research on reading difficulties

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• Published: 31 March 2017

Helping children with reading difficulties: some things we have learned so far

• Genevieve McArthur 1 &
• Anne Castles 1  

npj Science of Learning volume  2 , Article number:  7 ( 2017 ) Cite this article

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A substantial proportion of children struggle to learn to read. This not only impairs their academic achievement, but increases their risk of social, emotional, and mental health problems. In order to help these children, reading scientists have worked hard for over a century to better understand the nature of reading difficulties and the people who have them. The aim of this perspective is to outline some of the things that we have learned so far, and to provide a framework for considering the causes of reading difficulties and the most effective ways to treat them.

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Introduction

Over 20 years ago, The Dyslexia Institute asked a 9-year-old boy called Alexander to describe his struggle with learning to read and spell. He bravely wrote: “I have blond her, Blue eys and an infeckshos smill. Pealpie tell mum haw gorgus I am and is ent she looky to have me. But under the surface I live in a tumoyl. Words look like swigles and riting storys is a disaster area because of spellings. There were no ply times at my old school untill work was fineshed wich ment no plytims at all. Thechers sead I was clevor but just didn’t try. Shouting was the only way the techors comuniccatid with me. Uther boys made fun of me and so I beckame lonly and mishroboll”. 1

Alexander’s experience is not unique. Sixteen per cent of children struggle to learn to read to some extent, and 5% of children have significant, severe, and persistent problems. 2 The impact of these children’s reading difficulties goes well beyond problems with reading Harry Potter or Snapchat. Poor reading is associated with increased risk for school dropout, attempted suicide, incarceration, anxiety, depression, and low self-concept. 3 , 4 , 5 , 6 It is therefore important to identify and treat poor readers as early as we possibly can.

Scientists have been investigating poor reading—also known as reading difficulty, reading impairment, reading disability, reading disorder, and developmental dyslexia (to name but a few)—for over a century. While it may take another century of research to reach a complete understanding of reading impairment, there are number of things that we have learned about reading difficulties, as well as the children who experience reading them, that provide key clues about how poor reading can be identified and treated effectively.

Poor readers display different reading behaviours

One thing that we have learned about poor readers is that they are highly heterogeneous; that is, they do not all display the same type of reading impairment (i.e., “reading behaviour”; 7 , 8 , 9 , 10 , 11 , 12 ). Some poor readers have a specific problem with learning to read new words accurately by applying the regular mappings between letters and sounds. 7 , 8 , 13 , 14 This problem, which is often called poor phonological recoding or decoding, can be detected by asking children to read novel “nonwords” such as YIT. Other poor readers have a particular difficulty with learning to read new words accurately that do not follow the regular mappings between letters and sounds, and hence must be read via memory representations of written words. 7 , 13 , 15 , 16 This problem, which is sometimes called poor sight word reading or poor visual word recognition, can be detected by asking children to read “exception” words such as YACHT. In contrast, some poor readers have accurate phonological recoding and visual word recognition but struggle to read words fluently. 17 , 18 , 19 Poor reading fluency can be detected by asking children to read word lists or sentences as quickly as they can. In contrast yet again, some poor readers have intact phonological recoding and visual word recognition and reading fluency, but struggle to understand the meaning of what they read. These “poor comprehenders” 20 can be identified by asking them to read paragraphs aloud (to ascertain that they can read accurately and fluently), and then ask them questions about the meaning of what they have read (to ascertain that they do not understand what they are reading). It is important to note that most poor readers have various combinations of these problems. 21 For example, Alexander’s spelling suggests that he would have poor phonological decoding (since he misspells words like playtimes as “plytims”) and poor sight word knowledge (since he misspells exception words like said as “sead”). Thus, poor readers vary considerably in the profiles of their reading behaviour.

Reading behaviours have different “proximal” causes

Another thing we have learned about poor readers is that the same reading behaviour (e.g., inaccurate reading of novel words) does not necessarily have the same “proximal cause”. A proximal cause of a reading behaviour can be defined as a component of the cognitive system that directly and immediately produces that reading behaviour. 22 , 23 , 24 Most reading behaviours will have more than one proximal cause. Reflecting this, several theoretical and computational models of reading comprise multiple cognitive components that function together to produce successful reading behaviour (e.g., refs 25 , 26 , 27 , 28 ). While these models vary in some respects, all include cognitive components that represent (1) the ability to recognise letters (e.g., S), letter-clusters (e.g., SH), and written words (e.g., SHIP), (2) the ability to recognise and produce speech sounds (e.g., “sh”, “i”, “p”) and spoken words (e.g., “ship”), (3) the ability to access stored knowledge about the meanings of words (e.g., “a floating vessel”), and (4) links between these various components. Impairment in any one of these components or links will directly and immediately impair aspects of reading behaviour. Thus, guided by theoretical and computational models, we have learned that a poor reading behaviour can have multiple proximal causes, and we have some idea about what those proximal causes might be. 10 , 11 , 12

Reading behaviours have different “distal” causes

We have also learned that even if two poor readers have exactly the same reading behaviour with exactly the same proximal cause, this reading behaviour will not necessarily have the same “distal cause”. A distal cause has a distant (i.e., an indirect or delayed) impact on a reading behaviour. 22 , 23 , 24 Distal causes reflect the fact that reading is a taught skill that unfolds over time and across development. It depends upon a range of more cognitive abilities, such as memory, attention, and language skills, to name but a few. Depending on children’s strengths and weaknesses in these underlying abilities, and how these abilities affect learning over time, children will have different profiles of developmental, or distal, causes of their reading impairment. Stated differently, there can be different causal pathways to the same impairment of the reading system.

To provide an example, as mentioned earlier, a common reading behaviour observed in poor readers is inaccurate reading of new or novel words, which can be assessed using nonwords such as YIT. Indeed, some researchers have described this as the defining symptom of reading difficulties. 29 According to theoretical and computational models of reading, one proximal cause of impaired reading of nonwords is impaired knowledge of letter-sound mappings. But what is responsible for this proximal cause of poor nonword reading? There are multiple hypotheses. The prominent “phonological deficit hypothesis” proposes a pervasive language-based difficulty in processing speech sounds that affects the ability to learn to associate written stimuli (e.g., letters) with speech sounds. 30 The “paired-associate learning deficit hypothesis” proposes a memory-based difficulty in forming cross-modal mappings across the visual (e.g, letters) and verbal domains (e.g., speech sounds) that affects letter-sound learning (e.g., ref. 31 ). And the “visual attentional deficit hypothesis” proposes an attention-based impairment in the size of the attentional window, affecting the formation of the sub-word orthographic units (e.g., letters) used in the letter-sound mapping process. 32 These three hypotheses illustrate why a single reading behaviour (e.g., poor nonword reading) with a common proximal cause (impaired knowledge of letter-sound mappings) might not have the same distal cause (e.g., a phonological deficit, a paired-associate learning deficit, or a visual attention deficit). These hypotheses also raise the possibility that the distal causes of poor readers’ reading behaviours may vary as much (if not more) than the proximal causes and the reading behaviours themselves.

Poor readers have concurrent problems with their cognition and emotional health

Another thing we have learned about poor readers is that many (but not all) have comorbidities in other aspects of their cognition and emotional health. Regarding cognition, studies have found that a significant proportion of poor readers have impairments in their spoken language. 33 , 34 , 35 , 36 , 37 , 38 , 39 Studies have also found that poor readers have atypically high rates of attention deficit disorder—a neurological problem that causes inattention, poor concentration, and distractibility (e.g., refs 40 , 41 , 42 ). Regarding emotional health, there is evidence that poor readers, as a group, have higher levels of anxiety than typical readers (e.g., refs 43 , 44 ). The same is true for low self-concept, which can be defined as a negative perception of oneself in a particular domain (e.g., academic self-concept; e.g., refs 45 , 46 ).

The fact that poor readers vary in their comorbid cognitive and emotional health problems—as well as in their reading behaviours, and the proximal and distal impairments of these behaviours—creates an impression of almost overwhelming complexity. However, it is possible to simplify this complexity somewhat using a proximal and distal schema. Specifically, comorbidities of poor reading might be categorised according to whether they represent potential proximal or distal impairment of poor reading—or possibly both. For example, a child’s current problem with spoken vocabulary might be considered a proximal cause of their poor word reading behaviour since, according to theoretical and computational models of reading, vocabulary knowledge may directly underpin word reading accuracy or reading comprehension. However, a child’s previous problem with spoken vocabulary, which may or may not still be present, might be considered a distal cause of their poor word reading: A history of poor understanding of word meanings might reduce a child’s motivation to engage in reading (distal cause), which would impair their development of phonological recoding and visual word recognition (proximal cause), and hence their word reading accuracy and fluency (reading behaviour). Thus, the proximal and distal schema can prove useful in clarifying the causal chain of events linking a reading behaviour to a potential cause.

The proximal and distal schema can also be useful in clarifying reciprocal or circular relationships between comorbidities of poor reading and reading behaviours. For example, if a poor reader has low academic self-concept (distal cause), this may stymie their motivation to pay attention in reading lessons (distal cause), which will impair their learning of letter-sound mappings (proximal cause), and hence their poor word reading (reading behaviour). At the same time, a reverse causal effect may be in play: A child’s poor word reading in the classroom (distal cause) may create a poor perception of their own academic ability (proximal cause) that lowers their academic self-concept (behaviour). Thus, the proximal and distal schema can be used to help develop hypotheses as to whether comorbidities of poor reading are proximal and/or distal causes or consequences of poor reading. Ultimately, of course, all of these hypotheses must be tested through experimental training studies.

Proximal intervention is more effective than distal intervention

Poor readers have inspired, and have been subjected to, an extraordinary array of interventions such as behavioural optometry, chiropractics, classical music, coloured glasses, computer games, fish oil, phonics, sensorimotor exercises, sound training, spatial frequency gratings, memory training, medication for the inner ear, phonemic awareness, rapid reading, visual word recognition, and vocabulary training, to name just a selection. It is noteworthy that while many of these interventions claim to be “scientifically proven”, few have been tested with a randomised controlled trial (RCT)—an experiment that randomly allocates participants to intervention and control groups in order to reduce bias in outcomes. RCTs are the gold standard method for assessing a treatment of any kind, and the method that must be used to prove the effectiveness of a pharmaceutical treatment.

In order to make sense of the chaotic variety of interventions that claim to help poor readers, it may again be helpful to use the proximal and distal schema outlined above to subdivide interventions into two types: “proximal interventions” that focus training on proximal causes of a reading behaviour that are proposed to be part of the cognitive system for reading (e.g., phonics training, vocabulary training) and “distal interventions” that focus on distal causes of a reading behaviour (e.g., coloured lenses, inner-ear medication). The idea of making a distinction between proximal and distal interventions is supported by the outcomes of a systematic review of all studies that have used an RCT to assess an intervention in poor readers. 47 These studies assessed the effect of coloured lenses or overlays, medication, motor training, phonemic awareness, phonics, reading comprehension, reading fluency, sound processing, and sunflower therapy on poor readers. One key finding of this review is that it only identified 22 RCTs, which is a small number of gold-standard intervention studies given the huge number of interventions that claim to help poor readers. A second key finding is that the majority of RCTs of interventions for poor readers have assessed the efficacy of phonics training, which trains the ability to use letter-sound mappings to learn to read new or novel words. A third key finding is that only one type of intervention produced a statistically reliable effect. This was phonics training, which focuses on improving a proximal cause of poor word reading (i.e., letter-sound mappings). In contrast, interventions that focused on distal causes of poor reading did not show a statistically reliable effect in poor readers. The outcomes of this systematic review suggest that interventions that focus on phonics—a proximal cause of reading behaviour—are more likely to be effective than interventions that focus on a distal cause. In other words, the “closer” the intervention is to an impaired reading behaviour, the more likely it is to be effective.

Translating what we know (thus far) into evidence-based practice

At first glance, what we have learned (so far) about poor readers and reading difficulties paints a picture of such complex heterogeneity that it is tempting to throw one’s hands up in despair. And yet, somewhat paradoxically, it is this very heterogeneity that provides some important clues about how to maximise the efficacy of intervention for poor readers. First, the fact that poor readers vary in the nature of their reading behaviours suggests that the first step in identifying an effective intervention for a poor reader is to assess different aspects of reading (e.g., word reading accuracy, reading fluency, and reading comprehension). There are numerous standardized tests provided commercially (e.g., the York Assessment for Reading Comprehension available from GL Assessment) 48 or for free (e.g., the Castles and Coltheart Word Reading Test—Second Edition (CC2) available at www.motif.org.au ) 49 that can be used to determine if a child falls below the average range for their age or grade for reading accuracy, fluency, or comprehension. In our experience, a teacher who has appropriate training in administrating such tests can carry out this first step effectively.

Second, the fact that poor readers’ reading behaviours can have different proximal causes suggests that the next step is to test them for the potential proximal causes of their poor reading behaviours. This is where cognitive models of reading are a useful roadmap, providing an explicit account of the key processes directly underpinning successful reading behaviour. Again, this can be done using standardized tests that are available commercially (e.g., the Peabody Picture Vocabulary Test Fourth Edition available from Pearson) 50 or for free (e.g., the Letter-Sound Test available at www.motif.org.au ). 51 And well-trained teachers can administer these tests.

Third, the fact that poor readers vary in the degree to which they experience comorbid cognitive and emotional impairments suggests that it would be useful to assess poor readers for their spoken language abilities, attention, anxiety, depression, and self-concept, at the very least. This knowledge will reveal if they need support in other areas of their development, or if their reading-related intervention needs to be adjusted to accommodate their concomitant impairment in order to maximise efficacy. Trained speech and language therapists typically carry out the assessment of children’s spoken language; neuropsychologists are experts in assessing children’s attention; and clinical psychologists have the expertise to assess children’s emotional health.

Once a poor reader’s reading behaviours, proximal impairments, comorbid cognitive, and emotional health problems have been identified, it should be possible to design an intervention that is a good match to their needs. According to the systematic review conducted by Galuschka et al. 47 , current evidence suggests that this intervention should focus on the proximal impairment of a child’s reading behaviour, rather than a possible distal impairment. Two more recent controlled trials 52 , 53 and a systematic review 54 further suggest that it is possible to selectively train different proximal impairments of poor reading behaviours in order to improve those behaviours. The outcomes of these studies and reviews tentatively suggest that proximal interventions can be executed by a reading specialist or a highly-sophisticated online reading training programme.

In sum, over the last century or so, we have learned important things about reading difficulties and the people who have them. We have learned that poor readers display different reading behaviours, that any one reading behaviour has multiple proximal and distal causes, that some poor readers have concomitant problems in other areas of their cognition and emotional health, and that interventions that focus on proximal causes of poor reading behaviours may be more effective than those that focus on distal causes. This knowledge provides some clues to how we might best assist children with reading difficulties. Specifically, we need to assess poor readers for (1) a range of reading behaviours, (2) proximal causes for each poor reading behaviour, and (3) comorbidities in their cognition and emotional health. It should be possible to design an individualised intervention programme that accommodates for a poor reader’s comorbid cognitive or emotional problems whilst targeting the proximal causes of their poor reading behaviour or behaviours. This approach, which requires the co-ordinated efforts of teachers and specialists and parents, is no mean feat. However, according to the scientific evidence thus far, this is the most effective approach we have for helping children with reading difficulties.

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Behavior-genetic studies of academic performance in school students: a commentary for professionals in psychology and education.

• Brian Byrne, Richard K. Olson, Stefan Samuelsson

The Neurobiological Strands of Developmental Dyslexia: What We Know and What We Don’t Know

• Lesley A. Sand, Donald J. Bolger

Back Matter

This book provides an overview of current research on the development of reading skills as well as practices to assist educational professionals with assessment, prevention, and intervention for students with reading difficulties.  The book reviews the Componential Model of Reading (CMR) and provides assessment techniques, instructional recommendations, and application models. It pinpoints specific cognitive, psychological, and environmental deficits contributing to low reading skills, so educators can accurately identify student problems and design and implement appropriate interventions. Chapters offer methods for assessing problems in decoding, word and sound recognition, and comprehension. In addition, chapters emphasize the recognition of student individuality as readers and learners, from understanding distinctions between difficulties and disabilities to the effects of first-language orthography on second-language learning.

Topics featured in this book include:

• Learning the structure of language at the word level.
• Reading comprehension and reading comprehension difficulties
• Assessing reading in second language learners.
• Effective prevention and intervention for word-level reading difficulties.
• The neurobiological nature of developmental dyslexia.     

Reading Development and Difficulties is a must-have resource for researchers, practitioners, and graduate students in varied fields, including child and school psychology; assessment, testing, and evaluation; social work; and special education.

" I think the book has the potential to be a game changer. It will certainly challenge the expectations of policy makers, not to mention the teachers of beginning readers. These chapters will enhance the knowledge base of those in our schools who are charged with the lofty task of assuring that children have the best possible opportunities to acquire the skill of reading. ”

Sir Jim Rose Chair and author of Independent Review of the Teaching of Early Reading: Final Report (2006)

• Assessment and intervention of dyslexia
• Assessment and intervention of hyperlexia
• Assessment and intervention of learning disabilities
• Assessment and intervention of reading difficulties
• Assessment and intervention of reading disabilities
• Assessment of English language learners
• Evidence-based intervention for reading difficulties
• Evidence-based instruction for reading difficulties
• Orthographic learning and memory
• Phonological processing skills in students
• Reading and spelling difficulties in schools
• Reading comprehension problems in students
• Reading development in English language learners
• Reading intervention for students with learning disabilities
• Response to Intervention for reading difficulties
• RTI for students with reading difficulties
• Sight-word learning, acquisition, and memory
• Simple View of Reading and students
• Word identification and recognition

David A. Kilpatrick

College of Education and Human Development, Texas A&M University, College Station, USA

Richard K. Wagner

David A. Kilpatrick, Ph.D., is Professor of Psychology at the State University of New York College at Cortland. He has been teaching courses on learning disabilities for more than 20 years. Dr. Kilpatrick is also a New York State certified school psychologist and has conducted hundreds of evaluations of students with learning disabilities. He received his doctorate in psychology from Syracuse University. Dr. Kilpatrick is the author of Essentials of Assessing, Preventing, and Overcoming Reading Difficulties (Wiley & Sons, 2015) and Equipped for Reading Success (Casey & Kirsch, 2016).

R. Malatesha Joshi, Ph.D., is Professor of Reading/Language Arts Education, ESL, and Educational Psychology at Texas A&M. He is the Editor of the Reading and Writing: An Interdisciplinary Journal , co-author with P. G. Aaron and D. Quatroche of Becoming a Professional Reading Teacher (Brookes, 2008), and the Series Editor of Springer’s Literacy Studies: Perspectives from Cognitive Neurosciences, Linguistics, Psychology, and Education .

Richard K. Wagner, Ph.D., is Distinguished Professor of Psychology at Florida State University and Associate Director of the Florida Center for Reading Research. He is the author or co-author of more than 100 scientific research articles on reading, and author or editor of several books. Dr. Wagner is a co-author of the Comprehensive Test of Phonological Processing–Second Edition (CTOPP-2) and the Test of Word Reading Efficiency–Second Edition (TOWRE-2). In 2012, Dr. Wagner and his colleague Joseph Torgesen, Ph.D., were co-recipients of the Distinguished Scientific Contributions award from the Society for the Scientific Study of Reading.

Book Title : Reading Development and Difficulties

Book Subtitle : Bridging the Gap Between Research and Practice

Editors : David A. Kilpatrick, R. Malatesha Joshi, Richard K. Wagner

DOI : https://doi.org/10.1007/978-3-030-26550-2

Publisher : Springer Cham

eBook Packages : Behavioral Science and Psychology , Behavioral Science and Psychology (R0)

Copyright Information : Springer Nature Switzerland AG 2019

Hardcover ISBN : 978-3-030-26549-6 Published: 05 October 2019

Softcover ISBN : 978-3-030-26552-6 Published: 05 October 2020

eBook ISBN : 978-3-030-26550-2 Published: 25 September 2019

Edition Number : 1

Number of Pages : XIX, 272

Number of Illustrations : 3 b/w illustrations, 7 illustrations in colour

Topics : Child and School Psychology , Assessment, Testing and Evaluation , Social Work

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Preventing Reading Difficulties in Young Children

While most children learn to read fairly well, there remain many young Americans whose futures are imperiled because they do not read well enough to meet the demands of our competitive, technology-driven society. This book explores the problem within the context of social, historical, cultural, and biological factors.

Recommendations address the identification of groups of children at risk, effective instruction for the preschool and early grades, effective approaches to dialects and bilingualism, the importance of these findings for the professional development of teachers, and gaps that remain in our understanding of how children learn to read. Implications for parents, teachers, schools, communities, the media, and government at all levels are discussed.

The book examines the epidemiology of reading problems and introduces the concepts used by experts in the field. In a clear and readable narrative, word identification, comprehension, and other processes in normal reading development are discussed.

Against the background of normal progress, Preventing Reading Difficulties in Young Children examines factors that put children at risk of poor reading. It explores in detail how literacy can be fostered from birth through kindergarten and the primary grades, including evaluation of philosophies, systems, and materials commonly used to teach reading.

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National Research Council. 1998. Preventing Reading Difficulties in Young Children . Washington, DC: The National Academies Press. https://doi.org/10.17226/6023. Import this citation to: Bibtex EndNote Reference Manager

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Psychology: Research and Review

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• Published: 20 March 2021

Identification of struggling readers or at risk of reading difficulties with one-minute fluency measures

• Maíra Anelli Martins   ORCID: orcid.org/0000-0001-6946-6755 1 , 2 , 3 &
• Simone Aparecida Capellini 2 , 3 , 4  

Psicologia: Reflexão e Crítica volume  34 , Article number:  10 ( 2021 ) Cite this article

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To identify readers who are struggling or at risk of reading difficulties, reference standards in oral reading fluency (ORF) are used to conduct an assessment that is based on a widely reported method known as curriculum-based measurement (CBM), which itself is based on 1-min fluency measures. The purpose of this study was to evaluate students’ ORF (with a 1-min fluency measure) to characterize their fluency and to determine references of appropriate development in reading at the 50th percentile.

For this study, a database of readings made available by the Learning Studies Research Laboratory was used. This database consisted of 365 readings by elementary-school students from the third to fifth grades in two cities in the interior of the state of São Paulo from two different public school systems that use the same teaching methodology. The data consisted of digital audio recordings of the passage “The Umbrella” (text suitable for schooling levels) of the Protocol for Assessment of Reading Comprehension procedure. For this procedure, three steps were performed: step 1—listening to the 365 readings and assessing the scores for the number of words read correctly per minute; step 2—the calculation of the mean and percentiles for each grade; and step 3—the adaptation of the reference table to indicate students eligible to receive reading fluency intervention.

Third-year students who correctly read 86 or more words per minute, fourth-year students who correctly read 104 or more words per minute, and fifth-year students who correctly read 117 or more words per minute were considered students who had made adequate progress in reading.

It was possible to classify students based on the 1-min fluency measures, with reference intervals of words read correctly per minute per school year (for the third, fourth, and fifth years) for those who were making adequate progress in reading and reference intervals for those who were considered readers who were struggling or at risk of reading difficulties.

Little research has been conducted in Brazil on measures to assess reading fluency (Gentilini et al, 2020 ; Andrade, Celeste, & Alves, 2019 ; Moutinho, 2016 ; Pacheco & Santos, 2017 ; Peres & Mousinho, 2017 ), and a search for research on reading fluency in official documents of the Brazilian Ministry of Education (Martins, 2018 ) also reveals that such measures are not a type of assessment that is widely known or applied by teachers within the classroom. Nonetheless, research has continually indicated the importance of developing oral reading fluency (ORF; reading with appropriate rate, accuracy, and prosody) as a vital and necessary skill for the overall development of proficient reading (Machado, Santos, & Cruz, 2019 ; Rasinski & Young, 2017 ).

In addition to the lack of Brazilian research widely exploring this theme, the low performance data of Brazilian students in reading indicates that these students also face difficulties in learning this highly complex activity, including the many who do not become proficient, effective readers. It is noted that this is a recurring problem that affects students and, consequently, concerns educators. As is clear from the evaluations conducted throughout the national territory (large-scale evaluations), the problem has continued throughout the years and affects even the regions with the best educational indexes or socioeconomic status.

Measures assessment of reading oral fluency

The method widely publicized as curriculum-based measurement (CBM) is a curriculum-based progress-monitoring method for measuring growth in specific areas of basic knowledge and skills and assessing the effects of instructional programs (response to intervention). Curriculum-based assessment, as a longstanding assessment practice asserting that learning assessments should be based on what has been taught, has become popular in the field of special education. Thus, the CBM method is described as curriculum-based, as it is used within the context of the school curriculum (Deno, 1985 ).

The CBM method proposes simple measures for the assessment of academic competence that can be applied quickly by teachers. These measures help provide an overview of each student’s academic development; furthermore, when these simple measures are applied systematically over time, they can be used to track a student’s potential difficulties (Fuchs, 2017 ).

For example, to identify struggling readers, reference standards for ORF are used, which, based on the CBM assessment method initially proposed by Deno ( 1985 ), enable reading analysis in just 1 min (e.g., the number of words read correctly per minute–WCPM). The most widely used assessment of ORF, which focuses on two of the three components of fluency (rate and accuracy), simply requires the student to read a grade-appropriate passage, which they have not seen previously, for 1 min. At the end of 1 min, errors are subtracted from the total words read, and then the WCPM score is calculated (Hasbrouck & Tindal, 2006 ).

Thus, the method was developed to create procedures for measuring progressive development in a simple, reliable, and valid way. These procedures enable teachers to frequently and repeatedly measure students’ progress in basic reading, spelling, writing, and expression skills (Rasinski, 2004 ).

Regarding reading fluency assessment, it is recommended that the scoring of the number of words read correctly per minute (WCPM) and the number of words read incorrectly per minute (WIPM) be performed with three passages of the same difficulty level to then calculate the mean score. Thus, the WCPM measure can serve to screen for academically at-risk students, assign placement in remedial and special education programs, monitor student progress, improve teaching programs, and predict performance in high-risk assessments (Hasbrouck & Tindal, 2006 ; Rasinski, 2004 ).

A series of discussions began in the last decade in Brazil on the question of the “wait to fail to act” model, which highlighted the importance of the early identification of learning difficulties. There are also discussions about the broadening of knowledge about the advantages of early identification and scientific evidence-based assessment and screening methods (Almeida, Piza, Toledo, Cardoso, & Miranda, 2016 ; Batista & Pestun, 2019 ; Brito, Seabra, & Macedo, 2018 ; Justi & Cunha, 2016 ; Mayeda, Navatta, & Miotto, 2018 ; Nicolau & Navas, 2015 ; Palles da Silva & Guaresi, 2019 ; Rodrigues & Ciasca, 2016 ; Silva & Capellini, 2017 ; Silva & Capellini, 2019a ; Silva & Crenitte, 2016 ).

According to Elliott, Huai and Roach ( 2007 ), several factors contribute to the prevalence of the “wait to fail to act” model, such as the fact that educators understand that there is a certain heterogeneity of development and learning among students and seek to allow appropriate time for this development. By doing so, they are also allowing students a fair chance of progressing without early determination of the problem. Another factor for the prevalence of this action model is the fact that few large-scale screening instruments are time efficient and technically simple for teachers to apply.

In the Brazilian literature, early screening instruments are recent and focus primarily on metalinguistic skills, such as the “Early Identification and Reading Problems Protocol” (Capellini, César, & Germano, 2017 ), the “Evaluation of Cognitive-Language Skills Protocol: Professional and Teacher’s Book” (Capellini, Smythe, Silva, 2017 ) and the “Protocol for Cognitive-Language Skills Assessment of Students in Early Literacy” (Silva & Capellini, 2019b ). These instruments assess skills considered predictive of literacy, such as reading and writing skills; arithmetic; auditory and visual processing; metalinguistic skills; and processing speed with the rapid automatic naming test. Some tests evaluate mathematical logical reasoning, for example, the “Cognitive-Language Skills Assessment Protocol.”

Likewise, there has been a movement in Brazilian research in recent years to describe the importance of reading fluency measures, especially those related to using a chronometer for timing as measures for screening difficulties, in addition to the development of instruments to assist in this assessment. Alves et al. ( 2019 ) described such issues in the most recent publication of the LEPIC® software, which proposes a semiautomatic and instantaneous reading fluency analysis to assess and assist in diagnostics or to monitor reading skills. This analysis focuses on the importance of evaluating parameter fluency, which may include indicators of reading problems such as dyslexia. Another instrument recently developed by Brazilian researchers is a collection of passages in sequential order according to difficulty level and suitable for elementary-school students from the first through fourth grades, called the “Reading Fluency Performance Assessment” (Martins & Capellini, 2018 ).

Additionally, on 22 February 2018, the More Literacy Program (PMAlfa) was created via MEC Ordinance No. 142, a strategy by the Ministry of Education that aims to strengthen and support school units in the process of increasing the literacy of elementary-school students enrolled in the first and second grades; the program fulfills the criteria established in the Common National Curriculum Base (CNCB). The objective of the program is to perform reading, writing, and math evaluations. For the first time, a formal program of the Brazilian government will evaluate the fluency and accuracy in the reading ability of students in the second grade of elementary school. The assessment is performed individually and uses a proprietary application suitable for smartphones or tablets.

However, despite efforts to create adequate assessment procedures for ORF, research into the characterization of ORF in this population is still incipient. Pacheco and Santos ( 2017 ), for example, evaluated three groups of readers in relation to reading fluency who were classified into three groups: group I–second-grade readers with little reading experience and expectation of low reading fluency; group II–second-year high school readers with the expectation of having slightly more reading experience and moderate fluency; and group III–readers with a higher education level. However, the relatively small sample consisted of 12 participants (four participants in each group), and the reading rate was evaluated by using the number of words read compared to the total reading time measured in seconds, considering a total reading time of 180 s (3 min).

In another study (Moutinho, 2016 ), 46 sixth-grade students from public and private schools were evaluated by measuring the WCPM in 1 min from three different passages. However, the article focused on describing the accuracy errors, i.e., the number and type of WIPM, while data for the WCPM are not presented. Other researchers evaluated 55 students from the third to the seventh grades with the number of words per minute, reading four different types of passages, and analyzing student performance in each (Dellisa & Navas, 2013 ).

Some researchers have also conducted reading fluency assessment with elementary students, as in a study that evaluated 32 students in ninth grade and calculated the speed of words read per minute (using the formula of total number of words from the passage, divided by the time in seconds spent to complete the reading, and multiplied by 60) (Komeno, Ávila, Cintra, & Schoen, 2015 ). Furthermore, in another recent study, researchers characterized the ORF by 232 middle-grade students from the sixth to the ninth grades from public and private education. The study provided an estimate of the expected values for each grade surveyed by reading an easy passage based on the 1-min oral fluency assessment, with scores for words read per minute and WCPM (Andrade et al., 2019 ).

While only a small number of studies for elementary and middle students exist, even fewer studies evaluate reading fluency in high school students or adults. One research study evaluated 88 students in the second grade of high school. The CBM method was followed by selecting a passage compatible with students’ age and grade and comprising subjects corresponding to the basic curriculum studied in the classroom. Students read three different passages, lasting 1 min each, for the subsequent calculation of the number of WCPM (Oliveira, Amaral, & Picanço, 2013 ). Only one study evaluating reading fluency in adults was found, in which the sample consisted of 30 adolescents and adults who were evaluated by measuring the number of words per minute (Peres & Mousinho, 2017 ).

The assessment of ORF conducted through WCPM scores presents 30 years of validation research indicating that this is a valid and reliable measure that reflects a student's overall performance in reading development during the first years after literacy (Morris et al., 2017a , b ; Tindal, 2017 ; Valencia et al., 2010 ). Reading fluency benchmarks have been used both for screening and for monitoring reading development, and research in these fields seeks to answer questions such as “How is student performance compared to their peers?” and “Who are the students struggling with reading?” This practice of frequent assessment enables early intervention and the planning of activities that focus on the skills already acquired and those that still require further attention.

Benchmarks in ORF have been established by American researchers and collected from a range of students, from those identified as talented or otherwise exceptionally skilled to those diagnosed with reading disabilities, such as dyslexia. The largest sample of the ORF benchmark was collected from schools and districts in 23 states in the USA for over 4 years. Based on their vast experience in interpreting ORF data, it was established that a score of 10 words above or below the 50th percentile should be interpreted as an expected score, meaning that students are making satisfactory reading progress (Hasbrouck & Tindal, 2006 ).

Given the implications that ORF benchmarks would have for Brazilian education, a study to determine a fluency reference through appropriate assessment material would be of great relevance. This benchmarking considers the indication of a median score (50th percentile), with scores of 10 words above or below this median indicating students who have made appropriate reading progress, to assist in assessment and to create parameters for selecting students for interventional programs who are struggling readers or at risk for developing difficulties in reading proficiency later.

The purpose of this study was to evaluate the ORF of students from the third to the fifth grades (with a 1-min fluency measure) to characterize their fluency and determine references of appropriate development in reading at the 50th percentile and those below this reference.

This is a quantitative, descriptive-explanatory study. The dependent variable is a 1-min fluency measure. The independent variable is student grade.

General procedures and database

This study was approved by the Ethics Committee of the Faculdade de Filosofia e Ciências of Sao Paulo State University–UNESP-Campus de Marília-SP under protocol 2.550.190–CAAE 50201915.9.0000.5406.

For this study, a database of readings made available by the Investigation Learning Disabilities Laboratory (in Portuguese: Laboratório de Investigação dos Desvios da Aprendizagem–LIDA), registered by a research group of the National Counsel of Technological and Scientific Development (CNPq), called “Language, Learning, Education,” was used. All information related to the sample of students comprising our database was made available by the members of this group.

The readings database made available consists of 365 readings from elementary-school students from the third to the fifth grades in two cities in the interior of the state of São Paulo (in a medium- and a small-sized Brazilian city, Southeast Region of Brazil) from two different public school systems with the same teaching methodology. In the city of Marília-SP, there are 51 schools with regular elementary education in urban locations, in basic education, with 2221 students enrolled in the third year, 2119 students enrolled in the fourth year and 2033 students enrolled in the fifth year according to the School Census/(Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira – INEP, 2018 ).

In the city of Garça-SP, there are 14 schools with regular elementary education in urban locations, in basic education, with 478 students enrolled in the third year, 436 students enrolled in the fourth year and 401 students enrolled in the fifth year according to the School Census/(Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira – INEP, 2018 ). The schools were selected through convenience sampling (simple convenience sample). The students participating in the studies did not have a history of repeating grades; they were monolinguals and native speakers of Brazilian Portuguese. The data were digital recordings of participants reading the passage “The Umbrella” (text suitable for schooling levels) from the procedure “Protocol for Assessment of Reading Comprehension” (Cunha & Capellini, 2014 ).

Of the 365 readings, 98 were third-grade students (48.9% female), 130 were fourth-grade students (49.2% female), and 137 were fifth-grade students (51.8% female) (participants were elementary-school students ranging from 7 to 11 years old).

According to the latest results published (Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira, 2015-2017 ) by the Socioeconomic Level Indicator (Inse) of basic education schools in Brazil, developed by the National Institute of Educational Studies and Research Anísio Teixeira (Inep), in the Basic Education Assessment Directorate (Daeb), the schools from which the analyzed data were obtained have an average Inse (absolute value 58.46 and 57.47), with an average rating (group 5).

The inclusion and exclusion criteria used by the laboratory researchers in the data collection of the reading audio bank are described. The inclusion criteria for the sample selection were as follows: informed consent form signed by the parents or guardians for the students; students with no history of neurological or psychiatric illnesses, uncorrected auditory and visual impairments, and cognitive performance within normal, according to the description at the school records and teachers’ reports. The exclusion criteria for the sample selection were the presence of genetic or neurological syndromes in the students, students who did not present a satisfactory reading domain level for the observation of the variable proposed in the study, and students who presented recording errors in their respective audio files.

Specific instruments and procedures

The passage used was “The Umbrella” (history appropriate for the educational level) from the procedure “Reading Comprehension Assessment Protocol” (Cunha & Capellini, 2014 ). The choice for using this protocol occurred due to its careful assessment and development, since its issues were built from the rules for the psychometric tool development described by The Federal Council of Psychology. The Council is an official body that studies and establishes criteria and rules in Brazil for the construction of evaluation tools that ensures their accuracy and validity, and defines, as reliable procedures, those whose accuracy is understood as their level of consistency and their ability to reach the objectives for which they were built as their validity.

The protocol consists of four passages, two narratives, and two expository narratives. A medium-length (297 words) narrative passage was chosen. The choice of a passage with a narrative gender protocol occurred because the students had been more commonly exposed to such passages since childhood and throughout the education process, which would simplify the fluency evaluation and avoid the interference of any cultural issues of the passage in the reading results of the students of different schooling levels.

The choice of protocol also occurred because it presents passages that were selected to reach students from the third, fourth and fifth grades at representatively similar levels of difficulty for all school years, making it possible to apply a single passage in all school years.

Although the procedure is an instrument for assessing reading comprehension, due to the objectives of this study, only the reading recordings were used to assess fluency, while the multiple-choice questions were not applied.

The equipment used in the recordings was a Karsect microphone headset, which was unidirectional since the microphone picks up sounds with greater intensity and orients towards where it is directed, reducing the intensity of the external noise. The microphone was connected to an HP notebook with an Intel Pentium processor, 3 GB memory, and a 32-bit operating system. Recordings were made with an original HP software application and were saved as .wav files.

The collections were carried out by the researchers of the mentioned research group, following the guidelines for individual application. Each reading of the entire passage was recorded, taking an average of 5 min total for each individual recording session in spaces reserved for the researchers in the schools during class hours.

To analyze the readings on digital media, the following steps were planned and performed:

Step 1 : The rate was scored by listening to 365 digital recordings and assessing the WCPM scores, which was performed according to the reading error classification used by Begeny, Capellini, and Martins ( 2018 ) and by other researchers (Valencia et al., 2010 ). In this approach, the types of errors that are marked as WIPM are mispronounced words, words substituted with others, words omitted, words read out of order, addition or omission of word endings, and hesitation (words on which the student paused more than 3 s, after which he or she is told the word, and it is marked as incorrect. If necessary, the student is told to continue with the next word).

The following items indicate all situations that are marked as WCPM: words pronounced correctly, self-corrections, words decoded slowly but ultimately read correctly, repeated words, words mispronounced due to dialect or regional differences, and words inserted. To quantify errors, scoring rules are also proposed for certain situations: lines or multiple words omitted; when one or more lines are not read (four or more omitted words in sequence), they are not considered errors, although those words are excluded from the WCPM (such that this rule is applied whenever a student skips four or more words within a sentence). If the student skips one, two, or three consecutive words, each word should be counted as an error (WIPM). Regarding hyphenated words that can exist independently, each morpheme separated by a hyphen counts as an individual word if the two parts exist independently when the hyphen is removed, such as “Guarda-chuva ” [Umbrella in Portuguese] (counts as two words but is only marked incorrect when the student misreads), as opposed to the word “ anglo-China ” (considered as one word, regardless of which or both are misread).

Step 2 : The data thus obtained were tabulated and processed with Microsoft Excel® 2010. Data were analyzed through descriptive statistics (mean, standard deviation, and percentiles). Percentiles 5, 10, 25, 50, 75, 90, and 95 were calculated for each grade. Stratifying these percentiles helps to understand the different levels of difficulty that students may present.

Step 3 : The reference table was adjusted for the selection of students eligible to receive reading fluency interventions or programs. For this, the minimum reference threshold was the 25th percentile, and the maximum reference limit was the 50th percentile. The reference to the 25th percentile represents an approximate limit on the minimum level of ORF that a student should present to benefit from a fluency program. This reference was developed through years of research and related interventions (Begeny et al., 2018 ; Field, Begeny, & Kim, 2019 ).

Thus, it was determined that in the present research, WCPM intervals (maximum and minimum limits) would be established to select students who were not making adequate reading progress based on the ORF standard published by Hasbrouck and Tindal ( 2006 ).

The results regarding the reading fluency assessment measure as a procedure for selecting struggling readers or at risk of developing reading difficulties (grades 3 to 5) are summarized in Tables 1 and 2 .

From the data presented in Table 1 , students in the third year who read 86 or more WCPM, in the fourth year who read 104 or more WCPM, and in the fifth year who read 117 or more WCPM are considered students who are making adequate progress in reading. As shown in Table 1 , the lower the student scored beneath the 25th percentile, the more difficulties with reading the student will present, and the higher the student scored above the 50th percentile, the better the student’s performance.

Considering the standards proposed by Hasbrouck and Tindal ( 2006 , p. 639), in which students who read more than 10 WCPM above the 50th percentile present appropriate reading progress (unless there are other indicators for concern), the WCPM was established for Brazilian students (Table 2 ).

The reference intervals were calculated from the readings by the 365 students, considering that those who presented a WCPM score between the 25th and 50th percentiles did not make satisfactory progress in their reading fluency and taking the 25th percentile as the minimum reference limit and the 50th percentile as the maximum reference limit (Table 2 ). Students with WCPM scores at the 25th percentile or below are unlikely to benefit from a fluency-based intervention because they likely need assistance with decoding, phonics, and/or phonemic awareness.

Measures such as the number of WCPM offer numerous advantages for use in the context of ORF assessment. This measure has already been proven to be valid and is a quick and simple measure; it can be easily implemented in educators’ routines, either within the school routine or with professionals in their clinics. The reliability coefficient of this study could not be used if the test used because a single item test was used (number of words read correctly). If used as a screening measure for students at risk of reading difficulties, it should be performed by teachers from the third grade, since it is from this series that all students are expected to have passed the literacy phase and to move from the phase of learning to read to the phase of reading to learn. Consequently, within just a few hours, a teacher can evaluate their entire class because the assessment is performed quickly, which would also enable frequent assessments, which would, in turn, enable the monitoring of students’ progress in their fluency (Hasbrouck & Tindal, 2006 ; Rasinski, 2004 ; Rasinski & Young, 2017 ).

For reference values, the data obtained in this study served to identify students who were making adequate reading progress and those who could benefit from a fluency program. Among the academic skills considered central to reading success, fluency reveals not only its importance in assessing and screening key components but also in intervention response strategies and models for absorbing the demand encountered after the screening and early identification of reading difficulties (Kostewicz et al., 2016 ).

Considering the Brazilian studies on the characterization of ORF, we note that despite their small number (Andrade et al., 2019 ; Dellisa & Navas, 2013 ; Komeno et al., 2015 ; Moutinho, 2016 ; Oliveira et al., 2013 ; Pacheco & Santos, 2017 ; Peres & Mousinho, 2017 ), the results help to predict and compare student performance. It is necessary to advance the description of the results to create fluency references so that they can be used to screen for students with general reading difficulties, according to each region of the country. It is emphasized that due to the continental dimensions of the Brazilian national territory, there are considerable cultural and educational differences among regions.

Therefore, the method of assessing a measure of ORF in given passages can be used to assess student progress in reading fluency competence; to predict and compare students’ performance with peers or benchmarks (since their performance is compared over time) as well as conduct individual assessments; set annual goals; assess the effectiveness of intervention programs; develop standards for the class, school, and/or region; identify students at risk of dyslexia or in need of further intervention; and serve as the initial source of data collection in the response-to-intervention model (Mendonça & Martins, 2014 ).

Implications

There are public policy problems that involve this issue of early identification in Brazil, as there are no projects or actions directed at absorbing the demand of learning disabilities within the school itself. This difficulty makes the implementation of a screening process for early identification more difficult, since once these students with difficulties have been identified, there is a corresponding need for interventions, such as intervention response models together with the need for a complete structural and practical change within the classroom to modify the deeply rooted tradition of “waiting to fail to take action” (Elliott et al., 2007 ). However, as observed in a recent program created by the Ministry of Education (More Literacy Program–PMAlfa), new ways of implementing the screening of reading difficulties and continuing teacher education to ensure that they master the methodologies for progress monitoring and evaluation of student performance are beginning to appear.

It is also important to underscore that recent research has focused on the development of instruments and materials suitable for this type of evaluation and progress-monitoring, such as passages that are appropriate for the grade level and classified according to their difficulty, that not only allow the modification of the “waiting to fail to act” tradition but also allow suitable fluency assessment applications with materials that not only accelerate but also facilitate evaluation (such as software and applications) (Alves et al., 2019 ). This approach also means that three passages of the same level of difficulty can be offered (as a collection of sequential passages) to the students for assessment (Martins & Capellini, 2018 ), with sets of three passages to be applied throughout the school year to facilitate the monitoring of student progress.

Despite its limitations, this study extended the literature (Andrade et al., 2019 ; Dellisa & Navas, 2013 ; Komeno et al., 2015 ; Moutinho, 2016 ; Oliveira et al., 2013 ; Pacheco & Santos, 2017 ; Peres & Mousinho, 2017 ) as part of the research movement to obtain ORF subsidiary reference data for professionals in the health-education interface. However, it is necessary to note that one limitation of this study is the number of samples used. To complement this study and other Brazilian research in this context, new research is needed that increases the number and the representativeness of the sample of Brazilian readers who struggle.

From this study, it was possible to evaluate and characterize the reading fluency of Brazilian students. It was also possible to establish reference intervals for the assessment of ORF, which can be used to screen struggling readers or students at risk who present or may develop reading difficulties.

Therefore, similar research should be carried out and expanded to create measurement parameters related to ORF, which will help teachers make decisions about which paths need to be constructed or improved to assist those students who are presenting difficulty in this learning process.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Curriculum-based measurement

• Oral reading fluency

Words read correctly per minute

Words read incorrectly per minute

More Literacy Program

Common National Curriculum Base

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Acknowledgements

The authors would like to thank the members of the Investigation Learning Disabilities Laboratory (LIDA) of Sao Paulo State University-UNESP for making available reading data in digital audios.

Results of this publication funding PhD by the first author by the National Council for Scientific and Technological Development-CNPq.

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Martins, M.A., Capellini, S.A. Identification of struggling readers or at risk of reading difficulties with one-minute fluency measures. Psicol. Refl. Crít. 34 , 10 (2021). https://doi.org/10.1186/s41155-021-00174-z

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Reading interventions for struggling readers in the upper elementary grades: a synthesis of 20 years of research

Jeanne wanzek.

Florida State University, School of Teacher Education and Florida Center for Reading Research, C234B Psychology, 1107 Call St., P.O. Box 306-4304, Tallahassee, FL 32306, USA

Jade Wexler

The University of Texas at Austin, Austin, TX, USA

Sharon Vaughn

Stephen ciullo.

A synthesis of the extant research on reading interventions for students with reading difficulties and disabilities in fourth and fifth grade (ages 9–11) is presented. Thirteen studies with treatment/comparison study designs and eleven single group or single subject studies were located and synthesized. Findings from the 24 studies revealed high effects for comprehension interventions on researcher-developed comprehension measures. Word recognition interventions yielded small to moderate effects on a range of reading outcomes. Few studies were located implementing vocabulary and multi-component interventions.

Introduction

Considerable research conducted over the past 30 years provides extensive knowledge regarding early intervention for young readers with reading difficulties ( Blachman et al., 2004 ; Denton, Fletcher, Anthony, & Francis, 2006 ; Felton, 1993 ; Fletcher, Lyon, Fuchs, & Barnes, 2007 ; Jenkins & O’Connor, 2002 ; Lovett et al., 2000 ; Mathes et al., 2005 ; McMaster, Fuchs, Fuchs, & Compton, 2005 ; Torgesen et al., 1999 ; Vellutino et al., 1996 ). These reports indicate that the highest student effects result when explicit, systematic instruction is provided in both foundation skills such as phonological awareness and phonics as well as higher level reading tasks, such as fluency, with increased attention to word meaning and understanding text ( National Reading Panel, 2000 ). Incorporating these elements of instruction has been associated with reducing the incidence of reading difficulties ( Torgesen, 2000 ).

In addition, recent syntheses have examined the efficacy of methods to improve reading outcomes for older students with reading difficulties that persist into grades 4–12 ( Edmonds et al., 2009 ; Kamil et al., 2008 ; Scammacca et al., 2007 ; Torgesen et al., 2007 ). These reports indicate positive reading outcomes for older students when providing explicit instruction in (a) word study strategies to decode words, (b) word meanings and strategies for deriving the meanings of unknown words, and (c) comprehension strategy instruction. These findings hold specifically for students with reading difficulties ( Edmonds et al., 2009 ) and learning disabilities ( Scammacca et al., 2007 ) as well. Furthermore, recent reviews indicate that providing ample opportunities to practice and receive corrective feedback during instruction are associated with improved academic outcomes ( Hattie & Timperley, 2007 ; Shute, 2008 ).

Thus, the necessary components of effective reading instruction have been identified and synthesized for students in the younger grades (K-3) who struggle with reading acquisition, and the groundwork has been laid for research regarding effective reading intervention for students who struggle to read and comprehend in the secondary grades. Although a few studies in the previous syntheses of reading instruction for older readers have included students in grades 4–5, the findings largely reflect studies conducted with students in grades 6–12. Typically, there is an underlying assumption that 4th and 5th grade students are more similar to secondary students than elementary students. Kamil et al. (2008) best explained this assumption in a recently published Institute of Education Sciences practice guide document, “The panel purposefully included students in 4th and 5th grades within the realm of adolescents because their instructional needs related to literacy have more in common with those of students in middle and high school than they do with students in early elementary grades” (p. 1).

While there is some evidence from the previous syntheses that upper elementary students in grades 4–5 can benefit from the same interventions designed to meet the needs of students in grades 6–12, the findings for students in the upper elementary grades (4th–5th) have not previously been disaggregated and the recommended practices have been based mainly on studies conducted with students in grades 6–12. Furthermore, a synthesis focusing on reading interventions for students in grades 4 and 5 has not previously been conducted.

Teaching reading in the upper elementary grades: the unique needs of teachers

Unfortunately, despite our knowledge regarding effective instruction for young readers in the early elementary grades, it is estimated that 69% of fourth grade students cannot read at proficient levels with 36% of the fourth grade population unable to read at or above basic levels of understanding ( National Center for Educational Statistics, 2005 ). In the upper elementary grades, a shift from “learning to read” to “reading to learn” typically occurs. Thus, in addition to expectations that students have adequately mastered the basic reading skills such as decoding accurately and fluently, there are also expectations that students understand word meanings and are able to read text with comprehension ( Chall, 1983 ). The focus on these comprehension skills may be difficult for struggling readers who may still be learning to accurately and fluently decode grade level text. In addition, as early as fourth grade, students are presented with the supplementary challenge of transitioning from reading and understanding narrative text to reading and understanding content area expository text ( Grigg, Daane, Jin, & Campbell, 2003 ).

With the decreased emphasis on learning to read in the upper elementary grades, students who do not read proficiently by the end of the early elementary grades (K-3) may face serious consequences. Chall and Jacobs (1983) noted that many low income third graders reading at grade level experience a sudden drop in normative reading scores by the fourth grade, referring to this phenomenon as the “fourth grade slump”, indicating not that students go “backwards” in reading, but instead that they fail to thrive and cannot meet grade level expectations. The increased demands placed on students beginning in fourth grade may cause a slowing of reading growth relative to expected growth for some students who previously seemed on track in their reading growth. Teachers must be able to detect when a student is not thriving and intervene before the gap widens even more. Therefore, upper elementary teachers are often faced with the challenge of providing intervention not only for students with previously identified reading difficulties that have not been adequately remediated, but also students whose reading difficulties have manifested in the upper elementary grades.

Additionally, the trajectory of a young person’s academic success begins in the elementary grades, making it even more crucial to find ways to intervene and remediate deficits that persist into the upper elementary grades. When students experience a lack of success starting in elementary school, they may begin to disengage from school and be more inclined to drop out in the future ( Dynarski et al., 2008 ). It is necessary to determine appropriate methods to intervene with students in the upper elementary years before they reach the secondary grades and are then faced with a multitude of additional academic and social challenges.

Rationale and research question

We conducted this synthesis to examine the effects of reading interventions for students with reading difficulties and disabilities in the upper elementary grades including students in grades 4–5. The findings are expected to contribute to the research and practice knowledge regarding interventions for students who struggle with reading beyond third grade. We addressed the following research question: How effective are reading interventions on reading outcomes for students with reading difficulties and disabilities in fourth and fifth grade?

Selection of studies

Studies were identified through a two-step process. First, we conducted an electronic search of ERIC and PsychInfo for studies published in the last 20 years (1988–2007). Key disability search terms and roots ( reading difficult *, disab *, dyslex *, special education ) were used in combination with key reading terms and roots ( reading, phonics, fluency, vocabulary, comprehen *) to capture relevant articles. Second, we conducted a hand search of nine major journals (Exceptional Children, Journal of Educational Psychology, Journal of Learning Disabilities, Journal of Special Education, Learning Disabilities Quarterly, Learning Disabilities Research and Practice, Reading and Writing, Remedial and Special Education, and Scientific Studies of Reading) from 2006 through 2007 to ensure that all recently published studies meeting criteria were identified.

A total of 24 studies met selection criteria for the synthesis. Studies were selected based on the following criteria:

• More than 50% of the participants in the study were enrolled in 4th or 5th grade, or were 9–11 years old. Studies with less than 50% of the participants in 4th/5th grade were included if data were disaggregated for the 4th/5th grade population.
• Participants were struggling readers. Struggling readers were defined as low achievers, students with unidentified reading difficulties, dyslexia, and/or with reading, learning or speech/language disabilities. Studies also were included if disaggregated data were provided for struggling readers regardless of the characteristics of other students in the study.
• The interventions targeted reading instruction and articles were published in English.
• Reading intervention was provided for 15 sessions or more to ensure students with reading difficulties and disabilities received a sustained intervention prior to measurement of outcomes.
• A reading intervention including word study, fluency, vocabulary, comprehension, or a combination of these was provided as part of school programming. Home teaching, clinic, or camp programs were excluded.
• The research design was treatment-comparison, single-group, or single-subject.
• Reading or reading related outcomes were measured.

Coding procedures

An extensive coding document was developed and used to organize essential information about each study. The code sheet was based on code sheets used in previous research ( Edmonds et al. 2009 ; Vaughn et al. 2003 ) as well as the What Works Clearinghouse Design and Implementation Assessment Device ( Institute of Education Sciences, 2003 ).

The pertinent information coded included the following: (a) participants, (b) methodology, (c) intervention and comparison information, (d) clarity of causal inference, (e) measures, and (f) findings. There were 3 coders for the articles. Interrater reliability was established by having each coder independently code a single article. Responses from each coder were used to calculate the percentage of agreement (i.e., agreements divided by agreements plus disagreements). Interrater reliability was calculated separately for each codesheet category (e.g., participants, design, etc.). An interrater agreement of 90% or above was achieved for each category (range 90–100%). Each study was then independently coded by 2 raters. If disagreements occurred, meetings were held to discuss the coding with final judgments reached by consensus.

Effect size calculation

In order to provide additional quantitative information for this systematic review of the literature, effect sizes were calculated where data were available. For studies with treatment and comparison groups, effect sizes were calculated adjusting for pre-test differences using a procedure by Bryant and Wortman (1984) . The quantity of the pretest treatment mean minus the pretest comparison mean was divided by the quantity of the pretest comparison standard deviation. This quantity was subtracted from the quantity of the posttest treatment mean minus the posttest comparison mean divided by the posttest comparison standard deviation. Thirteen of the 24 studies in this synthesis used a treatment/comparison design (9 experimental and 4 quasi-experimental). Data for calculation of effect sizes were available in 10 of these 13 studies.

Experimental and quasi-experimental studies

Nine experimental studies ( Mason, 2004 ; Mathes & Fuchs, 1993 ; Miranda, Villaescusa, & Vidal-Abarca, 1997 ; O’Connor et al., 2002 ; O’Connor, White, & Swanson, 2007 ; Therrien, Wickstrom, & Jones, 2006 ; Takala, 2006 ; Torgesen et al., 2001 ; Xin & Rieth, 2001 ) and four quasi-experimental studies ( Das, Mishra, & Pool, 1995 [Study 1 and 2]; Das-Smaal, Klapwijk, & van der Leij, 1996 ; Lederer, 2000 ) examined reading interventions for students with reading difficulties and disabilities in the fourth and fifth grade. Summaries of the study characteristics and findings are presented in Tables ​ Tables1 1 and ​ and2. 2 . We present the effects of these studies by the type of intervention that was implemented in the study (e.g., word recognition, fluency).

Summary of study characteristics

SR Struggling readers; LD learning disabilities; RD reading; disabilities; LI language impaired; SLI speech/language impaired

Summary of study findings

T, Treatment; RD, Researcher-developed; WCPM, words correct per minute; C, comparison/control group; WRMT, Woodcock Reading Mastery Test–Revised; Word ID, word identification; WA, word attack; PC, passage comprehension; RT, response time; ns, non-significant; LAC, Lindamood Auditory Conceptualization Test; NARA, Neale Analysis of Reading Ability; AE, age equivalent; Comp., comprehension; F-U, Follow-up; na, not applicable; CRAB, Comprehensive Reading Assessment Battery; CBM, Curriculum-Based Measure; ARI, Analytical Reading Inventory; GORT-4, Gray Oral Reading Tests 4th Ed.; DIBELS, Dynamic Indicators of Basic Early Literacy Skills; ORF, oral reading fluency; WJ-III, Woodcock Johnson III: BRC, Broad Reading Cluster; TOWRE, Test of Word Reading Efficiency; GORT-III, Gray Oral Reading Test 3rd Ed.; CELF, Clinical Evaluation of Language Fundamentals; LAC, Lindamood Auditory Conceptualization Test; PDE, phonetic decoding efficiency; SWE, sight word efficiency; CTOPP, Comprehensive Test of Phonological Processing; KTEA, Kaufman Test of Educational Achievement; SS, standard score

Vocabulary and comprehension

Five studies implemented interventions with a focus on comprehension skills and strategies ( Lederer, 2000 ; Mason, 2004 ; Miranda et al., 1997 ; Takala, 2006 ; Xin & Rieth, 2001 ). All of these studies measured outcomes with researcher-developed measures that measured the specific skills taught in the intervention; no norm-referenced measures were administered. In one experimental study, Mason compared the effects of a self-regulated strategy (Think before you reading, think While reading, think After reading [TWA]) to a second treatment of reciprocal questioning for students with both reading difficulties and disabilities. There was no business as usual or typical instruction control group. Students in the TWA intervention were taught to think about the author’s purpose, think about what they already know, and think about what they want to learn prior to reading. During reading, students were taught to think about their reading speed, linking knowledge, and rereading sections. Finally, students developed the main idea for each paragraph and summarized the information after reading. In the reciprocal questioning condition, students were taught to generate questions for the teacher about the passage read as well as answer questions about the text from the teacher. Effects were higher at posttest for the TWA intervention on researcher-developed measures assessing main ideas, summarizing, and retell (mean ES = .99). Effects in favor of TWA were similar when measures were administered 3 weeks following intervention (mean ES = .90).

Miranda et al. (1997) also compared the relative effects of two interventions with a comprehension focus, self-instruction and self-instruction plus attribution training, to a control group that did not receive either of the interventions. Students with learning disabilities were identified for participation in the interventions. Self-instruction included training and practice in strategies for activating previous knowledge, previewing text, self-questioning, clarifying unknown words, and mapping main ideas. Students were also taught a general self-instruction procedure to follow when completing a reading task (i.e., Stop, Think and Decide, Check, Confirm, Evaluate). The self-instruction plus attribution condition consisted of all the elements in the self-instruction condition plus teacher modeling and student practice using positive attributions in relation to their work. As a result of the time spent on attribution training this treatment group spent less time on the comprehension skills and strategies. Students in the self-instruction condition outperformed students in the control condition at posttest on researcher-developed measures assessing main ideas, recall, and cloze (mean ES = 3.46). Students in the self-instruction plus attribution training also outperformed the control group on the posttest measures (mean ES = 2.63). Two months following the completion of intervention the same measures were administered with mean effect sizes of 1.98 and 2.09 for the self-instruction group and the self-instruction plus attribution training group respectively.

A third experimental study investigated student understanding of text with a focus on teaching target vocabulary words in two conditions ( Xin & Rieth, 2001 ). Students with learning disabilities in both conditions read the same passages, were taught the same target vocabulary words to aid understanding of the passage, and completed the same comprehension activities. However, one group received video-assisted instruction, watching chapters of a videodisc with content related to the topic and including the target words while the second group received instruction using only printed texts. The video instruction group outperformed the nonvideo group on researcher-developed measures of word definitions and cloze using the vocabulary words taught during instruction (mean ES = .58). There were no differences between the groups on a researcher-developed measure of comprehension on the content taught in the interventions (ES = .02). Follow-up measures were administered 2 weeks following intervention with effects: (a) maintained in favor of the video instruction group for word definitions (ES = .53), (b) decreased for sentence cloze with the target words (ES = .16), and (c) consistent to the posttest for passage comprehension (ES = −.04).

The final two studies examined reciprocal teaching as an intervention for students with disabilities ( Lederer, 2000 ; Takala, 2006 ). Lederer implemented reciprocal teaching in social studies instruction for students with learning disabilities in inclusive classrooms while Takala investigated the intervention for students with language and reading disabilities in special education classrooms in Finland. Neither study provided disaggregated data for the student participants meeting criteria for this synthesis that would allow for calculation of effect sizes. However, Lederer ran analyses on disaggregated data for the students with learning disabilities and reported no significant differences between the treatment and control groups on researcher-developed comprehension measures of answering questions and generating questions. Students with learning disabilities in the treatment group significantly outperformed students in the control group on composing summaries ( p < .05). Takala reported no significant differences between pretest and posttest scores for students with disabilities on researcher-developed measures of selecting the best title and main idea, and generating a question.

Two experimental studies implemented interventions with a focus on fluency instruction ( Mathes & Fuchs, 1993 ; O’Connor et al., 2007 ). Both studies examined treatment conditions using repeated reading of text or sustained/continuous reading of text along with a control condition. Mathes and Fuchs implemented the intervention with classwide peer-mediated instruction in special education resource rooms. Students with reading difficulties and disabilities in the O’Connor et al. study met one-on-one with an adult listener. In both studies, the number of minutes spent reading text was kept constant, with 9 min. of reading in the Mathes and Fuchs study (as well as 9 min. of listening to a peer) three times a week for 10 weeks, and 15 min of reading for the O’Connor et al. study implemented three times a week for 14 weeks. However, in the repeated reading condition of each study students reread the passages three times each. In the sustained or continuous reading conditions the students continuously read the text without repeating. In each condition either peers (Mathes & Fuchs) or the adult (O’Connor et al.) corrected errors during reading.

In the Mathes and Fuchs (1993) study, effects were low for the treatment conditions in comparison to the control condition across measures of fluency and comprehension (repeated reading mean ES = .08; sustained/continuous reading mean ES = .03). In contrast, higher effect sizes were found for both treatment conditions in the O’Connor et al. (2007) study across norm-referenced measures of fluency, word reading, and comprehension (repeated reading mean ES = .71; sustained/continuous reading mean ES = .69).

Word recognition

Four studies focused on word reading instruction as an intervention ( Das et al., 1995 [Study 1 and Study 2]; Das-Smaal et al., 1996 ; Torgesen et al., 2001 ). In an experimental study, Torgesen et al. examined two treatment conditions for students with learning disabilities that differed in the extent of instruction in phonemic awareness and phonemic decoding skills. No control group was included in the design of this study. In the auditory discrimination in depth (ADD) condition students spent approximately 95% of the lesson working with sounds and individual words including introduction to individual phonemes, practice reading and spelling individual words regular words and instruction of irregular words. Students then practiced reading with decodable text. Alternatively, the students in the embedded phonics (EP) condition spent about 50% of the instructional time on sounds and individual words and 50% in connected text activities. Explicit instruction was provided in phonics and reading/spelling words along with ample opportunities for students to practice reading connected text using trade books and basals. The students were introduced to sounds and practiced reading and spelling regular and irregular words. The students practiced reading with trade books and the basal and wrote sentences containing words from their sight word lists. A number of standardized measures were administered at posttest, 1 year follow-up, and 2 year follow-up to assess phonological awareness, word reading, comprehension, fluency, spelling, and expressive and receptive language (see Table 2 for measures). A mean effect size of .16 on these norm-referenced measures was found at posttest in favor of the ADD group. These effect sizes increased for the ADD group at 1 year (mean ES = .29), and for the 2 year follow-up were consistent with posttest (mean ES = .13).

In two studies conducted by Das et al. (1995) , the Planning, Attention, Simultaneous, and Successive Remedial Program (PREP) was implemented for students with reading disabilities. Study 1 examined the full program including global (strategies such as rehearsal, categorization, and prediction for successive or simultaneous processing) and bridging (extending these strategies to word identification) components. In Study 2, one group of students received intervention in the global components only and, thus, practiced the strategies without words (e.g., sequencing geometric shapes) while a second group received intervention in the bridging components only and, thus, practiced the strategies only with words and text (e.g., sequencing letters to form a word and then reading the word). A control group in Study 1 became the treatment groups in Study 2 while the treatment group in Study 1 became the control group in Study 2. Thus, all students in Study 2 had received some form of PREP (global, bridging, or previously instructed combined program). In Study 1, students receiving PREP outperformed students in the no treatment control group on the word attack and word identification subtests of the Woodcock Reading Mastery Test (mean ES = .70). In Study 2, effect sizes on the same measures favored the global (mean ES = .10) and bridging (mean ES = .34) groups over the control group of students who had previously received the combined PREP program in Study 1.

The study by Das-Smaal et al. (1996) implemented a computer-based program for students to practice detecting multi-letter units in words in Dutch. Students assigned to the control group received computer-based training in mathematical exercises similar to the cognitive and motor exercises of the training program provided to the treatment group. Posttest measures assessed student accuracy and speed on the computer tasks, detecting units that were trained and untrained, and reading real and pseudowords. The treatment group performed significantly better than the control group on reaction time for detecting units and reading pseudowords ( p < .05). No significant differences were reported on the accuracy of detecting units or reading real words. No norm-referenced measures were administered.

Multi-component

Two experimental studies examined the effects of a multi-component intervention for students with reading difficulties and disabilities ( O’Connor et al., 2002 ; Therrien et al., 2006 ). O’Connor et al. included phoneme awareness, word recognition and spelling, fluency, and comprehension in a 30 min, one-on-one intervention. Students were randomly assigned to receive this treatment with text matched to their reading level (reading level matched), receive the treatment using text from the classroom (classroom matched), or a control condition. Both treatment conditions outperformed the control condition on norm-referenced measures of phonemic awareness, word reading, comprehension, and fluency (reading level matched mean ES = 1.56; classroom matched mean ES = 1.26).

Therrien et al. (2006) incorporated fluency and comprehension components in 10–15 min one-on-one intervention. Students in the treatment condition read a new passage 2–4 times with feedback to reach a pre-established number of correct words per minute. This fluency instruction was followed by scaffolded assistance answering factual, inferential, and story structure questions. The treatment group demonstrated higher effects in comparison to the no-treatment control group in oral reading fluency (ES = .44) and general reading achievement as measured by the Broad Reading scale of the Woodcock-Johnson Achievement Test III (ES = .37).

Single group and single subject studies

Eleven studies examined the effects of reading interventions for single groups or individual students with reading difficulties and disabilities by examining student improvement ( Bruce & Chan, 1991 ; Butler, 1999 ; Daly & Martens, 1994 ; Ferkis, Belfiore, & Skinner, 1997 [Study 1 and 2]; Gillon & Dodd, 1997 ; Mason, Snyder, Sukhram, & Kedem, 2006 ; Rich & Blake, 1994 ; Taylor, Alber, & Walker, 2002 ; Thaler, Ebner, Wimmer, & Landerl, 2004 ; Wright & Mullan, 2006 ). We describe these studies and their outcomes by intervention type.

Comprehension

Four single subject studies implemented interventions with a comprehension focus ( Bruce & Chan, 1991 ; Mason et al., 2006 ; Rich & Blake, 1994 ; Taylor et al., 2002 ). Following up on the experimental study of the self-regulated strategy TWA described earlier, Mason et al. implemented a single subject study of the TWA reading strategy instruction combined with PLANS (Pick goals, List ways to meet goals, And, make Notes and Sequence notes) writing strategy instruction. Three instructional groups of 3 students each were included in the study. Participants with both reading difficulties and disabilities were included. Reading outcome measures consisted of oral and written retells of expository science or social studies passages. Students were scored according to the number of information units included in the retell as well as the quality of the retell. Quality was rated on a 7-point scale (0 points to 6 points) researcher-developed scale based on the student capturing the main ideas of the passage in the retell. Mean increases in information units from baseline to postinstruction ranged from 5.34–5.86 for oral retell and 8.23–18.87 for written retell across the three instructional groups. Mean increases in quality scores ranged from 2.17 to 3.00 for oral retell and 2.47–3.00 for written retell.

Rich and Blake (1994) also implemented a comprehension intervention that included instruction in self-regulated learning. Students with language/learning disabilities received instruction in identifying main ideas, self-questioning, and paraphrasing with the teacher reading the expository text. During the intervention, students kept daily journals evaluating their cognitive and affective behaviors. Reading outcomes were measured with expository passages excerpted by the researchers from informal reading inventories and students responded to 8 questions about each passage. The authors report that all 5 students made improvements from the pretest to the posttest in listening comprehension with scores on the outcome measure ranging from 56–100% (2 students below 75% on posttest). Four of the students also improved from pretest to posttest in reading comprehension with scores ranging from 63–100% on the posttest measure (1 student below 75% on posttest).

However, Bruce and Chan examined reciprocal teaching in the resource room as well as techniques for assisting students with reading difficulties in generalizing strategies learned to the general education classroom. Student’s total comprehension scores on measures that included main ideas and passage details increased to 75–90% accuracy (with average baseline levels ranging from 16–20%). However, no unprompted transfer of skills was reported and student levels were lower in the transfer phase than in the resource room instructional phase.

Taylor et al. implemented an alternating treatments design to examine the effects of story mapping, self-questioning, and no intervention for individual students with learning disabilities. The accuracy of students’ responses during each phase of instruction was collected. Two of the students in this study met criteria for inclusion for this synthesis. One student, Joseph, demonstrated slightly higher comprehension scores in the self questioning and story mapping conditions over the no intervention phase. The second student, Michelle, had some overlap in scores between the no intervention and intervention phases initially with scores improving further during the intervention phases. Accuracy was high for both students in each of the intervention conditions (80.9 and 86.4% for Joseph and Michele in story mapping; 88.2 and 94.6% for Joseph and Michele in self-questioning).

One fluency intervention with students with learning disabilities utilized a single subject study ( Daly & Martens, 1994 ). A multi-element design was used to compare student accuracy and fluency under 3 pre-reading conditions: (1) subject passage preview with the student doing a first read of the passage without help from the teacher, (2) taped words with the student reading a word list of words from the passage along with an audio tape speeded at 80 words per minute, or (3) listening passage preview with the subject following along in the text while listening to the passage read on audiotape. Following each of these prereading conditions, the student read the passage for assessment. The largest increases for oral reading accuracy and fluency were seen under the listening passage preview. However, no discernible differences between baseline and the three conditions could be seen on word list reading.

Word reading

Six single group or single subject studies examined student outcomes from interventions focusing on word reading instruction ( Butler, 1999 ; Ferkis et al., 1997 [Study 1 and 2]; Gillon & Dodd, 1997 ; Thaler et al., 2004 ; Wright & Mullan, 2006 ). Four of the studies incorporated training in sight word reading: students practicing reading unknown words to mastery with a peer (Butler), an adult (Ferkis Study 1 and 2), or a computer (Thaler et al.). Butler reported an increase in word reading on words taught from 50–79% for students with reading disabilities. Similarly, Ferkis et al. reported students with learning disabilities mastered 12–14 words taught in each condition of Study 1 and 2, with one student obtaining mastery of 21–23 words taught during the intervention phases. Study 1 consisted of 2 conditions, one with 1 correct response per word required in each training session and a second condition requiring 5 correct responses per word during training. Study 2 continued with similar conditions to Study 1 except that students practiced the set of words three times. No discernible differences in the number of words learned based on the number of repeated responses required during training in either Study 1 or Study 2 were noted. Thaler et al. measured the reading time on trained words following intervention for students with reading difficulties and found that students showed decreases in reading time for the words following intervention. The students who pretested with higher reading times made the most gains in decreasing their reading times.

Two of the word reading interventions taught phonological skills to students with reading disabilities and measured students’ phonological awareness, reading accuracy, and comprehension using standardized measures of general skills in these areas ( Gillon & Dodd, 1997 ; Wright & Mullan, 2006 ). All students made gains in each area from pretest to posttest. The largest gains appeared on the phonological measures for both studies.

The primary purpose of this research synthesis was to determine the effectiveness of reading intervention for students in the upper elementary grades (fourth and fifth grade) on reading outcomes. We prioritized this grade group because previous syntheses have examined extensively the effectiveness of reading practices for students in grades K-3 (e.g., McCardle & Chhabra, 2004 ) and more recently reading interventions for older students (e.g., Edmonds et al., 2009 ; Scammacca et al., 2007 ) leaving many upper elementary teachers unclear about how these findings apply to their instruction. In addition, considerable evidence suggests that student’s reading comprehension takes a negative turn in the upper elementary grades, often referred to as the “fourth grade slump” ( Chall & Jacobs, 2003 ), and determining research-based practices for intervening is important.

Overall, the number of experimental studies available for analysis was relatively few ( n = 9) and represented a range of treatment foci that included comprehension, word reading, fluency, vocabulary, and two that were multi-component addressing multiple elements of reading. The largest number of experimental studies ( n = 5) addressed reading comprehension or vocabulary development and all of these studies used researcher-developed measures to address outcomes. We think it is encouraging that the majority of outcomes for the comprehension and vocabulary treatments yielded effects that were moderate to large in size. However, it is typical for researcher-developed measures to yield higher effect sizes ( Swanson, Hoskyn, & Lee, 1999 ). This provides support for the influence of vocabulary and comprehension interventions on improving students’ understanding of text. However, the confidence in these findings would be more robust if the studies had not relied solely on researcher-developed measures. For vocabulary treatments, it is common that researcher-developed measures are used to tap the extent to which students learn the vocabulary words taught ( Scammacca et al., 2007 ). The rationale is that most vocabulary interventions are not perceived as being powerful enough to influence more broadly acquisition of untaught vocabulary which is what would be measured on more normative vocabulary measures (Scammacca et al.). The use of researcher-developed measures for comprehension is less necessary and it would be expected that researchers would use norm-referenced measures either solely or in combination with researcher-developed measures to assess the effects of treatment. Considering these caveats, we have learned from both the experimental studies and single-subject studies that for upper elementary students, comprehension practices that provided opportunities for students to preview text and connect with their knowledge, use self-questioning and self-regulating practices while reading, and summarize what they are learning were associated with moderate to high outcomes. It may be that these practices enhance the language functioning of target students with reading comprehension problems, many of whom are likely to also demonstrate low language ( Nation, Clarke, Marshall, & Durand, 2004 ). These findings are in line with a previous research syntheses on reading comprehension outcomes with older students ( Edmonds et al., 2009 ; Scammacca et al., 2007 ).

Two of the studies addressed fluency in which repeated reading of text was compared with continuous reading. The amount of time students read the text was held constant but in one treatment condition students read the text only one time and continuously (sustained/continuous treatment) and in the other condition the text was read three times (repeated reading). Findings in one of the studies ( Mathes & Fuchs, 1993 ) yielded very low effects for both treatment conditions using peers, whereas in the second study ( O’Connor et al., 2007 ) moderate to large effects for fluency and comprehension resulted when students were paired with adults. Because these two studies do not provide converging outcomes for students with reading difficulties and disabilities, we would suggest that teachers integrate both repeated reading and continuous reading into their interventions and monitor students’ progress to determine effectiveness. Also, it appears as though an adult or very able reader as a model is associated with improved fluency outcomes ( Daly & Martens, 1994 ).

Word study interventions that assisted students in learning to map the sounds of language to letters and words were associated with small to moderate effects for fourth and fifth graders. In contrast to the comprehension interventions that may have inflated effects due to the administration of researcher-developed outcome measures, the three word recognition studies providing data for effect size calculation administered norm-referenced measures at posttest. The Edmonds et al. (2009) meta-analysis examining interventions for secondary students with reading difficulties also revealed that reading comprehension outcomes were positively affected by word study treatments; however as with the current studies, the results were small to moderate. These findings are similar to previous research that suggests for many students oral language proficiency as well as phonological knowledge relates to their course of reading development ( Nation & Snowling, 2004 ).

It also likely that many students with reading difficulties or disabilities in fourth and fifth grade may continue to have word recognition difficulties; whereas other students suffering from the “fourth grade slump” may struggle more specifically with the increased vocabulary and understanding the variety of complex texts in the content areas. Thus, a word recognition treatment may have a greater effect for students who continue to struggle with word recognition. None of the studies synthesized has examined differential effects for students participating in the interventions based on level of reading, but investigation in this area may help further explain effects.

Only two studies in this synthesis examined multi-component reading interventions. The findings of these two studies revealed that treatments that included two or more components of reading (e.g., word study and comprehension) were associated with moderate to large effects. The value of multi-component interventions for older students was confirmed in three syntheses examining the effects of treatments with secondary students ( Kamil et al., 2008 ; Scammacca et al., 2007 ; Torgesen et al., 2007 ). Our interpretation of these findings is that older students may benefit when interventions focus on more than one element of reading. However, given the very small number of multi-component studies for students in grades 4–5 as well as the range of effects reported, additional research is needed to confirm the positive effects for multi-component interventions.

Summary of implications and further research

This synthesis of research for students with reading difficulties and disabilities in the upper elementary grades suggests: (a) instruction in comprehension strategies for application before, during, and after reading produces increased comprehension outcomes on researcher-developed measures, (b) mixed results for fluency interventions, (c) limited evidence (one study) for the effects of vocabulary instruction, and (d) multi-component interventions demonstrate promise for increasing student outcomes on a variety of measures. Fourth graders who struggle with reading can demonstrate a range of distinctive patterns of performance that contribute to their low reading comprehension difficulties and represent variation in performance on word identification, phonemic awareness, comprehension, vocabulary, rate of reading and expression ( Buly & Valencia, 2002 ). Future research may implement interventions that consider the type of reading comprehension problem and mapping interventions to specific comprehension problems.

Based on the current research, we also conclude that further research is needed to examine the effects of comprehension interventions on broad comprehension outcomes with standardized measures. Furthermore, we located only one vocabulary study and two multi-component studies for students with reading difficulties in the upper elementary grades. While previous syntheses have reported large effects for vocabulary interventions for secondary readers ( Kamil et al., 2008 ; Scammacca et al., 2007 ) and moderate effects for multi-component interventions ( Edmonds et al., 2009 ; Scammacca et al., 2007 ), additional work is needed to determine the effects of these interventions for upper elementary students.

E.D. Hirsch (2003) states, “We’re finding that even though the vast majority of our youngest readers can manage simple texts, many students-particularly those from low-income families-struggle when it comes time in grade four to tackle more academic texts.” (p. 10). This synthesis was designed to reveal those instructional practices that research documents are associated with improved outcomes for upper elementary students with reading difficulties. While this synthesis, like many in education, is only as good as the extant research, we believe that the findings from this report provide initial guidance to teachers and educators about practices that they can integrate into their interventions.

Contributor Information

Jeanne Wanzek, Florida State University, School of Teacher Education and Florida Center for Reading Research, C234B Psychology, 1107 Call St., P.O. Box 306-4304, Tallahassee, FL 32306, USA.

Jade Wexler, The University of Texas at Austin, Austin, TX, USA.

Sharon Vaughn, The University of Texas at Austin, Austin, TX, USA.

Stephen Ciullo, The University of Texas at Austin, Austin, TX, USA.

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EFFECTS OF READING DIFFICULTIES ON ACADEMIC PERFORMANCE

Reading is important in the learning context not only because it affects readers independent access to information in an increasingly information-driven society, but more importantly because it is a powerful learning tool, a means of constructing meaning and acquiring new knowledge.

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In language learning, mastering all four skills is considered ideal. Some say speaking comes naturally, even in the learning of a foreign language. Listening sis also a language skill many link with the skills of speaking. One needs to listen to how a language sounds to be able to imitate the sounds. Writing skills ,although has been seen as a difficult skill by many, are skills that people need-be it formally or informally. Finally, comes reading skills. There are extensive reading skills where people read on a regular basis-"feeding" on information that can either be considered as leisure, formal or even academic. When it comes to academic reading, many have mixed feelings-making that of fear. Students in higher institutions will find that academic reading is an important skill that they need to master. This study is done to explore the perception of learners on reading difficulties. This study is also done to investigate the influence of reading strategies such as cognitive, metacognitive and socialaffective strategies on reading difficulties. Findings also revealed that there is s negative significant moderate relationship between reading difficulties with metacognitive and social affective strategies. This study adds on to the existing body of knowledge on the use of reading strategies to reduce perception of reading difficulties during reading comprehension.

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Much of the student diversity in U.S. schools reflects increasing numbers of English language learners (ELL). ELL represent a very heterogeneous group in terms of their native language proficiency, educational experiences, access to quality early childhood programs, and immigration experiences. An unfortunate commonality they often share is poor academic achievement, particularly in the area of reading. Higher rates of grade retention and school dropout are consistently linked to poor academic performance. This article discusses literacy development, reading difficulties related to special education identification, and reading interventions for ELL. Practical strategies for reading instruction are also provided.

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This content emphasizes the significance of English as a global language and a tool for learning across various domains. It outlines the four essential language skills – listening, speaking, reading, and writing – and their role in effective communication. The importance of early reading education is highlighted, discussing its benefits in fostering memory, strengthening the brain, and enhancing analytical abilities. The text also emphasizes the role of reading in introducing students to diverse cultures and promoting independence and confidence. The theoretical background delves into reading challenges and categorizes them into specific word reading challenges (SWRD), specific reading comprehension challenges (SRCD), and mixed reading challenges (MRD). The content further discusses the methodology of identifying and addressing these challenges, emphasizing the need for systematic phonics support and intervention. The reflection section offers insights into observed improvements and challenges faced during the implementation of reading strategies. Recommendations for improving reading skills include building vocabulary, using online resources, employing visual aids, and encouraging critical thinking. The importance of summarizing techniques and question-answer scenarios is underscored, with a focus on enhancing students' comprehension and analytical abilities. The abstract concludes with a call for active engagement in teaching methods that foster critical thinking and creativity in students.

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Academic reading is one of the challenges commonly faced by university students especially EFL learners. This study aims to identify academic reading difficulties in higher education focusing on Indonesian university students. It used mixed-method by collecting quantitative data from close-ended questionnaires and qualitative data from one open-ended question. In this study, 60 students were asked to rate the reading aspects listed in the questionnaires based on its level of difficulty and provide commentaries as well as possible additional aspect. The statistic results showed that overall students considered academic reading easy (M=2.445, SD=0.568). Reading carefully to understand the text was found as the aspect with the least difficulty (M=2.16, SD= 0.963) and working out the meaning of difficult words was identified as the most difficult one (M=2.75, SD=1.235). These statistics are supported by the qualitative finding whereas 43% students having problems translating and underst...

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As literacy lags nationwide, Purdue researcher highlights ways to enhance reading and writing in young children

Written By: Rebecca Hoffa, [email protected]

A text message from a friend. A product label at the grocery store. A street sign. Even in the most basic elements of day-to-day life, reading is everywhere.

Cammie McBride , professor in the Purdue University Department of Human Development and Family Science and associate dean for research in the College of Health and Human Sciences , has dedicated her career to taking a global approach toward understanding how children learn to read, exploring literacy across English and Chinese languages, among others.

“Children need to learn to read and write because it helps us navigate our environments,” McBride said. “If we can’t read, that’s more difficult. If you look worldwide, illiteracy is correlated with gross domestic product and the learning of a country’s people.”

Cammie McBride

From contributing to a massive open online course (MOOC) titled “Teaching Struggling Readers Around the World” to developing new resources and screening capabilities, McBride’s developmental psychology approach toward literacy ranges from cognitive linguistics, or how the brain processes language, to the relationships among parents, children and teachers and how those influence reading and writing.

McBride also serves as a co-lead on a $1.5 million grant to strengthen literacy preparation for Indiana teachers using science-based methods.

“My whole career, I’ve tried to look at how children read in different aspects,” McBride said. “I’m really interested in: Does reading develop from birth or before birth even? There are lots of aspects that go into reading that start at the very beginning. I’ve always been interested in those developmental models.”

McBride noted that one of her most interesting research findings has been enhancing understanding of a new cognitive-linguistic skill that has a direct impact for reading in Chinese as well as vocabulary in English, Dutch and other languages. The task requires children to put together morphemes, or the smallest unit of meaning in language, in ways that make sense. For example, if a teacher or parent gave the example that the sun going down in the sky is called a sunset and then asked the child what the moon going down in the sky would be called, the expectation would be the child would answer “moonset.” They’re putting together smaller units in ways that make sense.

“I think this task is really useful because we can test vocabulary to improve vocabulary, but this is another way, which is a focus on morphemes and how they come together,” McBride said. “If you understand how to put these together to make new aspects of meaning, you tend to be a better reader in Chinese, but also, this is a really good way to test for kids’ vocabulary development over time in every language. It’s a fun task — kids love to do that.”

McBride uses cognitive-linguistic skills like the example above in her research to understand methods for assessing children’s literacy and training teachers and families in what children need to learn to read. In order to read, McBride explained children must develop both oral language, such as vocabulary and forming sentences, as well as an understanding of print, such as understanding letters and their sounds. She explained that assessing children’s literacy skills early is important to keep them on track in their reading and writing development.

“These cognitive-linguistic skills are things we use in assessment and training,” McBride said. “Most 3- and 4-year-olds cannot read, and it would be weird to try to test them with reading materials before they can read, but you need to catch them quickly so that they don’t have a sense of failure and are always trying to catch up. If you test them at 3, 4 or 5 on cognitive-linguistic skills, this often can be a good way to determine if they’re at risk for reading difficulties and then give them some tools to help them improve.”

McBride mentioned dialogic reading is an effective tool parents can use to build up their child’s language skills. Rather than simply reading a book and looking at the pictures or testing the child on knowledge presented in the book, dialogic reading turns the process of reading into a conversation. Parents can ask open-ended questions, such as what the child thinks will happen next or if they’ve ever had a similar situation happen to them. The goal is to encourage two-sided communication.

If the child is struggling with reading, McBride’s go-to piece of advice is giving them more practice. While the same learning methods still can be effective with students who have a learning disorder, such as dyslexia, they may need to put more time and energy into practicing the reading process. McBride suggested literacy-based video games as a great tool to help children master literacy skills they may be struggling with. The important thing to keep in mind is to avoid burning the child out on reading.

“Keep it light because the other part of reading besides oral language and print is motivation,” McBride said. “You don’t want to get kids to feel like they’re being tested early; you want them to get interested themselves.”

After various nationwide setbacks toward literacy resulting from the COVID-19 pandemic, McBride is currently looking to take her research one step further by making literacy tests, which screen for children’s risks for reading problems and often are expensive and require a licensed educational psychologist to administer, more accessible. Her most recent work is focusing on the development of affordable online tests for children and families — a significant step in continuing to improve children’s reading preparation.

“If we want to understand if children are maybe at risk for reading and writing problems early, it’s good to have tests that can help us to determine that,” McBride said.

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Kimberly McFadden Receives Hammill Institute Doctoral Fellowship

McFadden's research focuses on word reading intervention for students with reading difficulty in the upper grades.

Editorial Services

• Esther R. Lindström
• graduate education

Special Education doctoral student Kimberly McFadden has received a competitive Hammill Institute on Disabilities Doctoral Fellowship .

Esther R. Lindström , assistant professor of special education who serves as McFadden’s faculty advisor, said, “Kim was nominated in recognition of her research interests supporting secondary students with reading difficulties and her emerging leadership in special education and teacher preparation.”

Specifically, her research focuses on word reading intervention for students with reading difficulty in the upper grades.

Kimberly McFadden

“As a former middle and high school special education teacher, I found that many of my students had decoding difficulty,” McFadden explained. “However, the research addressing how to teach decoding skills in the upper grades was very limited at the time.”

When McFadden enrolled in the Special Education Ph.D. program at Lehigh, these experiences as a practitioner informed her research focus.

Her qualifying project is a systematic review of word reading interventions for students with reading difficulty in Grades 4-12.

“The Lehigh University Alumni Association was incredibly supportive of my project, and their contributions to my crowdfunding campaign last spring made this work possible,” McFadden added.

The results of her study indicate that many word reading intervention studies report a positive effect on reading outcomes, but additional work is needed to maximize efficacy and to investigate the social validity of such interventions.

She will propose her dissertation in the fall, building on her qualifying project. McFadden plans to recruit a national sample of secondary special education teachers and investigate their knowledge and perceptions of word reading interventions for their students with reading difficulty.

The Hammill Institute on Disabilities Doctoral Fellowship will enable me to continue my research, and I am incredibly grateful for their support.

Housed within the College of Education (COE), the Special Education program takes a person-centered approach to education and the inclusion of all people with disabilities in school and society. The program offers master’s and doctoral degrees. Learn more about the COE’s Special Education program.

The Hammill Institute on Disabilities awards the Hammill Institute on Disabilities Doctoral Fellowship for research that furthers the Institute’s charitable mission. The Fellowship provides financial assistance to students enrolled in a doctoral program, either full or part time. Learn more about the Hammill Institute on Disabilities.

Story by Beth Brew

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Kimberly McFadden Receives Hammill Institute Doctoral Fellowship

McFadden's research focuses on word reading intervention for students with reading difficulty in the upper grades.

Special Education doctoral student Kimberly McFadden has received a competitive  Hammill Institute on Disabilities Doctoral Fellowship .

Esther R. Lindström , assistant professor of special education who serves as McFadden’s faculty advisor, said, “Kim was nominated in recognition of her research interests supporting secondary students with reading difficulties and her emerging leadership in special education and teacher preparation.”

Specifically, her research focuses on word reading intervention for students with reading difficulty in the upper grades.

“As a former middle and high school special education teacher, I found that many of my students had decoding difficulty,” McFadden explained. “However, the research addressing how to teach decoding skills in the upper grades was very limited at the time.”

When McFadden enrolled in the Special Education Ph.D. program at Lehigh, these experiences as a practitioner informed her research focus.

Her qualifying project is a systematic review of word reading interventions for students with reading difficulty in Grades 4-12.

“The Lehigh University Alumni Association was incredibly supportive of my project, and their contributions to my crowdfunding campaign last spring made this work possible,” McFadden added.

The results of her study indicate that many word reading intervention studies report a positive effect on reading outcomes, but additional work is needed to maximize efficacy and to investigate the social validity of such interventions.

She will propose her dissertation in the fall, building on her qualifying project. McFadden plans to recruit a national sample of secondary special education teachers and investigate their knowledge and perceptions of word reading interventions for their students with reading difficulty.

“The Hammill Institute on Disabilities Doctoral Fellowship will enable me to continue my research, and I am incredibly grateful for their support.”  - KIMBERLY MCFADDEN

Housed within the College of Education (COE), the Special Education program takes a person-centered approach to education and the inclusion of all people with disabilities in school and society. The program offers master’s and doctoral degrees. Learn more about the COE’s Special Education program.

The Hammill Institute on Disabilities awards the Hammill Institute on Disabilities Doctoral Fellowship for research that furthers the Institute’s charitable mission. The Fellowship provides financial assistance to students enrolled in a doctoral program, either full or part time. Learn more about the Hammill Institute on Disabilities.  

Read our research on: Gun Policy | International Conflict | Election 2024

Regions & Countries

About half of americans say public k-12 education is going in the wrong direction.

About half of U.S. adults (51%) say the country’s public K-12 education system is generally going in the wrong direction. A far smaller share (16%) say it’s going in the right direction, and about a third (32%) are not sure, according to a Pew Research Center survey conducted in November 2023.

Pew Research Center conducted this analysis to understand how Americans view the K-12 public education system. We surveyed 5,029 U.S. adults from Nov. 9 to Nov. 16, 2023.

The survey was conducted by Ipsos for Pew Research Center on the Ipsos KnowledgePanel Omnibus. The KnowledgePanel is a probability-based web panel recruited primarily through national, random sampling of residential addresses. The survey is weighted by gender, age, race, ethnicity, education, income and other categories.

Here are the questions used for this analysis , along with responses, and the survey methodology .

A majority of those who say it’s headed in the wrong direction say a major reason is that schools are not spending enough time on core academic subjects.

These findings come amid debates about what is taught in schools , as well as concerns about school budget cuts and students falling behind academically.

Related: Race and LGBTQ Issues in K-12 Schools

Republicans are more likely than Democrats to say the public K-12 education system is going in the wrong direction. About two-thirds of Republicans and Republican-leaning independents (65%) say this, compared with 40% of Democrats and Democratic leaners. In turn, 23% of Democrats and 10% of Republicans say it’s headed in the right direction.

Among Republicans, conservatives are the most likely to say public education is headed in the wrong direction: 75% say this, compared with 52% of moderate or liberal Republicans. There are no significant differences among Democrats by ideology.

Similar shares of K-12 parents and adults who don’t have a child in K-12 schools say the system is going in the wrong direction.

A separate Center survey of public K-12 teachers found that 82% think the overall state of public K-12 education has gotten worse in the past five years. And many teachers are pessimistic about the future.

Related: What’s It Like To Be A Teacher in America Today?

Why do Americans think public K-12 education is going in the wrong direction?

We asked adults who say the public education system is going in the wrong direction why that might be. About half or more say the following are major reasons:

• Schools not spending enough time on core academic subjects, like reading, math, science and social studies (69%)
• Teachers bringing their personal political and social views into the classroom (54%)
• Schools not having the funding and resources they need (52%)

About a quarter (26%) say a major reason is that parents have too much influence in decisions about what schools are teaching.

How views vary by party

Americans in each party point to different reasons why public education is headed in the wrong direction.

Republicans are more likely than Democrats to say major reasons are:

• A lack of focus on core academic subjects (79% vs. 55%)
• Teachers bringing their personal views into the classroom (76% vs. 23%)

In turn, Democrats are more likely than Republicans to point to:

• Insufficient school funding and resources (78% vs. 33%)
• Parents having too much say in what schools are teaching (46% vs. 13%)

Views also vary within each party by ideology.

Among Republicans, conservatives are particularly likely to cite a lack of focus on core academic subjects and teachers bringing their personal views into the classroom.

Among Democrats, liberals are especially likely to cite schools lacking resources and parents having too much say in the curriculum.

Note: Here are the questions used for this analysis , along with responses, and the survey methodology .

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‘Back to school’ means anytime from late July to after Labor Day, depending on where in the U.S. you live

Among many u.s. children, reading for fun has become less common, federal data shows, most european students learn english in school, for u.s. teens today, summer means more schooling and less leisure time than in the past, about one-in-six u.s. teachers work second jobs – and not just in the summer, most popular.

About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

• COVID-19 and your mental health

Worries and anxiety about COVID-19 can be overwhelming. Learn ways to cope as COVID-19 spreads.

At the start of the COVID-19 pandemic, life for many people changed very quickly. Worry and concern were natural partners of all that change — getting used to new routines, loneliness and financial pressure, among other issues. Information overload, rumor and misinformation didn't help.

Worldwide surveys done in 2020 and 2021 found higher than typical levels of stress, insomnia, anxiety and depression. By 2022, levels had lowered but were still higher than before 2020.

Though feelings of distress about COVID-19 may come and go, they are still an issue for many people. You aren't alone if you feel distress due to COVID-19. And you're not alone if you've coped with the stress in less than healthy ways, such as substance use.

But healthier self-care choices can help you cope with COVID-19 or any other challenge you may face.

And knowing when to get help can be the most essential self-care action of all.

Recognize what's typical and what's not

Stress and worry are common during a crisis. But something like the COVID-19 pandemic can push people beyond their ability to cope.

In surveys, the most common symptoms reported were trouble sleeping and feeling anxiety or nervous. The number of people noting those symptoms went up and down in surveys given over time. Depression and loneliness were less common than nervousness or sleep problems, but more consistent across surveys given over time. Among adults, use of drugs, alcohol and other intoxicating substances has increased over time as well.

The first step is to notice how often you feel helpless, sad, angry, irritable, hopeless, anxious or afraid. Some people may feel numb.

Keep track of how often you have trouble focusing on daily tasks or doing routine chores. Are there things that you used to enjoy doing that you stopped doing because of how you feel? Note any big changes in appetite, any substance use, body aches and pains, and problems with sleep.

These feelings may come and go over time. But if these feelings don't go away or make it hard to do your daily tasks, it's time to ask for help.

Get help when you need it

If you're feeling suicidal or thinking of hurting yourself, seek help.

• Contact your healthcare professional or a mental health professional.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline , available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.

If you are worried about yourself or someone else, contact your healthcare professional or mental health professional. Some may be able to see you in person or talk over the phone or online.

You also can reach out to a friend or loved one. Someone in your faith community also could help.

And you may be able to get counseling or a mental health appointment through an employer's employee assistance program.

Another option is information and treatment options from groups such as:

• National Alliance on Mental Illness (NAMI).
• Substance Abuse and Mental Health Services Administration (SAMHSA).
• Anxiety and Depression Association of America.

Self-care tips

Some people may use unhealthy ways to cope with anxiety around COVID-19. These unhealthy choices may include things such as misuse of medicines or legal drugs and use of illegal drugs. Unhealthy coping choices also can be things such as sleeping too much or too little, or overeating. It also can include avoiding other people and focusing on only one soothing thing, such as work, television or gaming.

Unhealthy coping methods can worsen mental and physical health. And that is particularly true if you're trying to manage or recover from COVID-19.

Self-care actions can help you restore a healthy balance in your life. They can lessen everyday stress or significant anxiety linked to events such as the COVID-19 pandemic. Self-care actions give your body and mind a chance to heal from the problems long-term stress can cause.

Take care of your body

Healthy self-care tips start with the basics. Give your body what it needs and avoid what it doesn't need. Some tips are:

• Get the right amount of sleep for you. A regular sleep schedule, when you go to bed and get up at similar times each day, can help avoid sleep problems.
• Move your body. Regular physical activity and exercise can help reduce anxiety and improve mood. Any activity you can do regularly is a good choice. That may be a scheduled workout, a walk or even dancing to your favorite music.
• Choose healthy food and drinks. Foods that are high in nutrients, such as protein, vitamins and minerals are healthy choices. Avoid food or drink with added sugar, fat or salt.
• Avoid tobacco, alcohol and drugs. If you smoke tobacco or if you vape, you're already at higher risk of lung disease. Because COVID-19 affects the lungs, your risk increases even more. Using alcohol to manage how you feel can make matters worse and reduce your coping skills. Avoid taking illegal drugs or misusing prescriptions to manage your feelings.

Take care of your mind

Healthy coping actions for your brain start with deciding how much news and social media is right for you. Staying informed, especially during a pandemic, helps you make the best choices but do it carefully.

Set aside a specific amount of time to find information in the news or on social media, stay limited to that time, and choose reliable sources. For example, give yourself up to 20 or 30 minutes a day of news and social media. That amount keeps people informed but not overwhelmed.

For COVID-19, consider reliable health sources. Examples are the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

Other healthy self-care tips are:

• Relax and recharge. Many people benefit from relaxation exercises such as mindfulness, deep breathing, meditation and yoga. Find an activity that helps you relax and try to do it every day at least for a short time. Fitting time in for hobbies or activities you enjoy can help manage feelings of stress too.
• Stick to your health routine. If you see a healthcare professional for mental health services, keep up with your appointments. And stay up to date with all your wellness tests and screenings.
• Stay in touch and connect with others. Family, friends and your community are part of a healthy mental outlook. Together, you form a healthy support network for concerns or challenges. Social interactions, over time, are linked to a healthier and longer life.

Avoid stigma and discrimination

Stigma can make people feel isolated and even abandoned. They may feel sad, hurt and angry when people in their community avoid them for fear of getting COVID-19. People who have experienced stigma related to COVID-19 include people of Asian descent, health care workers and people with COVID-19.

Treating people differently because of their medical condition, called medical discrimination, isn't new to the COVID-19 pandemic. Stigma has long been a problem for people with various conditions such as Hansen's disease (leprosy), HIV, diabetes and many mental illnesses.

People who experience stigma may be left out or shunned, treated differently, or denied job and school options. They also may be targets of verbal, emotional and physical abuse.

Communication can help end stigma or discrimination. You can address stigma when you:

• Get to know people as more than just an illness. Using respectful language can go a long way toward making people comfortable talking about a health issue.
• Get the facts about COVID-19 or other medical issues from reputable sources such as the CDC and WHO.
• Speak up if you hear or see myths about an illness or people with an illness.

COVID-19 and health

The virus that causes COVID-19 is still a concern for many people. By recognizing when to get help and taking time for your health, life challenges such as COVID-19 can be managed.

• Mental health during the COVID-19 pandemic. National Institutes of Health. https://covid19.nih.gov/covid-19-topics/mental-health. Accessed March 12, 2024.
• Mental Health and COVID-19: Early evidence of the pandemic's impact: Scientific brief, 2 March 2022. World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1. Accessed March 12, 2024.
• Mental health and the pandemic: What U.S. surveys have found. Pew Research Center. https://www.pewresearch.org/short-reads/2023/03/02/mental-health-and-the-pandemic-what-u-s-surveys-have-found/. Accessed March 12, 2024.
• Taking care of your emotional health. Centers for Disease Control and Prevention. https://emergency.cdc.gov/coping/selfcare.asp. Accessed March 12, 2024.
• #HealthyAtHome—Mental health. World Health Organization. www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---mental-health. Accessed March 12, 2024.
• Coping with stress. Centers for Disease Control and Prevention. www.cdc.gov/mentalhealth/stress-coping/cope-with-stress/. Accessed March 12, 2024.
• Manage stress. U.S. Department of Health and Human Services. https://health.gov/myhealthfinder/topics/health-conditions/heart-health/manage-stress. Accessed March 20, 2020.
• COVID-19 and substance abuse. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/covid-19-substance-use#health-outcomes. Accessed March 12, 2024.
• COVID-19 resource and information guide. National Alliance on Mental Illness. https://www.nami.org/Support-Education/NAMI-HelpLine/COVID-19-Information-and-Resources/COVID-19-Resource-and-Information-Guide. Accessed March 15, 2024.
• Negative coping and PTSD. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/gethelp/negative_coping.asp. Accessed March 15, 2024.
• Health effects of cigarette smoking. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm#respiratory. Accessed March 15, 2024.
• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed March 15, 2024.
• Your healthiest self: Emotional wellness toolkit. National Institutes of Health. https://www.nih.gov/health-information/emotional-wellness-toolkit. Accessed March 15, 2024.
• World leprosy day: Bust the myths, learn the facts. Centers for Disease Control and Prevention. https://www.cdc.gov/leprosy/world-leprosy-day/. Accessed March 15, 2024.
• HIV stigma and discrimination. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/hiv-stigma/. Accessed March 15, 2024.
• Diabetes stigma: Learn about it, recognize it, reduce it. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/diabetes_stigma.html. Accessed March 15, 2024.
• Phelan SM, et al. Patient and health care professional perspectives on stigma in integrated behavioral health: Barriers and recommendations. Annals of Family Medicine. 2023; doi:10.1370/afm.2924.
• Stigma reduction. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/od2a/case-studies/stigma-reduction.html. Accessed March 15, 2024.
• Nyblade L, et al. Stigma in health facilities: Why it matters and how we can change it. BMC Medicine. 2019; doi:10.1186/s12916-019-1256-2.
• Combating bias and stigma related to COVID-19. American Psychological Association. https://www.apa.org/topics/covid-19-bias. Accessed March 15, 2024.
• Yashadhana A, et al. Pandemic-related racial discrimination and its health impact among non-Indigenous racially minoritized peoples in high-income contexts: A systematic review. Health Promotion International. 2021; doi:10.1093/heapro/daab144.
• Sawchuk CN (expert opinion). Mayo Clinic. March 25, 2024.

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Mental health care is hard to find, especially for people with Medicare or Medicaid

Rhitu Chatterjee

With rates of suicide and opioid deaths rising in the past decade and children's mental health declared a national emergency , the United States faces an unprecedented mental health crisis. But access to mental health care for a significant portion of Americans — including some of the most vulnerable populations — is extremely limited, according to a new government report released Wednesday.

The report, from the Department of Health and Human Services' Office of Inspector General, finds that Medicare and Medicaid have a dire shortage of mental health care providers.

The report looked at 20 counties with people on Medicaid, traditional Medicare and Medicare Advantage plans, which together serve more than 130 million enrollees — more than 40% of the U.S. population, says Meridith Seife , the deputy regional inspector general and the lead author of the report.

Medicaid serves people on low incomes, and Medicare is mainly for people 65 years or older and those who are younger with chronic disabilities.

The report found fewer than five active mental health care providers for every 1,000 enrollees. On average, Medicare Advantage has 4.7 providers per 1,000 enrollees, whereas traditional Medicare has 2.9 providers and Medicaid has 3.1 providers for the same number of enrollees. Some counties fare even worse, with not even a single provider for every 1,000 enrollees.

"When you have so few providers available to see this many enrollees, patients start running into significant problems finding care," says Seife.

The findings are especially troubling given the level of need for mental health care in this population, she says.

"On Medicare, you have 1 in 4 Medicare enrollees who are living with a mental illness," she says. "Yet less than half of those people are receiving treatment."

Among people on Medicaid, 1 in 3 have a mental illness, and 1 in 5 have a substance use disorder. "So the need is tremendous."

The results are "scary" but "not very surprising," says Deborah Steinberg , senior health policy attorney at the nonprofit Legal Action Center. "We know that people in Medicare and Medicaid are often underserved populations, and this is especially true for mental health and substance use disorder care."

Among those individuals able to find and connect with a provider, many see their provider several times a year, according to the report. And many have to drive a long way for their appointments.

"We have roughly 1 in 4 patients that had to travel more than an hour to their appointments, and 1 in 10 had to travel more than an hour and a half each way," notes Seife. Some patients traveled two hours each way for mental health care, she says.

Mental illnesses and substance use disorders are chronic conditions that people need ongoing care for, says Steinberg. "And when they have to travel an hour, more than an hour, for an appointment throughout the year, that becomes unreasonable. It becomes untenable."

"We know that behavioral health workforce shortages are widespread," says Heather Saunders , a senior research manager on the Medicaid team at KFF, the health policy research organization. "This is across all payers, all populations, with about half of the U.S. population living in a workforce shortage."

But as the report found, that's not the whole story for Medicare and Medicaid. Only about a third of mental health care providers in the counties studied see Medicare and Medicaid patients. That means a majority of the workforce doesn't participate in these programs.

This has been well documented in Medicaid, notes Saunders. "Only a fraction" of providers in provider directories see Medicaid patients, she says. "And when they do see Medicaid patients, they often only see a few."

Lower reimbursement rates and a high administrative burden prevent more providers from participating in Medicaid and Medicare, the report notes.

"In the Medicare program, they set a physician fee rate," explains Steinberg. "Then for certain providers, which includes clinical social workers, mental health counselors and marriage and family therapists, they get reimbursed at 75% of that rate."

Medicaid reimbursements for psychiatric services are even lower when compared with Medicare , says Ellen Weber , senior vice president for health initiatives at the Legal Action Center.

"They're baking in those discriminatory standards when they are setting those rates," says Steinberg.

The new report recommends that the Centers for Medicare & Medicaid Services (CMS) take steps to increase payments to providers and lower administrative requirements. In a statement, CMS said it has responded to those recommendations within the report.

According to research by Saunders and her colleagues at KFF, many states have already started to take action on these fronts to improve participation in Medicaid.

Several have upped their payments to mental health providers. "But the scale of those increases ranged widely across states," says Saunders, "with some states limiting the increase to one provider type or one type of service, but other states having rate increases that were more across the board."

Some states have also tried to simplify and streamline paperwork, she adds. "Making it less complex, making it easier to understand," says Saunders.

But it's too soon to know whether those efforts have made a significant impact on improving access to providers.

CMS has also taken steps to address provider shortages, says Steinberg.

"CMS has tried to increase some of the reimbursement rates without actually fixing that structural problem," says Steinberg. "Trying to add a little bit here and there, but it's not enough, especially when they're only adding a percent to the total rate. It's a really small increase."

The agency has also started covering treatments and providers it didn't use to cover before.

"In 2020, Medicare started covering opioid treatment programs, which is where a lot of folks can go to get medications for their substance use disorder," says Steinberg.

And starting this year, Medicare also covers "mental health counselors, which includes addiction counselors, as well as marriage and family therapists," she adds.

While noteworthy and important, a lot more needs to be done, says Steinberg. "For example, in the substance use disorder space, a lot of addiction counselors do not have a master's degree. And that's one of their requirements to be a counselor in the Medicare program right now."

Removing those stringent requirements and adding other kinds of providers, like peer support specialists, is key to improving access. And the cost of not accessing care is high, she adds.

"Over the past two decades, [in] the older adult population, the number of overdose deaths has increased fourfold — quadrupled," says Steinberg. "So this is affecting people. It is causing deaths. It is causing people to go to the hospital. It increases [health care] costs."

• Centers for Medicare & Medicaid Services
• mental health