Children at high risk of dyslexia should not have to wait for diagnoses before crucial interventions are put in place
According to recent UK statistics, 14 per cent of 11-year-olds fail to reach age-expected levels of reading. Many of these children are likely to have dyslexia, a learning difficulty which affects the ability to decode print. Arguably, of all the neurocognitive disorders, dyslexia is the best understood in terms of etiology, behaviour and life course, and it is well-established that, in cognitive terms, dyslexia is characterised by a deficit in phonological skills which compromises the ability to learn grapheme-phoneme correspondences (Vellutino, Fletcher, Snowling, & Scanlon, 2004). However, there are still far too many children who are disabled by dyslexia in the school system.
In this article, I will argue that it is possible to identify risk factors for dyslexia in the Early Years and hence, there is no reason to wait for children to fail before implementing intervention.
Several prospective longitudinal studies have followed children at family-risk of dyslexia by virtue of having an affected parent. Since dyslexia is known to be a heritable condition, the approach can be used to identify the precursors of dyslexia early in development, even before reading instruction begins (by comparing children who go on to be dyslexic with unaffected offspring). Together, these studies have shown that children who develop dyslexia at around the age of eight years typically experience delays and difficulties with language in the preschool period. At school entry, they show poorly developed phoneme awareness and limited letter knowledge which is the direct cause of reading and spelling problems. It follows that an ongoing process of screening and monitoring could be used during the Early Years to provide a good indication of children who are at risk of developing dyslexia.
Screening for dyslexia among children taught phonics
In May 2006, the Independent Review into the Teaching of Early Reading (the Rose review) recommended that all children should be taught to read using phonics, systematically, within a curriculum rich in language and literacy. Teachers working within the framework were expected to track pupils’ progress through a series of developmental phonic phases. Each phase was quantified by a number of phonic-related skills from sensitivity to rhyme and alliteration at Phase 1, to confident and fluent use of grapheme-phoneme correspondences for reading and spelling unfamiliar words at Phase 6. In a recent study, our group has examined whether teachers’ judgements made against phonic phases can provide a valid means of screening for children at risk of dyslexia (Snowling, Duff, Petrou, Schiffeldrin & Bailey, 2011).
For this study, we used data from a whole school population in a local authority that had implemented teaching of systematic phonics from school entry. Our assumption was that any child who was not secure at a developmentally-appropriate Phonic Phase (at the end of the first year of schooling) would be at-risk for dyslexia, since the child would be failing to develop adequate reading skills despite receiving systematic phonics instruction. Thus, we identified children who, at the end of the fourth term in school, were not secure in Phonic Phase 2. Phase 2 requires the child:
- to be able to provide the sound when shown any grapheme which has been taught – particularly being secure with the sounds of s, a, t, p, i, n
- to select the correct grapheme to represent any of the 19 phonemes taught in this phase
- to blend and to segment CVC (consonant/vowel/consonant) and VC words.
We proceeded to assess the predictive validity of these teacher judgments by assessing the same children six months later, on objective tests of reading and related skills. For the purpose of comparison, we also assessed a representative sample of children from the same classrooms, matched on age and gender to the “at-risk” group and rated by their teachers as progressing in line with expectation.
The findings of our study were clear and encouraging. First, we showed that teachers are good judges of their pupils’ progress; teacher assessments of phonics progress predicted 50 per cent of the variability in children’s reading skills at the end of the school year (bear in mind that objective test scores rarely produce better agreement over two points in time). Second, we found that the group of children deemed to be “at-risk” showed the characteristics of dyslexia highlighted in the Rose Review (2009) definition, namely poor phonological awareness, poor verbal memory and slow verbal processing speed. Third, consistent with a large body of research evidence, phoneme awareness, letter-sound knowledge and verbal processing speed (rapid automatized naming), but not verbal memory, predicted individual differences in reading skills, and IQ did not improve the prediction.
Based on the phonic phase assessments, 16.4 per cent of the school population was assessed as “behind expectation” in phonic skills. Since this is well above reported prevalence rates for dyslexia (typically seven to ten per cent), it is clear that these judgments alone would over-identify children who subsequently go on to be “free” of difficulty. However, this is precisely the property required of a good screener. At the time of writing, the Government is to introduce a formal phonics screening test in 2012 at the end of Year 1; it is highly unlikely that it will capture more of the variability between children than the monitoring described here. An ongoing monitoring system, such as Phonic Phases carries the advantage of being able to identify children with additional literacy needs at the earliest possible stage, ideally before the end of the Early Years, enabling teachers to hone their teaching to the needs of different members of their class.
Interventions to ameliorate the impact of dyslexia
There is now a considerable evidence base concerning effective interventions for children with dyslexia (Duff & Clarke, 2011; Snowling & Hulme, 2011). Many of these are cast with the “Three-Waves Framework”:
- Wave 1 – quality first teaching for all
- Wave 2 – additional teaching for children who are developing literacy slowly
- Wave 3 – individualized teaching for children with dyslexia.
However, if early identification and ongoing monitoring is to be a reality, then there is a pressing need for interventions that strengthen the foundations of literacy as soon as (and even before) formal reading instruction begins. Our group has in recent years been working to develop such interventions for delivery by trained teaching assistants in Early Years settings.
In one of these studies, we developed and evaluated an early intervention which aimed to prevent the development of decoding difficulties and compared it with an intervention designed to improve children’s spoken language skills. The intervention was a 20-week, daily, phonology with reading programme (P+R) delivered to children in Reception classes who were selected as being at high risk of dyslexia. The programme comprised training in letter-sound knowledge, segmenting and blending and reading from texts which were selected to be at the appropriate level following the administration of a “running record” (see Carroll, Bowyer-Crane, Duff, Hulme & Snowling, 2011). The children who received the P+R programme did significantly better than those who received the language programme (a treated control group) on tests of phoneme awareness, letter-sound knowledge and basic reading and spelling skills at the end of the intervention. Moreover, the gains were maintained some six months after the intervention had ceased.
Another way of considering these findings is in terms of how well the P+R intervention programme lifted children from the at-risk to the typical range of reading skills for their age. We were able to examine this issue because we had available data from some 500 of these children’s peers at the final time point. We found that the children who had received the P+R programme were mostly performing within the average range on tests of literacy skills – that is, although there was some variation, as a group they were doing as well as to be expected for their age. Moreover, whereas at the end of the intervention, 68.1 per cent of the control group remained at-risk for literacy difficulties, this was only the case for 50 per cent of the P+R group. A very important question, as yet virtually unaddressed, is the extent to which early interventions, such as the one discussed here, can have long term effects, and there is a pressing need for randomised trials of long duration to evaluate this issue.
The focus of this article has been on dyslexia, which primarily affects word-level decoding skills. It needs to be borne in mind that the screening and identification of children with word-level reading difficulties can miss children who take to phonics well but have more specific difficulties in reading comprehension and hence require different forms of intervention (Snowling & Hulme, 2011). Nonetheless, the findings of this study suggest that teacher observations can be considered reliable and they can be used to monitor children’s reading progress through the Early Years. Although screening processes tend to lead to the over-identification of children who are at-risk (and this was the case here), an obvious advantage is that they can lead to intervention in a timely fashion. Within this view, there is no reason for children to wait to be diagnosed as dyslexic; rather, teachers can begin to implement intervention strategies to improve reading skills as soon as they observe that children’s reading is failing to thrive in a quality teaching environment. Furthermore, once intervention is implemented, “response to intervention” can provide additional information with regard to a child’s additional needs (Fuchs & Fuchs, 2006).
Professor Maggie Snowling is based at the Department of Psychology, University of York. She served on Sir Jim Rose’s Expert Advisory Group on provision for Dyslexia (2009). She is Joint Editor of the Journal of Child Psychology and Psychiatry and the author of many influential works on dyslexia:
Carroll, J.M., Bowyer-Crane, C., Duff, F., Hulme, C., & Snowling, M.J. (2011) Developing Language and Literacy: Effective intervention for language and literacy in the early years. Oxford: Wiley-Blackwell.
Duff, F. J., & Clarke, P. J. (2011). Practitioner Review: Reading disorders – What are effective interventions and how should they be implemented and evaluated? Journal of Child Psychology & Psychiatry, 52, 3-12.
Fuchs, D., & Fuchs, L. (2006). Introduction to response to intervention: what, why, and how valid is it? Reading Research Quarterly, 41, 92-99.
Rose, J. (2006). Independent Review of the Teaching of Early Reading: Final Report. London: Department for Education and Skills Publications.
Rose, J. (2009). Identifying and teaching children and young people with dyslexia and literacy difficulties. DCSF Publications, DCSF- 00659-2009.
Snowling, M. J., & Hulme, C. (2011, in press). Evidence-based Interventions for Reading and Language Difficulties: Creating a Virtuous Circle. British Journal of Educational Psychology, 81(1), 1-23.
Snowling, M. J., Duff, F., Petrou, A., Schiffeldrin, J., & Bailey, A. M. (2011). Identification of children at risk of dyslexia: the validity of teacher judgements using “Phonic Phases”. Journal of Research in Reading, 34(2), 157-170.
Vellutino, F. R., Fletcher, J. M., Snowling, M. J., & Scanlon, D. M. (2004). Specific reading disability (dyslexia): what have we learned in the past four decades? Journal of Child Psychology & Psychiatry, 45(1), 2-40.