children at risk for developing reading difficulties

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Children at Risk for Developing ReadingDifficulties

A Remediation Study

TIMOTHY C. PAPADOPOULOSa, J.P. DASb,RAUNO K. PARRILAb and JOHN R. KIRBYc

aUniversity of Cyprus, bUniversity of Alberta, Edmonton,Canada and c Queen’s University, Kingston, Ontario, Canada

ABSTRACT This article reports two different experiments as part of alongitudinal study. The first experiment examines the long-term efficacyof two brief remedial procedures (a Meaning-Based procedure versus acognitive remediation program, the PASS Reading EnhancementProgram [PREP]) focusing on the differences in phonological andcognitive test performance of 40 children who needed remediation forpoor word decoding in Grade 1. The second study reports the outcomesof an intensified version of the PREP program that emphasizes strength-ening the cognitive processes underlying reading in a remaining groupof 24 difficult-to-remediate Grade 2 students. Follow-up data are alsoreported for this group. The results of the first study indicated that thePREP group improved significantly more in pseudo-word readingcompared to the meaning-based group right after remediation in Grade1. These differences, however, were somewhat reduced when re-test-ing occurred in Grade 2 and may be due to the influence of classroominstruction. Indeed, when both groups were compared to the normingsample, they appeared to continue to develop at an accelerated rate. Asfor the results of the second study, which focused on the longitudinaldevelopment of those 24 children who exhibited a history of chroniclow reading performance, it was shown that PREP remediation keptproducing significant gains, especially in word-decoding, a findingconsistent with the theoretical framework of PREP.

Please address correspondence to: Dr Timothy C. Papadopoulos, Department ofEducation, University of Cyprus, PO Box 20537, CY 1678, Cyprus. Email:[email protected]

School Psychology International Copyright © 2003 SAGE Publications (London,Thousand Oaks, CA and New Delhi), Vol. 24(3): 340–366. [0143–0343 (200302)24:3; 340–366; 034946]

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Papadopoulos et al.: Children at Risk for Developing Reading Difficulties

During the last decade a clear body of evidence has been developing infavour of phonological processing deficit as an explanation for readingacquisition problems (Adams, 1990; Cataldo and Ellis, 1988; Hurfordet al., 1994; Torgesen et al., 1994; Vellutino and Scanlon, 1987; Wagnerand Torgesen, 1987). It has also been suggested that dyslexia resultsfrom a specific deficit in phonological coding – the ability to translateprint to sound (Stanovich, 1988). Particularly for poor readers whoseIQ is distinctly higher than their reading level, phonological coding isfrequently identified as the core deficit (e.g. Siegel, 1992), whereas inthe ‘garden variety’ poor readers, the phonological deficit is suggestedto coexist with deficiencies in other information processing strategies(Stanovich, 1988). This approach is developed into an explicit model ofreading difficulties in Stanovich’s (1988, 1991, 1993) phonological corevariable difference model, which states that the vast majority1 ofchildren with reading disability have phonological deficits but mayvary considerably in other information processing characteristics.

These findings have led to training studies with kindergarten andprimary school students – such as those conducted earlier by Lundbergand his colleagues (e.g. Lundberg et al., 1988; Oloffson and Lundberg,1983) and more recently by Byrne and colleagues (e.g. Byrne andFielding-Barnsley, 1993) – that focus on teaching phonological skills tobeginning readers in order to facilitate their reading acquisition proc-ess. It seems that most of the research on phonological training hasbeen based on the assumption that explicit training of phonologicalawareness – that is, awareness of the sound structure of language – isinvaluable when the ultimate goal is to develop effective reading (Adams,1990).

There is, however, also growing agreement in regard to the limitationsof phonological awareness training studies. Torgesen (1995), for example,commenting on the success of those studies with specific reference tochildren who exhibit ‘phonologically-based reading disabilities’ (p. 91),recognized the existence of studies that report treatment failures withexplicit phonological instruction and suggests that ‘we still have muchto learn about word level reading instruction with these children’ (p. 93).Moreover, Wagner et al. (1993) concluded, after considering the resultsof phonological training studies, that ‘highly intensive and sustainedphonological awareness training by itself provides, at best, limitedimprovement in subsequent reading’ (p. 100). A recent meta-analysis ofphonological awareness training studies reported that experimentallymanipulated phonological awareness explains about 12 percent of thepost-test word reading variance, and that the long-term effect is smaller(Bus and van Ijzendoorn, 1999). This led the authors to conclude thatphonological awareness is an important but not a sufficient condition forearly reading.

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Bus and Van Ijzendoorn (1999) report that purely phonologicalprograms seemed to have a lesser impact on reading than programswhich combined phonological awareness training with reading or prac-tice with letters. Furthermore, variables such as length, group size andtiming of the treatment program have been suggested as factors thatendanger the outcome of phonological training. Bus and Van Ijzendoorn’s(1999) meta-analysis indicated that the number of training sessions wasonly weakly associated with success in reading and that the traininggroup size was not related to success. Timing, however, seemed to playa role: combined effect sizes for training studies with preschool childrenas participants were greater than combined effect sizes for studies withkindergarten or primary school samples.

One possible explanation for the relatively limited impact of phono-logical awareness training on reading is that in most cases, primaryschool children have been targeted and sample selection has been basedon poor reading performance rather than on poor phonological aware-ness per se. The population of primary school children exhibitingreading problems is perhaps more heterogeneous than the phonologicalcore-variable difference model predicts, even if we set aside the distinc-tion between phonological and surface dyslexics (Kirby et al., 2000;Manis et al., 1996; Stanovich et al., 1997). For example, slow readingacquisition has been reliably associated with such nonphonologicalfactors as motivation, print exposure and vocabulary knowledge (seeWhitehurst and Lonigan, 1998) which would require perhaps entirelydifferent kinds of intervention methods. Moreover, significant hetero-geneity may exist also within what is frequently treated as phonologicalprocessing (Wagner and Torgesen, 1987). Wolf and Bowers (1999; seealso McBride-Chang and Manis, 1996) have suggested that rapid serialnaming speed constitutes a second core deficit in developmental dyslexia.Their double-deficit hypothesis states that some poor readers (thosewith ‘rate-deficit’´) will only experience naming speed problems whiletheir phonological awareness remains unaffected. For such cases wewould expect phonological awareness training to have only limitedsuccess (see Schneider et al., 1997 for related evidence). Similarly,several studies (Brady et al., 1987; Das and Mishra, 1991; de Jong,1998; Morris et al., 1998) have suggested that children with readingdifficulties often exhibit problems in verbal short-term memory tasks.These problems are more specifically in the area of phonological memory,an area which has been linked to reading acquisition in several studies(Gathercole et al., 1991; Rohl and Pratt, 1995; Wagner et al., 1994).Whether we treat possible verbal short-term memory deficits as pri-mary or secondary to phonological deficits, phonological awarenesstraining is not likely to significantly improve memory functioning dueto the relative independence of these processes (e.g. Kirby and Parrila,

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1999; Wagner et al., 1994; see also Schneider et al., 1997). To summa-rize, it is possible that phonological awareness training studies havelacked breadth of intervention and subsequently failed to addressproblems other than those directly related to phonological awareness.

Alternatively, it is possible that phonological awareness trainingprograms have lacked depth. The point of discussion here is that perhapswe need to recognize the role of more distal cognitive processes indesigning intervention programs. If we treat phonological processes ingeneral as the proximal causes, then the distal cognitive processes wouldbe those more general and perhaps modality nonspecific underlyingcognitive processes that enable the development and successful employ-ment of phonological processes. Swanson and Alexander (1997) arguedthat working memory problems characterize and may explain word-reading deficiency in the majority of poor readers. They suggestedfurther that whereas phonological coding ability determines normalreaders’ scores on pseudo-word reading, ‘higher-order’ cognitivecomponents, including working memory and metacognition, fill that rolefor poor readers. We have proposed elsewhere that the child’s ability toorder information successively and simultaneously (e.g. Das et al., 2000;Kirby and Williams, 1991; Papadopoulos et al., 1997) are distal cognitiveprocesses that are associated with reading difficulties. Successive process-ing includes elements of short-term memory and working memory,naming time, and articulation speed, all of which have been frequentlylinked to word reading problems. Simultaneous processing, in turn,should be more strongly related to reading comprehension (Das et al.,1994; Kirby and Williams, 1991), and perhaps to the development ofletter recognition and later orthographic coding skills. These predictionsderive from the need for simultaneous processing in relating meaningfulunits (words or letters) and in their integration into higher level units(sentences or graphemes; Das et al., 2000; Kirby et al., 1996).

The present article reports on two studies utilizing a remediationprogram, the PASS Reading Enhancement Program (PREP) that doesnot focus specifically on phonological training but emphasizes thetraining of both proximal and distal processes. PREP was recentlydescribed in detail by Das and Kendrick (1997) and only a brief over-view of the program is offered here (see Methods section).

The efficacy of PREP has been the topic of several previous investiga-tions. Das et al. (1995) used PREP with a group of Grade 3 and 4students who were at least a year behind on either the Word Identifica-tion or Word Attack subtest of the Woodcock Reading Mastery Test-Revised (WRMT-R; Woodcock, 1987). Participants were first dividedinto two groups, PREP remediation and a non-intervention controlgroup. The PREP group received 15 sessions of training in groups of twostudents, over a period of two and a half months. Children in the control

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group participated in regular classroom activities. The results frompost-testing indicated that while both groups gained during the inter-vention period, the PREP group gained significantly more on both WordIdentification and Word Attack. In the second part of this study,children from the control group received either the global (focusing ondistal processes) or the bridging (focusing on proximal processes) com-ponent of PREP for the same length of time. Neither of these groupsbenefited from the program to the same extent as the original PREPgroup who had received both components.

Carlson and Das (1997) reported on two studies using a small-groupversion of PREP for underachieving Grade 4 students in Chapter 1programs. In the first study, the experimental group received 15 hoursof ‘add-on’ training with PREP while they continued to participate in theregular Chapter 1 program. The control group consisted of children whoparticipated in the Chapter 1 program but received no additionaltraining. Word Attack and Word Identification were administered at thebeginning and the end of the study. The results showed significantimprovement following training in PREP, as well as significant Group ×Time interaction effects. The second study reported by Carlson and Das(1997) replicated these results with a larger sample of Grade 4 students.Since then, several other replication studies completed in the sameschool district have essentially reproduced the original results withchildren from Grades 3, 4, 5 and 6, and with both bilingual (Spanish-English) and monolingual (English) children (Carlson, 1996).

Boden and Kirby (1995) reported on the effectiveness of a modifiedPREP for an older group. A group of Grade 5 and Grade 6 students wereidentified as poor readers and randomly assigned to either a control oran experimental group. The control group received regular classroominstruction and the experimental group received PREP, in groups of fourstudents for approximately 14 hours. As in previous studies, the resultsshowed differences between the control and PREP groups on the WordIdentification and Word Attack subtests after treatment. In relation tothe previous years reading scores, the PREP group performed signifi-cantly better than the control group.

More recently, Parrila et al. (1999), divided 58 Grade 1 childrenexperiencing reading difficulties into two matched remediation groups:PREP and Meaning-Based Reading intervention. The Meaning-Basedprogram emphasized the philosophy of the whole-language approach toteaching reading. In order to provide opportunities for learning to readin a natural way, children were read stories that they selected from theinstructor’s collection of high quality children’s literature. The storieswere rich in language and covered a wide range of topics. The childrendiscussed the events and pictures in the stories as they related to theirown personal experience with their teacher, but no direct, systematic

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reading instruction was provided. The overall objective of the Meaning-Based program was to encourage children to derive meaning from printby reconstructing the author’s message, based on their own experiences(Froese, 1990).

In the Parrila et al. (1999) study, both PREP and Meaning-Basedgroups received remediation twice a week for 20 minutes over a nine-week period (altogether six hours). Reading performance was assessedpre- and post-intervention using Word Identification and Word Attack(WA) tests from WRMT-R. Repeated measures ANOVAs showed asignificant main effect of Testing Time for both Word Identification andWord Attack. For Word Attack, the Testing Time by Remediation Groupinteraction was also significant. Examination of the means indicatedthat the PREP group gained more than the Meaning-Based group interms of simple decoding skills.

The present study expands on the Parrila et al. (1999) study in twoways. First, we provide follow-up information by examining the readingperformance of one part of the original sample one year after remediation.As noted also by Bus and van Ijzendoorn (1999) and Troia (1999), veryfew studies so far have included a follow-up component making itdifficult to establish whether reading remediation programs have long-lasting effects.

Second, those children who still experienced reading problems atGrade 2 in spite of having attended the first round of remediation, wereprovided a second, more intensive remediation. The purpose of thesecond study was to examine whether more intensive training withPREP would be sufficient to improve the reading performance of child-ren still exhibiting persistent word reading problems. We also reportfollow-up data for this study.

Methods

ParticipantsThe initial participants in the study were 58 Grade 1 students selectedon the basis of their poor reading performance from a sample of 90students from 31 public schools in Edmonton, Canada (see Parrila et al.,1999 for details). These 90 students were identified originally by theirkindergarten teachers as being at-risk for developing reading difficulties.Children were excluded from the sample if they were: (a) students whoseproblems were primarily emotional in nature; (b) students with sensoryhandicaps (impaired vision or hearing); (c) students with developmentaldisabilities (i.e. mental retardation) or (d) ESL students.

Forty (12 females and 28 males) of the 58 children participated in thefollow-up testing in Grade 2. In the majority of the missing cases, the

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participants had either changed schools without providing details oftheir new location or had moved out of the city of Edmonton. One of the31 schools withdrew from the study and parents of two of the children didnot provide further consent for their children to participate in Grade 2.Six of the missing cases had received PREP remediation in Grade 1 and12 had received the Meaning-Based remediation. The mean age of the 40remaining children was 89.38 months (SD = 3.21) at the time of thefollow-up testing.

Of these 40 students, 18 scored below or at the 26th percentile on bothWord Attack and Word Identification, and nine on Word Identificationonly. These 27 students were initially selected to participate in thesecond remediation. One student, however, refused to participate andtwo withdrew with less than half of the sessions completed. Thus, thefinal participants for the second remediation study were 24 students(five females and 19 males) who all scored below the 20th percentile onWord Identification (mean = 5.06, SD = 5.20) at pre-testing (follow-uptesting of Study 1). The mean Word Attack percentile score for this groupwas 21.40 (SD = 14.92). Sixteen of these students had received PREP inGrade 1 and eight had received the meaning based program followed bythe computerized PREP program. The mean age of this group in Grade2 pre-testing was 91.00 months (SD = 2.70).

Finally, follow-up data from Grade 3 was available for 15 of these 24students. Attrition in Grade 3 followed a similar pattern as in Grade 2.The mean Grade 2 Word Identification percentile score for these studentswas 5.28 (SD = 6.10) and the mean Word Attack percentile score was22.69 (SD = 15.29). Mean age of this group in Grade 2 pre-testing was91.07 months (SD = 2.74).

Reading measuresThe three reading measures were taken from the Woodcock ReadingMastery Test-Revised (Woodcock, 1987).

Word Identification. This test requires the participants to identifyisolated words that appear in large type on the pages in the test book. Asparticipants proceed through the items, they encounter words thatappear less and less frequently in written English. For an answer to bescored correct, the participant had to produce a natural reading of theword within five seconds. The task was discontinued after six consecutivemistakes.

Word Attack. This test requires the participant to read eitherpseudowords (letter combinations that are not actual words) or wordswith a very low frequency of occurrence in English, to determine theparticipant’s ability to apply structural analysis skills. All participantsbegan this test by responding to two sample items. If the participantfailed a simple item, practice was continued until the participant

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completed the item correctly. The test began with simple consonant-vowel combinations and concluded with multi-syllable pseudowords.The task was discontinued after six consecutive mistakes.

Passage comprehension. This test requires the participant to read ashort passage (usually two to three lines long) and identify a keyword(represented by a blank line) missing from the passage. To successfullycomplete the item, a participant generally has to understand not only thesentence containing the missing word but also the remaining sentences.Before starting the test, the examiner instructed the child to read eachpassage silently and then provide a suitable word for the blank space. Asample item was administered in order to ensure that the participanthad understood what was expected. The version used in this studycontained 68 items. The participant’s total score was the number ofcorrectly filled blanks. The task was discontinued after four consecutivemistakes.

Cognitive processing tasksNine tests taken from the standardization version of the Das-NaglieriCognitive Assessment System (DN-CAS; Das and Naglieri, 1993) wereused to assess participants’ cognitive processing skills (planning,attention, simultaneous processing and successive processing) on bothGrade 1 and Grade 2 pre-testing. The two planning tasks were PlannedSearch and Planned Connections, the two attention tasks were ExpressiveAttention and Receptive Attention, the two simultaneous processingtasks were Simultaneous Verbal and Figure Memory and the threesuccessive processing tasks were Word Series, Sentence Repetition andQuestions and Speech Rate.

Phonological processing tasksRhyme production. This task was used by Maclean et al. (1987) as ameasure of phonological awareness in children of three to five years ofage. In this task, the child was asked to provide a word that rhymed withone the experimenter had just spoken. Before the test started, each childwas given a series of practice trials, which involved forced choices. In thefive experimental trials proper, the child was asked to ‘Say a word whichrhymes with ___’ (e.g. ‘tail’). Both nonsense words and real words wereaccepted as correct responses. The five words used in this version were:‘land’, ‘goat’, ‘shop’, ‘tail’ and ‘hen’, and the participant’s score was thenumber of correctly rhymed words (max. 5).

Sound isolation. This task was originally developed and used byWagner et al. (1993) in a study that compared alternative models ofyoung readers’ phonological processing abilities. In this test, childrenwere asked to repeat the first, last or middle sound in a word. Six practiceitems and 15 test items consisting of three- and four- phoneme, one- and

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two-syllable words were included. The task was discontinued after fourfailures among the last seven items. The participant’s score was thenumber of correct items.

Phoneme elision. This task was also used by Wagner et al. (1993). Inthis task, children were asked to repeat a word after deleting anidentified phoneme. The specific instructions were as follows: ‘Say theword /cat/. Now say the word /cat/ without the /k/’. All phonemes to bedeleted were consonants and their position varied across items. Afterdeleting the target phoneme, the remaining phonemes formed a word(e.g. /seed/ without the /d/ leaves /see/). Six practice items and 15 testitems consisting of three- to five-phoneme, one- and two-syllable wordswere used. The task was discontinued after four consecutive mistakes inthe last seven items. The participant’s score was the number of correctitems.

Remedial methodsPASS reading enhancement program (PREP). PREP was developed as aremedial program based on the PASS (planning, attention, simultaneousprocessing and successive processing) model of cognitive functioning(Das et al., 1994). It is suggested that two out of the four components ofthe PASS model, simultaneous and successive processing, are the mosthighly related to reading skills, with simultaneous processing morestrongly related to comprehension and successive processing morestrongly related to word decoding (Das et al., 1994; Kirby and Williams,1991). These predictions derive from the need for simultaneous process-ing in the relating of meaningful units and their integration into higherlevel units, and from the involvement of successive processing in thesequential analysis and blending of phonemes and syllables (Kirby et al.,1996).

The PREP remediation program aims to improve the informationprocessing strategies – specifically, simultaneous and successive pro-cessing – that underlie reading, while at the same time tries to teachinductively word reading skills such as phoneme segmentation orblending. PREP is also founded on the premise that the transfer ofprinciples is best facilitated through inductive, rather than deductive,inference (Carlson and Das, 1997). The program is accordingly structuredso that tacitly acquired strategies are likely to be used in appropriateways.

PREP was originally designed to be used with students in Grades 2 or3. In the present study, eight of the ten tasks in the original programwere selected and adapted for the Grade 1 level (the tasks are describedin Appendix 1). Each of the tasks involves both a global trainingcomponent and a curriculum-related bridging component. The globalcomponents, which require the application of simultaneous or successive

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strategies, include structured non-reading tasks. These tasks alsofacilitate transfer by providing the opportunity for children to internalizestrategies in their own way (Das et al. 1995). The bridging tasks involvethe same cognitive demands as their matched global components, thatis, simultaneous and successive processing, that are now practiced withreading related materials (letters, parts of word and words).

To ensure that strategy acquisition occurs in small steps, the globaltasks begin with content that is familiar and non-threatening (Das et al.,1994). Complexity is introduced gradually. Through specific discussionsof strategies used during each remediation session, children areencouraged to apply their strategies to academic tasks such as worddecoding. Each task is designed to facilitate the development of strategiessuch as rehearsal, categorization, monitoring of performance, prediction,revision of prediction, sounding and sound blending. Children developtheir ability to use these strategies through experience with the tasks.It is important to emphasize, however, that rather than being explicitlytaught these strategies by the instructor, children are encouraged tobecome aware of their use of strategies through verbalization. Growth inthe ability to use strategies and to be aware of appropriate opportunitiesfor their use is expected to develop over the course of remediation.

It should also be noted that the global and bridging components arefurther divided into three levels of difficulty. In the present study, onlythe first two levels of difficulty for each task were administered. Inaddition, a system of prompts is an integral part of each global andbridging component. The series of prompts creates a scaffolding networkthat supports and guides the child to ensure that tasks are completedwith a minimal amount of assistance and a maximal amount of success.A record of these prompts was used as a monitoring system for theinstructor to determine when the material was too difficult for a child orwhen a child was able to successfully progress to a more difficult level.A criterion of 80 percent correct responses was required in this studybefore a child could proceed to the next level of difficulty. If the criterionwas not met, an alternate set of tasks, at the same difficulty level, wasused to provide the additional training required.

Of the ten tasks included in PREP, the following eight were selectedfor use with Grade 1 participants and presented to the children in theorder listed: Window Sequencing, Connecting Letters, Joining Shapes,Matrices, Related Memory Set, Transportation Matrices, Tracking, andShape Design. For a detailed description of the program, see Das andKendrick (1997).

Computerized PREPThe computerized version of PREP is based on the same rationale andfollows the same procedures as the non-computerized version (Kirby and

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Das, 2000). The major difference between the versions is that while theregular PREP requires manipulation of the physical materials on thetable, this manipulation on the computerized version takes place on thescreen with the help of a mouse. Also, some tasks have required minormodifications in terms of their presentation, and others were notincluded in the version used in this study. The six tasks that wereincluded were Joining Objects (similar to Related Memory Set),Connecting Shapes (similar to Joining Shapes Global), ConnectingLetters (similar to Joining Shapes Bridging), Sequencing (similar toTransportation Matrices), Window Sequencing and Matrices.

Meaning-Based programThe Meaning-Based program emphasized the philosophy of the whole-language approach to teaching reading. Although there is considerabledisagreement among theorists about what the whole-language approachentails, Pressley (1994) suggested that there are two essential character-istics. First, learning to read will occur naturally as long as opportunitiesare provided; in other words, direct, systematic instruction is notnecessary (Spiegel, 1996). Second, learning to read should be purposefulfor students and should involve real examples of language. That is, awhole-language approach should be child-centered and literature-based.

Accordingly, the Meaning-Based program in the present study wasdesigned as follows. In order to provide opportunities for learning toread in a natural way, children were read stories that they selectedfrom the instructor’s collection of quality children’s literature. Thestories, which were rich in language, covered a wide range of topics. Nodirect, systematic reading instruction was provided. Instead, the child-ren participated in discussions about events and pictures in the storiesas they related them to their own personal experiences. The overallobjective of the Meaning-Based program was to encourage children toderive meaning from print by reconstructing the author’s message,based on their own experiences (Froese, 1990).

ProcedureAfter the pre-testing in February and March of Grade 1, the first re-mediation began in March and consisted of 18 20-minute sessions,which were administered over a seven-week period during school hoursby certified teachers who were trained in the administration of eitherthe PREP or the Meaning-Based program. Students worked individu-ally or in groups of two or three, depending on the number of studentsreceiving particular remediation in each school. The variation in thegroupings was similar across both remedial programs. Post-testingwas completed immediately after the remediation programs finishedin late April.

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Those participants who received the Meaning-Based program werethen offered training using the computerized PREP in May: this wasfollowed by a second post-testing. This training consisted of ten 30-minute sessions. The version of computerized PREP used in this studywas a trial version and several training sessions were not completed dueto computer errors. On average, students attended approximately fourhours of effective training, mostly on global tasks, making it difficult toreliably establish the overall effect of this training. Overall, however,participants appeared to enjoy participating in the program.

The second remediation in Grade 2 (which took place the followingApril upon completion of the follow-up testing in January) consisted of20 30-minute daily sessions administered over a period of four weeks. Inaddition, all participating children worked individually with a tutor, asopposed to Study 1, in which some of the children worked in groups of twoor three. All four tutors were graduate research assistants trained inadministering PREP.

Results

Study 1: follow-up of Grade 1 remediationThe means and standard deviations for Grade 1 pre-test, Grade 1 post-test, Grade 1 second post-test and Grade 2 follow-up test on WordIdentification and Word Attack for those 40 participants for whomfollow-up data was available is presented in Table 1.

Testing time (2; pre- and post-test in Grade 1) × Remediation (2; PREPversus Meaning-Based) repeated measures ANOVAs were computed forboth reading tests. These analyses indicated that the main effect oftesting time was significant for both Word Identification, F(1,38) = 61.08,p < 0.001, and Word Attack, F(1,38) = 24.78, p < 0.001. The time ×Remediation interaction was also significant for Word Attack, F(1,38) = 6.65, p = 0.01, and approached significance for Word Identifica-tion, F(1, 38) = 3.05, p = 0.089. Together with the means in Table 1, theseresults indicate that the PREP group improved significantly more inpseudo-word reading than the meaning-based group, with a similartrend for Word Identification. These results are consistent with thosereported for the larger group of 58 children (Parrila et al., 1999).

Analysis of the follow-up reading scores in Grade 2 (2; post in Grade1 and follow-up in Grade 2) × Remediation (2; PREP versus Meaning-Based) revealed continued growth for both groups and no significantbetween-group differences. Of particular interest here are the follow-uppercentile scores, plotted in Figures 1a and 1b for Word Identificationand Word Attack, respectively. Follow-up percentile scores are muchlarger than the post-test (or post-test II) scores for both remediation

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Table 1. Means and standard deviations for PREP and Meaning-Based groups on reading measures for Grade 1 pre-test, Grade 1 post-test I, Grade 1 post-test II and Grade 2 follow-up

Remediated Groups

Grade 1 Grade 1 Grade 1 Grade 2 Pre-Test Post-Test I Post-Test II Follow-up

PREP Meaning PREP Meaning PREP Meaning PREP Meaning(n = 23) (n = 17) (n = 23) (n = 17) (n = 23) (n = 17) (n = 23) (n = 17)

Variables Mean Mean Mean Mean Mean Mean Mean Mean(SD) (SD) (SD) (SD) (SD) (SD) (SD) (SD)

Word IdentificationRaw 4.13 3.12 13.30 8.94 – 12.18 30.35 32.71

(3.76) (3.64) (8.96) (7.86) (8.76) (15.75) (13.40)Percentile 8.43 6.38 13.45 7.46 – 11.99 19.19 18.89

(8.82) (7.99) (14.88) (8.56) (8.76) (28.31) (17.72)

Word AttackRaw 0.35 0.12 4.61 1.47 – 2.71 16.00 16.41

(0.71) (0.33) (4.59) (1.87) (3.18) (10.02) (7.98)Percentile 4.13 2.59 19.70 7.70 – 12.59 33.66 35.67

(4.54) (1.66) (17.51) (7.84) (11.71) (29.78) (21.71)

Note: The Grade 1 post-test II was not administered to the PREP group.

groups, indicating that when compared to the norming sample, theseparticipants continued to develop at an accelerated rate. In terms of thePREP group, these results can be interpreted to mean that: (1) the PREPprogram had lasting effects on the participants’ reading performance orthat (2) there was a considerable amount of ‘spontaneous recovery’ –perhaps aided by teachers’ attention to these children’s specific needs –among the participants. In terms of the Meaning-Based group, there areat least four interpretations that are possible: (1) the Meaning-Basedprogram had a ‘sleeper-effect’ on the participants’ word reading anddecoding skills; (2) the computerized PREP had a positive long-termeffect over and above the approximate five percentile point gain evidentat the second post-testing; (3) the two programs interacted to producepositive long-term outcomes or (4) that there was a considerable amountof ‘spontaneous recovery’ or assistance provided by teachers. We willreturn to these alternative explanations in the Discussion section.

Study 2: second remediationAt the end of Study 1, 27 children still experienced reading difficulties.Twenty-four of these children participated in the second remediationstudy during the spring of Grade 2. In this second remediation, allchildren received an intensified PREP program since it was shown to be

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Figure 1. Follow-up percentile scores for Word Identification andWord Attack

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more effective than the Meaning-Based program in the Parrila et al.(1999) study, especially in regard to improving Word Attack skills.

The pre- and post-test means and standard deviations for the threereading measures and the three phonological processing tasks arepresented in Table 2. Repeated measures ANOVAs and effect sizes arealso presented as a function of improvement from pre- to post-testing.

Table 2. Pre- and post-test means and standard deviations, F-valuesand effect sizes on reading and phonological measures

Remediated Group (n = 24)

Pre-test Post-test

Tasks M (SD) M (SD) F-value d

Reading TasksWord IdentificationRaw score 23.83 (9.86) 34.08 (12.23) 64.83*** 0.92Percentile score 5.06 (5.20) 13.80 (12.85)

Word AttackRaw score 12.62 (6.00) 21.92 (8.57) 82.03*** 1.26Percentile score 21.40 (14.92) 47.89 (24.08)

Passage ComprehensionRaw score 13.09 (4.54) 19.17 (4.81) 80.87*** 1.30Percentile score 7.36 (4.54) 13.62 (10.51)

Phonological TasksRhyme Production 4.67 (0.76) 4.96 (0.20) 4.29* 0.52Phoneme Elision 10.42 (2.76) 12.29 (3.07) 17.54*** 0.64Sound Isolation 9.62 (3.08) 12.17 (3.16) 33.05*** 0.82

Note: small effect = 0.2 = d < 0.5; medium effect = 0.5 = d < 0.8; large effect = 0.8 = d < 8p = 0.05; *** p < 0.001; df = (1.23)

Significant improvement from pre- to post-testing was obtained for allreading and phonological tasks. The phonological tasks, however, sufferedfrom a ceiling effect at the time of Grade 2 post-testing. Together with thefact that no norming sample comparison data are available for thesetasks, this makes interpretation of the results difficult for the phonologi-cal tasks.

All reading tasks show large improvement from pre- to post-testingboth in terms of effect sizes and percentile comparisons. The mostnotable finding is that this twice remediated group reached averageperformance level on Word Attack (48th percentile). Both WordIdentification and Passage Comprehension performance levels showedlarge gains in terms of effect sizes. On both tasks the participants alsonarrowed the gap to the normed sample, but the mean post-test percen-tile scores were still low at 13.80 and 13.62.

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We should also note that 17 out of the 24 participants showed a 20-point or larger percentile gain on Word Attack from pre- to post-testing, and nine of these children showed a percentile gain equal to orhigher than 30 points. Nineteen children performed beyond theremediation inclusion criterion of the 26th percentile on Word Attackafter the remediation, compared to seven before the remediation. Onthe other hand, in reading real words and in Passage Comprehension,only two and three participants, respectively, performed above the26th percentile (compared to none before remediation).

In order to further examine whether the above results can be reli-ably attributed to remediation rather than classroom instruction, threerepeated measures ANCOVAs were calculated for the reading testswith the time difference between pre- and post-testing (that rangedfrom 43 days to 104 days, mean 74 days) as the covariate. Resultsindicated that all reading tasks showed significant improvement re-gardless of the time between pre- and post-test. However, for WordIdentification the interaction with time was significant, F(1, 22) = 7.67,p = 0.011. Examination of the change scores as a function of timedifference between pre- and post-testing revealed a surprising nega-tive correlation between these two variables (the Pearson correlationcoefficient was –0.511), indicating that improvement cannot be attrib-uted to additional classroom instruction.

In summary, participants of this study demonstrated significantgains in word-decoding task after ten hours of remediation, but con-tinued to perform at a relatively low level on word reading and PassageComprehension tasks. Although there are limitations in terms ofinterpreting the results in favour of PREP due to the lack of a controlgroup, the progress that these children made in a month of remediationwas remarkable given their history of chronic low reading perform-ance.

Follow-up in Grade 3Ten months later, when in Grade 3, 15 (three females, 12 males, groupmean age in years 8.42 [SD = 0.23]) of the 24 children who had partici-pated in the second remediation in Grade 2 were tested again. Attritionfrom Grade 2 to Grade 3 followed a very similar pattern as betweenGrade 1 and Grade 2. Ten of the 15 children were below the 25thpercentile in both Word Identification and Word Attack at the end ofremediation in Grade 2, while only two cases were below the 25thpercentile in Word Attack.

The means and standard deviations for the Grade 2 pre-test, Grade 2post-test and Grade 3 follow-up test on Word Identification, Word Attackand Passage Comprehension for the 15 participants for whom follow-updata were available are presented in Table 3.

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Table 3. Means and standard deviations on reading measures forGrade 2 pre-test, Grade 2 post-test I and Grade 3 follow-up

Remediated Group (n = 15)

Grade 2 Grade 2 Grade 3 Pre-Test Post-Test Follow-up

Variables Mean (SD) Mean (SD) Mean (SD)

Word IdentificationRaw 24.46 (8.74) 35.33 (11.40) 48.00 (11.56)Percentile 5.28 (6.10) 14.94 (14.89) 23.20 (22.30)

Word AttackRaw 12.73 (5.67) 22.73 (7.45) 23.20 (9.28)Percentile 22.69 (15.29) 49.53 (23.06) 38.69 (28.31)

Passage ComprehensionRaw 13.07 (5.43) 19.20 (4.71) 28.07 (4.20)Percentile 7.55 (4.90) 14.13 (11.09) 20.87 (13.12)

Grade 2 pre-test and post-test means reported in Table 3 are verycomparable to those for the larger sample (see Table 2), indicating thatattrition did not bias our follow-up sample in any obvious manner.Moreover, Testing time (2; pre- post-test in Grade 2) repeated measuresANOVAs produced results almost identical to those reported in Table 2.

Analysis of the reading scores in Grade 3 revealed continued growthon Word Identification and Passage Comprehension but not on WordAttack. Of particular interest are the follow-up percentile scores displayedin Table 3. For Word Identification and Passage Comprehension, follow-up percentile scores are much larger than the post-test percentile scores,indicating that when compared to the norming sample, these participantscontinued to develop at an accelerated rate. It is noteworthy that 12participants showed a percentile gain from 2 to 25 points in PassageComprehension with six of them performing beyond the 25th percentile(as opposed to three right after remediation in Grade 2). In WordIdentification, seven participants showed improvement ranging fromtwo to 59 percentile points, while five of them scored above the 25thpercentile (as opposed to only two right after remediation in Grade 2).

Similar development was not evident for Word Attack on which theGrade 3 raw score was equal to the Grade 2 post-test raw score, and thepercentile score respectively dropped. Thus, it is interesting to note thatwhile it was mostly decoding skills that continued to develop from Grade1 to Grade 2, this time it was the more complex reading tasks thatshowed most continued development. We will present some possiblereasons for these patterns of findings in the Discussion.

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DiscussionThe present study examined the short- and long-term effects of acognitive remediation program, PREP, that attempts to remediate bothproximal and distal cognitive processes and is therefore broader in itsapproach to remediation. Beneficial short-term effects of this programhad already been established in previous studies (e.g. Carlson and Das,1997; Parrila et al., 1999), and were again confirmed in this study. Byincluding a follow-up component on both parts of the study, we alsoestablished that the positive effects of the intervention, albeit moderate,were still evident up to ten months later.

More specifically, in Study I, as expected, both PREP and Meaning-Based groups improved during the first seven weeks of remediation.Also, as anticipated, children in the PREP group showed a greaterimprovement, particularly in their ability to decode pseudo-words,which indicated increased phonological coding ability that is necessaryfor fluent reading (e.g. Share, 1995). Thus, both of these expectationswere confirmed.

Next, it was encouraging to notice that similar positive long-termeffects were also found in Study 2 in which the participants were botholder and more selected in terms of their persistent word readingproblems. Taken together, these two pieces of evidence lead us to inferthat remediation had long-lasting beneficial effects, a finding that hasnot been frequently reported in reading remediation literature (Bus andIjzendoorn, 1999; Troia, 1999).

In addition, the results from the 15 cases for whom follow-up Grade 3data were available indicated that benefits were generalized to morecomplex reading tasks over time. Participants’ performances continuedto improve in terms of real word reading and Passage Comprehension.We suggest that the basic decoding skills that these participants hadacquired during the Grade 2 remediation supported the furtherdevelopment of more complex reading skills, even though the decodingskills themselves did not continue to improve. There are two possibleexplanations for these findings. First, it is possible that gains in WordAttack are less robust than gains in Word Identification and PassageComprehension, perhaps due to the artificial nature of this task. WhileWord Recognition and Passage Comprehension skills receive continuousattention and practice in the classroom, the same is perhaps not true fordecoding skills.

Second, these results relate to PREP’s theoretical framework. ThePREP program aims at improving the distal cognitive processes that areresponsible for the successful deployment of more proximal readingskills, such as phonological processing. The PREP program has also aninductive orientation in that students are encouraged to search for andtry out their own strategies rather than being explicitly told how the

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tasks should be solved and what the proper strategies are. By providingremediation at the level of distal processes and strategy discovery, PREPmay have created a basis for independent future learning, as well as acognitive foundation on which phonological processes can be built. Inother words, PREP’s global process training tasks and the bridging tasksthat are mapped onto these training tasks, aim at far transfer, which isbased on improving underlying, and more pervasive, cognitive processesand on discovering functional strategies (Kirby, 1989). In this sense, the‘rocky road’ (Salomon and Perkins, 1989) to transfer has been chosenwhich is perhaps the only road that can result in a more fundamentalexpression of the child’s potential. It is due to such transfer that theremediated group could also benefit from class instruction, as thepresent data suggest.

Primary school children exhibiting poor reading performance consistof a heterogeneous population which is characterized by several othercognitive, learning, emotional and motivational deficiencies beyondphonological processing (Byrne, 2000; Lepola et al., 2000; Manis et al.,1996; Stanovich et al., 1997). No single program will provide a remedyto all of the varied problems expressed by this population. But if readingand cognitive deficits are linked, then PREP did assist in improving wordreading and Passage Comprehension. While several other studies haveshown short-term benefits of the PREP program, ours is the first to showthat these benefits are long lasting. As such, these results need to bereplicated. Similarly, we need to examine at the micro-level how learn-ing occurs during remedial PREP training. Progress through PREPsessions needs to be analysed to determine how microgenetic develop-ment (Kuhn, 1995; Siegler, 1995) occurs within individual cases acrosstraining sessions. This approach will certainly advance our understand-ing of how PREP remediation tasks work, what cognitive processes arebeing used and why some children are more likely to gain from treatmentthan others.

Note1. Stanovich (e.g. 1988, p. 601) also acknowledges the existence of a small

group of dyslexics ‘who have severe problems in accessing the lexicon on a visual/orthographic basis’.

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Appendix 1

PREP tasksOf the ten tasks included in PREP, the following eight were selected foruse with the participants of the present study: Window Sequencing,Connecting Letters, Joining Shapes, Matrices, Related Memory Set,Transportation Matrices, Tracking and Shape Design. What follows is adescription of each of these tasks, including the levels that were admin-istered and any modifications made to ensure that the participants couldsuccessfully complete the tasks (given that the program was originallydesigned for students at the middle elementary level). The tasks arelisted in the order in which they were administered.

Window Sequencing. The focus of this task is successive processing. Inthe global component, the student’s task is to reproduce a series of chipsthat vary in colour and shape in the same order in which they arepresented by the instructor. The chips are presented one at a time, leftto right, through a 2 × 2 inch window. Each chip appears in the windowfor approximately one second. The series ranges in length from three tosix chips. Four series of each length are presented per session, for a totalof 12 items. There are three levels of difficulty in this task. DifficultyLevel 1 involves sequences of two different types of chips (circles andsquares) and holds the colour as a constant. Difficulty Level 2 involvesdifferent coloured chips (white, yellow, blue and black) and holds theshape as a constant. In Difficulty Level 3, both the colour and shape ofthe chips are manipulated. In the present study, only Levels 1 and 2 wereused. The task was adapted for the age group by limiting the length ofeach series to three shapes for Level 1 and four shapes for Level 2.

The student’s task in the bridging component is: (a) to reproduce aseries of letters in the same order in which they are presented by theinstructor and (b) to state the word that is spelled by the letters. Theletters, which the student views for approximately one second througha 2 × 2 inch window, are presented one at a time or in consonant or vowelcombinations. There are three levels of difficulty as well as a preliminarylevel, each corresponding to the phonetic complexity of the words used.Only the Preliminary and Level 1 items were used with the participantsin Grade 1. Level 2 was included for some participants in Grade 2.

Connecting Letters. Connecting Letters is predominantly a successiveprocessing task. In the global component, the student is required tofollow a line to find which letter on the left side of a page is connected towhich letter on the right side of a page. Each stimulus card contains fiveletters on each side. The student is presented with each card individually.He/she is then required to write (or say) all of the connections. After theinitial trial, the instructor directs the student’s attention to any errorsso that corrections can be made. There are three levels of difficulty. Three

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cards are presented at one difficulty level during a single session.Difficulty Level 1 contains strings that are colour-coded to aid inscanning. Difficulty Level 2 contains black lines only. Difficulty Level 3contains black lines as well as distracter lines that are not connected toany letters. For the purposes of this study, only the first two levels wereused.

In the bridging component, the student is presented with a stimuluscard with a column of five letters on the left side of the page and a columnof five letters on the right side of the page. The letters are connected withlines that run across the page. Along these lines, there are more letters.Sometimes the letters are presented alone, and sometimes they are insmall groups (consonant or vowel blends, or digraphs). Together, thesequence of letters on each line forms a word. Each line is colour coded.The student is required to follow each line, mentally connect the seriesof letters that run across the page, and state the word that is spelled bythe letters. Three levels of difficulty and a preliminary level are provided;each corresponds to the phonetic complexity of the words. Only thePreliminary level and Level 1 were administered to the participants inGrade 1, while Level 2 was introduced to some participants in Grade 2.

Joining Shapes. This task’s focus is also successive processing. Thepurpose of the global component is to join a series of geometric shapes inresponse to: (a) a series of verbal instructions and (b) a set of rulesprovided by the instructor. The shapes – triangles, squares and hexagons –are presented in rows on a sheet of paper. Each row of triangles, squaresor hexagons is always separated by a row of circles. Within each session,six items with varying numbers of rows are presented. The first twoitems contain one row of triangles and one row of squares, with a row ofcircles in-between. The third and fourth items contain one row oftriangles, one row of squares, and one row of hexagons, with rows ofcircles in-between. The fifth and sixth items contain a row of hexagons,a row of triangles, a row of squares and another row of hexagons, withrows of circles in-between. These items are presented on two differentstimulus cards. There are three levels of difficulty; each corresponds tothe number of consecutive instructions to which the student responds.Levels 1 and 2 were included in the present study.

The format for the bridging component is as follows. On a sheet ofpaper, several rows of letters are presented to the student. The purposeof the task is to join the letters from the top row to the bottom row –moving diagonally from left to right and following a set of rules – toproduce a word. When the student reaches the bottom, he/she uses thelast letter of that word as the first letter of the next word, and thenproceeds back to the top in the same manner to produce another word.This is continued until the student reaches the end of the sheet. Thestudent is required to tell the instructor the words that he/she has

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formed. There are three levels of difficulty as well as a preliminary level;each corresponds to the length of the words included in the level. Onlythe Preliminary level and Level 1 words were administered in Grade 1,while Level 2 was also administered to some participants in Grade 2.

Matrices. Successive processing is the focus of the Matrices task. In theglobal component, the student is required to memorize a sequence ofrandomly chosen letters displayed within a five-cell matrix. The matrixis designed as a cross: there is one central cell, with one cell on each ofits four sides. Each cell of the matrix contains one number (MatrixNumbers) or one letter (Matrix Letters). The student is shown thecomplete matrix containing one number or letter in each of the five cells.He/she is then asked to write (or say) the sequence in order, as theinstructor points at each cell of a blank matrix. If the student hasdifficulty reproducing the sequence, he/she is shown the matrix numbersor letters in five stages, with only one number or letter being revealed ata time. After progressing through the sequence, the student is againasked to recall the sequence. This task was modified for Grade 1 studentsby eliminating the top and bottom cells for Level 1 and eliminating thebottom cell for Level 2. Thus, for Level 1, students were required toremember numbers in three cells only, and for Level 2, they wererequired to remember letters in four cells only. For several students thismodified version was used as the introductory task in Grade 2 also. Lateron, some of students proceeded to the regular form of the task.

In the bridging component, the student memorizes the position andsequence of a series of words presented on a cross matrix by using theprocedures that were learned during Matrix Numbers and MatrixLetters. There are ten series of words. The first five series of words havebeen classified at a Grade 3 level of reading difficulty and the next fiveseries of words are at a Grade 4 level of reading difficulty. Each seriesconsists of five words arranged in a five-cell matrix, with one word ineach cell. Four of the words are semantically related, one is not. In Part1, the student is required to recall the words in their correct position andorder. In Part 2, the student is required to identify the four related wordsand explain why the fifth word does not belong. Only Part 1 was includedin Grade 1.

Related Memory Set. The Related Memory Set task involves bothsuccessive and simultaneous processing. The student’s task in the globalcomponent is to match the front half of an animal with its appropriateback half. The animal pictures are line drawings on 3 × 3 inch cards.Three fronts are presented in a column on the left side of a page and oneback is presented on a card placed on the right side of the page. Thestudent is required to point to the front that matches the back. Aftermaking this prediction, he/she then places the front and back togetherto determine whether the response was correct. The student is then

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allowed to alter his/her prediction as necessary. There are three levelsof difficulty; each corresponds to the difficulty of discrimination required.Levels 1 and 2 were included in this study.

The purpose of the bridging component is to: (a) choose the proper fronthalf of a word to match the back half and (b) to read the word. The studentchooses from three front portions of words placed on the left-side of apage in a column. To the right of this column is the back half of one of thewords. He/she is required to draw a line between one of the fronts and theappropriate back and to read the word. There are three levels of difficultyas well as a preliminary level; each corresponds to the complexity of thewords. The present study only included the preliminary level, Level 1and Level 2.

Transportation Matrices. In the global component of this successiveprocessing task, the student is required to reproduce a series of transpor-tation pictures in the correct order. The pictures are presented in asingle-line matrix strip divided into sections (cells). The entire strip isshown, and then each individual picture in the strip is shown from thestudent’s left to right on a horizontal line. There are three levels ofdifficulty: Level 1 contains six four picture series; Level 2 contains threefour and three six picture series; Level 3 contains six picture series. Onlyitems from Level 1 and 2 (Sets [a] and [b]) were used.

The student’s task in the bridging component is to reproduce a seriesof letters in the correct order, and then read the word that is formed bythe letters. The letters are exposed on a single-line matrix divided intocells to match the number of letters in the word. The letters arepresented together, and then one at a time in their respective positionson the matrix. There are three levels of difficulty as well as a preliminarylevel; each corresponds to the phonetic complexity of the words. Thereare 15 words for each level. The Preliminary level and Level 1 and 2words were administered to the participants, with Level 2 being intro-duced in Grade 2.

Tracking. In the global part of this simultaneous processing task, thestudent is presented with a line drawing map of a ‘village’ (Tracking MapI) and tracking cards illustrating a path from a starting point to eithera numbered house (Level 1) or a lettered tree (Level 2). The trackingcards outline the roads and street intersections of the village map. Thestudent’s task is to survey each card and the village map, and then locatethe number of the house or the letter of the tree on the map. Level 1 wasincluded in Grade 1, while Level 2 was also included in Grade 2.

The bridging component involves a floor plan of West Edmonton Mallon which several key features are identified. The student is allowed sometime to become familiar with the locations of the various key features.He/she is then given a series of printed passages (eight in total), one ata time. Each passage specifies a point of departure and two to four key

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features (listed randomly in the passage) to be visited by the student.Each passage also contains a constraint (e.g. time) under which thestudent is required to operate. The student’s task is: (a) to read eachpassage as it is presented (with as much assistance as is required); (b) toidentify the point of departure and the key features that are to beincorporated into the visit and (c) to use the floor plan to trace a path thatwill begin at the designated point of departure, incorporate all of thespecified features and move through the mall as quickly as possible. Thestudent begins with a passage that specifies two key features (includingthe point of departure) and finishes with a passage that specifies fourfeatures. In this study, when necessary, instructors read the passages tothe participants.

Shape Design. Shape Design is predominantly a simultaneous process-ing task in which the student is required to: (a) study a design that ispresented for ten seconds and (b) reproduce the design with the col-oured shapes provided. The shapes include circles, rectangles, squaresand triangles in three colours (red, blue and yellow) and two sizes. Thestimulus cards consist of designs composed of these shapes. The designsrange from a simple combination of three shapes, differing only incolour, to a complex combination of six shapes differing along dimen-sions of colour, shape and size. The task is divided into three difficultylevels with six items in each. Only Levels 1 and 2 were used.

The bridging component required students to read a phrase or storyfrom a card that describes how two to five animals are arranged inrelationship to one other. The student visualizes the scene with theanimals positioned appropriately. With the reading card turned facedown, he/she then arranges plastic figures to correspond with the sceneas it was described in the phrase or story. Three difficulty levels arepresented; each corresponds to the number and complexity of relation-ships. The first two difficulty levels were used.

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