**3. Literature relevant to the Phonological Side of 'The Tales of Jud the Rat' reading fluency programme**

### **3.1. Phonological and language correlates of reading ability**

A wide variety of different studies have indicated an association between phonological and language development and reading ability. Based on meta-analysis of 61 samples of data, Scarborough [63, 64] reported that the highest average correlations and effect sizes were between measures requiring the processing of print (e.g. letter-sound knowledge) and reading ability, followed by measures of oral language proficiency (e.g. phonological awareness). There were a number of average predictive correlations above 0.50 and still more above 0.40, but of the oral language predictors, only phonological awareness was found to have a causal relationship with learning to read [65, 66].

Overall, the evidence from predictive research within the phonologically based paradigm was both convergent and compelling [67, 68, 69]. In addition, a number of neurolinguistic studies (e.g. [70, 71, 72]) indicated that dyslexic readers process written stimuli atypically, suggesting abnormal functioning of the left hemisphere reading system.

These neurolinguistic studies were of particular interest in suggesting particular areas of the brain associated with reading difficulties. Schulte-Körne and her colleagues [73] used mis‐ match negativity (MMN) to investigate the relationship between dyslexia and central auditory processing in 19 children with spelling disability and 15 controls at grades 5 and 6 level. While there were no group differences for tone stimuli, a significantly attenuated MMN was found in the dyslexic group for the speech stimuli, suggesting that dyslexics have a specific speech processing deficit at the sensory level which could be used to identify children at risk at an early age.

In Shah-Wundenberg, Wyse and Chaplain's study, paired reading and hearing reading were found to be equally effective in developing children's beginning English reading skills, reading accuracy and comprehension, relative to controls. The data also indicated that parents had engaged in a variety of mediation behaviours to enhance their children's English reading development. In addition, parents reported that participating in their children's reading in both conditions had been both enriching and empowering, suggesting that parental involve‐

The development of the reading fluency programme described in the rest of this chapter should thus be viewed as one of a number of potential approaches to enhancing the development of reading ability. Its potential advantages to parents, therapists, teachers and schools lie in the fact that it is based on a theory of structured phonics which has been developed with children who have had reading and spelling difficulties, that the material is delivered via the internet and email, and that the programme can be used at distance. 'The Tales of Jud the Rat' thus provides a form of e-learning which has the potential to enable paired reading methods to be used in a variety of contexts to develop fluent reading. There would also be potential for

**3. Literature relevant to the Phonological Side of 'The Tales of Jud the Rat'**

A wide variety of different studies have indicated an association between phonological and language development and reading ability. Based on meta-analysis of 61 samples of data, Scarborough [63, 64] reported that the highest average correlations and effect sizes were between measures requiring the processing of print (e.g. letter-sound knowledge) and reading ability, followed by measures of oral language proficiency (e.g. phonological awareness). There were a number of average predictive correlations above 0.50 and still more above 0.40, but of the oral language predictors, only phonological awareness was found to have a causal

Overall, the evidence from predictive research within the phonologically based paradigm was both convergent and compelling [67, 68, 69]. In addition, a number of neurolinguistic studies (e.g. [70, 71, 72]) indicated that dyslexic readers process written stimuli atypically, suggesting

These neurolinguistic studies were of particular interest in suggesting particular areas of the brain associated with reading difficulties. Schulte-Körne and her colleagues [73] used mis‐ match negativity (MMN) to investigate the relationship between dyslexia and central auditory processing in 19 children with spelling disability and 15 controls at grades 5 and 6 level. While there were no group differences for tone stimuli, a significantly attenuated MMN was found in the dyslexic group for the speech stimuli, suggesting that dyslexics have a specific speech

ment can benefit children's English reading development.

272 E-Learning - Instructional Design, Organizational Strategy and Management

combining this programme with other instructional approaches [62].

**3.1. Phonological and language correlates of reading ability**

abnormal functioning of the left hemisphere reading system.

**reading fluency programme**

relationship with learning to read [65, 66].

Shaywitz et al. [74] reported that learning to read requires phonological awareness, which can be defined as an awareness that spoken words can be decomposed into the phonologic constituents that the alphabetic characters represent. Phonological awareness is characteristi‐ cally lacking in dyslexic readers, for the reason that dyslexic readers have difficulty in mapping alphabetic characters onto the phonologic constituents of the spoken word.

Shaywitz and her colleagues used functional magnetic resonance imaging (MRI) to compare brain activation patterns in dyslexic and non-impaired subjects as they performed tasks that made progressively greater demands on phonologic analysis. Brain activation patterns were found to differ significantly between the groups with dyslexic readers showing relative underactivation in posterior regions (Wernicke's area, the angular gyrus and striate cortex) and relative overactivation in an anterior region (inferior frontal gyrus). Shaywitz et al. thus concluded that the impairment in dyslexia is phonologic in nature and that brain activation patterns may provide a neural signature for this impairment.

Similar conclusions were reached by Brunswick et al. [75], who reported that dyslexic readers process written stimuli atypically, based on abnormal functioning of the left hemisphere reading system, and that the deficits are localised in the neural system underlying lexical retrieval. Klingberg et al. [76] used MRI analysis to examine the structure of white matter in dyslexic and normal adult readers and found differences between normal readers and individuals with poor reading ability. These differences occurred bilaterally in the temporoparietal white matter underlying perisylvian cortical areas. An overlapping region in the left temporo-parietal white matter also yielded significant correlation between white matter microstructure and reading ability across all 17 subjects. This correlation was apparent both in the poor reading group and in the control group, indicating a structural neural correlate of reading skill in both normal and poor readers and also indicating that white matter underlying left temporo-parietal cortex plays a critical role in reading ability.

Burton [77] reported that there were functional sub-regions within the inferior frontal gyrus that correspond to specific components of phonological processing (e.g. orthographic to phonological conversion in reading, and segmentation in speech). Temple et al. [78] suggested that difficulties in reading are associated with both phonological and orthographic processing deficits, and that dyslexia may be characterised in childhood by disruptions in the neural bases of both phonological and orthographic processes important for reading.

In addition, the neurolinguistic literature indicated that a number of areas of the cortex were involved in fluent reading, as well as in processing different types of reading material. Bentin et al. [79] conducted research based on the analysis of event-related potentials (ERPs) elicited by visually presented lists of words. Based on this evidence, Bentin et al. concluded that different levels of processing are involved for visual, phonological/phonetic, phonological/ lexical and semantic material in both hemispheres of the brain, and that a cascade-type process involving different but interconnected neural modules may be involved in the processing of print material, each responsible for a different level of processing of word-related information. Similar conclusions were reached by Brown et al. [80] on the basis of examination of the MR images of 16 men with dyslexia and 14 control subjects, and comparison of these using a voxelbased analysis. Brown et al. reported evidence of decreases in gray matter in dyslexic subjects, not only in the left temporal lobe and bilaterally in the temporo–parieto–occipital juncture but also in the frontal lobe, caudate, thalamus and cerebellum. Brown et al. thus concluded that widely distributed morphologic differences affecting several brain regions may contribute to the deficits associated with dyslexia.

The above research thus suggested associations between impaired neurological processing and reading disability in dyslexic children. Equally important, however, were the indications from the neurolinguistic literature that reading difficulties were not immutable and that improvements in reading ability also had physiological correlates. Specifically, the develop‐ ment of reading ability would be accompanied by improvement in connectivity between the variety of cortical and sub-cortical centres involved in the reading process. These studies are reviewed in the following section.

#### **3.2. The development of reading ability has correlates on a neurological level**

A number of studies suggest that there are associations between the development of reading ability and improvement in neurological processing of print material. Patterns of central processing might initially not be well developed in dyslexic children, but would be responsive to instruction.

Simos et al. [81] studied magnetic source imaging scans during a pseudoword reading task with a sample of eight children aged from 7- to 17-years-old, both before and after 80 hours of intensive remedial instruction. All children were initially diagnosed with dyslexia, having severe difficulties in both word recognition and phonological processing. After remedial training, the dyslexia-specific brain activation profiles became normal, suggesting that change in central processing of print had occurred following intensive remedial training.

Shaywitz et al. [82] reported that provision of a phonologically mediated reading intervention over a period of a year improved both reading fluency and the development of the fast-paced occipito-temporal systems serving skilled reading. After the year-long intervention, children taught with the experimental intervention had made significant gains in reading fluency and demonstrated increased activation in left hemisphere regions, including the inferior frontal gyrus and the middle temporal gyrus, These improvements appeared to be stable; as 1 year after the experimental intervention had ended, these children were activating bilateral inferior frontal gyri and left superior temporal and occipito-temporal regions. This indicated the phonologic reading intervention had facilitated the development of those fast-paced neural systems that underlie skilled reading.

Similar conclusions concerning change in neurological processing in children were reached by Maurer et al. [83], who investigated the development of coarse neural tuning for print by studying children longitudinally before and after learning to read, and compared these patterns to those exhibited by adults who were skilled readers. Maurer et al. reported that coarse neural tuning for print peaked when children learned to read. Coarse N1 tuning, which had been absent in non-reading kindergarten children, emerged less than 2 years later after the children had mastered basic reading skills in second grade. The coarse N1 tuning had become larger for words than symbol strings in every child. Coarse N1 tuning was also stronger for faster readers. On this evidence, Maurer et al. concluded that fast brain processes specialise rapidly for print when children learn to read, and play an important functional role in the fluency of early reading.

#### **3.3. Neural connectivity is associated with fluent reading**

Similar conclusions were reached by Brown et al. [80] on the basis of examination of the MR images of 16 men with dyslexia and 14 control subjects, and comparison of these using a voxelbased analysis. Brown et al. reported evidence of decreases in gray matter in dyslexic subjects, not only in the left temporal lobe and bilaterally in the temporo–parieto–occipital juncture but also in the frontal lobe, caudate, thalamus and cerebellum. Brown et al. thus concluded that widely distributed morphologic differences affecting several brain regions may contribute to

The above research thus suggested associations between impaired neurological processing and reading disability in dyslexic children. Equally important, however, were the indications from the neurolinguistic literature that reading difficulties were not immutable and that improvements in reading ability also had physiological correlates. Specifically, the develop‐ ment of reading ability would be accompanied by improvement in connectivity between the variety of cortical and sub-cortical centres involved in the reading process. These studies are

A number of studies suggest that there are associations between the development of reading ability and improvement in neurological processing of print material. Patterns of central processing might initially not be well developed in dyslexic children, but would be responsive

Simos et al. [81] studied magnetic source imaging scans during a pseudoword reading task with a sample of eight children aged from 7- to 17-years-old, both before and after 80 hours of intensive remedial instruction. All children were initially diagnosed with dyslexia, having severe difficulties in both word recognition and phonological processing. After remedial training, the dyslexia-specific brain activation profiles became normal, suggesting that change

Shaywitz et al. [82] reported that provision of a phonologically mediated reading intervention over a period of a year improved both reading fluency and the development of the fast-paced occipito-temporal systems serving skilled reading. After the year-long intervention, children taught with the experimental intervention had made significant gains in reading fluency and demonstrated increased activation in left hemisphere regions, including the inferior frontal gyrus and the middle temporal gyrus, These improvements appeared to be stable; as 1 year after the experimental intervention had ended, these children were activating bilateral inferior frontal gyri and left superior temporal and occipito-temporal regions. This indicated the phonologic reading intervention had facilitated the development of those fast-paced neural

Similar conclusions concerning change in neurological processing in children were reached by Maurer et al. [83], who investigated the development of coarse neural tuning for print by studying children longitudinally before and after learning to read, and compared these patterns to those exhibited by adults who were skilled readers. Maurer et al. reported that coarse neural tuning for print peaked when children learned to read. Coarse N1 tuning, which

**3.2. The development of reading ability has correlates on a neurological level**

in central processing of print had occurred following intensive remedial training.

the deficits associated with dyslexia.

274 E-Learning - Instructional Design, Organizational Strategy and Management

reviewed in the following section.

systems that underlie skilled reading.

to instruction.

Shankweiler et al. [84] also concluded that cortical integration of speech and print in sentence processing varies with reader skill. These researchers used functional magnetic resonance imaging (fMRI) to investigate the association between literacy skills in young adults and the distribution of cerebral activity during comprehension of sentences in spoken and printed form. The results from different analyses all pointed to the conclusion that neural integration of sentence processing across speech and print varies positively with the reader's skill. Further, Shankweiler et al. identified the inferior frontal region as the principal site of speech–print integration and a major focus of reading comprehension differences.

Additional studies used advances in fMRI to identify a relationship between white matter structure (as an indicator of myelination) and reading ability (e.g. [85, 86]). This area of the neurolinguistic literature was based on the premise that myelination was not only an index of the maturity of the insulation of individual fibres in the brain but was also an index of efficiency in neurological transmission [87, 88].

Hasan et al. [89] used diffusion tensor imaging to study the structure and distribution of white matter within the corpus callosum areas connecting the two hemispheres of the brain in children with dyslexia and those of typically developing readers of comparable age and gender. Hasan et al. reported that the posterior corpus callosum area was enlarged in children with dyslexia relative to the same area as measured in typically developing children. In addition, there were microstructural differences (e.g. the mean diffusivity of the posterior middle sector of the corpus callosum), which correlated significantly with measures of word reading and reading comprehension. Reading group differences between dyslexic and typically developing children were also found when using fractional anisotropy, mean diffusivity and radial diffusivity to measure the microstructural characteristics of the posterior corpus callosum.

Vandermosten et al. [90] also used diffusion tensor imaging tractography to examine the integrity of the three-dimensional white matter tracts connecting the left temporo-parietal region and the left inferior frontal gyrus, for which atypical functional activation and lower fractional anisotropy values have been reported in dyslexic readers. Their study revealed structural anomalies in the left arcuate fasciculus in adults with dyslexia. In addition, Van‐ dermosten et al. were able to demonstrate a correlational double dissociation, which suggested that the dual route reading model has neuroanatomical correlates. In the sample studied, the left arcuate fasciculus seemed to sustain the dorsal phonological route underlying grapheme– phoneme decoding in reading, while the left inferior fronto-occipital fasciculus seemed to sustain the ventral orthographic route underlying reading by direct word access.

#### **3.4. Repetition of phoneme-grapheme relationships is likely to build neural connectivity**

Later in this chapter, there is reference to the longitudinal work I conducted in the 1990s with a dyslexic child called Q. There were indications from the neurologist's reports that Q's dyslexia was linked to a disorder of neural network connections, as well as a function associ‐ ated with possible cortical immaturity (Dr Graeme Maxwell, personal communication). The research evidence reviewed in the previous sections was not available at this time, and it was only at the end of the 1990s that neurolingustic evidence began to emerge that many dyslexic children process reading material at a central level in ways different to normally developing readers [91, 92, 93].

Subsequent evidence suggested that the neural connections formed through the reading process involved a number of cortical areas [94], while also indicating a developmental trajectory by which exposure to written language engages areas originally shaped by speech on the path toward successful literacy acquisition [95, 96]. Equally important was the evidence from studies reviewed in the previous section (e.g. [97, 98, 99]), which suggested that connec‐ tivity in the brain could be enhanced through involvement in the process of learning to read, and that phonologically and phonemically based instruction could be particularly helpful in this process.

What my own clinical observations and the literature implied was that in Q's development as well as in the development of other dyslexic children, neural connections would not initially be strongly developed. Changes in connectivity as well as in white matter structure would also be likely to accompany phonologically based reading acquisition.

On a programmatic level, this implied that repeated reading of phonically based material would be likely to develop connections between the variety of cortical areas involved in fluent reading. Conversely, where repeated reading of phonically based material leads to observable changes in reading fluency, this would probably also point to increased functionality in the neural connections which underpin central processing of printed material.

In short, there was a two-way association involved. This suggested that in children with reading difficulties, increased time on task in reading tasks involving repetition of phoneme– grapheme relationships would be likely to build greater reading ability, as well as greater neural connectivity. This has informed the development of the 'Jud the Rat' reading materials described later in this chapter.

#### **3.5. Limitations in correlational research**

While the research reviewed in this section implies two-way associations between phonolog‐ ical- and language-based factors, reading ability, instruction in reading and brain connectivity, it is important to note that there are a number of limitations in correlational research.

As Scarborough [100] has suggested, two-way associations in the literature on reading may not be linear ones, for the reason that the development of reading is a multi-faceted process. In addition, Scarborough has suggested that there are many inconsistencies within the evidence on the relationship between phonological and language factors and reading disabil‐ ities, which may indicate that there is a second causal chain (e.g. a persisting underlying condition which may account for all the two-way associations observed).

**3.4. Repetition of phoneme-grapheme relationships is likely to build neural connectivity**

276 E-Learning - Instructional Design, Organizational Strategy and Management

Later in this chapter, there is reference to the longitudinal work I conducted in the 1990s with a dyslexic child called Q. There were indications from the neurologist's reports that Q's dyslexia was linked to a disorder of neural network connections, as well as a function associ‐ ated with possible cortical immaturity (Dr Graeme Maxwell, personal communication). The research evidence reviewed in the previous sections was not available at this time, and it was only at the end of the 1990s that neurolingustic evidence began to emerge that many dyslexic children process reading material at a central level in ways different to normally developing

Subsequent evidence suggested that the neural connections formed through the reading process involved a number of cortical areas [94], while also indicating a developmental trajectory by which exposure to written language engages areas originally shaped by speech on the path toward successful literacy acquisition [95, 96]. Equally important was the evidence from studies reviewed in the previous section (e.g. [97, 98, 99]), which suggested that connec‐ tivity in the brain could be enhanced through involvement in the process of learning to read, and that phonologically and phonemically based instruction could be particularly helpful in

What my own clinical observations and the literature implied was that in Q's development as well as in the development of other dyslexic children, neural connections would not initially be strongly developed. Changes in connectivity as well as in white matter structure would also

On a programmatic level, this implied that repeated reading of phonically based material would be likely to develop connections between the variety of cortical areas involved in fluent reading. Conversely, where repeated reading of phonically based material leads to observable changes in reading fluency, this would probably also point to increased functionality in the

In short, there was a two-way association involved. This suggested that in children with reading difficulties, increased time on task in reading tasks involving repetition of phoneme– grapheme relationships would be likely to build greater reading ability, as well as greater neural connectivity. This has informed the development of the 'Jud the Rat' reading materials

While the research reviewed in this section implies two-way associations between phonolog‐ ical- and language-based factors, reading ability, instruction in reading and brain connectivity,

As Scarborough [100] has suggested, two-way associations in the literature on reading may not be linear ones, for the reason that the development of reading is a multi-faceted process. In addition, Scarborough has suggested that there are many inconsistencies within the evidence on the relationship between phonological and language factors and reading disabil‐

it is important to note that there are a number of limitations in correlational research.

be likely to accompany phonologically based reading acquisition.

neural connections which underpin central processing of printed material.

readers [91, 92, 93].

this process.

described later in this chapter.

**3.5. Limitations in correlational research**

Studies by Galaburda [101], Poldrack [102] and Stein [103] have also suggested the high likelihood that some other mechanism (e.g. of magnocellular, auto-immune system or genetic origin) may account for the anatomical differences between the brain structures of dyslexics and normal readers. Underlying attentional or working memory factors (what Ahissar et al. [104, 105], have called an

anchoring-deficit) may also account for the evidence that only 5–10% of children who are fluent readers in the early grades at school stumble later, while between 65% and 75% of children designated as reading disabled early continue to read poorly throughout their school careers (and beyond), despite evidence that these readers have learned to read [106]. Anchoring deficit factors could also account for periods of 'illusory recovery', in which symptoms of reading disability appear to be remediated, but then reappear at later stages in schooling, suggesting that language skills may develop in a non-linear fashion [107].

In short, while the evidence of the associations between phonological and language factors and reading disability would appear to be compelling, other underlying factors besides a core phonological deficit may contribute to reading disability [108, 109, 110]. A number of other theories (e.g. those relating to how print material is processed visually) are thus reviewed in the following section. These theories have provided the rationale behind the use of large print in the 'Jud the Rat' materials, as well as the use of visual attentional cueing in the process of implementing the materials.
