We describe findings from a series of longitudinal studies utilizing a response to intervention framework implemented over 3 years with students in Grades 6 through 8 with reading disabilities and poor reading comprehension. Students were identified based on reading comprehension scores in Grade 5 (n = 1,083) and then randomized to treatment or comparison conditions. Beginning in sixth grade, students assigned to intervention were provided treatment for 1, 2, or 3 years based on their response to instruction in each preceding year. Screening procedures, progress monitoring tools, tiers of instruction, and findings from each year of the study are reported. Additional studies investigating reading and behavioral outcomes through multi-level, growth modeling, and studies of the cognitive and neural correlates of inadequate response are also reported.

This study examined the effectiveness of a researcher-provided intervention with 4th-graders with significant reading difficulties. The intervention emphasized multi-syllable word reading, fluent reading of high frequency words and phrases, vocabulary, and comprehension. To identify the participants, 1,695 fourth grade students were screened using the Gates MacGinitie Reading Test, and those whose standard score was 85 or lower were included in the study (N=485). Participants were randomly assigned (2:1) to receive either researcher-provided intervention (n=324) or intervention provided by school personnel (business as usual, BAU) (n=161). Findings revealed no statistically significant differences between students in the researcher-provided intervention and BAU groups. Using effect sizes as an indicator of impact, students in the researcher implemented treatment generally outperformed students in the school implemented treatment (BAU). Examining growth in standard scores, both groups made significant gains in reading outcomes with standard score growth from pretest to posttest of 3 standard score points on decoding, 5 on fluency,, and 2.0 to 7 standard score points on reading comprehension measures.

We examined the effectiveness of a researcher-provided reading intervention with 484 fourth graders with significant reading difficulties. Students were randomly assigned to one year of intervention, two years of intervention, or a business-as-usual comparison condition (BAU). Students assigned to two years of intervention demonstrated significantly greater gains in reading fluency compared to students who received one year of intervention and the BAU group. Students in both the one- and two-year groups demonstrated similar and significantly larger gains in word reading in comparison to the BAU group. There were no statistically significant differences between the three groups on standardized measures of reading comprehension. We discuss these results in the context of research with late elementary and secondary students targeting reading comprehension.

BACKGROUND AND OBJECTIVES: The Management of Myelomeningocele Study (MOMS), a randomized trial of prenatal versus postnatal repair for myelomeningocele, found that prenatal surgery resulted in reduced hindbrain herniation and need for shunt diversion at 12 months of age and better motor function at 30 months. In this study, we compared adaptive behavior and other outcomes at school age (5.9-10.3 years) between prenatal versus postnatal surgery groups. METHODS: Follow-up cohort study of 161 children enrolled in MOMS. Assessments included neuropsychological and physical evaluations. Children were evaluated at a MOMS center or at a home visit by trained blinded examiners. RESULTS: The Vineland composite score was not different between surgery groups (89.0 ± 9.6 in the prenatal group versus 87.5 ± 12.0 in the postnatal group; P = .35). Children in the prenatal group walked without orthotics or assistive devices more often (29% vs 11%; P = .06), had higher mean percentage scores on the Functional Rehabilitation Evaluation of Sensori-Neurologic Outcomes (92 ± 9 vs 85 ± 18; P < .001), lower rates of hindbrain herniation (60% vs 87%; P < .001), had fewer shunts placed for hydrocephalus (49% vs 85%; P < .001) and, among those with shunts, fewer shunt revisions (47% vs 70%; P = .02) than those in the postnatal group. Parents of children repaired prenatally reported higher mean quality of life z scores (0.15 ± 0.67 vs 0.11 ± 0.73; P = .008) and lower mean family impact scores (32.5 ± 7.8 vs 37.0 ± 8.9; P = .002). CONCLUSIONS: There was no significant difference between surgery groups in overall adaptive behavior. Long-term benefits of prenatal surgery included improved mobility and independent functioning and fewer surgeries for shunt placement and revision, with no strong evidence of improved cognitive functioning.

The Management of Myelomeningocele Study (MOMS), a randomized trial of prenatal versus postnatal repair for myelomeningocele, found that prenatal surgery resulted in reduced hindbrain herniation and need for shunt diversion at 12 months of age and better motor function at 30 months. In this study, we compared adaptive behavior and other outcomes at school age (5.9-10.3 years) between prenatal versus postnatal surgery groups. Follow-up cohort study of 161 children enrolled in MOMS. Assessments included neuropsychological and physical evaluations. Children were evaluated at a MOMS center or at a home visit by trained blinded examiners. The Vineland composite score was not different between surgery groups (89.0 ± 9.6 in the prenatal group versus 87.5 ± 12.0 in the postnatal group; P = .35). Children in the prenatal group walked without orthotics or assistive devices more often (29% vs 11%; P = .06), had higher mean percentage scores on the Functional Rehabilitation Evaluation of Sensori-Neurologic Outcomes (92 ± 9 vs 85 ± 18; P < .001), lower rates of hindbrain herniation (60% vs 87%; P < .001), had fewer shunts placed for hydrocephalus (49% vs 85%; P < .001) and, among those with shunts, fewer shunt revisions (47% vs 70%; P = .02) than those in the postnatal group. Parents of children repaired prenatally reported higher mean quality of life z scores (0.15 ± 0.67 vs 0.11 ± 0.73; P = .008) and lower mean family impact scores (32.5 ± 7.8 vs 37.0 ± 8.9; P = .002). There was no significant difference between surgery groups in overall adaptive behavior. Long-term benefits of prenatal surgery included improved mobility and independent functioning and fewer surgeries for shunt placement and revision, with no strong evidence of improved cognitive functioning.