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Keywords:

  • Dyslexia;
  • reading at-risk;
  • assessment;
  • teaching

Abstract

  1. Top of page
  2. Abstract
  3. Key Practitioner Message
  4. Design of the at-risk study
  5. Core findings of the at risk study
  6. Implications of the at-risk findings for practice
  7. Conclusion
  8. Acknowledgements
  9. References

A longitudinal study was conducted of 50 at-risk poor readers who were seen at four assessment points between the ages of three years and nine months and 12–13 years. This provided a wealth of data about the incidence of reading problems, the course of developmental relationships among language and literacy skills and the factors that influence outcome (including risk and protective factors and co-morbid difficulties). The practical implications of this study are considered for the management of poor readers; including identifying children at-risk of dyslexia, assessing and teaching poor readers, addressing co-occurring difficulties, capitalising on compensatory or protective factors and providing emotional support.


Key Practitioner Message

  1. Top of page
  2. Abstract
  3. Key Practitioner Message
  4. Design of the at-risk study
  5. Core findings of the at risk study
  6. Implications of the at-risk findings for practice
  7. Conclusion
  8. Acknowledgements
  9. References
  •  The link between early language and phonology and later reading ability suggests that it is possible to screen for dyslexia in children as young as five
  •  Assessment of the poor reader needs to reflect the multidimensional nature of literacy skills and its underlying phonological basis
  •  Assessing language, maths, attention and visuo-spatial difficulties is essential for detecting co-occurring difficulties common in children with dyslexia
  •  Additional literacy support needs to address the core phonological and decoding problems experienced by children with dyslexia
  •  Recognising and promoting the development of compensatory strategies may help to improve the outcome for many children with dyslexia

Becoming fluent in literacy might easily be considered to be the single most important challenge of a child’s early school life, forming as it does the foundation of later academic learning. Yet significant numbers of children (as many as 5–8% of the child population) have a constitutional difficulty in acquiring basic literacy skills. This paper explores the practical implications of findings from a longitudinal study of children at familial risk of developmental dyslexia (Gallagher, Frith, & Snowling, 2000; Snowling, Gallagher, & Frith, 2003; Snowling, Muter & Carroll, 2007; Snowling, 2008). The core findings over four assessment points (from age 3;09 to 12–13 years) are summarised and related to educational, behavioural and emotional issues that are of relevance to the practitioner working with children with dyslexia and their families.

Dyslexia is a language-based disorder that runs in families and shows substantial genetic influences (Pennington & Olson, 2005). One way to identify children at-risk of this condition, before they have had the opportunity to learn to read, is to select children from families where a first order relative (usually the mother or father) is known to be dyslexic. Studies of at-risk families provide a great deal of information about early predictors of reading failure while avoiding the bias of retrospective studies. In this long-term study, a sample of three-year-olds from families with a history of dyslexia, was recruited and followed over a period of about 10 years. The aims of the study were to:

  • Determine the incidence of dyslexia in children born into families where one parent was known to be themselves dyslexic
  • Specify the developmental relationships among oral language, phonological awareness and reading skills assessed longitudinally between the ages of three and 13 years
  • Determine the risk and protective factors that modify the expression of a dyslexic predisposition
  • Explore to what degree children’s behaviour and self-esteem are affected by their dyslexia, particularly as they enter their adolescent years
  • Consider the presence of co-occurring difficulties, including arithmetic problems, language disorder, and attention problems

Meaningful results that addressed these questions should provide clear implications for the management of children with dyslexia. In particular, such findings might influence identification, assessment and teaching practices, as well as permitting an understanding of what additional support needs to be made available to these children who have co-occurring learning, behavioural and emotional difficulties.

Design of the at-risk study

  1. Top of page
  2. Abstract
  3. Key Practitioner Message
  4. Design of the at-risk study
  5. Core findings of the at risk study
  6. Implications of the at-risk findings for practice
  7. Conclusion
  8. Acknowledgements
  9. References

Seventy-three children were drawn from volunteer (and therefore predominantly middle-class) families in whom a first-degree relative (parent or in a small number of cases a sibling) was reported to be dyslexic. At the same time, a control group was recruited in which no parent or sibling was known to have reading problems. Data from 63 of the at risk children and 34 controls, assessed at ages 3;09 years and 6 years (Phases 1 and 2 of the study) were reported by Gallagher et al. (2000). Further analyses were conducted on a sub-sample of 56 children from the at-risk group whose family risk was determined by formal tests rather than by self-report (together with 29 control children); the findings from this sample at ages 3;09, 6 and 8 (Phases 1, 2 and 3) were reported by Snowling et al., (2003). Most recently, 50 children from the at-risk group and 20 control children, now aged 12–13 years, participated in a final Phase 4 study (Snowling et al. 2007). In all four phases, the children completed a wide range of cognitive, language and educational tests. In Phase 4, further information was obtained from the children and from their parents in order to assess aspects of their learning and family environment, their behavioural and emotional adjustment, and their self-perception. For a full description of the methodology and results of the study, the reader is advised to consult Snowling et al., 2007.

Core findings of the at risk study

  1. Top of page
  2. Abstract
  3. Key Practitioner Message
  4. Design of the at-risk study
  5. Core findings of the at risk study
  6. Implications of the at-risk findings for practice
  7. Conclusion
  8. Acknowledgements
  9. References

Phase 1 (age 3 years)

Children in the at-risk group were noted to be significantly weaker than children in the control group in respect of their vocabulary development, expressive language and grammatical skills. There were also group differences in emergent literacy skills, notably letter knowledge.

Phase 2 (age 6 years)

By the time the children were assessed at age six, about half of the children in the at-risk group (37 of the sample of 63) were delayed in their literacy development when compared with the low-risk (control) children. The strongest predictor of early reading progress was letter knowledge. In addition, the children in the at-risk literacy delayed group showed mild delays in all aspects of spoken language (semantic and syntactic) as well as phonological development.

Phase 3 (Age 8 Years)

At age eight, 37 out of the 56 at-risk children (66%) were experiencing significant literacy problems compared with only four of 29 (14%) controls. Moreover, an unexpected finding was that, among those at-risk children who were classified as normal readers at eight years, there were significant weaknesses in spelling, nonword reading and reading comprehension relative to controls. Additionally, the at-risk unimpaired children showed mild, but nonetheless significant impairments of short-term verbal memory and phonological awareness. These findings highlight the fact that dyslexia is a dimensional disorder and imply that the family risk of dyslexia is continuous. This means that at-risk children who are apparently unimpaired in reading nonetheless show some of the behavioural characteristics of dyslexia, including phonological processing, decoding and spelling weaknesses. An important finding of Phase 3 was that at-risk children who have good oral language skills may be able to get around their reading difficulties by using compensatory strategies that ‘protect’ them from failure. Snowling et al. (2003) hypothesised that these children are able to rely on their strong semantic skills for reading from an early stage, so compensating for their weaker phonological decoding abilities. They went on to propose that the expression of a given child’s dyslexia will depend on the interplay between the severity of the underlying phonological deficit and the availability of compensatory resources including vocabulary and grammatical strengths.

Phase 4 (age 13 years)

At Phase 4, the prevalence rate of dyslexia was estimated to be 42% (21 out of 50 of the high-risk group were experiencing significant literacy difficulties). These findings were more in keeping with those of other at-risk studies of dyslexia than were the findings in Phase 3, though given sample attrition it is important to be cautious when interpreting this finding. The at-risk poor readers scored significantly below the at-risk unimpaired and the control groups on measures of Verbal IQ and on tests that are sensitive to phonological processing abilities (specifically, measures of phonological awareness, non-word repetition and non-word reading). More than 70% (16 out of the 21) of the at-risk poor readers showed additional difficulties in respect of language skills, non-verbal skills, arithmetic or attention control (and sometimes a combination of these). There was stability in performance on literacy tasks between Phases 3 and 4 for all groups, and neither progressive decline nor ‘catching up’ was observed. Although the at-risk children whose reading levels were within the normal range achieved acceptable levels of word recognition and reading comprehension, they nonetheless exhibited significant difficulties in reading fluency, exception word reading and spelling.

At Phase 4, additional non-cognitive measures were taken which allowed us to study the children’s psychosocial adjustment, their self-esteem and environmental factors that might have affected literacy outcome. Questionnaires that looked at the children’s ability to recognise the titles of books and the names of authors (essentially measures of print exposure) showed that poor readers read less than good readers. Consequently, not only did they struggle to read material, but they also avoided reading, which meant that they had less opportunity to practice this skill. Parent ratings using the SDQ revealed that the at-risk poor readers were rated as having greater problems of attention control and more emotional difficulties. In the absence of information from teachers, it was not possible to determine whether the emotional and attention difficulties seen at home extended also to the school setting. Also of interest was a significant association between poor reading and maternal general health, suggesting that having a poor adolescent reader within the family may raise stress levels of family members (although it remains possible that the causal direction is opposite to this and that poor maternal health is a risk factor for dyslexia). Finally, measures of self-perception revealed that the at-risk poor readers rated themselves as poorer scholastically than either the control or at-risk unimpaired children. However, there were no differences between the groups in respect of perceived social or athletic competence. This suggests that poor readers are aware of their academic difficulties, but that they do not have globally poor self-esteem.

Implications of the at-risk findings for practice

  1. Top of page
  2. Abstract
  3. Key Practitioner Message
  4. Design of the at-risk study
  5. Core findings of the at risk study
  6. Implications of the at-risk findings for practice
  7. Conclusion
  8. Acknowledgements
  9. References

Identifying children at risk of dyslexia

Incidence of dyslexia in the at-risk sample.  The findings of the present study, and indeed of others conducted in the US, Europe and Australia, indicate that children from families where a close relative has dyslexia may themselves be predisposed to having literacy difficulties. These results point to between one-third and one-half of the at-risk sample having significant literacy problems well into their secondary school years. In addition, there were significant numbers of children in the at-risk study who had avoided major reading problems, but who nonetheless had milder fluency and spelling difficulties. Consequently it would seem reasonable when a child is referred for a reading difficulty to explore whether there is a family history of such problems. Helping families to understand that there is a substantial genetic influence on reading problems (and yet there is positive action that can be taken to reduce its impact) may influence family acceptance of the issues and enable them to mobilise relevant support. In light of this, it is interesting to note that many of the at-risk children in the present study were receiving parental input with letter learning and aspects of phonics before they started school whereas this was less often the case in the control group. Also, informing parents of genetic influences alerts them to the possible at-risk status of other children in the family.

Pre-school predictors of reading problems.  The findings of our study add to the wealth of research evidence linking early language (in particular phonological) skill to later ease of learning to read. A study of normally developing readers followed from ages 4–7 years (during their first two years of learning to read) showed that the best longitudinal predictors of reading outcome at age 6–7 years were the children’s early alphabet knowledge and their awareness of the phonemic structure of words (Muter et al., 2004). The findings from our present study indicate that the same pattern emerges for at-risk poor readers as well as for normally developing readers. In addition, our at-risk study showed that the children who went on to become delayed readers at 6 had shown weaknesses in their vocabulary development and their expressive language (as well as their phonological skills) at age 3–4 years.

There are three important practical implications that follow from these findings. First, children who experience slow speech and language development should be considered at-risk for later reading problems - thus, their progress in literacy during their early years at school needs to be closely monitored. Additionally, given that early language and phonological skills are good predictors of reading outcome, it would seem to be appropriate for children entering school with poor oral language skills to receive intervention to promote foundation language skills (Bowyer-Crane et al.; in press).Second, it should be possible to identify children during the foundation years who continue to be at risk for reading problems, simply by administering tests of letter knowledge and phoneme awareness. Indeed, earlier studies using the Phonological Abilities Test, (PAT) (Muter, Hulme & Snowling, 1997) found that administering a test of letter knowledge, together with two tests of phoneme awareness, to 5-year-olds enabled prediction with more than 80% accuracy of whether the children will be ‘good’ or ‘poor’ readers one year later (Muter, 2003; see also Puolakanaho et al., 2007). Finally, the observation of a close association between early language/phonology and later reading suggests that parents potentially have a role to play in first, helping foster and promote the pre-literacy skills of both typically developing and at-risk pre-schoolers (Likierman & Muter, 2006). Additionally, the present study highlighted the importance of parents as their child’s advocate, particularly in terms of mobilising school-based support; 68% of the parents of the at-risk literacy impaired children had been to the child’s school with worries about their progress. Less advantaged families may need more support to enable them to be effective advocates.

Assessing children with dyslexia

The multidimensional nature of literacy assessment.  Children referred with literacy problems are typically assessed using standard measures of reading accuracy (often just single word reading) and of spelling. However, it is clear from these findings that literacy skills are multidimensional and that, in order to obtain a full picture of a child’s literacy difficulties and to understand how these might affect their access to the curriculum, it is important to assess:

  • Single word reading skill
  • Prose reading ability
  • Reading comprehension
  • Reading speed and fluency
  • Spelling

Examples of appropriate literacy assessment tools can be found in Hurry and Doctor (2007).

Beyond literacy testing.  When an in-depth assessment of a child with persisting reading difficulties (that have not responded to standard school intervention practices) is required, it is important to reflect the likely complex multidimensional nature of such difficulties in the breadth of tests given. The findings from this at-risk study highlight the need to determine the nature of the presenting child’s literacy problems by assessing those skills that contribute to reading success and failure. Literacy difficulties in this sample were strongly associated with deficits in phonological awareness, repetition skills and in decoding ability. Also, broader language skills can influence reading ability. Children with poor language ability may be particularly impaired in their reading comprehension, while conversely children who have strong language abilities may have an important compensatory resource available which can help to improve their reading skills. Consequently, an assessment protocol should include:

  • A test of decoding ability, typically nonword reading
  • A test of phoneme awareness
  • A test of short-term verbal working memory
  • A non-word repetition test (a marker of likely concomitant language impairment)
  • Tests of vocabulary and grammatical sensitivity

Assessing for co-occurring difficulties.  This at-risk study has confirmed that more than 70% of children with dyslexia have a co-occurring difficulty. Numeracy problems are in most cases as serious for these children as are their literacy problems. Consequently, it is important to assess the child’s number skills as well as their literacy achievements. Conditions that commonly co-occur alongside dyslexia include attention deficit with hyperactivity disorder (ADHD), nonverbal learning difficulties and specific language impairments. Again it is important in assessment to ensure that abilities relevant to these co-occurring disorders are evaluated. Given time constraints, useful information can be obtained through questionnaires such as the Strengths and Difficulties Questionnaire (Goodman, 1997) and the Children’s Communication Checklist 2, (CCC2) (Bishop, 2003).

Management of children with dyslexia

Teaching literacy skills to children with dyslexia.  The findings from this study of at-risk children add further weight to the now well established association between phonological skills, decoding and reading development. Together, prospective, longitudinal and intervention studies have confirmed a causal link between early phonological skills and subsequent progress in reading - a finding that may be exploited in specifying appropriate intervention programmes for children with dyslexia. Such programmes need to target the development of explicit phonological awareness within the context of learning to read and spell. A number of intervention studies conducted by ourselves and colleagues at the University of York have shown that phonological training that is explicitly linked to literacy instruction (to include work on phonic decoding) is effective in raising the literacy standards of poor readers (Hatcher et al., 2006).

Addressing co-occurring difficulties.  The teaching of children with dyslexia has focused largely on remediating their literacy problems. However, with sizeable numbers of such children experiencing additional problems, it is clear that these co-occurring difficulties may need to be addressed in their own right. Consequently, appropriate management programmes should not be limited to literacy instruction, but should also take into account individual children’s needs for speech and language therapy, occupational/physiotherapy, medication or behavioural programmes for ADHD and additional mathematics support.

Language skills and teaching children with dyslexia.  This study has provided evidence from data collected at ages eight and 13 years of a ‘bootstrapping’ effect in children with dyslexia who have good language skills. Certainly, the at-risk children with the best outcome in terms of reading were those with greater verbal ability. It is suggested that children with dyslexia who have good language skills are able to draw on their vocabulary knowledge, linking this with the context cues available in prose reading material, to aid word identification and presumably also reading comprehension. This in turn suggests a teaching methodology for the verbally able child with dyslexia that can be used to complement work on phonological and phonic skills. When they encounter a word in text they are unable to read, they should be encouraged to decode it as far as they can - even children with severe dyslexia can identify some constituent letter-phoneme pairings within words. They can then draw on their good language skills and the sentential framework within which the word is embedded, in order to make the ‘best possible estimate’ as to its actual reading. Reading Intervention is an approach with proven efficacy in which text-level reading is integrated with training in phonological awareness (Hatcher, 2006; Hatcher et al., 2006).

Poor readers should be encouraged to read.  By the age of 13 years, the at-risk poor readers in our study were reported on average to be reluctant to read. Furthermore, over and above their reading status at 8 years, print exposure was the only other concurrent predictor of reading achievement in this age group. Arguably, given fewer opportunities to practise their reading skills and to increase their word specific vocabulary, their literacy problems will become compounded. Educational programmes need to address print exposure by building in support and encouragement for children to read on a regular basis (choosing reading materials that appeal), and if necessary linking this to incentive programmes that specifically target their motivation.

Providing emotional support for teenagers with dyslexia.  These findings indicate that, by the age of 13 years, the chronic nature of the literacy difficulties experienced by some of the children had affected aspects of their behaviour, thus putting a strain on both the child and other family members. For some vulnerable adolescents, the provision of counselling and support therapies (including anxiety management) may be critical in helping them cope with the stress caused by their learning difficulties during their adolescent years.

Long-term outcome in at-risk children with dyslexia

Stability of reading problems over time.  The fact that the at-risk children’s reading skills changed relatively little after the age of eight implies that interventions to promote literacy skills should be delivered early (after school entry) to be maximally effective. Presumably, from late primary school onwards, other factors, that might include motivational issues and limited print exposure, could well act to impede the student’s progress and responsiveness to remedial intervention. Of course, older children also need, not just continuing literacy intervention, but also support to ensure that they remain motivated to engage in reading and writing exercises.

Protective influences.  The present study has suggested that good verbal skills act as protective factors to enable early compensation in children who carry a genetic risk of dyslexia. One mechanism that children use to circumvent poor phonological decoding skills is ‘semantic bootstrapping’. However, there may be other protective factors including the timing and quality of interventions the child receives, their ability to maintain attention, and conditions that might foster high levels of print exposure. As part of an educational plan, children should be encouraged to draw on their vocabulary knowledge and the context clues available in prose reading material to support their attempts at word identification. More broadly, children could be encouraged to engage in activities outside the academic domain in which they might excel and which serve to promote resilience in the face of possible educational underachievement.

Predictors of poor outcome.  While some poor readers may be able to capitalise on protective influences (that lead to improved long-term outcome), other less fortunate poor readers may find themselves exposed to adverse influences that result in a less favoured outcome. Recognising that dyslexia (like all learning disorders) occurs along a continuum of severity, it follows that some children will have greater degrees of phonological deficit than others. This in turn will contribute to the child’s extent of reading impairment and to their responsivity to remediation. Children with ‘pure’ dyslexias, uncontaminated by co-occurring difficulties, may well have better long-term outcomes than those children who have to contend not only with literacy-related problems, but also difficulties of attention control, mathematics, fine motor skill or spoken language. Environmental factors, that may be beyond the child’s control, can function to adversely affect outcome - so factors like failure to recognise the child’s difficulty, poor teaching quality, lack of learning support resources, low level of home support and dysfunctional family relations are likely to contribute to a worsening of outcome for the reading disabled child. Research from other sources (Maughan et al., 1996) suggests that when chronic reading problems occur alongside adverse family and schooling circumstances, the effects may well extend beyond poor academic outcome into the domain of longer-term anti-social behaviour.

Conclusion

  1. Top of page
  2. Abstract
  3. Key Practitioner Message
  4. Design of the at-risk study
  5. Core findings of the at risk study
  6. Implications of the at-risk findings for practice
  7. Conclusion
  8. Acknowledgements
  9. References

The opportunity to follow a sample of children at-risk for reading problems for some 10 years has provided a wealth of information with considerable practical implications for identifying, assessing and managing the child with long-standing literacy problems. This information in turn should enable the development of additional resources for these children so that their, often considerable, abilities may be harnessed and their long-term outcome improved for the benefit not only of themselves but also their families and the communities in which they live.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Key Practitioner Message
  4. Design of the at-risk study
  5. Core findings of the at risk study
  6. Implications of the at-risk findings for practice
  7. Conclusion
  8. Acknowledgements
  9. References

This study was funded by a grant from the Medical Research Council to Uta Frith and the Nuffield Foundation to Margaret Snowling who is currently funded by a British Academy Research Readership. We thank Uta Frith, Julia Carroll and Yvonne Griffiths for support at various stages of the research and all the families who took part.

References

  1. Top of page
  2. Abstract
  3. Key Practitioner Message
  4. Design of the at-risk study
  5. Core findings of the at risk study
  6. Implications of the at-risk findings for practice
  7. Conclusion
  8. Acknowledgements
  9. References
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