8. Summary and evaluation

Vygotsky suggests [84] that higher mental functions such as speech, reading and writing exist as a result of interaction between highly differentiated brain structures. These structures make their own individual specific contributions to the dynamic whole. Luria [85] thus conceptualises brain structures as being dynamic and changing, as lower level functioning evolves to provide a basis for higher level functioning. The structure of mental functions does not remain constant, but is dynamic and systemic, developing the capacity for greater integration through a process of automaticity, in which previously unconnected acts become highly automatized skills.

The fluency-based programme described in this chapter is based on these assumptions. It represents an attempt to operationalise Luria's theories, and to create a resource of low-cost material which can be used to develop basic skills and automaticity in reading, and basic skills and automaticity in writing and spelling. There are a number of different areas and components in the programme, as well as four sides to the assessment process used to establish basic skill and fluency needs, and to monitor the implementation of the programme in practice.

An attempt has been made in this chapter to indicate through one detailed case study how results from assessment can be used to develop an individual programme relating to both basic skill and fluency needs both in reading and in writing and spelling, and to link these needs to a variety of programmatic activities on a functional level. The results of 14 children who have been exposed to all three areas of intervention in the programme have then been presented in tabular format. The evidence presented indicates that each of the children in the main body of case studies has made observable improvement in each of the four sides of the

<sup>4</sup> Comment on slow learning children made by Janet Lerner to the author in 1977.

assessment used to monitor the implementation of the programme. Each of the children has also made observable improvements at school.

Lerner<sup>4</sup> has suggested that it is important to bear in mind that slow learning children learn, but that this is at a slower rate than many other children. This observation would be corroborated by the author's experience, as well as the experience of other teachers and therapists who have

It has also been the author's observation that certain of the children who have been treated in the practice make gains and can "bank" the skills learned and integrities developed. In other children, deterioration takes place in the absence of repetition, indicating difficulties in long-term memory processes and needs for ongoing work to maintain and consolidate

Vygotsky suggests [84] that higher mental functions such as speech, reading and writing exist as a result of interaction between highly differentiated brain structures. These structures make their own individual specific contributions to the dynamic whole. Luria [85] thus conceptualises brain structures as being dynamic and changing, as lower level functioning evolves to provide a basis for higher level functioning. The structure of mental functions does not remain constant, but is dynamic and systemic, developing the capacity for greater integration through a process of automaticity, in which previously unconnected

The fluency-based programme described in this chapter is based on these assumptions. It represents an attempt to operationalise Luria's theories, and to create a resource of low-cost material which can be used to develop basic skills and automaticity in reading, and basic skills and automaticity in writing and spelling. There are a number of different areas and components in the programme, as well as four sides to the assessment process used to establish basic skill and fluency needs, and to monitor the implementation of the programme

An attempt has been made in this chapter to indicate through one detailed case study how results from assessment can be used to develop an individual programme relating to both basic skill and fluency needs both in reading and in writing and spelling, and to link these needs to a variety of programmatic activities on a functional level. The results of 14 children who have been exposed to all three areas of intervention in the programme have then been presented in tabular format. The evidence presented indicates that each of the children in the main body of case studies has made observable improvement in each of the four sides of the

Comment on slow learning children made by Janet Lerner to the author in 1977.

worked with the materials and methods used in the programme.

gains made.

in practice.

4

8. Summary and evaluation

172 Learning Disabilities - An International Perspective

acts become highly automatized skills.

The results of six other children have then been presented in similar format as a case contrast group. This evidence has been drawn from the files of children in the practice for whom there has been one or other systematic variation in the way in which the programme has been implemented. Case contrast analysis has then been used to highlight three implementation variables likely to affect the successful implementation of the programme. These variables are:


There have also been unanticipated outcomes which are of interest. It was never anticipated that the reading fluency materials used in the fluency-based areas of the programme would be acceptable to children of different ages and cultural backgrounds in South Africa, for the reason that the animal characters and settings used in the ebooks were originally developed for use overseas with a child in Holland. As this child had severe learning disabilities which required long-term intervention, it was necessary to write a series of graded reading books which could lead to learning gains, while at the same time maintaining involvement, motivation, and interest [86]. The development of the first series of books then occurred over a 5 year period in the 1990s, with the content of the books being designed to match the interests and humour of this particular child as she got older.

Over the last 5 years since 2012, a large number of additional graded reading books have been written about the same set of animal characters. These reflect a variety of settings, and have been workshopped and used with South African children of different ages, and from different cultural backgrounds, whose parents report that they find them enjoyable. They are also being used by children in England, as well as in other countries adjacent to South Africa, whose parents are reporting that their children are learning to read more fluently, and at the same time enjoying the stories.

Similarly, the writing and spelling methods used in the programme have been developed over a considerable period of time, have been implemented clinically for a number of years, and have over the past 5 years been implemented with an increasing number of children of different ages, and cultural backgrounds. There is an emerging body of research evidence indicating that other therapists working with children diagnosed as having learning disabilities have used these methods successfully, (for example, see [87–89]). There is also evidence from the network of parents, teachers, therapists, and schools using the materials, that others are able to use these methods successfully at home, in their practices, as well as in the classroom.

There are limitations in both the data and in the aggregative case study analysis presented in this chapter. The author is a clinician running a busy practice, and referrals into the practice are made from other clinicians as well as on the basis of word of mouth. The composition of the sample is thus not only highly selected on the basis of a referral network, but the evidence presented in this chapter has been based on the results of an opportunity sample consisting of those children who have worked on fluency-based individual programmes, using materials drawn from the practice's database.

Nevertheless, despite limitations in sampling as well as limitations applying to conclusions based on ex post facto case analysis and aggregation, the evidence occurring across the different case studies is recurring. Progress made by 14 children working in all three areas of intervention in the fluency-based programme would suggest that the practice's database of materials is at a point in its development where it has been successfully used with children of a variety of ages and backgrounds in South Africa. There is also additional case by case evidence that it can be used successfully with children in other countries<sup>5</sup> .

This conclusion is based on evidence that in addition to gains in reading, spelling and dictation ages, the parents of young children, as well as adolescents report that there have been observable differences in both reading fluency, and writing and spelling fluency, linked to use of the programme's materials and methods. At the same time, their children have also made progress in relation to their learning difficulties at school, as evidenced by increase in marks and improvement in teacher comments and ratings.

The case studies presented in this chapter indicate gains in basic skills as well as gains in fluency associated with consistent use of the programme's materials and its methods,

<sup>5</sup> Children in South Africa, Botswana, Namibia, Mauritius as well as the United Kingdom are currently using the programme's materials and methods.

linking with positive evidence from parent evaluations, analysis of school books, and reports from school. The evidence from contrast case studies would also suggest broadbased difficulties with automaticity in the children with whom the author has worked, with gains made in areas where the programme has been implemented, and lack of gains in areas where there has been inconsistent or erratic implementation, or lack of implementation.

indicating that other therapists working with children diagnosed as having learning disabilities have used these methods successfully, (for example, see [87–89]). There is also evidence from the network of parents, teachers, therapists, and schools using the materials, that others are able to use these methods successfully at home, in their practices, as well as in the

There are limitations in both the data and in the aggregative case study analysis presented in this chapter. The author is a clinician running a busy practice, and referrals into the practice are made from other clinicians as well as on the basis of word of mouth. The composition of the sample is thus not only highly selected on the basis of a referral network, but the evidence presented in this chapter has been based on the results of an opportunity sample consisting of those children who have worked on fluency-based individual programmes, using materials

Nevertheless, despite limitations in sampling as well as limitations applying to conclusions based on ex post facto case analysis and aggregation, the evidence occurring across the different case studies is recurring. Progress made by 14 children working in all three areas of intervention in the fluency-based programme would suggest that the practice's database of materials is at a point in its development where it has been successfully used with children of a variety of ages and backgrounds in South Africa. There is also additional case by case evidence that it can be used successfully with children in other

This conclusion is based on evidence that in addition to gains in reading, spelling and dictation ages, the parents of young children, as well as adolescents report that there have been observable differences in both reading fluency, and writing and spelling fluency, linked to use of the programme's materials and methods. At the same time, their children have also made progress in relation to their learning difficulties at school, as evidenced

The case studies presented in this chapter indicate gains in basic skills as well as gains in fluency associated with consistent use of the programme's materials and its methods,

Children in South Africa, Botswana, Namibia, Mauritius as well as the United Kingdom are currently using the

by increase in marks and improvement in teacher comments and ratings.

classroom.

countries<sup>5</sup>

5

.

programme's materials and methods.

drawn from the practice's database.

174 Learning Disabilities - An International Perspective

It has not been possible in this chapter to describe the methods used in working with the children in detail, but interested readers are referred to the author's website at http://www. charlespotter.org for more information on the fluency-based areas of the programmes used with the children whose results are reported in this chapter, its methodologies, as well as how to access the resource of materials. The interested reader is also referred to a chapter on the theory underpinning the reading fluency area of intervention in the programme, which can be downloaded free of charge by clicking on the following link: http://www. intechopen.com/articles/show/title/using-phonically-based-e-books-to-develop-readingfluency

On the theoretical level, the results presented in this chapter would provide support for the theoretical framework developed by Luria [90–92], who has suggested that automaticity provides the necessary link between basic and more complex mental operations, and between the basic skills involved in reading, writing, and spelling and the integration required for their more complex use. The evidence of commonality of influence across different areas of the programme would also provide support for the notions of a common linguistic awareness suggested by Berninger et al. [93], and of a universal phonic principle suggested by the work of Perfetti et al. [94] and Perfetti and McCutchen [95].

It is tempting to go beyond functional descriptions of the data into clinical evidence from particular case studies which would indicate support for the various hypotheses developed in the literature to account for the phonological, visual, rate of work, procedural learning, and working memory deficits observed by others. This is beyond the scope of the two chapters presented in this book.

Overall, evidence of improvement through exposure to the programme would indicate, in line with the research of others, (for example, see [96–98]), that focused therapy not only produces changes in behaviour, but is also likely to produce changes on a central level. This, in turn, is likely to contribute to improved performance at school. This is not only a phenomenon observed internationally, but also applies in Southern Africa.
