RESEARCH AND PUBLICATIONS
*LearnAbility's staff are highly trained and educated reading, math and language specialists. Read the following publication from our Director Michelle AuCoin, who provides a framework and research on multi-modal interventions - the cornerstone of LearnAbility's programming. Invest in education that is research-based, designed and delivered by qualified practitioners. LearnAbility can provide that for you.
MEETING THE DIVERSE NEEDS OF LEARNERS:
An Analysis of Multi-Modal Interventions for Students with Reading Disorders
Athabasca University, Athabasca AL, (c) 2015
By MICHELLE AUCOIN, DIRECTOR LearnAbility Cape Breton
The old adage “if at first you don’t succeed, try, try again”, can be applied to the treatment and intervention of medical disorders and disabilities. Generally, each patient, client or student responds differently to the type of intervention that is employed by a qualified practitioner in the corresponding field. Examining treatment options is a process of trial and error. If practitioners examine only one option, it limits the possibility of the individual accessing supports that meet their individual needs.
The author, for example, was diagnosed thirty five years ago with idiopathic generalized epilepsy, resulting in numerous medical trials, ineffective medications resulting in dangerous grand mal seizures and significant injuries as a result of the seizures. Yet, a mixture of multiple medications, employed in 2009, resulted in controlled seizures. The supervising neurologist had research that indicated that patients with this particular type of epilepsy had responded well to each of the medications used – Divalprox and Lamotrigine - both individually and as a combination regiment. However, there was no way to know for certain that it would be effective in this particular case. Providing a medical or remedial intervention for any disability or disorder, does not ensure that treatment will be successful. Regardless of the type of disability, interventions are essential if the individual is to have a quality of life and be able to obtain the same opportunities as other persons who are disability free. Learning Disabilities are examined in this context.
Approximately ten percent of the general population, including both adults and children, have diagnosed Learning Disabilities in Canada. (LDAC, 2002)
“Learning Disabilities refer to a number of disorders which may affect the acquisition, organization, retention, understanding or use of verbal or nonverbal information. These disorders affect learning in individuals who otherwise demonstrate at least average abilities essential for thinking and/or reasoning. As such, learning disabilities are distinct from global intellectual deficiency.” (LDAC, 2002)
The Diagnosis of a Learning Disability falls under the DSM-IV-TR (2000) psycho- educational assessment classification of ‘Disorders usually first diagnosed in infancy, childhood or adolescence’ and identifies a discrepancy between ability and performance.
Reading disabilities refer to the reading ability of individuals who, suffering from this learning disorder, measure lower than their expected potential. This falls under the category of learning disorders on the DSM-IV-TR (2000). The question asked here is: what research based methods can be implemented into an integrated program plan or model for multi-modal learning for students with diagnosed reading disabilities? Merriam Webster (2015) defines multi-modal as relating to, having, or utilizing more than one mode or modality. In the context of this research, it is the use of more than one more or modality for reading intervention.
Individuals with Learning Disabilities may have more than one Learning Disability or a comorbid condition like Attention Deficit Disorder. Reading disorders, the focus of this study, are among the most common Learning Disabilities. Students with Learning Disabilities, usually require a combination of supports including: accommodations, individual program plans, interventions or pull out programs, and even behavioral intervention or medical treatment.
The Learning Disabilities Association of Canada points to several sub-types of Learning Disabilities, many of which are reading-based or can impact reading:
-oral language (e.g. listening, speaking, understanding);
-reading (e.g. decoding, phonetic knowledge, word recognition, comprehension);
-written language (e.g. spelling and written expression); and
-mathematics (e.g. computation, problem solving).
Learning disabilities may also involve difficulties with organizational skills, social perception, social interaction and perspective taking. (LDAC, 2002)
Outside of school, parents often have to access supplemental educational assistance in the form of assistive technology or one on one tutoring. A reading disorder is not exclusively a school-based problem. Learning Disabilities are a lifelong condition that is pervasive and limits the individual’s potential for success. According to the Learning Disabilities Association of Canada’s official definition:
The interventions need to be appropriate for each individual's learning disability subtype and, at a minimum, include the provision of:
- specific skill instruction;
- compensatory strategies; and
- self-advocacy skills.
The body of existing research on reading disabilities points to the delivery of individual programs, but not enough information exists on a combination of strategies and programs to build a comprehensive multi-modal learning environment. There was also no available evidence indicating that one specific strategy or method of intervention works best for each child with a reading disability. For this project, it was important to research and analyze some of these approaches individually and then, examine program planning and integration of individual interventions in an integrated or multi-modal setting. It was necessary to review multi modal learning for students with Learning Disabilities, by comparing and integrating the methods used by individual disciplines and approaching this from an interdisciplinary lens.
The acquisition of fundamental reading skills is necessary for the development of functional literacy and ultimately, academic achievement. Learning Disabilities, and specifically within this context reading disabilities, present significant barriers for a student learning to read. Reading deficits generally, in some way, affect all areas of reading development and therefore, it cannot be assumed that a single intervention will be effective for the remediation of the reading disorder. By providing multi-modal interventions, students get access to more options that will potentially help support them
in overcoming reading barriers. Swanson and Hoskyn (1998) argue that “Students with learning disabilities are a heterogenous sample, and no single treatment approach can be recommended for these students.” (278) Furthermore, Lyon, Fletcher, Shaywitz, Shaywitz, B. Torgesen, Wood& Olson, R. (2001) suggest that there needs to be a ‘rethinking’ of learning disorders and that “many of the persistent difficulties in developing valid classifications and operational definitions of LD are due to a reliance on inaccurate assumptions and about causes and characteristics of the disorder. Furthermore we argue that sufficient data exist to guide the development and implementation of early identification and prevention programs for children at risk for LD, particularly reading programs that can benefit many of these youngsters.” (259)
Practitioners in the field of Learning Disabilities include psychologists, educators, behavioral specialists, physicians, occupational therapists, speech-language pathologists, audiologist, optometrists and assistive technology experts. They bring their own recommendations for accommodations, adaptations and remediation. Yet, in reviewing the standards for accommodating Learning Disabled students in Canada, these recommendations cross professional lines, with the institution of programming planning and accountability standards for the Department of Education. Each practitioner provides a unique perspective on the assessment, diagnosis and treatment of Learning Disabilities based on their educational backgrounds. In a program planning setting, for example, their multi-disciplinary expertise is shared. These individual disciplines can only benefit from information on multi-modal intervention, as recommendations for this type of programming can be used within an integrated program plan or model for multi-modal learning.
Types of Reading Supports
Although there are differences in the current model of learning disability identification and support, the underlying framework is often the same. The goal of this process is to not only identify students with learning disabilities in reading, but remediate them accordingly. In the Alberta Learning Teaching and Resources Branch document,
Unlocking Potential: Key Components of Programming for Students with Learning Disabilities (2002) “Students with learning disabilities have the potential to be successful in school and in life. Success is highly dependent upon identifying and understanding an individual’s strengths and needs, and providing appropriate support during the school years.” Important to note here is that understanding the needs and strengths of the individual and not a generic intervention plan, is what is recognized as the standard for unlocking potential. The first step in the evolution of appropriate supports is evaluation, as it provides practitioners with essential information on the needs of the student.
However, much like the physician treating an epileptic patient can base his choice of treatment on research-based interventions and still be unsuccessful, there is no definitive way to know that a specific reading intervention will work for a student, either.
First, there is a broad range of reading deficits. Students may have difficulty with phonological awareness, auditory processing, visual processing, and reading comprehension. This means that learning should be approached in multi-modal formats: oral (speech), auditory, visual, tactile or motor. This also requires the expertise of multiple primary disciplines such as speech and hearing, language, education, psychology and medicine and some additional beneficial disciplinary perspectives from the fields of art, technology and occupational therapy, for example. Secondly, in some cases, students have more than one reading deficit, for example, auditory processing deficits might result in poor reading comprehension. Third, some individuals struggle with other comorbid conditions, like attention or behavioral disorders. Managing multiple deficits or even multiple disabilities results in more barriers to learning for the student and requires more than one intervention. The variety and range of instructional or remedial approaches, accommodations and interventions for supporting students with Learning Disabilities is reviewed here, but is not limited to this group.
Stone (1998) discusses scaffolding as an alternative to traditional classroom teaching for students with LD. He refers to it as a metaphor. The goal of scaffolding is to create a framework for students to work from (like a physical scaffold does) that is ultimately removed once the student develops independent learning. Furthermore, Hammond & Gibbons (2001) explain that “In the context of classroom interaction, the term scaffolding has been taken up to describe the temporary assistance that teachers provide for their students to assist them to complete a task or develop new understandings, so that they will later be able to complete similar tasks alone.” (8)
Price and Cole (2009) argue that differentiated instruction methods are also important forms of teaching LD students. “Effective instruction for students with learning disabilities is explicit and intensive and combines direct instruction with strategy instruction. Effective instruction is strategic and responsive to the specific information processing and learning needs of students.” (31). Price and Cole (2009) refer to five specific forms of instruction which can be applied to reading disabilities and not just learning disabilities in general:
1. Explicit Instruction – This refers to instruction that is clear, systematic and connects easily to other concepts.
2. Intensive Instruction – This is a set time that involves high student engagement.
3. Direct Instruction – This is similar to explicit, but involves breaking down concepts into smaller steps and employing ongoing direction and feedback between the student - teacher.
4. Strategy Instruction – Students are provided with strategies to essentially teach them how to learn. It uses a system of planning, performing and evaluating with the goal of developing greater independence and self-monitoring.
5. Combined Direct Instruction and Strategy Instruction – This method is considered to be the most comprehensive for instructing students with learning disabilities because it is multi-modal in nature. “A meta-analysis of intervention studies by Swanson, Hoskyn and Lee (1999) supported a combined model with the following elements: sequencing; drill-repetition and practice-review; segmentation; directed questioning and responses; controlling the difficulty of processing demands of a task; technology; modeling of problem-solving steps by teacher; instruction in small groups; strategy cues and reminders to use strategies.” This combination of direct and strategy instruction, targeting multiple reading processes, is a multi-modal approach to teaching reading and provides students in this environment with multiple skill instruction. Thus, the chances of a student receiving support with one or more areas of deficit is highly likely.
What Price and Cole (2009) note overall, is that the combination of instruction methods is necessary for LD students, thus recommending multi-modal instruction.
Phonological Awareness is the ability to analyze spoken language and recognize that it consists of smaller units. Lane, Pullen, Eisele, & Jordan (2002) state that it is an umbrella term used to describe awareness of spoken language at the word, syllable, onset-rime, and phoneme level. Phonological or phonemic awareness programs are designed to provide multiple modalities for the development of reading skills. According to Torgensen (2002) “Instructional Approaches that are more phonemically explicit and intensive have the strongest impact on the reading growth of children at risk of Learning Disabilities.” (91)
The Lindamood Phoneme Sequencing program or LIPS (formerly known as the Auditory Discrimination in Depth program) is a speech-based program that utilizes multiple modalities to facilitate reading skills. Speech-Language pathologists and trained educators generally provide the LIPS program in school-based or tutoring settings. As Pro-Ed notes: “Using an oral-motor, visual and auditory feedback system the LiPS program develops the student’s ability to distinguish phonemes in spoken patterns.” (3)
Colon (2005) discusses phonological awareness in depth. To support her arguments, she provides statistical results of what she refers to as limited case studies on the program’s efficacy. In one particular sample by Kennedy and Backman (1998), children of ages 11 – 17 from a school for severe learning disabilities were provided with 75 hours of the LIPS program in addition to the regular remediation program, while a comparative group received only regular remediation. The children who received Lindamood training showed significant difference in their ability to read. Kennedy and Backman (1998) state that, “The Lindamood program was a successful addition to a comprehensive remedial program in terms of improved ability to sequence speech sounds, phonetic accuracy in spelling real and nonwords within this sample of students with severe LD’s.”
In another study by Torgensen, Rashotte, Rose, Lindamood, Conway and Garvin (1999), younger children were placed in one of four teaching settings: 1) phonological awareness plus synthetic phonics, (PASP); 2) embedded phonics (EP) – less phonics, more reading and writing in context; 3) Regular Classroom support (RCS); and non-treatment control group. They received 20 minute sessions, 4 days per week for 2 1⁄2 years starting in Kindergarten with a combination of teachers (47 hours) and aids (41 hours). Note the results in Table A.
Torgensen, J. K., Wagner, R., Rashotte, Rose, E. Lindamood, P., Conway T. & Garvin C. (1999). Preventing Reading Failure in Young Children with Phonological Processing Disabilities: Group and individual response to instruction. Journal of Educational Psychology, 91, 579-593.
The chart demonstrates that PASP (phonological awareness and synthetic phonics – combined intervention) scored higher compared to EP, RCS and NTC. RCS and EP scored consistently the same, while the non-treatment group received minimal gains because no instruction was provided. PASP provided stronger phonemic decoding, word identification and passage comprehension.
The resulting success rate of the LIPS program and other phonemic or phonologically-based programs, like the sample training shown in the graph above, has created the need for these programs in schools around the globe. Phonological awareness, because it is already multi-modal or multi-sensory, could be incorporated into every classroom, targeting all students as they develop their reading skills because phonological awareness is a component of all reading development. These two studies show that utilizing phonological training results in improved reading scores. This is relevant to all students and only one program would need to be installed to create a multi-modal setting. Time is already dedicated to professional development for teachers every school year. A wise use of PD time would be teacher training in phonological awareness training delivery.
Reading Resource and Reading Recovery
Reading Recovery programs are not available in all schools, but normally involve a set of targets for reading based on grade level to the corresponding expected reading level. They are usually an eight to ten week program. Reading resource, however, is available in most schools. It is one on one or small group based and involves direct reading instruction in a method outlined and required by the school or district school board. The student is provided with a set number of hours per cycle and works on improving their reading level. It can include reading, reading comprehension, sight words, spelling and writing. Unfortunately, due to the number of students today needing help with reading. , many schools are unable to fully meet the need.
Pull out programs
Learning Disabilities to be taken out of the mainstream classroom for as little as one class per day and up to as much as most of the day, to work on subjects that are considered areas of deficit. The difference between resource and pull out, is the amount of time spent with a specialized teacher. They are not a form of intervention but a setting. Here, various forms of skill instruction, remediation or compensatory support can be provided, thus in
Pull out programs, much like resource classes, are designed for students with some cases, providing multi-modal support. It depends on the availability of such programming at a school and the format decided by the teachers and administration.
Individualized Program Planning
An IPP is a statement of annual and specific individualized outcomes based on the student’s strengths and needs that is developed and implemented for every student for whom public school programs curriculum outcomes are not attainable or applicable. In the case of students with learning disabilities, all reasonable methods of accommodation
and intervention are supposed to be undertaken before an IPP is decidedly the only alternative for the student’s academic success. IPP is a part of some LD student’s programs but its’ use is different depending upon the province. In Alberta, the IPP is based on adaptations and accommodations or assistive technology, which is discussed below. In Nova Scotia, an IPP is not used as a multi-modal intervention and may or may not include adaptations. It most often a way to lessen the course load, meaning that the student is not required to meet the same curriculum outcomes as other students in his/her grade.
Adaptations and Accommodations
Finally, adaptations and accommodations are a method of compensatory support for LD students in the regular classroom stream.. They can and should work in conjunction with learning strategies to enhance a student’s performance and provide them with equal educational opportunities. They can be technological: computer based software, voice recognition systems, scanned notes or using a computer to write tests or assignments. They can also be adaptive: copies of teacher’s notes, extra time for tests or assignments, oral testing/scribe, proctoring or adapted tests.
Multi-Modal Learning Environments and Integrated Program Plans
As demonstrated, there are more than enough options available for targeting reading disorders and accommodating the specific needs of the LD student. That being said, you cannot create a multi-modal environment without agreements between the professionals involved with the student at all levels.
The right combination of interventions, as mentioned, comes down to the identification of the weaknesses of each student and the choice of appropriate supports in order to create a multi-modal learning environment. This begins with a student’s physician and, therefore, various tests to rule out other potential medical conditions or referrals to other specialists in the fields of: audiology (difficulty processing auditory information), optometry (difficulty processing visual information), child psychology (behavioral or attentional concerns) and/or speech and language (sounds or language). Then, the services of an educational psychologist become necessary in order to determine if there is in fact an LD or other condition, perhaps behavioral, cognitive or attentional. The integration of the knowledge from these individual disciplinarians paves the way for other practitioners working consistently with students. They can view the diagnosis and recommendations and incorporate this knowledge into a program plan. Recall that in many cases, students with LD have more than one comorbid condition and require the input of more than one of these disciplines in order to receive adequate treatment.
Program planning involves the collaboration of parents and practitioners. Specialists in their disciplinary fields and the guardians or advocates for the child, meet to discuss results of any testing, diagnosis, ongoing assessment and feedback from the classroom. The intention is to implement recommendations for learning strategies, accommodations and instructional methods into the student’s profile. This, in theory, gives the student access to an equal learning opportunity based on potential and not previous performance. The process is initiated in this format and a plan is set with, in theory, all practitioners held accountable for its success.
As a sample, in the province of Nova Scotia, the program planning process, outlined in The Program Planning: a Guide for Parents. Department of Student services (2009), developed by the Department of Education, is based on four supporting documents: The Education Act, Public School programs, The Special Education Act and the Canadian Charter of Rights and Freedoms. It is further based on a statement of principles:
- - Right to an Appropriate Education
- - Right to Quality Education and Qualified Teachers
- - Right to an Inclusive Education
- - Teacher’s responsibility (based on the all levels of care but, included in that is program planning, evaluation and implementation).
- - Parents’ responsibility (obligation to the child’s education).
A model of successful support for the student, should not be based solely on plan requirements, but by guiding principles, such as those outlined by Alberta Learning.
Table B: Guiding Principles
• Programming must be based on an individual student’s needs.
• Programming is an active process, which is continuously monitored and adjusted to meet a student’s needs.
• Students with learning disabilities need to participate in the regular curriculum to the fullest extent possible.
• Many practices used to support students with learning disabilities will benefit all students.
• The key components of programming are not discrete; they are processes that work together.
– involves a problem-solving process, and is dynamic, interactive and changing
– requires consistency across settings and grades
– requires teamwork and collaboration (student, parent, school personnel)
– requires ongoing communication
– requires an organizational structure and school culture that support the ongoing implementation of the components
Unlocking Potential: Key Components of Programming for Students with Learning Disabilities (2002). Alberta Learning. Edmonton, AB: Alberta Learning, Learning and Teaching Resources branch.
With an integrated system of accurate evaluation, program planning and guiding principles, the final step, implementing the multi-modal interventions into the classroom or one on one setting, must occur. This requires the initiative of the teacher, the support of school administration, support from the program planning team and the opportunity for
professional development in multi-modal instruction for the teacher and ongoing assessment (accountability and student progress records). As presented, the options for multi-modal strategies and instruction are diverse and many. Various training tools and materials are available to assist teachers and instructors with the application of interventions through school boards, libraries, and even through online resources and webinars. Teacher training, of course, is the most effective way for ensuring that they have adequate knowledge to work in a multi-modal class or one on one setting to teach reading. Teachers deserve that investment.
The only point remaining here is regarding consistency. Is there ongoing follow through or follow up when the program plan is put in place? Who polices this process to ensure that each stakeholder is doing their job fairly and correctly? In all of the research undertaken for this project, there was no specific information available on follow up schedules or accountability measures for the stakeholders. Parents can request meetings and report cards on the students are provided generally three times per year, but teams rarely meet regularly or consistently and there is no information stating that each person on the team is held to standards based on the student’s plan. It seems to be a yearly meeting and often by request. Thus, how do we know for certain that the program plan is, in fact, working? Is it enough for practitioners to work thoroughly together to create the first plan without monitoring it regularly? All research on learning disabilities points to consistency as being the key to successful intervention, once a suitable intervention is found. Added to the program plan process and guiding principles, needs to be measures of professional accountability for the interdisciplinary team.
Parents should request meetings as often as possible to review the program plans. They are entitled to such meetings and this may help to facilitate ongoing communication between stakeholders and better determine whether or not the program is working. Monitoring progress is key here.
The implementation of multiple reading interventions, or a multi-modal learning environment, provides a student with access to one or more strategy(s) or mode of instruction for developing reading skills. Case studies and evidence has been presented, showing the merits of multiple methods, but in no way arguing that one works better than another. In the context of program planning, for students with reading disorders, multi-
modal learning environments must be stipulated because there are many academic areas impacted by poor reading. Through a combination of any of the following: scaffolding, differentiated instruction, phonological awareness, reading recovery, resource, pull outs and adaptations and accommodations, students increase the likelihood of finding strategies and formats that will help them.
By integrating multi-disciplinary perspectives in the program planning process and backing it up with evidence-based information on the student, it is hoped that the team supports the concept of a functional and comprehensive multi modal learning environment for the student with a reading disorder. With that, providing teachers with professional development in areas that will support LD students and offering ongoing support from the program planning team, there is greater chance for student success. Ongoing assessment and good record keeping are recommended to teachers to observe if a student is improving and what strategies are working best for him/her. Technology and rubrics have made record keeping easier and they can easily be incorporated into professional development days. Finally, the greatest measure of a successful multi-modal environment is the regular follow up and review of the goals outlined in the initial program plan, with revisions where necessary. It does not have to be complicated, just comprehensive.
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