*3.1.2 Development of an individual programme*

As initial assessment indicated that Child H had difficulties affecting a number of functional areas, his individual programme was conceptualised as multivariate, requiring a number of interventions. These are summarised in **Figure 4** below.

**Figure 4.** *Child H's individual programme.*

#### *3.1.3 Child H's individual programme here*

Child H's programme was thus conceptualised as linked to a number of areas of need. The reading side of the programme would be based on interventions aimed at establishing basic phonological and phonic skills, as well as skills in both synthetic, and analytical phonics. In addition, there would be interventions designed to improve Child H's skills in word reading as well as to establish his fluency in sequential reading as the basis for improving reading comprehension. These areas would then form the basis for learning support enabling Child H to improve in the types of language and reading comprehension tasks he was being given in the classroom in Grade 4, as well as to cope with the reading and comprehension requirements of word and story sums at Grade 3 level.

In addition to the reading side of the programme, there would be interventions aimed at establishing basic skills in spelling and writing, which were also influencing Child H's ability to achieve in classroom-based tasks, as well as to keep up with the amount of work and rate of work required. These areas of the programme would be commenced by teaching Child H how to use phonological referencing to analyse the structure of the words he was being asked to learn for his spelling tests at school. This would be done by focusing on the consonant blends and vowel digraphs in these words using a seven vowel analytical system, with the aim of making the vowel system used in English orthography transparent.

Use of the Seven Vowel Phonic Analysis System would initially be introduced through work with graded phonically based material. In order to link the writing and spelling side of the intervention with the work being done in the reading side of Child H's programme, this would be done using graded written material drawn from the reading fluency books Child H had completed. This would work from Child H's spatial strengths, using methods which combined phonic analysis with word, sentence and paragraph revisualisation to develop sequential working memory for words. This would then form the basis for work with a variety of written material directed at establishing fluency in sequential writing and spelling.

The different interventions would be implemented in therapy conducted in hour long sessions conducted once per week, with carry-over through reinforcement by Child H's parents at home using electronic materials drawn from the practice's database (Note 11). There would also be a family-based counselling intervention to enable the different areas of the programme to be implemented side by side with as well as linked to Child H's school work. Work ethic and motivation would be maintained through a reward system based on hundred squares and points (Note 12).

### *3.1.4 Child H's initial programme: focus on reading fluency side by side with the development of phonic skills*

Owing to the evidence that Child H's reading, writing and spelling problems were linked to phonological and phonic difficulties, the methods and materials used in Child H's initial programme targeted reading, writing and spelling fluency linked to interventions focusing on the development of phonic skills. The methods and materials used in the reading fluency side of Child H's programme are described in more detail in Potter [5], while the methods and materials introduced at the initial stage of Child H's writing and spelling fluency programme are described in Potter [6] as well as in Potter [8, 9].

#### *Multivariate Treatment of Dyslexia, Dysgraphia and Dyscalculia DOI: http://dx.doi.org/10.5772/intechopen.110287*

The interventions for the development of phonic skills involved use of phonogram and rime cards to target Child H's errors on the phonic inventories, to support work done using phonological referencing [105, 106]. This focused on teaching Child H how to code from the letters used in rhyming word families back to the movements of the mouth accompanying the sounds made when reading the words, and then how to reverse code from the sequence of sounds made in the spoken word back to the written words.

Focus was initially placed on working with families of rhyming words based on similar phonological and phonemic elements. The sequence of the materials used followed the phonologically and phonically based stages in spelling described by Moats [107, 108], as well as the phonically based stages in teaching spelling in South African primary schools, which are based on use of word families. Phonic associations based on short and long vowel sounds were then reinforced by being introduced side by side with reading fluency activities using our foundation level and then our basic level readers, with the aim of developing the variety of phonic associations as well as the span of working memory necessary to read, write and spell words in sequence [105].

#### *3.1.5 Use of phonological referencing and revisualisation in developing writing and spelling fluency*

The materials used in Child H's phonological referencing programme were designed to target the specific phonic errors as well as the types of phonic errors he had made on the Phonic Inventories, whilst at the same time developing the working memory skills necessary to write words individually and in sequence. These were thus written and then taught with these two aims in mind.

These were introduced working from Child H's spatial strengths. One reason for this was that his cognitive test profile indicated that he was a spatially competent child. Another was that pragmatic testing indicated that he had the ability to use eidetic imagery in recalling letter strings and written words (Note 13). These cognitive strengths indicated that phonic associations could be taught using phonological referencing in conjunction with revisualisation. These methods implied building the areas of phonic weakness through methods enabling Child H to use his good visualisation and visual memory abilities in recalling words.

For this reason, focus was placed on working with families of between five and seven words, each of which was based on use of a similar consonant blend of cluster. As the IQ profile indicated that Child H had coding difficulties, the aim was to use Child H's visualisation and visual memory integrities to develop the phonological and phonic working memory integrities necessary to write individual words accurately, as well as the ability to write words accurately in sequence (Note 14).

In teaching the tch ending in short vowel words, for example, the following words were written in Child H's writing book.


The letters making the vowel sound in each of the words in the /tch/ family were then identified and underlined in colour. The phonological referencing process then involved teaching Child H how to code from the sequence of written letters in each word back to the mouth movements accompanying the sounds made when the word was spoken orally, and then how to recode from the sounds back to the sequence of letters in the word.

These associations were taught through activities in which the hand was placed under the chin, as well as through use of a mirror tile to enable Child H to match the way his mouth opened in making each vowel sound and the way his mouth closed in making each consonant sound. This was done through an activity-based process, in which Child H was asked to:


This sequence of activities was first used to teach Child H how to code from the component sounds and letters in each word in the tch family, by linking when the word was spoken out loud with the letters used when the word was written down, and to recode from the sequence of sounds back to the written sequence of letters. Each of the words in the tch family was then contextualised in language by being used in sequence in a short sentence. The sentence was then written down by Child H, and the vowel or vowels in each word in the sentence then underlined in colour. Once this had been done, each word in the sentence was revisualised in sequence, and the sentence was then written by Child H from memory (Note 15).

The aim was thus to teach Child H how to identify the letters making particular sounds as well as combinations of letters making particular sounds in written words, and then to recode from particular sounds back to particular letters and sequences of letters in these words. This type of instruction was introduced side by side with work targeting other areas of difficulty identified in the initial assessment, as described in the following section.

#### *3.1.6 Development of formats to support side by side implementation of treatment in a number of areas*

The materials used in Child H's phonological referencing programme focused initially on specific errors made on the phonic inventories. This was introduced side by side with reading fluency work, as well as work in language, reading comprehension and maths.

As the aim was to provide graded materials in each of the areas in which Child H needed developmental work, his initial programme was implemented using a format system (Note 16), based on graded activities linked to electronic materials in the practice's database (**Table 4**).

#### *3.1.7 Child H—Learning cycle four implemented 15th October 2016 here*

Child H's initial programme was thus conceptualised as multivariate, and based on sequences of activities which had the common aim of developing fluency in reading, writing and spelling. Reading comprehension and proficiency in both processing and use of written language were conceptualised as linked to fluency in these areas, as well as to the development of working memory for individual words and sequence of words. Graded materials were then used to support work in each of these areas.
