Pilot Research Study Proposal Interventions for a Student with Dyslexia & Dysgraphia

EEX6625 November 12, 2011

Bernadette Harris University of North Florida College of Education & Human Services Graduate School

There have been numerous studies conducted with single or multiple subject designs. Five are cited herein for proposed interventions for this study. In a study conducted by Crouch & Jukubecy (2007), simple interventions in literacy instruction and motor skills were used to address dysgraphia in a single subject. The researchers implemented handwriting and letter naming drills, as well as physical exercises to improve fine motor skills. The results of this study were inconclusive; however, overall handwriting was slightly improved. In a second study by Jumani, Rahman, Dilpazir, Chishti, Chaudry & Malik (2011), similar methods were introduced. These researchers conducted a multiple subject experimental design for their research. They divided subjects with dyslexia into a control group and an experimental group. Both groups were taught under identical conditions, with the control group receiving standard literacy instruction and the experimental group receiving standard instruction and specific interventions. The interventions were one-onone word and reading drills both orally and in written worksheets, as well as paired reading activities. A pre-test was administered before interventions were implemented in the experimental group. The post-test at the conclusion of the study indicated marked improvement in the reading skills of the experimental group. Kohnen, Nickels and Coltheart (2010) conducted a similar study to the two aforementioned, but focused their study on spelling and word semantics. They used explicit instruction in phonics and teaching their subjects language and spelling ‘rules’ giving names to letters and to sounds, to help the students differentiate when certain letters create more than one sound depending on their use. This was done to address the working memory deficit associated with dyslexia and dysgraphia. Subjects with these exceptionalities have been found to have a physiological breakdown in the working memory as language and word patterns are being processed. The subject first was taught very basic words monosyllabic words and their “rules” and then moved onto more difficult words. He first had to respond and repeat the words, letter sounds and rules and later had to pick them out in written text. At the conclusion of the study, the assessment data showed significant improvement in spelling of learned words, but inconclusive improvements in unlearned words. The subject’s reading fluency improved marginally, as well. In a study conducted by Kipp and Mohr (2008), memory deficits in subjects with dyslexia/dysgraphia is also addressed. This was a single subject design, with a control group of 16 subjects and an experimental group of a single eight year old subject with dyslexia and dysgraphia. At the onset of the study, the student could only accurately name 8 out of the 26 letters of the alphabet. The method of intervention was to begin with letter sound and letter identification drills, with letters presented in both lower and upper case, then move onto words of increasing difficulty. Books were made out of each three sets of letters, and later by words. The student first had to look at and name the letters (or words) and later locate and name them in printed texts. The interventions were broken into two periods, with a delay between the two in order to measure consistency.

The researchers noted that the subject’s fluency decreased significantly when there was a long period between practices. With regular practice, the subject was able to accurately name and recognize as many as 16 of the letters on a regular basis. In a seemingly more comprehensive study by Beringer, Raskind, Richards, Abbott & Stock (2008), a multidisciplinary approach was taken to address all aspects that research suggests play a role in dyslexia. This includes the need for extensive and intensive literacy instruction not only in phonology, but in aspects such as speech development and working memory which affect language acquisition in a more intricate way for subjects with dyslexia. Their study addresses all physiological aspects of dyslexia as well as all of the whole language components to be considered in literary instruction. For this reason, their interventions included drills in phonics and semantics, but also expanded into morphology and understanding meanings of words as well as word structure. Tools such as word maps to link sounds, letters and meanings were used in an effort to help synthesize information for the subjects. In another research study by Egan & Tainturier (2011), 28 students with dyslexia and dysgraphia participated in a study to examine whether there was a deficit in their spelling of past tense verbs, and words with r- p- and t- verbs. The control group was given instruction in a regular class setting, where the experimental group was given theirs in a one-on-one setting. Testing included several components, including a regular written test where students were asked to write the verbs into spelling booklets, then were given oral tests with words given alone, in sentence context, and found both phonologically plausible and implausible errors. As part of the study, an examination in short term memory processing of words was given also. The experimental group (the dyslexic/dysgraphic students) scored significantly lower in the forward-given short term memory test. Students were also asked to spell words orally, and were measured for their phonological and morpheme accuracy. Extensive testing data was gathered and analyzed, and the results showed that dyslexic/dysgraphic students use very different strategies to apply or memorize spelling or words than the control group. Part of the reason for this was identified as the non-dyslexic/dysgraphic students (control group) being able to memorize lexical (syntactic) patterns of most words. These findings reinforce those found in many previous studies, including those mentioned above, that ascertain that dyslexic/dysgraphic students need diverse and explicit instructional methods in order to improve their reading and spelling. In a study by Berninger, Nielsen, Abbott, Wijsman, & Raskind (2008), 122 students who tested positive for dyslexia were placed into a control group and an experimental group to examine spelling problems of the two groups of students, over a ten week study. The purpose of the study was to examine the dyslexic students’ impairment with automaticity of word recognition and ability to write words fluently, and its effect on their ability to compose written composition. It was also to do away with the belief that people’s writing skills are solely dependent on their motor ability. To test the motor skill factor, two tests were given; the first a grapho-motor test where the student’s thumb is touched to each finger in succession and the test is timed, and an oral-motor test where contrasting syllables of words are given orally.

Next, the researchers referred back to a previous study conducted by Wolf, Bally & Morris which documented a considerable deficit in Rapid Letter Naming (RLN) in subjects with dyslexia. RLN is said to be one of the greatest predictors of reading and writing skills in people with dyslexia. The hypothesis formed in this study was that the automaticity deficit in students with dyslexia (as evidenced by a deficit in RLN) is a significant contributor to their ability to write, more so than a simple motor skills deficit. After using a battery of tests by Weschler & Grey, the results indicated that dyslexics did not show the same relationship between automatic letter writing and written composition as non-dyslexics did. This is probably due to the fact that they must find alternative methods for mastering these skills, since their memory processing deficit deters them from becoming fluent in spelling by conventional methods. The researchers concluded that students with dyslexia need to have accommodations AND explicit instruction and should not be dismissed from intervention programs simply because their reading ability improves. They concluded that additional explicit instruction in phonics and syntactic morphology in language is necessary in order for these students to become effective in their writing abilities. In another study performed by Dujardin, Etienne, Contentin, Bernard, Largy, Mellier, LaLonde, & Rebai (2011), two types of dyslexia were defined in order to test diversions in phonological VS surface dyslexia. Researchers defined surface dyslexia as “a deficit in the lexical pathway of the Dual Route Cascaded (DRC) model, leading to difficulties in reading irregular words but not regular words or non-words, orthographic representations, judgments in correct spelling, reading comprehension and in visual implicit memory. In contrast, phonological dyslexia, one of its most common types with high levels of specificity and robustness, is defined as impaired reading of pseudo-words and infrequent words with relative sparing of real and common words.” In the study, subjects with surface dyslexia made more errors in spelling than those with phonological dyslexia. Behavioral issues identified in subjects with phonological dyslexia include weak phonological awareness and short-term memory deficit. The study included research stating that phonological dyslexia itself has also been broken down into six separate subgroups as well! A control group of 29 non-dyslexics and 23 dyslexics participated in the study, which consisted of a lexical test given on computers in a dark room, where participants clicked one of two buttons with a mouse to identify words that did/did not exist in their language (which in the case of this study was French). The test measured the brain hemispheres against the responses, and analyzed the data. In the dyslexic group, results found that attention deficits affected and processing impairments of verbal stimuli affected orthographic and phonological ability. Delayed information processing speeds was shown in the group with phonological dyslexia which would affect auditory ability as well. These results again determine that explicit additional instruction in phonemic awareness and language processing are necessary to improve spelling ability in students with dyslexia. A unique study by Adi-Japha, Landau, Frenkel, Teicher, Gross-Tsur, & Shalev (2005) investigated writing and spelling deficiencies in students with ADHD in relation

to identifying whether students with ADHD have dysgraphia. A control group of nonADHD boys was used in the study, along with an experimental group of 20 boys diagnosed with ADHD. Reading tests for speed, fluency and letter naming were given, along with a spelling test. Tests were analyzed not only for spelling accuracy but for graphemic errors, motor pattern errors and spatial disorders. Motor production was tested by having students write words with repetition. Results indicated that the experimental and control group performed similarly in reading speed, letter naming and phoneme manipulation. However, although the ADHD group performed well on the reading assessment, they performed very poorly in spelling. The ADHD group also frequently omitted, inserted and transposed letters in all tests. Their writing took longer due to many corrections being made and was inconsistent in letter and word production, size, etc. The researchers concluded that the deficiency in spelling and word formation was due to nonlinguistic deficiencies in processing and attention, and only minorly affected by motor skill deficiency. The researchers concluded that ADHD students require additional instructional help with written language skills. They suggested implementation of word processing software to aid in letter formation, in addition to the use of spell-check programs to assist with spelling deficiencies. An additional study by Georgiou, Protopapas, Papadopoulos, Skaloumbakas & Parilla (2010), researchers examined the temporal processing, or rapid auditory processing abilities of students with dyslexia. The method used in this study was to present a control group of non-dyslexic students and an experimental group of dyslexic students with two sound tracks with equal modalities and durations but different “rise times”. The students were to identify which sounds had a sharper beat (aka shorter “rise time”). Next, they were given laptop computers and instructed to hit the mouse every time they heard a tone through their headphones. Phonological processing was tested with students being asked to say words without saying one of the word parts (such as an affix). Timed reading fluency tests were given to test auditory processing fluency. The results of the study indicated that although dyslexic students did not show a deficit in identifying sound beats, they showed difficulty with reading fluency and identifying auditory sound rises. They found the difference in rapid auditory processing to show little difference between the control group and experimental group. I found these results quite interesting, as they are in stark contrast with the results of all of the previous research studies cited in this paper. This was the first study I found that determined little if any difference in rapid auditory processing in dyslexic and nondyslexic subjects. In another study by Berninger, Winn, Stock, Abbott, Eschen, Lin, Garcia, Anderson-Youngstrom, Murphy, Lovitt, Trivedi, Jones, Amtmann, & Nagy (2008), two instructional experiments were used to evaluate the effectiveness of conventional writing instruction for students with dyslexia. Students were given spelling assessments, and were then taught strategies for planning, writing and revising narrative and expository texts. The treatment resulted in improved writing and spelling ability. In the second phase of the study, students were given explicit instruction in phonological working memory training, phonologic-orthographic spelling methods and science report writing.

This treatment resulted in significant improvements in both reading and spelling in students with dyslexia. Hands-on, engaging, problem solving instructional activities produced more improvements in phonological working memory skills than specialized phonological instruction alone. The researchers stated that they found it “surprising” that the hands-on problem solving activities produced more improvement than phonological instruction and drilling did. As an educator, I find this to be exactly what I would expect from this study, since students learn in diverse ways, and as educators we are aware that the more of our senses that we engage in our learning, the more meaningful and lasting that learning becomes! The study also cited that instructing dyslexic students in grades 4 and above is the most challenging because these students have transcription problems that they must learn to overcome at the same time they are expected to produce grade level written composition. Recommended interventions were Writers’ Workshop, use of word processing software programs for writing, one-on-one writing instruction including frequent teacher “cuing”, guided writing activities with visual aids, and explicit one-on-one orthographic spelling activities with index cards, as well as additional small group instruction. All of the methods used follow the Response To Intervention (RTI) Model, which is most commonly used in public schools in the U.S. currently. The methods fall under “Tier III” of RTI. Another study conducted by Berninger, Nielsen, Abbott, Wijsman, & Raskind (2007) examined gender differences in reading and writing skills in 122 children and 200 adults with dyslexia. The males in the study were found to be more deficient in handwriting, spelling and composing than the females. The males were also more impaired in their reading accuracy and fluency rates, as well as orthographic skills. The researchers have stated that orthographic rather than motor skills may be the key to the gender difference. Testing included verbal reasoning, alphabet writing from memory, Weschler spelling assessment (WRAT III), and WYAT II written composition assessment, Woodcock Reading Memory Test, Gray Oral Reading Assessment and the Wagner Comprehensive Test of Phonological Processing. In the children tested, gender differences were evident in writing but not reading. The writing deficits were in handwriting and automaticity and written expression, and automatic letter naming. Significant gender differences were found in both orthographic and phonologic tasks. In the adults, there was some gender difference in oral reading and written expression, but the differences were marginal. There were significant gender differences in spelling, with males showing more impairment. Their recommendations for interventions are instructional focus on automatic letter writing and phonological spelling and transferring these skills to written composition. Automatic letter naming ability may affect how well spelling instruction can be transferred to spelling in writing composition. Explicit instruction in selfmonitoring and regulation is recommended as well, and frequent progress monitoring. In an earlier study by Berninger, Rutberg, Abbott, Garcia, Anderson-Youngstrom, Brooks & Fulton (2006), researchers evaluated Tier 1 and Tier 2 (RTI) interventions for handwriting and composing on the critical skills needed in first through fourth graders for

high stakes testing. The first part of the study found that neurodevelopment training activities in orthographic and motor skills improved letter formation and handwriting legibility, but direct instruction with visual and verbal cues improved automaticity in handwriting and led to improved reading. The second part of the study found that neither motor skill nor orthographic instruction alone improved handwriting or composition. The third part of the study showed that adding handwriting instruction improved handwriting but did not improve reading ability in at risk students. The researchers concluded that comprehensive explicit instruction including exercises in phonologic awareness, small group instruction such as Writers’ Workshop, one-on-one drill and differentiated assignments are necessary for addressing early intervention in dyslexic students. In another study by Mihandoost, Elias, Nor & Mahmud (2011), researchers sought to examine the impact of an intervention program on motivation and reading fluency in dyslexic students. The subjects were fourth and fifth grade male and female students with dyslexia. They were divided into a control group and an experimental group, with the experimental group receiving the Barton intervention program for a period of three months. The Reading Motivation Scale and Reading Fluency Test was used both pre- and post- intervention. The Barton intervention system is a ten level reading and spelling program with lessons and procedures for each level. In this study, only Level I and Level II were used. Tools included color-coded letter tiles, word lists, letter cards, a whiteboard with markers, and a dictation notebook for each participant. There were 36 sessions over a 12 week period completed. The results indicated that the Barton intervention program had a significant impact on improving both reading fluency and reading motivation in students with dyslexia. These findings are consistent with those found in previous studies mentioned herein, which identify more explicit instructional strategies that are necessary for improving reading and writing skills in dyslexic students. Helland, Tjus, Hovden, Ofte & Heimann (2011) conducted a longitudinal study to examine the effects of two different intervention principles on children at risk for developmental dyslexia. The “bottom-up” intervention begins with sound (phonemes) and moves to meaning (morphemes), with the “top-down” going the opposite direction with instruction. The subjects were placed into four subgroups: top-down at risk, bottomup at risk, top-down control and bottom-up control. All subjects were preassessed for phonological awareness, working memory, verbal learning and letter knowledge. The results indicated that the control group scored significantly above norm after the interventions. For the at risk groups, the bottom-up intervention had the strongest effect on phonological awareness and improved working memory, where the top-down intervention showed the most improvement in verbal learning, letter knowledge and literacy scores. The researchers concluded that bottom-up strategies are best to improve pre-literacy skills and top-down strategies for improved literacy training.

Participants in the Study: JL is a fifth grade student with both dyslexia and dysgraphia. He cannot complete written or word processed tasks accurately, even with assistance. He can dictate information to be recorded by an outside party. Participants in this study will include JL, his regular classroom teacher, who will continue his regular classroom instruction, and the ESE teacher who will implement intensive interventions outside of the classroom, and will make modifications to the student’s current Individual Education Plan (IEP) based on these interventions. Setting: The study will begin being conducted within the regular inclusion classroom. For pullout services, JL will be given interventions in the ESE classroom. Target Behavior: Spelling, as part of written communication skills, is critical to JL’s future success as an active contributor to society. The target behavior for my research study is for JL to be able to spell third grade level spelling words with 70% accuracy Research Question: Can implementing letter, letter sound and word drills using flashcards from Lindamood Bell’s Seeing Stars program improve spelling skills in a child with dysgraphia and dyslexia? Proposed Design: The proposed research design is a single subject design using a rate of correct responses in a given time frame before and after implementation of intervention for data collection. Methods of Intervention: Regular Instruction Time: JL will spend the first 20 minutes of his 90 minute reading block receiving regular direct instruction from his classroom teacher daily. This will include the mini lesson on reading strategies and applications, word work, vocabulary and spelling. He will continue to be given a modified spelling list according to his current IEP. The remaining part of reading block on Tuesdays and Thursdays, JL will work in small guided reading group with classroom teacher and other students. Intervention: On Mondays, Wednesdays and Fridays, the ESE teacher will come into the classroom and work one-on-one with JL on sound, letter and word drills to improve his spelling. This will be done using flash cards and tracking forms from the Linda Moodbell Seeing Stars for Early Literacy curriculum. The ESE teacher will begin by using the least complex letter and letter sound cards, tracking the rate of correct answers in the 30 minute time period. Once JL has reached 70%, the ESE teacher will introduce the next set of cards. These are numbered and boxed in a series that graduate from least to most complex, beginning with single letters and phonemes, moving to monosyllabic words to multiple syllable, more complex words that eventually reach a Grade 3 vocabulary level.

Since JL has an accommodation in his current IEP that allows him to use a word processor when needed, after he successfully spells one set of letter/sound/word cards with 70% accuracy, he will be given a set of 10 of those words orally and asked to type them on his mini laptop. The scores on these assessments will be compared to his accuracy rates when naming the letters/words. Data Collection: The ESE teacher will use the rate of correct responses/30 minute time segments as baseline data. The ESE teacher will also record the % of accurately spelled letters/sounds/words on the assessments given on the mini laptop. They will transfer this information to a cumulative graph in order to compare the accuracy of oral responses vs. those typed on the mini laptop. For this type of graphing, a bar graph to differentiate activities would be best. A line graph with subcategories for each intervention tracked could be used as well. The regular classroom teacher will take anecdotal notes, and samples of regular classroom assessments to compare with the data collected by the ESE teacher. Interobserver Agreement: The classroom teacher and ESE teacher will compare their data, looking for patterns and creating a progress monitoring plan for JL to address the onset of the interventions and use time bound goal setting to track progress and improvement as the interventions are made.

Interval Observations (Baseline Data) Codes: T = time observed ST= student task A= accuracy achieved

Monday
10/24 T = 30 ST= writing narrative composition with paper & pencil with teacher prompting A= < 30%

Tuesday 10/25
T = 30 ST = writing narrative composition with paper & pencil with teacher prompting A = < 25%

Wednesday 10/26
T = 20 ST= paired writing of narrative composition with paper & pencil

Thursday 10/27
T = 40 ST = student dictating words for narrative composition with teacher recording on pencil & paper

Friday 10/28
T= 15 ST= 20 word spelling assessment taken on student mini laptop, modified list as per IEP A = 10%

10/31 T = 30 ST= writing narrative composition with mini laptop with teacher prompting A= < 25%

A = < 30% of student’s A = 70% writing, but 90% of partner’s writing 11/01 11/02 11/03 T = 30 T = 40 ST = writing ST = student narrative dictating composition words and with mini parent word laptop with processing on partner student’s mini laptop A = < 50% A = 90%

11/04 T= 15 ST= 20 word spelling assessment taken on student laptop, modified list as per IEP A = 10%

Intervention Data: Description of Problem: diagnosed dyslexia and dysgraphia; inability to spell or compose written assignments accurately Setting(s) in which interventions occur:: ESE classroom, pull out service
Frequency: Daily Intensity: requires

one-on-one drills in letters, sounds, phonemes, blends, digraphs and monosyllabic words 3X per week as a pullout service with ESE coordinator / intervention team
Duration:

30 minutes 3 times per week during language arts block

Describe Previous Interventions: modified

written assignments to word processing on mini laptop, modified spelling lists for assessment, modified length requirements for written assignments, allowing dictating content to a scribe to complete written assignments, oral spelling assessments
Educational impact: student

is unable to demonstrate ability to spell or write words, or complete grade level language arts assignments due to exceptionality

Function of Behavior: Specify hypothesized function for each area checked below. Affective Regulation/Emotional Reactivity: JL is generally withdrawn and seems to not want to draw attention to his exceptionality in the classroom. He becomes discouraged and even more withdrawn when he cannot complete written tasks Cognitive: JL’s comprehension of material seems to be at or above grade level; he understands genres and writing assignments, prompts, parts of the writing piece (such as introduction, body, etc). He is also able to create storylines and dictate stories to be written down, even though he cannot accurately do the writing part himself. Reinforcement: Encouraging JL as he produces stories orally, giving specific praise for this word choice, etc. has seemed to help him open up more and become a bit less withdrawn socially. He interacts more freely with me (his teacher) as he seems to understand that I recognize his limitations as well as his ability to overcome them. Antecedents: When JL has shut down completely from attempting any form of working on or completing assignments, it seems to have been when he felt they

were out of reach for him, or he simply couldn’t do them. This would include spelling assessments or reading of readers’ theater scripts or other reading materials being read either as a writing prompt or an introduction to a written assignment. Consequences: It is very difficult to grade JL in language arts due to the fact that many of the regular assignments for his classmates have to be “omitted” from his grade book, since he cannot do them. He is not currently participating in any written or oral spelling assessment because he has not demonstrated any ability to do so due to the dyslexia and dysgraphia. His current grade is based solely on material he has produced by dictating his writing assignments to a scribe, and participating in partnered and group discussions about reading materials. His exceptionality affects his reading fluency and comprehension as well. Physiological/Constitutional: The regular classroom teachers, JL’s mother and the ESE coordinator suspect, although currently undiagnosed as such, that JL also suffers from mild autism and OCD. Communicate need: JL’s need for written communications skills and improvement in reading skills are critical to his future success. Curriculum/Instruction: JL is receiving all classroom instruction via a standard viable curriculum selected by his school. Included in the reading curriculum, the Imagine It series are suggested reading interventions such as those JL was previously receiving (noted in the previous interventions section). He participates daily in guided reading activities and small group intensive reading instruction. During the pilot research study, JL received the additional intervention of being pulled out of the regular classroom by the ESE teacher three times a week for 30 minutes during which time he receives one-on-one language drill practice on improving phonemic awareness, letter sounds and patterns, word semantics and syntactics and word patterns, using the Linda Mood-Bell Seeing Stars for Early Literacy program. This program includes a series of letter, letter sound, blends, digraphs and word flash cards which increase with difficulty as the student successfully masters each set. The cards are held in front of the student for 20 seconds and then taken down. The student says the letter and letter sound. If the student is accurate, the teacher compliments him and moves onto the next letter/sound/word card. If he is only successful on PART of the word or phoneme (such as the onset), the teacher says, “Good job on the _____. When you say _____, what letter/sound do you hear (in the middle/end) of the word?” The student gives a response. If he/she is successful, the teacher compliments him/her and moves on to the next card. If not, the teacher says, “When you say _____ (incorrect sound or letter), it sounds like __. Can you air draw what it looks like?” The student traces the letter in the air with his/her finger. Then the teacher shows the original card and helps correct the error in sound as well as the formation of the letter/sound if that is wrong as well. The series of cards is set up in sets of 200 and goes through all letter/sound and “sight words” up to grade level 3 or 4. They increase with difficulty to help with mastery and each builds upon the other.

Pilot Results:
Dysgraphia & Dyslexia Interventions
100 Accuracy % 80 60 40 20 0 1 2 3 4 5 6 7 8 9 10 Observation #

The graph above represents the results of 10 observations of JL’s accuracy in spelling words he has been learning during his one-on-one time with the ESE teacher. These were collected over a four week period. As the graph demonstrates, the effectiveness of the intervention was inconclusive, as JL’s accuracy continues to remain inconsistent over the span of 10 observations. Conclusions: Based on the results of the intervention, the following conclusions were made: • • • • JL’s spelling did improve significantly during two intermittent observations JL’s improvement after the intervention was inconsistent People with dyslexia and dysgraphia of a severity equal to that of JL’s may need additional interventions in order to significantly improve their ability to spell accurately Further research is needed in order to determine the effectiveness of using Linda Mood-Bell’s Seeing Stars for Early Literacy to improve spelling accuracy in students with dyslexia and/or dysgraphia

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Helland, T., Tjus, T., Hovden, M., Ofte, S. & Heimann, M. (2011). Effects of bottomup and top-down intervention principles in emergent literacy in children at risk of developmental dyslexia: a longitudinal study. Journal of Learning Disabilities (44)2, 105-122. Jumani, N.B., Rahman, F., Dilpazir, N., Chishti, S. Chaudry, M. & Malik, S. (2011). Effectiveness of remedial techniques on performance of special students in the subject of English. Journal of Language Teaching and Research (2) 3, 697-704. Kipp, K.H. & Mohr, G. (2008). Remediation of developmental dyslexia: tackling a basic memory deficit. Cognitive Neuropsychology (25) 1, 38-55. Kohnen, S., Nickels, L. & Coltheart, M. (2010). Training ‘rule-of-<E>’: further investigation of a previously successful intervention for a spelling rule in developmental mixed dysgraphia. Journal of Research in Reading (33)4, 392-413. Mihandoost, Z., Elias, H., Nor, S., & Mahmud, R. (2011). The effectiveness of the intervention program on reading fluency and reading motivation of students with dyslexia. Asian Social Science (7)3.

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