essay about reading difficulties

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• Published: 31 March 2017

Helping children with reading difficulties: some things we have learned so far

• Genevieve McArthur 1 &
• Anne Castles 1  

npj Science of Learning volume  2 , Article number:  7 ( 2017 ) Cite this article

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A substantial proportion of children struggle to learn to read. This not only impairs their academic achievement, but increases their risk of social, emotional, and mental health problems. In order to help these children, reading scientists have worked hard for over a century to better understand the nature of reading difficulties and the people who have them. The aim of this perspective is to outline some of the things that we have learned so far, and to provide a framework for considering the causes of reading difficulties and the most effective ways to treat them.

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Introduction

Over 20 years ago, The Dyslexia Institute asked a 9-year-old boy called Alexander to describe his struggle with learning to read and spell. He bravely wrote: “I have blond her, Blue eys and an infeckshos smill. Pealpie tell mum haw gorgus I am and is ent she looky to have me. But under the surface I live in a tumoyl. Words look like swigles and riting storys is a disaster area because of spellings. There were no ply times at my old school untill work was fineshed wich ment no plytims at all. Thechers sead I was clevor but just didn’t try. Shouting was the only way the techors comuniccatid with me. Uther boys made fun of me and so I beckame lonly and mishroboll”. 1

Alexander’s experience is not unique. Sixteen per cent of children struggle to learn to read to some extent, and 5% of children have significant, severe, and persistent problems. 2 The impact of these children’s reading difficulties goes well beyond problems with reading Harry Potter or Snapchat. Poor reading is associated with increased risk for school dropout, attempted suicide, incarceration, anxiety, depression, and low self-concept. 3 , 4 , 5 , 6 It is therefore important to identify and treat poor readers as early as we possibly can.

Scientists have been investigating poor reading—also known as reading difficulty, reading impairment, reading disability, reading disorder, and developmental dyslexia (to name but a few)—for over a century. While it may take another century of research to reach a complete understanding of reading impairment, there are number of things that we have learned about reading difficulties, as well as the children who experience reading them, that provide key clues about how poor reading can be identified and treated effectively.

Poor readers display different reading behaviours

One thing that we have learned about poor readers is that they are highly heterogeneous; that is, they do not all display the same type of reading impairment (i.e., “reading behaviour”; 7 , 8 , 9 , 10 , 11 , 12 ). Some poor readers have a specific problem with learning to read new words accurately by applying the regular mappings between letters and sounds. 7 , 8 , 13 , 14 This problem, which is often called poor phonological recoding or decoding, can be detected by asking children to read novel “nonwords” such as YIT. Other poor readers have a particular difficulty with learning to read new words accurately that do not follow the regular mappings between letters and sounds, and hence must be read via memory representations of written words. 7 , 13 , 15 , 16 This problem, which is sometimes called poor sight word reading or poor visual word recognition, can be detected by asking children to read “exception” words such as YACHT. In contrast, some poor readers have accurate phonological recoding and visual word recognition but struggle to read words fluently. 17 , 18 , 19 Poor reading fluency can be detected by asking children to read word lists or sentences as quickly as they can. In contrast yet again, some poor readers have intact phonological recoding and visual word recognition and reading fluency, but struggle to understand the meaning of what they read. These “poor comprehenders” 20 can be identified by asking them to read paragraphs aloud (to ascertain that they can read accurately and fluently), and then ask them questions about the meaning of what they have read (to ascertain that they do not understand what they are reading). It is important to note that most poor readers have various combinations of these problems. 21 For example, Alexander’s spelling suggests that he would have poor phonological decoding (since he misspells words like playtimes as “plytims”) and poor sight word knowledge (since he misspells exception words like said as “sead”). Thus, poor readers vary considerably in the profiles of their reading behaviour.

Reading behaviours have different “proximal” causes

Another thing we have learned about poor readers is that the same reading behaviour (e.g., inaccurate reading of novel words) does not necessarily have the same “proximal cause”. A proximal cause of a reading behaviour can be defined as a component of the cognitive system that directly and immediately produces that reading behaviour. 22 , 23 , 24 Most reading behaviours will have more than one proximal cause. Reflecting this, several theoretical and computational models of reading comprise multiple cognitive components that function together to produce successful reading behaviour (e.g., refs 25 , 26 , 27 , 28 ). While these models vary in some respects, all include cognitive components that represent (1) the ability to recognise letters (e.g., S), letter-clusters (e.g., SH), and written words (e.g., SHIP), (2) the ability to recognise and produce speech sounds (e.g., “sh”, “i”, “p”) and spoken words (e.g., “ship”), (3) the ability to access stored knowledge about the meanings of words (e.g., “a floating vessel”), and (4) links between these various components. Impairment in any one of these components or links will directly and immediately impair aspects of reading behaviour. Thus, guided by theoretical and computational models, we have learned that a poor reading behaviour can have multiple proximal causes, and we have some idea about what those proximal causes might be. 10 , 11 , 12

Reading behaviours have different “distal” causes

We have also learned that even if two poor readers have exactly the same reading behaviour with exactly the same proximal cause, this reading behaviour will not necessarily have the same “distal cause”. A distal cause has a distant (i.e., an indirect or delayed) impact on a reading behaviour. 22 , 23 , 24 Distal causes reflect the fact that reading is a taught skill that unfolds over time and across development. It depends upon a range of more cognitive abilities, such as memory, attention, and language skills, to name but a few. Depending on children’s strengths and weaknesses in these underlying abilities, and how these abilities affect learning over time, children will have different profiles of developmental, or distal, causes of their reading impairment. Stated differently, there can be different causal pathways to the same impairment of the reading system.

To provide an example, as mentioned earlier, a common reading behaviour observed in poor readers is inaccurate reading of new or novel words, which can be assessed using nonwords such as YIT. Indeed, some researchers have described this as the defining symptom of reading difficulties. 29 According to theoretical and computational models of reading, one proximal cause of impaired reading of nonwords is impaired knowledge of letter-sound mappings. But what is responsible for this proximal cause of poor nonword reading? There are multiple hypotheses. The prominent “phonological deficit hypothesis” proposes a pervasive language-based difficulty in processing speech sounds that affects the ability to learn to associate written stimuli (e.g., letters) with speech sounds. 30 The “paired-associate learning deficit hypothesis” proposes a memory-based difficulty in forming cross-modal mappings across the visual (e.g, letters) and verbal domains (e.g., speech sounds) that affects letter-sound learning (e.g., ref. 31 ). And the “visual attentional deficit hypothesis” proposes an attention-based impairment in the size of the attentional window, affecting the formation of the sub-word orthographic units (e.g., letters) used in the letter-sound mapping process. 32 These three hypotheses illustrate why a single reading behaviour (e.g., poor nonword reading) with a common proximal cause (impaired knowledge of letter-sound mappings) might not have the same distal cause (e.g., a phonological deficit, a paired-associate learning deficit, or a visual attention deficit). These hypotheses also raise the possibility that the distal causes of poor readers’ reading behaviours may vary as much (if not more) than the proximal causes and the reading behaviours themselves.

Poor readers have concurrent problems with their cognition and emotional health

Another thing we have learned about poor readers is that many (but not all) have comorbidities in other aspects of their cognition and emotional health. Regarding cognition, studies have found that a significant proportion of poor readers have impairments in their spoken language. 33 , 34 , 35 , 36 , 37 , 38 , 39 Studies have also found that poor readers have atypically high rates of attention deficit disorder—a neurological problem that causes inattention, poor concentration, and distractibility (e.g., refs 40 , 41 , 42 ). Regarding emotional health, there is evidence that poor readers, as a group, have higher levels of anxiety than typical readers (e.g., refs 43 , 44 ). The same is true for low self-concept, which can be defined as a negative perception of oneself in a particular domain (e.g., academic self-concept; e.g., refs 45 , 46 ).

The fact that poor readers vary in their comorbid cognitive and emotional health problems—as well as in their reading behaviours, and the proximal and distal impairments of these behaviours—creates an impression of almost overwhelming complexity. However, it is possible to simplify this complexity somewhat using a proximal and distal schema. Specifically, comorbidities of poor reading might be categorised according to whether they represent potential proximal or distal impairment of poor reading—or possibly both. For example, a child’s current problem with spoken vocabulary might be considered a proximal cause of their poor word reading behaviour since, according to theoretical and computational models of reading, vocabulary knowledge may directly underpin word reading accuracy or reading comprehension. However, a child’s previous problem with spoken vocabulary, which may or may not still be present, might be considered a distal cause of their poor word reading: A history of poor understanding of word meanings might reduce a child’s motivation to engage in reading (distal cause), which would impair their development of phonological recoding and visual word recognition (proximal cause), and hence their word reading accuracy and fluency (reading behaviour). Thus, the proximal and distal schema can prove useful in clarifying the causal chain of events linking a reading behaviour to a potential cause.

The proximal and distal schema can also be useful in clarifying reciprocal or circular relationships between comorbidities of poor reading and reading behaviours. For example, if a poor reader has low academic self-concept (distal cause), this may stymie their motivation to pay attention in reading lessons (distal cause), which will impair their learning of letter-sound mappings (proximal cause), and hence their poor word reading (reading behaviour). At the same time, a reverse causal effect may be in play: A child’s poor word reading in the classroom (distal cause) may create a poor perception of their own academic ability (proximal cause) that lowers their academic self-concept (behaviour). Thus, the proximal and distal schema can be used to help develop hypotheses as to whether comorbidities of poor reading are proximal and/or distal causes or consequences of poor reading. Ultimately, of course, all of these hypotheses must be tested through experimental training studies.

Proximal intervention is more effective than distal intervention

Poor readers have inspired, and have been subjected to, an extraordinary array of interventions such as behavioural optometry, chiropractics, classical music, coloured glasses, computer games, fish oil, phonics, sensorimotor exercises, sound training, spatial frequency gratings, memory training, medication for the inner ear, phonemic awareness, rapid reading, visual word recognition, and vocabulary training, to name just a selection. It is noteworthy that while many of these interventions claim to be “scientifically proven”, few have been tested with a randomised controlled trial (RCT)—an experiment that randomly allocates participants to intervention and control groups in order to reduce bias in outcomes. RCTs are the gold standard method for assessing a treatment of any kind, and the method that must be used to prove the effectiveness of a pharmaceutical treatment.

In order to make sense of the chaotic variety of interventions that claim to help poor readers, it may again be helpful to use the proximal and distal schema outlined above to subdivide interventions into two types: “proximal interventions” that focus training on proximal causes of a reading behaviour that are proposed to be part of the cognitive system for reading (e.g., phonics training, vocabulary training) and “distal interventions” that focus on distal causes of a reading behaviour (e.g., coloured lenses, inner-ear medication). The idea of making a distinction between proximal and distal interventions is supported by the outcomes of a systematic review of all studies that have used an RCT to assess an intervention in poor readers. 47 These studies assessed the effect of coloured lenses or overlays, medication, motor training, phonemic awareness, phonics, reading comprehension, reading fluency, sound processing, and sunflower therapy on poor readers. One key finding of this review is that it only identified 22 RCTs, which is a small number of gold-standard intervention studies given the huge number of interventions that claim to help poor readers. A second key finding is that the majority of RCTs of interventions for poor readers have assessed the efficacy of phonics training, which trains the ability to use letter-sound mappings to learn to read new or novel words. A third key finding is that only one type of intervention produced a statistically reliable effect. This was phonics training, which focuses on improving a proximal cause of poor word reading (i.e., letter-sound mappings). In contrast, interventions that focused on distal causes of poor reading did not show a statistically reliable effect in poor readers. The outcomes of this systematic review suggest that interventions that focus on phonics—a proximal cause of reading behaviour—are more likely to be effective than interventions that focus on a distal cause. In other words, the “closer” the intervention is to an impaired reading behaviour, the more likely it is to be effective.

Translating what we know (thus far) into evidence-based practice

At first glance, what we have learned (so far) about poor readers and reading difficulties paints a picture of such complex heterogeneity that it is tempting to throw one’s hands up in despair. And yet, somewhat paradoxically, it is this very heterogeneity that provides some important clues about how to maximise the efficacy of intervention for poor readers. First, the fact that poor readers vary in the nature of their reading behaviours suggests that the first step in identifying an effective intervention for a poor reader is to assess different aspects of reading (e.g., word reading accuracy, reading fluency, and reading comprehension). There are numerous standardized tests provided commercially (e.g., the York Assessment for Reading Comprehension available from GL Assessment) 48 or for free (e.g., the Castles and Coltheart Word Reading Test—Second Edition (CC2) available at www.motif.org.au ) 49 that can be used to determine if a child falls below the average range for their age or grade for reading accuracy, fluency, or comprehension. In our experience, a teacher who has appropriate training in administrating such tests can carry out this first step effectively.

Second, the fact that poor readers’ reading behaviours can have different proximal causes suggests that the next step is to test them for the potential proximal causes of their poor reading behaviours. This is where cognitive models of reading are a useful roadmap, providing an explicit account of the key processes directly underpinning successful reading behaviour. Again, this can be done using standardized tests that are available commercially (e.g., the Peabody Picture Vocabulary Test Fourth Edition available from Pearson) 50 or for free (e.g., the Letter-Sound Test available at www.motif.org.au ). 51 And well-trained teachers can administer these tests.

Third, the fact that poor readers vary in the degree to which they experience comorbid cognitive and emotional impairments suggests that it would be useful to assess poor readers for their spoken language abilities, attention, anxiety, depression, and self-concept, at the very least. This knowledge will reveal if they need support in other areas of their development, or if their reading-related intervention needs to be adjusted to accommodate their concomitant impairment in order to maximise efficacy. Trained speech and language therapists typically carry out the assessment of children’s spoken language; neuropsychologists are experts in assessing children’s attention; and clinical psychologists have the expertise to assess children’s emotional health.

Once a poor reader’s reading behaviours, proximal impairments, comorbid cognitive, and emotional health problems have been identified, it should be possible to design an intervention that is a good match to their needs. According to the systematic review conducted by Galuschka et al. 47 , current evidence suggests that this intervention should focus on the proximal impairment of a child’s reading behaviour, rather than a possible distal impairment. Two more recent controlled trials 52 , 53 and a systematic review 54 further suggest that it is possible to selectively train different proximal impairments of poor reading behaviours in order to improve those behaviours. The outcomes of these studies and reviews tentatively suggest that proximal interventions can be executed by a reading specialist or a highly-sophisticated online reading training programme.

In sum, over the last century or so, we have learned important things about reading difficulties and the people who have them. We have learned that poor readers display different reading behaviours, that any one reading behaviour has multiple proximal and distal causes, that some poor readers have concomitant problems in other areas of their cognition and emotional health, and that interventions that focus on proximal causes of poor reading behaviours may be more effective than those that focus on distal causes. This knowledge provides some clues to how we might best assist children with reading difficulties. Specifically, we need to assess poor readers for (1) a range of reading behaviours, (2) proximal causes for each poor reading behaviour, and (3) comorbidities in their cognition and emotional health. It should be possible to design an individualised intervention programme that accommodates for a poor reader’s comorbid cognitive or emotional problems whilst targeting the proximal causes of their poor reading behaviour or behaviours. This approach, which requires the co-ordinated efforts of teachers and specialists and parents, is no mean feat. However, according to the scientific evidence thus far, this is the most effective approach we have for helping children with reading difficulties.

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English Learners and Reading Challenges

• Posted October 19, 2018
• By Grace Tatter

When English learners show signs of reading difficulties, educators often have a hard time figuring out what’s holding them back. Is a student struggling to read just because she is still learning English and hasn’t yet developed the academic language skills she needs? Or, might she have a learning disability in reading that has not yet been identified?

In either case, English learners who are struggling readers too often lack the instruction and supports they need, even as they are tasked with absorbing skills and content in English while they’re learning the language. They might be misdiagnosed with a disability, or a disability might go undiagnosed entirely.

Minding the Gap

Students who are learning English at school tend to be diagnosed with learning disabilities two to three years later than their native English-speaking peers, and they’re underrepresented in special education before the third grade — likely because their teachers assume their reading challenges are rooted in developing language rather than readiness to read. These delays are particularly worrisome, since it’s critical to identify reading challenges sooner, rather than later, to get the most out of appropriate reading interventions, and to minimize negative consequences, like low self-esteem.

On the flip side, older students are sometimes misdiagnosed with a disability because they score low on English proficiency tests, simply because they aren’t yet fluent in English or may need support in building their academic language abilities.

Both sets of experiences reveal a gap in our understanding of how best to identify and serve English learners with reading disabilities — a gap that researchers from the Harvard Brain. Experience. Education. Lab (B.E.E.) are trying to fill.

B.E.E. researchers, led by  Gigi Luk , are figuring out how English learners typically learn to read English, using neuroimaging, or brain scans, so they can better understand whether research on learning disabilities in monolingual students applies to English learners as well. Through their collaboration with a research team led by  Joanna Christodoulou  at the MGH Institute of Health Professions, they’re also administering a questionnaire to find out how schools are currently identifying reading disabilities among English learners, as well as among English proficient students, to identify current practices and determine what additional knowledge educators need to fully serve their students.   

Best Practices for Now

Once researchers understand how educators are currently identifying reading disabilities among English learners, they can better understand the challenges educators face, and help craft solutions.

Until then, though, we know there are best practices for identifying reading disabilities in English learners, including the following:

• If the child is able to read in a language besides English, assess language and literacy in the non-English language (if possible).
• Use informal and dynamic assessments (for example, test, teach, re-test) that allow English learners to demonstrate what they know and how they learn.
• Use multiple measures that cover oral and written language competencies. These can include measures of vocabulary, listening comprehension, phonological processing, rapid naming, phonics, timed and untimed word reading, verbal reasoning, and non-verbal reasoning — all of which can shed light on the source of the difficulty.
• Consult the manuals of all standardized tests administered in your school to investigate how English learners are represented in the norming sample, as well as whether there are specifications for how to modify the test for English learners.

Embracing Bilingualism: What to Keep in Mind

• Research shows that supporting a student’s first language will help the student learn to read in English . Educators can encourage family members to engage in language and literacy activities in their native languages.
• Bilingual education models are not yet a practical reality in most American schools, which creates a need for innovative approaches to evaluate how to implement bilingual education for all students , not just English learners. 
• One simple way that schools can promote English learners’ literacy and language development is to debunk the idea that parents should focus solely on English at home, says HGSE doctoral candidate Laura Mesite . “That’s the exact opposite of what most research suggests. Children need rich oral language exposure at home to promote literacy development. Oftentimes, when non-native English-speaking parents try to speak only in English with their children, they aren’t able to provide the rich linguistic environment necessary to foster language and literacy development in either language,” she says.

Additional Resources

• Bilingualism as a Life Experience
• Linguistically Responsive Teachers
• Head Start’s Dual Language Learner Resources
• Working with Culturally and Linguistically Diverse (CLD) Students in Schools

Usable Knowledge

Connecting education research to practice — with timely insights for educators, families, and communities

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Making Americans

Preventing Reading Difficulties in Young Children (1998)

Chapter: 1. introduction, 1 introduction.

Reading is essential to success in our society. The ability to read is highly valued and important for social and economic advancement. Of course, most children learn to read fairly well. In fact, a small number learn it on their own, with no formal instruction, before school entry (Anbar, 1986; Backman, 1983; Bissex, 1980; Jackson, 1991; Jackson et al., 1988). A larger percentage learn it easily, quickly, and efficiently once exposed to formal instruction.

SOCIETAL CHALLENGES

Parents, educators, community leaders, and researchers identify clear and specific worries concerning how well children are learning to read in this country. The issues they raise are the focus of this report:

1. Large numbers of school-age children, including children from all social classes, have significant difficulties in learning to read.

2. Failure to learn to read adequately for continued school success is much more likely among poor children, among nonwhite

children, and among nonnative speakers of English. Achieving educational equality requires an understanding of why these disparities exist and efforts to redress them.

3. An increasing proportion of children in American schools, particularly in certain school systems, are learning disabled, with most of the children identified as such because of difficulties in learning to read.

4. Even as federal and state governments and local communities invest at higher levels in early childhood education for children with special needs and for those from families living in poverty, these investments are often made without specific planning to address early literacy needs and sustain the investment.

5. A significant federal investment in providing bilingual education programs for nonnative speakers of English has not been matched by attention to the best methods for teaching reading in English to nonnative speakers or to native speakers of nonstandard dialects.

6. The passage of the Americans with Disabilities Act (ADA) provides accommodations to children and to workers who have reading disabilities. In order to provide full access for the individuals involved, these accommodations should reflect scientific knowledge about the acquisition of reading and the effects of having a reading difficulty.

7. The debate about reading development and reading instruction has been persistent and heated, often obscuring the very real gains in knowledge of the reading process that have occurred.

In this report, we are most concerned with the children in this country whose educational careers are imperiled because they do not read well enough to ensure understanding and to meet the demands of an increasingly competitive economy. Current difficulties in reading largely originate from rising demands for literacy, not from declining absolute levels of literacy (Stedman and Kaestle, 1987). In a technological society, the demands for higher literacy are constantly increasing, creating ever more grievous consequences for those who fall short and contributing to the widening economic disparities in our society (Bronfenbrenner et al., 1996). These economic dispari-

ties often translate into disparities in educational resources, which then have the self-reinforcing effect of further exacerbating economic disparities. Although the gap in reading performance between educational haves and have-nots has shrunk over the last 50 years, it is still unacceptably large, and in recent years it has not shrunk further (National Academy of Education, 1996). These rich-get-richer and poor-get-poorer economic effects compound the difficulties facing educational policy makers, and they must be addressed if we are to confront the full scope of inadequate literacy attainment (see Bronfenbrenner et al., 1996).

Despite the many ways in which American schools have progressed and improved over the last half century (see, for example, Berliner and Biddle, 1995), there is little reason for complacency. Clear and worrisome problems have to do specifically with children's success in learning to read and our ability to teach reading to them. There are many reasons for these educational problems—none of which is simple. These issues and problems led to the initiation of this study and are the focus of this report.

The many children who succeed in reading are in classrooms that display a wide range of possible approaches to instruction. In making recommendations about instruction, one of the challenges facing the committee is the difficult-to-deal-with fact that many children will learn to read in almost any classroom, with almost any instructional emphasis. Nonetheless, some children, in particular children from poor, minority, or non-English-speaking families and children who have innate predispositions for reading difficulties, need the support of high-quality preschool and school environments and of excellent primary instruction to be sure of reading success. We attempt to identify the characteristics of the preschool and school environments that will be effective for such children.

The Challenge of a Technological Society

Although children have been taught to read for many centuries, only in this century—and until recently only in some countries—has there been widespread expectation that literacy skills should be universal. Under current conditions, in many ''literate" societies, 40 to

60 percent of the population have achieved literacy; today in the United States, we expect 100 percent of the population to be literate. Furthermore, the definition of full-fledged literacy has shifted over the last century with increased distribution of technology, with the development of communication across distances, and with the proliferation of large-scale economic enterprises (Kaestle, 1991; Miller, 1988; Weber, 1993). To be employable in the modern economy, high school graduates need to be more than merely literate. They must be able to read challenging material, to perform sophisticated calculations, and to solve problems independently (Murnane and Levy, 1993). The demands are far greater than those placed on the vast majority of schooled literate individuals a quarter-century ago.

Data from the National Education Longitudinal Study and High School and Beyond, the two most comprehensive longitudinal assessments of U.S. students' attitudes and achievements, indicate that, from 1972 through 1994 (the earliest and most recently available data), high school students most often identified two life values as "very important" (see National Center for Educational Statistics, 1995:403). "Finding steady work" was consistently highly valued by over 80 percent of male and female seniors over the 20 years of measurement and was seen as "very important'' by nearly 90 percent of the 1992 seniors—the highest scores on this measure in its 20-year history. "Being successful in work" was also consistently valued as very important by over 80 percent of seniors over the 20-year period and approached 90 percent in 1992.

The pragmatic goals stated by students amount to "get and hold a good job." Who is able to do that? In 1993, the percentage of U.S. citizens age 25 and older who were college graduates and unemployed was 2.6 percent (U.S. Department of Labor, Office of Employment and Unemployment Statistics, quoted in National Center for Education Statistics, 1995:401). By contrast, the unemployment rate for high school graduates with no college was twice as high, 5.4 percent, and for persons with less than a high school education the unemployment rate was 9.8 percent, over three times higher. An October 1994 survey of 1993-1994 high school graduates and dropouts found that fewer than 50 percent of the dropouts were holding

jobs (U.S. Department of Labor, 1995 ; quoted in National Center for Education Statistics, 1995:401).

One researcher found that, controlling for inflation, the mean income of U.S. male high school dropouts ages 25 to 34 has decreased by over 50 percent between 1973 and 1995 (Stringfield, 1995 , 1997). By contrast, the mean incomes of young male high school graduates dropped by about one-third, and those of college graduates by 20 percent in the 1970s and then stabilized. Among the six major demographic groups (males and females who are black, white, or Hispanic), the lowest average income among college graduates was higher than the highest group of high school graduates.

Academic success, as defined by high school graduation, can be predicted with reasonable accuracy by knowing someone's reading skill at the end of grade 3 (for reviews, see Slavin et al., 1994). A person who is not at least a modestly skilled reader by the end of third grade is quite unlikely to graduate from high school. Only a generation ago, this did not matter so much, because the long-term economic effects of not becoming a good reader and not graduating from high school were less severe. Perhaps not surprisingly, when teachers are asked about the most important goal for education, over half of elementary school teachers chose "building basic literacy skills" (National Center for Education Statistics Schools and Staffing Survey, 1990-1991, quoted in National Center for Education Statistics, 1995:31) .

The Special Challenge of Learning to Read English

Learning to read poses real challenges, even to children who will eventually become good readers. Furthermore, although every writing system has its own complexities, English presents a relatively large challenge, even among alphabetic languages. Learning the principles of a syllabic system, like the Japanese katakana, is quite straightforward, since the units represented—syllables—are pronounceable and psychologically real, even to young children. Such systems are, however, feasible only in languages with few possible syllable types; the hiragana syllabary represents spoken Japanese with 46 characters, supplemented with a set of diacritics (Daniels

and Bright, 1996). Spoken English has approximately 5,000 different possible syllables; instead of representing each one with a symbol in the writing system, written English relies on an alphabetic system that represents the parts that make up a spoken syllable, rather than representing the syllable as a unit.

An alphabetic system poses a challenge to the beginning reader, because the units represented graphically by letters of the alphabet are referentially meaningless and phonologically abstract. For example, there are three sounds represented by three letters in the word "but," but each sound alone does not refer to anything, and only the middle sound can really be pronounced in isolation; when we try to say the first or last consonant of the word all by itself, we have to add a vowel to make it a pronounceable entity (see Box 1-1).

Once the learner of written English gets the basic idea that letters represent the small sound units within spoken and heard words, called phonemes, the system has many advantages: a much more limited set of graphemic symbols is needed than in either syllabic (like Japanese) or morphosyllabic (like Chinese) systems; strategies

for sounding out unfamiliar strings and spelling novel words are available; and subsequences, such as prefixes and suffixes, are encountered with enough frequency for the reader to recognize them automatically.

Alphabetic systems of writing vary in the degree to which they are designed to represent the surface sounds of words. Some languages, such as Spanish, spell all words as they sound, even though this can cause two closely related words to be spelled very differently. Writing systems that compromise phonological representations in order to reflect morphological information are referred to as deep orthographies. In English, rather than preserving one-letter-to-one-sound correspondences, we preserve the spelling, even if that means a particular letter spells several different sounds. For example, the last letter pronounced "k" in the written word "electric" represents quite different sounds in the words "electricity" and ''electrician," indicating the morphological relation among the words but making the sound-symbol relationships more difficult to fathom.

The deep orthography of English is further complicated by the retention of many historical spellings, despite changes in pronunciation that render the spellings opaque. The "gh" in "night" and "neighborhood" represents a consonant that has long since disappeared from spoken English. The "ph" in "morphology" and "philosophy" is useful in signaling the Greek etymology of those words but represents a complication of the pattern of sound-symbol correspondences that has been abandoned in Spanish, German, and many other languages that also retain Greek-origin vocabulary items. English can present a challenge for a learner who expects to find each letter always linked to just one sound.

SOURCES OF READING DIFFICULTIES

Reading problems are found among every group and in every primary classroom, although some children with certain demographic characteristics are at greater risk of reading difficulties than others. Precisely how and why this happens has not been fully understood. In some cases, the sources of these reading difficulties

are relatively clear, such as biological deficits that make the processing of sound-symbol relationships difficult; in other cases, the source is experiential such as poor reading instruction.

Biological Deficits

Neuroscience research on reading has expanded understanding of the reading process (Shaywitz, 1996). For example, researchers have now been able to establish a tentative architecture for the component processes of reading (Shaywitz et al., 1998; Shaywitz, 1996). All reading difficulties, whatever their primary etiology, must express themselves through alterations of the brain systems responsible for word identification and comprehension. Even in disadvantaged or other high-risk populations, many children do learn to read, some easily and others with great difficulty. This suggests that, in all populations, reading ability occurs along a continuum, and biological factors are influenced by, and interact with, a reader's experiences. The findings of an anomalous brain system say little about the possibility for change, for remediation, or for response to treatment. It is well known that, particularly in children, neural systems are plastic and responsive to changed input.

Cognitive studies of reading have identified phonological processing as crucial to skillful reading, and so it seems logical to suspect that poor readers may have phonological processing problems. One line of research has looked at phonological processing problems that can be attributed to the underdevelopment or disruption of specific brain systems.

Genetic factors have also been implicated in some reading disabilities, in studies both of family occurrence (Pennington, 1989; Scarborough, 1989) and of twins (Olson et al., 1994). Differences in brain function and behavior associated with reading difficulty may arise from environmental and/or genetic factors. The relative contributions of these two factors to a deficit in reading (children below the local 10th percentile) have been assessed in readers with normal-range intelligence (above 90 on verbal or performance IQ) and apparent educational opportunity (their first language was English and they had regularly attended schools that were at or above national

norms in reading). This research has provided evidence for strong genetic influences on many of these children's deficits in reading (DeFries and Alarcon, 1996) and in related phonological processes (Olson et al., 1989). Recent DNA studies have found evidence for a link between some cases of reading disability and inheritance of a gene or genes on the short arm of chromosome 6 (Cardon et al., 1994; Grigorenko et al., 1997).

It is important to emphasize that evidence for genetic influence on reading difficulty in the selected population described above does not imply genetic influences on reading differences between groups for which there are confounding environmental differences. Such group differences may include socioeconomic status, English as a second language, and other cultural factors. It is also important to emphasize that evidence for genetic influence and anomalous brain development does not mean that a child is condemned to failure in reading. Brain and behavioral development are always based on the interaction between genetic and environmental influences. The genetic and neurobiological evidence does suggest why learning to read may be particularly difficult for some children and why they may require extraordinary instructional support in reading and related phonological processes.

Instructional Influences

A large number of students who should be capable of reading ably given adequate instruction are not doing so, suggesting that the instruction available to them is not appropriate. As Carroll (1963) noted more than three decades ago, if the instruction provided by a school is ineffective or insufficient, many children will have difficulty learning to read (unless additional instruction is provided in the home or elsewhere).

Reading difficulties that arise when the design of regular classroom curriculum, or its delivery, is flawed are sometimes termed "curriculum casualties" (Gickling and Thompson, 1985; Simmons and Kame'enui, in press). Consider an example from a first-grade classroom in the early part of the school year. Worksheets were being used to practice segmentation and blending of words to facili-

tate word recognition. Each worksheet had a key word, with one part of it designated the "chunk" that was alleged to have the same spelling-sound pattern in other words; these other words were listed on the sheet. One worksheet had the word "love" and the chunk "ove.'' Among the other words listed on the sheet, some did indicate the pattern ("glove," "above," "dove"), but others simply do not work as the sheet suggests they should ("Rover," "stove," and "woven"). In lesson plans and instructional activities, such mistakes occur in the accuracy and clarity of the information being taught.

When this occurs consistently, a substantial proportion of students in the classroom are likely to exhibit low achievement (although some students are likely to progress adequately in spite of the impoverished learning situation). If low-quality instruction is confined to one particular teacher, children's progress may be impeded for the year spent in that classroom, but they may overcome this setback when exposed to more adequate teaching in subsequent years. There is evidence, however, that poor instruction in first grade may have long-term effects. Children who have poor instruction in the first year are more seriously harmed by the bad early learning experience and tend to do poorly in schooling across the years (Pianta, 1990).

In some schools, however, the problem is more pervasive, such that low student achievement is schoolwide and persistent. Sometimes the instructional deficiency can be traced to lack of an appropriate curriculum. More often, a host of conditions occur together to contribute to the risk imposed by poor schooling: low expectations for success on the part of the faculty and administration of the school, which may translate into a slow-paced, undemanding curriculum; teachers who are poorly trained in effective methods for teaching beginning readers; the unavailability of books and other materials; noisy and crowded classrooms; and so forth.

It is regrettable that schools with these detrimental characteristics continue to exist anywhere in the United States; since these schools often exist in low-income areas, where resources for children's out-of-school learning are limited, the effects can be very detrimental to students' probabilities of becoming skilled readers (Kozol, 1991; Puma et al., 1997; Natriello et al., 1990). Attending a

school in which low achievement is pervasive and chronic, in and of itself, clearly places a child at risk for reading difficulty. Even within a school that serves most of its students well, an instructional basis for poor reading achievement is possible. This is almost never considered, however, when a child is referred for evaluation of a suspected reading difficulty. Evidence from case study evaluations of children referred for special education indicate that instructional histories of the children are not seriously considered (Klenk and Palincsar, 1996). Rather, when teachers refer students for special services, the "search for pathology" begins and assessment focused on the child continues until some explanatory factor is unearthed that could account for the observed difficulty in reading (Sarason and Doris, 1979).

In sum, a variety of detrimental school practices may place children at risk for poorer achievement in reading than they might otherwise attain. Interventions geared at improving beginning reading instruction, rehabilitating substandard schools, and ensuring adequate teacher preparation are discussed in subsequent chapters.

DEMOGRAPHICS OF READING DIFFICULTIES

A major source of urgency in addressing reading difficulties derives from their distribution in our society. Children from poor families, children of African American and Hispanic descent, and children attending urban schools are at much greater risk of poor reading outcomes than are middle-class, European-American, and suburban children. Studying these demographic disparities can help us identify groups that should be targeted for special prevention efforts. Furthermore, examining the literacy development of children in these higher-risk groups can help us understand something about the course of literacy development and the array of conditions that must be in place to ensure that it proceeds well.

One characteristic of minority populations that has been offered as an explanation for their higher risk of reading difficulties is the use of nonstandard varieties of English or limited proficiency in English. Speaking a nonstandard variety of English can impede the easy acquisition of English literacy by introducing greater deviations

in the representation of sounds, making it hard to develop sound-symbol links. Learning English spelling is challenging enough for speakers of standard mainstream English; these challenges are heightened for some children by a number of phonological and grammatical features of social dialects that make the relation of sound to spelling even more indirect (see Chapter 6).

The number of children who speak other languages and have limited proficiency in English in U.S. schools has risen dramatically over the past two decades and continues to grow. Although the size of the general school population has increased only slightly, the number of students acquiring English as a second language grew by 85 percent nationwide between 1985 and 1992, from fewer than 1.5 million to almost 2.7 million (Goldenberg, 1996). These students now make up approximately 5.5 percent of the population of public school students in the United States; over half (53 percent) of these students are concentrated in grades K-4. Eight percent of kindergarten children speak a native language other than English and are English-language learners (August and Hakuta, 1997).

Non-English-speaking students, like nonstandard dialect speakers, tend to come from low socioeconomic backgrounds and to attend schools with disproportionately high numbers of children in poverty, both of which are known risk factors (see Chapter 4). Hispanic students in the United States, who constitute the largest group of limited-English-proficient students by far, are particularly at risk for reading difficulties. Despite the group's progress in achievement over the past 15 to 20 years, they are about twice as likely as non-Hispanic whites to be reading below average for their age. Achievement gaps in all academic areas between whites and Hispanics, whether they are U.S. or foreign born, appear early and persist throughout their school careers (Kao and Tienda, 1995).

One obvious reason for these achievement differences is the language difference itself. Being taught and tested in English would, of course, put students with limited English proficiency at a disadvantage. These children might not have any reading difficulty at all if they were taught and tested in the language in which they are proficient. Indeed, there is evidence from research in bilingual education that learning to read in one's native language—thus offsetting the

obstacle presented by limited proficiency in English—can lead to superior achievement (Legarreta, 1979; Ramirez et al., 1991). This field is highly contentious and politicized, however, and there is a lack of clear consensus about the advantages and disadvantages of academic instruction in the primary language in contrast to early and intensive exposure to English (August and Hakuta, 1997; Rossell and Baker, 1996).

In any event, limited proficiency in English does not, in and of itself, appear to be entirely responsible for the low reading achievement of these students. Even when taught and tested in Spanish, as the theory and practice of bilingual education dictates, many Spanish-speaking Hispanic students in the United States still demonstrate low levels of reading attainment (Escamilla, 1994; Gersten and Woodward, 1995; Goldenberg and Gallimore, 1991; Slavin and Madden, 1995). This suggests that factors other than lack of English proficiency may also contribute to these children's reading difficulties.

One such factor is cultural differences, that is, the mismatch between the schools and the families in definitions of literacy, in teaching practices, and in defined roles for parents versus teachers (e.g., Jacob and Jordan, 1987; Tharp, 1989); these differences can create obstacles to children's learning to read in school. Others contend that primary cultural differences matter far less than do "secondary cultural discontinuities," such as low motivation and low educational aspirations that are the result of discrimination and limited social and economic opportunities for certain minority groups (Ogbu, 1974, 1982). Still others claim that high motivation and educational aspirations can and do coexist with low achievement (e.g., Labov et al., 1968, working in the African American community; Goldenberg and Gallimore, 1995, in the Hispanic community) and that other factors must therefore explain the differential achievement of culturally diverse groups.

Literacy is positively valued by adults in minority communities, and the positive views are often brought to school by young children (Nettles, 1997). Nonetheless, the ways that reading is used by adults and children varies across families from different cultural groups in ways that may influence children's participation in literacy activities

in school, as Heath (1983) found. And adults in some communities may see very few functional roles for literacy, so that they will be unlikely to provide conditions in the home that are conducive to children's acquisition of reading and writing skills (Purcell-Gates, 1991, 1996). The implications of these various views for prevention and intervention efforts are discussed in Part III of this volume.

It is difficult to distinguish the risk associated with minority status and not speaking English from the risk associated with lower socioeconomic status (SES). Studying the differential experiences of children in middle- and lower-class families can illuminate the factors that affect the development of literacy and thus contribute to the design of prevention and intervention efforts.

The most extensive studies of SES differences have been conducted in Britain. Stubbs (1980) found a much lower percentage of poor readers with higher (7.5 percent) than with lower SES (26.9 percent).  Some have suggested that SES differences in reading achievement are actually a result of differences in the quality of schooling; that is, lower-SES children tend to go to inferior schools, and therefore their achievement is lower because of inferior educational opportunities (Cook, 1991). However, a recent study by Alexander and Entwisle (1996) appears to demonstrate that it is during nonschool time—before they start and during the summer months—that low-SES children fall academically behind their higher-SES peers and get progressively further behind. During the school months (at least through elementary school) the rate of progress is virtually identical for high- and low-SES children.

Regardless of the specific explanation, differences in literacy achievement among children as a result of socioeconomic status are pronounced. Thirty years ago Coleman et al. (1966) and Moynihan (1965) reported that the educational deficit of children from low-income families was present at school entry and increased with each year they stayed in school. Evidence of SES differences in reading achievement has continued to accumulate (National Assessment of Educational Progress, 1981, 1995). Reading achievement of children in affluent suburban schools is significantly and consistently higher than that of children in "disadvantaged" urban schools (e.g.,

NAEP, 1994, 1995; White, 1982; Hart and Risley, 1995). An important conceptual distinction was made by White (1982) in a groundbreaking meta-analysis. White discovered that, at the individual level, SES is related to achievement only very modestly. However, at the aggregate level, that is, when measured as a school or community characteristic, the effects of SES are much more pronounced. A low-SES child in a generally moderate or higher-SES school or community is far less at risk than an entire school or community of low-SES children.

The existence of SES differences in reading outcomes offers by itself little information about the specific experiences or activities that influence literacy development at home. Indeed, a look at socioeconomic factors alone can do no more than nominate the elements that differ between middle-class and lower-class homes. Researchers have tried to identify the specific familial interactions that can account for social class differences, as well as describe those interactions around literacy that do occur in low-income homes. For example, Baker et al. (1995) compared opportunities for informal literacy learning among preschoolers in the homes of middle-income and low-income urban families. They found that children from middle-income homes had greater opportunities for informal literacy learning than children of low-income homes. Low-income parents, particularly African-American parents, reported more reading skills practice and homework (e.g., flash cards, letter practice) with their kindergarten-age children than did middle-income parents. Middle-income parents reported only slightly more joint book reading with their children than did low-income families. But these middle-income parents reported more play with print and more independent reading by children. Among the middle-class families in this study, 90 percent reported that their child visited the library at least once a month, whereas only 43 percent of the low-income families reported such visits. The findings of Baker et al. that low-income homes typically do offer opportunities for literacy practice, though perhaps of a different nature from middle-class homes, have been confirmed in ethnographic work by researchers such as Teale (1986), Taylor and Dorsey-Gaines (1988), Taylor and Strickland (1986), Gadsden (1993), Delgado-Gaitan (1990), and Goldenberg et al. (1992).

ABOUT THIS REPORT

Charge to the committee.

The Committee on the Prevention of Reading Difficulties in Young Children has conducted a study of the effectiveness of interventions for young children who are at risk of having problems in learning to read. It was carried out at the request of the U.S. Department of Education's Office of Special Education Programs and its Office of Educational Research and Improvement (Early Childhood Institute) and the National Institute on Child Health and Human Development (Human Learning and Behavior Branch). The sponsors requested that the study address young children who are at -risk for reading difficulties, within the context of reading acquisition for all children. The scope included children from birth through grade 3, in special and regular education settings. The project had three goals: (1) to comprehend a rich research base; (2) to translate the research findings into advice and guidance for parents, educators, publishers, and others involved in the care and instruction of the young; and (3) to convey this advice to the targeted audiences through a variety of publications, conferences, and other outreach activities. In making its recommendations, the committee has highlighted key research findings that should be integrated into existing and future program interventions to enhance the reading abilities of young children, particularly instruction at the preschool and early elementary levels.

The Committee's Perspective

Our recommendations extend to all children. Of course, we are most worried about children at high risk of developing reading difficulties. However, there is little evidence that children experiencing difficulties learning to read, even those with identifiable learning disabilities, need radically different sorts of supports than children at low risk, although they may need much more intensive support. Childhood environments that support early literacy development and

excellent instruction are important for all children. Excellent instruction is the best intervention for children who demonstrate problems learning to read.

Knowledge about reading derives from work conducted in several disciplines, in laboratory settings as well as in homes, classrooms, and schools, and from a range of methodological perspectives. Reading is studied by ethnographers, sociologists, historians, child developmentalists, neurobiologists, and psycholinguists. Reading has been approached as a matter of cognition, culture, socialization, instruction, and language. The committee that wrote this report embraces all these perspectives—but we acknowledge the difficulty of integrating them into a coherent picture.

The committee agrees that reading is inextricably embedded in educational, social, historical, cultural, and biological realities. These realities determine the meaning of terms like literate as well as limits on access to literacy and its acquisition. Literacy is also essentially developmental, and appropriate forms of participation, instruction, and assessment in literacy for preschoolers differ from those for first graders and also from those for sophisticated critical readers.

Reading as a cognitive and psycholinguistic activity requires the use of form (the written code) to obtain meaning (the message to be understood), within the context of the reader's purpose (for learning, for enjoyment, for insight). In children, one can see a developmental oscillation between these foci: the preschool child who can pretend to read a story she has heard many times is demonstrating an understanding that reading is about content or meaning; the same child as a first grader, having been taught some grapheme-phoneme correspondences, may read the same storybook haltingly, disfluently, by sounding out the words she had earlier memorized, demonstrating an extreme focus on form. The mature, fluent, practiced reader shows more rapid oscillations between form-focused and meaning-focused reading: she can rely on automatic processing of form and focus on meaning until she encounters an unfamiliar pharmaceutical term or a Russian surname, whereupon the processing of meaning is disrupted while the form is decoded.

Groups define the nature as well as the value of literacy in culturally specific ways as well. A full picture of literacy from a cultural

and historical perspective would require an analysis of the distribution of literacy skills, values, and uses across classes and genders as well as religious and social groups; it would require a discussion of the connections between professional, religious, and leisure practices and literacy as defined by those practices. Such a discussion would go far beyond the scope of this report, which focuses on reading and reading difficulties as defined by mainstream opinions in the United States, in particular by U.S. educational institutions at the end of the twentieth century. In that context, employability, citizenship, and participation in the culture require high levels of literacy achievement.

Nature of the Evidence

Our review and summary of the literature are framed by some very basic principles of evidence evaluation. These principles derive from our commitment to the scientific method, which we view not as a strict set of rules but instead as a broad framework defined by some general guidelines. Some of the most important are that (1) science aims for knowledge that is publicly verifiable, (2) science seeks testable theories—not unquestioned edicts, (3) science employs methods of systematic empiricism (see Box 1-2). Science renders knowledge public by such procedures as peer review and such mechanisms as systematic replication (see Box 1-3). Testable theories are those that are potentially falsifiable—that is, defined in such a way that empirical evidence inconsistent with them can in principle be accumulated. It is the willingness to give up or alter a theory in the face of evidence that is one of the most central defining features of the scientific method. All of the conclusions reached in this report

are provisional in this important sense: they have empirical consequences that, if proven incorrect, should lead to their alteration.

The methods of systematic empiricism employed in the study of reading difficulties are many and varied. They include case studies, correlational studies, experimental studies, narrative analyses, quasi-experimental studies, interviews and surveys, epidemiological studies, ethnographies, and many others. It is important to understand how the results from studies employing these methods have been used in synthesizing the conclusions of this report.

First, we have utilized the principle of converging evidence. Scientists and those who apply scientific knowledge must often make a judgment about where the preponderance of evidence points. When this is the case, the principle of converging evidence is an important tool, both for evaluating the state of the research evidence and also for deciding how future experiments should be designed. Most areas of science contain competing theories. The extent to which one particular theory can be viewed as uniquely supported by a particular study depends on the extent to which other competing explanations have been ruled out. A particular experimental result is never equally relevant to all competing theoretical explanations. A given experiment may be a very strong test of one or two alternative theories but a weak test of others. Thus, research is highly convergent when a series of experiments consistently support a given theory while collectively eliminating the most important competing explanations. Although no single experiment can rule out all alternative explanations, taken collectively, a series of partially diagnostic studies can

lead to a strong conclusion if the data converge. This aspect of the convergence principle implies that we should expect to see many different methods employed in all areas of educational research. A relative balance among the methodologies used to arrive at a given conclusion is desirable because the various classes of research techniques have different strengths and weaknesses.

Another important context for understanding the present synthesis of research is provided by the concept of synergism between descriptive and hypothesis-testing research methods. Research on a particular problem often proceeds from more exploratory methods (ones unlikely to yield a causal explanation) to methods that allow stronger causal inferences. For example, interest in a particular hypothesis may originally stem from a case study of an unusually successful teacher. Alternately, correlational studies may suggest hypotheses about the characteristics of teachers who are successful. Subsequently, researchers may attempt experiments in which variables identified in the case study or correlation are manipulated in order to isolate a causal relationship. These are common progressions in areas of research in which developing causal models of a phenomenon is the paramount goal. They reflect the basic principle of experimental design that the more a study controls extraneous variables the stronger is the causal inference. A true experiment in controlling all extraneous variables is thus the strongest inferential tool.

Qualitative methods, including case studies of individual learners or teachers, classroom ethnographies, collections of introspective interview data, and so on, are also valuable in producing complementary data when carrying out correlational or experimental studies. Teaching and learning are complex phenomena that can be enhanced or impeded by many factors. Experimental manipulation in the teaching/learning context typically is less ''complete" than in other contexts; in medical research, for example, treatments can be delivered through injections or pills, such that neither the patient nor the clinician knows who gets which treatment, and in ways that do not require that the clinician be specifically skilled in or committed to the success of a particular treatment.

Educational treatments are often delivered by teachers who may enhance or undermine the difference between treatments and controls; thus, having qualitative data on the authenticity of treatment and on the attitudes of the teachers involved is indispensable. Delivering effective instruction occurs in the context of many other factors—the student-teacher relationship, the teacher's capability at maintaining order, the expectations of the students and their parents—that can neither be ignored nor controlled. Accordingly, data about them must be made available. In addition, since even programs that are documented to be effective will be impossible to implement on a wider scale if teachers dislike them, data on teacher beliefs and attitudes will be useful after demonstration of treatment effects as well (see discussion below of external validity).

Furthermore, the notion of a comparison between a treatment group and an untreated control is often a myth when dealing with social treatments. Families who are assigned not to receive some intervention for their children (e.g., Head Start placement, one-on-one tutoring) often seek out alternatives for themselves that approximate or improve on the treatment features. Understanding the dynamic by which they do so, through collecting observational and interview data, can prevent misguided conclusions from studies designed as experiments. Thus, although experimental studies represent the most powerful design for drawing causal inferences, their limitations must be recognized.

Another important distinction in research on reading is that between retrospective and prospective studies. On one hand, retrospective studies start from observed cases of reading difficulties and attempt to generate explanations for the problem. Such studies may involve a comparison group of normal readers, but of course inference from the finding of differences between two groups, one of whom has already developed reading difficulties and one of whom has not, can never be very strong. Studies that involve matching children with reading problems to others at the same level of reading skill (rather than to age mates) address some of these problems but at the cost of introducing other sources of difficulty—comparing two groups of different ages, with different school histories, and different levels of perceived success in school.

Prospective studies, on the other hand, are quite expensive and time consuming, particularly if they include enough participants to ensure a sizable group of children with reading difficulties. They do, however, enable the researcher to trace developmental pathways for participants who are not systematically different from one another at recruitment and thus to draw stronger conclusions about the likely directionality of cause-effect relationships.

As part of the methodological context for this report, we wish to address explicitly a misconception that some readers may have derived from our emphasis on the logic of an experiment as the most powerful justification for a causal conclusion. By such an emphasis, we do not mean to imply that only studies employing true experimental logic are to be used in drawing conclusions. To the contrary, as mentioned previously in our discussion of converging evidence, the results from many different types of investigations are usually weighed to derive a general conclusion, and the basis for the conclusion rests on the convergence observed from the variety of methods used. This is particularly true in the domains of classroom and curriculum research.

For example, it is often (but not always) the case that experimental investigations are high in internal validity but limited in external validity, whereas correlational studies are often high in external validity but low in internal validity. Internal validity concerns whether we can infer a causal effect for a particular variable. The more a study approximates the logic of a true experiment (i.e., includes manipulation, control, and randomization), the more we can make a strong causal inference. The internal validity of qualitative research studies depends, of course, on their capacity to reflect reality adequately and accurately. Procedures for ensuring adequacy of qualitative data include triangulation (comparison of findings from different research perspectives), cross-case analyses, negative case analysis, and so forth. Just as for quantitative studies, our review of qualitative studies has been selective and our conclusions took into account the methodological rigor of each study within its own paradigm.

External validity concerns the generalizability of the conclusion to the population and setting of interest. Internal validity and exter-

nal validity are often traded off across different methodologies. Experimental laboratory investigations are high in internal validity but may not fully address concerns about external validity. Field classroom investigations are often quite high in external validity but, because of the logistical difficulties involved in carrying out such investigations, are often quite low in internal validity. Hence, there is a need to look for a convergence of results—not just consistency across studies conducted with one method. Convergence across different methods increases confidence that the conclusions have both internal and external validity.

A not uncommon misconception is that correlational (i.e., nonexperimental) studies cannot contribute to knowledge. This is false for a number of reasons. First, many scientific hypotheses are stated in terms of correlation or lack of correlation, so that such studies are directly relevant to these hypotheses. Second, although correlation does not imply causation, causation does imply correlation. That is, although a correlational study cannot definitively prove a causal hypothesis, it may rule one out. Third, correlational studies are more useful than they used to be because some of the recently developed complex correlational designs allow for limited causal inferences. The technique of partial correlation, widely used in studies cited in this report, provides a case in point. It makes possible a test of whether a particular third variable is accounting for a relationship.

Perhaps the most important argument for quasi-experimental studies, however, is that some variables (for instance, human malnutrition, physical disabilities) simply cannot be manipulated for ethical reasons. Other variables, such as birth order, sex, and age, are inherently correlational because they cannot be manipulated, and therefore the scientific knowledge concerning them must be based on correlational evidence. Finally, logistical difficulties in carrying out classroom and curriculum research often render impossible the logic of the true experiment. However, this circumstance is not unique to educational or psychological research. Astronomers obviously cannot manipulate the variables affecting the objects they study, yet they are able to arrive at scientifically founded conclusions.

Outline of the Report

In Chapter 2 we present a picture of typical skilled reading and the process by which it develops. We see this as crucial background information for understanding reading difficulties and their prevention.

Part II presents a fuller picture of the children we are addressing in this report. We survey the population of children with reading difficulties in Chapter 3. In Chapter 4 we discuss risk factors that may help identify children who will have problems learning to read.

Part III presents our analysis of preventions and interventions, including instruction. Chapter 5focuses on the preschool years. Chapter 6 discusses prevention and literacy instruction delivered in classrooms in kindergarten and the primary grades. Chapter 7 presents our analysis of organizational factors, at the classroom, school, or district level, that contribute to prevention and intervention for grades 1 through 3. Chapter 8 continues discussion of grades 1 through 3, presenting more targeted intervention efforts to help children who are having reading difficulties.

Part IV presents our discussion of how the information reviewed in the report should be used to change practice. Chapter 9 discusses a variety of domains in which action is needed and obstacles to change in those domains. Chapter 10 presents our recommendations for practice, policy, and research.

While most children learn to read fairly well, there remain many young Americans whose futures are imperiled because they do not read well enough to meet the demands of our competitive, technology-driven society. This book explores the problem within the context of social, historical, cultural, and biological factors.

Recommendations address the identification of groups of children at risk, effective instruction for the preschool and early grades, effective approaches to dialects and bilingualism, the importance of these findings for the professional development of teachers, and gaps that remain in our understanding of how children learn to read. Implications for parents, teachers, schools, communities, the media, and government at all levels are discussed.

The book examines the epidemiology of reading problems and introduces the concepts used by experts in the field. In a clear and readable narrative, word identification, comprehension, and other processes in normal reading development are discussed.

Against the background of normal progress, Preventing Reading Difficulties in Young Children examines factors that put children at risk of poor reading. It explores in detail how literacy can be fostered from birth through kindergarten and the primary grades, including evaluation of philosophies, systems, and materials commonly used to teach reading.

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5 Ways to Support Students Who Struggle With Reading Comprehension

These strategies can help students who are able to decode well but have difficulty understanding what they read—and they’re beneficial for all students.

When we think of reading issues, we often imagine children who struggle to decode the letters in text and turn them into spoken language. This type of struggling reader has a very difficult time figuring out what many of the words are and has poor phonological (speech-sound) skills. However, there are also many students who sound like they’re reading beautifully but have difficulty with understanding vocabulary and figurative language, inferencing, verbal reasoning, grammatical development, and oral expression.

As children get older, if they are decoding text well we assume they are reading well. Once a person learns to decode, reading comprehension becomes more about language comprehension and focus. At this transition, starting around third grade, teachers may begin to notice some students who decode text fluently but are not understanding.

Since this type of struggling reader is less noticeable than ones who have difficulty decoding, they often slip under the radar until they begin to fail standardized state comprehension tests. Even then, their issues may go undetected for a long time, resulting in middle and high school students who sound like they’re reading but understand nothing that they have read.

These struggling readers should be targeted for remediation—the earlier the better. However, remediation consisting of practice passages and questions may be ineffective as it focuses too narrowly on text-based skills.

Supporting Students Who Struggle With Comprehension

Here are five strategies to try out with students who read fluently but struggle to comprehend what they’re reading.

1. Target overall comprehension of language: Recent research reveals that reading comprehension difficulties may stem from an underlying oral language weakness that exists from early childhood, before reading is even taught. It turns out that students who have poor reading comprehension also often understand fewer spoken words and less of what they hear, and have worse spoken grammar. So, to address reading comprehension deficits effectively, educators may have to use an approach that teaches vocabulary, thinking skills, and comprehension first in spoken language and then in reading and written language.

2. Teach vocabulary: Because students with poor comprehension often have poor vocabulary skills and understand less of what they hear, it’s helpful to teach the meanings of new words through the use of multisensory strategies like graphic organizers, pictures, and mnemonics. Improving their overall language skills increases the likelihood that they will understand the words they encounter in written text. Since it is impossible to know every word one might encounter, students should be taught about the different types of context clues and how to use them to determine the meaning of unknown words.

3. Teach thinking strategies: Once students have the vocabulary to be able to make it through a text, they often struggle with the complex thinking or sustained attention required to keep up with all of the important details and to access information that is implied but not directly stated. Teachers can instruct students on cognitive strategies they can use. Many common text reading strategies—such as annotation, SQ3R , and the KWL chart —make use of these thinking strategies, including:

• Discussing or activating prior knowledge,
• Developing questions while reading,
• Connecting what they are reading to another text, something they have seen, or something they have experienced,
• Visualizing or picturing what they are reading,
• Making predictions about what will come next in the text,
• Looking back for keywords and rereading in order to clarify or answer questions, and
• Thinking aloud to model the strategies and thought processes needed for comprehension.

Students can learn and then use the strategies that work best for them depending on the text they’re reading. Pulling deeper meaning out of text through the use of thinking strategies can be beneficial not just to reading comprehension but also to writing.

4. Have students practice reciprocal teaching: Once taught, cognitive strategies can be consistently practiced and implemented through the use of reciprocal teaching , which encourages students to take a leadership role in their learning and begin to think about their thought process while listening or reading. Teachers can use reciprocal teaching during class discussions, with text that is read aloud, and later with text that is read in groups. The students should rotate between the following roles:

• Questioner , who poses questions about parts of the lesson, discussion, or text that are unclear or confusing, or to help make connections with previously learned material.
• Summarizer , who sums up each important point or detail from the lesson, discussion, or text.
• Clarifier , who tries to address the Questioner’s issues and make sure that parts they found confusing are clear to others.
• Predictor , who makes a prediction about what will happen next based on what was presented, discussed, or read,

5. Directly teach comprehension skills: Students should be directly taught comprehension skills such as sequencing, story structure using the plot mountain, how to make an inference and draw a conclusion, and the different types of figurative language. Students should have the opportunity to first use the skills with text that they hear the teacher read aloud, and then later with text that they read independently at their own level.

The comprehension skills and strategies listed above can be used with the whole class, as they closely align with reading and language arts standards for elementary and middle school students. Teachers can help students select reading material with vocabulary that matches their current ability levels so that within a classroom, students are reading text and working on vocabulary at levels that are accessible for each of them.

Reading Disability Essay

A reading disability is a type of learning disability caused by neurological factors that affect the ability of a child to read normally (Safford, 2006). Reading disabilities impair the ability of a person to read according to the expected level.

A reading disability is also referred to as dyslexia and can affect any child including those with normal levels of intelligence. Children with reading disabilities are faced with a lot of challenges when it comes to learning (Safford, 2006).

Children with reading disabilities have persistent difficulties when it comes to using their decoding strategies and therefore completely rely on their whole memory for reading. This affects their fluency in reading and consequently their understanding of text becomes very difficult.

Children with reading disabilities read slowly due to their difficulties with spelling and phonological processing. The visual and verbal response of children with reading disability is also very poor and in the process affects their manipulation of sounds (Hatcher, 1999).

The reading accuracy and comprehension of children is normally impaired by the reading disability and therefore affecting their academic life. Students with reading disabilities should be given extra time to complete assignments and examinations.

Reading disabilities can be partially inherited or can be caused by physical damage to the brain (Hatcher, 1999). According to research findings, reading disabilities can be caused by gene mutations that lead to writing and reading deficits.

Children with visual problems tend to experience reading disorders in many occasions compared to those without visual problems (Hatcher, 1999). The nervous system of a person is very important in coordinating the brain and visual processes.

In case any of the brain and visual processes is interfered with, children are bound to have difficulties with their reading abilities. Children with language deficits may also experience difficulties when reading (Konza, 2006).

Neurological difficulties and the impairment of sensory nerves are among the physiological factors that cause reading impairments (Konza, 2006). The reading success of parents is a fundamental hereditary factor that can cause reading disabilities.

The intellectual environment created by parents plays a significant role in determining whether their children experience reading disabilities or not (Konza, 2006). Phonological processing and word recognition are in most cases influenced by genetics.

Racial identification and other socioeconomic factors can influence the reading abilities of a child. The learning strategies used by learning institutions can also affect the ability of children to read and comprehend information (Torgesen, 2002). Regular practice is needed for students to sharpen and perfect their reading skills.

Children with reading disabilities have certain characteristics that distinguish them from normal children (Torgesen, 2002). Identification of single words is the first difficulty that children with reading difficulties experience. Children with reading disabilities also find it difficult to understand rhymes and other sounds in words.

This group of students also experience difficulties with spelling and comprehension of reading materials (Torgesen, 2002). Children with reading disabilities are always unable to read at a faster rate whether silently or orally. Children with reading disabilities may omit or substitute words when reading.

The spoken language of children with reading disabilities is normally delayed and their written expression is also very poor. Reading disabilities makes children to be mixed up when it comes to directions and opposites. Decoding syllables is among the major challenges of children with reading disabilities (Konza, 2006).

Reversal of words is a common characteristic of children with reading disabilities. Associating syllables with specific sounds is another problem for children with reading disabilities. The functioning of brain hemispheres affects the reading speed of children.

It is important to evaluate the reading abilities of children on a regular basis in order to diagnose any kind of reading disabilities as early as possible (Malmquist, 1958). It is important to consider the fact that reading disabilities are not related to low intelligence.

The languages spoken at school and the child’s home are among the things considered when evaluating a child’s reading abilities. Cultural factors and educational opportunities also influence the reading abilities of children. It is possible for a child to compensate for a reading disorder through early intervention (Malmquist, 1958).

The severity of a reading disability and the kind of help they receive determine whether the case can be improved or not. The self-esteem of children with reading disabilities is normally very low and the situation can become worse if teachers and the immediate family do not offer their support towards improving the child’s condition.

It is possible to overcome a reading disorder if the condition is detected before the child reaches grade three (Konza, 2006). Children with reading disabilities may lack interest in learning activities which leads to poor academic performance. One of the best interventions for children with reading disabilities is to improve their word recognition skills (Konza, 2006).

It is important for students with reading disabilities to learn how to recognize real words as the first step towards improving their reading abilities (Hatcher, 1999). Teachers should help this group of students to improve their word recognition skills to supplement their sound recognition skills.

Phonemic awareness, word attack skills, phonics and decoding are some of the areas that this type of intervention aims at improving (Hatcher, 1999). Teachers and other professionals use direct instructions as the best method of teaching children with reading disabilities word recognition skills.

Direct instructions involve repetition practices that ensure that the children completely perfect their word recognition skills. Regular practice is the key to improving word recognition skills for children with reading disabilities (Safford, 2006).

The instructional components of improving word recognition skills include sequencing, segmentation and advanced organizers. The sequencing component involves breaking down reading tasks. This helps in matching students with the level of their reading disability.

The teachers arrange for short sessions where students are able to read, review and underline new words in a passage. The second instructional component under this intervention is segmentation where the various skills being taught to students are broken down into segments for quick understanding of the reading tasks.

Advanced organizers enable students to get familiar with the learning instructions in advance before the actual lessons (Safford, 2006). It is essential to improve the comprehension skills of students as they learn how to recognize words.

The reading program of children with reading disabilities should be constantly evaluated to ensure the programs deliver the expected results.

Children with reading disabilities encounter a lot of challenges and should therefore be given some special attention when it comes to school assignments and examinations (Safford, 2006). It is important to accommodate this group of students for them to feel loved and appreciated.

Students with reading disabilities can not compete at the same level with normal students. Their reading speed is slow and this should be compensated by allowing them some extra time to complete their assignments and examinations (Konza, 2006).

The level of reading disability should be used to determine the amount of extra time that children with reading disabilities should be added. It would be very unfair and inhuman to expect children with reading disabilities to compete at the same level with normal children.

According to research findings, children with visual problems have high chances of encountering problems in their reading. The extra time enables children with reading disabilities to understand questions at their speed and be able to answerer them according to their level (Konza, 2006).

Children with reading disabilities end up not completing their assignments and examinations in a case where they are not given some extra time. Their reading and writing speed is very slow and therefore can not allow them to finish their assignments and examinations within the normal time (Konza, 2006).

In conclusion, reading disabilities are a reality and parents in collaboration with teachers should look for ways of ensuring that children with this kind of disability are given enough support (Torgesen, 2002). Genetic and physiological factors are among the major causes of reading disabilities among children.

It is important for parents and teachers to detect any kind of reading disabilities as early as possible so that proper measures can be taken to prevent the situation from getting worse. Helping students with reading disabilities to perfect their word recognition skills is among the basic interventions for children with reading disabilities (Torgesen, 2002).

Children with reading disabilities should be given extra time in order to complete assignments and examinations because they can not compete at the same level with normal children (Hatcher, 1999). Accommodating children with reading disabilities helps in improving their self-esteem and academic performance.

Hatcher, P. (1999). Phonemes, rhymes, and intelligence as predictors of children’s responsiveness to remedial reading instruction: Evidence from a longitudinal intervention study. Journal of Experimental Child Psychology, 72(2), 130-153.

Konza, D. (2006). Teaching students with reading difficulties . New York, NY: Cengage Learning Australia.

Malmquist, E. (1958). Factors related to reading disabilities in the first grade of elementary school . New York, NY: Almqvsit & Wiksell.

Safford, P. (2006). Children with disabilities in America: A historical handbook and guide . New York, NY: Greenwood Publishing Group.

Torgesen, J. (2002). The prevention of reading difficulties. Journal of School Psychology , 40(1), 7-26.

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What are reading disorders?

Reading disorders occur when a person has trouble reading words or understanding what they read. Dyslexia is one type of reading disorder. It generally refers to difficulties reading individual words and can lead to problems understanding text.

Most reading disorders result from specific differences in the way the brain processes written words and text. 1 Usually, these differences are present from a young age. But a person can develop a reading problem from an injury to the brain at any age.

People with reading disorders often have problems recognizing words they already know and understanding text they read. They also may be poor spellers. Not everyone with a reading disorder has every symptom.

Reading disorders are not a type of intellectual or developmental disorder , and they are not a sign of lower intelligence or unwillingness to learn.

People with reading disorders may have other learning disabilities, too, including problems with writing or numbers . Visit our topic on learning disabilities for more information about these problems.

Types of Reading Disorders

Dyslexia is the most well-known reading disorder. It specifically impairs a person’s ability to read. Individuals with dyslexia have normal intelligence, but they read at levels significantly lower than expected. Although the disorder varies from person to person, there are common characteristics: People with dyslexia often have a hard time sounding out words, understanding written words, and naming objects quickly. 1

Most reading problems are present from the time a child learns to read. But some people lose the ability to read after a stroke or an injury to the area of the brain involved with reading . 2 This kind of reading disorder is called alexia .

Hyperlexia is a disorder where people have advanced reading skills but may have problems understanding what is read or spoken aloud. They may also have cognitive or social problems. 3 , 4

Other people may have normal reading skills but have problems understanding written words. 5

Reading disorders can also involve problems with specific skills:

• Word decoding. People who have difficulty sounding out written words struggle to match letters to their proper sounds.
• Fluency. People who lack fluency have difficulty reading quickly, accurately, and with proper expression (if reading aloud).
• Poor reading comprehension. People with poor reading comprehension have trouble understanding what they read.
• Hulme, C., & Snowling, M. J. (2016). Reading disorders and dyslexia.  Current Opinion in Pediatrics ,  28 (6), 731–735. Retrieved August 19, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293161/
• Cherney, L. R. (2004). Aphasia, alexia, and oral reading. Topics in Stroke Rehabilitation , 11(1), 22–36. Retrieved February 21, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/?term=14872397
• Ostrolenk, A., Forgeot d’Arc, B., Jelenic, P., Samson, F., & Mottron, L. (2017). Hyperlexia: Systematic review, neurocognitive modelling, and outcome. Neuroscience and Biobehavioral Reviews , 79, 134–149. Retrieved August 19, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/28478182
• Landi, N., & Ryherd, K. (2017). Understanding specific reading comprehension deficit: A review. Language and Linguistics Compass , 11(2), e12234. Retrieved August 19, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051548/

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Why Children With Dyslexia Struggle With Writing and How to Help Them

Michael hebert.

a Department of Special Education and Communication Disorders, University of Nebraska-Lincoln

Devin M. Kearns

b Department of Educational Psychology, University of Connecticut, Storrs

Joanne Baker Hayes

Pamela bazis, samantha cooper.

Children with dyslexia often have related writing difficulties. In the simple view of writing model, high-quality writing depends on good transcription skills, working memory, and executive function—all of which can be difficult for children with dyslexia and result in poor spelling and low overall writing quality. In this article, we describe the challenges of children with dyslexia in terms of the simple view of writing and instructional strategies to increase spelling and overall writing quality in children with dyslexia.

For spelling strategies, we conducted systematic searches across 2 databases for studies examining the effectiveness of spelling interventions for students with dyslexia as well as including studies from 2 meta-analyses. To locate other instructional practices to increase writing quality (e.g., handwriting and executive function), we examined recent meta-analyses of writing and supplemented that by conducting forward searches.

Through the search, we found evidence of effective remedial and compensatory intervention strategies in spelling, transcription, executive function, and working memory. Some strategies included spelling using sound-spellings and morphemes and overall quality using text structure, sentence combining, and self-regulated strategy development.

Conclusions

Many students with dyslexia experience writing difficulty in multiple areas. However, their writing (and even reading) skills can improve with the instructional strategies identified in this article. We describe instructional procedures and provide links to resources throughout the article.

Students with dyslexia often also have writing difficulties. This is not surprising, as reading is theorized to be a central component of writing in some cognitive models of writing development (e.g., Graham, 2018 ; Hayes, 1996 ). The writing difficulties of students with dyslexia can be partially attributed to their reading difficulties and can manifest in many ways in their writing, such as poor spelling, poor legibility, lack of diverse vocabulary, poor idea development, and/or lack of organization.

Dyslexia and writing difficulties co-occur for two overarching reasons. First, reading and writing rely on related underlying processes ( Graham & Hebert, 2010 , 2011 ). For example, dyslexia involves difficulties related to processing phonological information needed for decoding words, whereas writing requires encoding phonological information when writing words. Because the disability impacts the underlying process for both the reading and writing systems, the prevalence of writing difficulties for students with dyslexia is not unexpected. Second, reading is a subskill required throughout the writing process. Writers often need to read source materials before writing their own text and also need to read and reread their own writing to diagnose text problems, such as spelling errors, grammar errors, and disorganization ( Hayes, 1996 ). The presence of reading difficulties complicates this task, especially if students have poor handwriting skills that make it even more difficult for them to read their own writing.

The focus of this article is to address the various types of writing issues children with dyslexia may have and to provide information about research-based practices that can work toward remediation of these difficulties. First, we use the simple writing model to provide an overview of the skills needed for writing. To illustrate some of the writing difficulties students with dyslexia have, we then provide a case study of a student with dyslexia (Jordan) and discuss how some of his writing errors indicate difficulties related to reading challenges. Next, we provide theory for why students with dyslexia may struggle with writing by presenting research and theory about some of the links among their reading and writing difficulties. Finally, we identify instructional strategies shown to be effective for improving writing skills (and related reading skills) of students with reading and writing disabilities.

Conceptual Framework: Simple View of Writing

One way to characterize the skills involved in writing is to use the simple view of writing ( Berninger & Amtmann, 2003 ). This theoretical model includes the subskills that are essential for the writing task and provides a framework for showing how those skills are interrelated. The model includes skills in four overarching categories: transcription, executive functions, working memory, and text generation (see Figure 1 ). We use the model as a heuristic, meaning that it is useful as a basic framework for understanding the components of writing, but we do not use it as a comprehensive description of how writing occurs. Researchers have proposed more comprehensive cognitive models of writing development (e.g., Graham, 2018 ; Hayes, 1996 ; Hayes & Flower, 1980 ; Scardamalia & Bereiter, 1986 ), but we decided to use the simple view of writing because it focuses on important aspects of writing skills that are relevant for teaching students with dyslexia. As we discuss various reasons students with dyslexia may have difficulty with writing, we will reference the simple view of writing to help explain how these difficulties may impact their writing. We will then link suggested interventions with the model as well in order to illustrate why the interventions are likely to be effective.

A model of the simple view of writing.

The simple view of writing is represented by a triangle, with each of the vertices linked to a specific writing skill or outcome. The two vertices at the base of the triangle represent (a) transcription skills (e.g., spelling, handwriting) and (b) executive function skills (e.g., self-regulation, planning, organization). Berninger, Abbott, Abbott, Graham, and Richards (2002) provide evidence that these skills enable (c) text generation, which is represented by the top vertex of the triangle. Because of the complexity of writing, the center of the triangle is used to illustrate that all of these skills are constrained by (d) working memory. 1

When more working memory resources are needed for any individual component of the process, fewer resources are available to manage other components of writing tasks. For example, a writer with poor spelling skills may need to rely more on his or her working memory when spelling words, which leaves fewer working memory resources available for generating ideas for his or her writing or holding them in memory throughout the writing process. All too familiar is the anecdote of the student who stops to ask a teacher how to spell a word, only to return to his or her writing and state, “I forgot what I was going to say.”

Because all of the writing components operate in working memory and require considerable resources and attention, it is postulated that, when transcription skills are sufficiently automatic, more working memory space and resources are available for self-regulation strategies such as goal setting, planning, monitoring, and revising, allowing writers to generate text more similar to that of skilled adult writers ( Berninger et al., 2002 ).

Writings Difficulties of Students With Dyslexia in the Simple View of Writing

As we discussed previously, many students with dyslexia also have related writing difficulties. These difficulties can occur in many areas of writing related to the simple view of writing model and can manifest in many different ways. For example, the writing of students with dyslexia may suffer from one or more of the following issues: a high percentage of misspelled words, difficult-to-read handwriting, poor organization, a lack of fully developed ideas, and/or a lack of diverse vocabulary.

It is important to note that the causes of some of these writing difficulties may not be obvious. For example, it might be assumed that the cause of poor handwriting is poor motor control. Although this may be true, it could also be that the true causes of handwriting difficulties are more complicated than it first appears. Some researchers (e.g., Berninger, Nielsen, Abbott, Wijsman, & Raskind, 2008 ) have demonstrated that poor handwriting skills may actually be the result of poor spelling skills. These researchers hypothesize that students with poor spelling skills hesitate more often when writing words, leading to less fluent letter writing ( Berninger et al., 2008 ). When writing a single word, this may not make much difference to a writer's overall handwriting skills, but consistent hesitation and dysfluent word writing may not allow students to improve their handwriting skills. Similar to how spelling may contribute to poor handwriting, poor handwriting may sometimes contribute to poor organization in the writing of these students. We will explore some of the research behind these issues in more detail later in the article, but first, we illustrate some of the writing challenges a student with dyslexia might experience using a writing sample from Jordan, a fourth grader with reading disability.

Jordan: A Writing Case Study for a Student With Dyslexia

Jordan (a pseudonym) is a 10-year-old fourth grader. He participated in a research study led by the first author, and his scores indicate a level of difficulty that would qualify him for special education services based on a diagnosis of dyslexia. His scores on the word reading subtests of a standardized test, the Woodcock Reading Mastery Test–Third Edition, indicate a level of reading difficulty—below the 17th percentile—that is often used as an evidence of dyslexia (see the scores in Table 1 ).

Reading and writing scores for our example student with dyslexia (Jordan).

Note.  Scores at the 16th percentile are 1 SD below the mean. Scores at or below this often result in qualification for reading disability based on word reading difficulty, that is, dyslexia. WRMT3 = Woodcock Reading Mastery Test–Third Edition; WIAT4 = Wechsler Individual Achievement Test–Fourth Edition.

Jordan also shows difficulty with writing. He was given the Essay Composition Subtest of the Wechsler Individualized Achievement Test–Fourth Edition. For this test, children have 10 min to write about a favorite game and three reasons they like it. Jordan's essay writing places his performance at the 25th percentile compared with other fourth graders. Jordan's writing sample (see Figure 2 ) illustrates some of the writing difficulties of children with dyslexia.

A writing sample from Jordan, a fourth-grade student with reading disability as identified by performance on word reading tests. The transcribed text follows (misspelled words followed by asterisks): The game is battelships*. I like it because I get to play with frinds* and I like ships beause* their big. Plaing* with frinds* are fun to play with them But I ushal win .

His difficulties map onto the dimensions of the simple view of writing. First, Jordan has some difficulty with transcription skills. In terms of handwriting, Jordan appears to form letters in unconventional ways. For example, he appears to start and end the lowercase o on the bottom of the line. His handwriting also impairs the reader's ability to follow because he omits spaces between words and extends letters below the line, such as the L in battelships* and the A in play on Line 2. For spelling, he appears not to have memorized the spellings of frequent but irregular words such as friends (written frinds* ) and has an incomplete understanding of the “drop the E” convention that results in plaing* for playing (he overgeneralizes and drops the final Y ).

These difficulties appear to strain his working memory, as the simple view predicts. Jordan spells because in two different ways—one of them correct. So, he knows the correct spelling of because . His handwriting also appears to degrade as he writes (the third line has many more letters below the line than the first). These transcription difficulties indicate difficulty balancing transcription accuracy with the expression of ideas that requires strong executive function. Overall, he may be struggling with transcription simply because transcription is hard and also because the need to focus on other aspects of writing taxes his executive control. He has difficulty remembering the spoken word he intends to write (suggesting challenges retaining information in the phonological loop) or has difficulty retaining his visual representations of the letters (perhaps difficulty within the visuospatial sketchpad) in the face of other demands.

Turning to the other base of the simple view, the content of Jordan's paragraph suggests difficulty with executive function. The content of the paragraph is quite limited: He repeats his primary reason for enjoying Battleship (“I get to play with friends,” and “Playing with friends are fun to play with them”). Perhaps, these ideas are subtly different (first, the game is an excuse to spend time with friends, and second, he enjoys the gameplay), or he may simply have repeated himself. Either way, this confusion suggests he probably wrote his ideas as he thought of them, rather than creating an organizer first. In addition, the sentence “Playing with friends are fun to play with them” also has a circular logic that suggests he did not monitor his writing as he went.

On the basis of the simple view of writing model, it is likely that Jordan's difficulties with transcription skills and executive function skills are linked, due to constraints of working memory. Because Jordan has difficulty with transcription skills, more working memory resources are allocated to those tasks when he is transcribing his sentences. This decreases the available working memory capacity for holding ideas and organizational plans in memory while writing (even at the sentence level), leading to incoherence. Conversely, Jordan's lack of executive function skills for goal setting and planning (e.g., making a list of ideas before writing) places a burden on working memory resources, leaving fewer resources available for monitoring spelling and conventions.

In addition to the interrelationships among the difficulties with writing skills, Jordan's difficulties can also be shown to be related to his reading disability (i.e., dyslexia). We will explore these connections later, but we first provide theory and research evidence for why dyslexia and writing difficulties co-occur. Then, we will return to Jordan's case study based on the research evidence.

Theory and Research Evidence Linking Dyslexia and Poor Writing Skills

Data indicate that there is a strong relationship between dyslexia and writing difficulty, and we explore these data within the simple view. First, we focus on transcription, particularly spelling and handwriting. We then follow this up with a discussion of relationships between dyslexia and writing in both executive function and working memory skills.

Spelling Skills and Dyslexia

Spelling and reading involve reciprocal parts of one task—connecting letters and sounds. As a result, people with dyslexia often exhibit similar levels of spelling difficulty ( Scarborough, 1998 ), and children with dyslexia often show spelling difficulty into adolescence ( Ehri, 1997 ). The source of difficulty is in phonological processing ( Ramus & Szenkovits, 2009 ). People with dyslexia show impairment in the ability to encode, retain, and access phonological information. This makes it difficult to read unknown words (decode them): Readers must produce a grapheme for each phoneme, retain each in memory, combine them into a single pronunciation, and connect this pronunciation with a word in memory ( Kearns, Rogers, Koriakin, & Al Ghanem, 2016 ). Spelling unknown words (encoding) requires a complementary process, listening to an unknown spoken word, breaking it into phonemes, selecting the appropriate grapheme for the phoneme, repeating this process for each phoneme, and then checking the result to make sure it looks like a real word (see Figure 3 for an example of the reciprocal processes). For this reason, children's spelling abilities predict their later reading abilities ( Ouellette & Sénéchal, 2017 )

A representation of the difference between decoding (pronouncing written words by linking graphemes to phonemes and combining them) and encoding (writing spoken words by parsing the words into graphemes and writing each using knowledge of grapheme–phoneme correspondences and spelling conventions). In the spellings, the good reader has overapplied the spelling convention that ay is the spelling of /eɪ/ at the end of a word. If the written word looks incorrect, the spelling might be adjusted to writing the letters and adjusting the spelling as needed afterward. The good reader might realize that staiers looks incorrect and rewrite it correctly. Problems with encoding are particularly pronounced in people with dyslexia because encoding requires the ability to process the sound information correctly and represent it on the page. The reader with dyslexia in Figure 3 does not include the T —probably because of difficulty processing sound information.

Because reading and spelling skills both require phonological skills, spelling and phonological skills are strongly linked ( Furnes & Samuelsson, 2010 ). People with dyslexia are likely to make spelling errors that indicate some sounds were not adequately processed ( Bruck, 1993 ; Cassar, Treiman, Moats, Pollo, & Kessler, 2005 ; Pennington et al., 1986 ). For example, a child with dyslexia might spell jump as jup * or blind as blid * ( Bourassa, Treiman, & Kessler, 2006 )—suggesting that the child did not distinguish the two bilabial sounds (/m/ and /p/) in jump or the alveolar ones (/n/ and /d/) in blind . It also appears that people with dyslexia use different sources of information to spell words than their peers with typical achievement. College students with dyslexia appear to rely on words' meaningful parts (morphemes) to support their spelling ( Bourassa et al., 2006 )—more so than their typical peers ( Bruck, 1993 ; Frith, 1978 ). It is also noteworthy that spelling difficulty continues to be associated with word reading difficulty into the upper elementary and middle school grades. Studies generally suggest that the link between word reading skills and reading comprehension declines as children age, but the association with spelling remains very strong ( Badian, 1999 ).

People do not always spell using encoding. Eventually, they develop a representation of the word in which the letters, sounds, and meanings are very tightly connected ( Ehri, 2005 ). When that happens, spelling a word does not really involve encoding. The person simply remembers which letters to use and writes them. In many cases, people may use encoding and memory together. For example, Jordan's misspelling of because —after spelling it correctly earlier in the writing sample—probably suggests that he has much of the word memorized. The ause part is pronounced /ʌz/ so the correct pronunciation of that must be from memory. Missing the C probably indicates he failed to use encoding for that part.

Part of the challenge for children like Jordan is that English has a remarkably complex orthographic (letter) system. English has just 26 letters but about 40 phonemes, so some sounds must be spelled with multiple letters (e.g., /ʧ/ spelled with CH ). In addition, sounds sometimes have multiple spellings (e.g., /ʧ/ spelled with TCH as in batch ). However, the system has many “exemplary regularities” ( Perfetti, 1992 , p. 18) and helpful spelling conventions (a selection is given in Table 2 ). Jordan's writing suggests that he does not have a firm grasp on these. For example, battelship* should have LE instead of EL at the end of battle , a convention for spelling /əl/ or /l̩/ at the end of words, one used in more than 4,000 English words readers might encounter in first through eighth grades (analysis based on data from Fitt, 2001 , and Zeno, Ivens, Millard, & Duvvuri, 1995 ). He used plaing* for playing (but spelled play correct), potentially indicating that he has partial understanding of the convention to drop the E at the end of a word before adding a suffix beginning with a vowel (e.g., place to placing ). The good news is that children like Jordan can improve their spelling and reading by learning about English spelling conventions (also sometimes called patterns or [perhaps inaccurately] rules). 2

Examples of regular spelling patterns.

Learning to spell can also improve the quality of written compositions ( Berninger & Richards, 2010 ; Sanders, Berninger, & Abbott, 2017 ). Put differently, this means that learning to spell better results in children writing better overall. In short, the value of teaching spelling to children with dyslexia extends beyond reading into written composition.

In summary, people with dyslexia have difficulty with spelling because reading and spelling are related abilities. The errors people with dyslexia make when spelling are similar to the errors they make when reading. In addition, English spelling makes the task somewhat challenging anyway—although this does not mean children with dyslexia should be taught that English is a mess or totally confusing. There are many ways in which the system works well, and children with dyslexia can be taught to use it to improve their spelling.

Handwriting. Handwriting problems are often associated with dyslexia, although researchers and practitioners do not always consider them together (cf. Pagliarini et al., 2015 ). 3 However, children with dyslexia show persistent difficulty with handwriting ( Sumner, Connelly, & Barnett, 2016 ). As a result, it is important to consider handwriting on its own within the transcription dimension of the simple view.

Data appear to be clear that children with dyslexia experience handwriting difficulty, often showing difficulty writing quickly with correct letter formation. It is easy to conclude that these difficulties are the result of poor motor function, but studies have indicated that this may not be the case. Across all types of children—that is, when you consider a wide range of learners including those without dyslexia—there is a relationship between motor function and writing composition quality. However, this is not the case for children with dyslexia ( Graham, Berninger, Abbott, Abbott, & Whitaker, 1997 ). For example, Stanley and Watson (1980) examined the performance of children with and without dyslexia on a composition and figure drawing task. Both groups of children drew figures with similar speed and accuracy, whereas the students with dyslexia wrote more slowly and with more spelling errors. If handwriting difficulty was the result of motor problems, differences would occur in drawing and writing. This is not what the authors observed, suggesting that handwriting problems are related to spelling—not graphomotor—difficulty.

There is support for the connection between handwriting and spelling. Research on composition has found that some of the best early predictors of success have been the speed shown when writing the alphabet and coding orthographic material in spelling ( Berninger, 2004 ; Montgomery, 2008 ). To examine this further, Berninger et al. (2008) evaluated the role of non-handwriting graphomotor planning in dyslexia and showed that it did not have a significant relationship with the quality of written compositions. However, handwriting and spelling are themselves strongly linked ( Tarnopol & Feldman, 1987 ). Although the reason for this connection is not clearly established, poor letter formation may result from the working memory demand of retaining the correct phonological information in memory while producing the correct letter form. If children are focused primarily on spelling, they may struggle to simultaneously coordinate the handwriting task.

That does not mean that poor motor control should be ruled out of handwriting difficulties but instead suggests that the poor motor control exhibited by students may be the result of hesitations and lack of rhythmic movements due to uncertainty in spelling. In one study examining handwriting movements, Pagliarini et al. (2015) found that handwriting is controlled by two principles of organization: (a) isochrony , or the speed or timing of the movement in relation to the trajectory length, and (b) homothety , or the relative duration of the movement. The researchers also found that handwriting difficulties have a direct association to dyslexia and these difficulties can be characterized in terms of compliance with the rhythmic principles of writing. The dyslexic group was found to be slower in average writing speed and wrote less fluently than the typically developing group. Children who wrote less fluently turned out to read more slowly, make more errors, and have poorer receptive vocabulary. Overall, the study showed the individuals with dyslexia displayed rhythmic motor difficulties in handwriting.

To summarize, the data on handwriting suggest that handwriting difficulties may result from difficulty with spelling in children with dyslexia. Even those data indicating motor difficulties still suggest that this may result from spelling uncertainty. As a result, children with dyslexia have poor handwriting. It is possible that improved spelling will lead to improvements in handwriting, but the reverse is also true. On this basis, recent interventions for students with dyslexia have included both types of support (e.g., Berninger, Richards, & Abbott, 2015 ), and the very good news is that handwriting can be improved as the result of structured teaching focused on handwriting specifically ( Christensen, 2005 ).

Reversals . People with dyslexia appear to show a tendency to reverse letters and words when spelling ( b and d or saw and was ). This is one reason people have a fundamental misunderstanding that dyslexia is a visual processing problem ( Orton, 1925 ). It cannot be overstated: Dyslexia is not a visual processing problem. Reversals in spelling do not indicate that it is.

However, this topic is somewhat complex, and there are confusing nuances about apparent cases of reversals. Here is a brief summary of data on this point:

• Most children sometimes transpose similar letters such as b and d , and the percentage of reversals is similar between children with and without dyslexia. The reversals stand out in children with dyslexia because there are more reversals in their writing overall (although not in relative terms) and because they confirm our own biases ( Fischer, Liberman, & Shankweiler, 1978 ; Moats, 1983 ).
• When children with dyslexia perform visual tasks that do not involve letters, they perform as well as children with typical achievement. When visuals are paired with sounds, children with dyslexia mix them up ( Vellutino, Pruzek, Steger, & Meshoulam, 1973 ).
• When they reverse letters, children write the left-facing version ( b ) more often than the right-facing one ( d ). Right-facing letters are more common in English, so they may be using the more common pattern ( Treiman, Gordon, Boada, Peterson, & Pennington, 2014 ). What is important to understand is that reversals do not occur in both directions with equal frequency, so reversals are not arbitrary—as we would expect if it is a visual problem.
• Almost all people with dyslexia have phonological difficulties, but a very small minority also may have visual deficits. Some people with dyslexia do have problems with visual attention, that is, how much visual information they can process ( Goswami et al., 2002 ; Valdois, Bosse, & Tainturier, 2004 ). However, studies do not show that reversals specifically occur more in people with dyslexia.

Taken together, these data validate the idea that dyslexia is a phonological deficit, and reversals are not part of what is a visual processing deficit in some people. As a result, spelling instruction should not focus on reversals, although strategies to help children associate the correct letter with the correct sound are almost certainly important (see Intervention section).

Overall, data suggest that children with dyslexia have spelling difficulty that is strongly related to their reading difficulty. The data also indicate that the spelling problem originates in difficulty processing sound information, similar to the problem with reading. Children with dyslexia also appear to use morphemes to support their spelling. These data provide some clues about how we can provide effective spelling instruction for children with dyslexia.

Executive Function

As discussed in a recent Institute of Education Sciences report, research findings have suggested that children with dyslexia have difficulty with executive function skills, such as inhibition control and switching attention ( Zelazo et al., 2016 ). For example, Altemeier, Abbott, and Berninger (2008) found that students with dyslexia have difficulty inhibiting prepotent responses. When reading an unknown word, they often overrely on their first instinct and guess at the word before sounding out all of the letters, not inhibiting their response before confirming it is accurate. Similarly, Brooks, Berninger, and Abbott (2011) found evidence that difficulty switching attention may impact learning to read, due to momentary breakdowns in efficiency of cross-code integration of phonological and orthographic information.

According to the simple view of writing model, executive functioning in writing involves the ability to plan, organize, set goals, self-regulate, and self-monitor. Inhibition control and other executive functions are correlated with writing tasks in normally developing populations ( Hooper, Swartz, Wakely, De Kruif, & Montgomery, 2002 ), influence handwriting ( Berninger et al., 2006 ) and overall written output ( Hooper et al., 2002 ), and add unique variance to models of integrated reading–writing tasks such as notetaking and report writing ( Altemeier et al., 2008 ). Individual differences in executive function for self-regulation of the writing process may affect high-level composing and lower level transcription processes (spelling and handwriting). For example, handwriting automaticity depends on executive control to integrate the multiple processes (e.g., motor planning, orthography). Thus, for students with dyslexia, some handwriting issues may be related to poor executive function skills that contribute to poor coordination in time of phonological codes with serial finger movements in letter formation and production ( Berninger, 2009 ). Although more research needs to be conducted in the examination of the relationships among the reading, writing, and executive function skills of students with dyslexia, this work demonstrates that deficits in executive function can impact both reading and writing skills for these students.

The attention required for handwriting and other transcription skills may also detract from students' ability to plan and organize text at higher levels of language. Deficiencies in these areas could be addressed by providing students with strategy instruction aimed at improving planning and organization before writing. When students plan and rehearse their ideas before writing, it mitigates the impacts transcription difficulties might have on the quality of ideas and organization of a student's text. In other words, taking notes to plan and organize ideas before writing can act as an external memory, reducing the cognitive load during the writing task ( Graham, 2018 ) and allowing students to switch their attention between writing functions more readily.

Working Memory

Some researchers include working memory within the constellation of executive functioning skills. However, in the simple view of writing, working memory is separate from executive function and is represented as a constraint for the writing task. Working memory is made of three components: central executive, phonological loop, and the visuospatial sketchpad. Each of these components is linked to specific reading and writing skills, and deficits in any working memory are likely to lead to related deficits in both. Kellogg (1996) explored the heavy demands placed on working memory by writing tasks and how each of the components is used to support different components of the writing task.

Because dyslexia is primarily a phonological awareness deficit, the phonological loop is the most obvious aspect of working memory that might impact both reading and writing. The phonological loop helps students hold acoustic and verbal information in memory while manipulating it, a skill that is needed for reading. Information held in phonological memory decays over time but can be refreshed through rehearsal. However, if students have difficulty representing phonological information accurately, due to a phonological awareness deficit (such as those exhibited by students with dyslexia), they may also have difficulty holding the information in memory or rehearsing it correctly. Deficits in phonological memory compound this problem, because students with poor working memory skills may not be able to hold as much phonological information in their short-term memory. This can lead to difficulties in decoding longer words when reading, or spelling longer words and writing longer sentences in writing.

Comparable with how the phonological loop is used to hold and manipulate auditory information, the visuospatial sketchpad is used to hold and manipulate visual information, such as shapes of letters, but is also important for conceptualizing organizational diagrams, visual plans, and relationships among ideas. As we have already discussed, dyslexia is primarily a phonological processing problem, not a visual processing problem. There is some evidence that students with dyslexia have difficulty remembering orthographic patterns and that this difficulty is caused by an inability to process the phonological information and link it with the visual components of the orthography (i.e., letter order). This may also be related to deficits in visuospatial memory, as students who cannot hold a sequence of letters in their visual memory may have difficulty when writing those letters during spelling and writing tasks. In addition, it may be that, due to fewer reading and writing experiences, students with dyslexia also have difficulties visualizing organizational patterns for ideas.

The central executive is a system that regulates and controls information in working memory, including how information is used in the phonological loop and visuospatial sketchpad. The central executive helps in retrieving information from long-term memory, task switching, and determining how to allocate and switch attention resources. Students with deficits in working memory may have difficulty regulating their attentional resources, such as determining how much attention to allocate for phonological loop resources when manipulating sounds and words when reading and writing, or visuospatial sketchpad resources when planning and organizing ideas for writing or reading comprehension tasks. Research shows a relationship between dyslexia and deficits in central executive. For example, Montgomery (2008) found that handwriting difficulties were frequently comorbid with attention disorders such as those found in students with attention-deficit/hyperactivity disorder.

Revisiting Jordan's Writing Difficulties Through the Dyslexia Lens

Earlier in the article, we examined Jordan's writing in relation to the simple view of writing model and showed the potential relationships among his writing skills. After exploring how writing skills and dyslexia co-occur, it is clear that some of Jordan's writing difficulties stem from his reading disability in several ways. First, Jordan is having some difficulty with transcription skills, including spelling and handwriting (refer back to Figure 2 ). The research is clear that spelling difficulties co-occur with decoding difficulties for students with dyslexia, and it may be that his handwriting difficulties are partially related to those spelling and decoding difficulties as well. Second, we illustrated that students with dyslexia often have difficulties with working memory (including the phonological loop and visuospatial sketchpad), which may be exacerbating Jordan's transcription difficulties. Because he has incomplete phonological representations for words, for example, Jordan must devote a considerable amount of working memory resources to the writing task, and any potential deficit in working memory will leave even fewer resources available for executive function tasks. Third, we illustrated that students with dyslexia often have difficulties with executive function skills, such as goal-directed behavior, planning, and organization. Jordan's difficulty with sentence level grammar and clarity show that he either (a) did not have working memory resources available to reread his writing and identify errors, (b) had difficulty rereading his own writing due to transcription difficulties and his reading disability, or (c) both. It is also probable that Jordan did not set goals or develop a plan for his writing, which may show deficits in executive function related to his dyslexia. Despite the difficulties Jordan faces in writing, there are effective interventions available to help him, and knowing the relationship between his reading and writing problems can help teachers develop an appropriate instructional plan.

Interventions to Improve the Writing Skills of Children With Dyslexia

The co-occurrence of dyslexia and writing skills leads to questions about how to approach writing for these students. As we illustrated by examining Jordan's writing, the writing difficulties faced by students with dyslexia can vary, and the difficulties in one area may be related to difficulties in other areas. In other words, stress on one part of the complex writing system can impact a student's ability to use another part of the system, impacting text generation and writing quality. Because of that, a multifaceted approach to instruction, with multiple interventions, is likely to be more effective than a single intervention.

In this section, we provide an overview of instructional strategies, organized according to components of the simple view of writing model that are addressed by the intervention (transcription or executive function). Next, we discuss the interventions in terms of whether they are aimed at (a) remediation of a skill or (b) compensation for a skill deficit. Remediation involves directly addressing a student's skill deficit in an attempt to improve the skill, whereas compensation involves providing students with strategies to reduce the cognitive demands of writing and make the writing task more manageable. The decision to focus on remediation or compensation in a particular lesson may depend on the purpose of the writing task, and teachers may sometimes include both compensation and remediation strategies within a single intervention. Table 3 classifies strategies into remediation or compensation categories.

Strategies to help children with dyslexia write better.

To identify strategies, we conducted systematic searches (see Appendix ), examined meta-analyses for studies used with students with reading and writing disabilities, and conducted forward searches to identify studies of additional strategies. When identifying and recommending strategies, we include strategies that have been shown to be effective for students with both reading and writing difficulties, who struggle with writing for a variety of reasons.

Interventions to Address Poor Transcription Skills

There are a variety of remediation and compensation strategies for transcription skills. For some skills, there are both remediation and compensation strategies that teachers can use flexibly to meet students' needs.

Strategies That Support Spelling Development

The nature of English itself gives us some hints about the kinds of instruction that may be effective for improving spelling. We located 19 studies that (a) used experimental designs that support causal inference (randomization or single-case methods) and (b) had positive effects on spelling achievement. We examined the instructional components of all the interventions and counted how often each of these components was used in those studies. Four instructional components were present in at least four studies, data that we think suggest these components may be useful parts of a spelling program for students with dyslexia. We describe each of these here (see Table 4 for a number of studies supporting each strategy).

Instructional components in studies with positive effects on spelling.

Phonics. Phonics instruction was by far the most frequent of the instructional components related to spelling achievement, the focus in eight of the 19 studies. These studies included multicomponent phonics interventions and involved teaching students to (a) recognize and pronounce grapheme–phoneme correspondences (e.g., T = /t/, also called sound-spellings) and phonograms (the spellings of rhyming parts of words like OAT = /oʊt/), (b) decode words using sound-spellings and phonograms, (c) practice pronouncing and spelling high-frequency words, and (d) practice encoding using sound-spellings and phonograms (see Figure 4 for examples of these activities). Most programs also include reading words in sentences and texts with words chosen to focus on new and review skills. In our review, there were eight studies that used these types of phonics programs and found that they positively affected spelling outcomes: Guyer, Banks, and Guyer (1993) ; Lim and Oei (2015) ; Morris et al. (2012) ; O'Shaughnessy and Swanson (2000) ; Savage, Carless, and Stuart (2003) ; Schlesinger and Gray (2017) ; Schneider, Roth, and Ennemoser (2000) ; and Vaughn et al. (2010) . Phonics instruction has been very effective in improving the reading achievement of children with dyslexia, so it is no surprise that it has a similar effect on spelling in children with dyslexia ( National Institute of Child Health and Human Development, 2000 ). Phonics instruction helps children solidify the relationships between letters and sounds and helps them to identify each sound in a word. For example, reading jump would involve providing a sound for each letter, so this would reinforce the connection between /mp/ and mp . After extensive phonics practice, readers will be unlikely to make the jump – jup* error anymore. This knowledge will almost certainly translate to spelling because spelling unknown words involves encoding the sounds to write letters, just as reading unknown words involves decoding the letters to produce sounds. Moreover, many of these phonics programs deliberately include encoding practice. There are many programs available that include most or all of these skills. Databases that provide information about programs with evidence of effectiveness come from the What Works Clearinghouse, the National Center for Intensive Intervention, and the Best Evidence Encyclopedia, among others.

Examples of activities in phonics lessons that improve reading and spelling.

Learning sound-spellings and phonograms. In effective spelling-focused programs, one important feature was instruction on sound-spellings ( Berninger, Lee, Abbott, & Breznitz, 2013 ; Darch, Kim, Johnson, & James, 2000 ; Hart, Berninger, & Abbott, 1997 ; Santoro, Coyne, & Simmons, 2006 ; Shippen, Reilly, & Dunn, 2008 ; Vadasy, Sanders, & Peyton, 2006 ). Obviously, learning sound-spellings is part of phonics instruction, but it can also support spelling even if they are not taught as part of a phonics program. Conrad (2008) even showed that practicing spelling words benefits word reading—even more than reading benefits spelling.

In addition, children with dyslexia may benefit from learning how to select spellings when there are multiple possible options. For example, /ʧ/ can be spelled with CH or TCH , if a reader would be able to read a word either way. However, they might have less luck spelling unfamiliar /ʧ/ sounds because either spelling could be correct: For example, cach* and catch both say catch . However, there is a pattern children can learn: The TCH spelling is used after a short vowel (a lax vowel sound, usually spelled with a single A , E , I , O , or U ; refer back to Table 2 for examples of this and other short-vowel patterns). The point is that some spelling patterns support spelling accuracy but would have little additional impact on reading ( Caravolas, Hulme, & Snowling, 2001 ). Learning such spelling patterns still has value because they support transcription accuracy and therefore text generation.

One way to reinforce spelling patterns is to have students complete a dictation activity. In dictation, teachers have students examine words in sound-spelling or phonogram units. Students spell the word one unit at a time. See Figure 5 for an example.

An example of a spelling dictation activity. In spelling dictation, the teacher has children systematically spell words by breaking them into phonemes and writing the associated graphemes one at a time after the teacher's cues. In this example, the teacher has a set of cards where each card represents an English phoneme (or associated phonemes, as in r -controlled vowels). The image on each card contains the target phoneme and serves as a reminder of the pronunciation. Each card contains the most common spellings of the phoneme. For /ʧ/, the card includes both CH and TCH . The spellings sometimes include devices to help with spelling, such as the blank before TCH that indicates it cannot come at the beginning of a word. In this example, the teacher reminds the children of this pattern before they write the word to support them in selecting the correct one of the two.

Analysis of the morphemes in words. The phonological challenges children with dyslexia experience can make it difficult for them to use phonological information. In some cases, even the best phonics instruction may not result in adequate word reading improvement. One way to circumvent this problem is to teach children to recognize a different kind of unit, a morpheme. Morphemes are meaningful units in words, including affixes and base words. Replacement has the prefix re- , the base word place , and the suffix -ment . The problem with morphemes is that they are less efficient than sound-spellings because fewer words can be spelled correctly using morpheme information than using sound-spellings alone. English has many more morphemes than sound-spellings. For example, there are only 70 affixes with at least 100 occurrences in English words, versus 224 for sound-spellings. However, many words have more than one morpheme ( Nagy & Anderson, 1984 ), and readers at all ability levels appear to use morphological information ( Kearns, 2015 ). In short, there are good reasons for teaching students to spell using morphemes. To that end, five studies with positive spelling effects included instruction on using morphemes to spell words ( Darch et al., 2000 ; Kirk & Gillon, 2009 ; Shippen et al., 2008 ; Vadasy et al., 2006 ; Vaughn et al., 2010 ). These programs usually involved teaching both the spelling and meaning of affixes, with a greater emphasis on their spelling and pronunciation. Another valuable activity involves teaching base-word families, emphasizing how a base word changes when one or more affixes are attached to it (e.g., happy, happier, unhappy; Archer, Gleason, & Vachon, 2003 ; O'Connor, Beach, Sanchez, Bocain, & Flynn, 2015 ).

Orthographic analysis and word memory. Three studies indicate that children's spelling improves when they are taught strategies to remember the exact spellings of words ( Berninger et al., 2013 ; Fulk, 1996 ; Hart et al., 1997 ). For example, Berninger et al. (2013) taught students two strategies to remember the written forms of words, the Photographic Leprechaun and the Proofreader's Trick. The strategies both involved visualizing a word and answering questions about its spelling. For example, in the former, a reader like Jordan would look at a word, close his eyes, and answer questions such as “What is the second to last letter?” Then, he would open his eyes to check the answer. The latter was the same except that the children spelled the word backward with their eyes closed.

It is important to note that only three studies included this kind of instruction. In addition, two of these were in studies by the same research group, and the instruction in both included other components. However, the results were positive overall, so we included this study.

Spell-check. Spell-check has been available for quite some time, although evidence of effectiveness is limited ( Morphy & Graham, 2012 ) and (similar to the caveat for keyboarding skills) the effectiveness of spell-check will likely depend on students' ability to use it. Use of spell-check is also limited to computer-based writing and assumes that students can approach a reasonable approximation for the words they want to spell and identify the correct spelling for the word when options are provided.

Strategies to Help Students Improve Handwriting

Although there are ways to compose texts that do not require handwriting, it is still one of the most prevalent forms of writing in school, and some research shows that teaching handwriting can help improve reading outcomes for students with dyslexia. In a recent meta-analysis, Santangelo and Graham (2016) found that teaching handwriting instruction can improve legibility and fluency of students' writing and lead to improvements in writing quality and length of students' writing. Many studies involved students with significant handwriting difficulties, which we have demonstrated is a common attribute of students with dyslexia. It is important to note that Santangelo and Graham found that studies involving motor instruction did not produce better handwriting skills. However, individualizing handwriting instruction and using technology were effective. We identified some of the individual handwriting strategies from studies that included students with significant reading and writing difficulties.

Multicomponent interventions. By far, the most common and effective approach to teaching handwriting to students with handwriting difficulties has been the use of individualized approaches involving multiple components (e.g., Berninger et al., 1997 ; Christensen, 2005 ; Denton, Cope, & Moser, 2006 ; Graham, Harris, & Fink, 2000 ; Jones & Christensen, 1999 ; Peterson & Nelson, 2003 ; Sovik, Arntzen, & Thygesen, 1986 ; Veena, Romate, & Bhogle, 2002 ; Weintraub, Yinon, Hirsch, & Parush, 2009 ; Zwicker & Hadwin, 2009 ). Every study identified in Santangelo and Graham's (2016) meta-analysis as using a multicomponent intervention for handwriting instruction was found to be effective. Such interventions often group letters by shared characteristics (e.g., Christensen, 2005 ; Graham et al., 2000 ) and include some combination of teacher modeling (e.g., Jones & Christensen, 1999 ), assistance to correct specific errors, use of models or tracing letters' tracks (e.g., Weintraub et al., 2009 ), specific feedback (e.g., Denton et al., 2006 ), self-feedback (e.g., circle your best letter; Graham et al., 2000 ), and practice and repetition (e.g., Peterson & Nelson, 2003 ). See Figure 6 for an example of several tasks from a multicomponent intervention developed by the Center on Accelerated Student Learning; we have provided the URL in the reference list ( Graham & Harris, n.d. ).

Examples of handwriting activities in a multicomponent lesson.

Use of models to teach handwriting. A few studies with students with disabilities suggested that the use of models is effective. Specific strategies include copying letters from models ( Berninger et al., 1997 ; Walser, 1981 ), matching letters to models ( Walser, 1981 ), or use of visual cues ( Berninger, 1987 ). Some of these strategies were shown in the multicomponent interventions but were also shown to be effective on their own.

Technology for developing handwriting skills. Using technology was also found to be effective in two studies involving students with handwriting problems ( Carrieres & Plamondon, 1994 ; Sovik et al., 1986 ). In both studies, the researchers used a digitizing tablet, and students traced letters. This approach seems promising, as technology can provide instant feedback, providing the teacher more flexibility in how practice is applied. However, we suggest incorporating the use of technology into a multicomponent intervention.

Keyboarding. There is some literature that shows the impact of using keyboarding to compensate for poor handwriting skills, but this should be approached cautiously. In a meta-analysis, Graham and Perin (2007) examined studies comparing students' writing when they were allowed to use a word processor with when they used paper and pencil. They found an effect size of 0.50, indicating that students wrote higher quality texts when typing. However, a more nuanced examination by Graham, Harris, and Hebert (2011) indicated that this is only effective for students who have experience using a word processor/keyboard and that it can underestimate the writing skills of some students if they do not have experience in typing. In these cases, teachers would want to provide instruction in keyboarding before expecting it to be an effective way to compensate for poor handwriting skills. This presents the teacher with a choice to (a) teach keyboarding skills to help students circumvent handwriting difficulties, (b) remediate handwriting skills, or (c) both.

Technology Strategies to Help Students Compensate for Both Handwriting and Spelling Difficulties

Technological developments continue to provide new ways to compensate for writing difficulties and reduce the complexity of writing. The number of these technology solutions and the pace at which they improve and change make it difficult to evaluate the efficacy of their use. Therefore, we limit our recommendations to three approaches with some research behind them that are also recommended by dyslexia experts (see Table 5 ).

Technology solutions to help students compensate for poor transcription skills.

Interventions to Address Poor Executive Function Skills

We present three interventions for improving poor executive function skills in writing: sentence combining, text structure instruction, and self-regulated strategy instruction. These interventions reduce the cognitive load for executive function tasks by breaking down complex skills into more manageable components for the beginning writers and/or incorporating compensatory strategies that help students focus on higher level skills.

Importantly, these skills also address language-related components of writing, including grammar, syntax, discourse structure, and organizational features of text. The use of these strategies compensates for the primary difficulties students with dyslexia face (e.g., spelling difficulties), allowing them to focus on higher order language skills related to text construction. Practitioners are encouraged to employ these strategies with a focus on the intersection of oral language and written expression, to emphasize language components of writing and executive function skills simultaneously.

Sentence Combining

Sentence combining has been shown through meta-analysis to be effective for improving writing skills of adolescents ( Graham & Perin, 2007 ) and elementary grade students ( Graham, McKeown, Kiuhara, & Harris, 2012 ) and has also been demonstrated to improve reading fluency skills ( Graham & Hebert, 2011 ). We include sentence combining under executive function rather than transcription skills, because the goal of instruction is to help students plan and organize ideas at the sentence level. Sentence combining is a general intervention that involves providing students with two or more simple sentences (called kernel sentences ) and teaching them to combine those kernel sentences into a single, more complex sentence, while keeping the original ideas intact. The following example illustrates how sentence combining exercise works:

Kernel Sentence 1: Jellyfish have hoods and tentacles. Kernel Sentence 2: Their tentacles are numerous. Kernel Sentence 3: Their hoods are gelatinous. Combined sentence: Jellyfish have gelatinous hoods and numerous tentacles.

As shown in the example, providing the kernel sentences for students reduces the cognitive load during sentence writing instruction by (a) eliminating the need for students to generate ideas for the sentences, (b) providing content and vocabulary for students, and (c) providing students with the spelling of complex (and not so complex) words. This allows the students to think about how the ideas are related and develop plans and goals for writing better sentences, improving executive function skills, text generation, and writing quality.

Moreover, sentence combining exercises can be utilized in a myriad of ways to focus on particular language skills and make connections between oral language and writing. The focus of the previous example was adjective use, but sentence combining exercises can be used to teach a variety of grammatical structures, including compound sentences with connectors, compound subjects, compound predicate phrases, prepositional phrases, dependent clauses with because, and adverb clauses, to name a few. A nonexhaustive set of example exercises are included in Figure 7 .

A nonexhaustive set of example exercises to illustrate how sentence combining can be used to teach and facilitate higher order language use in students' writing.

As students gain more experience and facility with sentence combining exercises composed of two or three kernel sentences, practitioners can use more complex exercises to help children develop more complex language skills related to writing. Exercises with five or more kernel sentences can be used to facilitate the use of complex elements that can be combined in multiple ways. Several sentence combining exercises might be grouped to help students connect ideas across sentences or in paragraphs. Practitioners can also develop de-combining exercises that require children to break more complex sentences into simpler ideas units. These kinds of exercises can help students develop flexibility in their language use when writing. See Figure 8 for examples of more complex sentence combining activities.

Examples of complex sentence combining exercises that can be used to teach sophisticated language use in writing within and across sentences.

For Jordan and other students with dyslexia, these exercises are critical for improving writing skills. Jordan's writing included attempts at combining multiple ideas within a single sentence but included sentence level grammar errors that show a lack of sophistication in using dependent clauses. It may be that students with dyslexia either lack skills for complex sentence writing or have difficulty utilizing these skills when they write. Either way, this deficit is likely due to difficulties with transcription skills associated with demands on working memory during writing. Sentence combining instruction is an effective approach for remediating sentence construction of students with dyslexia because it reduces the demands transcription skills have on working memory. In turn, as students with dyslexia improve their sentence construction skills, it frees up cognitive resources that can be devoted to other executive functions and transcription.

Teachers can implement sentence combining intervention at a low cost, as they can create their own sentences using content and skills from class. A valuable resource for teachers looking who would like to learn to more about sentence combining is the Teacher's Guide to Effective Sentence Writing (What Works for Special Needs Learners) , written by Bruce Saddler (2012) .

Teach Children to Self-Regulate

One of the most effective approaches to improving the writing skills of students with writing difficulties is self-regulated strategy development (SRSD). The effectiveness of SRSD has been demonstrated in meta-analyses of group-design experimental research ( Graham & Harris, 2003 ; Graham, McKeown, et al., 2012 ; Graham & Perin, 2007 ) as well as single-subject–design research ( Rogers & Graham, 2008 ). It has been shown to be effective for students with reading and writing disabilities across the full range of grade levels. Students who have dyslexia may especially benefit from SRSD, as they often have fewer opportunities to learn how to use executive functions targeted by the intervention, including self-regulation skills, goal setting, self-speech, and self-monitoring. Students are taught to use these self-regulation skills through self-instruction involving defining the problem, focusing on attention and planning, engaging in writing, error correction, coping, and self-reinforcement, for example, when students might be taught to say things such as “My goals for this persuasive essay are to include three reasons,” or when self-evaluating, they might be taught to say, “Am I following my plan?” The teacher models specific self-speech, acting as an external voice for the student, and then the student practices using the self-speech until he or she internalizes it and come up with some of his or her own self-instructions.

These self-regulation strategies are often paired with planning, organization, and revision strategies specific to writing and are taught in six stages: (a) develop background knowledge, (b) discuss it, (c) model it, (d) memorize it, (e) support it, and (f) independent performance. Some features of SRSD help to simultaneously improve and reduce the demands of executive function skills, by sequencing them in a way that chunks the writing task and makes it manageable for the writer. This allows the writer to dedicate more working memory resources to text production. For example, many SRSD strategies include a mnemonic that helps remind students of important steps for completing the writing task (see Figure 9 for examples of SRSD mnemonics). A useful web resource for educator training in SRSD is https://iris.peabody.vanderbilt.edu/module/srs/ .

Examples of self-regulated strategy development (SRSD) strategy mnemonics.

Teach Children Text Structures

Text structure instruction has been identified as an effective strategy for improving the expository reading and writing skills of students, especially those with learning disabilities ( Duke & Pearson, 2002 ; Gersten, Fuchs, Williams, & Baker, 2001 ; Roehling, Hebert, Nelson, & Bohaty, 2017 ). Hebert, Bohaty, Nelson, and Brown (2016) found that these strategies were particularly effective when writing was involved and also found larger effect sizes for students with learning disabilities. For teaching students with dyslexia writing skills, text structure instruction may be particularly beneficial because it can simplify the writing organizational choices for students, based on the structure needed for their purpose. There are five basic text structures: description, compare/contrast, sequence, cause/effect, and problem/solution.

A promising approach to teaching these text structures is the Structures Writing program, which has been shown to be specifically effective for improving the informational writing skills of students with reading and writing disabilities ( Hebert, Bohaty, Nelson, & Lambert, 2018 ; Hebert, Bohaty, Nelson, & Roehling, 2018 ). In this approach, students are provided information to write about, which reduces the cognitive load of the students by providing them with ideas, vocabulary, and spelling within an information frame (see Figure 10 for an example). This approach is designed to improve executive function skills in writing by reducing cognitive demands of transcription skills and idea generation, focusing students' attention on learning a step-by-step approach to organizing and writing information according to the text structure chosen. More information and resources for Structures Writing can be obtained by contacting the first author of the current article.

An example information frame used in the Structures Writing program to teach students how to organize and write a simple description passage.

Students with dyslexia suffer from reading difficulties that co-occur with writing difficulties for a variety of reasons. We presented one writing sample of a student with dyslexia (Jordan) to help illustrate the writing difficulties these students face as well as research on the underlying relationships. We then presented several interventions for remediating writing difficulties and/or helping students compensate for skill deficits. Although we attempted to provide a set of recommended strategies that target skills that students with dyslexia may struggle with, this list of interventions is far from complete. Meta-analytic efforts over the past 15 years have revealed a compendium of effective strategies for improving students' writing skills. These include effective strategies for teaching writing skills to adolescent writers ( Graham & Perin, 2007 ) and elementary writers ( Graham, McKeown, et al., 2012 ); strategies for using writing to improve learning outcomes ( Bangert-Drowns, Hurley, & Wilkinson, 2004 ); strategies for using writing to impact reading ( Graham & Hebert, 2011 ); strategies illustrating the impacts of writing assessment on writing outcomes ( Graham et al., 2011 ); strategies targeting specific skills, such as handwriting ( Santangelo & Graham, 2016 ), spelling ( Graham & Santangelo, 2014 ), and SRSD ( Graham & Harris, 2003 ); and strategies that have specifically been effective for students with learning disabilities ( Gillespie & Graham, 2014 ). In addition to these meta-analyses, we point the reader to two additional useful resources developed by the Institute of Education Sciences: (a) a practice guide for teaching elementary school students to be effective writers ( Graham, Bollinger, et al., 2012 ) and (b) a practice guide for teaching secondary students to write effectively ( Graham et al., 2016 ).

We also encourage educators to use a combination of interventions to address the specific writing needs of their students with dyslexia. To illustrate how a teacher might approach this, we look one more time at the writing of our case study student, Jordan. We noted that Jordan had some difficulty with transcription skills, specifically some minor handwriting and spelling issues. Jordan's handwriting difficulties would not rise to the level of referral to an occupational therapist. Therefore, we would suggest targeted handwriting instruction for specific letters, such as circular letters like o and a , along with regular distributed practice. The spelling issues might be best addressed with a combination of phonics instruction and dictated spelling instruction targeting high-frequency words, in addition to regular classroom spelling instruction. Finally, Jordan has difficulty constructing sentences and holding onto ideas. To address these issues, we might recommend incorporating sentence combining instruction to improve sentence-level writing skills as well as teaching Jordan a planning strategy to compensate for working memory challenges; SRSD instruction would be a good choice for this. In this way, Jordan's complex writing challenges are addressed using a combination of interventions targeting an array of writing skills.

Finally, use of the instructional strategies we described can improve the writing skills of students with dyslexia, making it easier for those students to express their ideas. However, instruction should not stop with improvements in basic skills alone. Practitioners must help children use their improved skills to tell stories, teach others interesting information, and share their opinions and make arguments to address issues they care about ( Graham et al., 2017 ). In this way, targeted writing (and reading) interventions will help children with dyslexia exercise the immense power of communication by the written word.

Acknowledgments

Support for this research was provided by the National Institutes of Health Grant 1R37HD090153-01A1 (awarded to Haskins Laboratory). The content herein does not represent the views of the agency.

Search Procedure

To locate articles on intervention to support spelling, we searched ERIC and PsycINFO using four keyword categories, namely, that the studies involved (a) children or adolescents, (b) dyslexia in the title or abstract, (c) spelling in the title or abstract, and (d) instruction or intervention. We initially identified 196 studies that contained the required target words. We read them to make sure that they involved instruction for people with dyslexia and related difficulties, had research designs that would allow us to state confidently that the instruction is likely to be effective, measured spelling skill, and concerned reading in English. We decided to eliminate studies of other languages because of the unique characteristics of English orthography. We also examined meta-analyses by Galuschka, Ise, Krick, and Schulte-Körne (2014) , Goodwin and Ahn (2013) , Scammacca et al. (2007) , Wanzek et al. (2013) , and Williams, Walker, Vaughn, and Wanzek (2017) . We read each article to ensure they met inclusion criteria. We then removed studies where the authors did not observe significant improvement in spelling. The result was a set of 19 articles, those reported in this article.

Funding Statement

Support for this research was provided by the National Institutes of Health Grant 1R37HD090153-01A1 (awarded to Haskins Laboratory).

1 It should be noted that the simple view of writing separates working memory from executive function, although it is more often included under the umbrella of executive function skills, along with cognitive flexibility and inhibitory control (see Zelazo, Blair, & Willoughby, 2016 ). For the purposes of this article, we also discuss working memory and executive function skills as separate, in order to situate our discussion within the simple view of writing, which provides a straightforward framework for considering the links between dyslexia and writing.

2 Some studies (e.g., Moll & Landerl, 2009 ) have shown a dissociation between reading and spelling skills because reading is more strongly associated with rapid naming than spelling. That is, good spelling does not require the processing speed required for good reading. However, it is likely that this is a greater concern in more transparent orthographies than English. Moll and Landerl's study was conducted in German, and other studies have shown that English readers process words differently from their peers in more transparent orthographies (e.g., Rau, Moll, Snowling, & Landerl, 2015 ; Torppa, Georgiou, Niemi, Lerkkanen, & Poikkeus, 2017 ). As a result, we focus on the strong association between reading and spelling but acknowledge that there may be a dissociation between reading speed and spelling as English-speaking children with dyslexia become more accurate and better able to spell.

3 Difficulty with handwriting, particularly in the absence of word recognition or language comprehension difficulty, is sometimes called dysgraphia ( Berninger et al., 2015 ; Thompson et al., 2018 ). However, researchers have not agreed on common measures for identifying this difficulty, and it is not clear whether dysgraphia includes cases where children have fine motor problems beyond handwriting. Moreover, handwriting difficulties are frequently associated with other academic difficulties, so it is difficult to separate a specific dysgraphic profile. As a result, we do not use that term here, but we acknowledge that others do.

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The intermittent fasting trend may pose risks to your heart

Intermittent fasting — when people only eat at certain times of day — has exploded in popularity in recent years. But now a surprising new study suggests that there might be reason to be cautious: It found that some intermittent fasters were more likely to die of heart disease.

The findings were presented Monday at an American Heart Association meeting in Chicago and focused on a popular version of intermittent fasting that involves eating all your meals in just eight hours or less — resulting in at least a 16-hour daily fast, commonly known as “time-restricted” eating.

The study analyzed data on the dietary habits of 20,000 adults across the United States who were followed from 2003 to 2018. They found that people who adhered to the eight-hour eating plan had a 91 percent higher risk of dying from heart disease compared to people who followed a more traditional dietary pattern of eating their food across 12 to 16 hours each day.

The scientists found that this increased risk also applied to people who were already living with a chronic disease or cancer. People with existing cardiovascular disease who followed a time-restricted eating pattern had a 66 percent higher risk of dying from heart disease or a stroke. Those who had cancer meanwhile were more likely to die of the disease if they followed a time-restricted diet compared to people with cancer who followed an eating duration of at least 16 hours a day.

The study results suggest that people who practice intermittent fasting for long periods of time, particularly those with existing heart conditions or cancer, should be “extremely cautious,” said Victor Wenze Zhong, the lead author and the chair of the department of epidemiology and biostatistics at the Shanghai Jiao Tong University School of Medicine in China.

“Based on the evidence as of now, focusing on what people eat appears to be more important than focusing on the time when they eat,” he added.

Zhong said that he and his colleagues conducted the new study because they wanted to see how eating in a narrow window each day would impact “hard endpoints” such as heart disease and mortality. He said that they were surprised by their findings.

“We had expected that long-term adoption of eight-hour time restricted eating would be associated with a lower risk of cardiovascular death and even all-cause death,” he said.

Losing lean muscle mass

The data didn’t explain why time-restricted eating increased a person’s health risks. But the researchers did find that people who followed a 16:8 time-restricted eating pattern, where they eat during an eight-hour window and fast for 16, had less lean muscle mass compared to people who ate throughout longer periods of the day. That lines up with a previous clinical trial published in JAMA Internal Medicine , which found that people assigned to follow a time-restricted diet for three months lost more muscle than a control group that was not assigned to do intermittent fasting.

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Holding onto muscle as you age is important. It protects you against falls and disability and can boost your metabolic health. Studies have found that having low muscle mass is linked to higher mortality rates, including a higher risk of dying from heart disease, said Zhong.

He stressed that the findings were not definitive. The study uncovered a correlation between time-restricted eating and increased mortality, but it could not show cause and effect. It’s possible for example that people who restricted their food intake to an eight-hour daily window had other habits or risk factors that might explain their increased likelihood of dying from heart disease. The scientists also noted that the study relied on self-reported dietary information. It’s also possible that the participants did not always accurately report their eating durations.

A trendy form of dieting and weight control

Intermittent fasting has been widely touted by celebrities and health experts who say it produces weight loss and a variety of health benefits. Another form of intermittent fasting involves alternating fasting days with days of eating normally. Some people follow the 5:2 diet, in which they eat normally for five days a week and then fast for two days.

But time-restricted eating is generally considered the easiest form of intermittent fasting for people to follow because it doesn’t require full-day fasts. It also typically doesn’t involve excessive food restriction. Adherents often eat or drink whatever they want during the eight-hour eating period — the only rule is that they don’t eat at other times of day.

Some of the earliest studies on time-restricted eating found that it helped prevent mice from developing obesity and metabolic syndrome. These were followed by mostly small clinical trials in humans, some of which showed that time-restricted eating helped people lose weight and improve their blood pressure , blood sugar and cholesterol levels. These studies were largely short-term, typically lasting one to three months, and in some cases showed no benefit .

One of the most rigorous studies of time-restricted eating was published in the New England Journal of Medicine in 2022. It found that people with obesity who were assigned to follow a low-calorie diet and instructed to eat only between the hours of 8 a.m. and 4 p.m. daily lost no more weight than people who ate the same number of calories throughout the day with no restrictions on when they could eat. The two diets had similar effects on blood pressure, blood sugar, cholesterol, and other metabolic markers.

The findings suggest that any benefits of time-restricted eating likely result from eating fewer calories.

More questions about intermittent fasting

Christopher Gardner, the director of nutrition studies at the Stanford Prevention Research Center, said he encouraged people to approach the new study with “healthy skepticism.” He said that while the findings were interesting, he wants to see all the data, including potential demographic differences in the study subjects.

“Did they all have the same level of disposable income and the same level of stress,” he said. “Or is it that the people who ate less than eight hours a day worked three jobs, had very high stress, and didn’t have time to eat?”

Gardner said that studying intermittent fasting can be challenging because there are so many variations of it, and determining its impact on longevity requires closely following people for long periods of time.

But he said that so far, the evidence supporting intermittent fasting for weight loss and other outcomes is mixed at best, with some studies showing short-term benefits and others showing no benefit at all. “I don’t think the data are very strong for intermittent fasting,” he added. “One of the challenges in nutrition is that just because something works really well for a few people doesn’t mean it’s going to work for everyone.”

He said that his biggest complaint with intermittent fasting is that it doesn’t address diet quality. “It doesn’t say anything about choosing poorly when you’re eating,” he said. “What if I have an eight-hour eating window but I’m eating Pop Tarts and Cheetos and drinking Coke in that window? I’m not a fan of that long term. I think that’s potentially problematic.”

Do you have a question about healthy eating? Email [email protected] and we may answer your question in a future column.

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By Ben Protess ,  Maggie Haberman and Kate Christobek

Donald J. Trump’s lawyers disclosed on Monday that he had failed to secure a roughly half-billion dollar bond in his civil fraud case in New York, raising the prospect that the state could seek to freeze some of his bank accounts and seize some of his marquee properties.

The court filing, coming one week before the bond is due, suggested that the former president might soon face a financial crisis unless an appeals court comes to his rescue.

Mr. Trump has asked the appeals court to pause the $454 million judgment that a New York judge imposed on Mr. Trump in the fraud case last month, or accept a bond of only $100 million. Otherwise, the New York attorney general’s office, which brought the case, might soon move to collect from Mr. Trump.

Still, even if the higher court rejects his appeal, Mr. Trump is not entirely out of options . He might appeal to the state’s highest court, quickly sell an asset or seek help from a wealthy supporter.

Mr. Trump’s team has also left the door open to exploring a bankruptcy for corporate entities implicated in the case, according to people with knowledge of the discussions. That option, however, is politically fraught during a presidential race in which he is the presumptive Republican nominee, and for now it appears unlikely.

The judge in the civil fraud case, Arthur F. Engoron , levied the $454 million penalty and other punishments after concluding that Mr. Trump had fraudulently inflated his net worth to obtain favorable loans and other benefits. The case, brought by the New York attorney general, Letitia James, has posed a grave financial threat to Mr. Trump.

The former president has been unable to secure the full bond, his lawyers said in the court filing on Monday, calling it a “practical impossibility” despite “diligent efforts.” Those efforts included approaching about 30 companies that provide appeal bonds, and yet, the lawyers said, he has encountered “insurmountable difficulties.”

The company providing the bond would essentially promise to cover Mr. Trump’s judgment if he lost an appeal and failed to pay. In exchange, he would pledge cash and other liquid assets as collateral, and he would pay the company a fee as high as $20 million.

But Mr. Trump does not have enough liquidity to obtain the bond. The company would require Mr. Trump to pledge more than $550 million in cash and securities as collateral — a sum he simply does not have.

Although the former president boasts of his billions, his net worth is derived largely from the value of his real estate, which bond companies rarely accept as collateral. Mr. Trump has more than $350 million in cash , a recent New York Times analysis found, far short of what he needs.

He might have to post an appeal bond worth more than $454 million — possibly above $500 million, to reflect the interest he will owe — in order to prevent Ms. James from seizing his assets on March 25.

Under the law, Ms. James could have moved to collect from Mr. Trump as soon as Justice Engoron ruled, but she offered a 30-day grace period, until March 25. It is unclear whether she will provide Mr. Trump extra time or if she will move swiftly to collect. Nor is it clear whether the appellate court will rule on his plea for help before the deadline.

Mr. Trump could also seek to appeal to New York’s highest court, and it is unclear whether Ms. James will hold off on the seizure while he pursues that route.

A spokeswoman for Ms. James did not immediately respond to a request for comment.

Mr. Trump has denied all wrongdoing and claimed that Ms. James and Justice Engoron, both Democrats, are out to get him.

“This is a motion to stay the unjust, unconstitutional, un-American judgment from New York Judge Arthur Engoron in a political witch hunt brought by a corrupt attorney general,” Steven Cheung, a spokesman for Mr. Trump’s campaign, said in a statement. “A bond of this size would be an abuse of the law, contradict bedrock principles of our republic, and fundamentally undermine the rule of law in New York.”

The looming deadline could not come at a worse time for Mr. Trump. He also faces four criminal indictments, including one in Manhattan that is tentatively set for trial in mid-April.

And just last week he finalized a $91.6 million bond in a defamation case he recently lost to the writer E. Jean Carroll, a costly deal that drained him of precious cash.

Mr. Trump, who obtained that bond from the insurance giant Chubb, pledged an investment account at Charles Schwab as collateral, records show. He most likely pledged more than $100 million in cash and stocks and bonds that he could sell in a hurry — investments that are now no longer available for him to use in the civil fraud case.

A nearly $500 million bond, Mr. Trump’s lawyers wrote on Monday, “is unprecedented for a private company.”

Yet Mr. Trump’s legal team “devoted a substantial amount of time, money, and effort” to finding one, according to a court filing by Alan Garten, the top lawyer at Mr. Trump’s family business.

Using four separate brokers, the lawyers approached more than two dozen companies that provide appellate bonds, including Chubb and Berkshire Hathaway, the conglomerate run for decades by Warren E. Buffett, Mr. Garten said. He added that most of the companies were either unable or unwilling to handle a bond of this size, and that none were willing to accept property as collateral.

Their best bet appeared to be Chubb, but within the past week, Chubb notified Mr. Trump’s lawyers that it, too, could not accept property as collateral.

“This presents a major obstacle,” Mr. Garten wrote.

Mr. Trump’s company has not ruled out the possibility of having the corporate entities declare bankruptcy, the people with knowledge of the discussions said. That move would automatically halt the judgment against those entities and prevent Ms. James from seizing some of the former president’s properties.

But Mr. Trump, scarred from an experience in the 1990s when some of his companies filed for bankruptcy, is likely to balk at a filing.

And even if he supported it, bankruptcy — which Mr. Trump used to describe derisively as “the b-word” — might not be a cure-all, legal experts said. Seeking court protection could trigger defaults in loans he holds, and would most likely set off litigation over whether Mr. Trump is still responsible to pay his company’s debts.

Mr. Trump’s lawyers on Monday also submitted a filing from one of his insurance brokers, Gary Giulietti, who said his team had for several weeks been “scouring the market” for a bond.

“Simply put, a bond of this size is rarely, if ever, seen,” he wrote.

Mr. Giulietti, who testified as an expert witness at the trial, also occasionally golfs and dines with Mr. Trump.

In his decision, Justice Engoron criticized his testimony, saying that in more than 20 years on the bench, he had never encountered an expert witness who “not only was a close personal friend of a party, but also had a personal financial interest in the outcome of the case.”

Ben Protess is an investigative reporter at The Times, writing about public corruption. He has been covering the various criminal investigations into former President Trump and his allies. More about Ben Protess

Maggie Haberman is a senior political correspondent reporting on the 2024 presidential campaign, down ballot races across the country and the investigations into former President Donald J. Trump. More about Maggie Haberman

The Philippines economy in 2024: Stronger for longer?

The Philippines ended 2023 on a high note, being the fastest growing economy across Southeast Asia with a growth rate of 5.6 percent—just shy of the government's target of 6.0 to 7.0 percent. 1 “National accounts,” Philippine Statistics Authority, January 31, 2024; "Philippine economic updates,” Bangko Sentral ng Pilipinas, November 16, 2023. Should projections hold, the Philippines is expected to, once again, show significant growth in 2024, demonstrating its resilience despite various global economic pressures (Exhibit 1). 2 “Economic forecast 2024,” International Monetary Fund, November 1, 2023; McKinsey analysis.

The growth in the Philippine economy in 2023 was driven by a resumption in commercial activities, public infrastructure spending, and growth in digital financial services. Most sectors grew, with transportation and storage (13 percent), construction (9 percent), and financial services (9 percent), performing the best (Exhibit 2). 3 “National accounts,” Philippine Statistics Authority, January 31, 2024. While the country's trade deficit narrowed in 2023, it remains elevated at $52 billion due to slowing global demand and geopolitical uncertainties. 4 “Highlights of the Philippine export and import statistics,” Philippine Statistics Authority, January 28, 2024. Looking ahead to 2024, the current economic forecast for the Philippines projects a GDP growth of between 5 and 6 percent.

Inflation rates are expected to temper between 3.2 and 3.6 percent in 2024 after ending 2023 at 6.0 percent, above the 2.0 to 4.0 percent target range set by the government. 5 “Nomura downgrades Philippine 2024 growth forecast,” Nomura, September 11, 2023; “IMF raises Philippine growth rate forecast,” International Monetary Fund, July 16, 2023.

For the purposes of this article, most of the statistics used for our analysis have come from a common thread of sources. These include the Central Bank of the Philippines (Bangko Sentral ng Pilipinas); the Department of Energy Philippines; the IT and Business Process Association of the Philippines (IBPAP); and the Philippines Statistics Authority.

The state of the Philippine economy across seven major sectors and themes

In the article, we explore the 2024 outlook for seven key sectors and themes, what may affect each of them in the coming year, and what could potentially unlock continued growth.

Financial services

The recovery of the financial services sector appears on track as year-on-year growth rates stabilize. 6 Philippines Statistics Authority, November 2023; McKinsey in partnership with Oxford Economics, November 2023. In 2024, this sector will likely continue to grow, though at a slower pace of about 5 percent.

Financial inclusion and digitalization are contributing to growth in this sector in 2024, even if new challenges emerge. Various factors are expected to impact this sector:

• Inclusive finance: Bangko Sentral ng Pilipinas continues to invest in financial inclusion initiatives. For example, basic deposit accounts (BDAs) reached $22 million in 2023 and banking penetration improved, with the proportion of adults with formal bank accounts increasing from 29 percent in 2019 to 56 percent in 2021. 7 “Financial inclusion dashboard: First quarter 2023,” Bangko Sentral ng Pilipinas, February 6, 2024.
• Digital adoption: Digital channels are expected to continue to grow, with data showing that 60 percent of adults who have a mobile phone and internet access have done a digital financial transaction. 8 “Financial inclusion dashboard: First quarter 2023,” Bangko Sentral ng Pilipinas, February 6, 2024. Businesses in this sector, however, will need to remain vigilant in navigating cybersecurity and fraud risks.
• Unsecured lending growth: Growth in unsecured lending is expected to continue, but at a slower pace than the past two to three years. For example, unsecured retail lending for the banking system alone grew by 27 percent annually from 2020 to 2022. 9 “Loan accounts: As of first quarter 2023,” Bangko Sentral ng Pilipinas, February 6, 2024; "Global banking pools,” McKinsey, November 2023. Businesses in this field are, however, expected to recalibrate their risk profiling models as segments with high nonperforming loans emerge.
• High interest rates: Key interest rates are expected to decline in the second half of 2024, creating more accommodating borrowing conditions that could boost wholesale and corporate loans.

Supportive frameworks have a pivotal role to play in unlocking growth in this sector to meet the ever-increasing demand from the financially underserved. For example, financial literacy programs and easier-to-access accounts—such as BDAs—are some measures that can help widen market access to financial services. Continued efforts are being made to build an open finance framework that could serve the needs of the unbanked population, as well as a unified credit scoring mechanism to increase the ability of historically under-financed segments, such as small and medium-sized enterprises (SMEs), to access formal credit. 10 “BSP launches credit scoring model,” Bangko Sentral ng Pilipinas, April 26, 2023.

Energy and Power

The outlook for the energy sector seems positive, with the potential to grow by 7 percent in 2024 as the country focuses on renewable energy generation. 11 McKinsey analysis based on input from industry experts. Currently, stakeholders are focused on increasing energy security, particularly on importing liquefied natural gas (LNG) to meet power plants’ requirements as production in one of the country’s main sources of natural gas, the Malampaya gas field, declines. 12 Myrna M. Velasco, “Malampaya gas field prod’n declines steeply in 2021,” Manila Bulletin , July 9, 2022. High global inflation and the fact that the Philippines is a net fuel importer are impacting electricity prices and the build-out of planned renewable energy projects. Recent regulatory moves to remove foreign ownership limits on exploration, development, and utilization of renewable energy resources could possibly accelerate growth in the country’s energy and power sector. 13 “RA 11659,” Department of Energy Philippines, June 8, 2023.

Gas, renewables, and transmission are potential growth drivers for the sector. Upgrading power grids so that they become more flexible and better able to cope with the intermittent electricity supply that comes with renewables will be critical as the sector pivots toward renewable energy. A recent coal moratorium may position natural gas as a transition fuel—this could stimulate exploration and production investments for new, indigenous natural gas fields, gas pipeline infrastructure, and LNG import terminal projects. 14 Philippine energy plan 2020–2040, Department of Energy Philippines, June 10, 2022; Power development plan 2020–2040 , Department of Energy Philippines, 2021. The increasing momentum of green energy auctions could facilitate the development of renewables at scale, as the country targets 35 percent share of renewables by 2030. 15 Power development plan 2020–2040 , 2022.

Growth in the healthcare industry may slow to 2.8 percent in 2024, while pharmaceuticals manufacturing is expected to rebound with 5.2 percent growth in 2024. 16 McKinsey analysis in partnership with Oxford Economics.

Healthcare demand could grow, although the quality of care may be strained as the health worker shortage is projected to increase over the next five years. 17 McKinsey analysis. The supply-and-demand gap in nursing alone is forecast to reach a shortage of approximately 90,000 nurses by 2028. 18 McKinsey analysis. Another compounding factor straining healthcare is the higher than anticipated benefit utilization and rising healthcare costs, which, while helping to meet people's healthcare budgets, may continue to drive down profitability for health insurers.

Meanwhile, pharmaceutical companies are feeling varying effects of people becoming increasingly health conscious. Consumers are using more over the counter (OTC) medication and placing more beneficial value on organic health products, such as vitamins and supplements made from natural ingredients, which could impact demand for prescription drugs. 19 “Consumer health in the Philippines 2023,” Euromonitor, October 2023.

Businesses operating in this field may end up benefiting from universal healthcare policies. If initiatives are implemented that integrate healthcare systems, rationalize copayments, attract and retain talent, and incentivize investments, they could potentially help to strengthen healthcare provision and quality.

Businesses may also need to navigate an increasingly complex landscape of diverse health needs, digitization, and price controls. Digital and data transformations are being seen to facilitate improvements in healthcare delivery and access, with leading digital health apps getting more than one million downloads. 20 Google Play Store, September 27, 2023. Digitization may create an opportunity to develop healthcare ecosystems that unify touchpoints along the patient journey and provide offline-to-online care, as well as potentially realizing cost efficiencies.

Consumer and retail

Growth in the retail and wholesale trade and consumer goods sectors is projected to remain stable in 2024, at 4 percent and 5 percent, respectively.

Inflation, however, continues to put consumers under pressure. While inflation rates may fall—predicted to reach 4 percent in 2024—commodity prices may still remain elevated in the near term, a top concern for Filipinos. 21 “IMF raises Philippine growth forecast,” July 26, 2023; “Nomura downgrades Philippines 2024 growth forecast,” September 11, 2023. In response to challenging economic conditions, 92 percent of consumers have changed their shopping behaviors, and approximately 50 percent indicate that they are switching brands or retail providers in seek of promotions and better prices. 22 “Philippines consumer pulse survey, 2023,” McKinsey, November 2023.

Online shopping has become entrenched in Filipino consumers, as they find that they get access to a wider range of products, can compare prices more easily, and can shop with more convenience. For example, a McKinsey Philippines consumer sentiment survey in 2023 found that 80 percent of respondents, on average, use online and omnichannel to purchase footwear, toys, baby supplies, apparel, and accessories. To capture the opportunity that this shift in Filipino consumer preferences brings and to unlock growth in this sector, retail organizations could turn to omnichannel strategies to seamlessly integrate online and offline channels. Businesses may need to explore investments that increase resilience across the supply chain, alongside researching and developing new products that serve emerging consumer preferences, such as that for natural ingredients and sustainable sources.

Manufacturing

Manufacturing is a key contributor to the Philippine economy, contributing approximately 19 percent of GDP in 2022, employing about 7 percent of the country’s labor force, and growing in line with GDP at approximately 6 percent between 2023 and 2024. 23 McKinsey analysis based on input from industry experts.

Some changes could be seen in 2024 that might affect the sector moving forward. The focus toward building resilient supply chains and increasing self-sufficiency is growing. The Philippines also is likely to benefit from increasing regional trade, as well as the emerging trend of nearshoring or onshoring as countries seek to make their supply chains more resilient. With semiconductors driving approximately 45 percent of Philippine exports, the transfer of knowledge and technology, as well as the development of STEM capabilities, could help attract investments into the sector and increase the relevance of the country as a manufacturing hub. 24 McKinsey analysis based on input from industry experts.

To secure growth, public and private sector support could bolster investments in R&D and upskill the labor force. In addition, strategies to attract investment may be integral to the further development of supply chain infrastructure and manufacturing bases. Government programs to enable digital transformation and R&D, along with a strategic approach to upskilling the labor force, could help boost industry innovation in line with Industry 4.0 demand. 25 Industry 4.0 is also referred to as the Fourth Industrial Revolution. Priority products to which manufacturing industries could pivot include more complex, higher value chain electronic components in the semiconductor segment; generic OTC drugs and nature-based pharmaceuticals in the pharmaceutical sector; and, for green industries, products such as EVs, batteries, solar panels, and biomass production.

Information technology business process outsourcing

The information technology business process outsourcing (IT-BPO) sector is on track to reach its long-term targets, with $38 billion in forecast revenues in 2024. 26 Khriscielle Yalao, “WHF flexibility key to achieving growth targets—IBPAP,” Manila Bulletin , January 23, 2024. Emerging innovations in service delivery and work models are being observed, which could drive further growth in the sector.

The industry continues to outperform headcount and revenue targets, shaping its position as a country leader for employment and services. 27 McKinsey analysis based in input from industry experts. Demand from global companies for offshoring is expected to increase, due to cost containment strategies and preference for Philippine IT-BPO providers. New work setups continue to emerge, ranging from remote-first to office-first, which could translate to potential net benefits. These include a 10 to 30 percent increase in employee retention; a three- to four-hour reduction in commute times; an increase in enabled talent of 350,000; and a potential reduction in greenhouse gas emissions of 1.4 to 1.5 million tons of CO 2 per year. 28 McKinsey analysis based in input from industry experts. It is becoming increasingly more important that the IT-BPO sector adapts to new technologies as businesses begin to harness automation and generative AI (gen AI) to unlock productivity.

Talent and technology are clear areas where growth in this sector can be unlocked. The growing complexity of offshoring requirements necessitates building a proper talent hub to help bridge employee gaps and better match local talent to employers’ needs. Businesses in the industry could explore developing facilities and digital infrastructure to enable industry expansion outside the metros, especially in future “digital cities” nationwide. Introducing new service areas could capture latent demand from existing clients with evolving needs as well as unserved clients. BPO centers could explore the potential of offering higher-value services by cultivating technology-focused capabilities, such as using gen AI to unlock revenue, deliver sales excellence, and reduce general administrative costs.

Sustainability

The Philippines is considered to be the fourth most vulnerable country to climate change in the world as, due to its geographic location, the country has a higher risk of exposure to natural disasters, such as rising sea levels. 29 “The Philippines has been ranked the fourth most vulnerable country to climate change,” Global Climate Risk Index, January 2021. Approximately $3.2 billion, on average, in economic loss could occur annually because of natural disasters over the next five decades, translating to up to 7 to 8 percent of the country’s nominal GDP. 30 “The Philippines has been ranked the fourth most vulnerable country to climate change,” Global Climate Risk Index, January 2021.

The Philippines could capitalize on five green growth opportunities to operate in global value chains and catalyze growth for the nation:

• Renewable energy: The country could aim to generate 50 percent of its energy from renewables by 2040, building on its high renewable energy potential and the declining cost of producing renewable energy.
• Solar photovoltaic (PV) manufacturing: More than a twofold increase in annual output from 2023 to 2030 could be achieved, enabled by lower production costs.
• Battery production: The Philippines could aim for a $1.5 billion domestic market by 2030, capitalizing on its vast nickel reserves (the second largest globally). 31 “MineSpans,” McKinsey, November 2023.
• Electric mobility: Electric vehicles could account for 15 percent of the country’s vehicle sales by 2030 (from less than 1 percent currently), driven by incentives, local distribution, and charging infrastructure. 32 McKinsey analysis based on input from industry experts.
• Nature-based solutions: The country’s largely untapped total abatement potential could reach up to 200 to 300 metric tons of CO 2 , enabled by its biodiversity and strong demand.

The Philippine economy: Three scenarios for growth

Having grown faster than other economies in Southeast Asia in 2023 to end the year with 5.6 percent growth, the Philippines can expect a similarly healthy growth outlook for 2024. Based on our analysis, there are three potential scenarios for the country’s growth. 33 McKinsey analysis in partnership with Oxford Economics.

Slower growth: The first scenario projects GDP growth of 4.8 percent if there are challenging conditions—such as declining trade and accelerated inflation—which could keep key policy rates high at about 6.5 percent and dampen private consumption, leading to slower long-term growth.

Soft landing: The second scenario projects GDP growth of 5.2 percent if inflation moderates and global conditions turn out to be largely favorable due to a stable investment environment and regional trade demand.

Accelerated growth: In the third scenario, GDP growth is projected to reach 6.1 percent if inflation slows and public policies accommodate aspects such as loosening key policy rates and offering incentive programs to boost productivity.

Focusing on factors that could unlock growth in its seven critical sectors and themes, while adapting to the macro-economic scenario that plays out, would allow the Philippines to materialize its growth potential in 2024 and take steps towards achieving longer-term, sustainable economic growth.

Jon Canto is a partner in McKinsey’s Manila office, where Frauke Renz is an associate partner, and Vicah Villanueva is a consultant.

The authors wish to thank Charlene Chua, Charlie del Rosario, Ryan delos Reyes, Debadrita Dhara, Evelyn C. Fong, Krzysztof Kwiatkowski, Frances Lee, Aaron Ong, and Liane Tan for their contributions to this article.

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