does cognitively focused instruction improve the academic … · 2013-03-19 · strengthens working...

Vol. 79. No. 3, pp. 263-290.©2013 Council for Except ¡omil Children.

Exceptional Children

Does Cognitively FocusedInstruction Improve theAcademic Performance ofLow-Achieving Students?

DEVIN M.KEARNSBoston University

DOUGLAS FUCHSPeabody College ofVnriderbilt University

ABSTRACT:r: Stakeholders are debating the value of cognitively focused instruction for students who

have not benefited from a skills-based approach. Much of the discussion, however, is occurring

without recognition of research that has been conducted in the past 2 decades. In this article, we

reviewed the research. Electronic databases and hard copies of scholarly journals were searched; 239

references were identified; and 50 pertinent studies were analyzed to determine the effects of cogni-

tively focused instruction—delivered alone or in combination with academic instruction—on

students described as demonstrating poor academic achievement, learning disabilities, or specific

cognitive deficits. Findings suggest that several cognitive interventions accelerated low-achieving

students' academic progress. Nevertheless, when the research is taken as a whole—when the perti-

nent studies and the interventions they describe are considered with regard to their content, quality,

and results—we conclude that it does not support the use of cognitively focused instruction at this

time. Implications for future research are discussed.

any . educators believeresponsiveness to inter-vention (RTI) is a Funda-mencal reorganization ofservice delivery—a promis-

ing reconfiguring of general and special educationinto one unified set of multiple and increasinglyintensive tiers of skills-based instruction (cf.Fuchs, Fuchs, & Stecker, 2010). Skills-basedinstruction here means instruction reflecting anintent to strengthen academic skills (e.g., letter-

sound correspondence and math problem solv-ing) and to enhance knowledge in areas such associal studies and science. We also use the term tosignify an approach inspired by Direct Instruc-tion (DI; e.g., Becker, Englemann, Carnine, SiRhine, 1981). According to Gersten, Woodward,and Darch (1986), the key to DI is that "materi-als and teacher presentation of [these] materialsmust be clear and unambiguous" (p. 18), "muchmore detailed and precisely crafted" (p. 19) thanthe norm, for successful use with students with

Exceptional Children 2 6 3

academic challenges. Moreover, wrote Gersten eta!. (1986), this instruction "must contain clearlyarticulated [learning] strategies" (p. 19): a step-by-step process involving teaching to mastery, aprocedure for error correction, a deliberate pro-gression from teacher-directed to student-directedwork, systematic practice, and cumulative review{cf Gersten et al., 1986).

A belief in the efficacy of skills-based in-struction seems well founded. When imple-mented with fidelity, carefully scripted programsin reading, writing, and math—often involvinglearning strategies similar to DI—have beenshown to benefit numerous at-risk students (e.g.,Graham & Perin, 2007; Kroesbergen & VanLuit, 2003; Stuebing, Barth, Cirino, Francis, 6£Fletcher, 2008). Additionally, when researchersuse a skills-based approach at Tier 1 or Tier 2 inan RTÍ framework, they often accelerate the aca-demic progress of many children (Al Otaiba &CFuchs, 2006; McMaster, Fuchs, Fuchs, & Comp-ton, 2005; Vaughn, Linan-Thompson, & Hick-man, 2003) and decrease the likelihood that theywill be wrongly identified as requiring specialeducation.

As importantly, however, a skills-based ap-proach fails to advance the progress of all stu-dents. Multiple research teams grappling withschool-based implementations of RTl have inde-pendendy demonstrated the veracity of this claim(e.g., Fuchs, Fuchs, & Compton, 2004; Vaughnet al., 2010). Extrapolating from their respectivestudy samples, researchers have estimated chatfrom 2% to 6% of the general population will notbenefit from a skills-based approach when imple-mented by researchers (rather than by practi-tioners), suggesting these percentages are aconservative estimate. Thus, research (and com-mon sense) promotes a view that if a child has notresponded sufficiently to skills-based instructionat Tier I, nor to a more intensive version at Tier2, it makes little sense to "triple down" on thesame approach at Tier 3. This raises the impor-tant question: If not a skills-based approach, thenwhat?

COGNITIVELY FOCUSF.D INSTRUCTION

Cognitively focused instruction is a well-knownalternative (cf Learning Disabilities Association,

2010). One of two popular variants targets theputative cognitive processes responsible for aca-demic problems. Low-achieving students withworking memory difficulties, for example, aretrained to become more proficient on workingmemory tasks with the expectation that this willlead to stronger academic performance (e.g..Holmes, Gathercole, & Dunning, 2009). A sec-ond version of this approach aims to strengthencognitive processes and academic skills within thesame intervention. Chenault, Thomson, Abbott,and Berninger (2006), for example, implementedattention training followed by writing instruction.

Hale et al. (2008) have argued for the efFi-cacy of cognitively focused instruction, as haveFiorello, Hale, and Snyder (2006), who describedit as one potential approach to instruction used in"cognitive hypothesis testing." Hale and Fiorello(2004) presented case studies in which cognitivehypothesis testing (involving various combina-tions of cognitively focused and academic instruc-tion based on cognitive assessment) improvedchildren's academic performance.

Others take issue with the claim. A largegroup of academics, policy makers, and others (cfThe Consortium for Evidence-Based Early Inter-vention Practices, 2010) insists that cognitivelyfocused instruction fails to improve studentachievement. Critics of the approach often citeDiagnostic Prescriptive Instruction (DPI) as animportant case in point. In the 1960s, Frostig andHorne (1964), Kirk and Kirk (1971), and othersdeveloped DPI as an alternative to (and a reactionagainst) a popular, behavioral, task-analytic ap-proach to teaching at-risk students with and with-out disabilities. DPI embodied important featuresof cognitively focused instruction, particularly therelated beliefs chat weak cognitive processes wereresponsible for poor school achievement and thatthese processes could be identified reliably andstrengthened sufficiently through targeted train-ing, with the result that students' schoolworkwould improve. The position papers and empiri-cal evidence brought to bear against DPI in the1970s and 1980s are well known (e.g., Arter &Jenkins, 1979; Hammill & Larsen, 1974; Mann,1979).

Notwithstanding the cogent criticism ofDPI, one can question the fairness and relevanceof basing declarations against all cognitively

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focused instruction, in principle and practice, ondecades-old evidence and an antiquated, discred-ited approach. Since the 1970s and 1980s, cogni-tive science and neuroscience have developed intofields that are sprawling, overlapping, and excit-ing. Much more is now known about the cogni-tive mechanisms of learning and how learningreshapes brain networks that affect attention andacademic behavior (cf. Varma, McCandliss, &Schwartz, 2008). Yet as far as we know, there hasnot been a systematic and comprehensive reviewof the literature pertaining to cognitively focusedinstruction since Kavale's (1982) review morethan a quarter century ago. Thus, we suggest thatrecent claims made for and against cognitively fo-cused instruction should be regarded cautiously. Itis timely to ask: "What does the relevant andmore recent scientific literature say? Is there evi-dence that cognitively focused interventions pro-duce academic improvements for low-achievingstudents with and without a learning disabilities(LD) label; with and without presumed cognitivedeficits?" Those are the basic questions we addressin this article.

We suggest that recent claimsmade for and against cognitively

focused instruction should he

regarded cautiously.

OUR REVIEW

There are many compelling reasons for conduct-ing a comprehensive arid systematic review of theefficacy of cognitively focused instruction. Fore-most, as mentioned, a significant minority of stu-dents do not respond to validated skills-basedinstruction, even when applied with fidelity.Something more is needed to help these children.Educators require the equivalent of a new class ofdrugs to combat a serious and stubborn nationalhealth issue (persistent low achievement amongmany in the K-12 population). Cognitivelyfocused instruction may prove a useful alternativeor supplement to skills-based instruction in spe-cific instances for certain students. Second, as anindividualized approach, it seems well-suited in

principle for use at the most intensive tier in anRTI framework. Third, it reflects or aligns with atraditional belief held by many that LD is charac-terized by isolated weaknesses in basic psychologi-cal processes that negatively affect academicperformance. Fourth, as mentioned, given a siz-able increase in understanding over the past 2decades of the cognitive mechanisms that affectlearning, and an apparent absence of a review ofthe literature on cognitively focused instructionduring this interval, it is timely to conduct such areview now.

We searched for studies in which researchersattempted to use cognitively focused interven-tions—alone or in combination with academicinterventions^to improve the academic achieve-ment of low-performing students with and with-out LD and with and without specific cognitivedeficits. We organized these intervention studiesinto three categories, the first of which broughttogether aptitude-by-treatment-interaction (ATI)investigations. ATI refers to the matching of apopulation characterized by a specific need (i.e.,cognitive deficit) to a specific instructional inter-vention (cf. Cronbach, 1971). In principles thismatching of deficit to instruction is the essence ofcognitively focused instruction. Hence, we beheveATI studies represent the most meaningful andrigorous test of this instructional approach. Insuch studies, participants have one of two (ormore) cognitive deficits. If students with DeficitA do better in Cognitive Intervention A (matchedto Deficit A), whereas students with Deficit B dobetter in Cognitive Intervention B (matched toDeficit B), an ATI is observed. Such studies arerare.

A second category, and next-most-rigoroustest, is represented by studies in which researchersassign low-performing students (with or withouta specific cognitive deficit or an LD label) to cog-nitively focused instruction or academic instruc-tion. If students in the cognitively focusedintervention show greater academic improvement,it only suggests an ATI because the researchers donot explicitly match cognitive deficits to the in-tervention. Academic instruction here refers to justthat—instruction aiming to improve academicperformance. Few authors of studies in this sec-ond category conducted skills-based instruction as


defined by Gersten et al. (1986), a point to whichwe will return.

A third category is when investigators com-pare the academic performance of students partic-ipating in a cognitively focused intervention tobusiness-as-usual controls. We consider this a leastrigorous test because the comparison group re-ceives only business-as-usual classroom instruc-tion. If students in this group had received someform of systematic support from the researchers,they may have met or exceeded the gains of thetreatment group. Nevertheless, positive effects inthis third group of studies favoring cognitively fo-cused instruction would suggest the approachmay have benefits—no small feat when it oftenhas no academic components (e.g., covering onelens in glasses; Stein, Richardson, &c Fowler,2000).

In our review of these three types of cogni-tively focused intervention studies, the outcomeof interest was always academic achievement (e.g.,arithmetic, Naglieri & Gottling, 1997; readingaccuracy and reading comprehension, Robertson,2000; writing qualit)', Graham &: Harris, 1989).We deliberately excluded studies that examinedonly cognitive outcomes (e.g., Klingberg et al.,2005) because the value of cognitiveiy focused in-tervention, we believe, must be proved in terms ofacademic benefits. If working memory trainingstrengthens working memory but fails to improvereading or math skills, its practical importance ishard to defend.

The following were the specific questionsthat structured the review:

• Do cognitively focused interventions pro-duce better academic results when they arematched, versus not matched, to the stu-dents' cognitive deficits (i.e., has an ATI beendemonstrated)?

• Do cognitively focused interventions pro-duce greater school achievement than aca-demic interventions?

• Do cognitively focused interventions pro-mote greater academic progress than busi-ness-as-usual (control) instruction?

M ETH o DS

INCLUSION AND EXCLUSION CRITERIA

We had five requirements for a study to beincluded in this review. First, authors had to usea cognitively focused intervention. We definedthis as a program designed to improve a cognitivefunction (e.g., visual processing). As indicated,we also included studies of interventions thatcombined cognitively focused and academiccomponents (e.g., Goldstein & Obrzut, 2001).Second, authors of included studies used aca-demic outcomes. Studies with only cognitiveoutcomes were excluded (e.g., KÜngberg et al.,2005). Third, authors of qualifying studies alsoused experimental and control (or comparison)groups or students as their own controls. That is,only experimental or quasi-experimental studieswere included. Case studies (cf Hale & Fiorello,2004; Hale et al., 2008) were excluded becausethey did not permit cause-and-effect conclusions.Fourth, we did not include medical interven-tions, such as those testing drug effects (e.g.,methylphenidate for attention deficit hyperactiv-ity disorder [ADHD]). Finally, we omitted stud-ies of phonological processing/phonologicalawareness (PA) because many prior studies haveidentified the value of this type of cognitivetraining for reading (cf. Snow, Burns, & Griffin,1998).

LITERATURE SEARCH

Articles were obtained through electronicsearches of PsycINFO and ERIG, hand searchesof relevant journals, and ancestral searches of keyarticles. The electronic searches were conductedseparately for cognitive domains identified byGattell-Horn-Carroll (CHG) intelligence theory(Floyd, Keith, Taub, & McGrew, 2007) and chePlanning, Attention, Simultaneous, and Succes-sive (PASS) theory (Das, Naglieri, & Kirby,1994). The cognitive domains were attention,long-term memory, planning, processing speed,working memory, and visual-spatial processing.Only studies published in English since 1988were included. This search produced 239 refer-ences. Journals publishing the most articles iden-tified in the computer search were hand-searchedby the first author beginning with the volume

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corresponding to 1998. The journals were Devel-opmental Neuropsychology, Journal of ExperimentalChild Psychology, Journal of Learning Disabilities,Learning Disabilities Research & Practice, and Psy-chology in the Schools. Ancestral searches wereconducted of reviews of the cognitive interven-tion approach where authors argued for theirvalue—namely, Hale and Fiorello (2004),Fiorello et al. (2006), and Hale et al. (2008). Wealso conducted ancestral searches of the refer-ences of studies included in the review. The firstauthor of this article also received a citation of astudy (Iovino, Fletcher, Breitmeyer, & Foorman,1998) from a reviewer of an earlier draft of thisarticle.

CODING OF STUDIES

Thirty-nine articles met our inclusion criteria andwere coded by the first author to (a) describe par-ticipants, interventions, and measures; (b) evalu-ate study quality; and (c) calculate effect sizes foroutcome measures. Six of the 39 articles werecoded as two studies, one as three studies, andone as four studies. The database therefore con-tained 50 investigations from the 39 articlesshown in Table 1. A research assistant—a doctoralstudent in Special Education—coded 18 of the 50studies independently of the first author. The firstauthor and the research assistant achieved 88%interrater agreement across all coding categories,89% agreement for the descriptive features of thestudies, and 85% for methodological quality.

Thirty-nine articles met ourinclusion criteria and were coded by thefirst author to (a) describe participants,interventions, and measures; (b) evaluate

study quality; and (c) calculate effectsizes for outcome measures.

Where possible, effect sizes were calculatedusing Cohen's d formula. Pretreatment standarddeviations were used for these calculations be-cause they refiect the students' performance be-fore intervention. When means and standarddeviations were not available, effect sizes were cal-culated using z, t, or F statistics or p values. We

present effect sizes, but this is not a meta-analysis.We included studies that did not provide suffi-cient data for calculating effect sizes because wewished to describe and discuss as full a range aspossible of cognitively focused interventions inthis relatively limited literature.

RESULTS

GENERAL DESCRIPTION OE STUDIES

Collectively, study authors attempted to improvestudent academic performance by targeting abroad range of cognitive processes: attention,fluid processing/metacognition, language/auditory processing, motor processing, planning,processing speed, successive processing, visualprocessing, working memory, and multiple cogni-tive processes, which constitute the rows in Table2. (Several of these cognitive processes were notpart of initial search procedures but were addedduring subsequent hand and ancestral searches.)Moreover, within a single cognitive process cate-gory there were many approaches to intervention.Among the visual processing studies, for example,researchers used interventions involving colorreading overlays (Iovino et al., 1998), occludedlenses (Stein et al., 2000), and reading with eye-tracking control (Solan, Larson, Shelley-Tremblay,Ficarra, & Silverman, 2001).

The authors of the 50 studies selected adiverse range of participants (see Table 2). Theyworked with students with a specific cognitivedeficit in 21 studies, with children with an LDlabel in 13 studies, and with low-achieving stu-dents without a disability designation in 16 stud-ies. The methodological quality of the studiesvaried, too. We rated each on seven criteria,reflecting the combined recommendations ofGersten et al. (2005) and Booth (2006). Investi-gations were given a rating of 1 when they met acriterion; 0 when they did not. They wereawarded a 1 if subject attrition was less than 30%and if there was a 10% or less difference betweenattrition rates of the study groups (criterion #1).They were also given a 1 when the study groupswere comparable—that is, not significantly differ-ent on treatment outcomes at pretreatment or ondemographic characteristics such as gender or


T A B L E 1

Studies Included in Review

Participants

StudyDisability or

Cognitive DeficitAges/

Crades

ComparisonGroup

Ages/Crades

Method of Disability/Deficit Identification

Intervention

Ont)

Research Qtiestion #7 (n =5)"

Dryer, Beale, & Linguisric-rypeU m b m (1999). dyslexiaStudy A

Linguistic-type 10 8-12 (I) Reading achievement Linguistically focuseddyslexia more than 1.5 years below training, reading words

age; (2) More than 60% of with unusual lypefnces,"substantive" word reading plus reading words byerrors (incorrect word read) feeling letters in a box

Dryer, Beale, & Percepiual-typc 11 8-12 Perccptuai-type 10 8-12 (I) Reading achievementLambert (1999), dyslexia dysle.YÍa more ihan 1.5 yearsStudy B below age;

(2) More than 60% of"fragmentation" wordreading errors (long pauses)

Perceptually focusedtraining, includingreading abstract wordsand cloze passages withquestions about missingwords

Kerns, Eso, & ADHDThomson (1999)

7-11 ADHD 7—11 (I) Prior clinical diagnosisofADHDandage< 12;(2)K-BiTIQ>79;noprior head injury ordevelopmental disorder

Pay Attention! materialsfor sustained, selective,alternating, anddivided attention

Robertson (2000) Linguistic-typedyslexia

Ai= 12 Linguistic-typedyslexia

8 M= 12 Students made moresubstantive thanfragmentation errors inreading measured by theNARA

Linguistically focusedtraining, with wordreading with alteredtypefaces

Shalev,Tsai, ADHDMevonich (2007)

20 6-13 ADHD 16 6-13 Prior clinical diagnosisusing DSM-IV criteria

Computerizedcontinuous performancetasli, conjunctive searchtask, combined orientingand flanker task, andshift Stroop'like task

Research Qtiestion #2(n = 11)''

Chenault, DyslexiaThomson, Abbott,Si Berninger(2006)

10 'ith-6th Dyslexia 4rh-6th (1) 2/3 bdow mean onGORT-3 Reading Accurac)'.GORT-3 Reading Rate,WIAT-II spelling, WRAT-3spelling. Alphabet WritingTask, or WIAT-Il WrittenExpression; (2) SS > 87 onWISC-III VerbalComprehension

Attention processtraining followed bywriting instruction

Facoetti, Lorusso,Paganoni, Umilta,& Mascetti(2003)

Dyslexia 12 /W=10 Dyslexia M= 10 Oral reading of text, words,and nonwords all 2 SDsbelow norm on age-standardized Italian tests

Computer program toorient visual attention,different depending ontype of dyslexia identified(perceptual, linguistic,both)

Goldstein &Obrzut (2001).Study A

Perceptual-typedyslexia

13 11-15 Mixed-typedyslexia

15 1I-Í5 ( 1 ) Text reading at least 2years below grade level;(2) "slow and laborious"(p. 278) reading

Reading words presentedto left visual field, tactilereading of words, andreading of words withunusual typefaces

Goldstein &Obtïut(200l),Study B

Linguistic-typedyslexia

15 11-15 Mixed-typedyslexia

15 11-15 (l)Text reading at least2 )'ears below grade level;(2) "excessively fast" ,(p. 278) reading withmany errors

Reading of words presentedto right visual field, tactilereading of words, andreading of words wirhunusual typefaces

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Treatments

Comparison(Comp)

AssigfimentMethod

Outcomes

OutcomeMeasures

Times ofMeasurement Results

Perceptually focused training,including reading abstract wordsand cloze passages with questionsabout missing words

Random GORT-R Comprehension and Pretest andassignment Accuracy subtests; BoderTest posttest

of Reading-Spelling Problems;Burt Word Reading Test

No effects

Linguistically focused training, Randomreading words with unusual assignmentTypefaces, plus reading words byfeeling letters in a box

GORT-R Comprehension andAccuracy subtests; BoderTestof Reading-Spelling Problems;Burt Word Reading Test

Pretest andposttest

No effects

Computer-based academic activitieswith feedback

Matching onage, gender,and medication

Grade-appropriate researcher-selected arithmetic problems

Pretest andposttest

Int > Comp onarithmetic problems(0=3.70)

Perceptually focused training, with Randomexercises involving word deletion assignmentand rhyming

NARA reading accuracy andreading comprehension

Pretest andposttest

Unknown

Computer games with feedback and Randommultiple levels, and pencil and assignmentpaper activities

Grade-appropriate academic tests Pretest and Int > Comp on readingadministered in Hebrew in math posttest comprehensionand reading comprehension (ES = 0.74)

Reading fluency followed bywritine instruction

Random Alphabet Writing Task; WIAT-IIassignment Written Expression; GORT-3

Rate; CORT-3 Accuracy

Pretest; midtest(before writinginstruction);posttest

Int > Comp betweenmidtest and postteston WIAT-II WrittenExpression(£5=0.34)

Phonological awareness, perceptual Randomprerequisites, or guided reading, assignmentdifferent depending on "functionalprofile"

Speed and accuracy on Italiantest of oral text reading

Pretest and Statistical significanceposttest testing not conducted for

between-group contrast.However, students in Intshowed significant pretest-posttest improvement

"conventional reading instruction"(p. 279)

Only students with Multilevel Academic Skillsperceptual-type Inventory reading errorsdyslexia received and coitiprehensiontreatment; groupsnot comparable

Pretest andpost test

Unknown

"conventional reading instruction"(p. 279)

Only students with Multilevel Academic Skillslinguistic-rype Inventory reading errorsdyslexia received and comprehensiontreatment; groupsnot comparable

Pretest andpost test

Unknown

'̂Research Question #1: Do cognitive interventions matched to a cognitive deficit improve student academic performance more than interventionsnot matched to a cognitive deficit?''Research Question #2: Do cognitive interventions improve student academic performance more than academic interventions?

continues


T A B L E 1 . Continued

Participants

SnidyDisnbility or

Cognitive Deficit n GradesComparison

CroupAges/

CradesMethod of Disability/Deficit Identification

Interventiondm)

Research Question #2 (n = ¡ 1)^cotitiuued

Graham & Harris Learning II AÍ = i 1(1989) disability

Learning 11 M = \2 School-identified as havingLD, I Q & 8 5 a n d á 115,achievement £ 2 yearsbelow grade and teacherconfirmation of writingcomposiiion problems

Self-Instructional Stratcgj-Training for writing andSelf Regulation Training

Hayward, Das,&jan7.cn(2007)

Poor readers 3rd Poor readers 11 3rd Inability to complete STARReading Assessment

Cognition EnhancementTraining (COGENT)training for first 1/2followed by PREPcognitive training forPASS processes

Hook, Macariiso,& Jones (2001)

Learning 7-12 Learningdisabilit)'

7-12 Score below 16thpcrccntile on WRMT-RWord Identification orWord Attack, or verbalIQat lease 1 50 > thanWRMT-R score; verbalIQ> 90 or full-scaleIQ>80

Fast 1-orWord auditoryprocessing training

Mantzicopoulos,Morrison, Stone,Si Sctraiiian(1992). Study A

Students at riskfor readingproblems

59 Students at risk 52for readingproblems

Below the 33rd pcrcentilcon at least 5 of 10 subscalesof StL\RCH test battery ofspatial and temporalorientation

TEACH perceptualskills program,including vistial, motor,auditory, and body imageimproving activities

Parrila, Das,Kendrick,Papadopoulos, &Kirb)' (2000)

"At-risk forexperiencingreading diffi-culties" {p. 8)

29 1st "At-rislt forexperiencingreading diffi-culties" {p. 8)

29 Score below 26th percentileon both WRMT-R WordAttack and WordIdentification siibtests

PREP cognitivetraining

Solan, Larson,S h e 11 ey-1 re m b I ay,

I'icarra, &

Silverman (2001)

Reading 15 6th Reading 16 6th Scores 0.5 to 1.0 below

disability disability national means on GMG

Reading Test

Eye movement training

(controlling text

exposure to 3 words

and practicing eye

tracking)

Spencer, Snart,

& Das (1989)

Learning

disability8-12 Learning

disabilitj'Students attended specialclasses for students withlearning disabilities

Tasks to improvesuccessive processing,including beadthreading, digitsequencing, and spelling

Research Question #3 fn = 34) ••

Aro, Ahoncn, StudentsTolvanen, L)'ytinen, referred& Todd de Barra for "learning(1999) problems"

(p- 293)

54 M = 9 Studentsreferredfor "learningproblems"(p. 293)

43 Referred to remediationcenter by teachers forhaving learning problems;IQ>79

Cognitive training fortime and spaceorientation, languageand verbal skillsexpression, perception,numerac)', and skillintegration

Bakker, Bouma, Linguistic-& Gardien (1990), t>'peStudy A dyslexia

28 Al=]\ Linguistic-typedyslexia

A/ = 11 Substatitivc errors areabove group average andfragmentation errors arebelow group average

Tactile training, feelingletters that representconcrete words withthe right hand

Bakker, Bouma, Perceptual-tj'pe 20 AÍ = 9 Perceptual-& Gardien (1990), dyslexia typeStudv B dyslexia

23 M = \0 Fragmentation errorsabove grotip average andsubstantive errors arebelow group average

Tactile training, feelingletters that representabstract words withthe left hand

Spring 2013

Treatments

Comparison(Comp)

AssigfiwefitMethod

OutcomeMeasures

Outcon


Self-Instructional Strategj' RandomTraining for writing assignment

Story grammar elements; holistic Pretest andwriting quality ratings posttest

No effects

COGENT training combining Nonrandomcognitive training with reading assignment atpractice classroom level

WJ-ill Tests of Achievement, Pretest andWord Attack, Word Identification, posttestPassage Cohiprehension, and OralComprehension subtests

(1) hit > Comp on WordIdentification {ES = 0.76);(2) hit > Comp on PassageComprehension{ES = 1.00)

Orton-Cillingham readingintervention

Not stated WRMT-R Word Attack and WordIdentification subtests

Pretest andposttest

No effects

Phonics and spelling practiceworkbooks and word reading

Matching on SliARCHscores, gender, andK-ABC cognitiveability

Stanford Diagnostic Reading Test,Reading Comprehension subtest;WRMT Word Attack; TWSPhonetically Regular Words;K-ABC Read ing/Decoding

:est only No effects

Meaning-based readingcurriculum

Matching on cognitiveprocessing, phonologicalprocessing, andreading

WRJMT-R Word Attack andWord Identification subtests

Pretest andposttest

No effects

Comprehehsion lessons(clo7.e practice followed bycomprehension practice)

Matching on CMCscore

CMG Reading Test; learning rate,calculated as % change over initialCMG grade equivalent score;Visagraph eye tracking results forreading rate if comprehension >70%, fixations and regressions per100 words

Pretest andposttest

No effects

!-Can-SpeII program One classroom assignedto treatment and oneto comparison

TWS-11 Pretest andposttest

int > Comp on spelling(£•5 = 0.65)

Homework assistance Matching on gender,age, IQ, and SES andthen randomizing

Woodcock Spanish Psycho- Pretest andEducational Battery Reading, posttestMathematics, and Writingsubtests

No effects

At the discretion ofthe teacher. Matching on age. Text reading test; word reading Pretest and Comp > hitbut not including any gender, reading level, test posttest (£"5" = -0.48)intervention components and hand preference

and then randomization

At the discretion ofthe teacher. Matching on age,but not incliiding gender, reading level,intervention components and hand preference

and then randomization

Text reading test; word readingtest

Pretest andposttest

Comp > hit onreading test{ES = 0.67)

word

''Research Question #2: Do cognitive interventions improve student academic performance more than academic interventions?*̂ Rcsearch Question #3: Do cognitive interventions improve student academic performance relative to no-treatment controls?


T A B L E 1

Study

Continued

Disability orCognitive Deficit

Participants

Ages/Grades

ComparisonGroup

Ages/Grades

Method of Disability/Deficit Identification

InterventionOnt)

Research Qi/estion #3 (n = 3'^)'' continued

Boden & Kirby Poor readers 8 5th-6th Poor readers 5th-6tli Reading abiliiy in diebottom half of a sampleofsrudencs

PREP cogniti\'ctraining withapplication todecoding

Carlson & Das(1997), Study A

Chapter 1 ("poor 22 'ithperformance on... achievementtests," p. 93}

Chapter 1 15 'ith School idenrificaiion ofChapter i status

PREP with 2:1teacher-siiideniratio

Carlson & Das(1997), Study B

Chapter ! ("poorperformance on... achievementtests." p. 93)

4th Chapter 1 37 'ith School idenrificaiion ofChapter I status

PllEP with 4:1teacher-studentratio

Churches, Skuy,Das (2002)

Successiveprocessing

7 8-10 Successiveprocessing

8-10 CAS Speech Raie and PREP cognitiveWord Series subiest scores training< 25th percentile

Das, Mishra, SiPool (1995)

At least 12months belowexpccied agelevel

20 A i = 1 0 At least12 monthsbelow expcciedage level

M= 10 WRiMT-R WordIdentification or WordAttack subtest

PREP cognitivetraining withapplicarion todecoding

Geiger, Lcttvin,& Fahle (1994)

Iovino, Fletcher,Breitmeyer, &Foorman (1998),Study A

Dyslexia

Reading-spellingdisability

9 3rd-7th . Dyslexia 3rd-7th Züricher Lesetest wordreading and passagereading fluency

Home-based readingwiih visual field-limiting mask andenjoyable hand-eyecoordination tasks

Holmes, Low verbal 22 M= 10 Low verbal 20 M= 10 Scores below ihe J5th Adaptive working-Cathercole, working working percentile on two tests on memory training withSc Dunning memor)' memory verbal working memory, increasing diiTîculty(2009) tistenirlg recall, and as students mastered

backvk'ard digit recall tasks

Humphries, Learning 35 5—8 Learning 33 5-8 (I) Verbal, Performance, or Sensory integrationWright, Snider. disabilit)' disahilit)' fullscalc IQ> 85; (2) 1 SD& McDougali difference between highest(1992), Study A . iQscore and WRAT

reading, spelling, orariihnietic standard score

Humphries, Ij;arning 33 3-8 Learning 34 5-8 (1) Verbal, Performance, or Perceptual-motorWright. Snider, disabilit)' disability fullscale IQ > 83; (2) I SD treatment& McDougali difference benvecn highest( i 992), Study B IQ score and WRAT

reading, spelling, orarithmetic standard score

15 Af=12 None(owncontrols)

Reading and spelling scores< 30th percentile, averagingbelow the 10th percentile;arithmetic subtest scoresone half 5D higher thanreading and spelling scores

Blue colored overlaysfor text

Iovino, Fletcher,Breitme)'er, &Foorman (1998),Study li

Reading-spellingdisability

None-(owncontrols)

Reading and spelling scores< 30th percentile, averagingbelow rhe 10th percentile;arithmetic subtest scoresone half 5£) higher thanreading and spelling scores

Red colored overlaysfor text

Iovino, Fletcher,Breitmeyer. &Foorman (1998),Stud)' C

ADHD 15 / W = I 2 None

(owncontrols)

Student met DSM-III-Rcrireria for ADH D basedon parent and teacherquestionnaires

Blue colored overlaysfor text

Spring 2013

Treatments

Comparison(Comp)

AssignmentMethod

OutcomeMeasures

Outcomes


Not stated Random assignment WRMT-R Word Attack,Word Identification, andPassage Comprehensionsubtests with pretest covariateof CMC Comprehension andVocabulary subtest average

Posttest withcovariatedescribed atleft

, (I) Int > Comp for WordAttack [ES = 0.47);(2) Int > Comp for WordIdentification (£S= 0.71)

No treatment Random assignment WRMT-R Word Attack andWord Identification subtests

Pretest and (1) Int > Comp on Word Attackposttest (£5=0.65);

(2) Int > Comp on WordIdentification (£5= 0.80)

No treatment Random assignment WRMT-R Word Attack andWord Identification subtests

Pretest and (1) Int > Comp on Word Attackposttest (0.83);

(2) Int > Comp on WordIdentification (0.42)

No treatment One classroom assignedto treatinent and oneto comparisori

WRMT-R Word Attack andWord Identification subtests

Pretest and Unknownposttest \Note: Authors reported child-level

effects despite classroom-levelassignment with 2 classrooms.]

No treatment Not stated WRMT-R Word Attack andWord Identification subtests

Pretest and (I) Int > Comp on Word Attackposttest (£5= 0.76);

(2) Int > Comp on WordIdentification (£5 = 0.65)

No treatment Random assighnient(except Int studentswith poor complianceswitched to Comppost hoc)

Züricher Lesetest compositegrade equivalence

Pretest and Int > Comp on Züricherposttest Lesetest (£5= 1.45) [Note:

Authors changed "noncompllant"Int students to Comp foranalysis.]

Nonadaptive working memory Each school assignedtraining; same difficulty a different treatment;regardless of improvement school assignment

process not stated

Wechsler Objective ReadingDimensions basic readingsubtest; Wechsler ObjectiveNumber Dimensionsmathematical reasoning subtest

Pretest and No effects. {Note: Authors reportedposttest mathematical gains in Int between

posttest and six-month follow-upbut did not compare Int andcontrol.]

No treatment Random assignment WRAT reading, spelling. Pretest andarithmetic; Durrell Analysis posttestof Reading Difficulty; BasicSchool Screening Inventory

No effects

No treatment Random assignment WRAT reading, spelling. Pretest andarithmetic; Durrell Analysis posttestof Reading Difficulty; BasicSchool Screening Inventory

No effects

Clear overlays for text N/A (owncontrols)

Word reading accuracy; wordreading rate; readingcomprehensioh accuracy;reading comprehensionpassage reading rate

Posttest only No effects; blue overlays better forcomprehension accuracy for allgroups (including students withoutdisability)


Word reading accuracy; wordreading rate; readingcomprehension accuracy;reading comprehensionpassage reading rate

Posttest only No effects

Cle; ;rlays for N/A (owncontrols)

Word reading accuracy; wordreading rate; reading compre-hension accuracy; reading com-prehension passage reading rate

Posttest only No effects; blue overlays better forcomprehension accuracy for allgroups (including students withoutADHD)

*=Research Question #3: Do cognitive interventions improve student academic performance relative to no-treatment controls?


T A B L E 1 ContinuedParticipants

SillilyDisability or

Cogiiitlve DeficitAgesI

GradesComparison

GroupAgesI

GradesMethod of Oisabiliiyl

• Deficit IdentificationIntervention

Research Question if3 (n = 34) '' continued

Iovino, Plcicher, ADHD 13 M= 12 NoneBreitmeyer, & (ownFoorman {l'J9S), . controls)Srud)- D

Suident met DSM-ll i-Rcriteria for A D H D basedon parent and teacherquestionnaires

Red colored overlaysfor text

Kujnia et al.

(2001)

"Reading

impaired"

(p. 10509)

24 M =7 "Readitig 24 M =7 School identification of Computer-based tasks

impaired" reading impairment; requiring matching a(p. 10509) ANOVA confirmed lower sound seqttetice to

achievement of these images of bars

sttidents compared with representing soundsthose with typicalachievement

l^mminmaki,Ahonen,Todd deBarra, Tolvancn,MicKelsson, &Lyytinen (1997a)

Learning

problemsM = Learning

problems45 Ai = 9 Difficulty in three of these Cognitive training in

areas: sensorimotor skills, sp'atial orientation,niemory, spatial and tetii- language, perception,

poral concepts, speech and etiiotion, and

language, reading sills, tiiath mathematicsskills, visual processitig, reason-ing attention and behavior

Umminmaki, U-arning 38 AÍ = 9 Learning 36 A i = 9 Difficult)'in three of these Cognitive training inAhunen, Todd de problems problems areas; sensorimotor skills, spatial orientation.

Barra, lolvanen, memory, spaiial and language, perception,Michelsson, & temporal concepts, speech emotion, and

L)ytincn (1997b) and language, reading skills, mathematics, for 2

math skills, visual • years (continuationprocessing, reasoning, or of Lamminmaki etattention and behavior al., 1997a)

Lighrstone,Lightstone. &Wilkins (1999),Study A

Astheniopia/perceptualdistortion

9-18 None(owncontrols)

Siudems visited clinic and"had sympioms c fastheniopia or perceptualdistortion following aminimtim of 6 weeks oforthoptic treatment" (p. 280)

Colored overlay

chosen by the student

Lights tone,Light.stone, &Wilkins (1999).Sttidy 1Í

Astbeniopia/perceptualdistortion


Students visited clinic and"had symptoms ofastheniopia or perceptual .distortion following aminimum of (í weeks oforthoptic treatment" (p. 280)

Students chose acolored overlay andwore lenses of thesame color as theoverlay

Ligbtstone,Lightstone, &Wilkins (1999),Study C

Astheniopia/perceptualdistortion


Students visited clinic and"had symptotiis ofastheniopia or perceptualdistortion following aminit i ium of 6 weeks o forthoptic treatment" (p. 280)

Students were givena colored overlay andwore lenses matchingtheir Colorimeterassessnient results

Lovett, liansby,Hard wick, Johns,& Donaldson

(1989)

Disabledreaders

Notstated

8-13 Disabled

readers• Not

stated8-13 (1) Scores 1-5 years < grade

level on 4 measures of wordreading accuracj-, or(l)Scores 1.5 years < gradelevel on 4 reailing ratemeasures, and (2) Scores Sgrade level on 4 measuresof word recognition

Oral language,discourse, and readingcomprehensiontraining, plusvocabulary,structural analysis,grammar, andwritit ig

Manaicopoulos, Students at 59 1st Students 52 1st Below the 33rd percentile onMorrison, Stone, risk for at risk for at least 5 of 10 stibscales of

& Setrakian reading reading SEARCH test battery of spatial(1992), Study B problems problems and temporal orientation

TEACH perceptual skillsprogram, including visual,motor, auditory, and bodyimage improving activities

Mart in,

Mackenzie,

Lovegrove, &

fvlcNicol( l993)

Readitig 20S 2.5 gradesbelow andscotopicsensitivity

A i = 10 Reading >

2.5 grades* below, no

scotopicsetisitivity

A/ = 10 NARA score, plus a NonsenseWord Test score less than 30of 40; scotopic sensitivit)'diagnosis

Irlen lenses provided

Spring 2013

Treatments

Comparison(Comp)

AssigiîmentMethod

OutcomeMeasures

Outcomes



Word reading accuracy; wordreading rate; readingcomprehension accuracy; readingcomprehension passage reading rate

Posttest only No effects

No treatment Not stated Finnish test of reading accuracyand speed

Pretest and (1) Int > Comp on readingposttest accuracy {ES = 0.68);

(2) Int > Compon reading'speed (£5= 0.55)

Homework assistance N4atching on Fluency test; Woodcock Spanishgender, age, Psycho-Educational Battery,IQ, and SES Reading, iMathematics, and

Writing tests; AcademicPerformance Rating Scaletotal score

Pretest and Comp > Int. [Note: Authorsposttest dichotomized improvement

("major" versus "minor") andreported logistic regressioneffects. Effects favoredComp.l

Same cognitive trainingas in Int, for I year,following a year ofhomework assistance(continues Laniminmakietal., 1997a)

Matching on Woodcock Spanish Psycho- Pretest andgender, age, Educational Battery Reading posttestIQ, and SES subtests. Mathematics subtests,

and Writmg subtest

Int > Comp on Reading(£5= 0.50) [Nö/i. Authorsused MANOVA to calculatean effect across Woodcockreading subtests. Thedifference was only presentin the second year.]

No treatment N/A (owncontrols)

Rate of Reading test Posttest only Int > Comp on Rate ofReading test (£5= 0.31)


Rate of Reading test Posttest only Int > Comp on Rate ofReading test (£5=0.19)


Rate of Reading test Posttest only int > Comp on Rate ofReading test (£5 =0.38)

Social skills, classroometiquette, life skills,organizational strategies,academic problemsolving, and self-helptechniques

Random WRAT-R Reading and Spelling;assignment PIAT Reading Recognition and

Spelling; SORT; GORT Accuracy,Rate, and Comprehension;GFW Reading and Spelling

Pretest andposttest

Int > Comp on WRAT-R(£5=0.42)

No treatment Matching on Stanford Diagnostic ReadingTest, Reading Posttest onlySEARCH scores. Comprehension subtest; WRMT Wordgender, and K-ABC Attack; TWS Phonetically Regularcognitive ability Words; K-ABC Reading/Decoding

No effects

No treatment Determined by NARA reading accuracy and reading Pretest andtest of scotopic comprehension; Nonsense Word posttestsensitivity results Test

Unknown

*̂ Research Question #3: Do cognitive interventions improve student academic performance relative to no-treatment controls?cofitinues

Exceptional Chiliiren 2/5

T A B L E 1 . Continued

Participants

StudyDisability or

Cognitive DeficitAges/

GradesComparison

CroupAges/

CradesMethod of Disability/Deficit Identification

Intervention

(Int)

Research Question #3 (n = 34)'^ continued

Miranda, ADHD 29 8-Í)Presentación, &Soriano (2002)

ADHD 8-9 (1) Score of 12 on [nattention-Disorganization and Hypcr-aciivity-impulsivicy usingDSM-IV criteria, from teacherand parent ratings; (2) ADHDsymptoms for > I year; (3)ADH D symptoms by age 6

Cognitive behaviormodification (studentself-moni tori tig) plusbehavior modificationimposed by teaclier

Nagiieri &Gorrling(1997)

learningdisabilityand lowplanningabilit)'


(I) School-identified usingdiscrepancy criteria; (2) CASused to determine planningweakness [Note: Croupsidentiiied posi hoc]

Planning discussionsand modeling ofplanning strategicsbefore and after workingon math problems

Naglieri &Johnson(2000)

Maihdisability,grouped byby PASSweaknesses, andno weakness

12-H None(owncontrols)

(1) School-identified math Planning discussionsdisability (students had math and modeling oflEP); (2) CAS used to planning strategiesdetermine PASS weakness before and after

working on matbproblems

Papado pou I OS.Charalambous,Kanari,& Loizou (2004)

"At-risk fordevelopingreadingdifficulties"(p. 85)

"At-risk fordevelopingreadingdifHculries"(p. 85)

Teacher identification PREP cognitivetraining

Reynolds,Nicolson, &ÍHambly (2003)

"Potentiallyat risk ofreadingdifficulty"(p. 54)

7-10 "Potentiallyat-risk ofreadingdifficult)'"(p. 54)

8-10 "At-risk quotient" ^ 0.4,meaning low averageperformance on the 11 DSTsubtests

DDAT: "A complexprogramme of integratedsensor)' stimulationincorporating visuo-motor and vestibulartherapy" (p. 55)

Sm it-Claude,van Strien, Liciit,& Bakker(2005)

Linguistic-rypedyslexia

Linguistic- 9 1st (i) Principal components Words flashed on lefttype analysis wirh lower factor on side of computerdyslexia Recognirion Discrimination screen ro stimulate

and Beer)' Visual-Motor than right cerebralfactor on PPVTand Peabody hemisphereWord Knowledge; (2) Teacherreport of reading problem risk

Solan, Shelley-Tremblay, Hicarra,Silverman, &Urson (2003)

Moderatereaditigdisability

6th Moderatereadingdisabilir)-

6th 0.5 to I SD below meanon CMC ReadingComprehension subtest

Perceptual Accuracy/Visual Efficienc)'program andConipurerized PerceptualTherapy Program

Stein,Richardson, &Fowler (2000)

Dyslexia 7-11 Dyslexia 72 7-11 (1)2 5D discrepancy benveen Classes with left eyeIQand reading scores on BAS; occluded, worn during(2) Unstable binocular control reading and writingon Dunlop test of binocular workstability; (3) No overtophihalmological problem

van den Bosch, Poorvan Bon, & readersSchreuder(1995)

20 7-13 Poorreaders

7-13 (I) Attended school forstudents with learningdisabilities: (2) Identified byteachers as "poor readers"

Hmed, adaptivepseudoword computerflashcard reading

Note: ADHD = Attention deficit hyperactivity disorder; ANOVA = Analysis of Variance; ARQ = At-risk quotient; BAS = British Abilities Scale; CAS =Cognitive Assessment System; DDAT = Dyslexia Dyspraxia Attention Treatment; DSM III = Diagnostic and Statistical Manual of Mental Disorders III;DSM Ill-R s Diagnostic and Statistical Manual of Mental Disorders Ill-R; DSM-iV = Diagnostic and Statistical Manual of Mental Disorders IV; DST= Dyslexia Screening Test; EMT = Eén-Minuut-Test (One-Minute Test); ES = effect size; CFW = Coldman-Fristoe-Woodcock test; CMG = Gates-\/„.r-; .-:.:„. rr^o-y.^ ^ Gray Oral Reading Test 3; CORT-R = Gray Oral Reading Test R; K-ABC = Kaufman A.'aessment Battery for Children; K-BIT

. . . „ I I : , , ^ _ ' T " - - . . I ï ^ _ I : J : L t l " \ A \ K I / ^ \ Í A I Í . . I ^ T • _ _ A . _ _ I . . _ " _ _ Í ' I / . .- K I A I - I « M I A I .- r r\ i - A I - I -

Spring 2013

Treatments

Comparison(Comp)

AssignmentMethod

Outcon

OutcomeMeasures


No treatment Random assignment WISC-R Arithmetic subtest; teacher-administered national (Spain)mathematics, science, andlanguage tests

Pretest andposttest

Int > Comp on WlSC-RArithmetic {ES = 0.64)

N/A N/A Research-created math worksheetswith 54 arithmetic problems

Baseline(7 sessions) andIntervention(21 sessions)

Int > Baseline (£"5 =0.906)[Note: Statistical significancetesting not used; percentagechange compared. ES calculatedusing summed baseline andintervention data by participant.]

• N/A N/A Research-created math worksheetswith 4l arithmetic problems

Baseline(7 sessions) andIntervention(14 sessions)

Int > Baseline (£5 = 1.78)[Note: Statistical significancetesting not used; ES calculatedusing summed baseline andintervention data byparticipant.]

Regularkindergarteninstruction

Matching on age,gender, parentaleducation. Raven'sMatrices scores, andverbal IQ

Rhyme Oddity; Phoneme Elision;Sound Isolation

Pretest and (1) Int > Comp for rhyme oddityposttest .{ES= 1.09); (2) Int > Comp for

phoneme elision {ES = 1.47).(3) Int > Comp for soundisolation (£5 =2.29) [Note:Comp > Int on pretest]

No treatment Matching on gender,mean age, age range,mean ARQ, ARQ range

NFER test of reading; British -standardized tests in writing,comprehension, and numeracy; DSTtimed word reading, nonsense passagereading, 2 min spelling test, 1 minwriting

Pretest andposttest

Unknown

No treatment Random assignmentat school level

EMT (One Minute Test [for wordreadingl); AVI (Text Reading Test)

Pretest andposttest

No effects

No treatment Matching on readingscores

GMG Reading Goniprehension subtest Pretest andposttest

Int > Gomp on GMG(£5 = 0.85)

Glasses withoutany occlusion,worn duringreadmg andwriting work

No treatment

Random assignment

Random assignment

BAS, reading subtest

Pseudoword reading accuracy andspeed, word reading accuracy andspeed

Pretest and Int > Gomp on readingposttest (measured by reading age;

£5=0.35)

Pretest andposttest

No effects

Note, continued

Individual Achievement Test-il; WISG-IU = Wechsler Intelligence Scale for Ghildren-Ul; WISC-R = Wechsler intelligence Scale for Children-R;WJ-III = Woodcock-Johnson-IIi; WRAT = Wide Range Achievement Test; WRAT-3 = Wide Range Achievement Test-3; WRMT = WoodcockReading Mastery Test. WilMT-R = Woodcock Reading Mastery Test-R.^Research Question #i : Do cognitive interventions matched to a cognitive deficit improve student academic performance more than interventionsnot matched to a cognitive deficit?''Research Question #2: Do cognitive interventions improve student academic performance more than academic interventions?^Research Question #3: Do cognitive interventions improve student academic performance relative to no-treatment controls?


TABLE 2

Cognitive Processes Targeted by Interventions and Participants' Deficits and Disability Status

Targeted

Cognitive

Process 4

Attention

Fluidprocessing/Metacognition

Language/auditory

processing

Motorprocessing

Planning

Processingspeed

Successiveprocessing

Visualprocessing

Working

memory

Multiple

cognitiveprocesses

Column totals

Atten

2

1

0

0

0

0

0

2

0

0

5

Specific Deficit in Participant

Non-Specific Deficit

in Participant

PerceptttaV

Linguistic Successive Visual Working Learning Low Roiu

Attention Dyslexia Planning Processing Processing Memory Disability Achievement Totals

0 0

0

0

0

0

4

0

0

8

0

2

0

0

0

0

0

2

0 0 0

00

0

0

4

0

0

4

00

0

0

0

1

0

1

20

0

1

5

0

0

13

0

1

0

1

0

1

0

12

16

32

1

2

16

1

12

50

ethnicity (criterion #2); when random assignment(criterion #3) and control or comparison groups(criterion #4) were deployed; when treatmentduration was 8 hr or more (criterion #5); whenthe treatment was conducted with at least 75%accuracy (criterion #6); and when effect sizes wereeasy to compute (criterion #7).

Ease of calculating an effect size was the onlycriterion for which partial credit was given. Incases where authors did not provide pretreatmentand postcreatment—or gain—means and stan-dard deviations, but effect size calculation waspossible using an /^statistic, í statistic, or^ value,studies were rated 0.5. Seventy-nine percent ofstudies provided sufficient information to permitstraightforward calculation of effect sizes. Fewstudies met attrition (32%) and fidelity of imple-mentation (6%) criteria, mostly because they did

not report tbese data. A majority of studies, bycontrast, included a control or comparison group(78%) and described interventions of sufficientlength (60%) to detect effects. Only 40% usedrandom assignment; 60% documented that treat-ment and comparison students were comparableon key characteristics prior to intervention. Foreach study, we created an aggregate quality ratingby summing our evaluations ofthe seven criteria.Two caveats are necessary regarding our ratings ofstudy quality. First, we treated each of our sevencriteria as equally important. Yet, they are proba-bly not so. Second, the criteria are biased towardauthors of studies who conducted treatmentsrequiring multiple hours of implementation. Forthese reasons, our ratings should be regarded asrough estimates of study quality.

Spring 2013

RESEARCH QUESTION #1: Do LOW-

ACHIEVING STUDENTS WITH A SPECIFIC

COGNITIVE DEEICIT BENEEIT MORE

EROM A MATCHED COGNITIVELY EOCUSED

INTERVENTION THAN EROM ONE NOT

MATCHED EOR THE DEEICIT?

Studies addressing this question had to meet thecriteria that (a) students with a specific cognitivedeficic were identified and were given an inter-vention matched to their deficit, and (b) otherstudents with the same deficit in a comparisongroup were given an intervention that deliber-ately did not match their deficit. Five such stud-ies were found. Table 1 presents detailedinformation about each one, including partici-pants, interventions, measures, and results.Dryer, Beale, and Lambert (1999; reported astwo studies), examined the effects of two inter-ventions on two populations of students: thosewith "linguistic-type" dyslexia (who read quicklybut with many errors; Study A) and those with"perceptual-type" dyslexia (who had slow passagereading; Study B). Each study included twointerventions, which targeted the two putativetypes of dyslexia. The linguistically focused inter-vention consisted of reading words with unusualtypefaces and feeling wooden letters inside a box.The perceptually focused intervention directedstudents to read words with abstract meaningsand complete cloze exercises. The third study,conducted by Robertson (2000), focused on stu-dents with linguistic-type dyslexia but providedinstruction similar to that of Dryer et al.,designed for linguistic-type dyslexia in one groupand for perceptual-type dyslexia in the other. Theresearchers in the other two studies (Kerns, Eso,& Thomson, 1999; Shalev, Tsal, & Mevorach,2007) worked with students with ADHD andprovided cognitively focused interventiondesigned to improve four dimensions of atten-tion (e.g., selective attention).

In terms of our quality indicators. Dryer etal. (1999) met five of the seven criteria in each oftheir studies. They did not document rates of at-trition or fidelity of implementation. This wasalso true of the studies by Robertson (2000),Kerns et al. (1999), and Shalev et al. (2007). Ad-ditionally, Robertson did not establish pretreat-ment comparability of groups or provide effect

size information. The study was awarded a ratingof 3.0. Kerns et al. met comparability and effectsize criteria but did not use random assignment.This research group was awarded a 4.0 rating.Shalev et al. provided partial effect size infor-mation and met 3.5 criteria.

There were no statistically significant effectsin the Dryer et al. (1999) studies. In Study A, thestudents with linguistic-type dyslexia did no bet-ter in linguistically focused training than in per-ceptually focused training. In Study B, those withperceptual-type dyslexia performed equally whenthey participated in the two trainings. Robertson(2000) claimed to find a statistically significanteffect favoring linguistically focused training forstudents with linguistic-type dyslexia, but Robert-son calculated significance with a one-tailed testand obtained the effect mainly due to worseningtreatment group performance. Large effects werefound by Kerns et al. (1999) for their attentiontreatment {ES = 3.70) on an author-developedtimed arithmetic test. Shalev et al. (2007)reported a statistically significant reading compre-hension effect (£"5 = 0.74) for their computer-based attention training. Data from two of thefive studies provided evidence suggesting thatwhen a treatment is matched to a cognitive deficitit will produce better effects than when it is notdesigned for that deficit.

RESEARCH QUESTION #2: Do LOW-

ACHIEVING STUDENTS BENEEIT MORE

EROM A COGNITIVELY EOCUSED

INTERVENTION THAN AN ACADEMIC ONE?

Eleven of the 50 studies explored this question.One addressed attention difficulty (Chenault etal., 2006); two involved eye-movement training(Facoetti, Lorusso, Paganoni, Umilta, & Mascetti,2003; Solan et al., 2001); three explored thetraining of multiple cognitive processes (Hay-ward, Das, & Janzen, 2007; Mantzicopoulos,Morrison, Stone, & Setrakian, 1992, Study A;Parrila, Das, Kendrick, Papadopoulos, & Kirby,2000); two evaluated interventions for linguisticand perceptual dyslexia (both in Goldstein &Obrzut, 2001); one focused on successive process-ing (Spencer, Snart, & Das, 1989); one examinedself-regulation training in combination with writ-ing strategy training (Graham & Harris, 1989);


and one explored auditory processing {Hook,Macaruso, &Jones, 2001).

These investigations targeted students withLD (8 studies) or with low achievement and noidentified disability (3 studies). Studies were alsovariable in terms of the soundness of their respec-tive methods or quality ratings {M = 3.86, SD =0.90). We gave one a rating of 6.0 (Chenault etal-, 2006); two, a 4.5 (Facoetti et al., 2003, StudyA; Manr¿icopoulos et al., 1992); four, a 4.0 (Gra-ham & Harris, 1989; Hook et al., 2001 ; Parrila etal., 2000; Solan et al., 2001); and four, a 3.0(Goldstein & Obrzut, 2001, both studies; Hay-ward et al., 2007; Spencer et al., 1989).

Researchers of 2 of the 11 studies reportedstatistically significant results. Spencer et al.(1989) used the Test of Written Spelling to docu-ment that students who participated in their suc-cessive processing treatment performed morestrongly than students in a classroom-basedspelling program {ES = 0.67). Ghenault et al.(2006) obtained a significant effect (ES = 0.34)for an attention treatment (contrasted against afluency treatment) on the Wechsler IndividualAchievement Test Second Edition (WIAT-Il; Psy-chological Gorporation, 2005). Written Expres-sion between midtreatment and posttreatment.

Authors of five studies reported no statisti-cally significant effects. Students with reading dis-abilities in Solan et al.'s (2001) eye-movementtreatment showed no greater gains on the Gates-MacGinitie Comprehension subtest than studentsin a reading comprehension program. Parrila et al.(2000) found no effects on the Woodcock Read-ing Mastery Test-Revised (WRMT-R; Woodcock,1998). Word Attack and Word Identification sub-tests for the PASS Remediation Program (PREP),designed to train cognitive processes (Naglieri &:Das, 1997). Researchers conducted PREP in sev-eral studies. Typically, the researchers used a set ofcognitive training exercises that relied on such ac-tivities as bead-threading and memory for digitsin addition to requiring the practice of academicskills (e.g.. Spencer et al., 1989). In their Study A,Mantzicopoulos et al. (1992) administered fiveposttreatment-only reading-related tests and alsofailed to obtain reliable effects for a program tar-geting visual, motor, and auditory processes. Gra-ham and Harris (1989) compared self-regulationtraining and writing strategy instruction to writ-

ing strategy instruction alone. They did not findstatistically significant between-group differenceson story grammar or holistic writing qualityscores. Neither were Hook et ai. (2001) successfulwhen looking for statistically significant effectsfavoring Fast ForWord training over the Orton-Gillingham reading program. Indeed, nonsignifi-cant effect sizes in the Hook et al. study favoredOrton-Gillingham {ES = -0.25 on WRMT-RWord identification; ES = -0.88 on WRMT-RWord Attack).

In the Hayward et al. (2007) study, effects fa-vored the academic treatment. PREP training wascompared to a reading intervention called Gogni-tion Enhancement Training (COGENT). On theWoodcock-Johnson III Word Identification andPassage Comprehension subtests, students receiv-ing GOGENT outperformed those in PREP (£"5= -0.76 and-1.00).

Effects for three studies could not be deter-mined. In both of their studies, Goldstein andObrzut (2001) compared students in treatment tothose with different deficits in a comparisongroup. Those in the treatment groups (studentswith perceptual dyslexia in Study A; students withlinguistic dyslexia in Study B) were compared tostudents with "mixed type" dyslexia. The absenceof a comparable control makes determination ofthe Intervention's effect difficult. Effects acrossconditions could not be obtained for Facoetti etal. (2003). They found within-group differencesbetween pretreatment and posttreatment and sig-nificant improvements in reading speed and accu-racy, but they did not conduct a Group x Timetest of Intervention effects.

RESEARCH QUESTION #3: Do

COGNITIVE INTERVENTIONS HAVE

ACADEMIC BENEFITS IN COMPARISON

TO NO-TREAT/^ENT CONTROLS?

Studies addressing this question constitute theleast rigorous test of the importance of cognitivelyfocused Interventions. Nevertheless, If authors ofthis type of study find that students Involved Insuch interventions demonstrate greater gains thancontrols, we may conclude that cognitivelyfocused instruction has value. Thirty-four studies(the largest of three groups of investigations inour review) addressed this question. They

Spring 2013

TABLE 3

Summary of Findings, Effect Sizes, and Study Quality by Research Question

Effects

Studies with positive effects

Studies with no effects

Studies with negative effects

Studies where effectscould not be determined

Mean effect size (SD)''

Quality

Overall quality (range 0-7)

2

2

0

1

1

4

rn

.12

.5

= 5)

(40%)

(40%)

(0%)

(20%)

(1J5)

(1.41)

R(

in

2

51

3

0.26

3.86

= 11)

(18%)

(45%)

(9%)

(23%)(0.84)

(0.90)

18

11

2

3

0.60

3.31

•34)

(52%)

(32%)

(6%)

(9%)

(0.69)

(1.34)

Overall

(^=50)

22 (44%)

18 (36%)

3 • (6%)

7 (14%)

0.58 (0.86)

3.55 (1.31)

Note: "RQ#1 : Do cognitive interventions matched to a cognitive deficit improve student academic performance morethan interventions no: matched to a cognitive deficit? ''RQ#2: Do cognitive interventions improve student academicperformance more than academic interventions? "^RQ#3: Do cognitive interventions improve student academicperformance relative to no-treatment controls? ''EfFect sizes are not weighted according to sample size. EfFect sizesare averaged across all effects, including studies with reported nonsignificant and negative efFects for studies whereeffect sizes could be calculated.

included interventions for a range of cognitivedeficits including visual ptocessing (12 studies),multiple cognitive processes (9 studies), motorprocessing (3 studies), language or auditory pro-cessing (3 studies), and 7 studies in six other do-mains. These studies a|so varied considerably intheir overall quality {M - 3.31, SD = 1.35; seeTable 3).

Interventions for Multiple Cognitive Processes.These nine studies are discussed as a group be-cause all researchers attempted to improve aca-demic outcomes through a multidimensional,cognitively focused program. PREP was the focusof five studies (Boden & Kirby, 1995; Carlson &Das, 1997, Studies A and B; Das, Mishra, &:Pool, 1995; Papadopoulos, Charalambous, Ka-nari, & Loizou, 2004). Lamminmaki et al.(1997a; 1997b), Aro, Ahonen, Tolvanen, Lyyti-nen, and Todd de Barra (1999), and Mantzi-copoulos et al. (1992, Study B) also targeted arange of cognitive processes, including spatialand temporal orientation, perceptual skills, lan-guage skills, and skill integration, in addition toacademic elements such as reading or numericalskills. We assigned a quality rating to this groupin the average range (M= 3.83; SD = 0.83).

Effects for PREP were strong. The Carlsonand Das (1997) studies—reported sepatately be-cause the authors examined effects of student-

teacher ratios of 2:1 (Study A) and 4:1 (StudyB)—reported gains on WRMT-R Word Identifi-cation {ES = 0.80 in Study A; ES = 0.42 in SttidyB) and on the WRMT-R Word Attack {ES = 0.65in Study A; ES = 0.83 in Study B). Papadopouloset al. (2004) obtained statistically significanteffects for PA measures: rhyme oddity {FS =1.09), sound isolation {FS = 2.29), and phonemeelision {FS = 1.47), although these effect sizesmay be inflated by pretreatment floor effects. Wetreated these outcomes as academic measures be-cause the study was condticted in kindergartenclassrooms where PA is taught as an academicskill. The study was not excluded because the cog-nitively focused treatment did not involve PA.Boden and Kirby (1995) found a statistically sig-nificant positive effect of PREP for measures ofword reading {ES = 0.71) and pseudoword read-ing {ES = 0.47), although students in PREP didno better than controls on passage comprehen-sion. Das et al. (1995) also found statistically sig-nificant effects on word reading {FS = 0.65) andpseudoword reading {FS = 0.77). Overall, thesefive studies illustrated the potential value of a pro-gram focused on improving multiple cognitiveskills.

Lamminmaki et al. (1997a) found an effectfavoring their homework assistance control groupfor reading and mathematics, but there was not


sufficient information to calculate effect sizes.Lamminmaki et al. (1997b)—in a study thatextended Lamminmaki et a!. (1997a)—found astatistically significant effect favoring interventionfor reading (ES = 0.50) but not for mathematicsor writing. Aro et al. (1999) examined the impactof a similar cognitive treacment compared to anidentical homework assistance control using amultivariate analysis of variance (MANOVA) andfound no significant differences between thegroups in reading or mathematics. Manr¿icopou-los et al. (1992, Study B) found no reliable train-ing effects in terms of study participants' readingand spelling skills on six different academicmeasures.

Interventions for Visual Processing. Twelvestudies examined ways to improve visual process-ing. Two articles—by Iovino et al. (1998) andLightstone, Lightstone, and Wilkins (1999)—accounted for seven of the 12 studies. All sevenexamined the importance of text overlays andincluded participants used as their own controls.Iovino et al. gave students parallel forms of pas-sages to read when using either blue (Studies Aand C) or red (Studies B and D) overlays. Stu-dents in Studies A and B had reading or spellingdisabilities, and students in Studies C and D hadADHD. Lightstone et al. provided studentstinted lenses to wear for 2 months to help witheye strain. Then the researchers asked the studentsto read while wearing the lenses and using a col-ored overlay of the sttidents' choice (Study A), acolored overlay of the same color as the lenses(Study B), or a colored overlay that the re-searchers believed would match the lens color(Study C).

In the remaining studies, Martin, Mackenzie,Lovegrove, and McNicol (1993) provided coloredglasses to improve text readability to studentswith scotopic sensitivity, a condition reported tovisually distort black text on a white background.Geiger, Lettvin, and Fahle (1994) directed stu-dents with dyslexia to practice eye-hand coordina-tion and to read on a computer screen, restrictingthe amount of text visible at one time. Smit-Glaude, van Strien, Licht, and Bakker's (2005)students with dyslexia read words presented onlyon the left side of a computer screen ro stimulatethe right cerebral hemisphere. Bakker, Bouma,and Gardien (1990, Study B) tested an interven-

tion to treat perceptual-type dyslexia that wassimilar to Dryer et al. (1999) and Robertson(2000). Finally, Stein et al. (2000) customizedglasses so that students could only see throughone eye.

We gave low quality ratings to many of these12 studies. All but Stein et al. (2000) lacked ran-dom assignment; only Bakker et ai. (1990) in-cluded a lengthy intervention; and not one studyreported fidelity of treatment implementation. Inthe Martin et al. (1993) investigation, inferencesabout the effect of background color on a singlepopulation were not possible becatise the authorscompared qualitatively different groups, namelyintervention students with LD and with scotopicsensitivity and control students witb LD butwithout scotopic sensitivity. Geiger et al. (1994)initially used random assignment but laterswitched noncompliant students to the controlcondition. Smit-Glaude et al. (2005) randomlyassigned schools to treatment conditions, butthen analyzed their data at the student level.

Statistically significant effects were reportedfor six studies. Bakker et al. (1990, Study B) ob-tained reliable effects for word reading {ES =0.67) but none for text reading. For Geiger et al.(1994), treatment students made more progresstoward grade-level reading performance tbancontrols (£S = 1.40), although changing "non-compliant" intervention students to controlsweakens this finding. In all three of Ligbtstone etal.'s (1999) studies, students read faster wbengiven tbe overlay, whether it was student-chosen{ES = 0.31), matched the color of the lenses (ES= O.i9), or was consistent witb theoretical expec-tations {ES = 0.38). For Stein et al. (2000), a pos-itive effect for the occlusion treatment wasdetected in terms of cbildren's reading age on tbeBritish Abilities Scale {ES = 0.35).

Iovino et al. (1998) found that blue overlaysimproved tbe reading comprehension accuracy ofstudents witb reading and spelling disabilities,students witb ADHD, and students with typicalachievement. They did not find a statistically sig-nificant interaction sucb that the blue overlaysdifferentially improved reading comprehensionperformance. Sinit-Glaude et al. (2005) did notobtain significant effects for their treatment. Forreasons described above, effects could not be

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determined for the study conducted by Martin etal. (1993).

Interventions for Planning. Research byNaglieri and Gottling (1997) and Naglieri andJohnson (2000) examined the efficacy of an inter-vention focusing on planning skills fot studentswith a cognitive weakness in planning, identifiedusing PASS theory. The researchers asked the stu-dents to discuss good planning strategies for com-pleting researcher-designed mathematicsworksheets (e.g., "find the easy ones and do thosefirst," Naglieri & Johnson, 2000, p. 593). Follow-ing discussion, the students completed the work-sheets. The percentage of problems correct on theworksheets was the outcome of interest, and theresearchers compared baseline and treatment datafor the same children, using them as their owncontrols.

We gave the planning studies quality ratingsof 0.5 (Naglieri &c Gottling, 1997) and 1.5(Naglieri & Johnson, 2000). We judged experi-mental control to be lacking because the re-searchers did not stagger entry of participants, akey feature of studies that use participants as theirown conttols (cf. Kennedy, 2005). The repeateduse of the same type of mathematics worksheetalso makes repeated testing a plausible reason forimprovement.

In both studies, students with planning diffi-culty performed better during treatment thanbaseline on the worksheets {ES = 0.91 and 1.78).Naglieti and colleagues' (Naglieri ôc Gottling,1997; Naglieri & Johnson, 2000) samples, how-ever, were small (three or four participants), andno testing of statistical significance was used. Fi-nally, the auto-tegressive impact of using partici-pants as their own controls may have inflatedeffects.

Other Intervention Studies. The remaining 11studies included interventions for motor process-ing (Humphries, Wright, Snidet, & McDougall,1992, Study A and Study B; Reynolds, Nicolson,& Hambiy, 2003), attention (Solan, Shelley-Tremblay, Ficarra, Silverman, & Larson, 2003),metacognition (Miranda, Presentación, & Sori-ano, 2002), language or auditory processing(Bakker et al., 1990, Study A; Kujala et al., 2001;Lovett, Ransby, Hardwick, Johns, & Donaldson,1989), processing speed (van den Bosch, van Bon,& Schreuder, 1995), successive processing

(Churches, Skuy, & Das, 2002), and workingmemory (Holmes et al., 2009). t'he studies variedin quality, with tarings ranging from 2.0 to 6.0(M= 3.79, 5Z5= 0.90).

Four studies reported positive treatmenteffects. Kujala et al. (2001) showed positive effectsfor word and text reading {ES = 0.68 and 0.55) ina Finnish study sample. Lovett et al.'s (1989) lan-guage development ttaining improved students'outcomes on the WRAT-R Reading test whencompated to a nonacademic "classroom survivalskills" treatment {ES = 0.42), although this find-ing did not hold for nine other academic mea-sures. Miranda et al. (2002) reported that theirmetacognitive attention treatment produced ef-fects on the WISC-R Arithmetic subtest {ES =0.64). Solan et al. (2003) found that their atten-tion treatment improved performance on theGates-MacGinitie Reading Comptehension sub-test (£5 = 0.85).

Results for two studies could not be ascer-tained. Chutches et al. (2002) reported large stu-dent-level effects for their PREP-based training{ES = 3.05 for WRMT-R Word Identification andES = 3.56 for WRMT-R Word Attack), but hadconducted the assignment at the classroom levelwith only one classtoom pet treatment. Reynoldset al. (2003) claimed to have significant effects,E (1, 33) = 5.08 for a 2 X 2 ANOVA, but violatedthe assumption of equal-interval data by measur-ing progress with percentile scores.

Five studies did not find significant treat-ment effects compared to controls. BothHumphries et al. (1992) studies compared treat-ments to control on six academic measures andfound no statistically significant effects. Holmeset al. (2009) did not find posttest effects on basicreading and mathematical reasoning for theiradaptive working memory treatment. They didfind treatment students had higher mathematicalreasoning 6 months later, but this result was notcompared to controls, van den Bosch et al.'s(1995) ptocessing speed treatment had no effectsfor word reading or pseudoword reading accu-racy. Bakker et al.'s (1990, Study A) linguisticallyfocused training did not have an effect for read-ing connected text, but the researchers found anegative tteatment effect (i.e., control studentsimproved more) for word reading {ES = —0.48).


Table 3 summarizes the findings across allstudies for the three research questions. ForResearch Question #1, positive effects were foundfor two studies, with an average effect size of 1.12(where we could calculate effect sizes) and a meanquality rating of 4.5. For Research Question #2,18% of studies had positive effects, with an aver-age effect size of 0.26 and mean quality rating of3.86. For Research Question #3, 50% of studieshad positive effects, with an average effect size of0.60 and quality rating of 3.55. Again, for reasonsalready stated our ratings should be viewed asrough indicators of study quality.

PARSING THE IMPORTANCE OE

COGNITIVELY FOCUSED AND

ACADEMICALLY FOCUSED COMPONENTS

The idea behind cognitively focused interventionis that instruction addresses a putative cognitivedeficit directly, rather than focusing on academicskills. Holmes et al. (2009), for example, devel-oped a treatment comprising only working mem-ory practice; there was no academic component.More often, those who design cognitively focusedinterventions combine them with one or moreacademic components. The language processingprogram evaluated by Hook et al. (2001), for ex-ample, included letter-sound practice, eventhough most activities focused on the use of com-puter-modified speech to improve language pro-cessing. Use of the cognitive-academic hybridinterventions raises the question whether onecomponent or the other (or both) is responsiblefor obtained outcomes. With this in mind, we ex-amined outcomes for interventions that were (a)cognitiveiy and academically focused, or (b) cog-nitively focused only.

For Research Question #1, unweighted effectsizes were larger for the two studies of cognitivelyfocused treatments (Kerns et al., 1999, and Shalevet ai., 2007; mean ES = 2.17) than for the twostudies of combined cognitive and academic in-terventions for which effect sizes could be ascer-tained (the Dryer et al., 1999 studies; mean £S =0.06). For Research Questions #2 and #3, how-ever, outcomes favored the combined cognitiveand academic treatments (for combined treat-ments, mean ES = 0.27 and 0.79 for #2 and #3,respectively; for cognitively focused treatments.

mean ES = 0.19 and 0.32). Although study find-ings within and across research questions are in-consistent, results for Research Questions #2 and#3 suggest an added value for academicinstruction.

D I SC U SSI O N

Our overall aim in this review was to understandwhether cognitiveiy focused instruction enhancesthe academic performance of students at risk forschool failure. We first asked whether instructiondesigned for children with a particular cognitivedeficit promotes greater academic improvementthan instruction not matched to the deficit. Inother words, what benefit accrues from an align-ment of instruction and deficit? We found onlyfive studies addressing this question. Two pro-duced data to support the proposition. (Bothwere cognitively focused interventions.) Second,we explored whether cognitive approaches to in-struction (irrespective of whether they match chil-dren's specific deficits) produce greater academicachievement than academically focused instruc-tion alone. Here, we located 11 studies, two ofwhich reported effects favoring cognitive instruc-tion (and both representing hybrid, cognitivelyand academically focused interventions). Five ofthe 11 studies indicated no reliable between-group differences. For three additional studies, wecould not determine effects; and in one study, thegroup participating in academic instruction didbetter. Third, we inquired whether cognitively fo-cused interventions (matching and not matchingstudents' deficits) accelerate students' progress rel-ative to business-as-usual controls. Investigators of18 of 34 studies found statistically significant ef-fects favoring cognitively focused instruction(four of which were cognitively focused only).Eleven studies found no statistically significantgroup differences; three had methodologicalproblems precluding causal inference-making;and two indicated that controls outperformed thetreatment group.

Across these three groups of studies, 22 of 50investigations described statistically significantoutcomes favoring cognitively focused instruc-tion, four when such instruction was competinghead-to-head against academic instruction. (Two

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of these four were cognitively focused only ap-proaches.) Thus, a minority of reviewed studiessupported the efficacy of cognitive interventions;fewer still when the cognitive component was notpaired with an academic intervention. Complicat-ing interpretations of this work is that researcherssometimes used relatively weak experimental con-trols. The correlation between the studies' effectsizes and our quality-of-study ratings showed amarginally statistically significant negative trend(r = -.25, p = .09, n = 43) such that strongergroup differences were associated with weakermethods.

RESEARCH YES, PRACTICE NOT YET

An obvious conclusion from our review is thatcognitively focused instruction, in the main, isstill early in its development. Few cognitivelyfocused programs have been explored byresearchers in sufficient numbers and with appro-priate experimental control to warrant an en-dorsement as evidence-based practices. And yet,we believe we would be misrepresenting this liter-ature if we were to say that findings justify anout-of-hand, or conclusive, dismissal of such anapproach. We wish to see a greater number ofintervention researchers take cognitively focusedinstruction seriously, and we have two reasons forthis. First, the evidence suggests it may have po-tential. Second, there is indisputable need for al-ternative methods of instruction for the 2% to6% (cf. Wanzek & Vaughn, 2009) of the generalstudent population for whom academic instruc-tion—including Dl-inspired skills-based instruc-tion—is ineffective. The plight of these childrenand youth should challenge educational re-searchers to develop instructional programs andcurricula that are imaginative in design and appli-cation and empirically validated for those forwhom they are intended.

Many of the researchers whose work we havereviewed have demonstrated this spirit of inquiry.Some of their interventions are unusual, whichhas on occasion prompted skepticism and evenmockery. However, their intervention work isoften based on correlation research suggestinglinkages between cognitive processes (e.g., work-ing memory) and poor academic performance(e.g.. Holmes et al., 2009). It may also be impor-

tant to remember when considering some of them.ore unorthodox approaches among them thatthe research and development process is not al-ways predictable. Research on angiotensin-con-verting enzyme (ACE) inhibitors is a case inpoint. As is widely known, ACE inhibitors helpprevent stroke, heart disease, and major cardiovas-cular events and have proven more effective thandiuretics. Less known is that the ACE-inhibitingcompound—the active ingredient—was first iso-lated in the venom of the South American pitviper in the 1960s, a snake whose bite causes arapid drop in the blood pressure of its victims.Had the medical community been overly suspi-cious of the drug's strange origins, an importantblood pressure treatment may never have beenbrought to market.

The plight of these children and youthshould challenge educational researchers

to develop instructional programs and

curricula that are imaginative in designand application and empirically validated

for those for whom they are intended.

In this same spirit of inquiry, researchersmight consider creating novel interventions thatare neither strictly skilled-based academic pro-grams nor cognitive training as conceived in theDPI era. There are multiple possibilities. We havealready described the pairing of cognitivelyfocused instruction with academic instruction(e.g., Chenault et al., 2006). A second approach isthe use of skills-based interventions that involvetask-relevant cognitive processes so that the cogni-tive processes are not taught in isolation. Suchinterventions claim varying degrees of empiricalsupport. Self-regulated strategy development(SRSD), for example, is a skills-based writingintervention that requires students to use meta-cognition during their writing (e.g., Graham SiHarris, 1989). Mnemonics instruction aims toimprove both metamemory and academic skills(e.g., Mastropieri & Scruggs, 1998).

A third option: Accommodate students' cog-nitive deficits by modifying the learning context.Montgomery (2004), for example, showed that


by slowing by 25% che rate at which speech wasdirected at students with speech and languagedisorders, the children could comprehend at thesame level as syntax-matched, typically-achievingpeers.

Fourth, it may be productive to explorewhether cognitive characteristics moderate instruc-tion such that students with cognitive characteris-tic A improve more than students withcharacteristic B in the same skills-based program;or whether students with cognitive characteristic Agenerally outperform those with characteristic B inone program while the reverse is obtained in asecond program. Might cognitive characteristics,in short, cause differential responses to the sameor different instructional programs? More gener-ally, do cognitive attributes interact with featuresof instruction? (See Baron & Kenny, 1986, on theimportance of moderators to understand forwhom a treatment is important and under whatconditions.) The general point, here, is that cog-nitive moderators may be potentially importantnot because they can become targets of remedia-tion {through abilities training) but because theymay suggest ways to tailor instruction for thosenot benefitting from it in its current form. Im-plicit is the suggestion that skills-based and cogni-tively focused approaches are not mutuallyexclusive. Researchers and practitioners may beable to use both to develop more effective pro-grams for a greater number of children withsevere learning problems.

LIMITATIONS OF THE REVIEW

Our characterization of study Findings, and inter-pretation of results, must be considered in light ofseveral important limitations. The first is that wedid not conduct a meta-analysis. We calculatedeffecc sizes for individual studies but did not testthe statistical significance of effect size compar-isons. We chose against a meta-analytic approachbecause we wanted to include studies for whichwe could not calculate effects. In addition, ourgrouping of studies often resulted in too few stud-ies per group on which to conduct a meaningfulmeta-analysis.

A second limitation is that we did not ex-plore every possible cognitive domain. Wesearched for studies of cognitive processes associ-

ated with two theories of intelligence—namely,the CHC and PASS theories—because of theirprevalence in the literature. Other theories of cog-nition (e.g., Sternbergs triarchic theory and Gard-ner's notion of multiple intelligences) were notpursued because associated categories were toobroad to create searches.

Third, we intentionally omitted phonologicalprocessing because much has already been writtenabout its academic effects. Similarly, we elimi-nated SRSD and mnemonics instruction becausewe considered their foci academic rather thancognitive. The research reports included in thereview were judged by us more cognitively fo-cused than either SRSD or mnemonics, but werecognize that the degree of cognitive focus varies.We included a large number of studies that werealmost completely cognitive in their orientation(K = 19; e.g., Shalev et al., 2007) or had a strongcognitive emphasis (« = 23; e.g., Stein et al.,2000). Eight studies had a mix of cognitive andacademic elements, and some readers may con-sider the degree of academic emphasis close tothat of SRSD (e.g., the Dryer et al., 1999 andRobertson, 2000 studies). We drew lines we con-sidered clear but we acknowledge they are arbi-trary and disputable.

Fourth, "academic instruction" covers a verybroad range of interventions in this article. Someno doubt were conceptualized more strongly andimplemented with greater fidelity than others.Few, we suspect, would have qualified as "skills-based instruction" as defined by us and Gerstenet al. (1986). Most importantly, we infrequentlyhad adequate descriptions of the academic inter-ventions. As a result, the "counterfactual"—or the treatments to which cognitively focusedinstruction was compared—was often poorlyunderstood, which prevented us from fully under-standing how cognitively focused approacheswere better or worse.

Yet another limitation was that LD was theonly disability included in our review. Studies ofstudents with Down syndrome were excludeddespite evidence that these students tend to haveworking memory difficulty in comparison tomental-age matched controls without disabilities(Frenkel & Bourdin, 2009; Jarrold & Baddeley,1997). By describing these limitations, we hopeto help readers place our findings in proper con-

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text and to provide researchers with ideas forconducting future syntheses in this interestingarea of scholarship.

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ABOUT THE A U T H O R S

DEVIN M. KEARNS (Massachusetts CEC),Assistant Professor of Special Education, Schoolof Education, Boston University, Massachusetts.DOUG FUCHS (Tennessee CEC), Professor andNicholas Hobbs Chair in Special Education andHuman Development, Peabody College of Van-derbilt University, Nashville, Tennessee.

Correspondence concerning this article should be

addressed to Devin Kearns, Boston University

School of Education, 2 Silber Way, Boston, MA

02215 (e-mail: [email protected]).

Earlier versions of this article were presented atthe 2009 Learning Disabilities Association confer-ence in Salt Lake City and 2008 Council forExceptional Children convention in Boston.Funding for Devin Kearns was provided by anInstitute of Education Sciences' doctoral traininggrant (R305B04110) to Vanderbilt University.We thank Lynn Fuchs, Don Compton, and KarlaStuebing for their comments on an earlier draft ofthe article.

Manuscript received March 2009; accepted

December 2011.

Spring 2013

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