**5. Intervention trends in developmental dyslexia in Spain**

In Spain, a noteworthy effort has been made in recent decades to develop intervention programs and analyze their effectiveness that had not previously been seen in the field of learning difficulties. Clearly, this increase in intervention studies did not occur by chance, but rather it has accompanied advances made in characterizing the problems experienced by children with reading problems [55]. Although evidence‐based intervention programs for children with dyslexia are scarce, they seem to reflect the different explanatory theories for reading difficulties.

Most interventions have been designed to remediate the *phonological‐processing deficit*, proposed as the main deficit in all dyslexics. These studies have evaluated the efficacy of different approaches to treatment, mainly based on a combination of training in phonological skills and phonemic awareness. The first programs developed for students with dyslexia incorporated instruction in identifying phonemes, adding phonemes, and writing a word. The results showed that instruction produces a significant improvement in the subject's ability to write down dictated sentences and passages. Although this training favored the acquisition of metalinguistic skills (tasks such as reversal, addition, and omission of phonetic sounds), the children's reading level did not improve [56–58]. Thus, training in phonemic awareness does not have a positive effect on reading in children with dyslexia. These results are consistent with the conclusions of a meta‐analysis on reading intervention studies with children with learning difficulties [59]. They suggest that phonemic awareness is an important skill, but not sufficient to improve reading, especially in older children with reading difficulties.

Some researchers have suggested that the difficulties experienced by children with dyslexia could be based on a specific difficulty with the perceptual processing of speech. Therefore, one of the components introduced in phonological skill‐training programs involves training in speech perception. For example, the effects of two types of phonological training on children with dyslexia were examined [60]. The two programs consisted of intensive, systematic instruction in letter‐sound correspondence and phonemic awareness using five different tasks (see description in **Table 1**).

*Segmentation.* The children had to pronounce all the phonemes in a word read aloud by the trainer. As they pronounced each phoneme, the trainer provided them with visual feedback for the phoneme by placing the corresponding letter on the magnetic board. The task contained seven words that were presented to the children.

*Phoneme deletion.* This task consisted of 13 words. In the first six words, the children had to delete the final phoneme, and in the following seven words, they had to delete the initial phoneme (e.g., "Say Cat. Now say it again, but don't say/K/"). After the child had said each word with the missing phoneme, the trainer provided him/her with a feedback by putting the word on the board and removing the deleted phoneme.

*Phoneme blending.* In each session, one of the children was provided with a magnetic board where a word with the phoneme being taught was placed. That child had to pronounce each phoneme in the given word. The other children had to guess the word and say it out loud. Visual feedback for each word was provided by the child who was presenting the word on the magnetic board. Seven words were presented in this task.

**Table 1.** Description of letter‐sound correspondence and phonemic awareness training tasks.

*Letter‐sound correspondence.* First, a trainer showed a consonant and vowel combination on a magnetic board. The children had to give the sound for each letter and each combination of letters. The linguistic structure of these combinations could consist of consonant‐vowel, vowel‐consonant‐vowel, consonant‐consonant‐vowel, considering all the possible or likely phonemic combinations in the Spanish language.

*Phoneme identification.* The children were shown a magnetic lowercase letter and had to say words that began with this letter. Then, the trainer read them six or seven words aloud, and the children had to say whether each word contained the phoneme and where.

Subjects differed only in speech perception training, which was introduced only in the second training condition. The first part of each session involved instruction in three tasks that trained speech perception (see description in **Table 2**). There were 20 training sessions lasting for 20 min each in both intervention conditions over a period of 4 weeks. The children received training in a specific phoneme in each training session, following this order of presentation: /m/, /f/, /ř/, /b/, /n/, /p/, /l/, /s/, /d/, /t/, /k/, /g/, /x/, /r/, /Ø/. In the last five sessions, the most difficult phonemes were reviewed. In the training sessions, words with different syllabic structures (consonant‐vocal, consonant‐vocal‐consonant, and consonant‐consonant‐vocal) were presented. The results of this study [60] indicated that both experimental groups improved on phonemic awareness compared to the control group, but only the children with speech perception plus letter‐sound correspondences with phonemic awareness scored higher than the control group on reading. Thus, speech perception training shows promise for use with children with dyslexia.

On the other hand, some researchers [61, 62] have used computerized speech‐based reading in experiments on dyslexia remediation. Specifically, the program called TEDIS (Tratamiento Experimental de la Dislexia; in English, Experimental Treatment of Dyslexia) has been investigated. The participants were randomly assigned to five groups: (a) the whole‐word training group, (b) the syllable training group, (c) the onset‐rime training group, (d) the phoneme training group, and (e) the untrained control group. For 30–40 min for 5 days a week, they were individually trained. The control group followed the standard reading program, which included oral comprehension, spelling, reading aloud, and reading comprehension activities. However, they did not receive any of the sound spelling units in which the experimental participants participated. During 15 sessions in the TEDIS program, children are trained with this "talking" computer program, which provides support and feedback through digitized speech in four experimental conditions: full word, phonemes, syllables, and onset‐rime segments. Children could request more speech feedback by clicking the mouse on each item. During the computer‐based word reading, when the child made three mistakes in the same word, a new word was presented. The results indicate that the experimental groups that participated in the phoneme and syllable conditions improved their word recognition in comparison with the

*Word pair categorization.* This task was designed to teach the discrimination of consonant contrasts in word pairs. The task contained four pairs of words: two differed only on one consonant (e.g., alba, alga) and two were the same (e.g., toga, toga). The children listened to a pair of words and had to give an oral response of *same* or *different* after each trial.

*Phoneme discrimination in words.* The trainer read a set of five words aloud; of them, only one was different (e.g., puente, puente, fuente, puente, puente). The children had to raise their hands if they heard the word that was different. After each trial, the trainer provided a feedback by saying the set of words and having the children repeat them. This task contained three sets. In each set, the two words differed on only one consonant. The presentation of the sets was from less to more difficult (e.g., set 1/m/contrasted with/g/; set 3/p/contrasted with/b/.

**Table 2.** Description of speech perception training tasks.

children with reading problems [55]. Although evidence‐based intervention programs for children with dyslexia are scarce, they seem to reflect the different explanatory theories for

Most interventions have been designed to remediate the *phonological‐processing deficit*, proposed as the main deficit in all dyslexics. These studies have evaluated the efficacy of different approaches to treatment, mainly based on a combination of training in phonological skills and phonemic awareness. The first programs developed for students with dyslexia incorporated instruction in identifying phonemes, adding phonemes, and writing a word. The results showed that instruction produces a significant improvement in the subject's ability to write down dictated sentences and passages. Although this training favored the acquisition of metalinguistic skills (tasks such as reversal, addition, and omission of phonetic sounds), the children's reading level did not improve [56–58]. Thus, training in phonemic awareness does not have a positive effect on reading in children with dyslexia. These results are consistent with the conclusions of a meta‐analysis on reading intervention studies with children with learning difficulties [59]. They suggest that phonemic awareness is an important skill, but not

sufficient to improve reading, especially in older children with reading difficulties.

Some researchers have suggested that the difficulties experienced by children with dyslexia could be based on a specific difficulty with the perceptual processing of speech. Therefore, one of the components introduced in phonological skill‐training programs involves training in speech perception. For example, the effects of two types of phonological training on children with dyslexia were examined [60]. The two programs consisted of intensive, systematic instruction in letter‐sound correspondence and phonemic awareness using five different tasks

*Letter‐sound correspondence.* First, a trainer showed a consonant and vowel combination on a magnetic board. The children had to give the sound for each letter and each combination of letters. The linguistic structure of these combinations could consist of consonant‐vowel, vowel‐consonant‐vowel, consonant‐consonant‐vowel, considering all

*Phoneme identification.* The children were shown a magnetic lowercase letter and had to say words that began with this letter. Then, the trainer read them six or seven words aloud, and the children had to say whether each word contained

*Segmentation.* The children had to pronounce all the phonemes in a word read aloud by the trainer. As they pronounced each phoneme, the trainer provided them with visual feedback for the phoneme by placing the corresponding letter on

*Phoneme deletion.* This task consisted of 13 words. In the first six words, the children had to delete the final phoneme, and in the following seven words, they had to delete the initial phoneme (e.g., "Say Cat. Now say it again, but don't say/K/"). After the child had said each word with the missing phoneme, the trainer provided him/her with a feedback

*Phoneme blending.* In each session, one of the children was provided with a magnetic board where a word with the phoneme being taught was placed. That child had to pronounce each phoneme in the given word. The other children had to guess the word and say it out loud. Visual feedback for each word was provided by the child who was

reading difficulties.

50 Learning Disabilities - An International Perspective

(see description in **Table 1**).

the phoneme and where.

the possible or likely phonemic combinations in the Spanish language.

by putting the word on the board and removing the deleted phoneme.

the magnetic board. The task contained seven words that were presented to the children.

presenting the word on the magnetic board. Seven words were presented in this task.

**Table 1.** Description of letter‐sound correspondence and phonemic awareness training tasks.

*Phoneme discrimination in syllables.* The trainer read aloud a series of eight syllables that differed only on the initial phoneme (e.g., pe, te, le, me, se, te, me, le) and contained a target syllable (e.g., me). The children had to raise their hands if they heard the target syllable. This task presented four sets of syllables and four target syllables. In each set of syllables, the possible linguistic structures were CV, CVC, or CCV.

control group. In addition, dyslexics who participated in the phoneme, syllable, and onset‐ rime conditions made a greater number of requests during computer‐based word reading under conditions that required extensive phonological computation (low‐frequency words and long words). However, the reading time was higher for long words in the phoneme group. These results show that training in phonological processes improves word recognition in children with dyslexia who learn to read in a consistent orthography.

Another study [63] analyzed whether the *Tradislexia* videogame affected phonological awareness, considering separately the complexity of the syllable structure and the type of phonological awareness task, and word recognition in children with dyslexia. The results showed that when the phoneme position was controlled, multimedia training in segmentation and blending with words that include consonant‐vowel syllables was a better predictor of improvements in word‐decoding processes.

Unfortunately, programs designed to remediate the deficit in phonological processing, although beneficial, are not sufficient to achieve fluent word recognition in children with dyslexia. In fact, 90% of intervention studies include measures of reading accuracy, but not reading fluency [64]. Consequently, in recent years, some studies [65–68] have analyzed the efficacy of intervention programs mainly designed to improve reading fluency.

For example, one study analyzed the efficacy of a multicomponent program to improve reading fluency in Spanish children with dyslexia, called Velocilector [65–68]. This program integrates multiple instructional components that meet rigorous scientific standards for effectiveness (see **Table 3** for a description of instructional components). Special needs teachers were trained in the application of the program. Instruction was delivered one to one. The effects of the training program were evaluated using gains in scores on word and pseudoword reading and text‐reading fluency, as well as on a text comprehension test. Results showed that children who participated in the intervention obtained statistically significant gains on the reading measures used, with the exception of text comprehension, spelling, and reading motivation [62, 66–68].

Another study [65] analyzed the effectiveness of a computerized reading acceleration program (RAP), which is a different approach to improving reading fluency problems. The Spanish version consists of 600 sentences with comprehension questions with three alternative answers. Each child was trained during 20 sessions lasting for 30 min each over a period of 4 weeks (about 10 h of training). In each session, the children worked individually on the computer with 30 sentences with the corresponding questions, under the supervision of a previously trained graduate student. The sentences appeared one at a time on the computer screen. After reading a sentence, the children pressed the space bar, and the text disappeared. Next, a comprehension question appeared with three alternative answers. The children had to choose the correct answer by pressing a key on the computer. During the training, all the children were presented with the same set of sentences in the same order. The results of the accelerated reading training showed that children with dyslexia improved their reading speed on sentences, their level of reading comprehension, and their naming speed on letter and pseudoword‐reading time, providing empirical evidence for the acceleration phenomenon in Spanish.


**Table 3.** Instructional components of the Velocilector multicomponent program.
