Reading Comprehension Interventions for Students ...

J Autism Dev Disord (2014) 44:1303–1322 DOI 10.1007/s10803-013-1989-2

ORIGINAL PAPER

Reading Comprehension Interventions for Students with Autism Spectrum Disorders: A Synthesis of Research Farah El Zein • Michael Solis • Sharon Vaughn Lisa McCulley

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Published online: 12 November 2013 Ó Springer Science+Business Media New York 2013

Abstract The authors synthesized reading intervention studies conducted between 1980 and 2012 with K-12 students identified with autism spectrum disorders (ASD). Nine single-subject design studies, one quasi-experimental study, and two single-group design studies met the criteria for inclusion. Findings from the studies indicate that modifying instructional interventions associated with improved comprehension for students with reading difficulties may improve reading comprehension in students with ASD. Four studies implemented strategy instruction that included (a) question generation; (b) graphic organizers; and (c) making predictions. Two studies utilized anaphoric cueing instruction, three implemented explicit instruction, and three examined student grouping practices. Among the reviewed studies, the majority (n = 9) measured reading comprehension through researcher-developed probes, and two studies reported results from standardized measures. Keywords Autism spectrum disorders Reading comprehension Reading intervention Synthesis

Introduction Recent reports indicate a substantial increase in the number of students identified with autism spectrum disorder (ASD) over the last 20 years (Fombonne 2005; Kogan et al. 2009). Estimates suggest approximately 673,000 children ages

F. El Zein (&) M. Solis S. Vaughn L. McCulley The Meadows Center for Preventing Educational Risk, College of Education, The University of Texas at Austin, SZB 308 A, 1 University Station D4900, Austin, TX 78712, USA e-mail: [email protected]

3–17 (110 per 10,000) in the United States have been identified with ASD (Kogan et al. 2009). Other reports estimate that approximately 336,000 students with ASD are currently receiving services from public and private preKindergarten through 12th grade schools in the United States (Center for Disease Control and Prevention 2009). The interventions provided for students with ASD historically have focused on reducing challenging behavior and improving communication, rather than treatments designed to enhance academic performance. The science of applied behavior analysis (ABA) has provided a number of evidence-based interventions to improve challenging behavior and difficulties with communication. However, as the number of students identified with ASD continues to increase, there is a need to further investigate different means of increasing academic achievement of students with ASD. Within the area of academic achievement difficulties, previous studies have indicated that students with ASD may have unique challenges with reading comprehension (O’Connor and Hermelin 1994: O’Connor and Klein 2004), which requires further research to support the current challenges faced by educators. In particular, improving the knowledge and skills related to reading comprehension is of high importance. The current paper synthesizes reading comprehension interventions provided to students identified with ASD. Reading is a complex skill that is influenced by cognitive processes, linguistic abilities, and relevant knowledge. The acquisition of reading comprehension is an individual’s ability to learn to understand writing as well as he or she understands spoken language (Perfetti et al. 2013). There is empirical justification to support the correlations between broad reading ability and spoken language comprehension (Curtis 1980; Gernsbacher et al. 1990; Sticht and James 1984). Correlations between spoken language

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comprehension and reading ability are stronger for studies of older students and weaker with younger students. These differences are accounted for by the developmental differences with word reading skills (decoding). The seminal work by Gough and Tunmer (1986) on The Simple View of Reading outlined the underlying assumptions that reading comprehension is the combined product of word recognition (decoding) and oral language comprehension. Word recognition skills and oral language comprehension are necessary for skilled reading to occur. Weaknesses in one or both of these areas may lead to poor reading comprehension. While there is substantial empirical evidence to support the notions of The Simple View of Reading with typically developing readers and students with reading difficulties (e.g., Catts et al. 2006; San Chen and Vellutino 1997; Cutting and Scarborough 2006), few studies have investigated factors that explain differences in reading comprehension for students with ASD (Ricketts et al. 2013). A study by Nation et al. (2006) of students with ASD indicated that reading comprehension correlated with performance on word recognition and oral language tasks. While this study provided preliminary evidence in support of The Simple View of Reading for students with ASD, the results also indicated a high degree of variability across the sample of participants with some students with ASD having profiles of accurate word reading and very poor reading comprehension, profiles that are similar to students with hyperlexia. Hyperlexia is term used to describe children who show remarkably advanced word recognition skills coupled with social, cognitive, and linguistic deficits, (Grigorenko et al. 2003). Research studies of hyperlexia including case studies (e.g., Patti and Lupinetti 1993) and group studies (e.g., Grigorenko et al. 2002), demonstrate higher frequency of hyperlexia among students with the diagnosis of ASD than among those with other disorders. There is disagreement among researchers about whether hyperlexia is a subtype of ASD (Newman et al. 2007). Research also has been conducted investigating interventions for students identified with specific reading comprehension impairments. Students with specific reading comprehension difficulties can read accurately, but they have low reading comprehension. In a study of students with specific reading comprehension deficits, Clarke et al. (2010) concluded that difficulties with reading comprehension might be influenced by underlying oral-language weaknesses, which potentially could be ameliorated with appropriate interventions. Determining effective reading interventions for students with ASD is complicated. Word reading, oral language, and social factors appear to predict individual differences in reading comprehension for students with ASD (Norbury and Nation 2011; Ricketts et al. 2013). While students with ASD share some common characteristics, they also

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display wide variation in cognitive, social, and linguistic domains and a wide range of academic skills (Ghaziuddin and Mountain-Kimchi 2004; Ozonoff and Rogers 2003; Tsatsanis 2005). A consistent finding in much of the literature for many (not all) students with ASD describes a paradoxical combination of adequate word-identification skills and poor reading comprehension (Goldberg 1987; O’Connor and Hermelin 1994; Patti and Lupinetti 1993; Whitehouse and Harris 1984). This evidence suggests that many students with ASD can read accurately but have low levels of reading comprehension (Frith and Snowling 1983; Minshew et al. 1994; O’Connor and Klein 2004; Snowling and Frith 1986). The broad theoretical frameworks of reading comprehension (Perfetti et al. 2013) posit a strong correlation between linguistic ability and reading comprehension. Taking into account that a portion of diagnosis of ASD includes impairments with linguistic abilities, it is reasonable to expect these deficits may contribute to unique difficulties with reading comprehension that are different from other students with reading difficulties. Three theoretical frameworks have been proposed by the research community to help explain the specific and unique challenges students with ASD have with reading comprehension (Gately 2008). One explanation is the theory of Weak Central Coherence (WCC). According to WCC, students with ASD have difficulty summarizing salient points and understanding main ideas (Happe 2005; Williamson et al. 2009). A second explanation is the Theory of Mind (ToM) hypothesis of ASD, which states that attenuated ToM underlies the social and communication impairments that characterize ASD (e.g., Baron-Cohen 1989; Frith 1989; Leslie 1987). Specifically, ToM contributes to understanding the challenges of reading comprehension for students with ASD because often they lack understanding of the emotional state of characters in stories and have difficulty making predictions of character actions (Carnahan and Williamson 2010; Colle et al. 2008; Williamson et al. 2009). A third explanation is Executive Dysfunction Theory (EDF) (Pennington et al. 1997), which suggests that individuals with ASD may have differences in the frontal lobe activity of the brain that results in difficulties with flexibility, planning, and self-monitoring. According to Ozonoff et al. (1991), these deficits influence cognitive development, which in turn may hinder the individual’s ability to understand written text effectively. Collectively these three theories (WCC, ToM, EDF) posit difficulties by students with ASD in organizing, connecting, and monitoring the content of text conducive to successful comprehension of text. In order to comprehend text, students with ASD must be able to access prior knowledge, organize and summarize information appropriately, and be able to understand social situations within


stories and the emotions of story characters (Baron-Cohen 1989; Ozonoff et al. 1991; Williamson et al. 2009). Students with ASD are less likely than their typically developing peers to use applicable cues that would aid in making such connections effectively (O’Connor and Klein 2004). Many students with ASD have demonstrated significant difficulties with these high-level reading skills and as a result demonstrate poor reading comprehension. Evidence-based reading instruction approaches have proven to be effective for typically developing students (National Reading Panel 2002) and students with reading difficulties (e.g., Edmonds et al. 2009; Scammacca et al. 2007; Solis et al. 2012). However, the educational community is still challenged with finding targeted reading interventions to meet the needs of students who do not respond to current evidence-based practices, including students with low-incidence disabilities such as ASD (Vaughn and Fletcher 2012). Al Otaiba and Fuchs (2002) reported rates of nonresponse as high as 50 % for students identified with lowincidence disabilities including those with ASD. This paper synthesizes research studies of reading comprehension interventions provided to students with ASD. To further discern the current evidence-base of reading comprehension interventions for students with ASD, we reviewed previous syntheses of reading interventions for students with ASD (Chiang and Lin 2007; Whalon et al. 2009). Both syntheses revealed that the majority of research studies investigated sight-word comprehension, word reading, academic learning, and fluency outcomes. We were unable to identify a review that focused solely on interventions to improve reading comprehension outcomes for students with ASD. A more systematic examination is needed of the current evidence-base of interventions specifically those designed to address deficits in reading comprehension for students with ASD. To facilitate evidence-based practice in this critical area, the present synthesis provides a systematic review of research studies that examined the effects of reading comprehension interventions for students with ASD. The purpose of this synthesis is to examine findings of research studies based on a predetermined set of inclusion criteria to answer the following research question: How effective are reading comprehension interventions in improving reading comprehension outcomes for students identified with ASD?

Method Search Procedure and Study Identification A multi-step process was used to conduct a comprehensive search of intervention studies. First, electronic searches of

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the PsychINFO, ERIC, Psychology and Behavioral Sciences Collection, Medline, and ProQuest Dissertation and Theses databases were completed to locate studies in peerreviewed journals and dissertations published between 1980 and 2012. Every combination of the descriptors (autism, Asperger’s, autistic, PDD-NOS, reading instruction, reading intervention, vocabulary, reading comprehension) was used to systematically locate articles. To further ensure that all articles were located, references were gathered from the initial set of articles to identify additional articles. This preliminary search yielded 39 relevant results to be examined for possible inclusion. A total of 12 studies met the selection criteria for inclusion in this synthesis. Studies were selected based on the following criteria: 1.

2.

3.

4.

5.

The study utilized an experimental, quasi-experimental, single subject, or single group research design to evaluate the effects of a reading comprehension intervention. For experimental, quasi-experimental, and single group studies to be included, at least 50 % of its participants had to have been diagnosed with autism, Asperger’s, or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). For single subject studies to be included, at least one participant receiving the intervention had to have been diagnosed with autism, Asperger’s, or PDD-NOS. Participants were K-12 students. Studies that included college students as participants were excluded (e.g., Wahlberg and Magliano 2004). Study design must have included a dependent measure of reading comprehension. Studies that measured listening comprehension (e.g., Armstrong 2009) or word meaning comprehension independent of text reading (e.g., McGee et al. 1986) or measured solely on-task behavior or peer interaction during a reading activity (e.g., Carnahan et al. 2009) were excluded. The study was published in a peer reviewed journal or a published dissertation.

Coding Procedures An extensive code sheet was adapted from previously published syntheses (Edmonds et al. 2009; Solis et al. 2012) and was used to organize essential information based on the following study features: (a) participant characteristics; (b) dependent measures; (c) intervention components; (d) study findings; and (e) certainty of evidence. The coding sheet used a combination of forced-choice items (e.g., research design, assignment method, fidelity of implementation), open-ended items (e.g., characteristics of students or schools used to equate groups, age or grades of

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subjects as described in the text), and written description of the treatment condition. Prior to starting the coding process, two coders attended multiple training meetings in which specific categories and codes were discussed using sample studies. During the search process confusing terms were described and the inclusion and exclusion criteria were discussed at meetings until consensus was reached between the coders. A pointby-point method was used and interrater reliability was established through the use of a gold standard code sheet (Gwet 2001). To ensure that the agreed upon definitions and descriptions were followed consistently throughout the coding process, responses on the code sheets from two raters were used to calculate the percentage of agreement (i.e., agreements divided by agreements plus disagreements, multiplied by 100). Each rater independently coded an article, and the percentage of agreement was calculated, reaching an interrater reliability of 100 %. This level of agreement was reached after the two raters had coded 30 % of the articles. For the remaining 70 %, each article was independently coded and then double coded by the second rater to check for accuracy. If disagreements occurred, meetings were held to review article information and reach consensus. Data Analysis Quasi-Experimental Studies We summarized the effects of interventions from groupdesign studies by calculating effect sizes using means and standard deviations. For experimental and quasi-experimental studies, we calculated effect sizes using a formula that also accounts for pretest differences. The formula we chose to use was Hedges’s g because it is less subject to errors when used with small samples (i.e., n \ 30; Hedges and Olkin 1985). Following this formula, we calculated effect sizes by subtracting the mean pretest from the mean posttest scores and dividing the difference by the standard deviation of the control group on pretest (see http://ies.ed. gov/ncee/wwc/references). From this, we subtracted the mean posttest score of the control group minus the mean pretest score of the control group divided by the standard deviation of the control group on pretest. Single Subject Studies Single subject study results were calculated with percentage of non-overlapping data (PND). This procedure requires identifying the points of performance that are above the highest data point existing in the baseline condition. The total number of treatment sessions is divided by the number of data points above the highest baseline point,

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which identifies a PND score (Scruggs and Mastropieri 1998). The interpretation of PND scores was based on the following set of criteria: (a) more than 90 % of PND = very effective treatment, (b) 70–90 % of PND = effective treatment, (c) 50–70 % of PND = questionable treatment, and (d) less than 50 % of PND = ineffective (Scruggs and Mastropieri 1998). Percentage of non-overlapping data was calculated for all reading measures that included a line graph to display results. Other Studies For studies using pre-post single group and within-subjects designs, we calculated effect sizes by subtracting mean pretest from mean posttest scores and dividing the difference by standard deviation on pretest (Lipsey and Wilson 2001). Certainty of Evidence In order to provide an overview of the quality of evidence across the corpus of reviewed studies and to inform the interpretation of results from each study, the authors applied a certainty of evidence evaluation system utilized in previous syntheses (Schlosser and Sigafoos 2007). Certainty of evidence was classified as being conclusive, suggestive or inconclusive. Figure 1 illustrates the threestep screening process used to determine certainty of evidence for studies included in the current synthesis. First, only studies that included experimental, quasi-experimental, or single subject design could be considered as having the potential to provide conclusive evidence. Studies that that used single group or A–B single subject design were automatically classified as inconclusive due to insufficient evidence of experimental control, which precluded any conclusions regarding the impact of the intervention on the studies’ dependent measure(s). Second, studies designated as having a suggestive certainty of evidence were lacking certain features with respect to the design of the study, reliability of the dependent measures, or treatment fidelity. As part of the certainty of evidence criteria, studies identified with suggestive certainty of evidence there is limited evidence to support the notion study outcomes were the result of the intervention. Third, studies identified as conclusive certainty of evidence featured study designs associated with high levels of experimental control, the dependent variable was reliable (e.g., dependent measure operationally defined, and 20 % of sessions with 80 % or better inter-observer agreement), description of the procedure was adequate or better, and treatment fidelity was high. In the case of studies designated as conclusive, there is strong evidence to support the notion that outcomes were a result of the intervention (Millar et al. 2006).


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Opera tionally deined DV?

Adequate interobserver agreement?

YES

If YES to all

CONCLUSIVE

If NO to any

SUGGESTIVE

Thorough description of intervention?

Is experimental control established?

NO

Adequate treatment fidelity?

If NO to more than one

INCONCLUSIVE

Fig. 1 Certainty of evidence flowchart

Results Study Features A total of 12 studies between the years 1980 and 2012 met the inclusion criteria. All included studies reported the number of sessions, which ranged from one to 120 (M = 37 sessions). Ten of the 12 studies reported session duration ranging from 15 to 60 min (M = 33 min). Two dissertation studies reported the number of sessions and the period of intervention, yet did not mention the session duration (Campbell 2010; Knight 2010). The study interventions were implemented by researchers in nine studies and by teachers in three studies. We were unable to identify any studies that used experimental research design. One study utilized a quasiexperimental design (Campbell 2010). Nine studies employed single subject research designs (Flores and Ganz 2007; Ganz and Flores 2009; Kamps et al. 1989, 1994,

1995; Knight 2010; Stringfield et al. 2011; Van Riper 2010; Whalon and Hanline 2008). The other study designs utilized were within-subjects design (O’Connor and Klein 2004) and a pre- post single group research design (Asberg and Sandberg 2010). Five studies utilized predetermined criteria for selecting participants that included an ASD diagnosis (Campbell 2010; Kamps et al. 1989; Knight 2010; O’Connor and Klein 2004; Stringfield et al. 2011). Of those five studies, four included poor reading comprehension as a part of the criteria (Campbell 2010; Knight 2010; O’Connor and Klein 2004; Stringfield et al. 2011). Seven of the studies did not report use of criteria for participant selection (Asberg and Sandberg 2010; Flores and Ganz 2007; Ganz and Flores 2009; Kamps et al. 1989, 1995; Van Riper 2010; Whalon and Hanline 2008). Ten studies reported information about reading texts/ materials used in the study. Seven studies used narrative passages (Asberg and Sandberg 2010; Kamps et al. 1989,

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Table 1 Study features Study

Study design

Duration of treatment

Reading material

Person implementing

Asberg and Sandberg (2010)

Pre-intervention-postmeasurement

20–30-min sessions, 2–3 days/ week for 40 weeks

Narrative

Teachers

Campbell (2010)

Pretest posttest matched control group design

2 sessions a week for 11 weeks

Reading series from Harcourt Trophies reading language arts program

Researcher

Flores and Ganz (2007)

Multiple-baseline across behaviors

30 sessions, 20-min sessions/ participant

Not reported

Researchers

Ganz and Flores (2009)

Multiple-baseline across behaviors

17–25 sessions, 20-min sessions/ participant

Not reported

Researchers

Kamps et al. (1989)

Multiple-baseline across tasks

Training tutors: 12 sessions, 30-min sessions for 3 weeks

Student 1/Task 3: Ginn Reading Series (Narrative)

Researcher and classroom teacher

Tutoring: 20–55 sessions, 30-min sessions, 3 times a week

Student 2/Task 3: ‘‘Random House’’ from Structured Reading Program series (Narrative)

Kamps et al. (1994)

Multiple-baseline across participants with reversal

35–65 sessions, 25–30-min sessions, 3–4 days a week

Not reported

Researchers and classroom teachers

Kamps et al. (1995)

ABAB reversal design for both experiments

30–60-min sessions, 18–20 weeks

Grade-level narrative novels

Teachers and teacher assistants

Knight (2010)

Multiple-probe across participants

9–17 sessions

Expository text using Book Builder computer program based on grade-level science standards

Graduate assistant

O’Connor and Klein (2004)

Single group- within subjects design

One 60-min session

Stories adapted from Science Research Associates (SRA) series (1974); Fleish-Kincaid readability = grades 6.00–6.82

Researchers

Stringfield et al. (2011)

Multiple-baseline design across participants

42 sessions, 15-min sessions, 5 days a week

Accelerated Reading (AR) curriculum, narrative AR leveled books

Teacher

Van Riper (2010)

ABAB reversal design

24 sessions (12 sessions for each intervention), 60-min sessions, for 6 weeks

Narrative: ‘‘Bring the Classics to Life’’ chapter book

Special education teacher and teacher assistant

Whalon and Hanline (2008)

Multiple-baseline across participants

10–12 sessions, 30-min sessions

Narrative

Researchers

1995; O’Connor and Klein 2004; Stringfield et al. 2011; Van Riper 2010; Whalon and Hanline 2008), one study used expository text (Knight 2010), and one used passages from a basal reading series (Campbell 2010). The remaining three studies did not report information about reading material (Flores and Ganz 2007; Ganz and Flores 2009; Kamps et al. 1994). A summary of study features is provided in Table 1. After appraising the studies for certainty of evidence, three were found to be of conclusive evidence, five of suggestive evidence, and four of inconclusive evidence. Table 4 provides certainty of evidence results based on the predetermined set of criteria, which are shown in a checklist format. Previous research has shown that researcher-developed measures are consistently associated with larger effect sizes and may be less valid and reliable than standardized forms of assessment. In addition, researcher-developed measures are highly proximal to treatment conditions,

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which may indicate target effects (Solis et al. 2012). Among the reviewed studies, the majority (n = 9) measured reading comprehension through researcher-developed measures (Flores and Ganz 2007; Ganz and Flores 2009; Kamps et al. 1989, 1994, 1995; Knight 2010; O’Connor and Klein 2004; Stringfield et al. 2011; Whalon and Hanline 2008), and two studies measured reading comprehension through standardized measures (Asberg and Sandberg 2010; Campbell 2010). One of the studies administered both researcher-developed and standardized measures of reading comprehension to assess outcomes (Van Riper 2010). Participant Characteristics All of the studies included a total of 110 students, including 64 diagnosed with ASD and four diagnosed with both attention deficit hyperactivity disorder (ADHD) and an


intellectual disability (ID). The remaining 39 participants were typically developing peers of students with ASD. All studies included at least one participant identified with autism. Three studies included participants with Asperger’s syndrome (Asberg and Sandberg 2010; Whalon and Hanline 2008), two studies included participants with coexisting ID and ADHD (Flores and Ganz 2007; Ganz and Flores 2009), and two studies included participants with pervasive developmental disorders not otherwise specified (PDD-NOS) (Whalon and Hanline 2008). The age range of participants was 7–17.5 years and grade placement ranged from second to eighth. Participants in four of the studies were in grades 2–5 (Kamps et al. 1989, 1994, 1995; Whalon and Hanline 2008), six studies included participants from grades 6–12 (Asberg and Sandberg 2010; Flores and Ganz 2007; Ganz and Flores 2009; Knight 2010; O’Connor and Klein 2004; Van Riper 2010), and one study included participants in grades 2–7 (Campbell 2010). IQ scores of participants ranged from 42 to 125, which represents a wide range of cognitive abilities. Seven studies included one participant or more with an IQ score above 85 and at least one participant with an IQ score below 85 (Asberg and Sandberg 2010; Flores and Ganz 2007; Ganz and Flores 2009; Kamps et al. 1994, 1995; O’Connor and Klein 2004; Stringfield et al. 2011). Three studies included participants with an ASD diagnosis and IQ scores lower than 85 (Kamps et al. 1989; Knight 2010; Van Riper 2010). All participants in Whalon and Hanline’s study (2008) had IQ scores above 85. Campbell (2010) did not report information regarding the intellectual functioning of students. Five studies reported reading fluency and reading comprehension pre-intervention scores (Flores and Ganz 2007; Ganz and Flores 2009; Knight 2010; O’Connor and Klein 2004; Whalon and Hanline 2008), and three studies reported below-grade-level reading performance of participants (Campbell 2010; Stringfield et al. 2011; Van Riper 2010). Four studies did not report reading pre-intervention scores of any type (Asberg and Sandberg 2010; Kamps et al. 1989, 1994, 1995). Table 2 provides a summary of participant characteristics including gender, grade level, age, diagnosis, IQ scores, and reading pre-intervention scores. Treatment Conditions Studies reported nine treatment conditions, which included question–answer–relations (QAR), reciprocal questioning, pronoun identification, explicit instruction, directed reading thinking activity (DRTA), story map graphic organizer, peer tutoring, cooperative learning, and Book Builder computer program. Based on the description of the interventions offered by the researchers, we organized the

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following categories to describe the treatments: strategy instruction, anaphoric cueing, explicit instruction, and student grouping practices.

Strategy Instruction Four studies utilized strategy instruction interventions with students with ASD (Asberg and Sandberg 2010; Stringfield et al. 2011; Van Riper 2010; Whalon and Hanline 2008). Asberg and Sandberg (2010) examined the influence of Question–Answer–Relation (QAR) on reading comprehension performance of students with ASD ages 10–15 years. The interventionists were trained to use scaffolded instruction, a gradual release of responsibility from teacher to students (Franzen et al. 1996). Interventionists would model and scaffold strategies involved in developing questions about text and then classify the question type (i.e., ‘‘right there’’, ‘‘reflect and search’’, or ‘‘on my own’’ question). A pre-post design compared the decoding and reading comprehension performance of 12 students with ASD to a group of students without disabilities who served as a normative group. A standardized language measure, the Discourse Comprehension Test (DCT), assessed improvements in reading comprehension. A within-group comparison of pre and post scores on the DCT showed improvements in reading comprehension (ES = 0.35) after students with ASD received the QAR strategy. However, under the certainty of evidence criteria, studies with pre-post single group design such as that employed by Asberg and Sandberg (2010) were identified as inconclusive evidence. Whalon and Hanline (2008) investigated a reciprocal questioning intervention in a single-subject multiple baseline across subjects design. Participants in this study were three elementary students with ASD ages 7.5–8.7 years and nine general education peers. For the pre-baseline phase, a student with ASD and a typically developing peer took turns reading a story out loud, and the teacher reminded them to ask each other questions related to the story without providing them with any prompts or guidance related to question generation. Pre-baseline was followed by elements of a story instruction to ensure that the participants had a preliminary understanding of what setting, characters, events, problem, and solution meant. Following story elements instruction and preceding baseline, the SCORE (i.e., share, compliment, offer, recommend, and exercise) curriculum was introduced. SCORE represents the following five social skills: (a) share ideas, (b) compliment others, (c) offer help or encouragement, (d) recommend changes nicely, and (e) exercise self-control (Vernon et al. 1996). Baseline condition was the same as pre-baseline except that baseline followed story elements

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N = 12; gender not reported

N = 10; 10 males


Campbell (2010)

N = 4; 1 male, 3 females

N = 2; 2 males

N = 3; 3 males

Exp. 1: N = 1 male with ASD; 15 peers


Kamps et al. (1989)

Kamps et al. (1994)

Kamps et al. (1995)

N = 4; 3 males, 1 female

N = 20; 19 males, 1 female

N = 3, 3 males

Knight (2010)



Exp. 2: N = 2 females with ASD; 24 peers

N = 4; 1 male, 3 females


5 in the experimental group, 5 in the control group

Number and gender

Study

Table 2 Description of participants

MA = 12.5 years

Maze Fluency (Fuchs & Fuchs, 1992) P1: 3.00; P2: 2.00; P3: 4.00; P4: 3.00 MIQ = 59.5

6 participants: Asperger’s syndrome

Mean = 93.60; Range = 70–123

RIQ = 72–116

P1 = 2:6; P2 = 2:0; P3 = \ 1.0 MIQ = 83; RIQ = 70–115 P1 = 70; P2 = 71, P3 = 115

MA = 9 years

Autism

AR: 8.1–11.2

3rd and 5th grades

WIAT-2 (Reading GE)

Mean = 84.25; Range = 54–117

WJ-III (PC)

WJ-III (WLI)

SBIS: MIQ = 88.15

CogAT

4 participants: PDD-NOS

10 participants: Autism

AR = 14–17.5 MA = 15.11 years

RIQ = 53–67

P1: 55; P2: 51; P3: 72; P4: 68 Leiter R: P3 = 63; P4 = 67

AR = 11–14 years

6th, 7th, and 8th grade;

WJ- III (broad reading score)

Not reported

Not reported

SBIS: P2 = 53;

RIQ = 42–55 (Exp.2)

P2: 50; P3: between 42 and 55

P1: 101 (Exp. 1)

P1: 101; P2: 71; P3: not reported

Not reported

P1: 67; P2: 84; P3: 53; P4: 28

WJ-III (PC)

P1: 86; P2: 89; P3: 98; P4: 61

DAS-S: P1 = 55;

Autism

3 Autism

3 Autism

P2: 50

P1: 50

RIQ = 57–95

MIQ = 78.5

WJ-III (WLI)

MA = 12 years

P2: 13 years; P3: 12 years (5th grade);

P1: 8 years (3rd grade)

MA = 8.3 years

AR = 8–9 years

1 participant: 3rd grade

2 participants: 2nd grade

P2: 11 years

P1: 9 years

2 Autism

2 ID and ADHD

AR = 11–14 years

3 participants’’ 5th grade

TONI-3: P1 = 87; P2 = 75; WASI: P3 = 95; P4 = 57

P1: 53; P2: 67; P3: 28; P4: 84

2 Autism

WJ-III (PC)

RIQ = 57–95

MA = 12 years 1 participant: 6th grade

P1: 98; P2: 86; P3: 61; P4: 89

MIQ = 78.5

WJ-III (WLI)

AR = 10–14 years

TONI-3: P1 = 95; P2 = 87

2 ID and ADHD

6 participants on 1st grade reading level; 2 participants on the 2nd grade reading level; ad 2 participants were on a 3rd grade reading level

WJ-III (WLI & PC)*

Not reported

Reading scores (WI, RC)

WASI: P3 = 57; P4 = 75

2 Autism

NR

RIQ = 83–125

MIQ = 102.83

WASI

IQ scores

1 participant: 6th grade

Autism

Autism and Asberger’s syndrome

Diagnosis

3 participants’’ 5th grade

AR = 7–12 years

RA = 10–15

MA = 13 years

Grade and age

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** Words correct per minute

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* Standard scores

DIBELS (RF)**

ADHD attention deficit hyperactivity disorder, AR age range, CogAT cognitive abilities test, DAS-S Differential Ability Scale- School age, DIBELS dynamic indicators of basic early literacy, GE grade equivalence, ID intellectual disability, K-TEA Kaufman test of educational achievement, MA mean age, NR not reported, ORF oral reading fluency, P participant, PDD-NOS pervasive developmental disorder-not otherwise specified, PC passage comprehension subtest, RC reading comprehension, RF retell fluency, RI range of IQ scores, SBIS Stanford-Binet Intelligence Scale, WASI Wechsler abbreviated scales of intelligence, WI word identification, WIAT-2 Wechsler individual achievement test-2, WJ-III Woodcock Johnson III: test of achievement, WLI word and letter identification subtest

P1: 78; P2: 87; P3: 66

RIQ = 92–112 MA = 8.1 years

Elementary N = 3; 3 males


P1: 5; P2: 3; P3: 0

DIBELS (ORF)** P1: 101; P2: 112; P3: 92

MIQ = 101.7 AR = 75–8.7 years

Assessment tool NR

P1, P2, & P3 on 2nd grade reading level RIQ = 55–62 MA = 12 years

Autism; Asperger; PDD-NOS

WJ-III P1 = 62; P2 = 58; P3 = 55

MIQ = 58.3

N = 3; 3 males Van Riper (2010)

6th, 7th, and 8th grade

Autism AR = 12–14 years

IQ scores Number and gender Study

Table 2 continued

Grade and age

Diagnosis

Reading scores (WI, RC)


instruction and the researchers filled out the SCORES chart with stickers when cooperative behaviors were noticed. During the intervention phase, the researchers provided question generation instruction by ‘‘walking’’ them through the mental process. During this phase, participants used a self-monitoring checklist, story element cards, question word cards, and storyboards with Velcro as a manipulative. The researchers used scaffolding instruction to teach question generation and responding. Scaffolding procedures included modeling, verbal prompting, and corrective feedback. The dependent measure was the frequency of studentgenerated questions as well as correct responses to these questions. Questions and responses were coded as prompted or unprompted. Frequency count of unprompted question generation yielded PND scores of 92, 65, and 79 % for the three participants. Frequency count of unprompted correct responding to comprehension questions yielded PND scores of 100, 100, and 41 %. According to previously identified PND standards (Scruggs and Mastropieri 1998), one student was in the highly effective range on question generation and responding, one student was in the highly effective range on responding but in the questionable range on question generation, and the third student was in the effective range on question generation yet in the ineffective range on responding. This study was appraised at a suggestive level of evidence certainty because some procedural aspects were described ambiguously (e.g., a description of the SCORE curriculum was not provided, which prevents accurate replication of the study.) Van Riper (2010) examined the effects of DRTA on reading comprehension outcomes of students with ASD in grades 6–8 through a single-subject study with an ABAB design. The baseline phase consisted of students reading a narrative text, discussing unfamiliar words with the teacher, and answering multiple choice comprehension questions. The intervention phase consisted of scaffolded, explicit instruction of DRTA, which consists of activating background knowledge through the use of graphic organizers, clarification of unfamiliar words, making predictions, and ongoing discussions throughout reading. The Qualitative Reading Inventory- 4 (QRI-4), and a 10-question researcher-developed comprehension probe assessed reading comprehension outcomes. Researcher-developed reading comprehension check probes yielded PND score of 0 % for the three participants. A PND score of 0 % is interpreted as being in the ineffective range. This study was appraised in the inconclusive level of evidence certainty for the following reasons: (a) interobserver agreement data were not reported, (b) treatment fidelity data were not reported, and (c) very few data points were shown for several conditions (i.e., two to three data points). Stringfield et al. (2011) investigated the effects of a story map graphic organizer on the reading

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comprehension of three elementary students with ASD in a multiple baseline across participants design. Outcomes were measured with Accelerated Reading (AR) story quizzes. During the baseline phase, each participant individually read a story from the Accelerated Reader program and completed an AR quiz following every story. The AR quizzes were orally presented to the participants. During the choice condition, participants were given the opportunity to choose which story they wanted to read and were also given the choice to use the story map. In this study, the story map was a graphic organizer utilized to assist students to visually arrange story grammar elements (e.g., characters, time, place, beginning, middle, and end). Additionally, maintenance data were collected after choice condition criterion was met (i.e., 100 % on AR quizzes with or without story map). Maintenance procedures were identical to those followed during baseline except that participants were allowed to use the story map if students chose to do so. Data from this study revealed that percentage of correct responses on AR quizzes improved only after story map procedures were introduced across the three participants. All participants met criterion (i.e., three consecutive days of 80 % story map completion and 100 % on AR quizzes) during story map condition and maintained this level of performance during choice and maintenance conditions. Quizzes from AR yielded PND scores of 100, 90, and 88 % for the three participants. Percentage of non-overlapping data scores were interpreted as being in the effective to highly effective treatment ranges. This study met the criteria set for certainty of evidence evaluation and was found to be conclusive. Anaphoric Cueing Anaphoric cueing is a facilitation method that aids reading comprehension through identifying referents within text. Two studies investigated the effects of anaphoric cueing instruction on reading comprehension of students with ASD (Campbell 2010; O’Connor and Klein 2004). O’Connor and Klein (2004) investigated the effects of three different facilitation conditions (i.e., anaphoric cueing, prereading questions, and cloze completion) on reading comprehension in 20 adolescents with ASD. The researchers employed a within-subjects design to conduct their investigation. For each session, participants read five stories, one modified version for each of the conditions, and two control stories that were left unaltered. The sequence of the interventions was randomized and counterbalanced across participants (e.g., four read passage A first, four read passage B first, and so forth). In the prereading condition, the researcher asked the participants questions prior to reading the passage, and the participants

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responded verbally. During the anaphoric cueing condition, some referent words (such as pronouns) were underlined, and the participant had to identify which noun each referent stood for by circling one of the two options provided under each identified referent. During the cloze completion condition, the participants were asked to read an altered passage and fill in the blanks as they read by writing a word on each line to complete the sentence. To minimize the effect of the idiosyncratic writing abilities among participants, after each passage, the researcher asked a series of oral questions and the participants responded verbally. Participants did not have access to the text while answering the postreading questions. The possible score for each item ranged from zero to three points based on the information provided in the rubric, and the total possible score for the probe was 25 points. The repeated measures analysis of variance with post hoc calculations demonstrated that the effects of anaphoric cueing were statistically significant (ES = 1.09); whereas the effects of prereading questions (ES = 0.50) and cloze completion (ES = 0.47) were not statistically significant. The research design employed in this investigation (i.e., within-subjects) does not qualify the study to be considered conclusive. Furthermore, the authors did not report data related to treatment fidelity, and thus the study was appraised as inconclusive. Campbell (2010) investigated a pronoun identification intervention based on the hypothesis that providing anaphoric cueing for students with ASD ages 7–12 years may enhance their reading comprehension. The researchers employed a pretest–posttest matched control group design to conduct their investigation. During baseline phase, students were asked to read ten pairs of sentences, and after each pair was read, a ‘‘wh’’ question was asked. Student responses were recorded as correct or incorrect for the control and the intervention groups. During intervention, the investigator read a paragraph that explained what referents are and gave examples of identifying the correct referents for pronouns within text. After the introductory paragraph, the student read a sentence without a pronoun then followed by a sentence with an underline pronoun (i.e., written prompt), and was asked by the experimenter to identify what the pronoun referred to (i.e., verbal prompt). After the anaphoric cueing exercise, the student was asked a ‘‘wh’’ question about the two sentences, and responses were recorded as correct or incorrect. Anaphoric cueing was gradually decreased throughout the intervention until no anaphoric cues were provided by the tenth week of instruction. Two weeks after the intervention was completed, the Woodcock Johnson-Third Edition (WJ-III) achievement LetterWord Identification and Passage Comprehension subtests were administered to all participants. In addition, the


ability to identify pronouns was measured using the Grammatical Comprehension subtest of the Test of Language Development- Intermediate- Third Edition (TOLDI:3). Reading comprehension was also measured by the number of correct responses to ten ‘‘wh’’ questions presented after each reading session. Based on results from the Grammatical Comprehension subtest of the TOLD-I:3, post-intervention scores revealed no significant differences between the control and the experimental groups (ES = 0.21). The WJ-III Passage Comprehension subtest yielded a statistically significant difference between the two groups favoring the experimental group (ES = 1.78). However, the Campbell (2010) study was found to be inconclusive for the following reasons: (a) very small sample size (N = 10) for a matched control group design; (b) treatment fidelity measure data were not reported; and (c) interrater reliability data were not reported. Explicit Instruction Three studies implemented interventions based on explicit instruction to improve reading comprehension of students with ASD (Flores and Ganz 2007; Ganz and Flores 2009; Knight 2010). In both of their studies, Flores and Ganz (2007), Ganz and Flores (2009) examined the effects of specific instructional strands of a direct instruction (DI) program, Corrective Reading Thinking Basic: Comprehension Level A on the reading comprehension performance of students identified with ASD, intellectual disabilities, and ADHD in grades 5 and 6. Both studies employed single-subject multiple probe design across behaviors. Flores and Ganz (2007) used the statement inferences, using facts, and analogies instructional strands. In their 2009 study, the same authors used the picture analogies, deductions, inductions, and opposites instructional strands. In both studies, interventionists followed a set of structured procedures and behaviors outlined by the DI program. These procedures consisted of (a) directions given in a form of a script; (b) students responding in a choral fashion; (c) using an explicit signal to elicit student responding; (d) correction of inaccurate individual student responses; and (e) modeling, guiding, and providing independent practice. The baseline condition was collected prior to beginning instruction with the DI program and consisted of reading and completing strand-specific probes. Daily instruction began with one strand. Once a student reached criterion of three consecutive data points at 100 %, instruction in that strand was reduced to 2–3 sessions per week, and another strand began. Flores and Ganz (2007), Ganz and Flores (2009) used researcher-developed probes based on the skills targeted by the specific strands of the DI program. Probes were highly proximal to each instructional

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strand. Findings indicated gains by students on the researcher-developed probes for each strand. Additionally, results from both studies demonstrate maintenance of performance by students after 1 month (2007) and 6 months (2009) of not receiving intervention. In both studies, strand-specific researcher-developed probes yielded PND scores of 100 % across strands and across participants, which was interpreted as being in the highly effective treatment range based on the predetermined standards. Both Flores and Ganz (2007), Ganz and Flores (2009) studies met the criteria set for certainty of evidence evaluation and were found to be conclusive. Knight (2010) implemented a computer-based intervention along with explicit instruction and prompting techniques to students with ASD in grades 6–8 in a singlesubject multiple probe across participants design. During baseline, students read electronic texts with support resources of text to speech and illustrations. The electronic texts were created by Book Builder, a computer program designed to generate electronic text and assessment activities and allows to the addition of visuals, audio files, and other enhancements. Three different treatment conditions included (a) supported electronic text (i.e., using Book Builder text generator); (b) supported electronic text with explicit prompting; and (c) supported electronic text, explicit prompting of, and definitions for unfamiliar words. Supported electronic text included explanatory resources, illustrative resources, translations, summaries, enrichment, and instructional resources. Dependent measures were researcher-developed digital quizzes that included seven questions: three about vocabulary, three literal questions, and one application question. Digital quizzes yielded PND scores of 82, 71, 0, and 44 % for the four participants. These scores were interpreted as effective for one participant, questionable for one, and ineffective for two (Scruggs and Mastropieri 1998). This study was appraised as suggestive due to few data points collected (e.g., 2–3 data points) during some of the intervention conditions. Student Grouping Practices Three studies examined the use of different student grouping practices (e.g., cooperative learning groups and classwide peer tutoring) as a means to improve reading comprehension for students with ASD (Kamps et al. 1989, 1994, 1995). Kamps et al. (1989) investigated the effectiveness of peer tutoring with typically developing peers on the acquisition of designated academic tasks (including a reading comprehension task), for two students with ASD ages 9 and 11 years. Kamps et al. (1989) used a singlesubject multiple baseline design across tasks study. During baseline, no changes were made in the classroom instructional routines, and no instruction was provided on tasks

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selected for tutoring. During peer tutoring condition, typically developing peers provided one-on-one tutoring sessions on designated academic tasks followed by 10-min free play activities with the tutees. Peer tutoring consisted of providing task directions, modeling, and prompting. During oral reading sessions, the tutor asked the tutee to read aloud a passage, recorded the number of correct and incorrect words per minute, and asked the tutee factual recall questions related to the passage. Tutors were trained to provide positive reinforcement and corrective feedback to the tutees. Investigators collected acquisition data by recording the number of correct responses on researcherdeveloped reading comprehension probes (i.e., factual recall questions). These probes yielded PND scores of 63 and 75 % for the two participants, which were interpreted as being in the questionable range for the first participant and in the effective range for the other. Kamps et al. (1994) investigated the effects of a classwide peer tutoring (CWPT) intervention on reading skills of students with high-functioning autism ages 8–9 years and their typically developing peers. The study design was a single-subject multiple baseline across participants with a reversal. Reading comprehension outcomes were measured through a researcher-developed comprehension probe following a 2-min read aloud. The probes consisted of who, what, where, when, and why questions asked by the experimenter, and percent correct was determined after recording the number of accurate responses. Baseline consisted of teacher-directed instruction based on the usual instructional routines from the grade-level basal series. The CWPT condition consisted of peer-mediated instruction as a supplement to baseline reading instruction. Instruction during CWPT included passages read by students, feedback from peers for oral reading, correction of errors, and public posting. Following reading with feedback, the tutor asked 3 min of reading comprehension questions (who, what, when, where, why). Tutor-tutee roles were reciprocal, and thus the reading procedure was repeated in a reversed manner. Reading comprehension probes after CWPT yielded PND scores of 20, 80, and 0 % for the three participants. Results for two participants were interpreted as being in the ineffective treatment range, and one participant’s PND score was interpreted as being in the effective range. Kamps et al. (1995) examined the effects of Cooperative Learning Groups (CLGs) on reading performance of three students with ASD ages 8–13 years and their typically developing peers using single-subject reversal (ABAB) design. In two separate but similar experiments, baseline consisted of teacher-directed reading instruction in a form of whole class instruction and independent activities. During baseline, reading instruction focused on vocabulary presentation, story concepts and main idea, and

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sequencing. During CLGs in both experiments, students were assigned to perform three structured activities: (a) peer tutoring on vocabulary words; (b) practice on who, what, where, when, and why comprehension questions; and (c) an academic game on factual information from the story read. The CLG activities were supplemental to the usual teacher-led reading instruction. The second experiment was very similar to the first except for the following variations: (a) there was no direct teaching and practice of social skills, (b) students with ASD were given independent tasks during teacher lecture, and (c) a reward system based on earning points was put in place to facilitate transitions. Fifteen-item researcher-developed pre- and posttest probes were administered each week to measure reading comprehension. Most of the probe questions were factual in nature, and some inferential questions were included. During Experiment One, weekly reading comprehension probes administered after CLG yielded PND scores of 86 % for the student with ASD and 69 % for peers. During Experiment Two, similar probes yielded PND scores of 86 % for the first student with ASD, 56 % for the second, and 87 % for their peers. These scores were interpreted as being in the questionable to effective ranges during both experiments for both students with ASD and their typically developing peers. As for certainty of evidence evaluation results, the three studies (i.e., Kamps et al. 1989, 1994, 1995) were appraised as suggestive due to the absence of treatment fidelity measure. The three studies met the remaining criteria for certainty of evidence (Table 3).

Discussion We reviewed the extant research on students with ASD, specifically as it relates to the efficacy of interventions aimed at improving reading comprehension. We focused on reading comprehension for several reasons: (a) previous syntheses did not specifically address reading comprehension, (b) the number of students identified with ASD is increasing, and many of these students are being included in the general education curriculum, which indicates that teachers will require evidence-based approaches for improving these students’ understanding of text, and (c) finally, and perhaps most importantly, students with ASD (even those who read words accurately) have significant difficulties comprehending written text. Recent systematic reviews of research (i.e., synthesis, meta-analysis) on reading interventions for students with learning disabilities identified a number of potentially effective intervention approaches including main ideasummarization, strategy instruction, graphic organizers, mnemonics, explicit instruction, multi-component interventions, and self-monitoring procedures as a means to


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Table 3 Summary of interventions, measures, and outcomes Study

Intervention

Measures

Outcomes


QAR; modeling the strategies and scaffolding independent practice

Reading comprehension measure: discourse comprehension test (DCT)

Improvement in discourse comprehension after training (ES = 0.35)

Campbell (2010)

Pronoun identification instruction; fading of anaphoric cuing; positive reinforcement

Pronoun identification measure: Grammatical Comprehension subtest of the Test of Language DevelopmentIntermediate Third Ed. (TOLD-I:3)

Mixed results: Results from TOLD-I:3 showed that the intervention did not significantly improve the ability to identify pronouns (ES = 0.21), but the intervention did significantly improve passage comprehension as measured by PC subtest of WJ-III and ‘‘Wh’’ question probes (ES = 1.78)

Reading comprehension measures: Passage Comprehension Subtest of the WJ-III; number of correct responses to ‘‘Wh’’ questions presented after each reading session Flores and Ganz (2007)

Direct Instruction (DI) program, Corrective Reading Thinking Basic: Comprehension Level A

Reading comprehension measure: Researcher-developed probes based on the skills targeted in the DI program

Increased correct responding on reading comprehension probes across participants and across strands (PND* = 100 %)

Reading comprehension measure: Researcher-developed probes based on the skills targeted in the DI program

Increased correct responding on reading comprehension probes across participants and across strands (PND = 100 %)

Instructional procedures included: (1) use of script, (22) choral student responses, (3) cuing student responses, (4) correction of errors, (5) modeling, and (6) independent practice


Utilized strands: statement inferences, using facts, and analogies Direct Instruction (DI) program, Corrective Reading Thinking Basic: Comprehension Level A Instructional procedures included: (1) use of script, (22) choral student responses, (3) cuing student responses, (4) correction of errors, (5) modeling, and (6) independent practice Utilized strands: picture analogies, deductions, inductions, and opposites

Kamps et al. (1989)

Peer tutoring with typically developing peers

Oral reading fluency measure: Fluency probes; Reading comprehension measure: researcher-developed reading comprehension probes

Increased performance levels of academic behaviors for both participants across academic tasks (PND = 63, 75 %)

Kamps et al. (1994)

CWPT with typically developing peers: reading in pairs, feedback from peer, correction of errors, and public posting

Oral reading fluency measure: Fluency probes; Reading comprehension measure: researcher-developed reading comprehension probes; social interaction measure: Initiations, responses, and duration of interaction

Increased number of words read per minute, correct responding on reading comprehension probes, and social interactions with peers across participants (PND = 20, 80, 0 %)

Kamps et al. (1995)

Cooperative Learning Groups (CLG) with typically developing peers

Reading comprehension measure: Researcher-developed weekly pre- and posttest reading comprehension quizzes; Academic engagement: 10-s time sampling; Social interaction measure: Initiations, responses, and length of peer interactions

Increased number of correct responding on reading comprehension probes, academic engagement, and social interactions with peers across participants Experiment 1: PND = 86 % for students with ASD, 69 % for peers Experiment 2: PND = 86 and 56 % for students with ASD, 87 % for peers

Knight (2010)

Intervention 1: Book Builder (BB); Intervention 2: BB with explicit instruction (prompting); Intervention 3: BB, explicit instruction (prompting and referring to definitions of unfamiliar words)

Reading comprehension measure: responses on science vocabulary and comprehension digital quizzes (3 vocabulary questions, 3 literal comprehension questions, and 1 application question)

Finding of this study show an increase in correct responding on comprehension probes upon implementation of BB and explicit instruction PND (Across participants) = 82, 71, 0, 44 %

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Table 3 continued Study

Intervention

Measures

Outcomes


Procedural facilitation: anaphoric cuing, prereading questions, and cloze completion

Reading comprehension measure: researcher-developed post-reading comprehension questions scored based on a predetermined rubric. The questions included retelling, identifying main idea, generating a title, determining incongruous sentence in a paragraph from the story, factual recall (e.g., what, when, where) and inferential (e.g., why, how) questions

Positive effects of anaphoric cuing on reading comprehension measure were found statistically significant (ES = 1.09). Effects of pre-reading (ES = 0.50) and cloze completion (ES = 0.47) were not statistically significant with small effect sizes


Story Map condition: A graphic organizer Story Map was used after reading as a visual map of literal story elements (characters, place, time, beginning, middle, and end

Accuracy of Story Map completion: the percentage of correctly completed, first attempt, unprompted responses of fillin-the blank story elements

Positive effects of Story Map on both measures. All three participants met criteria in 8 to 11 sessions after Story Map procedures were implemented

Correct quiz responses: Percentage of correct unprompted answers on AR quizzes, which consisted of short answer questions

PND = 100, 90, 88 %

Choice condition: This condition was similar to Story Map condition except that the students were given a choice to use or not use the graphic organizer prior to completing the AR quiz Van Riper (2010)

DRTA: graphic organizers (circle thinking map, KWL chart); discussing the purpose for reading; prereading and explaining unfamiliar words; making predictions and discussing them; teacher providing clarifications and summarizations throughout reading; informal comprehension check

Reading comprehension measures: comprehension assessments from qualitative reading inventory- 4 (making predictions, literal and inferential questions); 10-question informal comprehension check associated with reading selections

The authors provided a visual interpretation of the graphs suggesting an increase in reading comprehension as measured through ‘‘Wh’’ questions and in frequency of prediction making in 2 out of the 3 participants. There was an increase in frequency of prediction making in all 3 participants. PND = 0 %


SCORE instruction; reciprocal questioning; scaffolded instruction

Frequency of student-generated questions related to the content of the reading material; frequency of correct responding to questions

Increase in frequency of studentgenerated questions and correct responding across participants Question generation PND = 92, 65, 79 %; responding PND = 100, 100, 41 %)

BB book builder programn ES effect size, PND percentage of non-overlapping data * PND scores are reported for participants in the order that was presented in each of the reviewed studies. A single PND score indicates that the intervention yielded equal PND across participants

improve reading comprehension outcomes (Edmonds et al. 2009; Scammacca et al. 2007; Solis et al. 2012). Many of these approaches were also identified previously by the National Reading Panel report in 2002. Based on findings from NRP, researchers from the field of students with intellectual disabilities and low incidence populations have suggested that many of the effective intervention approaches used for other populations of students may also be effective for students with ASD (Browder et al. 2006; Mirenda 2003; Quill 1997). In this review, we examined the quality and findings of research related to reading comprehension for ASD to interpret the extent to which findings from previous reviews could be confirmed. Collectively, the findings from this synthesis indicated a preliminary body of evidence to support the use of strategy instruction, student grouping practices, and explicit instruction.

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This synthesis on reading comprehension interventions for students with ASD yielded five intervention studies targeting cognitive approaches such as implementing questioning strategies, strategies for identifying main idea and summarizing, and anaphoric cueing, (i.e., Asberg and Sandberg 2010; Campbell 2010; O’Connor and Klein 2004; Van Riper 2010; Whalon and Hanline 2008). Results from these studies demonstrated that such cognitive approaches might enhance reading comprehension in students with ASD. While these interventions were designed to be responsive to students with ASD, most of these interventions were implemented in previous studies with students with reading difficulties and learning disabilities (e.g., Edmonds et al. 2009; Scammacca et al. 2007; Solis et al. 2012). This provides promise that many of the instructional interventions associated with improved


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Table 4 Certainty of evidence checklist Study

Design demonstrates experimental control

Dependent measure operationally defined

Adequate IOA

Intervention thoroughly described

Adequate treatment fidelity

Methodological limitations

Level of certainty


Pre-interventionpostmeasurement

Yes

Yes

Yes

Not reported

Experimental control not demonstrated through research design

Inconclusive

Campbell (2010)

Pretest–Posttest matched control group design (5 in each group)?

Yes

Not reported

Yes

Not reported

Several minor limitations: design, small sample size, IOA, TF

Inconclusive


Yes

Yes

Yes

Yes

Yes

No limitations identified

Conclusive


Yes

Yes

Yes

Yes

Yes


Conclusive

Kamps et al. (1989)

Yes

Yes

Yes

Yes

Not reported

Minor limitation: TF not measured

Suggestive

Kamps et al. (1994)

Yes

Yes

Yes

Yes

Not reported


Suggestive

Kamps et al. (1995)

Yes

Yes

Yes

Yes

Not reported


Suggestive

Knight (2010)

Few data points during one of the intervention phases

Yes

Yes

Yes

Yes

Minor limitation with design

Suggestive


Yes

Yes

Yes

Yes

Yes


Conclusive

Van Riper (2010)

ABAB design with very few data points per phase

Yes

Not reported

Not clearly described

Not reported

Several minor limitations in most areas, plus a major flaw in design

Inconclusive


Within subjects design

Yes

Yes

Yes

Not reported

Major limitation: research design does not demonstrate experimental control

Inconclusive


Yes

Yes

Yes

No: some aspects of the intervention were not clearly described (e.g., SCORE curriculum)

Yes

TF not reported Minor limitation: description of intervention

Suggestive

IOA interobserver agreement, TF treatment fidelity

comprehension for students with reading difficulties can be modified and implemented with students with ASD. The use of these cognitive approaches and appropriate modifications need to take into account the difficulties of integrating information as described by the theoretical frameworks (WCC, ToM, and EDF). Through careful consideration, this type of intervention approach may be able to limit the potential problem of cognitive overload through simplification of cognitive strategy instructional

procedures, which are specifically designed to support reading instruction for students with ASD. There were three studies investigating the relative effects of peer-pairing as a means of enhancing comprehension for students with ASD. All three of these studies were led by the same first author (Kamps et al. 1989, 1994, 1995) and provided positive findings for improving reading comprehension. Since peer pairing holds promise as a means of providing opportunities for oral language

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development in addition to enhancing comprehension and perhaps also social-emotional development, further research extending this work would be valuable. Similarly, Flores and Ganz (2007) implemented Direct Instruction reading program as a means of increasing reading comprehension outcomes of students with ASD. As with peerpairing, the initial findings are promising but additional work by other research teams would enhance confidence in this approach (Table 4). Three intervention studies included explicit instruction including the use of positive reinforcement as a major component in their instructional procedures (Campbell 2010; Kamps et al. 1995; Whalon and Hanline 2008). However, none of these studies met the criteria for conclusive evidence. While substantial research with students with ASD has established the effective use of explicit instruction and positive reinforcement for increasing accuracy of responding, the use and application of positive reinforcement within reading comprehension routines requires further research. Further consideration of the specific causes and deficits (social skills, information integration, and linguistic ability) associated with reading comprehension difficulties needs to be addressed regarding explicit instruction approaches. In addition, a combination of explicit instruction with appropriate cognitive approaches may be promising for improving reading comprehension in this population. There were two single-case studies with features categorizing them as inconclusive (Asberg and Sandberg 2010; O’Connor and Klein 2004) and one experimental design with too few participants per group and therefore inconclusive (Campbell 2010). Because of the low incidence and challenging access to students with ASD, obtaining adequate sample size for research is problematic. The studies identified appear to have been influenced largely by findings within the National Reading Panel Report of 2002, published over 10 years ago. While the NRP report included an extensive meta-analysis of previous reading research, the inclusion criteria for studies excluded studies of students with reading disabilities. A more appropriate body of previous research to consider as reference point for the population of students with ASD would be reviews that were more recently conducted on reading intervention with a focus on students with reading disabilities (Edmonds et al. 2009; Scammacca et al. 2007; Solis et al. 2012). For students with ASD, we identified studies of reading comprehension interventions that utilized strategy instruction such as question generation, graphic organizers, and making predictions. Other studies utilized anaphoric cueing instruction, explicit instruction, and different student grouping practices. The majority of these practices have been succesfully used for students with reading disabilities

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(Edmonds et al. 2009; Scammacca et al. 2007; Solis et al. 2012) with the exception of anaphoric cueing. However, there are still many approaches from the body of research on reading disabilites to be considered for students with ASD. Some potential practices might include a main-idea summarization strategy, multi-component interventions, inference instruction, and self-monitoring procedures. There was very little evidence to support the notion that theoretical explanations of reading comprehension difficulties for students with ASD have had a high degree of influence on the reading interventions represented by this synthesis. Taken together, the theoretical explanations of WCC, ToM, and EDF underscore the importance of considering alternate approaches to reading instruction. Since comprehension is highly dependent on connecting information within text as well as from the external world, deficits in integration are likely to hinder reading comprehension. The theoretical frameworks of WCC, ToM, and EDF provide guidance on the difficulties of students with ASD with organizing, connecting, and monitoring the content of text in a manner that is conducive to success with comprehension of text. The theories of WCC, ToM, and EDF, while providing strong rationale for the development of specific reading interventions for students with ASD, did not appear to be carefully considered as part of the interventions represented by the studies included in this synthesis. As stated previously there is a compelling body of research to support the use of ABA as an evidence-based practice for students with ASD. There are also studies of the use of ABA to support improvement in academic outcomes for students with ASD. Despite this, the use of ABA was very limited in the studies included in this synthesis.

Limitations As with research in reading with individuals with learning and reading disabilities (e.g., Edmonds et al. 2009: Solis et al. 2012), many intervention studies over-rely on researcher-developed, proximal measures of reading. These measures are often necessary and can provide valuable information about the extent to which target participants actually learn what we expect them to learn; however, they also can be limited in that they do not provide distal, normreferenced data about students’ reading achievement and are often based on measures of unknown reliability and validity. The majority of studies represented in this synthesis only included the use of researcher-developed measures, which limits the interpretation and generalizability of the findings. Among the studies reviewed for this synthesis, only three (Asberg and Sandberg 2010; Campbell 2010; Van Riper 2010) measured reading comprehension


performance by means of a post-intervention standardized reading assessment. The findings are limited by the quality of the study designs represented in this synthesis. Recent policy initiatives have encouraged the use of more rigorous research designs for both group-design studies (http://ies. ed.gov/ncee/wwc/pdf/reference_resources/wwc_procedures_ v2_1_standards_handbook.pdf) and single-case design studies (Kratochwill et al. 2010). Implications for Practice One of the intentions from this review was to provide educators guidance about instructional approaches to improve reading comprehension of students with ASD based on current research. This synthesis provides initial evidence suggesting that approaches commonly used for students with learning disabilities (e.g., Edmonds et al. 2009; Scammacca et al. 2007; Solis et al. 2012) may also improve reading comprehension for students with ASD. Specifically, educators should consider the use of explicit instruction, strategy instruction, graphic organizers, and the use of student grouping practices such as cooperative learning groups and CWPT. Implications for Future Research Consistent with previous reviews in the area of reading instruction for students with ASD, findings from the present synthesis suggest that this line of research has not been adequately explored, and there seems to be a high need for evidence-based knowledge to help enhance reading comprehension performance in students with ASD. Since, by definition, students with ASD typically have significant impairments in communication, research studies of oral language and reading interventions combined should be considered. This line of research should build upon the current understanding of the subtle linguistic anomalies that often persistently occur in students with ASD (Boucher 2012). A randomized control trial study conducted by Clarke et al. (2010) compared the effectiveness of textcomprehension (TC), oral-language (OL), and a combined (TC ? OL) treatment to a comparison condition for students identified with specific reading comprehension deficits. All three interventions indicated statistically and educationally significant improvements in reading comprehension. Similar studies of this type should be considered with samples of students with ASD, taking into account the language differences often related to ASD. Future research should consider more carefully the theoretical explanations of WCC, ToM, and EDF as rationale for the development of specific interventions designed to improve reading comprehension outcomes for students with ASD. Given that most students with ASD

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experience difficulty with reading comprehension, an important direction for future work is to pinpoint which aspects of the reading comprehension process are impaired. The identification of these aspects of the reading comprehension process should be guided by the established theoretical frameworks of reading (i.e., The Simple View of Reading), in addition to the theoretical frameworks more specific to students with ASD (WCC, ToM, EDF), and the findings of previous research on oral language development (Boucher 2012; Clarke et al. 2010). In combination, this is an important step in further development of appropriate and well-targeted interventions for students with ASD. Comprehension clearly is a highly complex process that may fail for a number of different reasons, especially for students with ASD, many of whom approach reading comprehension with identified deficits in linguistic ability. The application of principles of ABA that have been successfully used to support students with ASD in other areas of need (e.g., communication, learning outcomes) should be considered for future research as components of reading comprehension interventions for students with ASD. Future research should also consider the use of intervention components that support the cognitive strengths of visual processing that have previously been identified for many students with ASD (Kana et al. 2006). Future researchers who make use of more rigorous methodology as outlined in recent policy initiatives can make meaningful contributions to the field. Use of more rigorous designs, specifically those of single-case design to address the low incidence nature and heterogeneity of students with ASD will eventually lead to body of research practices that are considered evidencebased under recently proposed methodological and evidence standards (Kratochwill et al. 2010). Acknowledgments The research reported here was supported by Grant R324C120006 from the Institute of Education Sciences, U.S. Department of Education. The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Education.

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