Professional Documents
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C 2001, The Division for Learning Disabilities of the Council for Exceptional Children
Copyright
Roscoe A. Dykman
Arkansas Childrens Hospital
The double-deficit theory of reading disability (Wolf & Bowers, 1999) was examined in a
sample of 56 reading-disabled and 45 normal-reading elementary school children (aged 8 to
11). As hypothesized, the two groups differed markedly on all phonological analysis tasks
and on rapid continuous naming of digits and letters (the double deficits), but they differed
as well on orthographic tasks, attention ratings, arithmetic achievement, and all WISC-III
factors except perceptual organization. Within the reading-disabled (RD) sample, children in
the double-deficit subgroup were no more impaired in reading and spelling than those with a
single deficit in phonological analysis, and those with a single deficit in rapid naming were
no more impaired than those with neither deficit. Multiple regression analyses suggest that a
multiple causality theory of RD is more plausible than a double-deficit theory.
Numerous reports in the past decade document phonological impairments in children who experience difficulty learning to read and spell (see reviews by Goswami & Bryant,
1990; Pennington, 1991; Wagner & Torgesen, 1987). Many
researchers consider phonological impairment to be the
major deficit, and a few theorize it may be the only proximal
cause of reading failure (Gough & Walsh, 1991; Stanovich,
1992; Tunmer & Hoover, 1992). Gough and Walsh (1991)
state that children have to learn the cipher (i.e., that sounds
map onto letters) in order to become proficient readers. They
concede that children do learn to read perhaps hundreds of
sight words well before they master the cipher, but argue that
it is hard to acquire an adequate reading vocabulary without
the cipher. They further posit that word-specific knowledge
(needed to pronounce nonphonetic exception words) can be
acquired only with the aid of the cipher.
Perhaps the most stringent measure of the cipher is ability to pronounce nonsense words (Goswami, 1993). Indeed, in
a large sample of elementary school children with reading or
attention disorders, we (Ackerman & Dykman, 1993) found a
correlation of 0.85 (p < 0.001) between number of real words
and number of nonsense words successfully read. Both real
and nonsense word-reading levels were best predicted by the
same set of underlying variables: age and verbal IQ (forced
first), plus sensitivity to rhyme and alliteration as measured
by Bradleys (1984) auditory oddity task, continuous naming
speed (Denckla & Rudel, 1976; Wolf, 1991), and an auditory
echoic memory measure (Cohen & Netley, 1981). Thus, our
data support the Gough and Walsh position in that children
who can read short nonsense words can read real words proficiently; that is, they have the cipher, to use their term. But,
our data further suggest that in order to master the cipher, the
Requests for reprints should be sent to Peggy T. Ackerman, C.A.R.E.
Unit, Department of Pediatrics, Arkansas Childrens Hospital, 800 Marshall
Street, Little Rock, AR 72202.
METHOD
Participants
Two groups of elementary school children (aged 8 to 11)
served as participants. The reading-disabled (RD) group
(N = 56) included 23 Caucasian boys, 13 African-American
boys, 17 Caucasian girls, and 3 African-American girls. The
normal-reading (NR) comparison group (N = 45) included
25 Caucasian boys, 2 African-American boys, 13 Caucasian
girls, and 5 African-American girls.
The reading-disabled children were referred to the project
from several sources: The Child Psychiatry and the Dennis
Developmental Clinics at Arkansas Childrens Hospital
(ACH), local child psychologists, and local schools. Letters
describing the project were mailed to all these sources and
referrals were invited. The control children were recruited
via advertisements placed on bulletin boards at ACH.
All children considered for selection had to be in good
health with no limiting physical disabilities, and they had
to have had normal schooling opportunities. Additionally,
all had to speak English as a first language. Parents signed a
153
Behavioral Data
Subjects were not excluded for a known or suspected diagnosis of Attention Deficit Hyperactivity Disorder (ADHD).
However, any child taking stimulant medication was required
to omit the medication on the day of testing. The accompanying parent was asked to complete the Child Behavior Checklist (Achenbach, 1991) and an ADHD questionnaire adapted
from DSM-IV. The questionnaire listed 18 symptoms, with
severity of each to be rated on a 4-point scale (0 = not a
problem, 1 = just a little, 2 = pretty much, 3 = very much).
The first 9 items assessed problems with attention, the next 5
assessed overactivity, and the last 4 impulsivity.
154
Phonological Decoding
The 1- and 2-syllable pseudoword lists of the Decoding Skills
Test (Richardson & DiBenedetto, 1985) were given to each
child. The child sees a series of cards with 5 pseudowords on
each card and is asked to pronounce each item. There are 30
1-syllable and 30 2-syllable items. Testing is discontinued on
each list when the child makes 5 consecutive errors.
Orthographic Skills
Four tests assessed the childrens recognition of written orthographic patterns.
Part 1 of a written test of rhyme recognition utilized orthographically similar (regular) word-word or word-nonword
pairs (for example cat, hat; fat, zat), 20 of each type. Foils
were orthographically similar but nonrhyming words (e.g.,
cat, car) and nonwords (fat, fav), 20 of each type. The
completely randomized list was presented to the child and he
or she was asked to highlight the pairs that rhymed. In Part
II of the rhyme-recognition test, the word-word pairs were
orthographically dissimilar; 20 rhymed (e.g., blue, new) and
20 did not (e.g., rows, hole). The children were given as
much time as they needed to complete these tests.
Another task assessed spelling recognition. Ten graded
lists of 10 stimulus trials were used. The lists sampled from
preprimer, primer, and 1st- to 7th-grade master lists. The
child was asked to highlight the real word in each trial. One
foil was a phonologically legitimate spelling of the real word
(a pseudohomonym) and the other foil was not. For example,
a trial from the 1st-grade list was room, rume, ruom; a trial
from the 4th-grade list was blays, blaze, blais. Testing was
discontinued at the level where the child got fewer than 5
correct answers.
A second spelling test assessed the childs ability to spell
irregular words relative to regular words at his or her spelling
level ability. The word lists of the Boder-Jarrico Test (1982)
were used here. If a childs spelling grade level on the
WIAT was grade 2, for example, we asked the child to
write the spellings of 10 words from the grade 2 reading
list; 5 were phonetically regular words and 5 were irregular
words.
Normal Reading
(N = 56 )
(N = 45 )
Measure
Mean
SD
Mean
SD
t(99df)
Age (months)
WISC-III
Verbal IQ
Performance IQ
Full Scale IQ
Verbal
Comprehension
Perceptual
Organization
u Freedom from
Distractibility
Perceptual Speed
ACID pattern
WIAT
u Reading ss
u Spelling ss
Arithmetic ss
WRAT
u Reading ss
u Spelling ss
Arithmetic ss
116.6
8.3
115.8
8.1
0.48
94.3
97.6
95.4
95.3
10.3
11.0
9.3
10.7
106.9
105.0
106.3
106.8
12.3
12.8
11.9
12.5
5.58
3.15
5.18
4.97
99.4
11.9
103.9
14.2
1.73
90.4
9.9
103.5
12.4
5.75
98.6
33.1
12.0
6.2
108.2
43.5
11.8
6.8
3.98
8.06
79.7
79.5
92.4
7.0
7.3
10.4
103.6
101.8
102.2
12.4
14.1
11.2
11.51
10.20
4.56
12.8
14.5
10.2
10.63
Note. SS = standard
76.9
78.7
90.2
scores,
9.6
7.2
11.8
101.3
100.3
102.5
u = unequal
variances,
9.13
5.53
p < 0.05,
The tests of orthographic skills likewise significantly separated the groups (see Table 4), as did the Rapid Automatized
Naming tasks (Table 5).
155
TABLE 3
Phonological Skills: Group Means and Standard Deviations
Test of Auditory
Analysis (errors)
u Bradley Sound
Categorization
(errors)
u Pig Latin (correct)
Rhyme Generation
(correct)
Decoding Skills I
(correct)
u Decoding Skills II
(correct)
Reading Disabled
Normal Reading
Mean
SD
Mean
SD
t(99df)
3.93
1.92
1.96
1.73
5.37
5.50
4.22
1.69
1.98
5.99
10.86
15.88
7.51
7.32
16.73
22.60
5.69
8.74
4.47
4.21
8.33
5.83
21.89
5.67
11.76
3.66
3.77
16.53
7.26
10.78
TABLE 4
Orthographic Skills: Group Means and Standard Deviations (SD)
O+ (errors)
Rhymes O (errors)
u Spelling Detection
(correct)
Spelling, Regular
(correct)
Spelling, Irregular
(correct)
u Rhymes
Reading Disabled
Normal Reading
Mean
SD
Mean
SD
t(99df)
7.30
12.29
44.20
9.44
4.00
22.71
4.27
4.47
78.53
5.86
3.91
14.86
1.98
9.86
9.14
3.14
1.15
3.80
1.08
2.93
1.41
1.44
2.67
1.22
4.63
Note. O+ = orthographically similar, O = orthographically dissimilar, u = unequal variances, p < 0.05, p < 0.01, p < 0.001.
RD Subgroup Analyses
A primary reason for this study was to compare the
reading spelling performance of RD children with singleversus double-deficit profiles. To that end, we created four
subgroups using performance on the oral TAAS, Bradley,
and Pig Latin tests to define a phonological deficit and perTABLE 2
Behavioral Data: Group Means and Standard Deviations
Child Behavior
Checklist
Total ss
Internalizing ss
u Externalizing ss
ADHD
Attention sum
Hyperactivity &
Impulsivity sum
Reading Disabled
Normal Reading
Mean
Mean
SD
SD
t
4.03
59.8
57.7
56.3
11.5
12.1
13.1
50.8
52.9
48.6
11.0
11.6
10.3
2.01
3.31
15.8
6.3
8.5
7.4
5.25
11.7
8.2
6.0
5.8
4.11
u Digits
(sec)
Letters (sec)
u Alternating (sec)
Reading Disabled
Normal Reading
Mean
SD
Mean
SD
t(99df)
35.6
40.5
50.4
10.4
10.5
15.8
24.8
29.5
35.7
5.9
7.5
9.3
6.57
5.98
5.85
156
TABLE 6
Phonological and Rapid Naming Values for RD Subgroups
TAAS errors
Bradley errors
Pig Latin errors
RAN time sum
Rhyme sum
Neither
N = 18
Slow
N = 13
2.7
2.6
3.9
102.9
19.4
2.8
3.3
7.0
141.8
19.0
Phono
N =9
5.7
9.7
13.3
101.0
11.6
Both
N = 16
F3,52
Pairwise
5.3
8.2
14.4
155.2
11.8
18.44
17.82
10.09
17.23
6.42
<0.000
<0.000
<0.000
<0.000
0.001
1 = 2<3 = 4
1 = 2<3 = 4
1 = 2<3 = 4
1 = 3<2 = 4
1 = 2>3 = 4
Note. RD = reading disabled, TAAS = Test of Auditory Analysis Skills, RAN = Rapid Automatized Naming.
TABLE 7
Differences Between RD Subgroups
Neither
N = 18
Slow
N = 13
Phono
N =9
Both
N = 16
F3,52
Pairwise
101.9
36.1
82.9
83.3
81.8
81.4
329.4
18.5
93.6
31.1
81.5
80.4
80.6
80.2
322.7
16.4
87.9
32.4
76.8
75.8
72.8
75.2
300.6
3.8
93.6
31.7
76.2
76.7
70.6
76.3
299.9
5.8
4.81
2.39
3.84
3.76
6.52
2.53
5.81
19.96
0.005
0.080
0.015
0.016
0.001
0.067
0.002
<0.000
1>2=3=4
1 > 2,4
1=2>3=4
1 > 3,4; 1 = 2
1=2>3=4
1 > 3,4; 1 = 2
1=2>3=4
1=2>3=4
Note. WISC = Wechsler Intelligence Test for Children, ACID = WISC Arithmetic + Coding + Information + Digit Span, WIAT = Wechsler Individual
Achievement Test, WRAT = Wide Range Achievement Test, ss = Standard Scores.
157
TABLE 8
Correlation Matrix and Factor Loadings
1. Literacy Sum
2. Decoding Skills Sum
3. ADD Index
4. ACID factor
5. WISC Verbal Factor
6. Phonological Factor
7. RAN Sum
8. WRAT Arithmetic
0.886
0.576
0.755
0.605
0.703
0.594
0.671
0.490
0.650
0.567
0.777
0.528
0.505
0.538
0.306
0.406
0.433
0.459
0.756
0.606
0.560
0.760
0.574
0.345
0.517
0.519
0.451
0.429
Loadings on Factor I
0.923
0.864
0.649
0.892
0.742
0.801
0.686
0.758
Note. ADD = Attention Deficit Disorder, ACID = WISC Arithmetic + Coding + Information + Digit Span, WISC = Wechsler Intelligence Scale for Children, RAN = Rapid Automatized Naming, WRAT = Wide Range Achievement Test. All correlation coefficients are significant at p < 0.01 or higher.
R2
0.777
0.809
0.603
0.654
0.605
0.284
0.777
0.800
0.810
0.603
0.639
0.656
0.606
0.195
0.160
0.755
0.816
0.832
0.844
0.571
0.666
0.693
0.713
0.271
0.368
0.181
0.216
0.703
0.807
0.830
0.841
0.850
0.494
0.652
0.689
0.707
0.722
0.317
0.285
0.195
0.169
0.157
0.886
0.923
0.928
0.931
0.785
0.852
0.861
0.867
0.662
0.283
0.096
0.094
R2
0.773
0.597
0.773
0.615
0.742
0.378
0.551
0.535
0.424
0.615
0.742
0.768
0.378
0.551
0.590
0.287
0.458
0.313
158
DISCUSSION
Insofar as differentiating normal and disabled readers, this
study successfully replicated other studies from our laboratory and from other RD investigators. As expected, the RD
and NR groups clearly differed on oral word analysis skills
and on rapid naming speed. They also differed on parental
ratings of attention and behavioral problems and on three of
the four WISC III factor scores as well as the once clinically
popular ACID factor (Swartz, 1974; Ackerman et al., 1977;
Frederickson, 1999). Although selected for reading/spelling
deficits, the RD group was also impaired in arithmetic. The
comorbidity of attention disorder and RD has often been reported (Dykman & Ackerman, 1991; Willcutt & Pennington,
2000) as has the comorbidity of reading/spelling and arithmetic disabilities (Ackerman & Dykman, 1995). While reading disabilities and attention disorders occur at all levels of
intelligence, it is nonetheless the case that referred and/or
recruited samples of RD children generally have somewhat
lower IQs and higher levels of attention problems than standardization samples. Likewise, samples of ADHD children
generally have somewhat lower IQs and achievement scores
than standardization samples.
A primary reason for the current study was to assess possible additive effects of impaired oral word analysis (phonological) skill and slow continuous naming on degree of reading/spelling impairment. This question was addressed first
by subgrouping and then by stepwise multiple regression
analysis. The subgrouping maneuver revealed, as expected,
that those RD children with phonological deficits read and
spelled worse than those without serious phonological deficits. However, there was no evidence of an additive effect of
slow naming. Rather, the RD children with double deficits read and spelled no worse than those with a phonological deficit only, and the children with a single deficit
in naming performed no worse than those with neither
deficit.
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