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There is much that parents and caregivers can do to help their struggling readers, beginning with understanding how reading is taught in the classroom. The authors of this article offer families a research-based set of six practices for what they can do to support their child with reading difficulties.

Many states now mandate early screening for dyslexia, but vary in how they address these mandates. There is confusion about the nature of screening versus diagnostic assessments, risk versus diagnosis, concurrent versus predictive validity, and inattention to indices of classification accuracy as the basis for determining risk. To help define what constitutes a screening assessment, we summarize efforts to develop short (3-5 min), teacher-administered screens that used multivariate strategies for variable selection, item response theory to select items that are most discriminating at a threshold for predicting risk, and statistical decision theory. These methods optimize prediction and lower the burden on teachers by reducing the number of items needed to evaluate risk. A specific goal of these efforts was to minimize decision errors that would result in the failure to identify a child as at risk of dyslexia/reading problems (false negatives) despite the inevitable increase in identifications of children who eventually perform in the typical range (false positives). Five screens, developed for different periods during kindergarten, Grade 1, and Grade 2, predicted outcomes measured later in the same school year (Grade 2) or in the subsequent year (Grade 1). The results of this approach to development are applicable to other screening methods, especially those that attempt to predict those children at risk of dyslexia prior to the onset of reading instruction. Without reliable and valid early predictive screening measures that reduce the burden on teachers, early intervention and prevention of dyslexia and related reading problems will be difficult.

The degree to which a student expresses a reading difficulty is always an interaction between the child's opportunity to learn (due to absences, instructional quality, or other issues) and the extent of the student's reading impairment. Thus, youngsters who are provided a genuine opportunity to learn to read--including high-quality, explicit, evidence-based instruction--and yet still present with significant reading difficulties are likely to have a severe reading impairment. In contrast, children who have not consistently been able to access high-quality, evidence-based instruction and present with significant reading difficulties are likely to have reading problems that could have been prevented and still can be remediated. This difference is of the utmost importance. Currently, there are students with preventable reading problems who are suffering academically and emotionally, and who are placed in special education often to receive accommodations without effective remediation. And there are students with severe reading disabilities or dyslexia who are not getting the intensive interventions they need--in part because special education is overwhelmed with large numbers of students who do not actually have reading disabilities. These are systemic problems--and that is why the authors of this article have proposed a new, seamless, three-tiered system of general and special education to address them. The article discusses how a supportive, integrated general and special education system can be implemented. Six steps that teachers can implement in their classrooms to support students with reading difficulties or with mild to moderate disabilities or dyslexia are provided.

To learn to read, the brain must repurpose neural systems for oral language and visual processing to mediate written language. We begin with a description of computational models for how alphabetic written language is processed. Next, we explain the roles of a dorsal sublexical system in the brain that relates print and speech, a ventral lexical system that develops the visual expertise for rapid orthographic processing at the word level, and the role of cognitive control networks that regulate attentional processes as children read. We then use studies of children, adult illiterates learning to read, and studies of poor readers involved in intervention, to demonstrate the plasticity of these neural networks in development and in relation to instruction. We provide a brief overview of the rapid increase in the field's understanding and technology for assessing genetic influence on reading. Family studies of twins have shown that reading skills are heritable, and molecular genetic studies have identified numerous regions of the genome that may harbor candidate genes for the heritability of reading. In selected families, reading impairment has been associated with major genetic effects, despite individual gene contributions across the broader population that appear to be small. Neural and genetic studies do not prescribe how children should be taught to read, but these studies have underscored the critical role of early intervention and ongoing support. These studies also have highlighted how structured instruction that facilitates access to the sublexical components of words is a critical part of training the brain to read.

This article addresses the nature of dyslexia and best practices for identification and treatment within the context of multitier systems of support (MTSS). We initially review proposed definitions of dyslexia to identify key commonalities and differences in proposed attributes. We then review empirical evidence for proposed definitional attributes, focusing on key sources of controversy, including the role of IQ, instructional response, as well as issues of etiology and immutability. We argue that current empirical evidence supports a dyslexia classification marked by specific deficits in reading and spelling words combined with inadequate response to evidence-based instruction. We then propose a "hybrid" dyslexia identification process built to gather data relevant to these markers of dyslexia. We argue that this assessment process is best implemented within school-wide MTSS because it leverages data routinely collected in well-implemented MTSS, including documentation of student progress and fidelity of implementation. In contrast with other proposed methods for learning disability (LD) identification, the proposed "hybrid" method demonstrates strong evidence for valid decision-making and directly informs intervention.

Bowers ("Educational Psychology Review," 32, 681-705, 2020) reviewed 12 meta-analytic syntheses addressing the effects of phonics instruction, concluding that the evidence is weak to nonexistent in supporting the superiority of systematic phonics to alternative reading methods. We identify five issues that limit Bowers' conclusions: (1) definition issues; (2) what is the right question?; (3) the assumption of "phonics first"; and (4) simplification of issues around systematic versus explicit phonics. We then go on to consider (5) empirical issues in the data from meta-analyses, where Bowers misconstrues the positive effects of explicit phonics instruction. We conclude that there is consistent evidence in support of explicitly teaching phonics as part of a comprehensive approach to reading instruction that should be differentiated to individual learner needs. The appropriate question to ask of a twenty-first century science of teaching is not the superiority of phonics versus alternative reading methods, including whole language and balanced literacy, but how best to combine different components of evidence-based reading instruction into an integrated and customized approach that addresses the learning needs of each child. [For Bowers' "Reconsidering the Evidence That Systematic Phonics Is More Effective than Alternative Methods of Reading Instruction," see EJ1263190.]

The Management of Myelomeningocele Study (MOMS), a randomized trial of prenatal versus postnatal repair for myelomeningocele, found that prenatal surgery resulted in reduced hindbrain herniation and need for shunt diversion at 12 months of age and better motor function at 30 months. In this study, we compared adaptive behavior and other outcomes at school age (5.9-10.3 years) between prenatal versus postnatal surgery groups. Follow-up cohort study of 161 children enrolled in MOMS. Assessments included neuropsychological and physical evaluations. Children were evaluated at a MOMS center or at a home visit by trained blinded examiners. The Vineland composite score was not different between surgery groups (89.0 ± 9.6 in the prenatal group versus 87.5 ± 12.0 in the postnatal group; P = .35). Children in the prenatal group walked without orthotics or assistive devices more often (29% vs 11%; P = .06), had higher mean percentage scores on the Functional Rehabilitation Evaluation of Sensori-Neurologic Outcomes (92 ± 9 vs 85 ± 18; P < .001), lower rates of hindbrain herniation (60% vs 87%; P < .001), had fewer shunts placed for hydrocephalus (49% vs 85%; P < .001) and, among those with shunts, fewer shunt revisions (47% vs 70%; P = .02) than those in the postnatal group. Parents of children repaired prenatally reported higher mean quality of life z scores (0.15 ± 0.67 vs 0.11 ± 0.73; P = .008) and lower mean family impact scores (32.5 ± 7.8 vs 37.0 ± 8.9; P = .002). There was no significant difference between surgery groups in overall adaptive behavior. Long-term benefits of prenatal surgery included improved mobility and independent functioning and fewer surgeries for shunt placement and revision, with no strong evidence of improved cognitive functioning.

This study examines the initial word reading performance of fourth-grade struggling readers and the extent to which differing levels of word reading performance at pretest influenced their response to reading interventions. A large group of students with significant reading comprehension difficulties (N = 481) were classified into three clusters of word reading proficiency based on their pretest performance: (a) very low, (b) low, and (c) near adequate. We examined their performance on several academic, language, and executive functioning measures at the beginning of the year and their reading comprehension performance at the beginning of year and after 1 year of reading intervention to examine how each cluster responded to instruction. Results from a discriminant function analysis indicated that performance on five pretest variables were meaningful predictors of word reading proficiency cluster membership: phonological processing, writing fluency, math calculation, math fluency, and reading efficiency and comprehension. Results also demonstrated that word reading proficiency at pretest was related to response to intervention on reading comprehension measures. Students in the very low word reading proficiency cluster showed minimal response to intervention whereas the near-adequate word reading cluster demonstrated greatest response to intervention. These results suggest word reading is a critical predictor of response to intervention for students with significant comprehension problems in the upper elementary grades and that students with the most substantial word reading problems may require more intensive and specialized treatments than students with greater word reading performance to show meaningful progress in reading.

We examined the effectiveness of a researcher-provided reading intervention with 484 fourth graders with significant reading difficulties. Students were randomly assigned to one year of intervention, two years of intervention, or a business-as-usual comparison condition (BAU). Students assigned to two years of intervention demonstrated significantly greater gains in reading fluency compared to students who received one year of intervention and the BAU group. Students in both the one- and two-year groups demonstrated similar and significantly larger gains in word reading in comparison to the BAU group. There were no statistically significant differences between the three groups on standardized measures of reading comprehension. We discuss these results in the context of research with late elementary and secondary students targeting reading comprehension.

This study examined the effectiveness of a researcher-provided intervention with 4th-graders with significant reading difficulties. The intervention emphasized multi-syllable word reading, fluent reading of high frequency words and phrases, vocabulary, and comprehension. To identify the participants, 1,695 fourth grade students were screened using the Gates MacGinitie Reading Test, and those whose standard score was 85 or lower were included in the study (N=485). Participants were randomly assigned (2:1) to receive either researcher-provided intervention (n=324) or intervention provided by school personnel (business as usual, BAU) (n=161). Findings revealed no statistically significant differences between students in the researcher-provided intervention and BAU groups. Using effect sizes as an indicator of impact, students in the researcher implemented treatment generally outperformed students in the school implemented treatment (BAU). Examining growth in standard scores, both groups made significant gains in reading outcomes with standard score growth from pretest to posttest of 3 standard score points on decoding, 5 on fluency,, and 2.0 to 7 standard score points on reading comprehension measures.

The role of executive function (EF) in the reading process, and in those with reading difficulties, remains unclear. As members of the Texas Center for Learning Disabilities, we review multiple perspectives regarding EF in reading and then summarize some of our recent studies of struggling and typical readers in grades 3-5. Study 1a found that a bi-factor structure best represented a comprehensive assessment of EF. Study 1b found that cognitive and behavioral measures of EF related independently to math and reading. Study 1c found that EF related to reading, above and beyond other variables, but Study 1d found no evidence that adding an EF training component improved intervention response. Study 1e found that pretest EF abilities did not relate to intervention response. Neuroimaging studies examined EF-related brain activity during both reading and nonlexical EF tasks. In Study 2a, the EF task evoked control activity, but generated no differences between struggling and typical readers. The reading task, however, had group differences in both EF and reading regions. In Study 2b, EF activity during reading at pretest was related to intervention response. Across studies, EF appears involved in the reading process. There is less evidence for general EF predicting or improving intervention outcomes.

We examine the efficacy of an intervention to improve word reading and reading comprehension in fourth- and fifth-grade students with significant reading problems. Using a randomized control trial design, we compare the fourth- and fifth-grade reading outcomes of students with severe reading difficulties who were provided a researcher-developed treatment with reading outcomes of students in a business-as-usual (BAU) comparison condition. A total of 280 fourth- and fifth-grade students were randomly assigned within school in a 1:1 ratio to either the BAU comparison condition (n = 139) or the treatment condition (n = 141). Treatment students were provided small-group tutoring for 30 to 45 minutes for an average of 68 lessons (mean hours of instruction = 44.4, SD = 11.2). Treatment students performed statistically significantly higher than BAU students on a word reading measure (effect size [ES] = 0.58) and a measure of reading fluency (ES = 0.46). Though not statistically significant, effect sizes for students in the treatment condition were consistently higher than BAU students for decoding measures (ES = 0.06, 0.08), and mixed for comprehension (ES = -0.02, 0.14).

Disorders of reading, math, and attention frequently co-occur in children. However, it is not yet clear which cognitive factors contribute to comorbidities among multiple disorders and which uniquely relate to one, especially because they have rarely been studied as a triad. Thus, the present study considers how reading, math, and attention relate to phonological awareness, numerosity, working memory, and processing speed, all implicated as either unique or shared correlates of these disorders. In response to findings that the attributes of all three disorders exist on a continuum rather than representing qualitatively different groups, this study employed a dimensional approach. Furthermore, we used both timed and untimed academic variables in addition to attention and activity level variables. The results supported the role of working memory and phonological awareness in the overlap among reading, math, and attention, with a limited role of processing speed. Numerosity was related to the comorbidity between math and attention. The results from timed variables and activity level were similar to those from untimed and attention variables, although activity level was less strongly related to cognitive and academic/attention variables. These findings have implications for understanding cognitive deficits that contribute to comorbid reading disability, math disability, and/or attention-deficit/hyperactivity disorder.

This study examined how differences in listening comprehension and word reading at the beginning of the school year influence changes in reading comprehension for English learners (ELs) with significant reading difficulties compared to non-ELs with significant reading difficulties. The study investigated heterogeneity in response to instruction among 400 struggling readers in fourth grade (n = 183 for non-EL; n = 217 for EL) who received an intensive reading intervention. At pretest, word reading, listening comprehension, and reading comprehension were measured, and at posttest, reading comprehension was measured again. Results from moderated multiple regression analyses showed a significant three-way interaction such that reading comprehension at posttest was higher for ELs than non-ELs with similar levels of low word reading but relatively higher levels of listening comprehension. However, non-ELs outperformed ELs with similar levels of relatively high word reading and average to high listening comprehension. The findings suggest that pre-intervention skill profiles may need to be interpreted differently for ELs and non-ELs with significant reading difficulties in relation to language and literacy outcomes.

This study investigated the reading profiles of middle school Spanish-speaking emergent bilinguals (EBs) with significantly below grade level reading comprehension and whether these profiles varied in their reading comprehension performance over time. Latent profile analyses were used to classify Grade 6 and 7 Hispanic EBs (n = 340; 39% female) into subgroups based on their word reading and vocabulary knowledge. Growth models were then fit within each profile to evaluate reading comprehension performance over time. Analyses revealed four latent profiles emerged: (a) very low word reading and low vocabulary (10%), (b) low word reading and low vocabulary (71%), (c) average word reading and low vocabulary (16%), and (d) high word reading and low vocabulary (3%). Subgroups varied in their reading comprehension initially and over one year. Students in the subgroup marked by very low word reading and low vocabulary showed the lowest reading comprehension performance initially; however, they also showed the greatest growth over one year. These findings suggest that there is heterogeneity in the reading skill profiles of Spanish-speaking EBs with reading comprehension difficulties. They also underscore the prevalence of word reading difficulties among these students. These may be important factors to consider when developing interventions to prevent and remediate these difficulties. [ABSTRACT FROM AUTHOR]

We investigated the classification accuracy of learning disability (LD) identification methods premised on the identification of an intraindividual pattern of processing strengths and weaknesses (PSW) method using multiple indicators for all latent constructs. Known LD status was derived from latent scores; values at the observed level identified LD status for individual cases according to the concordance/discordance method. Agreement with latent status was evaluated using (a) a single indicator, (b) two indicators as part of a test-retest "confirmation" model, and (c) a mean score. Specificity and negative predictive value (NPV) were generally high for single indicators (median specificity = 98.8%, range = 93.4%-99.7%; median NPV = 94.2%, range = 85.6%-98.7%), but low for sensitivity (median sensitivity = 49.1%, range = 20.3%-77.1%) and positive predictive value (PPV; median PPV = 48.8%, range = 23.5%-69.6%). A test-retest procedure produced inconsistent and small improvements in classification accuracy, primarily in "not LD" decisions. Use of a mean score produced small improvements in classifications (mean improvement = 2.0%, range = 0.3%-2.8%). The modest gains in agreement do not justify the additional testing burdens associated with incorporating multiple tests of all constructs.

We examined the effectiveness of a researcher-provided reading intervention with 484 fourth graders with significant reading difficulties. Students were randomly assigned to one year of intervention, two years of intervention, or a business-as-usual comparison condition (BAU). Students assigned to two years of intervention demonstrated significantly greater gains in reading fluency compared to students who received one year of intervention and the BAU group. Students in both the one- and two-year groups demonstrated similar and significantly larger gains in word reading in comparison to the BAU group. There were no statistically significant differences between the three groups on standardized measures of reading comprehension. We discuss these results in the context of research with late elementary and secondary students targeting reading comprehension.

We describe findings from a series of longitudinal studies utilizing a response to intervention framework implemented over 3 years with students in Grades 6 through 8 with reading disabilities and poor reading comprehension. Students were identified based on reading comprehension scores in Grade 5 (n = 1,083) and then randomized to treatment or comparison conditions. Beginning in sixth grade, students assigned to intervention were provided treatment for 1, 2, or 3 years based on their response to instruction in each preceding year. Screening procedures, progress monitoring tools, tiers of instruction, and findings from each year of the study are reported. Additional studies investigating reading and behavioral outcomes through multi-level, growth modeling, and studies of the cognitive and neural correlates of inadequate response are also reported.

We review literature related to the assessment and identification of Specific Learning Disabilities (SLD) and Intellectual Disabilities (ID). SLD and ID are the only two disorders requiring psychometric test performance for identification within the group of neurodevelopmental disorders in Diagnostic and Statistical Manual – 5. SLD and ID are considered exclusionary of one another, but the processes for assessment and identification of each disorder vary. There is controversy about the identification and assessment methods for SLD, with little consensus. Unlike ID, SLD is weakly related to full-scale IQ, and there is insufficient evidence that the routine assessment of IQ or cognitive skills adds value to SLD identification and treatment. We have proposed a hybrid method based on the assessment of low achievement with norm-referenced tests, instructional response, and other disorders and contextual factors that may be comorbid or contraindicative of SLD. In contrast to SLD, there is strong consensus for a three-prong definition for the identification and assessment of ID: (a) significantly subaverage IQ, (b) adaptive behavior deficits that interfere with independent living in the community, and (c) age of onset in the developmental period. For both SLD and ID, we identify areas of controversy and best practices for identification and assessment. [ABSTRACT FROM AUTHOR]

Component skills and discourse frameworks of reading have identified characteristics of readers and texts that influence comprehension. However, these 2 frameworks have not previously been integrated in a comprehensive and systematic way to explain performance on any standardized assessment of reading comprehension that is in widespread use across a broad developmental spectrum. The current study undertook such an integration using the reading comprehension subtest of the Gates-McGinitie Reading Tests, investigating characteristics of the test's reading passages and comprehension questions and the component reading skills of students in middle and high school (n = 1,190) in order to determine the extent to which each of these dimensions affect test performance, both on average and through interaction with one another. The component skills of reading included word reading, reading fluency, vocabulary, background knowledge, and working memory. Test questions were coded for their processing demands, specifically the need to recall information from test and to form text-based inferences, while text passages were measured on word frequency, sentence length, text cohesion, and genre. We found that better vocabulary and background knowledge were the most important reader characteristics in accounting for reading comprehension. The processing demands of test questions were not highly predictive of item difficulty. Rather, genre was the most important passage feature in explaining item difficulty. Reader-test interactions were present, but were not pronounced. We discuss the importance of these findings as they relate to the measurement of comprehension and the integration of component skills and text-discourse models of reading.