Early Intervention for Children at Risk for Reading Disabilities: The Impact of Grade at Intervention and Individual Differences on Intervention Outcomes

Abstract

Across multiple schools in three sites, the impact of grade-at-intervention was evaluated for children at risk or meeting criteria for reading disabilities. A multiple-component reading intervention with demonstrated efficacy was offered to small groups of children in 1st, 2nd, or 3rd grade. In a quasi-experimental design, 172 children received the Triple-Focus Program (PHAST + RAVE-O), and 47 were control participants. Change during intervention and 1-3 years later (6-8 testing points), and the influence of individual differences in predicting outcomes, were assessed using reading and reading-related repeated measures. Intervention children out-performed control children at posttest on all 14 outcomes, with average effect sizes (Cohen’s d) on standardized measures of .80 and on experimental measures of 1.69. On foundational word reading skills (standardized measures), children who received intervention earlier, in 1st and 2nd grade, made gains relative to controls almost twice that of children receiving intervention in 3rd grade. At follow-up, the advantage of 1st grade intervention was even clearer: First graders continued to grow at faster rates over the follow-up years than 2nd graders on six of eight key reading outcomes. For some outcomes with metalinguistic demands beyond the phonological, however, a posttest advantage was revealed for 2nd grade Triple participants and for 3rd grade Triple participants relative to controls. Estimated IQ predicted growth during intervention on seven of eight outcomes. Growth during follow-up was predicted by vocabulary and visual sequential memory. These findings provide evidence on the importance of early intensive evidence-based intervention for reading problems in the primary grades.

Full text

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Running head: EARLY INTERVENTION FOR READING DISABILITIES
Early intervention for children at risk for reading disabilities: The impact of grade
at intervention and individual differences on intervention outcomes
Maureen W. Lovett
The Hospital for Sick Children and the University of Toronto
Jan C. Frijters
Brock University
Maryanne Wolf
Tufts University
Karen A. Steinbach
The Hospital for Sick Children
Rose A. Sevcik
Georgia State University
Robin D. Morris
Georgia State University
Journal of Educational Psychology, in press
© 2017, American Psychological Association. This paper is not the copy of record and may
not exactly replicate the final, authoritative version of the article. Please do not copy or cite
without authors permission. The final article will be available, upon publication, via its
DOI: 10.1037/edu0000181

Abstract
Across multiple schools in three sites, the impact of grade-at-intervention was evaluated
for children at risk or meeting criteria for reading disabilities. A multiple-component reading
intervention with demonstrated efficacy was offered to small groups of children in 1st, 2nd, or 3rd
grade. In a quasi-experimental design, 172 children received the Triple-Focus Program (PHAST
+ RAVE-O), and 47 were control participants. Change during intervention and 1-3 years later
(6-8 testing points), and the influence of individual differences in predicting outcomes, were
assessed using reading and reading-related repeated measures. Intervention children out-
performed control children at posttest on all 14 outcomes, with average effect sizes (Cohen’s d)
on standardized measures of .80 and on experimental measures of 1.69. On foundational word
reading skills (standardized measures), children who received intervention earlier, in 1st and 2nd
grade, made gains relative to controls almost twice that of children receiving intervention in 3rd
grade. At follow-up, the advantage of 1st grade intervention was even clearer: First graders
continued to grow at faster rates over the follow-up years than 2nd graders on six of eight key
reading outcomes. For some outcomes with metalinguistic demands beyond the phonological,
however, a posttest advantage was revealed for 2nd grade Triple participants and for 3rd grade
Triple participants relative to controls. Estimated IQ predicted growth during intervention on
seven of eight outcomes. Growth during follow-up was predicted by vocabulary and visual
sequential memory. These findings provide evidence on the importance of early intensive
evidence-based intervention for reading problems in the primary grades.
Keywords/Phrases: reading, reading disabilities, early intervention, outcomes, follow-up.

Educational Impact And Implications Statement
Does it matter in what grade early reading intervention is provided for young children
who are struggling with learning to read—in 1st, or 2nd, or 3rd grade? Children with reading
disabilities (RD), or at risk of RD, were taught in small groups an hour a day for 125 hours using
a reading intervention developed and found effective in our earlier research; the children
received this program either in 1st or 2nd or 3rd grade. All children improved their reading after
receiving this program when compared to other children with RD who received whatever their
schools offered. Children who received the program in 1st or 2nd grade made greater gains in
basic reading skills than those who received it in 3rd grade; and those who received it in 1st grade
continued to develop reading at faster rates well after the program ended. These findings provide
evidence for the importance of early intensive reading intervention for struggling readers, and
support intervention starting in 1st grade.

Early intervention for children at risk for reading disabilities:
The impact of grade at intervention and individual differences on intervention outcomes
Several landmark studies reported in the late 1990s compared different approaches to the
remediation and/or prevention of reading acquisition problems in the early elementary grades
(Foorman, Francis, Fletcher, Schatschneider, & Mehta, 1998; Foorman et al., 1997; Scanlon &
Vellutino, 1997; Torgesen, Wagner, & C.A. Rashotte, 1997; Torgesen et al., 1999; Vellutino et al.,
1996). Research by Foorman and her colleagues (1998) provided important evidence that explicit
classroom instruction in letter-sound correspondences can prevent reading failure in 1st and 2nd
grade children at risk for reading problems. Another classroom-based intervention, Peer-Assisted
Learning Strategies (PALS), developed by Doug and Lynn Fuchs, yielded positive results on
measures of word recognition and text reading skill, and was been found to improve reading
skills for both struggling and average readers (Fuchs & Fuchs, 2005; Mathes, Howard, Allen, &
Fuchs, 1998). These results demonstrate that opportunities exist to provide targeted and
differentiated instruction within the classroom setting to reduce the prevalence of reading
problems (Fletcher, et al., 2007; Fuchs, Fuchs, Mathes, & Simmons, 1997).
Torgesen, Wagner, Rashotte et al. (1999) also reported seminal early intervention
research, but their work involved one-on-one remedial intervention outside of the classroom over
a period of 2 ½ years. Their participants were at-risk children, those lowest in letter naming and
phonological awareness, entering kindergarten. At the end of the 2 1/2 year intervention, children
who had received explicit phonological awareness and synthetic phonics training were the
strongest readers when average group scores were assessed. Both their nonword reading (Word
Attack) and word reading (Word Identification) skills fell overall within the average range. Their
advantage relative to other groups was not consistently established, however, on all dimensions

of reading skill at the end of second grade, suggesting that early intervention efforts may not
yield equivalent impact on different reading-related processes (Torgesen et al., 2001; Torgesen,
Wagner, Rashotte, Alexander, & Conway, 1997; Torgesen, et al., 1999).
Overall, these landmark studies and those that have followed have provided strong
converging evidence for the efficacy and cost-effectiveness of early intervention efforts (Al
Otaiba, 2000; Berninger et al., 2000, 2002; Connor, Morrison, Fishman, et al., 2007; Mathes et
al., 2005; O'Connor, 2000; O’Connor, Fulmer, Harty, & Bell, 2005; S. Vaughn, Linan-Thompson,
& Hickman, 2003). Foorman and Al Otaiba (2009) contend that better classroom instruction can
reduce the number of low-achieving children to around 5%, and further supplemental small
group or individual tutoring can bring the numbers down even lower to 1% - 3%. Evaluations of
multi-tiered intervention models have suggested rates of inadequate response could be as low as
2%–5% with effective and well-timed early reading intervention (Berninger et al., 2003; Mathes
et al., 2005; McMaster, Fuchs, Fuchs, & Compton, 2005; Torgesen, 2000).
Such efforts require coordinated infrastructure and investment at the school level,
including universal early screening for academic risk, access to effective early intervention
within the school, teacher preparation and confidence in such procedures, regular progress
monitoring for all children, and access to booster interventions when needed (Fletcher & Vaughn,
2009). The growing literature on response to intervention (RTI) provides guidance on how this
infrastructure can be put in place and its benefits, while also recognizing the challenges still to be
addressed (Denton, Fletcher, Anthony, & Francis, 2006; Fletcher & Vaughn, 2009; Fuchs &
Fuchs, 1998; Glover & Vaughn, 2010; Vaughn & Fuchs, 2003; Vaughn et al., 2011).
How important is the timing of early intervention?
Despite evidence of the effectiveness of early intervention for children at risk for reading

failure, relatively few empirical studies have been conducted to compare the relative efficacy of
reading intervention initiated at different ages. The majority of early intervention research has
been conducted with at-risk children in kindergarten or first grade and has reported positive
outcomes. A meta-analysis by Wanzek and Vaughn (2007) summarized evidence from early
intervention studies offering at least 100 sessions. There were diverse outcomes reported from
this work, although the majority described effect sizes in the moderate-to-large range. In this
review, effect sizes were found to be larger for intervention studies conducted with Kindergarten
and first graders (average e.s. ranging from .31 to .84) than with children in 2nd and 3rd grades
(average e.s. .23 - .27). Scammacca, Vaughn, Roberts et al. (2007) in their report suggest that
gains from early interventions of longer duration tend to be maintained at least until the 2nd
grade. Vadasy and colleagues provided two years of intervention in 1st and 2nd grade, and
reported average effect sizes of .64 on reading outcomes, suggesting that longer duration of
intervention was also relevant to benefits of early intervention (Vadasy, Sanders, Peyton et al.,
2002). It is noted that the meta-analysis cannot address causal evidence examining the effects of
duration, intensity, or timing of intervention and that the studies assessed varied greatly in the
extent to which interventions were operationalized.
Evidence from classroom intervention studies
The only experimentally controlled study to date of the timing of reading intervention
was reported by Connor and her colleagues (Connor, Morrison, Fishman, Crowe, Al Otaiba, &
Schatschneider, 2013). These researchers asked whether the timing and duration of
individualized reading instruction within the classroom would make a difference to children’s
reading achievement by the end of 3rd grade. The reading intervention included teacher
professional development and instruction individualized through computer software to match the

student’s performance on word reading, vocabulary, and comprehension assessments; this
intervention has been found to yield positive effects in smaller efficacy trials conducted within
single grade levels (A2i – Connor et al., 2007; Connor, Morrison, Schatschneider et al., 2011;
Connor, Morrison, Fishman et al., 2011). The intervention itself varies the amount of
instructional time allocated different instructional components and types of reading activities.
While not a supplemental reading intervention, Individualizing Student Instruction (ISI)
individualizes instruction by differentially weighting instructional time and components within
the classroom.
In Connor’s 2013 study, the influence of ISI was evaluated longitudinally over three
grades in a cluster-randomized controlled design; classrooms were randomly assigned to ISI
treatment or control conditions, and teachers in the control condition received an equivalent
amount of professional development and attention in a mathematics intervention condition.
Randomization of classrooms to condition occurred every year, so there were children who
received one, two, or three years of ISI, with ISI beginning in their 1st, 2nd, or 3rd grade year. Both
the timing and duration of the ISI intervention therefore could be evaluated. Results revealed an
overall advantage for those children who received ISI reading instruction throughout Grades 1-3;
these children on average were performing above grade level by the end of 3rd grade,
demonstrating the advantage of accumulated benefit (e.s. = .90 relative to three years control
placement). There was an advantage for 1st grade intervention: Those who received only one
year of ISI in 1st grade outperformed those whose year of ISI occurred in 2nd or 3rd grade. Connor
and colleagues note, however, that the first grade advantage was “inconsistent” and was not
replicated for children who received two years of ISI. For these children, there was greater
benefit to receiving ISI in Grades 1 and 3 rather than Grades 1 and 2 or Grades 2 and 3.

Rather than a supplementary or pull-out remedial intervention, Individualizing Student
Instruction (ISI) is a weighting of instructional time and components within the general
classroom (Connor et al., 2007; Connor et al., 2011; Connor et al., 2013). Many early
intervention studies are classroom studies and typically recruit entire classes as samples. The
emphasis is one of preventing reading failure through early intense instruction for at-risk
children. These studies do not focus on samples of struggling learners and may be expected to
produce different patterns of findings than those that recruit samples performing substantially
below age level expectations.
Evidence from supplemental intervention studies
In contrast, other early intervention studies have involved well-defined supplemental
programs for at-risk learners and have operationalized these interventions. It should be noted that
almost all of this research has avoided evaluation of school-based special education programs. In
fact, as Fletcher and Vaughn (2009) point out, outcome data from evaluations of at-risk learners
in special education placements have not been encouraging—many reports have documented
limited growth and poor outcomes, suggesting typical interventions in many special educational
settings to be generally ineffective in terms of accelerating academic growth (Hanushek, Kain, &
Rivkin, 1998; Morgan, Frisco, Farkas, & Hibel, 2010; Vaughn, Levy, Coleman, & Bos, 2002). As
Fletcher and Vaughn suggest, “There is a major disconnection between what is known about
efficacy of instruction for students with academic difficulties and how students are taught in
schools, especially for students most at risk for academic and behavioral difficulties” (2009, p.
33).
A recent report using a national US dataset (the Early Childhood Longitudinal Study-
Kindergarten Cohort) provides quite a different perspective on the potential effectiveness of

special education placement. Ehrhardt, Huntington, Molino, and Barbaresi (2013) were
interested in determining whether grade at entry to special education was related to reading
growth between 1st and 5th grades in a sample of children with reading problems. Lacking
standard measurement for reading disorders, these investigators selected children from the cohort
who had an IEP targeting reading and for whom the special education teacher listed specific
learning disability as the primary category of disability. Early entry to special education proved
significantly associated with reading achievement: Children entering before or during 1st grade
demonstrated superior reading achievement gains to those who entered in 2nd or in 3rd grade. Of
interest, these early-entry children were not significantly different from those who entered
special education in 4th or 5th grade however; it is acknowledged that the latter students may have
had less severe reading impairment than those with earlier identification (Leach, Scarborough, &
Rescorla, 2003).
Another meta-analysis was undertaken with a developmental perspective, focusing on the
interaction of grade and intervention modality to assess moderators of intervention efficacy
(effect sizes) for at-risk and struggling readers. Suggate (2010) was interested in whether
intervention effect sizes varied with grade at intervention (preschool through Grade 7) and type
of intervention offered (phonics, comprehension, or mixed focus). Overall he reported that
reading intervention was associated with clear improvement in reading outcomes following
intervention both in the immediate short-term (d = 0.49) and over the longer-term (d = 0.36).
Overall effect sizes were found to be greater for older children (Gr 5-7: d = 0.68) than for
children in preschool and kindergarten (d = 0.36), Grades 1 and 2 (ds = 0.52 and 0.54), and
Grades 3 and 4 (d = 0.59). Mixed and comprehension-focused interventions were associated with
greater effect sizes for older children, and phonics interventions for children in kindergarten and

1st grade.
Suggate’s finding of greater effects with older readers stands in contrast to that of most
previous studies and should be considered in light of how effect sizes are calculated in his report.
Mean effect sizes were calculated for each outcome measure from the original 85 studies
included in the meta-analysis: intervention group performance minus control group performance
divided by the pooled standard deviation of the two groups (Cohen’s d; Hunter & Schmidt,
2004). Lower effect sizes for children in the younger grades may indicate not that they did not
gain with intervention but that control participants in those grades also made reading gains
without the intervention. Such an interpretation is possible given that Suggate (2010) describes
significant negative correlations between grade and control group standard scores, illustrating
that older children were more impaired relative to norms.
Measurement issues complicate the interpretation of intervention effects for different
reading outcomes
Evaluating timing-of-intervention effects is made much more complex by the interaction
between age at intervention and the type of reading outcome being evaluated, as well as
differences in the ability to reliably measure different dimensions of reading skill at different
ages. There is ample evidence of reading interventions having demonstrated efficacy on some,
but not all, dimensions of reading skill. Meta-analyses such as those conducted by Scammacca,
Edmonds, and their colleagues have revealed marked variability in reading comprehension
effects across studies, and that at least with older students, average gains in reading
comprehension with intervention were typically smaller than those seen on basic reading skills
(Edmonds, Vaughn, Wexler, et al., 2009; Scammacca, Roberts, Vaughn, et al., 2007). Connor’s
data on the timing of her ISI intervention with younger readers (Grades 1, 2, 3) also

demonstrated some variability in effect size estimates for word identification vs. comprehension
outcomes in 3rd grade (Connor et al., 2013). For 1st and 2nd graders, effect sizes for ISI instruction
were roughly equivalent for word identification and passage comprehension outcomes (1st grade
Cohen’s d = .32 and .36; 2nd grade d = .44 and .43 respectively), while for 3rd graders, ISI yielded
effect sizes of .26 on word identification, but only .06 on passage comprehension. Similarly the
Reading First Impact Report noted that while the Reading First initiative had no effect on the
reading comprehension scores of students in Grades 1, 2, or 3, small positive effects on decoding
skills were observed for the subsample of 1st graders studied (Gamse, Jacob, Horst, Boulay, &
Unlu, 2008). Another higher-level reading outcome has also demonstrated variable outcomes
following early intense reading intervention—reading rate or fluency. When Torgesen collected
follow-up data on his intervention participants at 8 and 10 years of age, he found that they
exhibited substantial deficits in reading rate despite otherwise positive reading outcomes
(Torgesen, Alexander, Wagner, Rashotte et al., 2001).
Part of the problem concerns the continuing difficulty in developing appropriate
measurement for more complex dimensions of reading skill like text comprehension and reading
fluency. Outcome measures that have been used across studies have varied enormously in their
power and sensitivity to intervention-related change. Many investigators have acknowledged that
reading interventions typically yield larger effects on researcher-developed than standardized
measures (Edmonds, et al., 2009; Lovett, Barron, & Frijters, 2013; Swanson, Hoskyn, & Lee,
1999). Experimental measures with more trials per level of difficulty result in more visible gains
and better opportunities to demonstrate intervention-related change over the short-term. Many
questions remain regarding the best measurement models for evaluating an intervention that
targets functions as complex as reading comprehension and fluency.

Individual variability in response to early intervention
Another contributor to variability in response to early intervention may stem from
individual differences among the children receiving reading intervention. There have been some
efforts to determine whether children with different cognitive and academic profiles respond
differently to early intervention and some evidence to support that suggestion (Connor, Morrison,
Fishman, Schnatschneider, & Underwood, 2007; Frijters, Lovett, Steinbach, Wolf, Sevcik, &
Morris, 2011; Foorman, et al., 1998; Nelson, Benner, & Gonzalez, 2003). Al Otaiba and Fuchs
(2002) reviewed 21 studies examining nonresponders to reading intervention; they found that
although seven child characteristics had been related to nonresponse, phonological awareness
was the most consistently correlated across studies. These investigators subsequently conducted
a longitudinal study with kindergarteners and 1st graders and found that a combination of naming
speed, vocabulary, sentence imitation, problem behavior, and amount of reading intervention
correctly predicted 82% of nonresponsive students and 84% of always responsive students (Al
Otaiba & Fuchs, 2006). Inconsistent responders were predicted far less reliably (30%), focusing
attention on the issue of how treatment response is actually defined and operationalized, an issue
Frijters and our group recently assessed with older disabled readers (Frijters, Lovett, Sevcik, &
Morris, 2013).
Multiple component interventions in the remediation of reading disabilities
In addition to measurement issues, many intervention reports over the past two decades
have suggested that progress in remediating phonological decoding deficits has not been matched
by gains in fluency and reading comprehension. Compton and his colleagues (Compton, Miller,
Elleman, & Steacy, 2014) noted recently that successfully learning how to decode a new word
does not ensure that that word will come to be integrated into what has been called “ a rich

orthographic reading vocabulary” (Torgesen, Wagner, & Rashotte, 1997b). Torgesen suggested
that the problem reflects the complexity of the processing impairments seen in more severely
disabled readers (Torgesen, et al., 1997b). Such children require intervention that includes
systematic and explicit phonological decoding instruction, but also offers focused remedial
components to address other areas of deficit.
Researchers have demonstrated that many children with RD experience particular
difficulties with strategy learning and the acquisition of self regulatory strategies, and that these
problems appear to exist independent of their phonological difficulties (Swanson & Sáez, 2003;
Swanson, Sáez, & Gerber, 2006; Swanson & Siegel, 2001). The strategy deficits of children at
risk for reading acquisition failure extend beyond the word identification and word attack
foundations of literacy and encompass all aspects of reading for meaning, expository text
comprehension, and written expression. There is evidence that low-achieving readers can make
gains in reading comprehension with systematic instruction and practice on specific reading
comprehension strategies (Mason, 2004; Vaughn et al., 2000). It is reasonable to hypothesize that
explicit strategy training and metacognitive instruction could be used to address and prevent
generalization failures, and provide an important component of effective remediation for RD in
the acquisition of both decoding and reading comprehension skills.
Lovett, Lacerenza, Borden, et al. (2000) reported evidence supporting this speculation:
When a phonological reading intervention (PHAB/DI for Phonological Analysis and Blending)
was combined with the teaching of specific word identification strategies, and these strategies
were implemented, practiced, and evaluated using self-directing dialogue (WIST for Word
Identification Strategy Training), severely disabled readers demonstrated superior reading
achievement and faster learning than when they received an equal amount of intervention in

phonological or strategy training conditions separately. The combined intervention conditions
were associated with the greatest generalization of gains for these children with severe RD.
These results provided evidence of the importance of strategy instruction to effective remediation
and led to integration of these two interventions into the PHAST (Phonologcial and Strategy
Training) Reading Program (Lovett, Lacerenza, & Borden, 2000). In earlier work, the authors
had demonstrated in a controlled evaluation the efficacy of both the PHAB and WIST Programs
relative to a control program, and some program-specific effects (Lovett et al., 1994).
The need for a multidimensional perspective on the core processing deficits of children
with RD is echoed in the work of Wolf and her colleagues who identify naming speed deficits as
a window on the failure of struggling readers to build integrated, rapid, and automatic
connections among the component processes necessary to fluent reading acquisition (Wolf, 2007;
Wolf & Bowers, 1999; Wolf & Katzir-Cohen, 2001). Citing the support of research on the
importance of high quality orthographic, semantic, morpho-syntactic, and phonological lexical
representations, and of their interconnections, Wolf and colleagues developed a reading
intervention designed to strengthen lexical representational systems and teach explicitly the
connections among representations. Called RAVE-O (for Retrieval, Automaticity, Vocabulary,
Engagement with Language, and Orthography), the program seeks to teach young readers to
enrich and connect all their knowledge about a word as quickly as possible. The idea is to
simulate what typically developing brain circuitry does during the early stages of reading
development (Wolf et al, 2009). RAVE-O is designed to accompany a systematic program of
phonologically-based decoding instruction, and is directed to development of an appreciation of
the richness of oral and printed language, and an enjoyment of words and reading for meaning.
Both the PHAST and the RAVE-O Reading Programs have been evaluated in a previous

multi-site intervention study conducted by the present authors (Morris et al., 2012). This
previous study included 279 2nd and 3rd grade children meeting low achievement or IQ-reading
discrepancy definitions of RD (the majority meeting both criteria), and with diverse demographic
profiles (IQ, SES, race). Children were randomly assigned to program according to a 2x2x2
factorial design according to the demographic variables of IQ (70-89; 90+), SES (low; average),
and race (Black; Caucasian). The effectiveness of two multiple-component intervention
programs for children with RD (PHAB/DI + RAVE-O (Wolf et al., 2000); and the PHAST
Reading Program (Lovett et al., 2000) were evaluated against both an alternative treatment
control program (Classroom Survival Skills (CSS) + Math), and a phonological treatment
program paired with CSS (PHAB/DI + CSS). Interventions were taught an hour daily for 70
days on a 1:4 ratio at 3 different sites (Atlanta, Boston, Toronto).
Results indicated that both the PHAST and the RAVE-O (+ PHAB/DI) Programs were
associated with significant improvement on basic reading skills relative to the alternative control
group and the phonological treatment group at the end of the program and at one-year follow-up
testing (Morris et al., 2012). Equivalent gains were observed for children of different racial,
SES, and IQ groups; these factors did not systematically interact with treatment program and did
not differentially predict outcomes at either posttest or at one-year follow-up. Both multiple-
component programs were confirmed to be effective vehicles of intervention for struggling
readers from a wide range of backgrounds and with differing levels of intellectual functioning.
Differential treatment outcome effects were found between the multi-dimensional programs at
post-testing based on the respective emphases of the programs.
In the present study, the PHAST and RAVE-O Programs were integrated to produce what
is called the Triple-Focus Program, designed to capitalize upon the positive effects associated

with both multiple component programs. (The PHAST Program is considered a ‘double program’
because it integrates the PHAB and WIST Programs.) The Triple-Focus Program provides
tailored and intensive remediation that combines explicit phonological instruction with word
identification strategy training, reading comprehension strategy training, and instructional
activities that foster enriched lexical representations and increased engagement with word play,
reading, and text comprehension.
Questions motivating the present study
The present study was undertaken to evaluate issues related to the timing of reading
intervention for children meeting criteria for reading disabilities at the end of 1st or 2nd grade, or
meeting risk criteria at the end of kindergarten. A full year of small group intervention using the
Triple-Focus Program was provided for a total of 100-125 instructional hours in Grades 1, 2, or
3. The questions addressed in the present study included:
1. Did grade at intervention influence treatment outcomes and rate of growth in the short-term
and/or over follow-up?
2. Did grade at intervention influence rate of normalization of reading scores following
intervention?
3. Were there individual differences in cognitive and reading-related profiles that influenced
response to intervention in the short- and long-term?
Method
Study Design
This present design evaluated the impact of developmental timing of reading intervention
(1st, 2nd, or 3rd grade), longitudinal change in a repeated measurement design (testing at 0, 35, 70,
105, 125 hours of instruction, and at 1-3 years follow-up), and the role of individual differences

on short- and long-term reading outcomes. The experimental reading intervention used here
integrates two research-based remedial reading programs with demonstrated efficacy (PHAST +
RAVE-O) into a comprehensive Triple-Focus intervention. The Triple-Focus intervention
employed the same format as our previously reported interventions PHAST and RAVE-O
(Morris et al., 2012), was taught by trained research teachers hired for the project, and was
independently monitored for treatment integrity. The program was a pull-out intervention taught
on a 1:4 ratio for an hour a day in the child’s home school. Reading outcomes for the Triple-
Focus participants were compared to those of curricular or business-as-usual controls in the same
grades and with the same degree of reading and reading-related impairment. Because
participants were not consistently assigned randomly to intervention or control condition, this is
considered a quasi-experimental design.
Participants. Participants were recruited from multiple schools in three large
metropolitan areas (Atlanta, Boston, and Toronto) on the basis of teacher referral for significant
underachievement in reading. General inclusion criteria consisted of: English as their first and
primary language, enrolment in 1st, 2nd, or 3rd grade at time of teacher referral, and normal or
corrected hearing and vision. A total of 416 children with reading problems were referred for
screening across the three study sites to see if they would qualify for participation.
All participants were required to meet specified exclusion and inclusion criteria. Children
who had histories of hearing impairment (>25dB at 500+Hz bilaterally), of uncorrected visual
impairment (>20/40), serious emotional/psychiatric disturbance (i.e., psychotic, pervasive
developmental disorder), or chronic medical/neurological conditions (i.e., uncontrolled seizure
disorder, congenital heart disease, acquired brain injuries) were excluded based on a brief
demographic and history form completed by their parents. In addition, children were excluded if

they had repeated a grade or received a K-BIT composite score below 70. The repetition of a
grade was an exclusionary criterion because of our attempt to recruit each grade level groupings
of the same age; in practice, grade retention was very rarely seen in participating schools. The
co-occurrence of ADHD, a disorder common in RD populations, did not exclude a child from
participation.
Participants were further selected from this pool based on their performance on a
screening battery that included the Kaufman Brief Intelligence Test (K-BIT; Vocabulary and
Matrices; Kaufman & Kaufman, 1990), Woodcock Reading Mastery Test-Revised (WRMT-R;
Woodcock, 1987), and the Wide Range Achievement Test-3rd Edition–Reading (WRAT-3;
Wilkinson, 1993). Subtests from the WRMT-R included Word Identification, Word Attack, and
Passage Comprehension; for those children screened at the end of Kindergarten or beginning of
Grade 1, WRMT-R Visual-Auditory Learning and Letter Identification were also administered
although almost no children qualified solely on the Readiness Cluster score to which these
subtests contribute.
All children selected for participation qualified based on meeting a low-achievement
criterion for reading disabilities; this criterion required reading performance at or below a
composite standard score of 85 on multiple standardized reading measures. Reading performance
was measured using one or more of the following indices: (1) a Reading Total score calculated
by averaging the standard scores on the WRMT-R Passage Comprehension, Word Identification,
Word Attack, and WRAT-3 Reading subtests; (2) the WRMT-R Basic Skills Cluster score; (3)
and/or the WRMT-R Total Reading Cluster score (Short Scale). The Basic Skills Cluster Score is
the composite of Word Identification and Word Attack; the Total Reading Cluster - Short Form is
the composite of Word Identification and Passage Comprehension. Children qualified by

demonstrating low achievement on one of these three reading indices—i.e., at least one of their
reading composite standard scores was 85 or below (at or less than the 16th % tile). Of the
participants who qualified for inclusion, 63% met all three criteria, 18% met two, and 19% met
one.
Children of any race or ethnic group, or either sex, were included as long as they met the
English as the primary language requirement and the low achievement criterion for RD. We
sought to include diverse samples of children, with the goal of including large numbers of
minority children, girls, and children from low SES families. Given that our studies were located
within public schools in three major cities, obtaining this level of minority children involvement
was not difficult, although obtaining samples with 50% girls proved to be more difficult (Morris
et al., 2012).
SES was assessed by parental occupation and educational status using an index of the
families’ SES. SES data from all sites was derived using two American SES scales (Entwisle &
Astone, 1994; Hollingshead, 1975; Nakao & Treas, 1992) and one Canadian SES scale (Blishen,
Caroll, & Moore, 1987). Our goal was to develop an index for systematically identifying the
children's families as average or above SES, or below average SES. The particular differences or
actual levels of SES provided by the scales were not as critical as an accurate ranking of
children. A systematic evaluation of the reliability and concordance of these different scales was
undertaken and results were used to classify the children into the Average or Low SES groups
based on a systematic combination of the different indices. Details of this work on SES
measurement have been published (Cirino, et al., 2002).
Of the 237 participants who met all criteria and were selected, 172 children participated
in instructional groups in the Triple-Focus Program (79 Grade 1, 43 Grade 2, 51 Grade 3) and

47 served as control participants (18 Grade 1, 13 Grade 2, 16 Grade 3). Attrition was fairly low
in the study given the length of the participation period (31 out of 237 enrolled cases, or a rate of
13%). A total of 17 children were lost to attrition between enrollment and the start of
intervention, and an additional 14 were lost between pretest and posttest. Attrition generally was
due to families relocating, switching schools, or having difficulties transporting children to the
classes. Random assignment of children to intervention condition was not possible during the
first and last years of data collection, and the design therefore should be considered quasi-
experimental1. Children meeting criteria within a school were grouped together on the basis of
grade and raw reading scores (WRMT-R Word Identification and Word Attack); the group was
then proposed as an instructional group to the main site in Atlanta. If accepted, the instructional
group was assigned to the Triple-Focus intervention in the present study. The control group
included participants who met all criteria for inclusion but failed to match into an instructional
group: Any participant meeting criteria who did not match into an instructional group, or who
was referred and screened after classes had started, or was from a school where other participants
were not available to form an intervention class, was assigned to the control condition. Despite
efforts to enroll more control participants, control numbers remained far lower than projected
due to the difficulty in enrolling children with reading disabilities and having them wait a full
year before they could access our intervention program. In the final year of data collection, there
was a bias towards ‘catching up’ by attempting to add more control participants; this led to
inclusion of some control participants from schools who did not have any Triple-Focus
intervention classes running. The study ran over five school years in total. A flowchart provides
an overview of recruitment, enrollment, assignment, and intervention for 1st, 2nd, and 3rd grade
1 In Year 1, a decision was made to start as many intervention classes as possible in the two sites
developing content for programming (Toronto, Boston).

participants in Atlanta, Boston and Toronto (see Supplementary Table 1 in the Appendix).
Table 1 displays overall reading scores and participant profiles for the sample. Results of
a multivariate ANOVA confirmed that intervention and control participants were comparable at
pretest on all selection criteria, including age, F (8, 199) = 1.44, p = .18. Descriptive statistics
for every outcome measure subdivided by time of test (pretest, posttest), intervention condition
(Triple-Focus, Control), and grade (Grades 1, 2, 3) have been provided in Supplementary Table 2
(Appendix). Additional evidence of group comparability can be seen in Table 3, in which γ01
represents the test of intervention and control pretest differences on each outcome. The total
sample was confirmed to be significantly impaired on all measures of reading achievement,
performing more than one standard deviation below expectations on measures of decoding, word
reading, and passage comprehension, but at the lower end of the average range on measures of
receptive vocabulary and intellectual functioning. Overall the sample was almost a full SD below
expectation on the Freedom from Distractibility factor score from the WISC, suggesting that a
high proportion of participants may have had attention difficulties. Approximately 51% of the
sample was from low SES families, and 64% were males.
<Insert Table 1>
Measures
The reading and reading-related measures below were selected because they are
standardized, widely-used in educational and intervention outcome research, and
psychometrically-appropriate for growth-curve modeling. Use of these and the experimental
measures allow for comparison with our own past research and other major intervention studies
in the literature. The robust psychometric properties of the experimental measures of learning
and transfer-of-learning have been documented in a separate report by our group (Cirino et al.,

2002). As well, the standardized measures have been selected because of similar excellent
psychometric characteristics, including reliability, construct validity, and the ability to sensitively
measure change in reading and related skills. Measures were administered by Masters-level
research assistants or senior graduate students trained and supervised by the Research
Coordinator in each site. Examiners were only allowed to test independently after completing
training, observing a trained examiner, and being observed by the Research Coordinator during
testing. Double scoring was used to ensure the accuracy of scoring and to assess inter-scorer
reliability.
Standardized measures of reading and related skills (intervention: pre, mid, post,
and follow-up; controls: pre and posttest).
Word reading. Woodcock Reading Mastery Test - Revised (WRMT-R, Form G,
Woodcock, 1987)—Word Identification subtest. The Word Identification subtest presents letters
and then words in isolation for students to identify. Wide Range Achievement Test-3 (WRAT-3).
The WRAT-3 (Wilkinson, 1993) similarly measures both individual letter identification and word
reading (Reading). Test-retest reliability exceeds .95 for the WRMT-R Word Identification
subtest; alternate form reliability exceeds .87 for the WRAT-3 Reading subtest.
Speeded word identification. Test of Word Reading Efficiency (TOWRE), Sight Word
Efficiency subtest (Torgesen, Wagner, & Rashotte, 1999). Sight Word Efficiency assesses the
number of real words that can be accurately read within 45 seconds. Alternate-form reliability
exceeds .88 for Sight Word Efficiency.
Nonword decoding. WRMT-R Word Attack subtest; TOWRE Phonemic Decoding
Efficiency subtest. On these measures, students decode a series of progressively harder
pronounceable nonsense words; the TOWRE has a speed component as students are asked to

read as many nonwords as possible in 45 seconds. Alternate-form reliability exceeds .91 for
Phonemic Decoding Efficiency; test-retest reliability for Word Attack exceeds .73 for this grade-
range.
Reading comprehension skills. Gray Oral Reading Test–Version 4 (GORT-4; Wiederholt
& Bryant, 2004); Standardized Reading Inventory-2 (SRI-2; Newcomer, 1999); WRMT-R
Passage Comprehension subtest. The GORT-4 and SRI-2 both provide text reading accuracy and
comprehension scores. The GORT-4 stories are read aloud once, obtaining a measure of reading
rate and comprehension. The SRI-2 stories are read once aloud and once silently, with
comprehension measured using lexical, inferential, and factual open-ended questions about the
text. Time to read each passage is also recorded to provide an additional indicator of reading rate.
The Passage Comprehension task assesses comprehension using a cloze procedure. Test-retest
reliability exceeds .85 for the GORT-4, .85 for the SRI-2, and .91 for the WRMT-R.
Spelling. PIAT-R Spelling subtest assesses the child’s ability to recognize standard
spellings of spoken words, a measure of orthographic awareness. Test-retest reliabilities were .91
in this age range and with this population (Cirino et al., 2002).
Experimental measures of training and transfer (intervention: pre, mid, post, and
follow-up; controls: pre and posttest). Sound Combinations tests the reader’s ability to
pronounce a set of 30 letter clusters including vowel digraphs (ee, oa, ai), diphthongs (oo, oi,
ou), vowel-controlled consonants (ge, gi, ce, ci), r- and l-controlled vowels, and high frequency
bound morphemes (-ing, -tion). This measure has been found to be a reliable index of training
success (Lovett et al., 1994; Lovett et al., 2000; Lovett & Steinbach, 1997). Observed internal
consistency (Cronbach’s alpha) was .83.
The Challenge Words Test consists of 55 uninstructed, multisyllabic words that embed the

instructed spelling patterns and affixes. This test provides students with the opportunity for
application of the decoding strategies taught in both the PHAST and Triple-Focus Programs. It is
also a sensitive index of transfer of learning for children and adolescents with RD (Lovett et al.,
1994; Lovett et al., 2000; Lovett & Steinbach, 1997) and consistently produces 70-hour
treatment effect sizes ranging from .65 to .85. Observed internal consistency (Cronbach’s alpha)
was .93.
Word Knowledge Tests (pre and post-testing only). Multiple Definitions: This task
assesses the student’s ability to provide two or more definitions for words with multiple
meanings. Students receive credit for each unique definition provided. All items on this test are
words presented and discussed in the RAVE-O portion of the Triple-Focus Program, and thus
this test serves as a measure of instructed vocabulary content. Test-retest reliability for this task
was .66, calculated on a pre-intervention repeat assessment using a similar sample as reported in
Morris et al., 2012.
The Word Test 2, Flexible Word Use subtest (Bowers, Huisingh, Johnson, LoGiudice, &
Orman, 2004): This task, assessing vocabulary knowledge, asks students to produce two
meanings for each stimulus word provided. The standardized scoring is 1 or 0 per item – with 1
point only being awarded if the child provides two definitions. Standardized scoring was used,
but we also deviated from test administration guidelines and asked participants to provide as
many definitions as they could. We then calculated an alternate raw score for this subtest that
summed ALL of the definitions provided, thus yielding similar scoring as used for the Multiple
Definitions test but on an uninstructed vocabulary list. The Word Test 2 has average test-retest
reliability of .90 and average internal consistency reliability of .81.
Language and cognitive abilities: predictor variables.

Phonological processing. Comprehensive Tests of Phonological Processing (CTOPP;
Wagner, Torgesen, & Rachotte, 1999): 1) Blending Words measures the ability to combine orally-
presented, individual speech sounds into words; 2) Elision measures the ability to repeat a
spoken word omitting one of the phonemes. The average internal consistency reliability is .84 for
Blending Words, and .89 for Elision.
Naming speed (at multiple time points). Rapid Automatized Naming (RAN; Wolf &
Denckla, 2005). These tasks assess the ability to rapidly name visual symbols (letters, colors,
objects, letters, or combinations). Test-retest reliability exceeds .84. Rapid naming of letters is
reported here.
Cognitive ability (pretesting only). Wechsler Abbreviated Scale of Intelligence (WASI;
Wechsler, 1999). The WASI is an abbreviated measure of verbal and nonverbal cognitive ability,
adapted from the Wechsler Intelligence Scale for Children–III (Wechsler, 1991), and the
Wechsler Adult Intelligence Scale–III (Wechsler, 1997). Students were administered all four
subtests (Vocabulary, Similarities, Block Design and Matrix Reasoning). Test-retest reliability
exceeds .90 for composite scores.
Receptive vocabulary (pretesting). Peabody Picture Vocabulary Test—Third Edition
(Dunn & Dunn, 1997). The PPVT-III assesses receptive vocabulary skills; participants select
from one of four pictures that which best represents the meaning of a word presented orally. Test-
retest reliability exceeds .91 for the PPVT-III.
Visual Sequential Memory (pretesting). The Visual Sequential Memory subtest of The
Test of Visual Perceptual Skills-Revised (Gardner, 1996) tested the child’s ability to recall a series
of forms just presented from four possible alternatives. Average internal consistency reliability
for this age range is .54.

Intervention Conditions
Subjects with similar single word reading levels (WRMT-R Word Identification and
Word Attack raw scores) were assigned to an instructional group of four children who received
the Triple-Focus Program outlined below. A total of 100-125 intervention sessions were
conducted during the school year; children typically were seen in a ‘pull out’ format for 60
minutes a day, five days a week, in their own schools. At the school’s discretion, these
intervention sessions were scheduled to occur while their classroom was receiving the day’s
reading instruction, and this occurred in approximately 75% of cases. Where this schedule was
not possible, schools elected to have their children come to the program during art, science, and
social science instruction. Classes were not scheduled to occur during math instruction. Because
we were in multiple cities, school districts and schools, we chose to allow previous and current
curriculum to vary randomly to better evaluate the generalizability of our specific program
results.
The Triple-Focus Program was an experimental reading intervention developed and
directly based upon our previous work demonstrating that (i) developmental reading problems
are associated with multiple core linguistic and cognitive deficits (phonological awareness,
naming speed, and cognitive strategy use) that limit reading acquisition; and that (ii) remedial
reading interventions that address more then one of these deficits are most effective (Lovett,
Lacerenza, Borden et al., 2000; Morris et al., 2012). The Triple-Focus intervention integrated
proven instructional modules from our previous randomized control trial report (Morris et al.,
2012).
Samples from the Triple-Focus Scope and Sequence for Lessons 32, 77, and 106 are
provided in Supplementary Figure 3 (Appendix). Looking at lessons sampled from different

points in the program illustrates how the components were integrated, the amount of instructional
time allocated different components, and how the focus and time allocation shifts over the course
of 125 hours of Triple-Focus intervention.
The Triple-Focus Reading Program is an integration of the PHAST Reading Program:
Parts One (Decoding) and Two (Comprehension) with the RAVE-O Program (Retrieval,
Automaticity, Vocabulary Elaboration, Orthography; Wolf, Miller, & Donnelly, 2000; Wolf et al.,
2009). The PHAST Reading Program: Decoding teaches children five specific metacognitive
word identification strategies so they may become competent and independent readers (overview
in Lovett, Lacerenza, & Borden, 2000). Part Two of the program teaches children comprehension
strategies (predicting, summarizing, clarifying, questioning) using a metacognitive approach to
improve text reading and comprehension skills (overviews in Lovett, Lacerenza, Steinbach, &
De Palma, 2014; Lovett, Lacerenza, De Palma, & Frijters, 2012). The RAVE-O Program is an
experimental, fluent comprehension intervention developed by Wolf and her colleagues (Wolf,
Donnelly, & Miller, 2000; Wolf et al., 2009) that is based on theoretical neurocognitive models
of reading. Specifically, RAVE-O facilitates the development of accuracy and fluency in
underlying phonological, orthographic, semantic, syntactic, and morphological skills, and their
rapid amalgamation at the sublexical, lexical, and connected text levels. RAVE-O addresses the
need to explicitly teach children each of these components, and to teach explicit inter-
connections among these component systems of oral and printed language at the time core words
are taught (Wolf et al., 2009). Core words are taught that exemplify the polysemous nature of
many words, their varied syntactic functions in different contexts, and how morphemes facilitate
meaning. Thus, the RAVE-O Program focuses on the linguistic building blocks of reading
fluency, as well as three strategies for comprehension.

All groups started at the first lesson, but more advanced groups could progress through
the lessons more rapidly. As the program progressed, the number of strategies increased and
time was devoted to acquisition of a metacognitive ‘Game Plan’ so that children learned how to
select a strategy, monitor its effectiveness, and evaluate the results. The focus moved from
building phonological and orthographic skills and knowledge to increasing attention paid
multiple components of words and connected text at the semantic, syntactic morph-syntactic, and
discourse levels.
The Triple-Focus Program was designed to teach the children a set of word identification
strategies and specific decoding procedures so that they become more competent and
independent in their approach to reading unfamiliar words in print—and, at the same time, to
develop accuracy and fluency in underlying linguistic retrieval skills so the children could learn
to read text fluently and with comprehension. As an extension of two reading interventions that
had been used with positive results in our Atlanta, Boston, and Toronto sites, the Triple-Focus
program was designed to offer a structured and scaffolded instructional framework of effective
decoding and reading strategies. The original five decoding strategies of the PHAST Program
were supplemented by and tied to the fluency, orthography, vocabulary, syntax, and morphology
activities of the RAVE-O Program. This allowed a richer linguistic framework of component
skills and strategies with which to remediate the multifaceted language-based deficits of these
struggling readers.
As in our previous implementations, the program began with phonological remediation,
acquisition of the letter- and letter-cluster sound mappings, phonological analysis and blending
skills, and practice using a ‘Sounding Out’ strategy with precision in how sounds were blended
(Engelmann & Bruner, 1988). As strategy-specific preskills and knowledge were acquired,

additional word identification strategies were learned and practiced, using a strategy dialogue
modeled by the teacher and acquired by the children; these included Rhyming (word
identification by analogy- Gaskins et al, 1986), Peeling Off (separating affixes in multisyllabic
words), Vowel Alert (learning the multiple pronunciations of vowel and vowel combinations
according to their frequency in printed English), and I Spy (useful for compound words—
identifying smaller known words). Each lesson contained RAVE-O activities and games,
drawing upon words and sublexical patterns from PHAST and the core words of RAVE-O,
incorporating words with shared phonemes and orthographic patterns, and semantic richness
(multiple meanings) into work on vocabulary and orthographic knowledge, word retrieval, and
other linguistic building blocks of reading fluency (Wolf et al., 2000; Wolf & Katzir-Cohen,
2001; Wolf et al., 2009).
The Triple-Focus Program was taught by experienced and certified teachers working for
the research teams; some had Masters degrees, and all had special education and/or reading
additional qualifications. There were multiple teachers at each site; several had participated in
our earlier studies and had experience teaching PHAST and RAVE-O. All teachers were trained
to provide multiple interventions within our research (i.e., in other related studies). All were
trained a priori to a level of competence during intensive training conducted in Boston. All
teachers had a detailed Scope and Sequence, scripted lessons to follow, and timelines with which
to adhere for their teaching.
Throughout the study, a senior/lead research teacher at each site (i) continually monitored
the progress and pace of each teacher and group through the lessons, (ii) initiated cross-site
teleconferences between teachers to answer questions and problem-solve challenges, and (iii)
offered reminders and instructional refreshers during regular team meetings. To further support

fidelity of implementation in each class and across sites, an email list-serve was established
where teachers could ask questions and receive an immediate response. Every teacher prepared a
weekly progress report, summarizing all lessons and activities completed by each class. This
report was posted weekly on the list-serve. In-person mentor visits by the senior/lead teacher
occurred 3-4 times per year with feedback being provided. Finally, videotapes of classes were
shared between sites so that trainers/lead teachers could ensure cross-site consistency in program
implementation.
The control condition was a curricular control group, including children who met study
criteria for RD, and who were not placed in the Triple-Focus intervention; these children
constituted a ‘business-as-usual’ control to be followed and evaluated over time. As a classroom-
based control, these children received whatever level and type of intervention the schools or their
parents would provide for them. Because schools in these years (2001-2006) frequently waited
until 3rd grade to identify children as needing help, it is unlikely that many children in Grades 1
and 2 received extra reading assistance in school. This was the case for all three sites. Schools in
all sites provided 90 minutes of classroom literacy instruction daily. For ethical reasons, these
children were offered access to the intervention program the year following their control
participation. Control participants were assessed at pre- and posttest only.
The full 125 hours of instruction were implemented as planned for 68% of the sample (n
= 117). The remaining 55 intervention children received an average of 104.5 hours of instruction
(SD = 14.5; range = 70 to 124 hours). All control participants were assessed on intervention
outcomes after equivalent time in the business-as-usual condition. Post-intervention assessments
for all participants occurred after the final lesson was delivered, with those who did not
complete the full 125 hours having their last observation carried forward.

Results
First Analysis
The first analysis is preliminary to the main analyses presented in the following section.
The goals of the first analysis were to replicate program findings from our previous work, to
generate traditional effect sizes, to maximize power for the intervention versus control contrast,
and to provide a conservative test of the efficacy of the intervention. As such, the first analysis
included all participants who contributed any valid outcome data, regardless of how much
instruction was delivered, carrying forward the last outcome measurement for those who dropped
out prior to the planned 125 hours. Moderated regression models were formed, regressing each
outcome on pre-intervention outcome scores, intervention group (i.e., Triple; Control), grade
(i.e., a priori focused contrasts of Grades 1/2 vs. 3; Grade 1 vs. 2), the interaction between grade
and intervention assignment, and the interaction between pre-intervention scores and
intervention group. This final interaction, representing the homogeneity of regression slopes in
ANCOVA, was initially included in each model, but dropped from the final model if
nonsignificant. Since each model explicitly included a developmental indicator (i.e., grade), raw
scores on each outcome were analyzed, except on the WJ-III outcomes, which utilized the
Rasch-scaled W scores.
Since children were nested within their instructional groups, the analysis was conducted
within a mixed model framework, with instructional group as a random effect. Cross-level
interactions and nested group effects were not of substantive interest and are not reported here,
but simply incorporated into each model to account for the group-level dependence in the data
and to obtain appropriate standard errors for grade and treatment effects. The resulting intra-class
correlations (ICC) are included in Table 2 for use in conducting power analyses for future

cluster-randomized trials. In addition to the moderated regressions, intervention effect sizes
(Cohen’s d) were calculated via the pooled pretest standard deviations of the intervention and
control groups, along with the model-adjusted post-intervention mean score on each outcome.
Table 2 reports these values for outcome models formed for 14 outcomes. Since this analysis
involved 14 correlated outcome measures, the potential for an inflated false-discovery rate
existed. As a result, the Benjamini-Hochberg procedure (Benjamini & Hochberg, 1995) was
implemented to correct for multiple significance tests and control the false-discovery rate.
<Insert Table 2>
Globally, across all outcomes, statistically significant and substantial program effects
were observed on adjusted posttest scores. In every case, participants in the Triple intervention
outperformed those in the Control condition, with effect sizes ranging from a moderate .57 to a
large 1.82. Effect sizes were largest for experimental outcomes assessing directly instructed
content and lowest, but still moderate-to-large, for standardized measures of single word
identification. Very strong effect sizes were observed for measures of nonword decoding, and
strong effect sizes for reading comprehension outcomes. The average effect size across the 14
outcomes was 0.99. The average effect size on standardized measures was .80 and on
experimental measures was 1.69. Intra-class correlations ranged from 0.05 to 0.43, with the
largest ICCs observed for experimental measures of instructed content and comprehension
outcomes.
The grade by treatment interaction was statistically significant for five outcomes, and
marginally significant for one. After accounting for pretest scores, the difference between
intervention and control for Grade 1/2 participants at posttest was approximately twice as large
as the difference for Grade 3 participants. This pattern was repeated across TOWRE Sight Words

(Grade 1/2 intervention-control posttest difference of 11.1 versus Grade 3 difference of 3.7;
illustrated in Figure 1), WRMT-R Word Identification (Grade 1/2 intervention-control difference
of 26.6 versus Grade 3 difference of 14.6), and WRMT-R Word Attack (Grade 1/2 intervention-
control difference of 19.7 versus Grade 3 difference of 12.1; marginally significant). A reverse
pattern was observed for three other outcomes, whereby the difference between intervention and
control for participants in higher grades was approximately twice as large as the difference for
younger participants. The Grade 2 intervention-control difference was greater than the Grade 1
difference on the Challenge test outcome (Grade 2 intervention-control posttest difference of
22.9 versus Grade 1 difference of 12.2). A similar pattern was observed for the WORD-2
outcome (Grade 2 posttest difference of 0.71 versus Grade 1 difference of 0.36). This pattern was
repeated for the PIAT Spelling outcome, with three times the intervention-control posttest
difference for Grade 3 participants (15.5) compared to Grade 1/2 participants (5.1).
The interaction between pretest scores and intervention condition was significant for the
Sound Combination and PIAT Spelling outcomes. Within the ANCOVA framework, this would
indicate a violation of the homogeneity of regression assumption, being differential adjustment
of posttest scores by group. Within the moderated regression framework, these two effects can be
explicitly modeled and interpreted as substantive effects. In the case of Sound Combinations, a
dramatic increase in intervention group score variance from pretest to posttest resulted in a lower
pre-post correlation for that group compared (r = .30) to Controls (r = .62). A similar, but less
dramatic, pattern was observed for PIAT Spelling, with a few Intervention participants making
large gains by posttest, thereby reducing the correlation between pre- and posttest for the
Intervention group.
Second Analysis

The goals of the second analysis were to utilize all available repeated observation data to
precisely estimate specific trajectories of change, incorporating trajectories representing the
yearly follow-up outcome measurement, and exploring predictors of these two intra-individual
parameters. Growth curves were used to estimate intercepts and trajectories, and to model
individual differences in intervention response across five repeated observations: pretest, after
35, 70, 105, and 125 hours of instruction, and at each follow-up occasion, which occurred yearly,
one to three times after the intervention depending on grade at entry to the study (i.e., up to the
end of 4th grade only).
The growth curve analysis was performed on the eight outcomes for which there were
outcome measurements at each of the time-points mentioned above. For precision in estimating
fixed effects and to utilize all available data, this second analysis included all cases that had at
minimum pretest outcome scores. All available outcome data were utilized, and every dropout
was represented in the growth curve analysis. Data density across observation points was as
follows: pretest, 219 participants (100%); 35 hours, 172 (78.5%); 70 hours, 172 (78.5%); 100
hours, 158 (72.1%); 125 hours, 205 (93.6%); first follow-up, 52 (23.7%); second follow-up, 52
(23.7%); third follow-up, 28 (12.7%). Lower data density at the 35, 70, and 100 hours testing
points and at follow-up represent the fact that control participants were only tested at pretest and
posttest.
Growth models were based on a two-piece parameterization of time that modeled linear
growth to posttest, with a separate component representing linear growth from posttest through
the follow-up period. Not presented here are the competing piecewise and polynomial models
that each provided a less adequate fit (via nested -2LL comparisons) across all outcomes. The
most notable practical advantage of the chosen parameterization was that it afforded the ability to

segregate and estimate effects that might interact with intervention condition from effects that
might predict follow-up trajectories. This segregation was important, since follow-up trajectories
could not be estimated for participants in the control condition. Several metrics for time were
considered, including time as intervention days, chronological time, and models that
incorporated both metrics. The most parsimonious and well-fitting model, used in the analyses
reported here, was a hybrid model in which intervention days were utilized as the metric for
time, with time to follow-up rescaled to this metric.
Model fitting proceeded according to current best practices in multilevel growth
modeling (e.g., Hox, Moerbeek, & van de Schoot, 2010; Snijders & Bosker, 2012). Initial model
fitting also investigated several models to account for nesting of observations within individuals,
within teacher and/or instructional group. Since the control condition was business-as-usual, and
thus individual children were not cluster-randomized, clusters of one were formed for analysis
purposes. Simulation studies have shown this strategy to be both more efficient and powerful
than either forming pseudo-clusters, or treating the entire condition as one cluster (Bauer, Sterba,
& Hallfors, 2008; Roberts & Roberts, 2005). Null and growth models involving only random
effects were first fit and competitively evaluated within measure via BIC/AIC values. Across the
eight outcomes, the best fitting random effects model included variance components for intercept
and intervention growth rate, both at the participant and participant nested within instructional
group levels. The best fitting model per outcome also included the follow-up trajectory piecewise
parameter as a variance component, but in almost every case only for participants nested within
instructional group. Finally, individual differences were incorporated as predictors of either
program-related growth and/or as predictors of follow-up trajectories. The initial fixed-effect
predictor model included intervention group, grade at intervention start, and the interaction

between group and grade. Fixed effects results from these models are presented in Table 3.
<Insert Table 3>
Examination of the fixed effects for Pretest, rows γ01 to γ03 in Table 3, indicate that
participants in Grade 3 began intervention with substantially higher scores on all outcomes when
compared to those in Grade 1/2 (row γ02); participants in Grade 2 began with higher scores than
those in Grade 1 (row γ03), except for scores on the Challenge Test. When considering Growth to
Posttest, row γ10 represents the growth rate in the control group, with γ02 growth made by
Intervention participants over and above this baseline. Given the scaling of the growth models’
time parameter, the estimates in these rows are a direct representation of estimated growth over
the course of 125 hours of instruction. For example, control participants gained an average of
21.87 Challenge Test words over 125 hours, and Intervention participants gained an additional
18.15. Across all outcomes, additional gains by Intervention participants were both substantial
and statistically significant.
Rows γ12 and γ13 represent growth rates across the grade contrasts. On four of eight
outcomes, Grade 1/2 participants gained skills at a faster rate than Grade 3 participants (row γ12).
In the case of two outcomes (WRMT-R Word Identification and TOWRE Sight Words), this
effect interacted with intervention group (row γ14). In these cases, the growth rate of Grade 1/2
participants in the intervention group far exceeded the rate of growth for Grade 3 participants
(see Figure 1). This replicates similar effects seen in the first analysis. On four of eight outcomes,
Grade 1 participants gained skills at a faster rate than those in Grade 2 (row γ13). This pattern was
reversed for the Challenge Test and interacted with intervention group, such that the intervention
effect was much more pronounced for participants who received the intervention in Grade 2 (row
γ15).

A pseudo-R2 (Hox, 2010; Raudenbush & Bryk, 2002) was calculated as an estimate of the
proportion of variance in growth rates that could be accounted for by a) assignment to
intervention or control condition; and b) the incremental proportion of variance explained by the
grade by intervention interaction. Treatment assignment accounted for an average of 32% of the
explainable variation in growth rates (range = 21% to 49%); grade by intervention interactions
accounted for an average of 52% additional variance in growth rates (range = 29% to 76%).
The rows γ20 to γ22 in Table 3 characterize follow-up trajectories. Overall, participants
continued to gain reading skills from posttest through the follow-up occasions, on all outcomes
except WRMT-R Word Attack (row γ20). The parameters in this row represent skill growth per
year of follow-up. On six of eight outcomes, continued growth interacted with grade at
intervention. In these cases, participants who began the intervention in earlier grades continued
gaining skills at a rate that exceeded later intervention starts through the follow-up years (row
γ22). Figure 2 illustrates this effect on the WRMT-R Passage Comprehension outcome. Note that
by the second follow-up observation, participants starting the intervention in Grade 1 had caught
up to those starting the intervention in Grade 2, despite being one year younger at that
observation point.
Examination of variance component residuals indicated that additional intra-individual
variability remained after accounting for intervention and grade effects. As a result, a secondary
analysis was conducted incorporating additional individual difference factors as follows:
receptive vocabulary scores (Peabody Picture Vocabulary Test), phonological awareness
(Comprehensive Tests of Phonological Processing phonological composite score), rapid naming
(Rapid Automatized Naming Letters score), visual sequential memory (Test of Visual Perceptual
Skills-Revised), and IQ (Wechsler Abbreviated Scales for Intelligence: 4-subtest IQ score). Each

of these factors was introduced to the model initially alone, as predictive of growth to posttest,
and as predictive of follow-up trajectories. Interactions of intervention group with these
predictors were also included. Models were pruned of higher-order nonsignificant results to
reflect a parsimonious model of individual differences. Table 4 reports significant results for
these fixed effect individual difference predictors and their interaction with intervention
condition.
<Insert Table 4>
In Table 4, rows γ00 to γ04 indicate whether each individual difference predictor was
related to pretest scores on each outcome measure. Across multiple outcomes, phonological
awareness and rapid automatized naming were related to pretest reading skill. Rows γ10 to γ14
indicate whether initial levels of the individual difference predictors were related to rate of
change during the intervention period. Most of these effects are not interpretable, since they were
included to ensure that all nested effects within a significant higher-order interaction were
included, as reported in rows γ15 to γ19.
Across seven out of eight outcomes, IQ interacted with intervention group growth rates
(this relationship was marginally significant for the remaining outcome-GORT Rate). Post-hoc
examination of these interactions indicated that intervention growth rates were highest among
lower-IQ Triple participants, with the greatest discrepancy in growth rates between intervention
and control occurring when WASI IQs were low. In fact, the only group not demonstrating
growth during the intervention period was the control subgroup with lower WASI IQ scores at
entry. Post-hoc examination indicated parallel slopes across participants with lower vs. higher
IQs if they participated in the Triple-Focus intervention. The interaction between WASI IQ and
response to intervention on the WRMT-R Word Attack outcome is depicted in Figure 3. A

reverse pattern was observed on SRI comprehension outcomes with receptive vocabulary
(PPVT) as the predictor (row γ12). Higher vocabulary scores were associated with a greater
difference in growth rates between intervention and control participants. The greatest growth
rates in comprehension were observed for Triple-Focus participants who began intervention with
relatively stronger vocabulary skills.
Rows γ20 to γ22 indicate the relationship between growth trajectories during the follow-up
period and the individual difference predictors. Across four of eight outcomes (row γ23), higher
visual sequential memory skill was associated with greater gains in the follow-up period. Post-
hoc visual inspection of this effect showed that participants with the highest visual sequential
memory skills continued to gain reading skills, while those with the lowest did not continue to
gain, but rather leveled off one year after intervention. This pattern is depicted in Figure 4 for
measure of multisyllabic challenge word reading. The same pattern was evident on five of eight
outcomes for the receptive vocabulary predictor. Relatively higher vocabulary skill was
associated with greater continued gains during the follow-up period (row γ22).
Normalization rates
A final examination was made of the proportion of participants in each condition and
each grade whose posttest scores fell within the average range following the intervention period.
The proportions ‘normalized’ on four standardized outcome measures are displayed in Table 5.
<Insert Table 5>
Chi-square tests of independence were calculated to establish whether the proportion of
children achieving scores in the average range at posttest differed between the Triple and control
groups. On the WRMT-R subtests (Word Attack, Word Identification, Passage Comprehension),
significantly greater normalization was achieved by the Triple group in every grade, the only

exception being a greater but nonsignificant advantage of the Triple over the control children in
Grade 3 on Word Identification. On the SRI-2, lower rates of normalization were observed
overall, however, Triple intervention children were normalized at significantly greater rates for
SRI Accuracy and Reading Quotient scores in Grades 1 and 2, but the difference fell short of
significance for Grade 3 children.
Discussion
The preliminary analysis confirmed that the research intervention, the Triple-Focus
Reading Program, was associated with reliable gains in reading achievement that were evident
on multiple dimensions of reading skill. Across 14 reading outcomes, ranging from experimental
measures of skills targeted for instruction (e.g. Sound Combinations, multisyllabic Challenge
Word reading, Multiple Definitions vocabulary knowledge) to standardized measures of word
identification, word attack, word reading efficiency, and reading comprehension, children who
received the Triple-Focus intervention substantially out-performed those in the control condition.
Effect sizes (Cohen’s d) ranged from .57 to 1.82, with an average effect size of 0.99 and a
median effect size of .84. These effect sizes, achieved after only 125 hours of instruction
(approximately 7 months chronological time), are comparable to those reported by Connor et al.
(2013) comparing three years of ISI intervention to three years of control placement. The present
effect sizes surpass most of those reported in the meta-analysis conducted by Wanzek and
Vaughn (2007), however, in which effects were generally greater for children receiving
intervention in Kindergarten and Grade 1 (average e.s. ranging from .31 to .84) than in Grades 2
or 3 (.23 - .27).
The efficacy of the Triple-Focus Reading intervention was anticipated because its
component programs (PHAST and RAVE-O) had been rigorously evaluated against two control

groups in a previous multi-site study with Grades 2 and 3 children with reading disability
(Morris et al., 2012). Both multiple component programs shared an emphasis on phonology,
orthography, and morphology, and both included specific motivational and metacognitive
components in their design. The two programs offered the same base of phonological reading
intervention (PHAB/DI), but differed in some other areas of cognitive-linguistic focus. The
RAVE-O Program provided instruction on several linguistic aspects of word knowledge (e.g.,
semantic depth and flexibility, lexical retrieval, syntactic and morpho-syntactic structure) and
offered many game-like practice opportunities to build engagement with language learning. The
PHAST program provided a metacognitive approach to decoding, with attention paid sub-
syllabic orthographic patterns, variable vowel pronunciations, affixes, and the direct teaching of
five word identification strategies, along with a plan for their implementation, monitoring, and
evaluation. These two research-based intervention programs were associated with superior
outcomes relative to controls on multiple standardized reading achievement tests at posttest, and
participants continued to demonstrate a significant advantage a full year after intervention ended
(Morris et al., 2012). The superiority of the PHAST and PHAB/DI + RAVE-O programs was
replicated across multiple measures of reading and spelling achievement at one-year follow-up.
In the present design, these multidimensional programs were integrated and extended to form the
Triple-Focus program, and given our previous evidence, there was ample reason to believe that
the new intervention would have efficacy for struggling readers in the early grades.
In this previous work, interventions offered only 70 hours of small-group instruction.
Sampling was conducted according to a 2 x 2 x 2 factorial design such that every treatment
group included equal numbers of Caucasian and Black children, children from average or below-
average family socio-economic circumstances, and children of average or below-average IQ (IQs

70 - 89). In this study, program benefits generalized to a much broader sample of disabled
readers than typically evaluated. These multidimensional, systematic and intense, linguistically-
motivated reading interventions were associated with positive outcomes for young children with
RD, of high and low IQ, and from a range of ethnic backgrounds and environmental
circumstances (Morris et al., 2012).
In the present research, 125 hours of small-group instruction was offered over the course
of 1st, 2nd, or 3rd grade, allowing an integration of the PHAST and RAVE-O components and
further development of reading comprehension instruction. Of primary interest was the question
of whether grade at intervention would influence intervention outcomes and rate of growth.
While robust intervention effects were observed on all 14 outcomes, the interaction between
intervention condition and grade-at-intervention was significant for just less than half of these
outcomes: For five of the 14 outcomes, outcomes differed according to grade and a 6th outcome
was marginal. In five of six cases, these effects concerned acquisition of basic foundational
reading skills.
There was powerful evidence of an early intervention advantage on most basic word
reading skills assessed: For word attack, word identification (WRMT-R), and sight word reading
efficiency (TOWRE), intervention in Grades 1 and 2 was associated with greater gains than in
Grade 3. The only standardized word reading measure that did not demonstrate this advantage
was WRAT-3 Reading. Phonological decoding training appeared to benefit all grades equally on
measures of letter-sound combination knowledge and nonword reading efficiency (TOWRE
decoding), although on one central measure of decoding skills (WRMT Word Attack), 1st and 2nd
grade Triple children were at a substantial advantage relative to 3rd grade Triple children.
After controlling for pretest, the average posttest difference between intervention and control

Grade 1/2 participants was 20.6 W-scores, relative to 12.1 for Grade 3 participants. On Word
Identification (28.7 vs. 14.5 W-scores) and TOWRE sight words outcomes (11.9 vs. 3.9 words),
the two younger grades demonstrated posttest advantages relative to controls two to three times
as great as those in Grade 3. These grade-by-intervention interaction effects were substantial:
after accounting for the effects of assignment to condition, grade-by-intervention effects
accounted for an average of 54% of the explainable variation in growth rates.
These data provide evidence in support of the efficacy of early intervention within the 1st
or 2nd grade of elementary school. This result is of practical significance given the still prevailing
stance of some school districts to delay detailed assessment until a child reaches 3rd grade with
persisting academic problems. These results are consistent with those of Connor and colleagues
(Connor et al., 2013) who found a 1st grade advantage for students receiving only one year of her
ISI intervention relative to those whose single year of ISI occurred in 2nd or 3rd grade. Connor et
al. noted, however, that their 1st grade advantage was inconsistent and not replicated for students
receiving two years of ISI intervention. In this case, students receiving ISI in 1st and 3rd grades
outperformed those with ISI in 1st and 2nd or 2nd and 3rd grades.
In the present data, the early intervention effect was not replicated on three other
outcomes for which a significant intervention x grade interaction was revealed. As the word
literacy outcome became more complex, different grade x intervention patterns emerged. On two
measures relevant to specific metacognitive and metalinguistic instruction in the Triple-Focus
Program, multisyllabic word identification (Challenge Words) and the ability to provide multiple
definitions of multiple-meaning vocabulary (Multiple Definitions), 2nd grade Triple children
demonstrated a greater intervention-control posttest advantage than 1st grade Triple children.
Finally on an orthographic awareness or spelling recognition measure (PIAT Spelling), 3rd grade

Triple participants achieved a greater posttest advantage relative to controls than 1st and 2nd grade
Triple participants. Each of these outcome measures requires awareness of and a capacity to
manipulate linguistic components of written language beyond the phonological domain. On
Challenge Words, morphological awareness and an ability to work with bound morphemes are
tapped, on Multiple Definitions, morpho-syntactic and semantic awareness and flexibility, and on
PIAT Spelling, orthographic awareness. These findings are among the first to attempt to examine
developmental effects in disabled readers’ response to intervention according to the complexity
of the component reading skills being assessed.
Perhaps the most complex aspects of reading development involve the comprehension of
connected text. In this regard, it is of interest that no intervention condition x grade interactions
were found on any of the three standardized reading comprehension tests included in the pre- and
posttest battery. Substantial intervention effects were revealed on all three comprehension
outcomes, with large effect sizes reported (GORT Comprehension d = .90, SRI Comprehension d
= .64, WRMT-R Passage Comprehension d = .63). Similarly, a measure of text reading rate
(GORT Rate d = .78) demonstrated a reliable posttest advantage for the Triple intervention
participants, but no interaction with grade.
It is difficult to know whether this pattern truly reflects no grade differences in how the
Triple intervention affected reading comprehension performance. The failure to observe
developmental response differences on these text reading measures may reflect instead the
current state of measurement for more complex dimensions of reading skill like text
comprehension and reading fluency. It is acknowledged that traditional measures assess
somewhat crudely the products of reading comprehension—what is understood after a text is
read. Different limitations of these standardized reading comprehension tests have been

extensively discussed, including inadequate content validity, concurrent validity, task sensitivity,
and an imbalance in the type of comprehension questions included (Cain & Oakhill, 2006;
Cutting & Scarborough, 2006; Keenan, Betjemann, & Olson, 2008; Kendeou, Papdopoulos, &
Spanoudis, 2011; Morsy, Kieffer, & Snow, 2010).
These concerns are particularly acute when attempting to assess comprehension of text by
beginning readers whose skills are undergoing rapid developmental change. Kendeou and
colleagues reported a longitudinal study comparing different comprehension measures widely
used in the early grades (Kendeou et al. 2011). These investigators demonstrated that these tests
vary in the processing demands they make on young readers’ component reading-related skills
(e.g., vocabulary, orthographic processing, rapid naming, phonological processing, working
memory, fluency), skills that are developing rapidly during the early grades. Of relevance to the
present work, one of the tests used here as an outcome measure, Passage Comprehension, was
found to exert particular processing demands on orthographic processing and working memory,
and less on phonological decoding. It should be noted, however, that the Kendeou study sample
included typically developing Greek children, and that phonological decoding is typically
mastered early in reading development in languages like Greek with highly consistent letter-
sound mapping.
The growth curve analyses undertaken with the present data allowed two types of
determination of individual differences effects: a) an examination of predictors of growth during
the intervention period, with Triple-specific determinants of growth revealed through interactions
between the predictor and intervention condition (Triple vs. control); and b) predictors of growth
following intervention for children who had received the Triple. Control children did not
contribute to the follow-up data since after posttest they received the Triple reading intervention.

Compatible with evidence establishing phonological awareness and rapid naming speed
as predictors of reading achievement in young readers (Kirby, Parrila, & Pfeiffer, 2003; Manis,
Doi, & Bhadha, 2000; Parrila, Kirby, & McQuarrie, 2004), these two factors were related to
pretest reading skill for the present sample. These individual difference factors were not,
however, consistently related to rate of growth during intervention or over the follow-up years.
In contrast, and across seven of the eight outcomes analyzed, IQ interacted with
intervention condition on rates of growth during the intervention period. Specifically, better rates
of growth in the Triple intervention, relative to controls, were seen among those participants with
lower WASI IQ estimates. Another way of expressing this interaction is that the difference in
growth rate between Triple and Control children was greatest for children with lower WASI
scores at entry. This is put into context by the fact that Control participants with lower WASI IQs
did not demonstrate growth across the intervention period in marked contrast to higher WASI
Control children (see WRMT-R Word Attack growth, Figure 3). Post hoc examination revealed
parallel slopes (rates of growth) across Triple participants with higher- and lower WASI scores,
indicating that equal growth was attained in the intervention for lower and higher-IQ children.
These data suggest that the provision of systematic, linguistically-informed, and intense reading
intervention is particularly critical for struggling readers with lower overall cognitive and
language functioning, and that children of varying cognitive profiles at entry were able to profit
equally from the Triple instruction.
Two other individual differences factors emerged to be of interest. The first was an
estimate of vocabulary knowledge (PPVT), and this factor was associated with a different pattern
than that seen for WASI IQ. In this case, the difference in growth rates between Triple and
control children was greater for those children demonstrating relatively stronger vocabulary

skills at entry. Greater growth in intervention on SRI Comprehension was observed for Triple
children with relatively better vocabulary skills. Similarly greater continued growth on four
outcomes including single-word reading, comprehension, and fluency during the follow-up
period was revealed for high-vocabulary Triple children. It is not surprising that vocabulary
knowledge is related to growth in and development of comprehension skills; there is evidence of
the substantial correlations between estimates of vocabulary knowledge and reading ability
(Baumann, Kame’enui, & Ash, 2003; Kamil, 2004; Nagy, 2007).
An unexpected predictor of growth during the follow-up period emerged for four of eight
outcomes. Visual Sequential Memory performance predicted rate of growth after intervention
ended on four reading outcome measures over the follow-up period. Triple children with higher
visual sequential memory scores at pretest made greater continued growth on word attack and
nonword reading efficiency standardized measures, on multisyllabic challenge word reading, and
on GORT Reading Rate over the follow-up year. Verbal working memory is more typically
related to differences in reading growth among children and youth, but recent evidence by Pham
and Hasson (2014) suggests that visual spatial working memory also significantly predicts
reading achievement in children. Swanson (2000, 2010) has speculated that any advantage that
visual spatial working memory may give to children with reading disabilities may vary according
to the processing demands that reading places on different components of the working memory
system.
Grade at intervention continued to exert an influence in predicting differences in rate of
growth during the follow-up period. While many of the intervention x grade interactions revealed
in the first analysis of posttest change revealed an advantage for Triple participants in Grades 1
and 2, a more specific advantage for 1st graders is found in follow-up growth rates. Children who

received the Triple intervention in 1st grade continued to grow during the following three years at
faster rates than children who received the intervention in 2nd grade. The grade x follow-up effect
was consistently found across outcome measures, with six of the eight demonstrating this robust
effect.
The latter observation of superior growth after treatment for our 1st grade sample is
reinforced by examination of the normalization rates achieved on different dimensions of reading
development by children receiving intervention in Grades 1, 2, or 3. On standardized tests of
word attack, word identification, and passage comprehension, significantly greater normalization
was attained by Triple participants in every grade, with the exception of a greater but
nonsignificant advantage of Triple over control children in Grade 3. On the word attack measure,
78% of Triple 1st graders scored within the average range at posttest, 50% of Triple 2nd graders,
and 38% of Triple 3rd graders. In contrast, control participants were normalized at the following
rates in these grades: 28% 1st grade, 0% 2nd grade and 6% 3rd grade. Although relatively fewer
participants were normalized on the SRI Reading Quotient, 40% of Triple 1st graders and 24% of
Triple 2nd graders scored within the average range at posttest compared to 12% and 0% of their
control peers.
These data provide further support for the clear benefits of early intervention, particularly
in 1st grade. These findings are compatible with those recently reported by Al Otaiba and
colleagues (Al Otaiba et al., 2014). These investigators compared two response-to-intervention
(RTI) models implemented in 34 first grade classrooms using a randomized controlled design. A
typical RTI procedure, that deferred further intervention until Tier 1 response was measured, was
compared with a dynamic RTI model that provided Tier 2 or Tier 3 intervention immediately
based on children’s screening results. The interventions differed only with respect to when

intervention began. Children in the dynamic RTI condition had significantly higher reading
achievement at the end of 1st grade than children in the typical RTI condition. As with the present
results, these findings suggest that delaying intervention for struggling early readers is not
associated with any advantage for the children; to the contrary, the best outcomes are seen with
intervention that begins in Kindergarten or Grade 1. As Al Otaiba and colleagues indicate, any
effect of false negatives seems negligible. And as our follow-up data demonstrate, superior
growth for 1st graders on foundational reading skills continues over three years after the
intervention ends.
Limitations
Clear limitations characterize the present study and qualify the findings. The most
obvious concerns the inability to randomly assign participants to intervention or control
conditions. Quasi-experimental research designs lack the credibility of RCTs with respect to
assessing causality. An inability to randomly assign participants to treatment and control
conditions is not uncommon in clinical and applied research settings however (Gliner & Morgan,
2000; Harris, McGregor, Perencevich, Furuno, Zhu, Peterson, & Finkelstein, 2006). The use of
both repeated measurement and a comparison group makes it easier to avoid certain threats to
validity within a quasi-experimental design. In that regard, the present study provided
compelling evidence of the comparability of intervention and control groups on all selection
criteria, and on all pretest and demographic measures.
Another limitation concerns the unequal sample sizes for the intervention and control
groups, and resulting imbalance across intervention and control conditions within each grade.
In our study, the lower control group numbers were associated with difficulty enrolling control
children with reading disabilities who would be required to wait a full year before receiving the

intervention.
Related and equally important issues qualify interpretation of the follow-up data. First,
no follow-up data are available for control participants. The failure to follow control children
untreated over a follow-up period was due to the ethical need to offer the Triple intervention to
control children immediately following their posttest assessment. Although Triple placement
could not be arranged for all control children for logistical reasons (school location,
transportation, etc.), no follow-up assessment was conducted for them because of the intent to
offer intervention. This necessitated two separate analyses to consider predictors of outcomes
immediately following intervention and then in the years after intervention ended. Second,
decreased numbers were available for follow-up analyses due to attrition of the intervention
sample over the follow-up years. Of the intervention participants, follow-up data were collected
on 30.2% at Follow-up Year 1, 30.2% at Follow-up Year 2, and 16.3% at Follow-up Year 3.
Follow-up was only conducted until the end of 4th grade, and so follow-up opportunities
decreased with intervention at later grades. These limitations qualify the conclusions that may be
offered on the basis of these follow-up data.
A third limitation also concerns the control comparison available in this curricular control
design. Because early intervention and RTI initiatives were less prevalent during the time period
of the present study, it is possible that some control participants received less reading instruction
overall that those in the intervention group. Some intervention children received whole class
reading instruction in addition to the small group Triple intervention program. In these cases,
because small group intervention is considered a good vehicle for intensifying reading
instruction for struggling readers, it is difficult to determine whether these intervention
participants’ post-intervention superiority can be attributed to the research-based Triple

intervention itself, to the additional amount of reading instruction offered, or to the increased
individual attention that small group programs can afford. This concern is attenuated somewhat
by two previous RCTs demonstrating efficacy of the components of the Triple-Focus
intervention relative to other intervention conditions offering additional reading instruction in
groups of equal size (Lovett et al., 2000; Morris et al., 2012).
In addition, it should be noted that the majority of intervention children (approximately
75%) attended their Triple-Focus class during the time of whole class literacy instruction.
These intervention sessions were scheduled at the school’s discretion and many school boards
preferred that classes occur while regular classroom reading instruction was occurring. Where
this scheduling was not possible, schools generally elected to have children come to the program
during art, science, and social science instruction.
An added limitation relevant to the control participants was the lack of specific
information on what type of literacy instruction they received in their schools. The majority of
control children (81%) were from Toronto and surrounding area schools, and an eclectic
approach to literacy instruction was used, largely at the teacher’s discretion. The Ministry of
Education in the Province of Ontario provided general instructional guidelines but did not
endorse any particular reading program or instructional approach during those years. Children in
the elementary grades received 90 minutes of literacy instruction daily, covering reading and
writing activities, and including a range of approaches. The same 90-minute block of literacy
instruction also characterized our schools in Atlanta and Boston.
Other limitations relate to the context and time within which these data were collected.
The study was undertaken in two American cities (Boston, Atlanta) and one Canadian city
(Toronto). The study was conducted during a time when NCLB legislation in the US may have

affected the instructional practices of teachers in early reading and math instruction, and this may
have disproportionately affected control participants from US sites. As noted above, however,
81% of control children were from Toronto schools. Although it could be speculated that
Canadian schools were not as influenced by the instructional emphases encouraged by NCLB
and therefore at a disadvantage, the superiority of Canadian students’ reading achievement
results over those of their American peers in international comparisons (PISA) might assuage
such concern. Students in Canada outrank those in the United States in reading, math, and
science on PISA testing. Canada is ranked 7th in the world, while the US is ranked 24th on PISA
reading scores (OCED, 2013). Although conclusions from this research are necessarily qualified
by all these contextual and design factors, it is unlikely that the preponderance of Canadian
controls biased intervention findings in a positive direction.
Finally, because this study was conducted in three sites with quite different school
calendars, there was a difference between sites in the ability to complete 125 hours of
intervention within the school year. The full 125 hours of instruction were implemented as
planned for 68% of the intervention sample (n = 117). The remaining 55 intervention children
received an average of 104.5 hours of instruction (SD = 14.5; range = 70 to 124 hours). Data
density varied considerable across time-points for testing, therefore, and as expected fewer
participants were available for follow-up assessment. As in other long-term studies, attrition
during the follow-up years occurred.
Conclusion
In conclusion, the present study contributes more evidence on the relative importance of
the timing of early intervention for reading problems in the primary grades. Although the Triple-
Focus intervention was associated with benefits for struggling readers across 1st, 2nd, and 3rd

grades, on all reading and reading-related outcomes, there was a marked advantage on some
outcomes for early intervention. Children who received intervention earlier, in 1st and 2nd grade,
made gains relative to control children almost twice that of children receiving intervention in 3rd
grade on foundational word reading skills such as word attack, word identification, and sight
word efficiency. On follow-up testing, the advantage of 1st grade intervention was even clearer:
First graders in the Triple condition continued to grow at faster rates over the follow-up years
than 2nd graders on six of eight reading outcomes (word attack, passage comprehension, sight
word and phonemic reading efficiency, multisyllabic challenge word reading, and GORT reading
rate.). Normalization rates indicated that a majority of first graders in the Triple intervention
improved and achieved age-appropriate performance scores at posttest on the WMRT reading
achievement subtests. These findings suggest that the cost of investing in first grade intervention,
using an instructional vehicle with demonstrated efficacy, is offset by the substantial immediate
gains, benefits still evident years after the intervention ends. The substantial effect sizes attained
with provision of 100-125 hours of intervention provide compelling evidence for the early
intervention position.
Finally, the present study is one of the first to examine grade effects in intervention
response according to different types of reading outcomes. Evidence was provided of
developmental differences in intervention response according to the complexity of the
component reading skills being evaluated. On two measures relevant to metacognitive and
metalinguistic aspects of the Triple instruction (Challenge Words, Multiple Definitions), 2nd
grade Triple children demonstrated a greater posttest advantage relative to controls than 1st grade
Triple children. On an orthographic awareness measure (PIAT spelling), 3rd grade Triple children
achieved a greater posttest advantage over controls than the 1st or 2nd grade participants. On these

outcome measures that require an ability to manipulate linguistic components of written
language beyond the phonological dimension, 2nd and 3rd graders enjoyed some intervention
advantage. On tests of reading comprehension, however, despite robust intervention effects and
large effect sizes, no intervention-by-grade interactions were revealed. This may be attributable
to difficulties in reading comprehension measurement for this age and level of reading skill.

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Tables
Table 1: Participant characteristics at intervention start (n = 219).
Table 2: First Analysis: Results of the mixed model moderated regressions on reading and
language outcomes.
Table 3 Second Analysis: Growth curve model fixed effects for intervention group, grade, and
group by grade interactions.
Table 4: Second Analysis: Individual difference effects and interactions with intervention
condition.
Table 5: Percentage of participants normalized (>90 SS by final Posttest) across four reading
outcomes.

Table 1
Participant characteristics at intervention start (n = 219)
Intervention (n = 172)
M (SD)
Control (n = 47)
M (SD)
Age in months 89.2 (12.2) 91.5 (11.9)
WRMT-R Word Attack Scaled Score 76.6 (9.3) 74.2 (8.2)
WRMT-R Word Identification Scaled Score 81.1 (9.9) 77.7 (11.1)
WRMT-R Passage Comprehension Scaled Score 79.2 (8.9) 76.9 (10.6)
WRAT-III Reading Scaled Score 85.4 (10.0) 79.3 (10.0)
WISC Freedom from Distractibility Index 87.3 (12.6) 83.2 (12.6)
WISC Processing Speed Index 96.6 (15.2) 95.1 (13.8)
Kaufman Brief Intelligence Test 92.6 (10.4) 93.0 (10.6)
Peabody Picture Vocabulary Test 92.1 (13.6) 98.1 (14.9)
Proportion Male .624 .702
Number in Grade 1 79 18
Number in Grade 2 43 13
Number in Grade 3 51 16
Proportion Low Socio-Economic Status .487 .574

71
Running head: EARLY INTERVENTION FOR READING DISABILITIES
Table 2
First Analysis: Results of the mixed model moderated regressions on reading and language outcomes.
Outcome Model
ICC
FaAdj. mean
difference
SE CI Lower CI
Upper
d Grade by
Treatment
F p
Experimental measures
Sound combinations 0.43 58.11 9.17 0.96 7.26 11.08 1.81
Challenge Test 0.23 70.17 16.65 2.08 12.52 20.79 1.82 2 > 1b4.44 .04
Multiple Definitions Trained 0.34 77.73 0.50 0.06 0.38 0.62 1.44 2 > 1 6.05 .02
Standardized/Norm-referenced measures
TOWRE Phon. Decoding 0.12 36.30 6.36 1.07 4.23 8.49 1.39
TOWRE Sight Words 0.10 22.69 8.81 1.74 5.36 12.26 0.57 1/2 > 3c3.91 .05
WRAT-3 Reading 0.11 15.66 4.40 0.59 3.23 5.58 0.91
WRMT-R Word Attack 0.17 75.32 17.48 1.98 13.56 21.41 1.08 1/2 > 3 3.09 .08
WRMT-R Word Identification 0.07 55.34 22.97 2.93 17.17 28.77 0.59 1/2 > 3 3.93 .05
WRMT-R Passage Comp. 0.21 55.69 16.52 2.21 12.13 20.91 0.63
GORT-R Comprehension 0.27 18.23 6.22 1.46 3.33 9.11 0.90
SRI Comprehension 0.27 19.34 7.66 1.74 4.20 11.11 0.64
GORT-R Rate 0.21 23.20 3.86 0.80 2.27 5.46 0.78
WORD-R 0.05 25.06 0.22 0.04 0.14 0.31 0.61
PIAT-R Spelling 0.20 19.23 8.23 1.32 5.60 10.84 0.72 3 > 1/2d7.37 .01
Notes: ICC = Intraclass correlation; a Reports the F statistic for the Intervention versus Control test of posttest adjusted means, all p < .001 after adjustment for
the False Discovery Rate; b Grade 2 adjusted posttest mean greater than Grade 1; c Combined Grade 1/2 adjusted posttest mean greater than Grade 3; d Grade 3
adjusted posttest mean greater than combined Grade ½. All analyses reported in this table were performed on raw scores, unless the measure was from a WRMT-
R subtest, and these were analyzed using W scores.

[Type text] [Type text] [Type text]
Table 3
Second Analysis: Growth curve model fixed effects for intervention group, grade, and group by grade interactions
Fixed Effects Par. CHT WAT WID WPC SRI TSW TPD GRT
Pretest Intercept γ00 4.25** 456.00** 404.05** 439.57** 7.55** 19.31** 4.08** 3.94**
Intervention γ01 0.33 6.27** 9.64** 6.37** 0.46 2.60 0.72 0.65
Grade 1/2 vs. 3 γ02 -4.08** -6.49** -17.46** -10.66** -4.57** -8.01** -1.70** -2.89**
Grade 1 versus 2 γ03 -0.27 -4.84** -17.38** -9.70** -3.21** -6.31** -0.91* -0.83**
Growth to Interceptaγ10 21.87** 25.95** 47.33** 29.76** 12.59** 18.64** 6.21** 7.00**
Posttest Intervention γ11 18.15** 15.80** 19.37** 14.80** 8.61** 9.56** 6.21** 4.23**
Grade 1/2 vs. 3 γ12 -0.85 5.81** 11.79** 5.41** 0.76 2.98** 0.23 0.02
Grade 1 versus 2 γ13 -4.80** 3.99** 15.12** 5.50** -0.12 3.99** 0.28 -0.07
Interv. X Grade 1/2 vs. 3 γ14 0.46 1.18 5.62* 1.30 0.58 2.44* 0.40 0.03
Interv. X Grade 1 versus 2 γ15 -6.88* 0.21 4.98 2.74 -0.92 1.92 1.88 0.66
Followup Interceptaγ20 2.93* -0.69 7.19** 4.21** 3.12** 5.81** 2.38** 2.89**
trajectory Grade 1/2 vs. 3 γ21 0.86* -0.05 -0.62 -0.28 0.22 -0.31 -0.54** -0.07
Grade 1 versus 2 γ22 1.37** 1.32** 0.94 1.56** 0.52 0.68** 0.83** 0.95**
Notes: * p < .05; ** p < .01. a all effects FDR corrected at p < .001. CHT = Challenge Test, WAT = WRMT Word Attack, WID = WRMT Word Identification,
WPC = WRMT Passage Comprehension, SRI = Standardized Reading Inventory Comprehension, TSW = TOWRE Sight Word Efficiency, TPD = TOWRE
Phonemic Decoding Efficiency, GRT = GORT Rate. All analyses reported in this table were performed on raw scores, unless the measure was from a WRMT-R
subtest, and these were analyzed using W scores.
72

73
Running head: EARLY INTERVENTION FOR READING DISABILITIES
Table 4
Second Analysis: Individual difference effects and interactions with intervention condition
Fixed Effects Par. CHT WAT WID WPC SRI TSW TPD GRT
Pretest Phonological Awareness γ00 1.70** 4.04** 4.53** 2.37** 0.63 2.00** 1.53** 0.26
Rapid Naming γ01 2.04** 2.67** 8.44** 6.82** 2.10** 5.71** 0.95** 2.46**
Vocabulary γ02 -0.54 -1.07 1.49 -0.34 0.56 -1.25* -0.33 -0.01
Visual Sequential Memory γ03 -0.90* -0.54 0.52 0.83 -0.03 -0.59 -0.56** -0.01
IQ γ04 1.16 1.47 1.98 1.53 0.93 1.00 0.48 0.09
Growth to Phonological Awareness γ10
Posttest Rapid Naming γ11 -2.62**
Vocabulary γ12 2.55** 3.43**
Visual Sequential Memory γ13
IQ γ14 0.51 -0.09 1.83 0.01 -0.31 1.04 0.71 -0.04
Int. X Phonological Aware. γ15
Int. X Rapid Naming γ16
Int. X Vocabulary γ17 -3.08*
Int. X Visual Seq. Memory γ18
Int. X IQ γ19 10.79** 16.93** 16.36** 11.11** 7.76* 7.58* 6.02* 1.67~
Followup Phonological Awareness γ20
-0.89** -0.63** -0.12*
trajectory Rapid Naming γ21 0.48* 0.66** 0.36*
Vocabulary γ22
2.14**
0.60~
1.95** 1.99** 1.34** 0.33**
Visual Sequential Memory γ23 1.58** 0.85** 0.36* 1.12**
IQ γ24 -1.02* -1.46** -1.92* -1.24**
Notes: ~ p < .10; * p < .05; ** p < .01. CHT = Challenge Test, WAT = WRMT Word Attack, WID = WRMT Word Identification, WPC = WRMT Passage
Comprehension, SRI = Standardized Reading Inventory Comprehension, TSW = TOWRE Sight Word Efficiency, TPD = TOWRE Phonemic Decoding
Efficiency, GRT = GORT Rate; Int. = Intervention. All analyses reported in this table were performed on raw scores, unless the measure was from a WRMT-R
subtest, and these were analyzed using W scores.

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Table 5
Percentage of participants normalized (>90 SS by final Posttest) across four reading outcomes
Triple Intervention Control
Outcome Grade 1 Grade
2
Grade
3
Grade 1 Grade
2
Grade 3
WRMT-R Word Identification 76.3* 52.6* 21.3 38.9 7.7 12.5
WRMT-R Word Attack 77.6* 50.0* 38.3* 27.8 0.0 6.3
WRMT-R Passage Comprehension 67.1* 36.8* 34.0* 29.4 0.0 6.3
SRI Passage Comprehension 40.3 21.6 28.3 17.6 0.0 12.5
SRI Accuracy 61.1* 62.2* 57.8 17.6 7.7 37.5
SRI Reading Quotient 40.3* 24.3* 15.6 11.8 0.0 6.3
Note: * χ2 test indicated that the proportion normalized within grade differed across intervention and control
conditions, p <.05.
74

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Figures
Figure 1 Adjusted posttest (95% confidence intervals) means on TOWRE Sight Words (raw
scores).
Figure 2 Model-predicted WRMT-R Passage Comprehension (W scores) by Grade and
Intervention status.
Figure 3 Model-predicted WRMT-R Word Attack (W scores) by low versus high WASI IQ
scores and Intervention status
Figure 4 Model-predicted multisyllabic challenge word reading scores by low versus high visual
sequential memory scores and Intervention status.

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Running head: EARLY INTERVENTION FOR READING DISABILITIES
Figure 1. Adjusted posttest means (95% confidence intervals) on TOWRE Sight Words (raw scores).

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Figure 2. Model-predicted WRMT-R Passage Comprehension (W scores) by Grade and Intervention status

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Figure 3. Model-predicted WRMT-R Word Attack (W scores) by low versus high WASI IQ scores and Intervention status.

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Running head: EARLY INTERVENTION FOR READING DISABILITIES
Figure 4. Model-predicted multisyllabic challenge word reading scores by low versus high visual sequential memory scores and
Intervention status.

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Appendix
Supplementary Table 1: Flowchart illustrating recruitment, assignment, and intervention for 1st,
2nd, and 3rd grade participants in Atlanta, Boston and Toronto.
Supplementary Table 2: Descriptive statistics for every outcome measure, subdivided by
measurement occasion, intervention condition, and grade.
Supplementary Table 3: The Triple-Focus Reading Program: An overview of Lessons 32, 77, and
106
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Supplementary Table 1
Flowchart illustrating recruitment, enrollment, assignment, and intervention for 1st, 2nd, and 3rd grade participants in Atlanta, Boston
and Toronto
Recruitment and Referral in Schools
416 Participants referred and screened for study
51% were Caucasian and 60% Male.
47 Control
0 ATL
9 BOS
38 TOR
65% Cauc.,
172 Intervention
68 ATL
48 BOS
57 TOR
41% Cauc.
18 Grade 1
79 Grade 1
16 Grade 3
13 Grade 2
51 Grade 3
43 Grade 2
Attrition
17 children enrolled but left prior to start of
intervention; one case receiving intervention had
significant missing data. These 18 cases were not
included in the analysis sample.
14 additional children were lost to attrition between
Enrollment
237 children qualified as RD and participated in study
68 in Atlanta, 57 in Boston, 95 in Toronto

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Supplementary Table 2
Descriptive statistics for every outcome measure, subdivided by measurement occasion, intervention condition, and grade
Pretest
Intervention Control
Grade 1 Grade 2 Grade 3 Grade 1 Grade 2 Grade 3
Sound combinations 1.71 (2.30) 5.91 (4.50) 10.37 (3.98) 2.33 (3.09) 4.58 (4.32) 11.08 (3.55)
Challenge Test 0.01 (0.12) 1.44 (3.03) 13.30 (12.76) 0.00 (0.00) 0.18 (0.60) 11.31 (11.19)
TOWRE Phon. Decoding 1.14 (1.93) 3.14 (3.44) 8.20 (5.22) 0.71 (1.33) 2.08 (3.45) 7.17 (4.32)
TOWRE Sight Words 4.42 (4.20) 18.21 (10.62) 35.75 (12.03) 5.33 (6.31) 14.85 (8.07) 31.00 (11.52)
WRAT-3 Reading 14.61 (2.29) 18.91 (3.39) 23.45 (3.09) 13.72 (3.53) 17.54 (3.23) 23.25 (2.93)
WRMT-R Word Attack 438.28 (7.46) 450.00 (13.65) 466.04 (12.74) 436.44 (6.13) 443.85 (10.80) 468.88 (10.07)
WRMT-R Word Identification 358.90 (15.63) 402.84 (24.51) 440.00 (16.41) 360.00 (18.67) 394.69 (21.48) 428.56 (25.17)
WRMT-R Passage Comp. 412.71 (10.78) 435.7 (17.84) 461.06 (12.45) 413.28 (11.58) 426.69 (15.34) 459.63 (17.81)
GORT-R Comprehension 1.34 (1.81) 3.21 (3.28) 12.20 (8.21) 1.20 (1.78) 4.08 (3.77) 12.31 (8.69)
SRI Comprehension 0.45 (0.64) 6.16 (7.98) 16.71 (10.58) 1.15 (3.29) 4.00 (5.79) 19.42 (11.84)
GORT-R Rate 0.34 (0.67) 2.40 (3.09) 9.29 (5.24) 0.33 (0.62) 2.23 (2.95) 7.25 (4.80)
Multiple Definitions Trained 0.81 (0.29) 0.90 (0.37) 1.24 (0.26) 0.82 (0.33) 0.88 (0.23) 1.19 (0.23)
WORD-R 18.99 (5.04) 29.28 (7.98) 39.96 (10.09) 18.44 (4.03) 27.69 (4.94) 37.38 (9.65)
PIAT-R Spelling 1.71 (2.30) 5.91 (4.50) 10.37 (3.98) 2.33 (3.09) 4.58 (4.32) 11.08 (3.55)
Posttest
Intervention Control
Grade 1 Grade 2 Grade 3 Grade 1 Grade 2 Grade 3
Sound combinations 14.75 (5.27) 18.24 (6.35) 20.20 (4.67) 7.12 (6.36) 6.75 (3.17) 11.56 (5.23)
Challenge Test 15.44 (13.58) 25.71 (14.20) 34.84 (9.43) 4.88 (10.20) 0.58 (1.00) 17.75 (11.65)
TOWRE Phon. Decoding 10.75 (7.05) 11.05 (7.42) 15.71 (6.77) 6.00 (7.16) 2.85 (3.05) 8.13 (5.03)
TOWRE Sight Words 28.49 (12.78) 34.4 (11.86) 47.94 (12.17) 17.13 (11.37) 22.38 (8.91) 37.81 (12.53)
WRAT-3 Reading 24.27 (4.18) 25.79 (3.57) 28.76 (2.61) 19.53 (5.14) 19.85 (2.70) 25.06 (3.66)
WRMT-R Word Attack 474.86 (12.92) 476.88 (11.45) 481.39 (10.38) 455 (17.86) 454.85 (10.33) 469.75 (9.50)
WRMT-R Word Identification 429.73 (20.83) 442.33 (18.79) 461.25 (13.84) 401.28 (30.54) 415.69 (20.55) 441.19 (23.12)
WRMT-R Passage Comp. 453.33 (14.96) 465.86 (14.6) 479.94 (8.13) 435.47 (17.39) 443.00 (16.05) 466.38 (12.98)
GORT-R Comprehension 8.71 (8.06) 15.8 (9.17) 22.28 (8.46) 5.59 (6.19) 6.77 (6.88) 16.13 (10.16)
SRI Comprehension 12.48 (9.51) 19.24 (11.28) 27.9 (10.54) 6.12 (7.36) 7.38 (7.69) 22.44 (11.03)
GORT-R Rate 6.67 (5.57) 9.46 (5.84) 15.59 (6.31) 3.76 (4.01) 4.46 (3.18) 9.8 (5.99)
Multiple Definitions Trained 1.27 (0.35) 1.56 (0.45) 1.80 (0.35) 0.97 (0.29) 0.86 (0.23) 1.19 (0.31)
WORD-R 34.65 (7.53) 41.5 (6.92) 51.37 (10.45) 26.89 (8.30) 32.85 (6.00) 39.80 (8.30)
PIAT-R Spelling 14.75 (5.27) 18.24 (6.35) 20.2 (4.67) 7.12 (6.36) 6.75 (3.17) 11.56 (5.23)

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Lesson 32
Instructional
Components (time)
Lesson 77
Instructional
Components (time)
Lesson 106
Review program goals (e.g., Why is it important to
learn how to read? What do you want to be able to
read?)
Strategy Skills Review #2 (Metacognitive
Dialogue for decoding strategies; e.g., How many
strategies have we learned? When/How/Why do we
use the strategy?)
Metacognition
(3-5 min)
Strategy Skills Review #4 (Metacognitive
Dialogue for all strategies)
Game Plan review (Metacognitive dialogue
selection and application of multiple strategies;
e.g., Which strategy(ies) would you choose to
figure out this word? Why?)
Metacognition
(3-5 min)
Comprehension Strategy Skill Review
(Metacognitive Dialogue to review
comprehension strategies (e.g., What
strategy(ies) are we going to use to understand
text? What is the first thing we do to clarify?
What are the 4 questions we ask ourselves after
reading the beginning of a story?)
New sound: j; Reading Vocabulary: shop, soon,
must, never, hop, talked, was, day, walked, brush,
brushed;
Workbook activities
Sounding Out
(10 min)
Reading Vocabulary: nothing, bine, bin, flower,
anyhow, magic, scream, saying, holding, picked,
spells, you’re, biggest, can’t, salt, doesn’t...side,
hopper, hoper, fine, fin; Story: The Ghosts Turn
on Boo
Sounding Out
(5 min)
Reading Vocabulary: soft, third, first, cried, tried,
could, thud, mountain, eaten, cloud, chop,
shouted, eating, around, stepped, grape,
bananas, grabbed,...disappear, striped, pat hs,
myself, more; Story: Jean Eats Red Bananas
Word identification by Analogy.
Teacher models Rhyming Strategy and introduces
new keywords
Students complete worksheet (e.g., If I know
"luck", then I know "truck".)
Rhyming Strategy
(10 min)
Word identification by Analogy.
Teacher models Rhyming Strategy and
introduces new keywords
Students complete worksheet (e.g., If I know
"page", then I know "stage".)
Comprehension
Instruction
(25-30 min)
Metacognitive comprehension strategies
(predicting, summarizing, clarifying,
questioning) to improve student's engagement
with and understanding of text.
bug, luck, bus
Words of week page, boat, food, fool
The policy took a mugshot of us in the truck.
Teacher Model Sentence
On stage, the goat was in a bad mood and
kicked the stool.
The bug ran out of luck.
Harder Starters squ
Vowel/concepts
Review L-spells (i.e., l-controlled vowels -al, -
ol); introduce -ul (lesson + worksheet)
-ed (past tense); -er (one who) (lesson + worksheet) Affixes di- (lesson + worksheet)
NOTES: Vowels Review vowel combinations: -oo, -ea, -ow, -ie
SPY Strategy
(5 min)
Finding small words in larger words (e.g., I SPY
"base" I SPY "ball". The word is "baseball".
Application Activities
2
(5 min)
Challenge words (multisyllabic words on which
the students can apply the decoding strategies)
Application Activities
2
(5 min)
Focus is on consolidation and automaticity;
alternate activities such as Speed Wizard and
Challenge Words Challenge words
Application to text
The Plot Graph; applying the Questioning
Strategy to Fiction (e.g., At the beginning of a
story, we ask 4 questons to focus our attention on
the important characters and events: the 4Ws:
Who? When/Where does the story take place?
What is the problem?)
Activities to develop vocabulary breadth and depth
(e.g., understanding homonyns, building word
meanings, exploring impact of prefixes/suffixes).
bug, luck (e.g., What does bug mean? What would
someone mean if he says, "This place is bugs me." If
a bug lands on your arm, what do you do?)
Identification of affixes in multisyllabic words
(e.g, I peel off___ at the end of the word. The root is
___. The word is ____. )
Speed Wizard (computer activity to develop
automaticity and fluency)
Minute Story (application of strategies and skills
to text)
Vocabulary
Development
(10 min)
Activities to develop vocabulary breadth and
depth (e.g., understanding homonyns, building
word meanings, exploring impact of
prefixes/suffixes).
Word Web
1
place (A semantic activity that provides a visual
way of illustrating how words are interconnected
and gives visual images to aid memory.)
Peeling Off Strategy
(5-10 min)
1
Each week, 2-4 multiple meaning words were introduced and 1
Word Web was completed
2
Application Activities alternated each day through out program
Flexibility with the variant sounds of vowels,
vowel combinations, and other vowel concepts
(e.g., -ol, -al, ul).
Vocabulary Development
(10 min)
Peeling Off Strategy OR
SPY Strategy
(5-10 min)
Alternate activities that (i) review, consolidate,
and apply all affixes introduced with activities
appropriate to the application of the SPY
Strategy.
Flexibility with the variant sounds of vowels and
combinations. (e.g., I see the double trouble twin -
ow and underline it with two lines. First I try -
ow as in glow; then I try -ow as in cow. I go
when I get a word that makes sense.)
Vowel Alert Strategy
(5-10 min)
Multiple meaning
words
1
bug, luck (e.g., What does bug mean? What
would someone mean if he says, "This place is
bugs me." If a bug lands on your arm, what do
you do?)
Supplementary Table 3
The Triple-Focus Reading Program: An overview of Lessons 32, 77, and 106
Vowel Alert Strategy
(5-10 min)
Identification of affixes in multisyllabic words
I peel off___ at the beginning/end of the word.
The root is ___. The word is ____.
Vocabulary Developmen t
(5 min)
Multiple meaning words
1
Peeling Off Strategy
(10 min)
Activities to develop vocabulary breadth and
depth (e.g., understanding homonyns, building
word meanings, exploring impact of
prefixes/suffixes).
Affixes
Application Activities
2
(15 min)
Instructional
Components (time)
Metacognition
(3-5 min)
Sounding Out
(10 min)
Rhyming Strategy
(15 min)
Words of week
Teacher Model
Sentence
Student Model Sentence

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Acknowledgements
The research reported here was supported by a National Institute of Child Health and
Human Development Grant (HD30970) to Georgia State University, Tufts University, and The
Hospital for Sick Children/University of Toronto.
In Atlanta, Boston, and Toronto, we are especially grateful to the 237 children who
participated in this research for their interest, enthusiasm, and effort. We also gratefully
acknowledge their parents, teachers, and schools for their commitment and support during the
course of this study. The cooperation and contribution of the principals and staff of all the
participating schools, all of whom offered space and opportunities for our programs, are much
appreciated.
In Atlanta, we acknowledge the students and their families from the Fulton County
School system, administrators, participating schools, their principals and staffs, particularly
Susan Grabel; our research teachers—Eileen Cohen, Mary Bucklen, Kim Imbrecht, Victoria
Burke, Heather Lubeck, Cashawn Myers, Judith Mahoney, Nioyonu Olutosin, and members of
our research team- Paul Cirino, Marla Shapiro, Cynthia Martin, Nicole Mickley, Becky Doyle,
Justin Wise, Hye K. Pae, Jennifer Harrison, and Laina Jones.
In Boston, we acknowledge the students and their families from Somerville, Medford,
and Newton School systems, administrators, particularly Alice O’Rourke and Roy Belson,
participating schools, their principals and staffs; our research teachers- Katharine Donnelly-
Adams, Terry Joffe Benaryeh, Joanna Christodoulou, Fran Lunney, Anne Knight, Jill Ludmar,
Jane Hill-Lovins, Andrea Marquant; and members of our research team— Beth O’Brien, Cathy
Moritz, Julie Jeffery, Lynne Miller, Alyssa Goldberg O’Rourke, Chip Gidney, Wendy Galante,
Tami Katzir, Alexis Berry, Laura Vanderberg, Ellen Boiselle, Sasha Yampolsky and Gordon

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Running head: EARLY INTERVENTION FOR READING DISABILITIES
Goodman.
In Toronto, we acknowledge the children and their families from the Toronto District
School Board, the Toronto Catholic District School Board, and the Peel District School Board;
our Senior Teacher Trainer and Program Developer, Léa Lacerenza; our research teachers: Denis
Murphy, Jody Chong, Tammy Cohen, Vicky Grondin, and Steacy O’Connor; and our psychology
assessment team: Jennifer Janes, Jennifer Goudey, Leslie Daniels, Jennifer McTaggart, Jennifer
Lasenby; and our senior research team members—Maria De Palma, Meredith Temple, and the
late Dr. Nancy Benson.