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What Is the Language Developmental Perspective as It Relates to Reading Disabilities?

Written By quinta-feira, 3 de março de 2022 Add Comment Edit

The ultimate goal of reading is comprehension: for the reader to reconstruct the mental globe of the author. As skilled readers, this normally feels pretty effortless and comprehension flows naturally every bit we read along. This sense of ease is misleading, nevertheless, equally it belies the complexity of what nosotros do as we read, even when a text is simple and straightforward. A whole range of cerebral and linguistic operations are at play, from identifying individual words through to making inferences about situations that are not fully described in the text (Castles, Rastle, & Nation, 2018). This complication means that finding a simple answer to questions like "how does reading comprehension develop" and "why does it sometimes fail" chop-chop becomes an impossible task.

Against this complexity, enter the Elementary View of Reading. This was first described by Gough and Tunmer in 1986, and supported with data in a follow-upward paper past Hoover and Gough (1990). Together, these 2 papers have been cited over 5000 times in the academic literature (source: Google Scholar, Jan 2019) and the influence of the Simple View has been edifice in educational policy and practice (due east.g., Rose, 2006). I was fortunate to begin my career every bit a post-doc working with Maggie Snowling, employed on a project inspired past the Simple View—and from our first paper onwards (Nation & Snowling, 1997), it provided the framework within which nosotros set up our work. Over 20 years later, my goal in this newspaper is to consider the question "why practice some children find reading comprehension difficult" from the perspective of the Simple View, and by discussing some of the enquiry it has motivated.

I brainstorm by introducing the Elementary View of reading and outlining some of the evidence that supports it. Part II will consider reading comprehension in children who struggle to read words. In Part III, attention turns to poor comprehenders—children who read words adequately but nevertheless take reading comprehension difficulties. Finally, in Part IV, I offer some reflections on the Simple View of reading and consider its many strengths, as well as some limitations.

Part I: introducing the Simple View of reading

What is the Simple View?

Imagine yourself a fluent speaker of a strange language but with no cognition of its written form. Reading comprehension would fail equally you would have no ability to access significant from impress. If the text was read to you, even so, agreement would follow, via listening. An alternative scenario is equally easy to imagine. Information technology would be quite possible for you to larn to assign acceptable pronunciations to words printed in a foreign language, only this would not hateful that y'all were able to encompass what had been written in that language.

The Simple View of reading (Gough & Tunmer, 1986; Hoover & Gough, 1990) elegantly captures the essence of these scenarios by stating that reading comprehension is the product of two sets of skills, decoding and linguistic comprehension (RC = D 10 LC, illustrated in Figure ane). We will return to definitions shortly but for present purposes, decoding can be defined every bit the ability to identify words in print and linguistic comprehension as the power to empathise spoken linguistic communication. The logical case for the Elementary View is clear and compelling: both decoding and linguistic comprehension are necessary for reading comprehension and neither solitary is sufficient. Like a fluent speaker of a foreign language who has never seen it written down, if a child cannot decipher words from print they have no facility to understand written linguistic communication, no matter how sophisticated their agreement in the oral domain might be. Similarly, being able to decipher words brings no guarantee that a child will understand what it is they take read. The Simple View assumes that once written input is decoded,

Effigy one. The Simple View of reading.

reading comprehension is achieved via exactly the same processes used to understand spoken linguistic communication. If those processes are absent or not working well, reading comprehension volition too fail, even if the material has been decoded perfectly. The Unproblematic View as well states that the relative contributions of decoding and linguistic comprehension to reading comprehension should change over time. Early on, reading comprehension is highly constrained by limitations in decoding. Equally children get older and decoding skills increase, the correlation between linguistic comprehension and reading comprehension strengthens. This reflects the fact that once a level of decoding mastery has been achieved, reading comprehension is ultimately constrained by how well an private understands spoken language.

Information technology is hard to contend with the underlying principles of the Simple View, or with the evidence base that now supports information technology. For example, Lervag, Hulme, and Melby-Lervag (2018) followed nearly 200 Norwegian children as they learned to read. They measured decoding and linguistic comprehension in multiple means to form latent variables to capture each construct. Well-nigh all of the variation in reading comprehension at 7.5 years was captured by the two constructs, decoding and linguistic comprehension. Other studies taking a similar approach have found the same (e.1000., Language and Reading Research Consortium [LARRC] & Chui, 2018; Hjetland et al., 2019; Lonigan, Burgess, & Schatschneider, 2018) and findings are robust across alphabetic (Florit & Cain, 2011) and non-alphabetic writing systems (Ho, Chow, Wong, Waye, & Bishop, 2012). There is also evidence to support the irresolute pattern of associations betwixt decoding, linguistic comprehension and reading comprehension over time, with the correlation between linguistic comprehension and reading comprehension strengthening, as children's decoding skills increment (Catts, Adlof, Hogan, & Weismer, 2005; García & Cain, 2014; LARRC, 2015). Taken together, this evidence base of operations provides overwhelming back up for the Unproblematic View, including the principle that it "does not deny the complexity of reading, merely asserts that such complexities are restricted to either of the ii components" (Hoover & Gough, 1990, p. 150).

Defining decoding and linguistic comprehension

What exactly is meant by "decoding" and "linguistic comprehension"? Starting with decoding, this has been operationalised in different means in different studies. Some experiments accept compared words and nonwords while others have investigated whether fluency is a better alphabetize than accuracy (e.chiliad., Adlof, Catts, & Fiddling, 2006; LARRC, 2015). Going back to the original article, it is clear that Gough and Tunmer (1986) themselves grappled with how all-time to ascertain decoding. They explained that it tin refer to the overt "sounding-out" of a word (sometimes termed phonological decoding or alphabetic decoding), perhaps as measured past nonword reading. But, they argued, this is not what good reading comprehension demands. Instead, comprehension in skilled readers depends on high quality input from a discussion recognition system that identifies words quickly and precisely (Perfetti, 2008). For the Simple View to adequately describe skilled reading, "decoding" needs to be defined and measured past something that captures this fluency and expertise. At the same time however, this definition does non work for children at the outset of learning to read as their word recognition system is non yet in place and reading is far from fluent and adept. What needs to be captured by the term "decoding" is dependent on the reading level of the private.

At the centre of this issue is the need to consider learning and development. The dazzler of the Simple View is that information technology explains variation in a way that is timeless: the equation RC = D x LC works for get-go readers as it does skilled readers, assuming the constructs have been measured appropriately. Critically however, the Simple View does not, on its own, explain how development happens—how children move from overt and laborious phonological decoding to reading words effortlessly and fluently. For that, we need focussed and precise cognitive models that are developmentally informed. There is consensus that phonological decoding provides the initial foundation for learning to read words in English language (e.g., Ehri, 2005; Share, 1995). From this starting point, children gradually accumulate orthographic knowledge via reading feel. This is a slow process of edifice expertise through which children harness their powers of perception, memory and language to acquire and to generalise (see Castles et al., 2018). The Simple View does not explicate in particular how whatever of this is achieved. Nor does information technology intend to. Instead it provides a theoretical framework to help united states empathise variation in reading comprehension beyond individuals at any particular time-betoken. How "decoding" is defined and measured needs to reverberate the appropriate developmental fourth dimension-indicate, and also familiarity with the words existence read. Learning is likely to continue in an item-based style, so that at any point in time a person may be reading some words slowly and only with corking attempt, while other words are read chop-chop and efficiently with less reliance on phonological decoding (Castles & Nation, 2006; Share, 1995).

Permit us now turn to the other component of the Simple View, linguistic comprehension. This was defined past Hoover and Gough (1990, p. 131) as "the ability to take lexical data (i.e., semantic data at the word level) and derive sentence and discourse interpretations". At a descriptive level this captures exactly what has to happen for reading (and language) comprehension to exist successful. Just how should linguistic comprehension be measured? A common approach has been to use listening comprehension, typically measured using a reading comprehension test just one that has been adapted so that children mind to the text rather than read it themselves. Some studies have argued that some other cistron, be it vocabulary, inference-making or working retentivity, makes a straight contribution to reading comprehension (e.g., Oakhill & Cain, 2012; Ouellette & Beers, 2010; Tunmer & Chapman, 2012). A different approach has been to construct a latent variable that taps linguistic comprehension in a broad sense, drawing on multiple indicators. For example, Hjetland et al. (2019) formed a single factor from measures of vocabulary, grammar, listening comprehension and verbal working memory. In line with the central tenet of the Simple View, variations in operation on this latent factor, in combination with variations in decoding, predicted near all of the variation in children'southward reading comprehension at seven years of age. At that place is as well good evidence that variation in listening comprehension is itself a consequence of variation in underlying oral language. Lervåg et al. (2018) assessed vii.5 year-olds' vocabulary, grammar, verbal working memory and inference making skills. Together, these abilities predicted the children'due south listening comprehension.

Cartoon across these studies, a stiff case can exist made that linguistic comprehension is broadly captured by listening comprehension, that listening comprehension itself subsumes children's vocabulary, grammar and language processing abilities and that these abilities (along with decoding) predict reading comprehension (LARRC & Chui, 2018; Foorman, Petscher, & Herrera, 2018; Hjetland et al., 2019; Lonigan et al., 2018). As per our give-and-take of decoding, notwithstanding, this does not explain how reading comprehension happens, nor how it develops. Comprehension is non typically a verbatim record of what'south been read, replicating its grade and structure. Instead, every bit people read or heed, they build a mental model, sometimes called a situation model, culminating in a rich interpretation of the text that goes beyond what is explicitly stated. The text is the substrate that allows the reader to pull in relevant data, including, for example, the meanings of words, rules of syntax, background knowledge and an appreciation of how the earth works. This information is so processed to brand connections, depict inferences and construct intended meaning. The Unproblematic View does not tell us how whatever of this achieved. For that, once over again we need to look to detailed cognitive models. An important lesson from the extensive literature on reading comprehension is that it is not one affair that tin be measured past a single indicator. Instead, reading comprehension is the product of a complex gear up of cognitive and linguistic factors operating across a text (for word, see Castles et al., 2018; Perfetti & Stafura, 2014), in interaction with the nature of the text and the purpose of the reading situation.

This word of definitional issues is not to say that the Simple View is false or express as a framework to help us understand variation in reading comprehension. On the contrary, the Uncomplicated View is extraordinarily successful in this regard. When measured comprehensively and reliably, variations in decoding and linguistic comprehension capture private differences in reading comprehension almost perfectly (Hjetland et al., 2019); this means that the terms decoding and linguistic comprehension have utility, if we accept that they denote complex constructs rather than explaining a particular cognitive process. At the same time, however, to motility us beyond capturing variance to empathise how cerebral and linguistic processes happen—and why they might go amiss in children with poor reading and language – we demand to attend to effectively level definitions. In keeping with the principles of the Uncomplicated View, I use the terms decoding and linguistic comprehension in a neutral way throughout this paper as labels to note "things to practice with identifying words" and "things to do with understanding spoken language" respectively.

Varieties of reading disorder within the Simple View

Gough and Tunmer (1986) used the Unproblematic View to classify different types of reading bug. To illustrate, Effigy ii shows decoding and linguistic comprehension plotted orthogonally. Individuals can be placed into this multidimensional space according to their abilities on tasks that tap each of the two constructs.

Figure 2. Classifying reading disorders within the Unproblematic View of reading.

For children falling in quadrant A, reading comprehension is constrained past poor decoding, whereas poor linguistic comprehension constrains those in quadrant D. Quadrant C captures children who are poor at both decoding and linguistic comprehension. The logic of the Simple View is that all three varieties of reading disorder—termed dyslexia, hyperlexia and garden-variety poor reader in the original paper—result in poor reading comprehension simply for different reasons. Nomenclature may vary, but there'due south plenty of prove for these distinct reading profiles. It's rare to see mention of "garden-multifariousness" poor readers in the more recent literature, just children with co-occurring dyslexia and language impairment are typically plotted in quadrant C (Bishop & Snowling, 2004; Catts et al., 2005). This quadrant is discussed in the adjacent department, along with quadrant A ("classic" dyslexia). Turning to quadrant D, there are complexities with the term hyperlexia (Nation, 1999). That is not to say that a quadrant D reading profile does not be. These children are more typically described every bit poor (or less skilled) comprehenders. Nosotros will return to discuss quadrant D in Function III.

Part 2: reading comprehension in children with poor decoding

Reading comprehension tends to be depression in children and immature people with dyslexia (east.g., Ferrer et al., 2015; Shaywitz et al., 1999). This is considered a directly effect of poor decoding, and dyslexia is usually associated with quadrant A in the Simple View (due east.k., Gough & Tunmer, 1986; Stanovich & Siegal, 1994). Rather surprisingly, however, few studies accept investigated the nature of reading comprehension in dyslexia in much particular. Bruck (1990) assessed reading comprehension in a group of adults who had a history of developmental dyslexia. Although the mean performance of the group was depression-average (centile score of 41), there was huge variability in functioning, with centile scores varying from vi to 97. This shows that some children with dyslexia go along to brand first-class progress in reading comprehension while others do non. Comparison those adults with good vs. poor reading comprehension, Bruck (1990) establish no differences in word or nonword reading. However, the ii groups did differ in vocabulary: poor reading comprehension was associated with vocabulary deficits whereas practiced reading comprehension was non. This finding tin be accommodated within the Uncomplicated View, on the assumption that while all of the participants had poor decoding, just a subset (those with low vocabulary) as well had poor linguistic comprehension. Arguably, as decoding skills strengthened through development, adults with good vocabulary (quadrant A) were able to make gains in reading comprehension whereas those with depression vocabulary (quadrant C) did not.

Bruck's study tells usa that some people with a diagnosis of dyslexia also have broader language problems. These bug are not unusual, with weaknesses in vocabulary, grammer and discourse-level processing beingness seen in many studies (eastward.g., Catts, Fey, Tomblin, & Zhang, 2002; McArthur, Hogben, Edwards, Heath, & Mengler, 2000). There has been a tendency to consider these broader language problems as a event of the arrears in phonological processing that underpins dyslexia, or of reading failure itself. For example, rather than a 18-carat problem with grammar, poor performance on a test of circuitous syntax might exist a consequence of a phonological processing clogging disrupting working memory (eastward.g., Shankweiler et al., 1995). Or, if dyslexic children read less, they have less opportunity to build vocabulary via reading, such that vocabulary deficits emerge over time (Stanovich, 1986). Although these factors are likely to exist at play, it is now abundantly clear that they are not the whole story. First, in adults with a history of developmental dyslexia, oral linguistic communication accounts for straight variance in reading comprehension, even when decoding and phonological skills are controlled (e.g., Ransby & Swanson, 2003). Stronger show comes from family risk studies. These accept consistently institute that children who go on to receive a diagnosis of dyslexia in mid-childhood show language difficulties every bit infants and toddlers, well earlier reading failure could exert its influence (for meta-analysis across 21 independent studies and 95 manufactures, come across Snowling & Melby-Lervåg, 2016). These findings confirm poor language as a precursor; they also add together to the growing evidence base of operations that sees depression language as an of import factor within a complex multiple risk model of the disorder (Snowling & Melby-Lervåg, 2016; Pennington, 2006). Such evidence also forces us to consider the overlap betwixt dyslexia and spoken language difficulties, and how all-time to characterise the 2 types of difficulty. While a full discussion of this is beyond the telescopic of this paper (for further detailed discussion, run into Adlof & Hogan, 2018; Bishop & Snowling; 2004; Catts et al., 2005; Nash, Hulme, Gooch, & Snowling, 2013; Ramus, Marshall, Rosen, & van der Lely, 2013), information technology is important to impact some of this literature where information technology relates to reading comprehension outcomes in children with dyslexia.

Some studies following at-risk children accept at present traced the path from pre-schoolhouse language to school-aged reading comprehension. Broadly, these findings sit comfortably with the Simple View. Hulme, Nash, Gooch, Lervåg and Snowling (2015) analysed information from the Wellcome Reading and Language project. This longitudinal report recruited pre-school children at loftier risk for poor reading (they had a diagnosis of developmental language disorder, or were at family risk for dyslexia) and followed them through the chief school years. Hulme et al. (2015) establish that linguistic communication skills (linguistic comprehension) at iii.5 years made a direct contribution to reading comprehension at viii.5 years, and an indirect contribution via their effect on decoding at 5.5 years, which also influenced reading comprehension at eight.5 years. Like findings were reported by Van Settern et al. (2018) who found that vocabulary in Grade 3 explained a substantial amount of variance in Grade half-dozen in the Dutch Dyslexia Plan, a longitudinal study following Dutch children at family take chances for dyslexia. Snowling, Hayiou-Thomas, Nash & Hulme (in grooming). categorised children from the Wellcome project into four groups, based on their decoding and oral language profile at eight years: pure dyslexia (quadrant A), pure developmental language disorder (DLD; quadrant D), co-morbid dyslexia+DLD (quadrant C) or unimpaired (quadrant B). Equally predicted by the Simple View, all three impaired groups showed poor reading comprehension at 8 years. Interestingly, when re-assessed 12 months afterwards, the pure dyslexia grouping had improved in reading comprehension, relative to both the DLD and the combined group, although they were withal impaired relative to their typically-developing peers. Finally, the combined group showed the nigh severe deficits in reading comprehension at both time points, reflecting underlying weaknesses in both decoding and oral language.

Drawing across these at-take chances studies, there is articulate bear witness in line with Gough and Tunmer's view that "at that place is a common denominator in every example of dyslexia, a deficit which could stand well as the proximal cause of the disorder. This is an disability to decode" (1986, p. 8). This exerts a direct influence on reading comprehension. Whether in that location are additional negative influences on reading comprehension from linguistic comprehension depends on the status of a child'southward oral linguistic communication. Rather hit is the proportion of children with dyslexia who have language weaknesses, placing them into quadrant C rather than the traditional home of dyslexia, quadrant A. For instance, of the 50 poor decoders identified past Snowling, Nash, Gooch, Hayiou-Thomas, and Hulme (2019) at viii years, merely 21 had "pure" dyslexia; the other 29 also showed pregnant levels of language damage. One might fence that this high figure reflects the nature of the at-risk sample. However, it chimes with other piece of work showing that approximately 50% of children with a diagnosis of dyslexia have language weaknesses measured meantime in a sample non recruited for family risk (e.g., McArthur et al., 2000). It seems that when researchers measure oral language in children identified on the footing of a diagnosis of dyslexia, it is not at all unusual to find high levels of poor oral language (encounter also Adlof & Hogan, 2018).

Given the lack of research investigating reading comprehension in children with poor decoding, especially from studies that take not recruited on the basis of family unit risk, I took the opportunity to look into one of my own longitudinal datasets charting reading development from pre-schoolhouse through the school years. The primary aim of the original project was to identify poor comprehenders and chart their reading and language development (Nation, Cocksey, Taylor, & Bishop, 2010; come across Function Iii). Still, this rich dataset also provided an opportunity to explore patterns of reading comprehension in children identified on the basis of poor decoding.

The learning to read longitudinal dataset

This study recruited a large and unselected sample of children on schoolhouse entry shortly before their 5th birthday, and followed their reading and language evolution through the primary school years. Seventeen primary schools serving a socially mixed range of neighbourhoods in Oxfordshire took role in the study. All children beginning these schools at the start of the study were invited to participate. Informed consent from parents was received for 242 children (141 girls and 108 boys). The children were first assessed within iii months of starting school, respective to a mean age of approximately iv years and 10 months.

Our principal focus hither is with information from two time points: when the children outset entered school (Reception class, Chiliad age = four.83 years, SD= 0.34, N = 242) and three years after (Yr two in school, M age = 7.23 years, SD= 0.35; N = 202). To compare profiles beyond language and literacy tests that had been standardised on different populations, raw scores on these tests were converted to z-scores, using the hateful and standard deviation of the entire sample assessed at each fourth dimension point; for ease of reference, z-scores were transformed to standard scores (Thou = 100, SD= 15).

Reading skills at 7 years across the entire sample

At this time point, the children completed both the word (Word Reading Efficiency) and nonword (Phonemic Decoding) component of the Exam for Word Reading Efficiency (TOWRE; Torgesen, Wagner, & Rashotte, 1999). This requires children to read aloud as many words (or nonwords) every bit possible in 45 s and the number read correctly is converted to a mensurate of word (or nonword) reading fluency. The Neale Analysis of Reading Ability-Ii (NARA-II; Neale, 1997) provided an assessment of text reading. In this exam, children read aloud curt passages of text (reading accuracy) and are then asked questions to assess literal and inferential understanding (reading comprehension). Finally, the British Ability Scales Word Reading subtest (Elliot, Smith, & McCullouch, 1996) provided an assessment of word reading. This is an untimed exam in which children are presented with single words and asked to read each aloud. As is articulate from the data summarised in Table one, the correlation betwixt performance across the different measures of reading was high.

Table i. Correlation between different reading measures at 7 years across unabridged sample, North = 202.

Levels of reading comprehension in poor decoders at vii years

Next nosotros plough to those children who were poor at decoding. As discussed earlier, decoding is defined and measured in different ways in different studies. Here, children were identified on the basis of poor performance (standard score below 83) on the TOWRE, averaging beyond the two subtests. Thirty-4 children were identified; from now on, I refer to these children every bit having a reading disorder (RD). Their operation across all reading assessments is detailed in Table 2. While in that location is some variation, it is notable that performance is low across the lath, including in reading comprehension. It is also important to note that only 22 of the 34 RD children were able to consummate the Neale Assay: the other 12 struggled with reading individual words to the extent that testing was abandoned. This means that the text accuracy and comprehension scores reported in Table 2 underestimate the difficulties experienced past the RD children; however, reading comprehension was very poor with every child scoring below population average.

Table two. Performance of RD children on reading assessments at 7 years (standard scores derived from the entire sample, Due north = 202).

Oral language skills in children with RD at 7 years

Tabular array iii summarises the performance of the 34 children on 5 different measures of oral linguistic communication. Expressive vocabulary was measured using the vocabulary subtest from the Wechsler Abbreviated Intelligence Scales (WASI, Wechsler, 1999). Children were asked to provide definitions for words supplied by the experimenter. Judgement comprehension was measured using the Comprehension subtest from the Wechsler Intelligence Calibration for Children (WISC, Wechsler, 2003), a test which requires children to reply orally-presented socially-relevant comprehension questions. Ii subtests from the Clinical Evaluation of Language Fundamentals (CELF-threeUK; Semel, Wiig, & Secord, 2000) provided an gauge of expressive and receptive language skills. Recalling Sentences requires children to repeat sentences of increasing length and grammatical complexity; Sentence Structure assesses acquisition of structural rules at the sentence level past asking children to select a motion picture that matches the target sentence. Finally, in the Bus Story (Renfrew, 1991) children listen to a narrative describing events in a picture show book. They so re-tell the story and their responses are analysed. Scores hither reflect the information content of their re-tells.

Table 3. Performance of RD children on measures of oral linguistic communication at 7 years (standard scores derived from the entire sample, N = 202).

Averaging beyond the five tests produced a hateful standard score of 88, right at the cease lesser end of normal range. Still, this average hides a substantial amount of variability. For each test, functioning varied from extremely poor to proficient.

Comparison of "pure" RD and RD with poor linguistic communication at 7 years

It is clear that some children with RD at 7 years of age also perform poorly on tasks borer oral language: in Elementary View terms, they have poor linguistic comprehension alongside poor decoding. To investigate further, I used Bishop et al.'south (2009) methodology to classify a child every bit language impaired if they obtained at least two standard scores more than 1.33SD below the population mean on the v oral linguistic communication measures described in a higher place. Of the 34 children with RD, thirteen also met this criterion for language harm. The results of this classification exercise are summarised in upper part of Table 4. For children with reading disorder only, scores were at the population average. As to be expected, those classified as language impaired obtained scores well below the normal range.

Table 4. Comparing of RD children with and without linguistic communication impairment at seven years.

Despite big differences in oral language characterising the two subgroups, they showed an identical pattern of reading accomplishment across the all the reading tests, including reading comprehension (see Figure iii).

Effigy iii. Mean (SD) standard scores on reading assessments at 7 years.

Table iv likewise shows the performance of the 2 subgroups on three assessments of phonological power, namely ii assessments of nonword repetition (the Children's Nonword Repetition Examination, Gathercole et al., 1996 and from the Comprehensive Test of Phonological Processing [CTOPP]; Wagner, Torgesen, & Rashotte, 1999) and 1 measure of phoneme deletion (also from the CTOPP). Both groups performed below boilerplate on these tests, and there was no difference in profile or severity across the two groups.

In summary, children selected as having RD at 7 years of age, defined in terms of poor operation on word and nonword reading fluency, besides showed pregnant impairments in reading comprehension (and phonological skills). Over a third of the group could be classified as having a language impairment, placing them in quadrant C rather than quadrant A. Interestingly, having a concomitant linguistic communication impairment was not associated with more severe reading comprehension difficulties. Despite relative strengths in oral language, reading comprehension was as poor in the RD-only group as the RD+LI group.

Having identified children with RD at vii years and classified them on the ground of oral language at that time signal, we at present plough to look dorsum at the data from the two subgroups at school entry. Of interest is the children'southward oral language at this time, before the onset of reading.

Looking backwards in time: oral language, phonological skills and emergent literacy at school entry

The 34 children identified as RD at 7 years were iv.88 years old (SD= 0.37) at the first assessment. Oral linguistic communication was measured using 3 different tests. Expressive vocabulary was assessed using the vocabulary subtest from the Wechsler Preschool and Primary Calibration of Intelligence (WPPSI, Wechsler, 2002). Initial items require children to name pictures simply virtually items involve the child providing definitions for words supplied by the assessor. Children besides completed the Examination for Reception of Grammar-two (TROG-2, Bishop, 2003). This measures children's comprehension of sentences, with grammatical complexity increasing over the test. Sentence comprehension was assessed using the comprehension subtest from the WISC, as administered at vii years. Functioning is plotted in Figure 4 for the 34 children identified as RD at 7 years, separated by linguistic communication condition at vii years.

Figure 4. Mean (SD) standard scores on oral language measures at 5 years, as a part of reading and language status at seven years.

Consistent with their subsequently classification, children in the RD+LI grouping showed essentially lower levels of oral language at schoolhouse entry than children in the RD group. Every bit the children were pre-readers, these linguistic communication weaknesses cannot be attributed to lack of linguistic communication learning via reading. It is notable that the RD-only children obtained hateful language scores of 95, 93 and 93 for vocabulary, receptive grammar and sentence comprehension respectively. While at that place was variation within the group, this mostly places the children inside normal range, in contrast to those in the RD+LI group (recall that standard scores were calculated from the entire sample of children who were assessed at this time point, N = 242). Overall, these findings betoken to stability in language skills, with profiles at school entry mirroring those seen three years later.

V tests provided an assessment of the children's phonological skills at schoolhouse entry. Phonological awareness was measured using two subtests from the CTOPP (Wagner et al., 1999): Phoneme Elision, in which children delete an initial or last phoneme from orally presented words, and Audio Matching, where children hear three words and are asked to select which one starts (or ends) with the same audio every bit a target detail. We also administered Rime Judgement, a task developed past Bird, Bishop, and Freeman (1995) to measure phonological awareness in young children. Children selected from an array of 4 pictures the one that rhymed with a target item. Nonword repetition was assessed using the Children's Test of Nonword Repetition (Gathercole & Baddeley, 1996) and the Nonword Repetition subtest from the CTOPP.

As shown in Figure 5, the two subgroups did non differ in terms of phonological awareness. It is important to note that performance across the entire sample was quite low in terms of phoneme deletion and audio-matching, as to be expected given the age of the children at this time point. As a issue, the data must be interpreted cautiously. On the rime job (where performance was stronger across the unabridged cohort), the RD-just children scored within normal range, and performed better than the children in the RD+LI group. This pattern was also evident across both measures of nonword repetition. It is interesting to annotation that the RD-only children performed quite well across all measures of phonological processing at schoolhouse entry, yet past 7 years of age, they were beneath normal range, and performed every bit poorly every bit the RD+LI children. This might reflect a blueprint of phonological skills becoming more dumb over fourth dimension, as children with RD do good less from reciprocal links with reading and alphabetic knowledge (see Nation and Hulme (2011) for a detailed investigation of this within the aforementioned dataset).

Effigy v. Mean (SD) standard scores on phonological measures at 5 years, as a role of reading and language condition at 7 years.

Turning to reading, nigh of the children in the entire sample were unable to read at the start of the study. There was however a good amount of variation in letter noesis. Tellingly, given their future difficulties with word reading, alphabetic character cognition was low for the children who were later classified as RD-only and RD+LI (standard scores of 84 and 83 respectively).

Looking forrad in fourth dimension: reading accurateness and reading comprehension at viii and x years

While it is possible to classify children equally RD and RD+LI at 7 years, this is a young historic period to be measuring reading comprehension, peculiarly in children with plain poor reading at the word level. We had the opportunity to assess reading skills later in time, when the children were 8 years of historic period (N = 20 RD and xi RD+LI) and once again at 10 years of historic period (Due north = 12 RD and 7 RD+LI). Performance on both the reading accuracy and reading comprehension components of the Neale Analysis of Reading Ability from these two timepoints are plotted in Figure half dozen, along with information from vii years. At no time point is in that location any departure in reading skills between the RD-but and RD+LI subgroups; at x years of age, it is clear that the RD-only children are still poor at reading comprehension, despite their strengths in oral language. Figure 6 indicates some improvements over time in both groups, only note that this upwardly trajectory reflects only minor differences in terms of standard score.

Effigy 6. Mean standard scores of Neale Analysis (accuracy and comprehension) scores over time, every bit a role of reading and linguistic communication status at 7 years.

Summary and discussion

This exploration of the Learning to Read dataset shows that 7-year-olds with poor decoding also show impairments in reading comprehension, in line with the principles of the Simple View. It would be a mistake, withal, to infer that reading comprehension is compromised past poor decoding solitary. Approximately one third of the sample showed poor oral language at vii years, and these difficulties were evident earlier in time, at school entry. These findings align with data from family unit risk studies (Snowling & Melby-Lervåg , 2016) and reinforce the need to consider children's language skills as well as their decoding ability.

A number of implications follow for both research and educational practice. For research, there is a pressing need to expect across standardised scores on an off-the-shelf test of reading comprehension to consider the nature of reading comprehension in children with poor decoding. It is surprising that few studies have looked at reading comprehension itself in dyslexia. It would exist interesting to vary question blazon, or use methods such as center tracking to investigate factors such as inference-making while reading. Such experiments could address whether at that place are systematic differences in RD children with and without concomitant oral language weaknesses. Longitudinal data are also needed to help us to empathise which children make progress in reading comprehension, and how.

The consistent finding that a substantial proportion of children identified on the basis of poor decoding accept co-occurring language issues highlights the need to assess broader linguistic communication skills in poor readers, and for intervention approaches to target language as well equally decoding. Duff, Fieldsend, Bowyer-Crane, Hulme, Smith, Gibbs and Snowling (2008) identified a subgroup of poor readers who had non responded to an intensive intervention programme targeting reading and phonology. Equally a group, these children showed depression language. Their expressive vocabulary was at the vth centile, and their performance on tests of grammatical skill corresponded to the 5.5 year old level—still they were nearly eight years quondam. In contrast, poor decoders who had responded well to the reading and phonology programme in previous studies achieved normal-for-age vocabulary scores. These observations advise that co-occurring language difficulties place children at run a risk of being "treatment resistors", pregnant more intensive and specialist provision is required, extending to rich oral language intervention besides equally instruction in decoding (run across Duff et al., 2014; Fricke, Bowyer-Crane, Haley, Hulme, & Snowling, 2013). Extending these research findings to educational practice can be facilitated by collaborations between teachers and speech and language pathologists (Adlof & Hogan, 2018; Snow, 2019).

Office III: poor comprehenders

Having reviewed poor decoding as a source of reading comprehension difficulty, we at present plow our attention to quadrant D. Poor comprehenders were start described in the scientific literature past Oakhill (1982; 1983; 1984) who used the Neale Analysis of Reading Ability to identify children who appear to have circumscribed difficulties with reading comprehension. In this test, children read aloud short passages of text (generating a score for reading accuracy) then answer questions to assess their literal and inferential agreement of the text, generating a score for reading comprehension. Oakhill (1982) identified 7–viii year olds who were disproportionality poor at reading comprehension, despite age-advisable reading accurateness. Looking across the experimental literature since Oakhill's original work, studies have used unlike selection criteria. This makes precise prevalence hard to judge. Perhaps the virtually reliable estimates come from nationally representative and large samples in the UK, extracted from the data used in the standardisation of the York Assessment of Reading for Comprehension (Snowling et al., 2009; Stothard, Hulme, Clarke, Barmby, & Snowling, 2010). In the primary school sample, 5.3% of children with age-advisable levels of give-and-take reading ability obtained reading comprehension standard scores below 77.5 (equating to more 1.5 SDs below average for their age); in the secondary school sample, the figure was five%. Thus, poor comprehenders of this severity exist and this profile of reading difficulty is not rare.

Equally reviewed earlier, according to the Uncomplicated View, reading comprehension is the product of decoding and linguistic comprehension. It follows from this that children identified every bit poor comprehenders must have deficits either in decoding, linguistic comprehension, or both. This logic forces the conclusion that reading comprehension deficits cannot be specific, merely instead must exist related to weaknesses in one or both of its component parts. For the children described above equally having "specific" reading comprehension impairments, which component is at fault?

As is to be anticipated given the selection methods used to place poor comprehenders, weak decoding is an unlikely explanation for the patterns of poor reading comprehension identified by Oakhill in her early studies. Subsequent research has bolstered this decision. It is not the case that poor comprehenders accept accurate-simply-tiresome reading, indicative of subtle decoding problems that cause a bottleneck and disrupt reading comprehension: information technology is perfectly possible to place poor comprehenders who have good reading fluency alongside proficient reading accurateness. For example, Ricketts, Bishop and Nation (2007) used assessments of word and nonword reading fluency (provided by the TOWRE, Wagner et al., 1999) to identify and match poor comprehenders with command children. These children were 8–10 years old. This leaves open the possibility that they might have had poor decoding before in development and this has somehow left a lasting legacy of less than optimal decoding, which in plow hampers reading comprehension. But this does not seem to be the example. Reporting on data from the Learning to Read project introduced in Part Two, Nation et al. (2010) identified poor comprehenders in mid-childhood. They and so looked back in the dataset to nautical chart reading development from its initial stages onwards. Those children who went on to show a poor comprehender profile at eight years showed all the hallmarks of practiced decoding from the showtime. They started school with normal levels of letter of the alphabet knowledge, and throughout evolution they showed age-appropriate reading fluency for words and nonwords, and text reading too. For children identified as poor comprehenders and then, weaknesses in decoding cannot explicate why reading comprehension is compromised.

Turning to the other component of the Elementary View, there is plenty of prove demonstrating that poor comprehenders prove impairments on tasks that tap linguistic comprehension. Using a version of the Neale Analysis of Reading Ability where the children listened to the stories rather than read them, Nation and Snowling (1997) found that poor comprehenders performed less well than control children. Equally discussed before, listening comprehension is a broad construct: like reading comprehension itself, there are many reasons why a child might detect it hard. Nation et al. (2004) made a thorough investigation of eight–9 twelvemonth-old poor comprehenders' oral language skills using a range of standardised assessments that tapped phonological skills as well as vocabulary, morphosyntax and the agreement of non-literal language. Consistent with bear witness from before experiments (Cain, Oakhill, & Bryant, 2000; Nation & Snowling, 1998; Stothard & Hulme, 1995), the poor comprehenders performed as well as their peers on the phonological tasks. Still, on all other tests they performed less well than the control children as a group, leading Nation et al. to conclude that low language characterises many (but non all) poor comprehenders. Furthermore, a substantial minority of the sample showed meaning linguistic communication difficulties and met criteria for specific linguistic communication damage (at present known as developmental language disorder: Bishop, Snowling, Thompson, Greenhalgh, 2016).

An important question is whether these mild-to-moderate oral language weaknesses might exist a issue of reading comprehension failure, rather than a precursor. This is a plausible proposition. Written language provides many opportunities to support language development. Once children can read, they have the opportunity to larn new words via reading (Nagy, Anderson, & Herman, 1987) and to absorb the rich morphological cues to meaning that are axiomatic in spelling patterns (Rastle, 2018, Rastle, 2019). Reading also provides experience with syntactic structures that are quite rare in conversation (Montag & McDonald, 2013). If poor comprehenders read less, this could contribute to oral language deficits emerging over fourth dimension as a upshot of this lack of input from reading experience.

The Learning to Read Projection provided an opportunity to test this hypothesis directly. Nation et al. (2010) selected poor comprehenders on the ground of their reading profile at 8 years. Tracing back in the dataset to when the children started school, the children who went on to be identified equally poor comprehenders at 8 years on the basis of their reading profile showed low oral language at 4.five years and throughout the main school years. Despite these language weaknesses, the poor comprehenders showed historic period-appropriate phonological skills, consequent with the view that relative strengths in phonological ability supported the development of word reading, only relative weaknesses in other aspects of language contributed to the children'due south difficulties with reading comprehension. Similar findings have been reported in other retrospective longitudinal studies (Catts, Adlof, & Weismer, 2006; Elwér, Keenan, Olson, Byrne & Samuelsson, 2013; Petscher, Justice, & Hogan, in printing). Together, these findings bear witness that oral linguistic communication weaknesses precede reading development in poor comprehenders, meaning that difficulties observed later in evolution are not a straightforward consequence of lack of reading—although of grade, reciprocal influences are to be expected.

In summary, the contour of strengths in decoding but relative weaknesses in aspects of oral linguistic communication indicates that many poor comprehenders fit within quadrant D of the Simple View. More than generally, the oral linguistic communication contour that characterises poor comprehenders fits with what we have learned from typical evolution—that oral linguistic communication skills are highly associated with listening comprehension (Lervåg et al., 2018; LARRC, 2017), and that variation in oral language and listening comprehension is associated with afterwards reading comprehension (e.g., Hulme et al., 2015).

I have focused here on poor comprehenders—children identified on the basis of their reading contour. The literature on children with DLD (identified on the basis of primary impairments in oral language) also describes some children whose reading profile fits inside quadrant D. Many DLD children struggle with both decoding and linguistic comprehension, consistent with a quadrant C reading profile. Some, still, can decode quite well, but equally to exist expected given deficits in oral language, reading comprehension tends to exist dumb (Catts et al., 2002; Nation & Norbury, 2005; Snowling et al., 2019). These children are probably overlapping with those identified as poor comprehenders—that is, when oral language is measured, some (but not all) poor comprehenders meet criteria for DLD, and when reading is measured, some (just not all) children with DLD bear witness the same reading profile equally poor comprehenders.

Why does reading comprehension go wrong for poor comprehenders?

The Uncomplicated View is helpful in reminding us that reading comprehension has its bases in language comprehension. Once children tin read words adequately, variation in reading comprehension is strongly associated with variation in language comprehension more by and large. Beyond this truism, nevertheless, the Simple View does not provide further specification as to why comprehension might fail. Reading comprehension is not "i thing"; like language comprehension more generally, it is a complex construct, drawing on a range of cognitive and linguistic capacities (for review, see Castles et al., 2018; Perfetti & Stafura, 2014). Is information technology possible to farther specify where in this circuitous set up of processes comprehension breaks down for poor comprehenders?

To address this question, experiments have compared poor comprehenders and a control group on tasks hypothesised to be relevant to reading comprehension. These experiments accept found that poor comprehenders are less able to make inferences (Cain & Oakhill, 1999), understand words or activate their meanings in context (Nation & Snowling, 1998, 1999), connect ideas in text (Ehrlich & Remond, 1997), remember verbal information (Hua & Keenan, 2014) and monitor their comprehension (Oakhill, Hartt, & Samols, 2005). They are also less skilled at learning and remembering new words and adding to their cognition (Cain, Oakhill & Elbro, 2003; Ricketts, Bishop, & Nation, 2008). It is hard to derive conclusions beyond different experiments, not to the lowest degree because of methodological limitations such equally sample size, and variations in historic period and the methods used to define samples. Nevertheless, two observations are noteworthy. Offset, there is no "magic profile" that captures all children and totally "explains" their poor comprehension. This reflects both the complexity of comprehension and the difficulty of separating one component of comprehension cleanly. Every bit Castles et al. (2018) talk over in item, comprehension is not simply multifaceted with factors interacting in multiple means during the process of reading, it is also complex developmentally, every bit factors collaborate and change over time. Second, common to most of the experiments that find a poor comprehender difference is that the task is within the verbal domain. For instance, Pimperton and Nation (2010) found that poor comprehenders showed more interference in working retentiveness, but just for verbal materials; when the task switched to the visuo-spatial domain, the poor comprehenders were duplicate from their peers. This is consistent with underlying language weaknesses influencing performance on any job that places demands on those linguistic resources—including, of grade, reading comprehension. Farther research is needed to unpack global constructs such as "reading comprehension" and "linguistic comprehension", not least in order to guide effective teaching and intervention in the classroom.

Assessment and intervention for poor comprehenders

The Simple View has been influential in highlighting the existence of the poor comprehender profile, and the need to place advisable approaches to assessment and intervention. It is clear that the ability to read words accurately and fluently—while critical for adequate comprehension—is no guarantee that acceptable reading comprehension will follow. In turn, this means that a thorough assessment of reading should also include a measure of text comprehension. This is not, however, a straightforward thing. Reading comprehension tests vary. Some are heavily dependent on a child'southward discussion reading; others are and then dependent on background knowledge that the questions tin be answered quite well without actually reading the passage (Keenan & Meenan, 2014). The same test can also tap different component skills, depending on the operation level achieved by a child (Hua & Keenan, 2017). Knowledge effects are impossible to avert—comprehension is a reflection of our knowledge and for all of us, reading comprehension is more difficult when topic noesis is low. The bulletin here is that we demand to be mindful of the nature of the test being used, and appreciate that test performance depends not only on the child's knowledge and abilities, but also the features of the text (a signal that holds for all children, not but poor comprehenders). The poor comprehender literature also has implications for the need to appraise children's oral language (beyond phonological skills) every bit role of any thorough assessment of reading.

One approach to intervention is to accost a particular component of reading comprehension, for instance, vocabulary, inference making, or comprehension monitoring. Such intervention studies take mostly been with poor decoders, or children who notice both word reading and comprehension hard, rather than with poor comprehenders specifically. While gains are made on what has been taught, transfer effects to not-trained components or on standardised measures of reading comprehension are small (Elleman, 2017; Elleman, Lindo, Morphy, & Compton, 2009). This is perhaps not surprising, given the complex nature of reading comprehension, and its dependence on stiff content knowledge. That said, there are excellent examples of promising approaches to teaching reading comprehension (for review, run across Oakhill, Cain, & Elbro, 2014) that could exist developed and trialled for children identified as poor comprehenders.

A different approach is to consider the key part of oral language (or linguistic comprehension, in terms of the Simple View) in reading comprehension and aim intensive intervention at that place. Working from the finding that poor comprehenders have impairments in linguistic comprehension, Clarke, Snowling, Truelove, and Hulme (2010) developed a language intervention that directly and explicitly worked on 8–9 year-olds' oral language with direct instruction tapping vocabulary, grammer and narrative. Using a randomised controlled design, they compared this xx-week intervention with one focussing on text comprehension itself, and a combined approach targeting both oral language and text comprehension. Intervention was delivered in modest groups by trained pedagogy assistants, with iii xxx-minute sessions per week. Pleasingly, all iii groups improved in reading comprehension relative to a waiting list control grouping. Those receiving oral language grooming showed most improvement in reading comprehension 11 months subsequently, and improvements in reading comprehension were predicted past improvements in vocabulary. Fricke et al. (2013) used a similar approach but with materials designed for much younger children. They identified children with low language at around the fourth dimension of school entry. Those who received an intensive language intervention showed improvements in oral language, and got off to a meliorate start with reading comprehension than children in the control group. These findings are encouraging, and back up the rationale for improving children's oral linguistic communication equally the basis for bringing virtually improvements in reading comprehension. Note all the same these interventions are intensive, and are designed to be delivered past teaching assistants who have been specifically trained—quick fixes are non to be expected.

Part Iv: reflections on the Simple View

In the 30-plus years since the Simple View was commencement articulated by Gough and Tunmer (1986), its elegance and force in describing the essence of reading comprehension has become clear. By setting out decoding and linguistic comprehension as separate merely interacting components, information technology reminds the states that reading comprehension requires both the ability to identify private words, and the power to construct meaning from text. When assessed reliably using comprehensive measures, how adept children are at decoding and linguistic comprehension predicts how skilful they are at reading comprehension extraordinarily well. The Uncomplicated View provides a framework for classifying reading difficulties, and information technology has washed much to promote our understanding of the relationship between spoken language and reading evolution. It is non simply children with "archetype dyslexia" who need extra support in the classroom: inquiry conducted within the Elementary View framework has shown that a large proportion of children with low word reading also testify poor oral linguistic communication, as do children with reading comprehension impairments. These research findings have important implications for assessment and intervention and information technology is a positive evolution to see materials written for practitioners framed inside the Unproblematic View (e.g. Stuart & Stainthorp, 2015).

Despite these strengths, the Simple View has led to some imitation impressions. As noted earlier, the Simple View "does not deny the complexity of reading, merely asserts that such complexities are restricted to either of the two components", linguistic comprehension and decoding (Hoover & Gough, 1990, p. 150). Nonetheless, Catts (2018) discusses how visualisations of the Simple View—diagrams similar Figure 1, with the ii components appearing to be the same size—have inadvertently camouflaged the complication of reading comprehension and in doing, created faux impressions about its malleability, and the extent to which it tin be captured by a score on an omnibus test. These concerns intersect with some of our earlier discussion—that the Simple View is not a model of what needs to develop to bring virtually change in either of the two components. In terms of partitioning and explaining variance, information technology is articulate that the relative weighting of the two constructs changes over time, with linguistic comprehension becoming more closely associated with reading comprehension as decoding skills strengthen (e.k., Language and Reading Enquiry Consortium, 2015). Early on, the decoding component predominates, but beyond the early stages of learning to read, the linguistic comprehension oval in diagrams like Figure one needs to be much bigger, and accept more indicators feeding into it, reflecting its multifaceted nature.

Another false impression is that the two components are entirely separable. A good deal of variation in reading comprehension is shared between the 2 components. Lonigan et al. (2018) suggested that this common variance might exist related to some underlying general cognitive linguistic power, and in their analyses, shared variance predicted differences in reading comprehension beyond the unique variance associated with each component. Consistent with this, longitudinal data have shown that some factors predict multiple components of reading. As noted before for instance, Hulme et al. (2015) plant that language skills at three.5 years contributed to decoding at 5.5 years likewise every bit reading comprehension at 8.5 years. Similarly, there is no doubt that oral vocabulary is a vital component of linguistic comprehension, nor that it is closely associated with reading comprehension. This does non mean it is irrelevant for give-and-take reading. On the opposite, vocabulary is also associated with word reading, both in typical development and singular development (eastward.g., Nation & Snowling, 1998; Taylor, Duff, Woollams, Monaghan, & Ricketts, 2015). Consider likewise the importance of morphology. Numerous studies have found associations betwixt children'due south reading comprehension and their cognition and appreciation of morphology (e.g., Levesque, Kieffer, & Deacon, 2019; Tong, Deacon, Kirby, Cain, & Parrila, 2011), consistent with morphology beingness a disquisitional component of linguistic comprehension. At the same time, all the same, skilled discussion recognition is highly sensitive to morphological regularities that are marked in the orthography, reminding us that English language is a morphophonemic in nature (Rastle, 2019; Venezky, 1999). As reading develops, the word recognition arrangement comes to embody this structure and this is reflected in how single words are read and candy (east.g., Dawson, Rastle, & Ricketts, 2018; Kearns & Al Ghanem, in press). Thus, morphological knowledge is not merely role of linguistic comprehension. It is also core to word recognition and its development—that is, what is captured within the Simple View as "decoding".

What are the implications of these findings for the Simple View? To take development on board, it might be that our visual representation needs to be more than complex, with some underlying linguistic communication gene feeding into both components, and/or bi-directional connections between decoding and linguistic comprehension, as shown in Figure 7.

Figure 7. An expanded view of the Simple View of reading.

This figure also shows feedback arrows from reading comprehension into language. This is to remind the states of the importance of reading feel. Information technology is the substrate from which basic decoding skills develop and automatise (run across Castles et al., 2018). It likewise provides rich and varied opportunities for linguistic communication learning, as children encounter new vocabulary and new syntactic structures via reading (Montag & MacDonald, 2015; Montag, Jones, & Smith, 2015). The implication of this for children with reading difficulties is neatly captured by Stanovich'southward (1986) description of the Matthew effect—the richer get richer and the poor get poorer. Low levels of spoken language set the scene for reading difficulties, which in turn atomic number 82 to greater differences in spoken linguistic communication, relative to peers who read well. Or, in the words of Snow (2016), "language is literacy is language".

The Simple View provides a useful framework for thinking most reading comprehension and its development. Information technology positions decoding as central to learning to read and reminds the states that no corporeality of oral language prowess can bring about successful reading, if a child has not learned the principles of how their writing system works. This is what learning to read is about, and what needs to be taught at the kickoff. Getting ameliorate at reading words, and developing all that is needed to serve reading comprehension in all its infinite varieties, obviously demands more decent decoding: the knowledge and processing skills nested within linguistic comprehension are key. There is no doubt that the Simple View explains variance in reading comprehension. But we likewise need to look beyond the Simple View, if nosotros are to understand more about how subcomponent processes work and develop, and how they tin can be optimised in the classroom and the clinic by well-designed reading and language instruction.

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Source: https://www.tandfonline.com/doi/full/10.1080/19404158.2019.1609272

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