevant to this important area of reading remediation. According to Bruner, the more deeply and thoroughly a child understands the structures underlying a system of knowledge, the more likely he or she is to transfer that knowledge. Bruner advocated guided deep explorations of the knowledge structures underlying procedural learning. He posited that programs that aim to improve phonological awareness and decoding may improve transfer by teaching the underlying structures of articulatory phonetics, and that teaching the history of English word structures should similarly ground instruction in phonological and morphological decoding and encoding in English. Many reading educators, both before and since Bruner, have suggested ways of helping children discover the linguistic structures underlying the English system of printed language (e.g., Dale, 1898, 1902; Henry, 1990; Lindamood & Lindamood, 1975; Orton, 1936; Wise, 1998-2000, 1999).
No research to date has found differences in reading outcomes between well-structured phonological training with and training without an articulatory base (Torgesen, 1997; Wise, Ring, & Olson, 1999; Wise, Ring, Sessions, & Olson, 1997). However, the children in these studies used computers for support, which tend to tell children the answers rather than guiding discovery with focused questions and hints, as Bruner would advocate. Further research with teachers or coaches who provide this kind of support, and/or with more intelligent computers that attempt to do the same, is needed to see whether deeply grounding the work in its speech–motor base improves transfer beyond well-structured but less grounded phonological work. In the meantime, teachers can choose methods they understand and enjoy from theoretically appropriate methods designed to improve phonological awareness and decoding and help students transfer the skills to reading and writing beyond the teaching situation.
Linguistic Remedies. The therapy that K. C., her mother, and I embarked on incorporates many of these ideas and grounds them deeply in articulatory phonetics and in the history of the English language. I call the combination of approaches I use “linguistic remedies” (LR; Wise, 1998-2000; and advanced LR, Wise, 1999); these combine deep but efficient explorations of language at phonological, orthographic, morphological, and etymological levels, depending on the needs of the child. LR encourages a cycle of learning, with the goal of transfer. The learning cycle begins with efficiently guided discovery of principles (such as how r affects the pronunciation of vowel letters), followed by practice using the principles in reading and spelling items, first to competence and then to mastery (with accuracy and smoothness). Only after the child has achieved mastery does she or he move to three crucial steps aimed specifically at transfer. These steps include speeded practices of mastered skills until times no longer decrease, application of all skills in contextualized reading and writing, and encouragement and monitoring of independent transfer of the skills to new material beyond the teaching situation. (Some of these transfer ideas were piloted in Wise, Ring, Sessions, Parette, & Olson, 2000.) One of the ways I encourage practice and transfer in my private work is to train a coach, usually a parent or a teacher interested in refining his or her skills, to use positive attention, hints, and focused questions to support daily practice at home.
K. C.’s Journey as an Explorer of Language
After testing, K. C. and I discussed why and how our program would be different from instruction she had encountered previously. To get her “buy-in” for why we would explore how language works in the mind and body and in print, I described how people’s brains are just as much the same, and just as different, as people’s faces are. While all people’s brains have the same structures, how efficient the structures are and what is easy or hard to learn is different for each person. K. C. told me she was good at learning Spanish and at learning about animals, especially dinosaurs. We discussed how parts of the brain in and near “the language wrinkle” (Sylvian fissure) seem less efficient for many people who mix up and leave out sounds in reading and spelling, including people like Edison and Einstein. K. C. agreed that a brain can probably learn anything it wants to, if it practices a lot with the right tool. She agreed to try the tools I offered to teach her, and to practice using them a lot, so that reading might become as effortless and enjoyable for her as walking.
As a rationale for “guided discovery learning,” we discussed how K. C. would learn like an explorer or scientist, who observes data, makes hypotheses, and tests them. Her mother would be her coach and I would be the guide, as I had helped guide many coaches and explorers through the territory before. K. C. liked the idea of being a scientist, because she liked science. We discussed how good coaches give hints and support but do not tell answers. Although K. C.’s mother would usually coach K. C., K. C. learned that she could sometimes coach her mother, giving her positive hints and guidance to find an answer.
K. C. agreed to have her first lesson with her mother and me in front of a teachers’ class. There we discussed the purpose of foundations in houses and how the “reading house” we would build would be stronger if it rested on a strong foundation of language skills. K. C. started to discover in that class how the body produces speech, but it was difficult for her and she became silly and distracted. Some class members were surprised that I selected a model child who seemed distractible and oppositional, yet these qualities made her ideal. Teachers saw her spirit, protectiveness, fear, and gradual willingness to begin to discover and trust herself and me that learning about language might help her one day be able to read.
The “Hard Work” of the Practice
The Coaching Throughout. K. C. progressed and maintained gains partly because the work was theoretically well grounded, but also because of her mother’s dedicated coaching, and the hours of practice K. C. put in. Part of my job as guide was to help her mother learn to use positive attention as her best reward, and to question and hint rather than tell or say “no.” We worked to get questions clearly focused and to keep K. C. from getting frustrated. K. C.’s mother was an excellent coach who learned to tell when K. C. was just guessing or was memorizing an answer without understanding it. From the start, she praised K. C.’s progress and encouraged and praised her growing independence.
The Foundation Work. To ground her phonological work, K. C. began by exploring how her “language player” (her vocal tract) produced consonants (Wise, 1998-2000). She learned that scientists group speech sounds by “family names” according to how air is released (i.e., manner), for example, stops, streams (fricatives), or nasals. She discovered that within each family, a sound’s “first name” described where in the vocal tract the air was stopped, streamed, or narrowed (i.e., its place). She learned that in the stop and stream families, every member had an “identical twin” that looked exactly the same but was different on the inside; that difference, she discovered, was due to whether or not the vocal cords vibrated (was voiced or voiceless). Thus, every sound had a “first name” (place) and a “family name” (manner). The names were simple to learn as direct, child-friendly translations of linguistic place and manner terms (e.g., /f//v/= Lip Stream for labiodental fricative; /p//b/ = Lip Stop for bilabial stop; and /m//n//ng/ = Lip, Tip, and Back Noses, for bilabial, alveolar, and velar nasals). K. C. learned to make “ponies” gallop in her language player by repeating and feeling the voiceless or voiced stops from front to back (e.g.,/ptkptkptk/), at first slowly, then with eyes closed for greater awareness, and eventually quickly. Even though K. C. already knew her consonant sounds, this activity improved her articulatory awareness to deep and automatic levels, providing a kinesthetic basis for the perception of vowels and for the presence and order of consonant sounds in multisyllable words. K. C. practiced many games and activities with her mother, earning stickers from me for cooperative practice at home and for mastering concepts. She was highly motivated by the stickers, which she saved and traded for small prizes. She was very proud of her ability to figure out the language system and test hypotheses. Her attitude and confidence improved with each success.
After learning a map of vowels based on place and manner of articulation, K. C. attached letters to her map. She played many games to practice vowel awareness, her favorite of which was a “lip reading” game whereby she built a tower of blocks for every “silent” vowel that she, her mother, or I could demonstrate and others could identify. The game encouraged precise, energetic use of the mouth, to encourage a strong base for later phonics work. All this foundation work in phonetics took about 5 weeks, with K. C. and her mother seeing me once a week and practicing at home 30 to 60 minutes a day.
Basic Phonics. K. C.’s phonics work began in early September with short and long vowels and digraphs. It proceeded through alternate vowel spellings, r-controlled vowels, and other predictable spelling patterns (as in task vs. tack and beach vs. batch).
For spelling, we began with a short, imaginative discovery lesson to tie a new spelling pattern to the phonetics beneath it (an example follows). We turned that discovery into a visual or verbal “quick trick,” to decrease the memory load required when applying it in spelling or writing in context. Next, we practiced applying the trick in isolation and in context and eventually rewarded its application in homework, away from the teaching situation. To illustrate, K. C. learned the “cliffs” story, where the /k//l//f//s/ letters are “uncomfortable” at the ends of one-syllable words. They are so afraid that they might fall off a cliff that they always want a partner after the “strong man” first vowel letter, who never holds hands (e.g. leaf, snarl: “strong man” bolded, partner underlined). If spelling by sounds alone did not provide a partner, K. C. had to add a partner letter that would not change the sound of the word (e.g., clif has to become cliff, by giving f another f as a partner). That process shortened just to marking the strong man and underlining the cliffs letter and partner, as in steal and stork versus stall and stock. K. C. next practiced writing sentences with cliffs words (e.g., The small black duck took a real walk) and then practiced spelling root words that did or did not end with/klfs/. Finally, she earned points for applying the “cliffs” pattern correctly in writing in her journal and literature log.
In reading practice, K. C. always started reading a newly learned pattern slowly, in controlled lists of isolated words, then in lists that mixed the pattern with others, and then in context. After she could read the list not only accurately but smoothly (fluently), she practiced reading the lists to speeded levels until her times quit decreasing, which we considered automatic. Her contextualized reading began with controlled vocabulary, from simple to more complex material, sometimes practicing easier, shorter passages for speed. She began with the very easy and regular Programmed Readers (Buchanan, 1973, 1988) starting with Book 2 (primer level), with the single goal of accuracy and fluency. Stickers certainly helped motivate this work, though K. C. enjoyed her success and her ability to correct her own answers. At the same time, she read stories with controlled vocabularies from Primary Phonics (Makur, 1995) and from the Steck-Vaughn (1989) New Ways with Literature series, which includes interesting stories with natural language, progressing from a first- to a third-grade reading level.
K. C. first learned the common spelling patterns in English words with Anglo-Saxon histories, or “Robin Hood” words (Wise, 1998-2000, 1999). She learned and drew illustrations for “pattern breaker sentences,” which contain words that use consistent but unusual orthographic patterns. For example, the sentence “I will write about taking quite a bite out of the polite white kite” includes all the common one-syllable “–ite” words that are not spelled “–ight.” Polite is included to make the sentence more imaginative. K. C. imagined and then drew pictures to help her remember the words without having to repeat the sentence. As with the “cliffs” pattern, she practiced first contrasting “–ite” and “–ight” words, then in writing sentences with both patterns, then in lists with other kinds of word patterns, and then in free writing. She learned other techniques for using her mouth, ears, and eyes to remember words with “sneaky” silent letters or with choices of regular spellings. Most of the students who work with me place sticky notes around the house or school with the “sneaky” parts of such spelling words highlighted, and they study these by themselves as well as once a day with their coach. K. C. refused to look at the notes and did only the portion where she studied with her coach and later practiced the words in sentences. By late December, K. C. was learning about the Romance (Latin) and Greek layers of English, about how they merged with Robin Hood’s English, and how to recognize words with different histories and spelling patterns (see Henry, 1990; Klausner, 1990; Wise, 1999). For most of another year, she refined her knowledge of spelling patterns, prefixes, and suffixes at all three layers.
Home Reading and Practice. From the beginning of our work together, K. C. worked daily at home for at least 30 minutes. Within 3 months, she was practicing nearly an hour a day at home. She read some material from SRA Reading Laboratories 1b, IIa, and 2b (Parker, 1960, 1969; Parker & Scannell, 1973) and from the Junior Reading for Understanding kits (Thurstone, 1963). These provided guided independent work that her mother could easily check. K. C. worked on speeded repeated readings with Rate Builders from the SRA IIb kit, always with selections at least a grade below her independent reading level.
Most home reading, however, was from books she liked of gradually increasing difficulty, including Amelia Bedelia (Parish, 1966), Commander Toad in Space (Yolen, 1982), Where the Sidewalk Ends (Silverstein, 1974), and Tales of a Fourth Grade Nothing (Blume, 1972), at a fourth-grade level, sometimes discussing and sharing reading with her mother, sometimes reading to her mother, and sometimes reading independently. Learning to summarize was at first quite difficult for K. C. She started logging brief summaries of what she read, and she “point edited” a few sentences, earning a point for each word she was sure was spelled correctly and avoiding losing points for misspelled words by ordering their sounds correctly and underlining the ones she knew needed checking. She wrote and edited daily in her literature log, her journal, or with dictation from her mother. Although her writing never became very neat, her spelling and writing fluency improved greatly with all this practice.
Finishing Up. K. C.’s therapy finished with concept refinement and review and with reading and writing about more advanced books. As we completed therapy the next December and January, K. C. was independently reading Fat Men From Space (Pinkwater, 1977), at a fifth-grade level, proud of the progress she had made. She later wrote a letter to share with other children and parents. In it she said,
When I was working with Barbara it was fun. And I would recommend her if
your kid is dyslexic because she teaches you fun tricks in reading and
spelling. Plus she is very nice because she gives you stickers for doing a
good job and you can cash in your stickers for fun prizes. When I
graduated, I gave her a stegosaurus because it is her favorite dinosaur and
I had the kit for a long time but was not able to read it and build it
until I had my dyslexia training. It was pretty tough, but now I can read
and write a whole lot better so it was all worth it.
Progress Midway
In March of 1999, after 8 months of working once a week with me and her mother and practicing about an hour a day for 5 days a week with her mother, K. C. read at grade equivalent 5.7 on the WRAT. That score is an overestimate but suggests three grade levels’ gain in that time, where previously she had made little or no progress from first grade through her first time through third grade. Her spelling grade equivalent score was 4.5, 2.5 grade levels higher than the previous July.
K. C.’s teachers also noted her remarkable progress. In the autumn of her second time through third grade, her literacy teacher was skeptical about our work. However, on the May report card he commented,
K. C.’s growth throughout the year has been nothing short of phenomenal
(due to her hard work at home with her mom and at school). She is an
excellent reader now–it is a strength of hers now! She has been exited
from Title 1….Likewise her writing is improved in all areas. Since she is
so confident, she writes more, and it is smoother, easier to read, and
mechanically sound. I am so proud of her, and it is obvious she is also.
Despite K. C.’s progress, I wanted to continue until she read fluently, eagerly, and independently, self-correcting her errors, at or above next year’s grade level. We completed the training described above.
Posttesting
In December of her fourth-grade year we completed our work together. K. C. now earned scores “appropriate for success at 6th grade level” on the LAC. K. C. also took the WRAT and WRAT 3 Reading tests. She scored an 8.1 grade equivalent on the “optimistic” WRAT, a gain of 5.6 grade levels over the 18 months of therapy. The WRAT 3, which had not been pretested, showed a more conservative posttest level of 4.8 grade equivalent.
By posttesting I had started using the Woodcock Reading Mastery Test (Woodcock, 1987) for a more reliable grade-level measure and to calculate valid percentile rankings and standard scores. Because K. C. had repeated third grade, posttest percentiles were calculated by age and grade. K. C. scored at the 5.9 grade level in Word Reading (81st percentile by grade, 67th percentile by age); 9.7 in Word Attack (73rd percentile by grade, 67th percentile by age); and 5.9 in Passage Comprehension (71st percentile by grade, 63rd percentile by age; see Table 1). The best estimate of K. C.’s improvement is attained by comparing the percentile rankings from the Woodcock-Johnson, given in late second grade, and those from the Woodcock Reading Mastery Tests, given at posttest and follow-up. These results are shown in Table 1. The growth estimate is conservative, as K. C.’s percentile ranking would, if anything, have decreased from late second to late third grade, based on the little progress made her first time through third grade, as reported by her mother and her teacher. Comparing her second-grade Woodcock-Johnson percentiles with her posttest Woodcock Reading Mastery percentiles reveals gains in Word Reading of 51 percentile points by age, or 65 percentile points by grade. In Word Attack, K. C. gained between 54 points by age and 60 points by grade. In Passage Comprehension, she gained between 42 percentile points by age and 50 points by grade. Whether calculating by age or by grade, K. C. made remarkable gains and now scored above expected levels where before she had been woefully behind.
K. C. also took the WRAT 3 Spelling at posttest, on which she earned a grade equivalent of 4.5. K. C. correctly spelled watch, grown, kitchen, result, and heaven, words that would have put her at approximately a 5.7 on the WRAT–about three grades’ gain in 8 months. The errors she now made were phonetic, showing none of the omissions or reversals seen at pretest (e.g., egeukate for educate, sugjestion for suggestion, muesium for museum, and illogicle for illogical).
Follow-up Testing
In July of 2000, K. C. returned to check her follow-up progress for the purposes of this article, about 7 months after completing our work together. Because of her busy schedule, she took the tests in the evening after a full day of camp and karate.
K. C.’s performance at follow-up revealed strong phonological skills. The CTOPP revealed strong Rapid Naming, as mentioned earlier (112 standard score, 79th percentile, for Digits and Letters combined). Her Phonological Memory standard score was 115 (84th percentile), with particular strength in Nonword Repetition, but with no pretest score for comparison. K. C. scored a standard score of 100 (50th percentile) on follow-up Phonological Awareness on the CTOPP. This test was not yet published at pretest. However, the non-standardized tests she took at pre- and follow-up testing showed good progress: At the start of her second time through third grade, her levels were “appropriate for low first-grade” on the LAC and “expected for low-second grade” on the TAAS; at follow-up, K. C. scored at levels “appropriate for sixth grade” on the LAC and at ceiling on the TAAS (which only measures up to “expected for end of third grade”). We did not have time for spelling at follow-up.
K. C. maintained or improved her gains in word recognition and decoding even 2 months into summer vacation, gaining another .6 grade level in word recognition on the WRAT. On the Woodcock Reading Mastery Test (Woodcock, 1987) from post- to follow-up testing, K. C. gained another .8 grade equivalent in Word Reading (to grade level 6.7), lost .3 grade equivalents in Word Attack (from 9.7 to 9.4), and gained another 1.4 levels (to 7.3) on Passage Comprehension. Her percentile rankings went slightly down from posttesting by grade in Word Attack and gained or lost only a little in Word Reading percentiles, depending on whether percentiles are calculated by age or by grade (see Table 1). From posttest to follow-up, K. C. gained another 8 to 11 percentile points, to a final percentile ranking between the 71st and 84th percentile (by age or grade) on Passage Comprehension. This reflects a remarkable change in percentile ranking of between 50 and 63 points from her rank in second grade. Recall that the tester reported that K. C. succeeded only from picture cues on Woodcock Passage Comprehension in second grade. Interestingly, on the few items that contained picture cues at follow-up, K. C. complained that they were too easy and that the pictures gave away the answers!
Discussion
K. C.’s pattern of skills is consistent with the double-deficit hypothesis picture of a single phonological deficit with at least average naming abilities. Although a rapid naming test was not given until follow-up, research suggests that training has little impact on standard scores in naming speed, that is, on growth beyond expected rate, even from training aimed directly at improving it (Deeney et al., this issue). Thus, K. C.’s above-average follow-up rapid naming standard score should provide a reasonable estimate of her naming speed ranking compared to age-mates prior to therapy, as discussed previously.
K. C. had remarkably strong scores in Phonological Memory at follow-up. Whereas it is possible that our training improved her phonological memory, her success with learning Spanish as a second language, even in first and second grade, suggests that her phonological memory was strong even then. This ability is unusual, but not unheard-of, for a child with K. C.’s severe problems in phonological awareness, decoding, reading, and writing. Recall that at the end of third grade, despite her participation in a year’s small-group Title 1 reading and 4 months of after-school remediation, which included individualized work in phonics, K. C. could not read independently at a first-grade level. Her skills profile is consistent with the description of a “single” deficit in phonological awareness, decoding, and encoding prior to intensive remediation.
This case history demonstrates in other ways how labeling a child as having a “single” deficit can indeed be an oversimplification. Many, but not all, children with deficits in phonological awareness and decoding also have problems in phonological memory, and many but not all have “double-deficits” in rapid naming. Yet “single deficit” K. C. had other significant deficits that also contributed to her lack of progress then and that still influence her performance. She showed marked visual-motor difficulties and slowness, seen in her very poor and slow handwriting. K. C.’s handwriting improved in form and in speed with all the writing she did in her remedial work, but it remains noticeably awkward. The handwriting of most students I have worked with shows much more marked improvement with similar writing practice and improved confidence in spelling. K. C. also appeared to have had attention problems, according to one psychologist. These could have just reflected a child with high energy who became noticeably frustrated, distracted, and silly when asked to read or write. But that tendency, and the motivation problems her teachers and testers mentioned, were important components of K. C.’s profile. K. C. also presented with many strengths: tenacity; talents with Spanish, science, and animals; and her very dedicated parent. K. C.’s problems and her progress reflect the entire constellation of skills and experiences previous to and during our work together.
According to the double-deficit hypothesis, K. C., with a single deficit in phonological awareness and decoding, should have made good progress in reading, given appropriate, intensive remediation. Happily, her progress matched the predictions of the hypothesis. Not only did she achieve reading skills well above average, but she is maintaining her skills and reading eagerly and independently. Her fourth-grade teacher told K. C.’s mother that she was one of her best students, and that the teacher would often forget that K. C. might sometimes need extra help. According to her mother,
It feels like magic to me now….K. C. is now in fourth grade and reading
at a solid sixth-grade level. K. C. is extremely happy with her skills. It
is extremely gratifying for me to see her enjoy reading and writing
creatively and neatly. [Her therapy] has helped K. C. in all aspects of her
life. K. C. can … cooperate without the defense mechanisms she had
developed to cover her lack of literacy.
A case study cannot identify which aspects of K. C.’s program were most important for her progress; it can only note that success occurred with an intensive program that contained many elements consistent with what current research and practice suggest. K. C.’s program included structured phonologic work, a guided discovery approach, and much practice: first to competence, then to fluency, and, later, to automatic levels. It included extensive practice applying skills in reading and writing in context and careful monitoring of how well K. C. transferred skills to independent work away from the support of her coach or therapist. The phonological work was well-grounded in the underlying articulatory and morphological knowledge that informs the English sound-spelling system. Although research has not shown that articulatory knowledge is an essential component of good phonological instruction, it supports that it can be a powerful component of such a program. K. C.’s progress is consistent with this picture.
The significance of K. C.’s motivated coach, her mother, should shine through this story. K. C.’s progress could not have been the same without her mother’s support and hard work. Her coaching at home and monitoring of schoolwork surely also aided transfer, for many reasons. K. C. practiced in many settings, with more and less support, and with many kinds of materials. She gained a sense of the importance of the work from her mother’s commitment to it. It was exciting to see how effective K. C. and her mother were as a learning team, when guided by a therapist who helped them learn and practice linguistically grounded techniques designed to improve K. C.’s deficits and take advantage of her strengths. Time will tell whether K. C. is able to keep engaging in enough reading and writing practice to maintain these rates of gains in the future.
K. C. made more progess than one would expect from children doing similar work but in small groups, without parental support. However, groups of four to five children have made good (though less stable) progress in studies with “talking computers” acting as individualized practice coaches (Wise, Ring, & Olson, 1999, 2000; Wise, Ring, Sessions, & Olson, 1997). Although the use of computers has provided individualized practice for some children, the type of support given may have hindered transference of skills to later independent book-reading. If computers tell answers, rather than helping kids figure them out, they may make it less likely that children will learn to use the skills independently (see Wise et al., 2000; Wise, Ring, Sessions, & Olson, 2000). Thus, teachers may want to choose well-designed computer programs, while also encouraging self-checking in independent work. Once computer speech recognition improves, computer programs should improve drastically in their ability to give positive hints and focused questions to help children actively check and correct their own errors.
Teachers who have taken Linguistic Remedies classes have successfully used the material with groups of seven or even larger. Using a “coach” can extend the ability of an expertly trained teacher to work with more children individually. In a school setting, that coach may be an aide who sits in on the lessons and then practices with the group, while the teacher practices with children needing extra help. It may be a way to enlist a parent who requests something extra for her child. A successful coach can even be a child with a less severe deficit. Children who learn to hint and question positively can help each other with “learning center” activities, while the teacher spends time with children who need more intensive guidance. Teaching the game I Spy with initial sounds can be a great way to teach positive focused hinting, if the goal of the game is for “It” to get the players to the correct answer with as few hints as possible (e.g., “I agree it could be `panda’ since `panda’ starts with /p/, but I’m thinking of something on the couch”). K. C.’s mother reports that K. C. is now a karate coach for younger children, where she gives hints and lots of positive reinforcement, applying what she learned to do in therapy.
A final important aspect of K. C.’s program is that it balanced teaching and practicing of foundational and higher level aspects of reading, discussing, and writing about real books. The double-deficit view could make one wonder why K. C.’s program included speeded practice of mastered skills, as she had no problems in naming speed. Yet, K. C. had had years of not reading, and her little-practiced foundation-level skills needed to become automatic before more complex ones could become automatic themselves. If K. C.’s improved decoding skills required conscious effort, she would be unlikely to apply them when independently reading something as interesting as Harry Potter (Rowling, 2000). Of course she would guess from context, to keep the story moving! Any remedial program that instructs a new skill should include enough speeded practice and application to ensure that it becomes automatic.
The double-deficit hypothesis might similarly lead one to wonder why the remedial program for B. H., the child in Deeney et al.’s (this issue) article, included so much work on phonological skills, when his deficit was only in naming speed. Perhaps this is because many researchers and clinicians are coming to believe that a strong foundation in phonics is an important component of every early reading program (Brady & Moats, 1997), and B. H. was an early reader. In any event, the case studies in this issue are consistent with the idea that all children need balanced reading programs, but that the proportion of time and the intensity of the work spent in each component should differ according to individual needs. Such programs can attempt to capitalize on children’s strengths, remedy their deficits, and practice all components beyond mastery to independent and fluent application beyond the teaching situation.
TABLE 1. Late Second-, Mid Fourth-, and Entering Fifth-Grade
Woodcock Percentile Scores
Item Pretest Posttest
Grade End 2nd (b) Mid 4th (d)
Age 7 yr. 8 mo. 10 yr. 4 mo.
Mos. of therapy 0 18
Word Identification 16th percentile 81st percentile grade
Word Attack 13th percentile 73rd percentile grade
Passage Comprehension 21st percentile (c) 71st percentile grade
Item %ile age Follow-up (a) %ile age
Grade Enter 5th (d)
Age 10 yr. 11 mo.
Mos. of therapy 18
Word Identification 67 77th percentile grade 68
Word Attack 67 71st percentile grade 65
Passage Comprehension 63 84th percentile grade 71
Note. K. C. began therapy at the start of repeating third grade.
(a) Follow-up testing conducted 7 months after completion of
therapy. (b) Pretest Woodcock-Johnson was 1 year prior to onset
of therapy; %-ile at onset of therapy was probably lower, as mother
and school reported little or no progress in first time through
third grade. (c) School tester reported success only with picture
cues, but none without them. (d) Posttest and follow-up Woodcock
Reading Mastery %-iles calculated by age and grade, as K. C. repeated
third grade at onset of therapy.
AUTHOR’S NOTE
The author thanks Jerry Ring, Luanne Sessions, Laura Rogan, Melinda Gillette, Jenny Wise, Bob Sheffield, Becky Felton, and Susan Brady for comments and suggestions on an earlier draft of the paper, and especially thanks K. C. and her mother for doing the work and for agreeing to share their story.
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Barbara W. Wise, Remedies for Reading Disabilities
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