The importance of cognitive functions in a response to treatment paradigm for writing
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The Importance of Cognitive Functions in a Response-to-Treatment Paradigm for Writing. Stephen R. Hooper, Lara-Jean Costa, Matthew McBee, Kathleen Anderson, Donna C. Yerby, & Sean Knuth University of North Carolina-Chapel Hill.

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The importance of cognitive functions in a response to treatment paradigm for writing

The Importance of Cognitive Functions in a Response-to-Treatment Paradigm for Writing

Stephen R. Hooper, Lara-Jean Costa, Matthew McBee, Kathleen Anderson, Donna C. Yerby, & Sean Knuth

University of North Carolina-Chapel Hill

This project was conducted with support from the Institute for Educational Science (R305H060042)


Introduction
Introduction Response-to-Treatment Paradigm for Writing

  • The cognitive origins of written language view it as a problem-solving process whereby authors attempt to produce their declarative knowledge.

  • This is more challenging for preschoolers and early elementary school children as they are just beginning to learn to write.

  • We are only beginning to develop evidence-based intervention approaches for written expression for students at-risk for such problems.


Cognitive influences in writing
Cognitive Influences in Writing Response-to-Treatment Paradigm for Writing

  • Empirical efforts have demonstrated various relationships between the development of written expression and selected cognitive abilities including:

    • Fine-Motor (e.g., Graham & Harris, 2005)

    • Executive Functions (e.g., Hooper et al., 2002)

    • Working Memory (e.g., Swanson & Berninger, 1996)

    • Linguistic skills (e.g., Berninger et al., 1992).

  • Written language subtyping efforts have demonstrated valid clusters based on cognitive abilities (e.g., Wakely et al., 2006).

  • Taken together, these findings suggest that underlying cognitive processes may strengthen or undermine a student’s ability to produce a quality written product, and implicate these cognitive factors as potential moderators in RTI paradigms.

  • Little research to date has been devoted to examining the influence of various cognitive functions on response-to-interventions in written language.


Writing skills development project
Writing Skills Development Project Response-to-Treatment Paradigm for Writing

  • Longitudinal study funded by the Institute for Educational Science to:

    • Examine the cognitive underpinnings for the development of written expression.

    • Examine the co-morbidity that is present in children at-risk for writing problems.

    • Examine the response to an evidence-based intervention for children at-risk for writing problems.


Research questions
Research Questions Response-to-Treatment Paradigm for Writing

  • Can we show improvement in the writing of at-risk writers using an evidence-based approach to writing?

  • Do specific cognitive variables have any influence on response to treatment?

  • Do selected cognitive subgroups perform differently in their response to treatment?


Participants
Participants Response-to-Treatment Paradigm for Writing

  • N = 205 students ascertained from a single school district in NC (stratified across 7 elementary schools and associated classrooms).

  • Inclusion/Exclusion criteria:

    • English-speaking

    • Participation in kindergarten

    • Bulk of education in the regular curriculum


Participants1
Participants Response-to-Treatment Paradigm for Writing

  • Chronological Age

    • First Grade = 6.54 years

    • Second Grade = 7.54 years

    • Third Grade = 8.54 years

  • Race: 75.1% Caucasian

  • Gender: 57.1% Male

  • Maternal Education: 75% with at least HS

  • IQ = 96.78 (13.09)


Participants2
Participants Response-to-Treatment Paradigm for Writing

  • First grade participants were screened with respect to their writing skills using the WIAT-II Written Expression scale.

  • This resulted in 138 students deemed at-risk for a written language disorder (i.e., < 25th percentile), and 67 students not at-risk for writing problems.

    • The not at-risk students were selected randomly at the school and classroom levels.

  • Students deemed at-risk were randomly assigned into treatment (n = 68) versus no-treatment (n = 70) conditions.


Measures
Measures Response-to-Treatment Paradigm for Writing

  • Cognitive measures included measures of language and attention/executive functions derived from confirmatory factor analysis procedures.

  • Motor

    • PAL Finger Sense Succession-Dominant Hand

    • PAL Finger Sense Succession-Nondominant Hand

  • Language

    • PAL Elision

    • PAL Letters

    • PAL Word Choice

  • Attention/Executive Functions

    • Verbal working memory

    • Visual working memory

    • WJ-III Planning

    • WJ-III Verbal Retrieval

    • Vigil Errors of Omission

    • Vigil Errors of Commission


Measures1
Measures Response-to-Treatment Paradigm for Writing

  • The WIAT-II Written Expression Subtest served as the primary outcome measure.

    • At grades 1 and 2, the Written Expression subtest consists of three tasks: timed alphabet writing, written word fluency, and sentence combining.

    • At grade 3, the student is asked to write a paragraph in accordance with a specific writing prompt.

  • The WIAT-II Spelling Subtest includes items to demonstrate knowledge of written letters, letter groups, and words.

  • The WIAT-II Written Expression Subtest was administered to the entire sample each fall, and at the beginning and ending of the treatment trial to the designated At-Risk students.


Procedures
Procedures Response-to-Treatment Paradigm for Writing

  • Comprehensive assessments were conducted in the fall of first, second, and third grade.

  • Interventions were conducted via small groups (i.e., 3 to 6 students) between January and May of the second grade.

  • Interventions comprised use of the PAL Lesson Plans #4 and #7 (Abbott & Berninger, 2003).

    • Focused on development of alphabetic principle at the subword and word levels, and aspects of text generation.

    • Manualized treatment protocol that is commercially available.

  • Conducted twice a week for 12 weeks at 25 minutes per session.

    • 94% fidelity rate for the second grade intervention.

    • 85% attended at least 75% of the sessions.


Procedures1
Procedures Response-to-Treatment Paradigm for Writing

  • Students assigned to the no treatment at-risk group and the typical group received written language instruction via the regular classroom setting in a Business-As-Usual model.

    • For these students, their instruction in written language followed a state-wide standard course of study.

    • Writing skills were immersed in daily classroom activities, with little in the way of direct instruction for written expression.


Data analyses
Data Analyses Response-to-Treatment Paradigm for Writing

  • To address the question of treatment effects, a multilevel growth model or mixed linear model was fit to the WIAT-II scores for the three groups.

    • Time was conceptualized as a continuous variable indexing grade as the time of assessment.

    • Non-treatment participants were measured at three time points. Treatment participants were measured at the same three time points with two additional administrations being conducted during second grade (pre and post treatment).


Data analyses1
Data Analyses Response-to-Treatment Paradigm for Writing

  • To examine the question pertaining to cognitive moderators, we included latent variables for fine-motor, language and attention/executive functions, and these latent variables were employed in the multilevel growth model using only the at-risk group.

    • These analyses tested the hypothesis that the treatment effect was moderated by fine-motor, attention/executive functions, and/or language.

  • To examine the question pertaining to level of function, we subdivided the groups using latent class analysis, and the derived subgroups were employed in the multilevel growth model.

    • These analyses tested the hypothesis that the treatment effect would be different for cognitive subgroups.


Question 1 findings
Question 1: Findings Response-to-Treatment Paradigm for Writing

  • All three of the groups demonstrated growth in their writing skills over time for both the linear and curvilinear trajectories.

  • When the contrasts between the three groups are examined, the treatment effect was significant only on the quadratic component of the slope (B Estimate = 1.18, p < .006).

    • The quadratic component represents an acceleration parameter, indicating that the treatment induced acceleration in the rate of writing skill acquisition for treated participants.

  • The growth rate for the treated group following treatment begins to accelerate such that by the start of third grade the growth rate for the treated group has significantly exceeded the rate for the untreated at-risk group (B Estimate = 2.79, p < .003).

  • Effect sizes were small.


Question 1 findings1
Question 1: Findings Response-to-Treatment Paradigm for Writing

  • Using curriculum-based measures for the Treatment Group, we also found evidence for significant progress in:

    • Writing Organization as determined by (A) sentence structure and (B) the T-Unit scoring for the total number of words correctly sequenced.

    • The number of varied vocabulary words used.

    • The number of words spelled correctly.

    • The total number of words written.

    • Overall holistic score


The Number of Varied Vocabulary Words Used Response-to-Treatment Paradigm for Writing


The Total Number of Words Spelled Correctly Response-to-Treatment Paradigm for Writing


The Total Number of Words Written Across Treatment Response-to-Treatment Paradigm for Writing


Question 2 findings
Question 2: Findings Response-to-Treatment Paradigm for Writing

  • When the interactions between the treatment group were examined, both the attention/executive function and language moderators approached significance.

    • There was no interaction between treatment group and fine-motor speed.

  • For language, this was seen in both the linear (B = -1.42, p < .10) and quadratic (B = -1.95, p < .06) growth curves.

  • For attention/executive functions it was noted largely for the linear growth function (B = 1.20, p < .08).

  • These findings suggest that the moderating effects of different cognitive functions cannot be ruled-out as contributors to the response-to-intervention effects.


WIAT-II Written Expression Response-to-Treatment Paradigm for Writing

Standard Scores

Assessment Time Points

Moderating Effects of EFs on Treatment

p < .08


Question 3 findings
Question 3: Findings Response-to-Treatment Paradigm for Writing

  • To construct the latent class groupings, we employed the three latent variables from our measurement model (Fine-Motor, Attention/Executive Functions, Language), and included the additional variables of WASI IQ, receptive vocabulary, phonological processing for the available 138 students.

  • Findings revealed two latent classes.

    • Specific Deficit Group (n = 90), with average probability of class membership of .93.

    • Low g Group (n = 58), with average probability of class membership of .93.


Question 3 findings1
Question 3: Findings Response-to-Treatment Paradigm for Writing

  • Based on our latent class groupings, the analysis is now based on five groups:

    • Typically Developing (TD)

    • Specific-Deficit Untreated

    • Specific-Deficit Treated

    • Low-g Untreated

    • Low-g Treated

  • Findings indicated that there was significant change over time on the WIAT-II Written Expression for all five groups.

  • When we focused on the treatment effects within the two latent classes, significant treatment effects were observed within both the Specific-Deficit and Low-g classes.

  • For the Specific-Deficit Class, the treatment significantly affects only the quadratic component of the trajectory (B = 1.28, p < .02), although the linear component of the growth trajectory approached significance in the expected direction (B = 0.73, p < .10).

    • In each instance, the students in the treatment group showed a steeper slope than the untreated students following the intervention.

  • In the Low-g Class, the treatment positively and significantly affects both the linear component (B = 1.54, p < .01) and the quadratic component (B = 2.08, p < .002).

    • The Low-g treated group showed a faster rate of gain on the WIAT-II Written Expression score following the intervention.


Conclusions
Conclusions Response-to-Treatment Paradigm for Writing

  • This study provides modest support for the PAL Lesson Plans in the treatment of young elementary school children at-risk for problems in written expression.

    • This change follows only 10 hours of intervention.

    • The rate of growth for the treatment group was superior to the other two groups following intervention.

  • This study also examined possible moderator effects on educational treatment for students at-risk for writing disorders.

    • Both language and attention/executive functions approached significance such that lower scores influenced overall performance.


Conclusions1
Conclusions Response-to-Treatment Paradigm for Writing

  • In addition to specific cognitive moderators, when latent class groupings of students were derived, a differential rate of change also was noted. These differences were seen in:

    • Students with skill deficits in writing, but showing relatively intact language and attention/executive functions.

    • Students with overall lower functioning.


Cautions and considerations
Cautions and Considerations Response-to-Treatment Paradigm for Writing

  • An RTI model and associated curriculum based measures likely are not enough for many children to succeed with treatment.

  • Variables, such as executive functions and other cognitive abilities, need to be considered and factored into the intervention paradigm.

  • These findings suggest the need for more detailed assessments of many children prior to beginning an RTI paradigm so as to facilitate the effectiveness of instruction.


Questions email address stephen hooper@cdl unc edu
Questions? Response-to-Treatment Paradigm for WritingEmail Address:[email protected]


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