414277

2011

CLT28110.1177/0265659011414277Baylis and SnowlingChild Language Teaching and Therapy

Evaluation of a phonological reading programme for children with Down syndrome

Pamela Baylis and Margaret J Snowling
University of York, UK

Child Language Teaching and Therapy 28(1) 3956 The Author(s) 2011 Reprints and permission: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0265659011414277 clt.sagepub.com

Abstract
This article reports the evaluation of a 10-week phonologically-based literacy programme involving 10 children with Down syndrome (DS). At the outset, each child relied on a whole word method of reading with no apparent use of decoding strategies. The reading and phonological skills of the children were assessed twice prior to undertaking the training (baseline), at the end of training and after three months. The literacy programme targeted phonological skills at the onsetrime level, alphabet work, word analysis and whole word reading within the context of reading books. The results showed a significant improvement in word reading skill and alphabet knowledge for the group, with 4 children developing a decoding strategy for the reading of unfamiliar words. Reading progress was maintained for the majority of children three months after the training programme had finished. Thus, a teaching programme incorporating phonological word analysis can be beneficial to individuals with DS but there is considerable variability in response.

Keywords
Down syndrome, reading intervention, literacy, case series design

Introduction

Children with Down syndrome (DS) have significant problems of language and communication (Fowler, 1995; Chapman, 1997; Stoel-Gammon, 2001); however, for many, reading is a strength (Byrne et al., 2002; Groen et al., 2006). According to Byrne (1998), learning to read depends upon possessing knowledge of lettersound relationships and the acquisition of phoneme awareness. Indeed such skills are strong predictors of word-level decoding in typically developing children (Muter et al., 2004), yet they have been found to be weak in children with DS (e.g. Kay-Raining Bird et al., 2000; Snowling et al., 2002). Together these findings represent a conundrum: many children with DS can learn to read proficiently, yet the foundation skills that underpin reading are not secure. It seems likely therefore that children with DS must accomplish reading using different strategies to typically developing children (Roch and Jarrold, 2008).

Corresponding author: Margaret J Snowling, Department of Psychology, University of York, York, YO10 5DD, UK Email: mjs19@york.ac.uk

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In fact, the nature of reading development in individuals with DS has been the subject of much debate. Early studies by Cossu et al. (1993) and Evans (1994) found an apparent dissociation between reading and phonological skills in children with DS compared with typically developing children, but studies using simpler tasks have disputed these findings (Boudreau, 2002; CardosoMartins and Frith, 2001; Cupples and Iacono, 2000; Fowler et al., 1995). Focusing on phonological awareness, a number of studies have reported that children with DS have greater problems with rhyme than phoneme awareness (e.g. Cardoso-Martins et al., 2002; Roch and Jarrold, 2008; Snowling et al., 2002), suggesting that the typical progression from onsetrime to phoneme awareness (Goswami and Bryant, 1990) is not observed in DS. One factor that might account for the unusual pattern of reading development observed in DS is the teaching they receive. Until recently, most children with learning difficulties were taught to read using a whole word approach emphasizing functional literacy (for reviews, see Browder and Lalli, 1991; Browder and Xin, 1998; Conners, 1992). Training programmes with an emphasis on phonological skills were seldom used (Conners, 1992; Joseph and Seery, 2004). This approach contrasts with that generally recommended for poor readers, namely training in phonological awareness combined with reading instruction (for reviews, see Bus and van Ijzendoorn, 1999; Torgesen, 2005). However, there is growing evidence that children with DS can benefit from phonic approaches to reading (Conners et al., 2006; Cupples and Iacono, 2002; Kennedy and Flynn, 2003) and training in phonological awareness (van Bysterveldt et al., 2006), although most studies have been small in scale or lacking in control groups (for a review, see Lemons and Fuchs, 2010a). In one such study, Goetz et al. (2008) evaluated a reading intervention programme delivered by trained teaching assistants to 15 children with DS attending mainstream schools. The programme placed an emphasis on phonological skills at the phoneme level (including segmentation and blending exercises), lettersound skills and reading from books. The children were allocated to either a taught group or a waiting group. The taught group received daily 40-minute one-to-one instruction for 16 weeks, with the waiting group receiving their training programme beginning 8 weeks after the taught group had commenced. Using this design it was possible to evaluate the effectiveness of the intervention programme 8 weeks into the 16 weeks when the waiting group had yet to receive instruction. The intervention brought about modest gains in word reading and had a somewhat smaller effect on phoneme awareness. In the largest study to date, Lemons and Fuchs (2010b) evaluated the efficacy of explicit phonics instruction delivered by trained teachers on a twice-daily basis for 6 weeks to 24 children with DS. The programme comprised teaching of letters, letter combinations, decodable words, sight words and an intervention story. Each lesson was repeated for three days, and progress after each lesson was monitored using tests of lettersound knowledge, decodable words and sight words. In addition, to measure transfer of learning, the ability to read non-words was measured. A series of growth curve analyses showed that by the end of the intervention, most children had gained in lettersound skills and sight word reading, 16/24 children demonstrated growth in reading of decodable words, and 9/24 improved in non-word reading. Growth in decodable word reading was predicted by initial word-level reading skill and growth in non-word reading by phoneme segmentation ability. Together these studies suggest that it is possible to bring about gains in word recognition among children with DS through systematic phonologically-based reading instruction but generalization of taught skills is more limited. Moreover, as the findings of Lemons and Fuchs (2010b) highlight, there appears to be continuing dissociation of word reading skills (based on word recognition) and decoding abilities (non-word reading dependent on phoneme awareness). One plausible reason for

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this dissociation is the pervasive deficits in phonological awareness observed in DS. Thus, even when lettersound knowledge is well developed, deficiencies in their ability to move from a segmented word form to a whole word pronunciation may compromise reading. If this hypothesis is correct, then reducing the cognitive demands of phoneme blending by emphasizing how larger phonological units relate to orthographic onsets and rimes may be a productive approach. The study to be reported here was a small-scale evaluation of a literacy programme designed to address the rime deficit in DS and to build on emergent literacy skills. The foundation of the approach was an integrated programme bringing together single word and text reading combined with phonological awareness training (Hatcher et al., 1994; Hatcher, 2000). The programme was similar in structure to that described by Goetz et al. (2008) but teaching targeted the onsetrime level of phonological awareness rather than the phoneme level. The rationale was that such an approach would have lower working memory demands than one requiring a synthetic phonemeby-phoneme approach and may be useful for children who do not respond well to a phoneme level approach. The study addressed three main issues: 1. 2. 3. Is it possible to design an effective reading intervention programme that will promote reading skills in Down syndrome? Will the programme also promote gains in alphabetic skills (lettersound knowledge and phonological awareness)? Will the programme bring about generalizable gains in decoding, as measured by non-word reading?

II

Method

The intervention study was embedded within a longitudinal study spanning four years. The study was approved by the University of York, Department of Psychologys Ethics Committee and parents of children gave informed consent for their children to participate. Figure 1 shows the two main test phases of the over-arching study and the training study within it. The children were assessed at T0 and T5 for the longitudinal study; the intervention took place between these times with children taught in two waves.

Participants

The children were drawn from a cohort of 38 children with DS who were participating in a fouryear longitudinal study of reading (Baylis, 2005), all of whom attended mainstream schools. There was considerable variation among the children in this sample: following Fowler (1995), the children were classified into four bands according to reading skills, guided by performance on two tests of word recognition: Early Word Recognition Test (Hatcher et al., 1994) and British Ability Scales II Basic Reading (Elliot, Smith and McCulloch, 1996). Children who had low scores on both tests and only recognized a few words by sight were classified as emerging readers; beginning readers were able to read simple first stage reading books; developing readers scored at a higher level on both tests, could read many high frequency sight words, but did not use this knowledge to decode unfamiliar words in their reading; finally, good readers were reading at or above an 8-year level and could decode some non-words. Ten children from the developing reader group were invited to participate in the study; three were unable to take part, and they were therefore replaced by the three best readers from the beginning readers.

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Figure 1 Time frame of the study for intervention group A and B within the longitudinal study

Participants ranged in age from 9 years, 10 months to 14 years, 10 months and in reading age from 6 years 4 months to 7 years 4 months. Descriptive statistics are shown in Table 1. Of the 10 children (five girls and five boys), nine wore glasses, two wore hearing aids, and one had benefited from a procedure to widen the external ear canal three years earlier. Seven of the children attended primary schools and three attended secondary schools. All of the children attending primary school received literacy instruction through the daily Literacy Hour based on the UKs National Literacy Strategy (DfEE, 1998). This comprised shared and guided reading and activities to promote phonological awareness at the rime and phoneme levels. The three children attending mainstream secondary school were taught English as a set subject and received literacy instruction in a special needs group three times a week. The content of these sessions was variable.

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Table 1 Times of assessments Tests Times of assessment T0 Reading: BAS-II Reading Scale Early Word Recognition (EWR) Oxford Reading Tree (ORT) Nonword Reading (NWR) Spelling: 10 spellings Alphabetic skills: Letter knowledge: 26 upper and lower case letters Phonological skills: Initial/final syllable matching Syllable completion Rime matching Alliteration matching Phoneme completion X T1 X X X T2 X X X T3 X X X T4 X X X

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T5 X

X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Design and materials

The intervention study adopted a single case research design, with each of the 10 children acting as their own control (Cohen et al., 2000). For practical reasons, the intervention group was divided randomly into two teaching groups, each consisting of five children (in Figure 1, subscript A or B denotes the times of delivery/assessment respectively for the two groups). The first group (A) was assessed and taught over two terms of an academic year, and then the second group (B) was assessed and taught. Two pre-intervention assessments were made at T1 (prior to the teaching intervention) and T2 (after a two-week interval). For each child, their mean performance across the two first assessments (T1;T2) formed the baseline against which response to intervention was monitored. A period of 20 teaching sessions then took place, each child in the group receiving two 1-hour individual teaching sessions in school per week. Assessments of progress were made at T3 (post-intervention) during the week following the last teaching session and T4 (maintenance) three months after the last teaching session. The same person (the first author) carried out all of the teaching and assessments. Each teaching session was planned and documented but no formal tests of fidelity of delivery were made.

Test battery

A battery or reading and reading related tests were given to monitor the progress of children through the intervention. A summary of the tests and the times of assessment is provided in Table 2. Details are provided in the following sections. a Reading skills: The British Ability Scales II Reading Scale A (Elliot, et. al. 1996) includes a range of regular and irregular words. The number of items correctly read was used to calculate a reading age for each child according to the test manual.

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Table 2 Descriptive statistics for the intervention group Mean Age (years/months) Performance IQ (WISC-III) Receptive Vocabulary (BPVS-II) (standard score) Early Word Recognition (EWR) (maximum 42 words) Basic reading (BAS-II) (raw score) Reading age (years/months) 11.20 55 59.70 36 26.60 6.88

Child Language Teaching and Therapy 28(1)

SD 1.9 5.5 11.76 4.26 6.76 0.36

Range 9.214.10 4662 4177 2741 1837 6.47.4

The Early Word Recognition Test (Hatcher, et al., 1994) consists of 42 of the most commonly occurring words taken from seven frequently used reading schemes in the United Kingdom. The Oxford Reading Tree Reading Scheme (Oxford Reading Tree, 1987) was used to assess knowledge of the core print vocabulary used in the intervention; this test consisted of 117 words presented on ten A4 cards. b Non-word reading: The non-word reading test comprised 45 non-words, graded in difficulty beginning with single letter sounds and proceeding with two-letter sounds with a vowel/consonant pattern, two-letter sounds with a consonant/vowel pattern, three-letter sounds with a consonant/ vowel/consonant pattern, one-syllable non-words and two syllable non-words. Correct responses were scored 1. c Spelling: The first 10 items of the spelling subtest of the British Ability Scales II (Elliot, et.al.1996) were administered. The words were a, on, and, the, up, go, big, sit, bus, my, box. d Letter knowledge: Each child was presented all 26 lower-case letters of the alphabet in the same random order and asked to identify their sounds. e Syllable awareness: The syllable-matching task consisted of initial and final syllable matching (Carroll et al., 2003). In the initial syllable-matching condition the children were presented with three picture cards each named by the experimenter. The child was asked to select the two that shared the same first syllable, e.g. fireman, firework, doctor. The test consisted of eight trials, two practice sets and six test sets with corrective feedback. In the final syllable task, the child was asked to select the two picture cards that shared the same end syllable, e.g. treehouse, greenhouse, garden. The test again consisted of eight trials, two practice sets and six test sets with corrective feedback. For the syllable completion test (PAT; Muter et al., 1997), the child was presented with a picture prompt and was required to finish off a word spoken by the experimenter, e.g. This is a ra [rabbit], the child was required to say /bit/. There were two demonstration items and eight test items. f Onsetrime skills: Alliteration matching was used to assess awareness of word onsets (Carroll et al., 2003). A set of three pictures was presented and named by the experimenter. The child was asked to select the two pictures that start with the same letter sound, e.g. bell, boat, dog. There were eight trials consisting of two practice items and six test items with corrective feedback. Rhyme skills were assessed using the parallel rhyme-matching task. In this task a set of three pictures was

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presented and named by the experimenter placing an emphasis on the end sound. One of the pictures was moved to be placed above the other two, and the child was then asked, Which card sounds like ; the experimenter then pointed to the card and named it, e.g. hat. The other two cards e.g. cat, dog were then named again and the child had to select one that sounded like the cue card. The test consisted of eight trials, two practice sets and six test sets with corrective feedback. g Phoneme awareness: Children were given the PAT phoneme completion test (Muter et al., 1997). Each child was presented with a picture prompt of a single syllable word. The examiner supplied the first two phonemes of the word and the child was requested to finish off with the final phoneme, e.g. the examiner supplied the incomplete word ca_ for which the correct response was /t/ to complete the word cat. There were 8 test items all accompanied by pictures.

Procedure

Each participating school agreed to a teacher visiting the school and withdrawing a child for two individual sessions a week, and to providing a room where the teaching could take place. Parents were informed by letter detailing the programme and all gave informed consent for their child to participate in the study. The assessment tasks were administered in a set order during 2 or 3 sessions depending on distractibility and interruptions. Usually the child was seen alone, but in some schools a learning support assistant was present. For the reading programme the children were withdrawn from lessons over a 10-week period, but care was taken to ensure they were not withdrawn from a literacy session.

The literacy programme

The programme was an adaptation of Reading Intervention developed by Hatcher et al. (1994) and incorporated activities from the structured approach adopted by the UKs Dyslexia Institute Literacy Programme (Walker and Brooks, 1993). It adopted a multisensory approach and consisted of two 1-hour individual sessions each week. The four main aims of the programme were (1) to develop alphabet skills, (2) to develop onsetrime awareness, (3) to improve sight vocabulary, and (4) to develop skills in decoding words. The programme also included comprehension, spelling and writing tasks. The 20 individual teaching sessions followed a structured format with each task delivered in a set order, consisting of: alphabet work (using wooden letters); lettersound tasks based on the rhyme and analogy strand of the Oxford Reading Tree scheme; key word and shared book reading; and comprehension exercises based on the shared reading.

At the beginning of each session the child was asked to lay out wooden letters of the alphabet in correct order in an arch shape. The child named all the letters by name and then named them again by sound. Phonological tasks incorporated in the programme were based on onsetrime activities using wooden letters, onsets consisting of initial consonants and blends. All oral work was linked to wooden letters to enable the child to pair the sounds heard with the division of the word. To introduce the concept of onsetrime, a familiar short word, e.g. /at/, was made by the

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child using the wooden letters from the arch. The child was asked to place a letter to make /bat/. The child was encouraged to locate the letter in the arch. Further letters were selected until a group of words had been made. Each child was presented with 12 rimes over the 20 lessons; /an/, /in/, / at/, /ap/, /en/, /og/, /un/, /ip/, /ed/, /ad/, /it/, /eg/, and the initial blends /bl, /br/, /cr/, /cl, /sp/, /fl/, /fr/, /scr/, /sk/, /tr/, as well as the digraphs /ch/, /kn/, /sh/, /th/, /wh/. The teaching sessions were organized in pairs (for examples of two teaching sessions in a pair, see Appendix 1). In the first session, the target rime ending and the new story-book were introduced. The onsetrime words for the target rime ending were read in the onsetrime book by the teacher emphasizing the relevant rhyme ending. The child was encouraged to read and identify the sentences from this book that contained the target rhyme ending. A worksheet based on the rhyme endings was also completed. The worksheets made use of rearranged text presented with different pictures with simplification where necessary. The story-book was then introduced to the child, and the core sight vocabulary discussed. To prepare for text reading, the child pointed out onsetrime words, for example if the target ending was at then they were encouraged to find it in bat, cat, mat. The book was then read using a shared reading approach: the teacher read the book aloud, with the child following the text with his or her finger. When they came to a word containing the target rime, the child was encouraged to read it. The word ending made in wooden letters was left on the table as a visual prompt. If the onset rime book contained easy enough text the the child would read it aloud again at the end of the session. In the second of the paired teaching sessions, there was revision of the onsetrime work, again using the wooden letters and with a different worksheet being completed. The theme of the storybook was revised and a running record completed as a means of assessing weekly reading progress (Clay, 2000; Hatcher, 2000). The running record consisted of choosing a passage of 100 words in the story-book and the child reading it aloud while the teacher checked off words on a runningrecord sheet. An accuracy score of 95% or over had to be achieved before the child could progress to a new book. The running record also yielded detailed information on strategies of reading and word decoding. In addition to the running record, comprehension worksheets were completed for the story-book and a new story-book chosen to be read over the next two sessions. All of the worksheets were written or modified by the experimenter to control for vocabulary and picture content. The children attending primary school used books and materials from the Oxford Reading Tree reading scheme beginning at level 5 (Oxford Reading Tree, 1987), a scheme already in use in their schools. The children attending secondary school read books from the Wellington Square reading scheme beginning at level 2 (green) (Wellington Square, 1999), a scheme already in use with individuals with learning difficulties in their schools. The books from the two schemes were comparable on reading level and core vocabulary (apart from character names, which were taught separately). The children all began reading books at the same level. Individuals progressed through the available books at different rates, with movement onto a new book determined by obtaining a score of 95% or more in the running record. If a child failed to achieve this score, specific words that were causing a problem were identified and the book was re-read. The range of reading age scores based on the reading age of the first to last book read over the 20 sessions was from 6 years 6 months to 7 years 11 months (Hinson and Gains, 1993), equivalent to bookband 5 to bookband 7 (Bickler et al., 2003).

III

Results

In order to evaluate the effects of the literacy programme we assessed the performance of the children on reading and reading-related phonological tasks immediately after the intervention and

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Table 3 Pre-and post-intervention test battery measures for the 10 children, showing t-values for changes in reading score from baseline at T3 and T4 and effect sizes Test T1 Mean SD Early Word Recognition 35.5 4.38 (EWR) (maximum 42) BAS single word 28.5 7.44 (maximum 90) Oxford Reading Tree 92.2 18.42 (maximum 117) BAS spelling 7.6 1.7 (maximum 10) Letter Knowledge 23.9 2.42 (maximum 26) Rime (maximum 6) 2.9 1.6 Alliteration 4.0 1.82 (maximum 6) Syllable beginning 3.0 1.9 (maximum 6) Syllable ending 3.2 1.75 (maximum 6) PAT syllable 3.7 2.5 completion (maximum 8) PAT phoneme 3.4 2.8 completion (maximum 8)
Notes: ** p < .01; *** p < .001

T2 Mean SD 37.0 27.6

T3 Mean SD t(9)

T4 Mean SD 41.2 36.8 t(9)

Baseline T4: Cohens d 1.56 1.19 .82 .34

4.35 40.8 1.23 4.39** 6.7 34.3 3.60 3.56**

1.03 4.47** 7.60 3.40**

92.1 19.11 104.1 12.94 3.73** 7.1 23.8 2.7 4.5 4.2 3.0 4.9 3.8 3.14 2.3 1.42 1.84 1.88 1.2 2.42 2.7 8.8 2.0 2.75**

106.0 14.57 5.40*** 8.4 26 3.0 5.4 4.7 4.3 7.8 6.4 2.84 1.61

25.6 0.84 2.97** 3.9 2.0 2.24 5.2 0.92 3.00** 5.0 1.2 6.53***

0.00 3.15*** 1.29 1.76 0.76 1.3 1.56 1.3 1.3 3.10** 4.03** .12 .72 .67 .86

4.5 0.85 5.10*** 7.5 0.53 5.10*** 5.6 2.0 2.10

0.42 5.06*** 1.98 2.41 2.89** 1.08

compared this with their pre-intervention performance. To assess maintenance of gains, we also examined performance three months after the intervention finished. Table 3 shows the mean performance of the group at T1, T2, T3, T4 across the test battery, together with the results of related t-tests and effect sizes for the change in scores from baseline (the mean of T1, T2) and T4 in the right-most column. We first asked whether the programme was effective in bringing about gains in reading skills. As can be seen in the first three rows of Table 3, there were substantial gains in reading for the group as a whole. The effects sizes were large for gains in single word reading and letter knowledge, less so for reading of the books from the Oxford Reading Tree (ORT; text reading). Figure 2 shows individual plots for the reading gains made by each child. The figure reveals considerable variability between children: 9 children made gains at T3 and 8 of these children maintained the gains at T4. A further child gained between T3 and T4. The mean spelling score also increased between baseline assessments and T3, but there was some fall-back by T4 and the effect size of the gains was small (d = .34). A series of related t-tests compared childrens baseline scores with scores at T3 and T4 separately. Despite the variability, changes between baseline and T3 were statistically significant for all of the reading measures (BAS; EWR; ORT). These findings were replicated for differences between baseline and T4.

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Child 1
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Figure 2 Performance on reading tests (EWR and BAS) made by individual children during the intervention
Notes: BAS = British Ability Scales; EWR = Early Word Recognition

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A limitation of this form of data analysis is that each child acted as his or her own control; this approach does not control for changes with the passage of time or take account of variations in baseline score. Since the case-series was embedded within a larger longitudinal study it was possible to use data from the remaining children in the cohort as an untreated comparison group. In other words, it was possible to ask whether children who had received the intervention gained higher reading scores at the end of the study than would have been expected given their pre-intervention performance. All of the children in the longitudinal sample had been assessed on the British Ability Scales II Reading Scale (Elliot et. al., 1996) six months before the reading training programme had begun (T0), and their reading was assessed six months after the reading training programme had ended (T5). A regression approach was used to assess whether gains made in reading for the treated group were greater than predicted for children who did not receive intervention. The regression of the BAS reading scores at T5 (excluding those of the intervention group) (BAS2) on the BAS reading scores at T0 (BAS1) is plotted in Figure 3, together with 95% confidence intervals (defining the range within which data for untaught children would be expected to fall with a probability of 0.95). The scores for the 10 children who participated in the reading training are in bold. From the graph it can be seen that six of the children in the reading training group achieved scores above the upper 95% confidence interval boundary, indicating that the training had been successful in accelerating their reading progress relative to the progress of the children in the main cohort who had not received reading intervention. Three further children in the reading intervention group achieved scores within the prediction boundaries. For one child in this group, the score was below the lower prediction boundary. This child consistently achieved lower scores after the reading training had ended. Together these findings suggest that the literacy programme provided an effective reading intervention. Since the programme incorporated training in phonological awareness and letter sound knowledge, our next set of analyses assessed whether the programme had brought about gains in these foundation skills. Data pertaining to this issue are shown in the lower 7 rows of Table 3. As for reading, it can be seen that there were substantial improvements in letter knowledge as a result of the intervention. Letter knowledge scores ranged from 1926 at the beginning of the intervention, and all children knew all of the letters by T4. There were also promising gains in phonological skills, with the exception of rime awareness. Changes between baseline and T3 were statistically significant for letter knowledge, alliteration, syllable beginning, ending and completion, but not for phoneme completion or rime awareness. The pattern was replicated at T4 except that by this stage gains in phoneme completion score were also significant. At neither point did the group show an improvement in rime detection and the effect size was small (d = .12). Finally, our third question asked whether the reading gains made by the treated children were associated with gains in decoding skill rather than limited to increases in sight-word reading. A nonword reading test administered at T0 and T5 was used to provide an indication as to whether there had been gains in pure decoding skill. As for the analysis of reading data, we again used a regression approach. The regression of non-word reading test scores at T5 (NWR2) on non-word reading test scores at T0 (NWR1) is plotted in Figure 4, with the scores for the 10 children who participated in the reading training in bold. The graph shows that four of the children in the reading training group achieved scores above the upper 95% confidence interval boundary, indicating that the training had been successful in promoting the use a decoding strategy. The remaining six children in the reading training group achieved scores within the boundaries of the confidence interval.

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BAS Word Reading T5

80 60 40 20 0 -20 -20 0 20 40
Untaught Regression for untaught chidlren 95% prediction interval Taught

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Figure 3 The relationship between BAS word reading at T0 and T5 for children participating in the longitudinal study, with performance of the intervention group in bold Note: The central line is the regression and the outer lines represent the 95% prediction intervals.
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Nonword Reading T5

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Untaught Regression for untaught children 95% prediction interval Taught

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Figure 4 The relationship between nonword reading at T0 and T5 for children participating in the longitudinal study, with performance of the intervention group in bold Note: The central line is the regression and the outer lines represent the 95% prediction intervals.

IV

Discussion

This study evaluated the efficacy of a phonologically-based literacy programme for children with DS incorporating training in phonological awareness and text-reading. At the beginning of the programme the children could read simple text using a whole (sight) word reading strategy and identify some letter sounds, but they were unable to decode unfamiliar words. The programme progressed in small steps, focusing on the development of lettersound knowledge and segmenting and blending at the onsetrime level, with the aim of providing children with a framework on which to develop decoding skills. In order to achieve this, phonological training was reinforced using worksheets adapted from the reading books to enable the rime unit to be easily identified. Throughout

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the reading programme emphasis was placed on how different skills (letter knowledge, spelling, reading, writing and comprehension) were integrated during the process of reading (Farrell and Elkins, 1994). We focus our discussion on the three research questions posed at the outset: 1. 2. 3. Is it possible to design an effective reading intervention programme that will promote reading skills in Down syndrome? Will the programme also promote gains in alphabetic skills (lettersound knowledge and phonological awareness)? Will the programme bring about generalizable gains in decoding, as measured by non-word reading?

1 Is it possible to design an effective reading intervention programme that will promote reading skills in Down syndrome?
For all of the 10 children who participated in this evaluation study, there was an overall improvement in reading single words and text (relative to their own baseline level). The average reading age gain was 5.1 months in 10 weeks, with two children making impressive gains of 12 months). Moreover, progress in reading was maintained for all but one of the children at T4. This child had changed educational setting to a college environment that did not place an emphasis on literacy skills, and this may suggest that ongoing practice is required to maintain gains in the longer term (Farrell and Elkins, 1994; Moni and Jobling, 2000, 2001). Notwithstanding this, the present findings add to a growing body of evidence that systematic phonic-based instruction can benefit the literacy development of children with DS (Lemons and Fuchs, 2010a). It is important, however, to acknowledge that in real terms the gains were modest and the recipients of the programme remained well behind age expectations in reading. Furthermore, whether or not this rate of progress could be sustained remains at this juncture an empirical question.

Does the programme promote gains in alphabetic skills?

A key question given the inclusion of training in lettersound knowledge and phonological skills was whether these foundation skills also increased. The data are convincing with regard to letter knowledge since all of the children could demonstrate excellent knowledge of lettersound correspondences by T3, and this was consolidated three months later at T4; there were robust gains in syllable awareness. In addition, gains in phoneme awareness were revealed on a test of sensitivity to alliterative relationships between words and on a test of phoneme completion, requiring more explicit awareness between baseline and T4. However, despite the emphasis on rime units during the intervention, it was surprising that there was no significant improvement on a test of sensitivity to rhyming relationships. Scrutiny of the performance of individual children suggested that there were improvements on the rhyme task for 6 children at T3, but these were only maintained for 2 children. Given the similarity in the programmes, it is perhaps instructive to compare the gains made here with those reported by Goetz et al. (2008) for a programme in which children received phonological awareness training at the level of the phoneme. In the present study, gains in alliteration skills were smaller, consistent with its emphasis on larger rime units. Moreover, in both studies, gains in phonological awareness were more limited than gains in reading. These findings corroborate those from other studies, which show it is possible to improve phoneme awareness in children with DS (van Bysterveldt et al., 2006). However the findings also

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underline the rime deficit in DS and suggest it may be intransigent to intervention. Moreover, although gains in syllable awareness were robust these are unlikely to mediate gains in reading in English, given it is an alphabetic language in which the mappings are at the phoneme level. It will be important for future research to assess the relationship between emergent phonological awareness and reading skills and perhaps to compare directly the benefits of systematic phonics instruction with and without training in phonological awareness (e.g. Hatcher et al., 2004).

3 Does the programme bring about generalizable gains in decoding skills?

Our final question relates to whether the gains in reading and in phonological awareness brought about by the current programme generalized to the reading of new words. In order to assess this, we analysed data from a non-word reading test administered prior to and 6 months after the end of the intervention, comparing the gains made by the children in the programme with their expected gains based on starting level. Our analysis showed that 4 of the 10 children significantly improved their performance on a non-word reading task. It seems that for these children at least, the change in reading ability was associated with transition to the use of a decoding reading strategy. Notwithstanding this, progress in the development of decoding skills was limited; there was less good evidence of gains in spelling skills. It is possible that reported hearing losses in some of the children could have contributed to the difficulties they experienced with phonological awareness. However, there are two further alternative possibilities. First, it might be that in order to encourage children to apply emergent skills in phonological awareness to reading, a training programme would need to be delivered for longer and with more intensity. Second, it might be that the language difficulties that children with DS experience are such that it is not possible to ameliorate phonological deficits sufficiently to enable them to develop a generative decoding system that draws on the ability to segment and to assemble phonology. In particular, it will be important for future research to assess how difficulties in speech production may mitigate progress in the acquisition of phoneme segmentation and blending processes. The present study had a number of limitations. Each child acted as their own control, and the longitudinal comparison group was untreated. In addition, the same person undertook the teaching and the assessments. Together these limitations mean it is difficult to rule out a Hawthorne effect (Rosenthal and Jacobson, 1968) as the cause of the gains in reading. It should also be noted that the sample size was small making it difficult to generalize to a wider population of children with DS. Indeed, the study focused on reading, and therefore it is not possible to comment on a number of variables that may have affected response to intervention, including problems of auditory perception, speech perception, phonological memory, wider language skills, behaviour and attention. In summary, the phonological training programme reported here was moderately successful in providing a bridge between whole word reading and decoding of children with DS. This study demonstrates that teaching children in a structured way with an emphasis on phonological awareness and decoding reinforced by text reading can be effective, consistent with previous research. Whether the gains made in reading are mediated by gains in phonological awareness remains an important issue for future research. The present study was small in scale and hence the implications for practice are tentative. It seems the programme is suitable for beginning readers who have not yet developed decoding skills. However it would be important, as with all interventions, to carefully monitor childrens response to the intervention in the knowledge that many children with DS have pervasive phonological deficits that may compromise the development of reading and wider literacy skills.

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Appendix 1 Lesson: 1A Aims: 1) 2) 3) 4) 5) 6)

Example of a paired set of teaching sessions

To develop alphabet skills. To improve sight vocabulary. To develop skills in decoding words. To develop spelling skills. To develop comprehension skills. To improve writing skills.

Tasks: 1) 2) 3) 4) 5) 6) 7) 8) 9) To lay out alphabet letters correctly in an arc shape. To identify the letters by their sound. To begin onset rime work using the letter chunk at. To make real words using single consonants and the at chunk. To read a book containing the onset/rime pattern at. To complete an onset/rime sheet. To read the key words necessary for the reading book. To read the reading book aloud. To complete the work sheets on key words from reading book.

Lesson: 1B Aims: 1) 2) 3) 4) 5) 6) 7) To develop alphabet skills. To improve sight vocabulary. To improve ability to distinguish between the sounds in words. To develop skills in decoding words. To develop spelling skills. To develop comprehension skills. To improve writing skills.

Tasks: 1) 2) 3) 4) 5) 6) 7) To lay out alphabet letters correctly in an arc shape. To identify the letters by their sound. To revise the at words by completing a spelling sheet. To continue onset rime work using the letter chunk at. To make real words using single consonants and the at chunk. To read a short story containing the onset/rime pattern at. To complete an onset/rime sheet for the rime at.

56 8) 9) 10) 11) 12) 13)

Child Language Teaching and Therapy 28(1) To read the key words necessary for the reading book. To read the reading book aloud. To complete the work sheets on key words from the reading book. To answer comprehension questions about the reading book using sentences. To choose a book for next lesson. To play a game related to the lesson.

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