Introduction

Dyslexia is one of the most prominently discussed and debated learning disabilities in the 21^st century. As defined by the International Dyslexia Association,

“Dyslexia is a specific learning disability that is neurological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede the growth of vocabulary and background knowledge” (International Dyslexia Association, 2017).

This definition for dyslexia highlights several critical components. First is recognition of a phonological deficit involving the auditory components of language. Second, reading difficulty is unexpected in the context of strong instruction. A defining characteristic of dyslexia is that difficulties in accurate and/or fluent word recognition (decoding) persist despite effective classroom instruction.

Rates of dyslexia in the United States vary widely from less than 5% to 20% of the population depending upon the criteria used (Wagner et al., 2020). Dyslexia is often comorbid with conditions such as language impairments, math impairments, and social and behavior challenges such as attention deficit hyperactivity disorder, behavior disorders, and anxiety (Snowling et al., 2020). Dyslexia has a strong genetic connection with approximately 70% of monozygotic twins both manifesting symptoms of dyslexia (Protopapas, 2019). The reading environment at home and the quality of instruction at school are critical factors that can lead to different outcomes for students with a genetic predisposition to dyslexia.

The contemporary understanding of dyslexia developed in the 1960s. Operational definitions focused on a struggle to decode and spell words fluently, a language-based disorder, and unexpectedness of the reading difficulty despite typical cognitive ability (Protopapas, 2019).

As research efforts in neuroscience, cognitive science, education, and psychology continue to define and characterize dyslexia, a consensus aligns with the 2002 definition from IDA. Given the importance of instruction in this conceptualization, it is critical to examine dyslexia in the context of the science of reading.

The Science of Reading

The science of reading is a vast, interdisciplinary body of scientifically-based research related to literacy and why some learners have difficulty developing as proficient readers. One empirically-validated model for understanding reading is The Simple View of Reading. The Simple View of Reading outlines two critical components required for proficient reading comprehension: word recognition and language comprehension (Gough & Tunmer, 1986).

Word recognition refers to decoding or lifting the word off the page. This component requires phonemic awareness, phonics and fluency. Phonemic awareness entails noticing, thinking about, and working with the smallest units of spoken language, which are called phonemes. Without looking at text, phonemic tasks include segmenting sounds (verbally responding to an oral prompt such as “what are the sounds in ‘cat’?”), blending sounds (what word is made up of /f/ /i/ /sh/?) and finally through more advanced manipulation (say “skip”, take away /k/ and substitute with /l/. What’s the new word? “slip”). Phonics requires knowing relationships between sounds (phonemes) and letters (graphemes). Phonics includes the alphabetic principle: making sound-symbol correspondence, and phonological recoding: blending the known sounds into words (“b” represents the sound /b/, and letter sequences blend together into words: /b/ /a/ /t/ = bat). Finally, fluency is reading connected text accurately, fluently, and with meaning. Accuracy of word reading is critical, followed by a rate, and finally prosody or expression that mirrors natural speaking (e.g., efficiently and accurately reading the entire sentence). Returning to the definition of dyslexia, the deficit in phonological awareness is a critical characteristic. Simply put, dyslexia is the breakdown in connecting letter symbols with sounds.

Language Comprehension, the second component in the Simple View of Reading, refers to having the background knowledge, word and language in one’s mental lexicon to make meaning. First, one must be able to decode the word (word recognition). With dyslexia, challenges with vocabulary and comprehension are secondary. They are not the primary cause of reading difficulty, rather, they fail to develop over time as students do not build vocabulary and knowledge through reading.

Reducing Risk of Reading Failure through Prevention and Intervention

The United States is experiencing a reading crisis. Nationally, only approximately 35% of fourth grade students read at or above a proficient level (National Assessment of Educational Progress, 2019). Yet, scientific studies have indicated that with effective literacy instruction and intervention, 90%-95% of students can become proficient readers (Foorman et al., 2003; Simos et al, 2002; Torgesen, 2004, 2007). Advances in the science of reading provide a curriculum and instruction roadmap for meeting the needs of struggling readers, including those with reading disabilities such as dyslexia.

Pre-Kindergarten Curriculum and Instruction

Research from the science of reading provides guidance on the what and how of teaching in early education. The National Early Literacy Panel (NELP, 2008) identified three foundational literacy skill areas whose importance has been strengthened and expanded with subsequent research: oral language, phonological processing, and print knowledge.

Oral language instruction focuses on (1) listening comprehension, (2) vocabulary connected to background knowledge, and (3) developing expressive language. Oral language and related skills are strong predictors of achievement through third grade (Hart & Risley, 2005). Expectations for phonological processing in early childhood include: recognizing rhyming words (e.g. hearing fan/man) and recognizing words heard within a sentence (four words in the sentence “I see a cat”). With modeling and support, young children are expected to identify, blend and segment syllables in spoken words (e.g. the syllables in table are ta – ble); orally blend and segment familiar compound words (split apart and put back together “hotdog”); blend and segment onset and rhyme in single-syllable spoken words (f – ish = fish); and finally, identify initial and final sounds (phonemes) in spoken words (e.g. the first sound in hot is /h/, the final sound is /t/). Phonological processing skills involve the auditory identification and manipulation of words and sounds and are developed without looking at print. Print knowledge in pre-kindergarten includes beginning awareness of letter names and sounds, print concepts such as understanding that books contain words, words are made up of letters, and that print carries meaning.

Phonological awareness instruction and intervention have been shown across many studies to produce strong gains and significant positive effects on early literacy skills (Koutsoftas et al., 2009; Yeh & Connell, 2008; Ziolkowski & Goldstein, 2008). Early childhood settings should provide structured literacy instruction in phonological awareness, oral language development and print awareness/writing. This can be accomplished through play-based opportunities to engage with letter names and sounds through read aloud, manipulatives and writing to develop skills in phonological awareness, letter name and sound recognition, production, and writing. Curricula that include explicit and sequenced instructional activities that target specific competencies have shown positive impact on early literacy and language skills (NELP, 2008). A meta-analysis indicated that small-group instruction in phonological skills resulted in increased phonological awareness and early literacy skills (NELP, 2008). These results were even stronger when combined with instruction in letters and print. The NELP (2008) study emphasized the positive impact of shared reading and interactive shared reading (dialogic reading) on oral language skills.

School-Age Curriculum and Instruction

The focus of the curriculum and instruction at school-age shifts to the Big 5 components of reading identified in the National Reading Panel (NRP, 2000). The Big 5 components are phonemic awareness, phonics, fluency, vocabulary, and comprehension. Phonemic awareness is the ability to identify and manipulate individual sounds in language. Phonics is the ability to associate sounds with symbols and blend these into words. As words are encountered numerous times, they are orthographically mapped onto the brain to become sight words that are recognized automatically and no longer need to be decoded (Kilpatrick, 2015). Vocabulary and language comprehension focus on developing the lexicon and language structures through discussion, read aloud, vocabulary instruction, and focus on grammar and sentence structure.

Instruction targeting the Big 5 components of reading must be explicit, systematic, and sequential (NPR, 2000). Explicit instruction involves modeling new skills, guiding students to the correct responses, meeting error responses with immediate corrective feedback, and practicing skills to mastery and automaticity (Archer & Hughes, 2011). Systematic instruction is characterized by consistent instructional routines that are used to guide students to correct responses and instructional time that is carefully allocated to maximize time on task. With sequential instruction, instruction adheres to an intentional sequence aligned with research on literacy skill progression within and across lessons and within and across grade levels. Explicit, systematic, and sequential instruction focusing on the direct teaching of reading is a key feature of the structured literacy approach (Spear-Swerling, 2018). The other key features include cumulative practice, ongoing review, maximizing student-teacher interactions, the use of examples and nonexamples, decodable text, prompting and feedback (Spear-Swerling, 2018). Structured literacy instruction is beneficial for all students, but essential for those who struggle in building their foundational reading skills, such as students at risk for dyslexia. The effectiveness of the structured literacy approach is supported by research (e.g., Fletcher et al., 2007; Foorman et al., 2016).

Assessment of Dyslexia

Advances in the identification of dyslexia have moved from a focus on a within-child deficit assessment toward an intervention-based assessment approach. Concerns with the validity, reliability, and fairness of norm-referenced tests using an ability-achievement discrepancy approach to identify within-child deficits led to reform efforts in how a child could be identified in the United States in the Individuals with Disabilities Education Act (IDEA, 2004). IDEA (2004) established that states were no longer required to use an ability-achievement discrepancy approach and could instead use criteria that relied in part on a response to evidence-based instruction approach for the identification of students with disabilities (IDEA, 2004). An intervention-based assessment approach identifies students for early intervention and/or remediation and evaluates the student’s response to intervention to determine how the student should best be served.

A response to evidence-based instruction approach to the assessment of dyslexia and other learning disabilities was well established at the time its use was authorized by the IDEA (2004). The direct, systematic assessment of a student’s response to evidence-based interventions has come to be known as Response to Intervention (RTI; Brown-Chidsey & Steege, 2010; Jimerson et al., 2007). RTI involves the use of evidence-based instruction/intervention to address student needs while monitoring progress over time. Definitive indicators of risk for dyslexia using an RTI approach include: (a) Difficulty with essential reading skills on measures of accurate and fluent reading, word reading and decoding, and especially phonological processing including phonemic awareness and phonics, and (b) sustained lack of adequate progress in learning the essential reading skills, when (c) provided with generally effective classroom instruction (Good, 2021).

RTI as a Multi-Tiered System of Supports Framework

Recognizing the need for systemic structures and processes for use of assessment data to match students to a continuum of evidence-based interventions targeting specific reading skills, RTI evolved over time to be conceptualized as a Multi-Tiered System of Supports (MTSS) framework. A Multi-Tiered System of Supports (MTSS) is a proactive and preventative framework that integrates data and instruction to maximize student achievement and support students’ social, emotional, and behavior needs. The core features of an MTSS framework are: (a) universal screening, (b) data-based decision making and problem solving, (c) continuous progress monitoring, (d) a continuum of evidence-based practices across tiers (typically tier 1, 2 and 3), and (e) a focus on fidelity of implementation (McIntosh & Goodman, 2016).

Assessment within MTSS

Assessment serves four purposes within an MTSS framework: Screening, diagnostic, progress monitoring, and outcome evaluation (Table 1.1). Screening is a central feature of a school-based prevention and early intervention model as a first gate in a multiple-gate system to detect risk and address reading concerns (Albers & Kettler, 2014). Universal screening is used for the purposes of (a) identifying the number and percentage of students who are responding to the core instruction as a measure of the overall effectiveness of the core reading instruction, and (b) identifying the students who are not responding to the core instruction and therefore are at elevated risk for reading failure (Albers & Kettler, 2014). Screening for reading skill deficits involves the use of research-based early literacy assessment measures of foundational reading skills using curriculum-based measurement. Decades of research indicate that the use of screening data to identify students to receive reading intervention increased reading achievement and reduced the number of students in need of special education (Speece et al., 2003; VanDerHeyden et al., 2003).

Table 1.1. Purposes of Assessment Using a Response to Intervention Framework

(Good, 2021; Shapiro & Clemens, 2009)

Within an RTI framework, students who are identified by universal screening as having “some risk” or being “at risk” for reading difficulties are provided additional diagnostic assessment to pinpoint specific reading skill needs, as part of the multiple-gate system recommended by research (Cho et al., 2017). Diagnostic assessments evaluate specific skills or components of reading such as phonemic awareness, alphabetic principle, blending, decoding, word and pseudoword reading, as well as spelling and comprehension to inform instruction and intervention planning (Siegel & Hurford, 2019). The focus of diagnostic assessment within an RTI framework is to inform instructional planning and intervention design (i.e., intervention-based diagnostic assessment) rather than classification (i.e., clinical diagnostic assessment).

The third purpose of assessment within an RTI framework is to monitor a student’s progress to an evidence-based intervention designed to target the student’s specific skill need. Curriculum-based measures selected for universal screening are well-suited for progress monitoring intervention outcomes because they are sensitive to incremental growth, repeatable, and criterion-referenced so that they can be used to determine when a student has mastered a specific skill (Hosp et al., 2014). The frequency of progress monitoring, based on the student’s risk level, ranges from weekly to monthly.

The final purpose of assessment within an RTI framework is outcome evaluation. Outcome evaluation focuses on determining the effectiveness of the RTI system using multiple metrics to assess whether there is a reduction in risk of reading failure for individual students and across each grade level (Shapiro & Clemens, 2009). Evaluation models emphasize the use of short-term, sensitive indicators that enable schools to evaluate the impact of the RTI system as it is being implemented to inform the continuous improvement of the system. These indicators include monitoring changes in student risk levels (i.e., at risk, some risk, little to no risk) at each benchmark screening period across each grade level and assessing individual student rates of improvement between benchmark screening periods for all students in each grade level and for students receiving strategic and intensive interventions (Shapiro & Clemens, 2009).

MTSS Decision Making and Problem-Solving Processes

Within an MTSS framework, data-based decision making and problem solving are used to meet the needs of students proactively. Teams of educators review universal screening data to inform their delivery of the core instruction and universal supports (Tier 1) aligned with the science of reading. Universal screening data are used to select students in need of intervention-based diagnostic assessment in order to match students to interventions that vary in intensity (Daly et al., 2007). Decision rules applied to progress monitoring data dictate when a student has demonstrated accurate mastery of the specific skill in which the student received intervention and whether the student should continue with the intervention or receive an intervention of greater or lesser intensity (Ardoin et al., 2013).

MTSS Implementation: Impact and Challenges

Research indicates that an MTSS framework, when implemented with fidelity, holds promise for addressing several key outcomes including increasing student achievement (VanDerHeyden et al., 2007), the early detection and intervention of students at risk for academic problems (Al Otaiba & Torgeson, 2007), and improving the means by which students are determined to be eligible for special education services (Speece & Case, 2001). However, implementation challenges emerged when MTSS formed as a system of instructional and intervention practices (that is, RTI). Some researchers questioned its effectiveness in meeting students’ needs (Balu et al., 2015; Vellutino et al., 2008). Reading intervention researchers contend that the instructional techniques that produced significant word-reading outcomes (Torgeson et al., 2001) risk being diluted or dropped within an MTSS framework (Vellutino et al., 2008). Both decision rules and intervention adherence are critically important to effective implementation of MTSS (VanDerHeyden et al., 2016). Weak procedural adherence and inconsistent fidelity contribute to only the surface manifestations of an MTSS framework (e.g., sorting students into tiers based on universal screening data) grafted on top of traditional practices (Hall, 2018; Kilpatrick, 2015).

Implementation fidelity challenges exist because an MTSS framework requires educators to fundamentally change how they support struggling readers. To be effective, educators must have a requisite knowledge and skills in scientifically-based reading approaches (Kilpatrick, 2015), and be skilled in the timely use of data to inform instructional decision making (Daly et al., 2007). The following sections provide an overview of the factors shown to drive implementation of effective innovations, such as MTSS, and describes a model for supporting the high-fidelity implementation of MTSS to meet the needs of students with, or at risk for, dyslexia.

The PARTNERS Project

The Promoting Achievement in Reading Through Needs-driven Evidence-based Reading Structures (PARTNERS) project represents a collaboration between a university-based Reading Science Program, a university-based School Psychology Program, and a state Department of Education to substantially improve outcomes for students with, or at risk for, dyslexia. The project was informed by decades of research on the effectiveness of early language and literacy instruction and intervention along with recent evidence of closing gaps in early literacy skill performance and increasing school readiness among pre-kindergarten students (Murdoch et al., 2021). This project illustrates the application of the science of reading within an MTSS framework implemented with fidelity to provide a comprehensive support for students with, or at risk for, dyslexia, beginning at the pre-kindergarten level.

Given the critical importance of implementation fidelity, the PARTNERS project was designed to provide the system supports needed to promote high-fidelity practices. Advances in implementation science emphasize the critical need for systemic supports to drive implementation forward (Fixsen et al., 2005). Successfully implemented practices and programs share common factors shown to be “drivers” of effective implementation (Fixsen et al., 2005). When in place and functioning at a high level, these drivers can help propel an innovation by increasing its capacity and strengthening its infrastructure to support practitioners’ use of high-fidelity practices. A research synthesis conducted by the National Implementation Research Network resulted in the development of the Implementation Drivers Framework (Fixsen et al., 2005). The Implementation Drivers Framework is comprised of three sets of drivers: Competency Drivers, Organization Drivers, and Leadership Drivers. This framework guided the PARTNERS project described here.

Competency Drivers

The Competency Drivers of the Implementation Drivers Framework are the mechanisms needed to develop, improve, and sustain practitioners’ competent usage of program practices. The Competency Drivers include Selection, Training, Coaching, and Performance Assessment. Selection involves the process of recruiting, interviewing, and hiring practitioners by carefully considering the skills, abilities, and dispositions specific to the initiative. Training requires an understanding and application of adult learning strategies to provide skill-based instruction and support to increase practitioners’ competencies. Coaching must be combined with training to increase the likelihood that new learning acquired through training is supported in its use through job-embedded guidance, assistance, and monitoring. Finally, a Performance Assessment process must be in place to ensure practitioners are proficient in their use of the intended practices.

PARTNERS Selection

The PARTNERS Project was implemented in three elementary schools in the greater Cincinnati area. The schools were selected based on their readiness to engage in the work of the project as defined by the following criteria: (1) The school must have been engaged in previous work to build staff knowledge in the science of reading, to provide a foundation on which to build a strong MTSS for decision making. (2) The school must have been administering one of two curriculum-based measurement systems (e.g., Acadience or aimswebPlus with an added preschool assessment) at least three times a year for screening early literacy skills of students in kindergarten and first grade and for progress monitoring of student growth. Priority for selection was also given to schools that had a preschool program, schools that served students from diverse racial/ethnic backgrounds or a significant proportion of students from families experiencing poverty, and schools that represented one of each type on the urban, rural, and suburban continuum.

PARTNERS Training

Two consultants from the Reading Science Program at one of the universities in the PARTNERS Project and a consultant from a regional agency of the state Department of Education provided on-site training to build the capacity of pre-Kindergarten, Kindergarten, and Grade 1 teacher teams to strengthen their core instruction and intervention supports. The teacher teams were trained in the use of the Literacy Analysis and Planning Guide (LAP-G), a systems analysis tool developed for use in the PARTNERS Project. The LAP-G facilitated analysis of evidence-based literacy practices across each tier of MTSS through special education decision making. The LAP-G provided a structure for engaging in a problem-solving process whereby each tier (i.e., core instruction, strategic intervention, and intensive intervention) was evaluated by the team, priority areas of opportunity were identified and action plans were set to improve upon current practices.

PARTNERS Coaching

The three consultants were each assigned one school to provide on-going coaching and consultation in the application of the science of reading to prevent and reduce risk of reading failure and to strengthen the school’s MTSS framework. Consultants were guided by the Student-Focused Coaching model (Hasbrouck & Michel, 2021), in which consultants served as coaches to provide support for improving and maintaining evidence-based practices aligned with the science of reading. Consultants provided professional development, regularly observed in classrooms and provided feedback, helped teachers access and use new resources, engaged in problem solving with individual teachers, supported data interpretation meetings, and facilitated use of the LAP-G for problem solving across all tiers, all with a lens on student performance and progress data. Systems coaching focused on all of the key features of the MTSS framework. 

PARTNERS Performance Assessment (Fidelity of Implementation)

Direct classroom observations were conducted by the consultant supporting each school to assess the quality of instruction and alignment with the science of reading. Performance feedback was delivered to individual teachers and teacher teams regarding their fidelity of implementation of the components of the Project (e.g., continuum of evidence-based practices, data-based decision making and problem solving). Coaches observed each classroom instruction (MTSS Tier 1) and intervention (MTSS Tier 2) as frequently as once a month, so that comprehensive data across grades pre-kindergarten to Grade 1 were collected monthly. Observations ranged from 30-75 minutes each, and feedback was shared with individual teachers regarding implementation fidelity, including strengths, and recommendations. Data on problem solving were reviewed via the LAP-G. These data provided baseline information on student performance as well as implementation of science of reading aligned practices at each tier and the data were examined annually to review progress and set new goals.

Organization Drivers

The Organization Drivers are the mechanisms needed to establish and sustain effective and efficient system structures and processes. The Organization Drivers include Decision Support Data Systems, Facilitative Administration, and Systems Intervention (Fixsen et al., 2005). A Decision Support Data System is a system for identifying, collecting, and analyzing process data (e.g., fidelity data and student outcome data) over time to provide timely, reliable data to inform decision making. Facilitative Administration pertains to the internal processes, policies, regulations, and structures in place to create a context that is supportive and engaged in learning, continuous improvement, and removing barriers as it relates to the initiative. Systems Intervention is focused on the external systems to ensure the availability of organizational, financial, and human resources required to support the initiative.

PARTNERS Decision Support Data Systems

Universal screening was conducted three times a year using a reliable and valid curriculum-based measure. Each school engaged in multi-pronged screening and follow-up diagnostic assessment when needed to pinpoint specific needs to match students to targeted or individual/intensive intervention. As part of the Multi-Tiered System of Supports, the schools used technically adequate progress monitoring measures for students found to have “some risk” or be “at risk” to evaluate an individual student’s response to evidence-based interventions of increasing intensity. Decision rules were applied to determine whether the student’s response to the intervention was adequate (resulting in a rate of improvement that indicated a reduction of risk) or whether a different or more intensive intervention was needed.

A decision-oriented evaluation approach was used to examine the degree to which the PARTNERS project was accomplishing its stated goal. Using a decision-oriented approach, evaluation is defined as the process of delineating, obtaining, reporting and applying descriptive and judgmental information about a program’s merit, worth, and significance to guide decisions, support accountability, disseminate effective practices, and increase understanding of the program (Stufflebeam & Coryn, 2014). The evaluation examined student-level, teacher-level, and systems-level outcomes both formatively and summatively.

PARTNERS Facilitative Administration

Administrators and leadership teams at each school were involved in initial conversations regarding plans to improve literacy within MTSS frameworks to ensure top-down leadership support. Leadership in each building coordinated introductory meetings, compiled initial information needed, coordinated time and place for team meeting and attended meetings to provide support for their teachers. All of these steps provided a supportive environment, referred to as an enabling context in implementation science (Fixsen et al., 2015). Professional learning included two years of summer institutes focused on improving tiers of literacy instruction as well as ongoing coaching and feedback. Leadership support of ongoing coaching and access to teacher classrooms also created a context of ongoing support, enabling the work.

PARTNERS Systems Intervention

As a collaboration among a university-based Reading Science Program, a university-based School Psychology Program, and a state Department of Education, the PARTNERS project was well-positioned to leverage the assets of each partner to align with and inform the state’s literacy improvement efforts.

Leadership Drivers

The Leadership Drivers focus on the use of effective leadership strategies for different types of leadership challenges: Technical challenges and adaptive challenges. Technical challenges respond well to a more traditional management approach where problems are defined and solutions are generated, evaluated, and acted upon. Adaptive challenges, in contrast, involve complex, persistent problems that require engaging different, often competing perspectives among stakeholders to address the challenge at many different levels. Principals and literacy leaders were involved in decision making throughout the PARTNERS project. Leaders collaborated with coaches to develop internal systems of literacy support. In particular, each building chose two teachers to obtain dyslexia certification through a Reading Science graduate program to help build internal capacity to coach and support tiered literacy instruction and intervention.

Conclusion

Advances in the science of reading provide a roadmap for meeting the needs of children with dyslexia and other struggling readers, with an emphasis on early identification, appropriate and frequent screening and progress monitoring, and strengthened core instruction and evidence-based interventions tailored to meet specific needs. Curriculum and instruction that are research-based serve to ensure the majority of students become proficient readers. For students who struggle despite the provision of otherwise effective instruction, empirically-based approaches to the assessment of reading skill difficulty are used for the purposes of screening, intervention-based diagnostic assessment, and progress monitoring response to intervention.

The promise of an MTSS framework is the immediate identification of struggling readers and timely intervention support regardless of label (e.g., dyslexia, reading disability, or at-risk reader). Information collected through data-based problem solving in the context of strong instruction and intervention is imperative to improve reading outcomes for all students and necessary to fully understand reading needs of struggling readers to more accurately identify and support those readers with or at risk for dyslexia.

Acknowledgements

Work completed through the Office of Special Education Dyslexia Model Demonstration grant (H326M190004; Promoting Achievement in Reading Through Needs-driven Evidence-based Reading Structures).