International Journal of Disability, Development and Education

Vol. 58, No. 1, March 2011, 4759

Examining the Efficacy of an Intervention to Improve Fluency and

Reading Comprehension in Spanish Children with Reading Disabilities
Manuel Sorianoa*, Ana Mirandaa, Emilia Sorianob, Francisco Nievasc and Vicente Flixa
aDepartamento de Psicologa Evolutiva y de la Educacin, Universidad de Valencia, Valencia,
Spain; bConsellera de Educacin, Generalitat Valenciana, Valencia, Spain; cDepartamento de

Psicologa Evolutiva y de la Educacin, Universidad de Almeria, Almeria, Spain

The main goal of the present study was to examine the efficacy of a multi-component
programme to improve reading fluency and text comprehension in Spanish children
with reading disabilities (RD). Special needs teachers were trained in the application of
the programme, which included repeated reading plus phonological awareness training
and graphemephoneme decoding training. Instruction was delivered one to one.
Participants were 22 students with RD, aged 1013, distributed in two groups: one with
12 children who received the intervention (experimental group), and the other with 10
children who received no intervention (comparison group). The effects of the training
programme were evaluated using gains in scores on word and pseudo-word reading and
text reading fluency, as well as on a text comprehension test. Results of analyses of
covariance comparing the two groups with age as a covariate showed that children who
participated in the intervention obtained statistically significant gains on the reading
measures used, with the exception of text comprehension. Results are discussed with
regard to effective interventions for students with reading disabilities. Reflections on
the studys limitations provide a basis for recommending future lines of research.

International
10.1080/1034912X.2011.547349
CIJD_A_547349.sgm
1034-912X
Original
Taylor
102011
58
Manuel.Soriano@uv.es
ManuelSoriano
00000March
and
&
Article
Francis
Francis
(print)/1465-346X
Journal
2011Ltd
of Disability,
(online)
Development and Education

Keywords: intervention; multi-component training; phonological awareness training;

reading comprehension; reading disabilities; reading fluency; repeated reading;
transparent orthography

Introduction
Reading proficiency is an academic skill that plays an essential role in school success.
However, even though reading is a basic objective of the curriculum, many students have
severe problems with this foundational skill. Therefore, it is not surprising that there is a
great deal of interest in studying the factors involved in reading acquisition difficulties.
The currently most widespread interpretation is that reading disorders are caused by ineffective phonological processing. In fact, the results of several studies have indicated that
students with reading disabilities (RD) exhibit significant difficulties in grapheme-tophoneme decoding, empirically supporting the view that ineffective phonological processing is a core deficit underlying RD (Herman, Matyas, & Pratt, 2006; Rack, Snowling, &
Olson, 1992). Along the same lines, various studies carried out in Spain have also found a
deficit in phonological awareness in children with specific reading disabilities who exhibit
poor reading fluency rather than mere inaccuracy. Typically, their reading is characterised
as being dysfluent and inaccurate, suggesting that RD in Spanish, a language with a transparent orthography, represents a severe and complex deficit in lexical access (Jimenez &
*Corresponding author. Email: Manuel.Soriano@uv.es
ISSN 1034-912X print/ISSN 1465-346X online
2011 Taylor & Francis
DOI: 10.1080/1034912X.2011.547349
http://www.informaworld.com

48

M. Soriano et al.

Hernndez, 2000; Jimnez, Rodrguez, & Ramrez, 2009; Serrano & Defior, 2008; Soriano
& Miranda, 2010). Consequently, phonological training has become the basis for the
majority of remediation programmes for students with reading disabilities.
Cumulative findings from intervention studies have shown that phonologically-based
interventions can significantly increase young childrens reading skills, with the gains more
consistent and robust when phonological awareness is taught together with letter-sound
correspondence (Bus & van Ijzendoorn, 1999). In contrast, the results obtained with this
training approach do not seem to be equally effective in older children with RD (HernndezValle & Jimnez, 2001; Kerstholt, van Bon, & Schreuder, 1994; Rueda & Snchez, 1996).
In sum, it seems that although phonological awareness plus lettersound correspondence
may be a necessary training component, it is not sufficient to improve reading skills, particularly in the case of older students with RD. Moreover, phonological awareness training by
itself does not seem to be effective in increasing word reading fluency and comprehension,
skills that gradually become more important throughout the reading development process
(Torgesen, Rashotte, & Alexander, 2001). The ability to read involves a close connection
between decoding, fluency and comprehension, so that a fluent reader has automated
many of the decoding processes and is able to devote their full attention to the meaning of
the text. In contrast, readers who are not fluent in reading are less motivated to practice,
struggle more in learning academic content, and have a poor understanding of what they
read (Kuhn & Stahl, 2003).
The above-mentioned considerations explain why reading fluency, defined as the ability
to read with speed and accuracy (Samuels, 1979), has become a crucial goal in the treatment
of children with RD, even though it is one of the reading dimensions where remediation is
not easy (Kamps & Greenwood, 2005; Lovett & Steinbach, 1997; OConnor et al., 2002;
Rasinski, Rikli, & Johnston, 2009). The most commonly used method for enhancing reading
fluency has been the repeated reading of words or passages, which has been shown to have
positive effects on students reading achievement (e.g., accuracy, rate, prosody, or comprehension) (Chard, Vaughn, & Tyler, 2002; Hintikka, Landerl, Aro, & Lyytinen, 2008; Kuhn
& Stahl, 2003; Meyer & Felton, 1999; National Reading Panel, 2000; Therrien, 2004).
Nevertheless, when this type of training has been directed specifically toward readers with
severe problems, transfer effects to untrained materials have generally been fairly small
(Berends & Reitsma, 2006; Therrien, 2004).
One possible explanation for the limited transfer of repeated reading procedures is that
positive effects of the training on speed and accuracy could be due to an increased specification of the orthographic representation of a word in the mental lexicon. In other words,
the more specified this representation is, the easier it is to read the word fluently. Recent
research has provided a theoretical framework for the word-specific training effect of
repeated exposure. The Share (2004) self-teaching hypothesis indicates that every successful
decoding event will improve the future reading of a particular word. That this effect is the
result of decoding instead of pure visual exposure is demonstrated by the fact that minimising
phonological processing during presentation significantly diminishes the orthographic
learning effect. Furthermore, the self-teaching hypothesis also proposes that training effects
are item based. The repeated reading training effects are expected to be word specific, and
generalisation to untrained words is, therefore, unlikely. Within this framework, it makes
sense to provide training in sub-lexical units, due to its possible positive influence on generalisation. Syllables are the most consistent sub-lexical units in regular orthographies like
Spanish (Carreiras & Grainger, 2004). Thus, facilitating visual identification of syllables
could help individuals with RD to build up orthographic representations of recurrent syllables, achieving faster automatic direct word recognition (Tresoldi, Vio, & Iozzino, 2007).

Intervention to Improve Fluency and Reading Comprehension

49

Therefore, training designed to make the participant familiar with syllables repeated in
different words will help him or her to read other words containing the same syllables. Thus,
systematic phonological awareness training at the syllabic and phonemic level is one of the
components of the reading fluency programme being tested in this study.
In another vein, various studies have found that decoding practice alone, although
effective in improving word recognition, does not necessarily improve reading rate (Meyer
& Felton, 1999; Torgesen, Wagner, & Rashotte, 1997). In addition, quick recognition of
words in lists has also produced inconsistent findings for fluency in context (Levy, Abello,
& Lysynchuk, 1997). Thus, in order to improve their reading rate, students probably need
to dedicate a large amount of time to repeatedly reading texts within programmes designed
to teach reading fluency.
One last matter of great educational interest involves the contribution of fluency to
reading comprehension, the final goal of learning to read. Fluency is undoubtedly an important factor in the reading process. Poor readers have to dedicate a large portion of their
cognitive resources to decoding words, which impedes flow of thought and interferes with
comprehension. In contrast, fluent readers decode words accurately and quickly, conserving many resources that they can use for comprehension. A recent meta-analysis indicated
that repeated reading has a moderate impact on students comprehension (Therrien, 2004).
Along the same lines, in their excellent review, Kuhn and Stahl (2003, p. 9) concluded that,
with few exceptions, the results for comprehension mirror those for fluency: generally,
where an increase in fluency was found, there was also an increase in comprehension.
Study Purpose
The main purpose of this study was to extend the research in reading fluency training to
Spanish, an orthographically transparent language. More specifically, our first objective
was to use indicators of reading accuracy and speed to evaluate the efficacy of a multicomponent programme consisting of repeated reading plus phonological awareness training and graphemephoneme decoding, designed to improve reading fluency in Spanish
children with RD.
The second objective of this study was to examine whether the application of the multicomponent programme, which provided no instruction in the meanings of words or texts,
produced a generalised improvement in comprehension. We expected to find moderate-tostrong correlations between reading fluency and reading comprehension, and our programme
was designed according to critical instructional variables shown to optimise the efficacy of
reading fluency intervention (see meta-analysis by Therrien, 2004). Thus, the training was
carried out during an extended period of time, and the material in each session was worked
on until the performance criterion was reached. The instruction was individualised. The
student received continuous performance feedback and the intervention was performed by
an expert adult who modelled appropriate prosodic marking to divide sentences in the
repeated reading of the texts.
Method
Participants
In this study, 22 primary and secondary school students with reading disabilities from
different schools in Valencia, Spain participated. They had lowmiddle socio-economic
status, but no cultural or environmental disadvantages. All the participants were Caucasian
or South American and used Spanish as their first oral language. They ranged in age from

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M. Soriano et al.

10 to 13 years (mean age = 11 years, 7 months, standard deviation [SD] = 1 year, 1 month).
The sample comprised 17 boys and five girls.
All the children, as stipulated in the regulations currently in force in Spain for students
with learning disabilities, attended special education classes (i.e., resource rooms) three
hours a week in their respective schools. They were classified into two different groups: the
intervention group (IG), which was made up of 12 students with RD (mean age = 12 years,
5 months, SD = 0.67; nine male and three female); and the untrained comparison group
(CG), which was composed of 10 children with RD (mean age = 10 years, 7 months, SD =
0.43; eight male, two female). Due to the distance between the different schools, the participants were not randomly assigned to the treatment regimen and the comparison regimen.
The intervention group was made up of students who attended schools near each other, so
that the first author could maintain fortnightly contact with the teachers responsible for
implementing the intervention. This arrangement was designed to promote the fidelity of
the intervention; that is, the application of the treatment by the teachers was in exactly the
way it had been designed.
The presence of RD was confirmed using an adaptation of the multifaceted approach
developed by Pereira-Laird, Deane, and Bunnell (1999). The requirements followed in the
assessment were: poor academic performance in reading, according to a teachers rating
report, and average achievement in other academic areas (e.g., arithmetic); scores of 80 or
higher on an intelligence test (Cattell & Cattell, 1950/1989), in order to exclude students
with intellectual disability; no evidence or history of neurological damage, environmental
disadvantage, emotional disturbance, hearing or vision impairments, or any other major
handicapping condition, in accordance with the conventional exclusion criteria for learning
disabilities (LD); and the achievement criteria in reading adopted in this study have been
commonly used in the LD literature. Specifically, RD was determined using a score corresponding to the 25th percentile or less on the word-reading subtest from the standardised
Reading Test PROLEC-SE (Ramos & Cuetos, 2003).
Results of analyses of variance (ANOVAs) showed no significant differences between
the two groups in: IQ, F(1,20) = 0.008, 2 = 0.000, p = 0.929; naming speed, F(1,20) = 0.162,
2 = 0.008, p = 0.692; verbal working memory, F(1,20) = 0.875, 2 = 0.042, p = 0.361; or
phonemic awareness, F(1,20) = 1.24, 2 = 0.059, p = 0.278, prior to training. However, there
were significant differences between the groups in age, F(1, 20) = 57.52, 2 = 0.74, p =
0.001. Table 1 shows the means and SDs for age, IQ, naming speed, verbal working
memory and phonemic awareness by group.
Children in the study learned to read with a focus on spellingsound mapping, corresponding to the syllable. The children were taught to pronounce consonants associated with
vowels in simple consonantvowel syllables (e.g., ma, me, mi, mo, mu). The teaching
builds on the pronunciation of these simple syllables by showing the children how the syllables can be combined to construct words (e.g., mama [mother]). These lessons were then
extended to other sets of syllables through the association of different consonants with the
same vowels (e.g., pa, pe, pi, po, pu). Further teaching extended to more complex syllables
(e.g., cos, a consonantvowelconsonant syllable) and later to constructing words from
these syllables.
The informed consent of the parents of the students who received the treatment was
obtained, once they had been informed about the participation requirements (e.g., content
and number of sessions, place and anticipated length). Furthermore, permission to evaluate
the reading performance of the children in the comparison group was obtained from their
parents, with the first author promising to personally provide them with an extensive report
on the results found.

Intervention to Improve Fluency and Reading Comprehension

Table 1.

Descriptive data for the intervention group and the comparison group.

Age
IQ
Naming speed
Verbal working memory
Phonemic awareness
Gender

51

Mean
SD
Mean
SD
Mean
SD
Mean
SD
Mean
SD
Male
Female

IG (n = 12)

CG (n = 10)

12.57
0.67
106.58
10.1
40.50
6.28
3.33
0.98
38
2
9
3

10.71
0.43
106.20
9.8
39.50
5.14
3.70
0.82
36.92
2.46
8
2

57.52

0.001

0.742

0.008

0.929

0.000

0.162

0.692

0.008

0.875

0.361

0.042

1.24

0.278

0.059

Note: IG = intervention group; CG = comparison group.

Measures and Procedure

Various reading and reading-related cognitive tests were used to select and compare the two
groups of children with RD and examine the efficacy of the intervention programme. All
the tests were applied individually in a quiet room, and the same experimenter administered
all of them. The test presentation order was randomised and took place in various sessions,
in order to avoid fatigue effects in the children.
Tasks Given only as Pre-tests
Culture Fair Intelligence Test (Scale 2, Form A). This test (Cattell & Cattell, 1950/1989)
measures general mental capacity without the interference of cultural basis. The authors
used the two halves method to calculate reliability, and they reported a correlation coefficient of 0.86. For validity, they used criteria scores on the Test of Scholar Aptitudes (TEA
Test: Seisdedos, De la Cruz, Cordero, & Gonzlez, 1991). A correlation coefficient of 0.68
was found between the g factor measure and results on the TEA test, which measured
verbal, reasoning, and numerical aptitudes.
Phonemic awareness. We administered the Test of Phonemic Awareness (Jimnez,
1995). This test evaluates the participants ability to manipulate the sounds or phonemes in
spoken words, and consists of four tasks containing 15 items each. On the isolation task,
the child listened to a word (e.g., lana [wool]) and had to say its beginning sound, /l/. On
the segmentation task, the child listened to a word (e.g., rana [frog]) and then had to say its
constituent sounds, phoneme by phoneme (e.g. /r//a//n//a/). A correct response consisted of
pronouncing the sounds or saying the names of the letters. On the deletion task, the child
listened to a word (e.g., blusa [blouse]) and then had to delete its initial sound and say the
remaining sounds (e.g., lusa). On the blending task, the child listened to a sequence of
phonemes (e.g., /m//e//s//a/) and had to say the whole word (e.g., mesa [table]). The total
score was calculated by adding the correct responses on the four tasks. Each task had a
Cronbachs alpha ranging between 0.75 and 0.86.

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M. Soriano et al.

Naming speed. The colour naming subtest from the Stroop Test (Golden, 1994) was
administered. The child was told to name the colour, as rapidly as possible, of five rows of
xxxx written in three basic colours (red, green and blue). The testretest reliability of this
test was 0.85.
Verbal working memory. To assess the childrens working memory, we administered the
task used by Siegel and Ryan (1989). The child heard sentences with the final word
missing. The task required him or her to provide the missing word and then repeat all the
missing words from the set. There were three trials at each level or set size (two, three, four
or five words). For each trial, the score was one point (three per set) when the child
performed the task successfully, and the score was zero when the child failed to complete
the task. Task administration was stopped when the child failed all the trials at one level.
Tasks Given as Pre-tests and Post-tests
Word reading fluency (PROLEC-SE; Ramos & Cuetos, 2003). This test requires the correct
identification of 40 words that vary in frequency, length and linguistic structure (CCV, CVV,
CVC, CCVC, CVVC and VC, where C = consonant and V = vowel). The childs score
consisted of an accuracy score divided by the reading speed, measured as the time taken to
complete the task, and then multiplied by 100.
Pseudo-word fluency reading (PROLEC-SE; Ramos & Cuetos, 2003). This test consists
of 40 pseudo-words (e.g., erpisa), which were constructed by changing or adding one or two
letters for each of the 40 words on the reading test. In this case, the combined pseudo-word
reading score was also based on an accuracy score divided by the reading speed, and then
multiplied by 100.
Oral text reading fluency. Children had to read aloud an appropriate 165-word text taken
from the TALE-2000 Reading Battery (Toro, Cervera, & Uro, 2002). Two combined oral
reading scores were taken: text reading speed and text reading accuracy. The former score
was calculated by dividing the number of words read correctly by the total time in seconds
to read the passage, multiplied by 60 (Parker, Hasbrouck, & Tindal, 1992). Text reading
accuracy was calculated by dividing the number of words read correctly by the total
numbers of words read and multiplying this result by 100 (Parker et al., 1992).
Reading comprehension (PROLEC-SE; Ramos & Cuetos, 2003). On this test, the children had to read a descriptive text Los esquimales [The Eskimo] only once and then
answer 10 open-ended literal and inferential questions about the text. The reading battery
has been found to have an internal consistency of Cronbachs = 0.84. Teachers ratings
of reading ability were used as validity criteria. Teachers were asked to rate reading ability
on a 10-point scale ranging from low (one) to high (10). Correlations between reading
measures and teachers ratings were statistically significant (p < 0.0001).
The test presentation order was randomised in the pre-test evaluation, alternating the
administration of the cognitive tests (intelligence, phonemic awareness, naming speed
and verbal working memory) with the administration of the reading performance tests
(word reading fluency, pseudo-word fluency, oral text reading fluency and reading
comprehension). This presentation order was used in order to avoid fatigue effects in the

Intervention to Improve Fluency and Reading Comprehension

53

children, because the reading tests are less motivating for students with RD than the
cognitive tests.
Intervention Programme
The intervention programme consisted of 40 training sessions held three times a week,
which corresponded to the timing of the special education services the participants were
receiving in their schools. The programme was carried out throughout the second quarter
of the school year, from January to April. The sessions lasted 45 minutes each, and instruction was delivered one to one. In each training session, the children were trained in one
specific phoneme (a, b, c, ch, d, e, f, g, h, i, j, k, l, ll, m, n, , o, p, q, r, s, t, u, v, w, y, z) or
consonant blend (br, bl, cl, cr, pr, pl, gr, gl, fl, fr, dr, tr). Material included: simple and
combined syllables composed of the phoneme or consonant blend; words with the
phoneme or blend in the initial, middle and, when possible, final position; sentences with
various words containing these phonemes or blends; and passages and texts of 100200
words in length.
This supplemental programme was designed to include instructional components from
the repeated reading and phonological awareness training and graphemephoneme decoding. Thus, the intervention consisted of the following instructional components: repeated
readings, and phonological awareness training and graphemephoneme decoding. With
respect to the repeated readings, in each session, the student read and reread all the material
from the session (syllables, words, sentences and passages/texts) following four steps: the
student read the material aloud; the teacher provided a prosodic reading as a model of fluent
reading; the student reread the material four times (silent reading); and the student read the
material from the session aloud again. The teacher provided corrective feedback on reading
errors. Error correction entailed saying the item(s) and asking the student to repeat it/them.
Feedback was provided on gains in speed or accuracy from the first to the last readings of
the material. With respect to the phonological awareness training and graphemephoneme
decoding, the teacher prompted the students to phonologically segment the words on which
they had made reading errors. Students applied the following steps in reading each word
(adapted from Bhattacharya & Ehri, 2004): students read the word aloud, with help if necessary; students orally divided the words pronunciation into its syllables with the visual
support of letters; students orally divided the words pronunciation into its phonemes with
the visual support of letters (phonemegrapheme correspondence); students reread the
word three times and, finally, read the word aloud; and students blended the phonemes to
say the whole word. If incorrect, they were told the word and had to repeat it. The children
were given enough help to be able to resolve the task successfully and this help was
gradually reduced.
Special needs teachers participated in two two-hour training sessions about how to
apply the programme. The first session introduced the teachers to the instructional procedures and the intervention plan. The second session focused on modelling the use of
repeated readings and the phonological awareness training and graphemephoneme decoding with the materials.
The untrained comparison group completed pre-tests and post-tests, but they received
no special instruction from the research staff. They remained in their classrooms and also
continued to receive the typical reading instruction provided by the school in the special
education classroom three days a week. The programme they followed had a more
general academic content and focused less on reading than the programme followed by
the intervention group.

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M. Soriano et al.

Analysis and Results

Gain scores were calculated comparing the pre-intervention levels for word and pseudoword reading skills, oral text reading speed and accuracy, and text comprehension for the
two groups of children who participated in the study.
The comparison of the intervention group with the untrained comparison group on the
reading variables studied was compromised by the fact that the untrained comparison group
had a lower mean age than the intervention group. To control for this difference, we carried
out a multivariate analysis of covariance (MANCOVA) using age as a covariate. Afterwards, analyses of covariance (ANCOVAs) were performed for each indicator of the reading skills evaluated: word and pseudo-word reading, text reading speed, text reading
accuracy, and text comprehension.
In addition to the results of the MANCOVA and ANCOVAs, we also provide the partial
eta squared statistic (2), which estimates the proportion of total variance accounted for by
the independent variables. For this statistic, values between 0.01 and 0.10 are considered a
small effect size, values between 0.10 and 0.30 are regarded as a medium effect size, and
those above 0.30 are considered a large effect size.
The MANCOVA performed on the gain scores at the post-intervention phase revealed
that there were significant main group effects (Wilks Lambda () = 0.286, F(5, 15) = 7.482,
2 = 0.71, p = 0.001) with large effect sizes. The results obtained from comparing the two
groups of children with and without treatment (see Table 2) revealed significant differences
in word reading skill gains, F(1, 19) = 13.620, 2 = 0.41, p = 0.002, pseudo-word reading
skill gains, F(1, 19) = 15.954, 2 = 0.45, p = 0.001, text reading speed gains, F(1, 19) =
24.072, 2 = 0.55, p = 0.001, and text reading accuracy, F(1, 19) = 12.320, 2 = 0.39, p =
0.002, with large effect sizes in all variables. In contrast, there were no differences between
the groups in comprehension gains, F(1, 19) = 0.458, 2 = 0.024, p = 0.507, at the post-intervention phase.
Thus, students in the intervention group obtained statistically significant gains on the
majority of the reading measures, except comprehension. As expected, the children with
reading disabilities in the treatment condition showed greater gains in word and pseudoword reading skills and on text reading measures (speed and accuracy) than the untreated
group of children with reading disabilities.
Table 2. Means and standard deviations of pre-test, post-test and gain scores of reading fluency
and comprehension measures for the intervention group and the comparison group.

Word reading fluency

Pseudo-word reading fluency
Text reading speed
Text reading accuracy
Text comprehension

Mean
SD
Mean
SD
Mean
SD
Mean
SD
Mean
SD

Intervention group (n = 12)

Comparison group (n = 10)

Pre-test

Post-test

Gain

Pre-test

Post-test

Gain

32.41
2.59
25.08
1.03
69.34
9.74
79.49
1.96
4.08
1.37

52.82
8.71
35.30
2.42
114.28
14.41
89.49
4.21
4.25
1.28

20.41
7.9
10.22
2.76
34.59
9.79
10
3.66
0.17
0.38

31.81
2.68
26.03
2.67
69.15
10.70
77.59
3.9
4
1.05

34.39
3.32
28
2.61
71.99
16.60
77.72
7.32
4.4
1.07

2.5
1.72
1.96
4.45
3.74
3.93
0.132
4.19
0.40
0.51

Intervention to Improve Fluency and Reading Comprehension

55

Discussion
This study examined the effectiveness of a multi-component programme that combined
empirically-supported intervention componentsthat is, repeated readings plus phonological awareness training and graphemephoneme decodingon fluency and reading
comprehension skills in Spanish children with reading disabilities.
The findings demonstrate that the children in the intervention group showed large gains
in word and pseudo-word reading skills [(accuracy/speed) x 100]. Despite the frequently
reported difficulty of improving the reading rate of very poor readers (Lovett & Steinbach,
1997), the students in the intervention condition made improvements in reading rate and
accuracy of isolated words and pseudo-words.
Recent proposals about the growth in childrens word recognition suggest that, after the
initial phases of reading acquisition, the learning effects in reading are mainly based on
the accumulation of knowledge about individual words or word representations, and the
specific problem of children with RD lies not so much in gaining orthographic access to
whole words as in computing sub-lexical phonology (Ziegler & Goswami, 2005). In the
study by Hintikka et al. (2008), a generalisation effect from the sub-lexical level to word
reading was found. Overall, the results of the present intervention study suggest that facilitating the visual identification of syllables could enhance a rapid phonological recoding
strategy, pseudo-word reading skills. However, gains in the pseudo-word reading skill
could also be due to greater knowledge about the rules of graphemephoneme conversion,
as shown in studies focused on phonemic instruction with visual support of letters (National
Reading Panel, 2000; Torgesen, 2002; Torgesen et al., 1997).
In addition, the children in the intervention group showed significant gains on the two
measures of oral text reading fluency, speed and accuracy. Studies in which students
learned to quickly recognise words in lists have produced inconsistent findings regarding
fluency in context (Levy et al., 1997). In fact, the results of a recent study by Chard, Ketterlin-Geller, Baker, Doabler, and Apichatabutra (2009), which examined research focused on
determining the efficacy of repeated reading approaches for improving the reading fluency
of students with or at risk for learning disabilities, suggested that repeated reading was not
supported by rigorous research according to the quality indicators used.
Therefore, there may be several reasons for the positive outcomes in our study. The first
is the fact that the students in the intervention group practiced repeated reading with a
connected text. Repeated practice of the words in context, in passage reading, seemed to
have enhanced their orthographic representation. However, another possible reason for the
magnitude of the fluency gains could be related to the intensity of the intervention (40
sessions), which included twice the number of sessions normally used in studies dealing
with this topic (Chard et al., 2002; Kuhn & Stahl, 2003; Meyer & Felton, 1999; National
Reading Panel, 2000; Therrien, 2004). It should also be pointed out that the implementation
of the repeated reading procedure in our study took place in optimal instructional conditions: modelling by the teacher, provision of a prosodic reading as a model of fluent
reading, along with continuous and immediate corrective feedback.
Regarding the second objective of our study, the results indicated that the multicomponent programme did not produce significant gains in reading comprehension.
Several studies have reported that an increase in fluency is also accompanied by an
increase in comprehension (see Kuhn & Stahl, 2003; Schwanenflugel et al., 2009;
Therrien, 2004). But such positive effects on comprehension are not always achieved with
fluency training, especially with secondary school students who are required to read and
comprehend more complex and elaborated texts. In general, the relationship between

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M. Soriano et al.

fluency and comprehension is weaker in older children than that usually found in younger
ones (Silberglitt, Burns, Madyum, & Lail, 2006). Supporting this idea, a recent synthesis
study carried out by Wexler, Vaughn, Edmonds, and Reutebuch (2008) on fluency interventions for struggling secondary school readers concluded that the improvements
obtained on reading rate were not necessarily generalised to word reading accuracy or
comprehension. These findings, which coincide with ours, fit the idea that comprehension
depends on skills other than just speed in recognising words. Fluent reading may improve
the readers micro-comprehension processes without directly affecting macro-comprehension processes, which are influenced by prior knowledge and more global comprehension
strategies that depend on the executive system. In such a case, it would be advisable to
complement fluency training with instruction in cognitive and meta-cognitive reading
comprehension strategies, an approach that has been shown to be quite effective in
students with RD (Berkeley, Marshak, Mastropieri, & Scruggs, 2010; Gajria, Jitendra,
Sood, & Sacks, 2007). It must be kept in mind that reading comprehension is a powerful
learning instrument. Consequently, special attention should be paid to instruction in
comprehension strategies to awaken the motivation of the students to grasp the meaning
of the text, from the initial phase of learning to read. As shown in a recent study by
Denton et al. (2010), the intervention programmes implemented with children at risk of
having learning disabilities led to gains in comprehension when they combined explicit
instruction in phonics skills and text-reading strategies with modelling and instructional
scaffolding.
Moreover, general comprehension measures (e.g., the standardised achievement tests
used in this study) may be less able to detect change than other assessment procedures, as
some studies have found that fluency training produced better performance on literal and
referential reading comprehension tasks designed by the authors (Alber-Morgan, Ramp,
Anderson, & Martin, 2007; OConnor, White, & Swanson, 2007).
In summary, results from the implementation of this multi-component intervention
programme suggest that explicit and structured instruction targeting core skills, such as
orthographic representation and phonological processing, is quite promising in the treatment of children with RD. The availability of a familiar phonological pattern is certainly a
basic pillar in enabling children with RD to perform the orthographic learning that will
provide them with direct and rapid access to the mental lexicon. Likewise, in this study,
repeated passage reading is confirmed as an effective and valuable method for increasing
word reading fluency and improving connected reading, although it does not necessarily
produce direct effects on comprehension.

Limitations and Future Research

Several limitations are evident here, including the small sample size along with the greater
number of male participants, which limit the possibility of generalising the results. Another
limitation of our study is the significant difference that exists in the age variable between
the treatment group and the comparison group. An analysis of covariance was used to
control for the possible effect of this variable on the treatment, but the best option for
experimental control would have been to match the two groups on age by pairs.
Furthermore, as this intervention was carried out one to one, future research should
explore how to best produce fluency gains in students with RD through small group instruction, which is less costly in terms of human resources. In addition, the intervention took place
in the resource room and was delivered by teachers specially prepared to instruct students
with LD. Therefore, the results cannot be generalised to the regular classroom where the

Intervention to Improve Fluency and Reading Comprehension

57

instructional conditions provide fewer opportunities for scaffolding or accommodations.

Another limitation of our study is a lack of information about both the receivers (the
students) and the direct agents of the programme (the teachers) that could support its social
validity. This issue is quite important, given that monotony and fatigue, characteristics of
repeated readings, could increase substantially when sub-lexical training is added, in which
case it would be necessary to weigh up the advantages and disadvantages of this intervention
component. Finally, another question for future studies involves the programmes possible
effects on long-term reading comprehension. A constant level of practice over a more
prolonged period of time might help students with RD to become aware of the importance
of directing their cognitive resources more to text comprehension than to speed and accuracy. Determining the impact of a multi-component programme at all levels of reading
performance would require a long-term study.
Acknowledgements
The findings reported here are based on research conducted as part of the project,
Efficacy of a Multicomponent Programme for the Treatment of Developmental Dyslexia.
Variables that Predict Treatment Response under Grant No. EDU2009-08082 from
Ministerio de Ciencia e Innovacin, and no restrictions have been imposed on free access
to, or publication of, the research data. The content of this publication does not necessarily reflect the views or policies of Ministerio de Ciencia e Innovacin, nor does mention
of trade names, commercial products, or organisations imply endorsement by Ministerio
de Ciencia e Innovacin. Opinions reflect those of the author(s) and do not necessarily
reflect those of the funding agency(ies). The author(s) had no financial or other conflicts
of interest.

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