Interventionseffekte bei Lese-Rechtschreibstörung: Evaluation von zwei Förderkonzepten unter besonderer Betrachtung methodischer Aspekte
Abstract
Die Lese-Rechtschreibstörung (LRS) ist eine der häufigsten umschriebenen Entwicklungsstörungen schulischer Fertigkeiten und bleibt meist bis ins Erwachsenenalter bestehen. Schulische Schwierigkeiten und psychische Störungen sind oft Begleitsymptome der LRS. Aus diesem Grund ist nachhaltige Förderung von größter Bedeutung. Die Fördereffekte bisheriger Interventionsstudien sind jedoch recht gering, und vielen Studien mangelt es an ausreichender methodischer Fundierung. Ziel dieser Studie ist daher die Überprüfung zweier Interventionsprogramme in einem Prä-Post Experimental-Warte-Kontrollgruppendesign. Vier Gruppen von Drittklässlern nahmen an der Studie teil. Zwei Gruppen von Kindern mit LRS (n = 40) wurden über sechs Monate zweimal wöchentlich mit einem Lese- oder Rechtschreibprogramm gefördert und mit einer Wartegruppe (n = 17), die erst nach sechs Monaten gefördert wurde, sowie einer nicht betroffenen Kontrollgruppe (n = 26) verglichen. Die quantitative und qualitative Analyse der Lese- und Rechtschreibleistungen vor und nach der Förderung zeigte, dass sich alle Kinder mit LRS signifikant verbesserten. Betrachtungen auf individueller Ebene zeigten jedoch auch, dass eine deutlich spezifischere Zuweisung zu einzelnen Förderprogrammen notwendig ist. Eine Überlegenheit einer einzelnen Gruppe fand sich nicht. Da sich auch die Wartegruppe der unbehandelten Kinder mit LRS verbesserten, können keine eindeutigen Schlüsse über die Effektivität der Förderung gezogen werden. Die Gründe hierfür sind unklar, müssen aber unbedingt verstanden werden. Hierzu fehlen jedoch weltweit Studien. Es ist dennoch zwingend notwendig, die spezifischen von den unspezifischen Fördereffekten zu unterscheiden. Eine Studie mit einer Placebogruppe mit gleicher Förderdauer und Zuwendung und einer unbehandelten Kontrollgruppe sowie eine nicht randomisierte und individuelle Zuweisung zu spezifischen Förderprogrammen könnte hierfür ein sinnvoller Lösungsansatz sein.
Background: Reading and spelling disorders belong to the most common developmental disorders affecting about 5 % of school children in Germany despite average or above average intelligence and adequate schooling. In languages with transparent orthographies, like German, reading and spelling disorders are characterized by significantly decreased reading speed, impaired reading comprehension and poor spelling abilities resulting in a high number of spelling errors. Problematic are the added scholastic, social and psychological strains that can result from such disorders and often accompany the affected children well into their adult lives. Therefore, the attainment of sustainable intervention effects in children is crucial. Contrary to expectations, only a small number of empirical German studies have been published, describing the effectiveness of reading and spelling interventions. Current meta-analyses calculated the effectiveness of treatment approaches on reading and spelling disabilities and investigated possible impact factors to the improvement of interventions. The effect sizes of the included studies are marginal, or at best, average. Furthermore, inspections reveal a lack of methodologically sound studies, which might explain the very heterogeneous findings in this field.
Aims: The current study aimed to investigate the effectiveness of two established German intervention programs for primary school children. One program focussed on reading skills, while the other program focussed on spelling skills. Due to the heterogeneous results reported from former studies, particular attention was paid to a well-grounded research design and implementation. Results should elucidate whether or not intervention effects are present after a six-month training period; if they can be assessed by standardized reading and spelling tests; and if intervention effects differ depending on the training type.
Methods: The sample comprised 82 elementary school children from the 3rd grade (age range: 7.5 – 9.3 years at first measurement) who participated in a pre-post intervention design study. From this sample a cohort of 56 children exhibited severe reading and spelling deficits (at least one standard deviation below the age specific mean) and were diagnosed with developmental dyslexia (“Lese-Rechtschreibstörung”) according to the ICD-10. For the purpose of the study the children with reading and spelling deficits were assigned pseudo-randomly to three groups: first group (n = 20) received an intensive reading training (Kieler Leseaufbau; Dummer-Smoch & Hackethal, 1994, 2007); second group (n = 19) received an intensive spelling training (Marburger Rechtschreibtraining; Schulte-Körne & Mathwig, 2007); and the third group acted as a control wait-group (n = 17) and received training only after a six month wait period. Training of all groups lasted six months and was performed twice a week for 45 minutes by a specially educated staff member. Another group of 26 children without any reading or spelling difficulties served as a control group. Literacy skills (reading speed of words and pseudo-words, reading comprehension and spelling errors) of all children were assessed before and after the intervention. The comparison between the intervention groups and the wait-group is important in order to distinguish specific intervention effects from developmental effects of children with reading and spelling problems. An additional comparison with an unaffected control group is necessary in order to draw conclusions regarding normal and disturbed development of literacy skills.
Results: Comparison of performance before and after intervention between the two treatment groups, the control wait-group and the unaffected control group were calculated with repeated measures analyses of variance (ANOVAs). Additionally, spelling errors were analysed in a qualitative way and literacy skills were examined on an individual basis. Analyses of raw data for reading speed, reading comprehension and spelling performance revealed significant improvements for all participants with strong intervention effects, but no effects were found for analyses using standardized values. The treatment groups did not reveal preponderance over the control wait-group. The unaffected control group and the groups of children with reading and spelling deficits showed a parallel developmental course. On the one hand, inspections of the individual development revealed within both intervention groups responders (children who significantly improved by a gain of at least one third of a standard deviation on standardized values) in either reading or spelling performance. Differences between training programs could not be found. But, regarding the responders on reading speed an obvious difference between the intervention and the control wait- groups could be found. From the children who received either a reading or spelling treatment 14 showed substantial improvement of their word reading speed whereas in the control wait-group only one child improved. Inspection of spelling performance revealed five children within the spelling treatment group who showed significant improvement while in the reading treatment group only two responders could be identified. However, according to these criteria, four responders were also identified in the control wait-group, indicating that some children of this group might have received additional spelling instructions either at home or at school. On the other hand, a large amount of intervention non-responders were observed. So even if the four responders of the control wait-group did receive undisclosed spelling trainings, it does not explain why we have non-responders in our intervention groups.
Discussion: Our findings reveal a significant improvement of literacy skills for all participants with reading and spelling disorders, as well as for the control group. However, we were surprised to find no performance differences between treatment groups and the control wait-group. We found that all children with reading and spelling disorders improved according to the raw data, and therefore the question arises whether or not the wait-group may have received another type of intervention during the wait period of six months? Thus, we question if it is realistic to require parents to forego any kind of training for their child for a specific period of time despite their child being diagnosed as dyslexic. A possibility to avoid this dilemma would be to use placebo groups instead of wait-groups. However, caution in determining the appropriate placebo approach would need to be taken, as a number of other skills such as working memory and even mathematics are associated with dyslexia.
Finally, the individual analysis also shows a high number of treatment non-responders (on standardized values). This indicates that a more specific and individual assignment to the treatment, by means of qualitative reading and/or spelling analyses or by better diagnostic criteria indicating the specific type of intervention for each individual child, might increase the number of responders. A (pseudo)-randomized assignment to treatment groups in order to investigate intervention effects is therefore highly questionable.
Literatur
(1991). Manual for the Child Behavior Checklist/4 – 18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.
(2012). Evaluation des Marburger Rechtschreibtrainings an Zweit- und Drittklässlern mit Rechtschreibproblemen. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 40, 171 – 179.
(2008). A dual-route perspective on poor reading in a regular orthography: evidence from phonological and orthographic lexical decisions. Cognitive Neurospsychology, 25, 653 – 76.
(1994a). Weingartener Grundwortschatz Rechtschreib-Test für zweite und dritte Klassen (WRT2+). Göttingen: Hogrefe.
(1994b). Weingartener Grundwortschatz Rechtschreib-Test für dritte und vierte Klassen (WRT3+). Göttingen: Hogrefe.
(2004). Graphosyllabic Analysis Helps Adolescent Struggling Readers Read and Spell Words. Journal of Learning Disabilities, 37, 331 – 348.
(2002). Reliabilität, Trainierbarkeit und Stabilität auditiv diskriminativer Leistungen bei zwei computergestützten Mess- und Trainingsverfahren. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 30, 261 – 267.
(2010). Introduction to meta-analysis. Chichester, UK: Wiley.
(2006). The dual-route model and the developmental dyslexia's. London Review of Education, 4, 49 – 61.
(1997). Grundintelligenztest Skala 1 (CFT 1). 5. revidierte Auflage. Göttingen: Hogrefe.
(2006). Variabolus, Ein Schnelllesetraining zur Steigerung der lautgetreuen Lesegeschwindigkeit. Gesamtausgabe. Kiel: Veris.
(2001). DRC: A Dual Route Cascade Model of Visual Word Processing and Reading Aloud. Psychological Review, 108, 204 – 256.
(1991). Internationale Klassifikation psychischer Störungen ICD-10, Kapitel F. Bern: Huber.
(2003). Pretest-posttest designs and measurement of change. Work, 20, 159 – 165.
(1994). Handbuch zum Kieler Leseaufbau. Kiel: Veris.
(2007). Kieler Leseaufbau. 7. Auflage. Kiel: Veris.
(2000). How effective are one-to-one tutoring programs in reading for elementary students at risk for reading failure? A meta-analysis of the intervention research. Journal of Educational Psychology, 92, 605 – 619.
(2002). Was wird aus Achtjährigen mit einer Lese- und Rechtschreibstörung? Zeitschrift für Klinische Psychologie, Psychiatrie und Psychotherapie, 31, 235 – 242.
(1985). Beneath the surface of developmental Dyslexia. In K. E. Patterson, J. C. Marshall, & M. Coltheart (Eds.), Surface dyslexia (pp. 301 – 330). London: Hilsdale.
(in Vorbereitung). The effectiveness of treatment approaches on reading disabilities – A systematic review and meta-analysis of randomized controlled trials.
(2002). Remedial interventions for children with reading disabilities: Speech perception – An effective component in phonological training? Journal of Learning Disabilities, 35, 334 – 342.
(2003). Neural plasticity following auditory training in children with learning problems. Clinical Neurophysiology, 114, 673 – 684.
et al. (2007). Computer speech-based remediation for reading disabilities: The size of spelling-to-sound unit in a transparent orthography. Spanish Journal of Psychology, 10, 52 – 67.
(2012). Was hilft bei der Lese-Rechtschreibstörung? Kindheit und Entwicklung, 21, 122 – 136.
(2001). Incidence of reading disability in a population-based birth cohort, 1976 – 1982, Rochester, Minn. Mayo Clinic Proceedings, 76, 1081 – 1092.
(2009). Integrated Morphological Awareness Intervention as a Tool for Improving Literacy. Language, Speech and Hearing in Schools, 40, 341 – 351.
(1998). Psychologie der Lese- und Schreibschwierigkeiten. Weinheim: Beltz.
(1993). Lesen und Schreiben. Entwicklung und Schwierigkeiten. Die Wiener Längsschnittuntersuchungen über die Entwicklung, den Verlauf und die Ursachen von Lese- und Schreibschwierigkeiten in der Pflichtschulzeit. Bern: Huber.
(2006). Längsschnittstudie. Die mittelfristige Entwicklung von Schülern mit Teilleistungsschwierigkeiten im Bereich der Lese- und Rechtschreibschwierigkeiten. Kindheit und Entwicklung, 15, 216 – 227.
(2006). Ein Leseverständnistest für Erst- bis Sechstklässler (ELFE 1 – 6). Göttingen: Hogrefe.
(2000). Components of Effective Remediation for Developmental Reading Disabilities: Combining Phonological and Strategy-Based Instruction to Improve Outcomes. Journal of Educational Psychology, 92, 263 – 283.
(1997). The Effectiveness of remedial programs for reading disabled children of different ages: does the benefit decrease for older children? Learning Disability Quarterly, 20, 189 – 210.
et al. (2012). Phonics training for English-speaking poor readers. Cochrane Database of Systematic Reviews, 12.
(2003). The Development of Reading Impairment: A Cognitive Neuroscience Model. Mental Retardation and Developmental Disabilities Research Reviews, 9, 196 – 204.
(2010). Salzburger Lese- und Rechtschreibtest II (SLRT II). Verfahren zur Differentialdiagnose von Störungen der Teilkomponenten des Lesens und Schreibens. Bern: Huber.
(2000). Report of the National Reading Panel. Teaching children to read: An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction (NIH Publication No. 00-4769). Washington, DC: U.S. Government Printing Office.
(2008). Computational modelling of phonological dyslexia: how does the DRC model fare? Cognitive Neuropsychology, 25, 165 – 193.
(2000). A comparison of two reading interventions for children with reading disabilities. Journal of Learning Disabilities, 33, 257 – 277.
(1993). Behandlung der Lese-Rechtschreibschwache nach der Grundschulzeit: Anwendung und Überprüfung eines Konzeptes. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 21, 135 – 147.
(1991). Segmental Awareness and Dyslexia: Is it Possible to Learn to Segment Well and Yet Continue to Read and Write Poorly? Reading and Writing: An Interdisciplinary Journal, 3, 11 – 18.
(2005). Dyslexia (Specific Reading Disability). Biological Psychiatry, 57, 1301 – 1309.
et al. (1999). Persistence of dyslexia: the Connecticut Longitudinal Study at adolescence. Pediatrics, 104, 1351 – 1359.
et al. (2004). Development of Left Occipitotemporal Systems for Skilled Reading in Children After a Phonologically-Based Intervention. Biological Psychiatry, 55, 926 – 933.
(2001). Lese-Rechtschreibstörung und Sprachwahrnehmung. Münster: Waxmann.
(2002). Legasthenie: Zum aktuellen Stand der Ursachenforschung, der diagnostischen Methoden und Förderkonzepte. Bochum: Winkler.
(2010). The prevention, diagnosis, and treatment of dyslexia. Deutsches Ärzteblatt Int., 107, 718 – 727.
(2001). Das Marburger Rechtschreib-Training – Ergebnisse einer Kurzzeit-Intervention. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 29, 7 – 15.
(2003). Nachuntersuchung einer Stichprobe von leserechtschreibgestörten Kindern im Erwachsenenalter. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 31, 267 – 276.
(1998). Das Marburger Eltern-Kind- Rechtschreibtraining – Verlaufsuntersuchung nach zwei Jahren. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 26, 167 – 173.
(2001). Zur Diagnostik der Lese-Rechtschreibstörung. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 29, 113 – 116.
(2003). Rechtschreibtraining in schulischen Fördergruppen – Ergebnisse einer Evaluationsstudie in der Primarstufe. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 31, 85 – 98.
(2007). Das Marburger Rechtschreibtraining. Ein regelgeleitetes Förderprogramm für rechtschreibschwache Kinder. 3. überarbeitete Auflage. Bochum: Winkler.
(1999). An den Schwächen üben oder durch Stärken ausgleichen? Vergleich zweier Strategien in der Förderung von Kindern mit einer umschriebenen Lese-Rechtschreib-Schwäche. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 27, 103 – 113.
(2006). How persistent are phonological difficulties? A longitudinal study of reading retarded children. Dyslexia, 12, 3 – 20.
(1999). Reading research for students with LD: A meta-analysis of intervention outcomes. Journal of Learning Disabilities, 32, 504 – 532.
(1998). Experimental intervention research on students with learning disabilities: A meta-analysis of treatment outcomes. Review of Educational Research, 68, 277 – 321.
(2000). A meta-analysis of single subject-design intervention research for students with LD. Journal of Learning Disabilities, 33, 114 – 136.
(2010). Oldenburger Fehleranalyse für die Klassenstufen drei bis neun (OLFA 3 – 9). 2. überarbeitete Auflage. Oldenburg: ISB.
(1997). Welche Effekte bringt das zusätzliche Einbinden von Lautgebärden für den Leseunterricht bei Förderschülern? Heilpädagogische Forschung, 23, 122 – 131.
et al. (2010). A dual-route perspective on poor reading in a regular orthography: An fMRI study. Cortex, 46, 1284 – 1298.
(2010). Dyslexia in regular orthographies: manifestation and causation. Dyslexia, 16, 283 – 299.
(2008). Developmental dyslexia and the dual route model of reading: simulating individual differences and sub-types. Cognition, 107, 151 – 178.
