INT J LANG COMMUN DISORD, MARCHAPRIL VOL.

2011,

46, NO. 2, 231242

Research Report Follow-up study on reading comprehension in Downs syndrome: the role of reading skills and listening comprehension
Maja Roch, Elena Florit and Chiara Levorato
Department of Developmental Psychology, University of Padua, Padua, Italy

(Received 8 June 2009; accepted 15 April 2010) Abstract

Background: According to the Simple View of Reading, reading comprehension requires some abilities such as reading skill and listening comprehension. Individuals with Downs syndrome show relative strengths in reading skills, mainly in word recognition, where they attain a reading age of about 78 years. Compared with word recognition, their reading comprehension is usually delayed by at least 6 months. Poor reading comprehension is paralleled by weak listening comprehension. It is claimed that poor listening comprehension might constrain the development of reading comprehension and, therefore, be a cause for the asynchrony between reading skills and reading comprehension. Aims: A follow-up study was carried out in order to analyse the improvements in reading skills, listening and reading text comprehension, and to support the hypothesis of a causal relationship between listening and reading comprehension. Methods & Procedures: Ten children and adolescents with Downs syndrome, aged between 11 years 3 months and 19 years 10 months, were assessed twice over a one-year period as to their reading skills, listening and reading text comprehension. Outcomes & Results: Three main ndings emerged: (1) reading skills, on the one hand, and comprehension (both listening and reading), on the other hand, are independent; (2) reading comprehension development is determined mainly by listening comprehension, which in the present study proved to be very poor; and (3) an improvement after a one-year period, even though limited, occurred for all examined abilities except for listening comprehension. Conclusions & Implications: The results are discussed in the light of the theoretical framework of the Simple View of Reading and of their relevance for practical and educational issues. Keywords: Downs syndrome, Simple View of Reading, reading skills, listening comprehension, reading comprehension, follow-up study.

What this paper adds What is already known on this subject Recent studies have shown that most individuals with Downs syndrome who attend mainstream schools develop at least some degree of reading skills, despite their impaired linguistic competence. For reading comprehension to occur, both reading skills and language comprehension are necessary, and they both give a unique and specic contribution to reading comprehension. The role played by these components in the reading comprehension of individuals with Downs syndrome is atypical and similar to that exhibited by typically developing children who are poor comprehenders. Their ability to understand written texts is more strongly related to their listening comprehension level rather than to their reading skills. What this study adds The current study supported the hypothesis that the nature of the relationship between listening and reading comprehension in Downs syndrome is causal: the level of listening comprehension is the strongest predictor of the level of reading comprehension one year later. On the other hand, the relative contribution of reading skills to reading comprehension one year later is weak. The educational implication of this study is that training based on abilities related to listening comprehension might be appropriate for the improvement of reading comprehension as are training in reading skills.

Address correspondence to: Maja Roch, Developmental Psychology, University of Padua, via Venezia, 8, Padua I-35133, Italy; e-mail: maja.roch@unipd.it
International Journal of Language & Communication Disorders ISSN 1368-2822 print/ISSN 1460-6984 online c 2011 Royal College of Speech & Language Therapists http://www.informahealthcare.com DOI: 10.3109/13682822.2010.487882

232 Introduction The current study analysed the development of reading comprehension in individuals with Downs syndrome; specically, a follow-up investigation analysed the role played by reading skills and listening comprehension in the development of reading comprehension. Learning to read is an essential competence not only for typically developing children, but also for people with cognitive impairments, such as individuals with Downs syndrome. In fact, literacy may broaden vocational opportunities as well as contribute to increase personal autonomy and independence in community activities and living (Boudreau 2002). In Italy, as in various other European countries, individuals with Downs syndrome attend mainstream educational institutions together with typically developing children of a similar age. This educational integration allows most children with Downs syndrome to develop at least some degree of reading competence. All the studies conducted to date on reading skills1 agree that, despite their severe language difculties, individuals with Downs syndrome show relative strengths in word identication, where they can attain a reading age of about 78 years (Byrne et al. 2002). On the other hand, they show a selective disadvantage in non-word reading (Cupples and Iacono 2002). This pattern of strengths and weaknesses can be attributed to a relatively preserved visual approach in word recognition, which contrasts with an impairment in phonology (Roch and Jarrold 2008). Compared with word and non-word reading, which are skills that have been extensively investigated, reading comprehension has been less studied in individuals with Downs syndrome. Some recent studies suggest that the advantage in word identication is not a guarantee that what is read is also understood (Roch and Levorato 2009). In fact, the comprehension of written sentences or short texts seems to be delayed at least 6 months with respect to word identication (Boudreau 2002, Laws and Gunn 2002, Verucci et al. 2006). Reading comprehension difculties are likely to reect weaknesses in oral language abilities. Compared with non-verbal cognition, language acquisition in Downs syndrome is particularly impaired (Chapman 1995, Abbeduto et al. 2007). Since the comprehension of what is read is the ultimate aim of learning to read, a detailed investigation of reading comprehension and its components is essential both to identify the difculties that individuals with Downs syndrome may encounter in this process and, subsequently, to plan educational programmes. In the current study we used a follow-up design to investigate the extent to which reading skills and listening comprehension are causally linked to the

Maja Roch et al. development of reading comprehension in a group of children and adolescents with Downs syndrome. The Simple View of Reading (Hoover and Gough 1990) The theoretical background provided by the Simple View of Reading (Gough and Tunmer 1986, Hoover and Gough 1990) indicates that reading skills and listening comprehension are components of reading comprehension. According to this model, reading comprehension is the product of two distinct components, each of which makes its own unique and independent contribution (Savage 2001): decoding and listening comprehension. Both of these abilities are necessary, but neither is sufcient in itself to explain reading comprehension (Gough et al. 1996). The model may be expressed by the formula: r = dc where r is reading comprehension; d is decoding, and c is listening comprehension. Each of these variables can assume a value between zero and one, and for reading comprehension to occur, both values must be greater than zero. According to this model, reading comprehension correlates with both of these components, which in turn are independent of each other and are based on different mechanisms (Savage 2001). Decoding refers to the ability to read printed symbols by applying the graphemephoneme conversion rules and is based mainly on phonological skills (Kirby and Savage 2008). In the original denition, Gough and Tunmer (1986) conceptualized listening comprehension as the ability to take lexical information (word level) and derive sentence and discourse interpretations. Hoover and Gough (1990) stated that measures of listening and reading comprehension should assess the ability to answer questions about the contents of aurally and written presented text. Additionally, de Jong and van der Leij (2002) found in rst to third grades of typically developing children that the effect of listening comprehension was more important than the effect of vocabulary in predicting reading comprehension. While the former explained unique variance, the vocabulary did not add a unique contribution over and above the listening comprehension. For this reason, the Simple View of Reading has been tested mainly by taking into account the relationship between the comprehension of oral and written texts. In different phases of the acquisition of the ability to read and understand written texts, the two components decoding and listening comprehensionhave different levels of impact: Decoding is a strong predictor of reading comprehension mainly in the early stages of reading development because most of the necessary

Reading comprehension in Downs syndrome resources are involved in the processing of graphic symbols. On the other hand, when reading becomes an automatized activity, during middle and high school listening comprehension is increasingly strongly related to reading comprehension (Diakidoy et al. 2005). The validity of this model has been demonstrated in typically developing children, both English speakers (for example, Catts et al. 2006, and Joshi and Aaron 2000) and speakers of languages, such as Dutch and French, which have a more transparent orthography than does English (Aro and Wimmer 2003, de Jong and van der Leij 2002). These studies have demonstrated that the degree of orthographic transparency of the language that has to be mastered affects the development of reading comprehension. First of all, in orthographically transparent languages word recognition is more predictive of reading comprehension than decoding; since reading is in general accurate, speed is a more reliable measure than accuracy. Moreover, learning to decode is a more rapid process and, as a consequence, listening comprehension becomes a powerful predictor of reading comprehension since the early phases of literacy acquisition (Megherbi et al. 2006). Italian has a highly regular orthography. A study carried out with Italian third- and fth-grade typically developing children conrmed the predictions of the Simple View of Reading. Both word-reading skills and listening comprehension were related to reading comprehension; the latter accounted for more variance in reading comprehension in older children than reading skills, while in third graders word recognition and listening comprehension accounted for a similar amount of variance (Florit et al. 2008). The validity of this model has also been conrmed in some populations characterized by difculties in the development of language and reading skills. Studies that compared children as to their ability to read, to understand oral language, and to understand written language have identied different proles. Children with decits in reading comprehension, often accompanied by decits in oral language comprehension, but with age-appropriate word reading, have been dened as poor comprehenders (Cain and Oakhill 2006). On the other hand, poor decoders are characterized by an opposite pattern: They show average language abilities but poor decoding skills and phonological processing (Catts et al. 2006). These studies indirectly support the claim that reading skills and language comprehension are both involved in reading comprehension and that they are independent of each other, even though some children can be impaired in both (garden variety poor readers).

233 The Simple View of Reading in Downs syndrome Recently, the Simple View of Reading provided the basis for an investigation regarding individuals with Downs syndrome (Roch and Levorato 2009). In this study, a group of individuals with Downs syndrome (mean age = 15 years and 5 months) and a group of typically developing children (mean age = 6 years and 8 months) were matched for their level of reading comprehension and then compared as to their reading skills and listening comprehension (both word and non-word reading). Some differences emerged in the proles of the two groups. When matched with typically developing children with the same level of reading comprehension, participants with Downs syndrome were shown to be weaker in listening comprehension and more advanced in word recognition. The authors concluded that individuals with Downs syndrome show an uneven prole when compared with typically developing children, and that their prole might be considered to be similar to that exhibited by poor comprehenders. The analysis of the relationships between the components considered and reading comprehension showed that: (1) in typically developing children, both reading skills and listening comprehension accounted to a similar extent for differences in reading comprehension, as expected on the basis of the Simple View of Reading; and (2) in the group with Downs syndrome, listening comprehension was a stronger predictor of reading comprehension than reading skills. Even though the reading comprehension level was similar in the two groups, the underlying abilities proved to be different. These results call for a deeper analysis of a possible causal link between listening and reading comprehension, on the one hand, and reading skill and reading comprehension, on the other hand. The follow-up procedure is a privileged method for tracing causal relations between reading comprehension and its components (Cain and Oakhill 2007). For this reason, we carried out a study on the development of reading comprehension in a follow-up investigation, and, in the light of the results reported by Roch and Levorato (2009), it was expected that poor listening comprehension might be causally related to the difculties that individuals with Downs syndrome exhibit in reading comprehension. Development of reading skills in Downs syndrome Several studies have undertaken a longitudinal analysis of the development of reading and reading-related skills in Downs syndrome. In a 5-year-longitudinal study, Laws and Gunn (2002) tested the hypothesis that learning to read improves language comprehension in a group of 30 individuals with Downs syndrome aged

234 between 10 and 24 years. Most of the participants who were able to read made progress over the 5-year period covered by the study, although they showed an uneven prole. Compared with their word-reading skills, which were relatively preserved, they showed a disadvantage in reading comprehension, which was 6 21 months delayed in comparison with word-reading skills. Several measures at Time 1 were signicant predictors of the level reached in both reading skills and reading comprehension at Time 2: non-verbal ability, language comprehension and production, phonological memory and phonological awareness, but no evidence was found that learning to read produced benets in the development of language comprehension. Byrne et al. (2002) also conducted a longitudinal study that analysed the development of reading skills and the cognitive abilities associated with reading progress in children with Downs syndrome. Twentyfour children with Downs syndrome aged between 4 and 12 years were followed over a two-year period. They were administered annually a large battery of tests evaluating the progress of their reading, language and cognition. Their proles were compared with that of two control groups of children with typical development: one consisting of slow readers who had the same reading age as children with Downs syndrome; and one having age-appropriate reading skills. The results indicated that individuals with Downs syndrome performed well in word recognition in comparison with their cognitive abilities, and that they made signicant progress over a one-year period in single word-reading skills. On the other hand, signicant improvement in reading comprehension was observed only after two years, and the gains were very small: reading comprehension scores did not rise above the reading comprehension age of 6 years compared with average readers. When compared with the control group of younger reading-age children, participants with Downs syndrome did not differ in single-word reading from them, even though they had poorer language memory and general intelligence. Overall, this result suggests that reading may be relatively independent from other cognitive and linguistic skills: in all three groups there was no evidence of any strong and direct relation between reading ability, reading comprehension, and other measures of language acquisition. This study supported the view that reading skills and reading comprehension develop independently in Downs syndrome, but it did not provide evidence about the factors that determine improvements in reading comprehension. Aims and predictions The aim of the current study was to identify the causal contribution made by the components of reading

Maja Roch et al. comprehension in a one-year period. In accordance with the Simple View of Reading, both reading skills and listening comprehension were included as possible predictors of reading comprehension. Taking the theoretical background of the Simple View of Reading and the above-mentioned evidence together, the following aims were formulated: To trace the trend of improvement in all the abilities examined (listening and reading comprehension, word and non-word reading) after a one-year period. Consistently with previous longitudinal studies (Byrne et al. 2002, Laws and Gunn 2002), we expected greater gains in reading skills than in comprehension, both listening and reading. To verify whether listening comprehension was a stronger predictor of the development of reading comprehension than reading skills. In accordance with Roch and Levorato (2009) and coherently with the prole described for poor comprehenders (Cain and Oakhill 2006), it was hypothesized that listening comprehension might be causally related to reading comprehension while reading skills, although more preserved, might have a less strong inuence on the development of reading comprehension. Method Participants Ten individuals with Downs syndrome took part in every phase of the present study. An additional ve participants dropped out between Time 1 and Time 2 and were not considered as participants. They were selected from a larger group of 20 children and adolescents who were attending elementary, middle and high school, were younger than 20 years, and were able to read. They were all native Italian speakers (four males and six females). Only those who did not have any physical or neurological problems, or who were not being treated for either physical or neurological diseases at the time of the assessments, were included as participants of the study. They were assessed twice in a one-year period. At Time 1, participants were aged between 11 years and 3 months and 19 years and 10 months (mean = 15 years and 6 months, standard deviation (SD) = 2 years and 8 months). All these participants had full trisomy 21, and had normal or corrected vision and hearing. The National Health Service (NHS) provides them with regular medical examinations, psychological evaluation, and monitoring once or twice a year. In accordance with Italian law, all of them were attending mainstream schools with children and adolescents who had approximately the

Reading comprehension in Downs syndrome same chronological age (mean years of schooling = 9 years, SD = 2 years); these children were supported for normal class activities by a specially trained teacher. The NHS supplied the data regarding their full-scale intelligence quotient (IQ), as measured by the WISC-R test (adapted for Italian speakers by Orsini 1993): their mean IQ was 52 (SD = 9), ranging from 40 to 65. Materials Evaluation of reading comprehension In order to assess reading comprehension, a test MT testvalidated on Italian school-age children (n = 5700) sampled in different areas of Italy was used (Cornoldi and Colpo 1998). The test for the rst grade was chosen in accordance with results from the literature, indicating that reading comprehension in Downs syndrome individuals is usually comparable with that of 67-year-olds (Verucci et al. 2006). The test requires each participant to read a one-page story followed by ten multiple-choice questions, which are answered by choosing one out of three alternatives. The story is formed of syntactically simple sentences, the text structure respects the story grammar, and the words used are appropriate for children of 67 years of age. The comprehension questions concern information that may be either explicitly or implicitly stated in the text. There are no time limits, and to minimize the memory load children are allowed to return to the text whenever they want while answering the multiplechoice questions. Scores correspond to the number of correct answers (zero to 10) and are transformed into the percentage of correct answers. The reliability of the test measured by an item total correlation ranges between 0.41 and 0.69. Evaluation of listening comprehension Listening comprehension was evaluated by using the test TOR 38, which was standardized on 1700 Italian children aged between 3 and 8 years (Levorato and Roch 2007), and it measures listening text comprehension without involving language-production skills. The test is similar to the reading comprehension test in terms of story structure, types of questions (that is, literal and inferential) and type of task (that is, multiple choice), and it was chosen in order to have a parallel measure of listening and reading comprehension, as suggested by previous studies (Hoover and Gough 1990, de Jong and van der Leij 2002). In this study, participants were asked to listen to two stories which were of the same level of difculty as those used for the reading comprehension, namely for 68-year-old Italian children. The two stories are

235 characterized by sentences with a simple syntax and by a lexicon appropriate for Italian children of the age considered. The test procedure calls for the stories to be read aloud by the experimenter who, in order to minimize the cognitive and the memory load, interrupts the reading of the story in two predetermined points and veries comprehension up to the point of interruption. Comprehension is evaluated by multiple-choice questions having four alternative answers, each of which is accompanied by an image. The alternatives are expressed verbally by the tester, who also points to the corresponding picture and participants are asked to point to the correct picture. Half the questions concern information explicitly stated in the story and half require an inference to be made. The score consists of the sum of correct answers, twelve for each story, for a total of 24. The raw scores were transformed into percentages of correct answers. The reliability of the test measured by Cronbachs alpha is 0.60 and the testretest reliability is 0.85. Evaluation of reading skills: uency and accuracy Given the uneven prole of participants with respect to their reading skills, both word and non-word reading were assessed. We used two tasks from the Battery for Dyslexia Evaluation (Sartori et al. 1995) standardized on 929 Italian-speaking children: the tasks evaluate word and non-word reading for 7-year-old typically developing children. The test requires participants to read a list of items consisting of 112 words and 48 non-words as fast and as accurately as they can. The words are bi-, tri-, and quadri-syllabic items which differ for the age of acquisition and frequency (ranging from high to moderately low). All the items have a regular pronunciation. The non-words are similar to the word items for length (two, three of four syllables) and are constructed respecting the phonotactic rules of Italian. The average time (seconds) needed to read the list of words and non-words (total time/number of items) and the proportion of word and non-word-reading errors (total errors/number of items) produced four variables: Word-reading uency: speed (seconds) of word reading.2 Word-reading accuracy: percentage of wordreading errors. Non-word-reading uency: speed (seconds) of non-word reading. Non-word-reading accuracy: percentage of nonword-reading errors. The testretest reliability is 0.80 for speed and 0.71 for accuracy.

236 To evaluate the role of reading skills, we used the measure of word-reading uency, which is the most powerful predictor of reading comprehension in languages with transparent orthographies (cf. Aro and Wimmer 2003, Florit et al. 2008, Roch and Levorato 2009). Procedure The tests were administered to all participants twice by the same person, whom they already knew in advance, with a one-year period of distance between the rst (Time 1) and the second (Time 2) assessments. The same tests were administered at both time points. Testing took place over two visits, and the participants were assessed individually in a quiet room. The usual order of assessments was word reading then listening comprehension in the rst session and non-word reading then reading comprehension in the second session. Each session lasted from 30 to 40 min. Schools and parents provided written consent for participants to be assessed at school or at home. Results In order to analyse the role played by the individual characteristics of the participants with Downs

Maja Roch et al. syndrome, their performance on each of the tasks (reading and listening comprehension, word and nonword reading) was related at both time points to each of the individual characteristics: chronological age, years of schooling and IQ. No signicant correlation emerged between the variables (r < 0.35 in all cases). See table 1 for details. These results suggest that: (1) in the age range of the participants, the impact of life experience on reading and reading related skills might be marginal; and (2) no important changes in literacy experience occurred during the year of the study. In the light of these considerations, age, years of schooling and mental development were not taken into consideration in any subsequent analysis. Table 2 presents the performances of the group of participants at Time 1 and Time 2. In reading comprehension, seven out of ten participants (at both points in time) achieved a level of comprehension which, according to the guidelines of the test, is considered appropriate for rst graders. Three participants achieved the highest score, which means that their comprehension level might be even higher than that expected in rst graders. On the other hand, listening comprehension was an area of weakness in this group of participants, in particular in comparison

Table 1. One-tailed zero-order correlations between individual characteristics (age, schooling and intelligence quotient (IQ)) and the tasks adopted in the study (word and non-word reading speed and accuracy, listening and text comprehension) at Time 1 and at Time 2 Time 1 Age Reading comprehension Listening comprehension Speed (words) Speed (non-words) Errors (words) Errors (non-words) Table 2. 0.129 0.261 0.119 0.217 0.010 0.005 Schooling 0.180 0.221 0.192 0.189 0.034 0.040 IQ 0.032 0.029 0.156 0.128 0.324 0.297 Age 0.295 0.233 0.263 0.287 0.271 0.344 Time 2 Schooling 0.246 0.266 0.295 0.269 0.120 0.219 IQ 0.256 0.212 0.162 0.056 0.058 0.064

Description of participants at Time 1 and Time 2: proportions of correct answers, standard deviations, and ranges on reading and listening comprehension, and on word and non-word reading (speed and accuracy) Time 1 Time 2 0.64 (0.26) 0.201.0 0.41 (0.13) 0.250.63 1.5 (0.34) 1.122.05 2.5 (0.37) 1.773.15 0.07 (0.07) 0.010.20 0.15 (0.13) 0.040.42 t 0.89 d = 0.19 0.12 d = 0 1.6 d = 0.68 1.7 d = 0.69 1.4 d = 0.30 2.4 d = 0.80

Reading comprehension Range Listening comprehension Range Speed words Range Speed non-words Range Errors words Range Errors non-words Range

0.59 (0.25) 0.201.0 0.41 (0.14) 0.170.63 1.4 (0.23) 1.045.73 3.3 (1.6) 1.175.73 0.10 (0.12) 00.41 0.31 (0.26) 0.060.92

Notes: The comparison of the performance on each task between Time 1 and Time 2 is reported (t-test and effect size). p < 0.05.

Reading comprehension in Downs syndrome with their ability to understand written texts. In fact, only four participants answered more than 50% of the comprehension questions correctly, which means that listening comprehension is poorer than reading comprehension. Word recognition seems to constitute a relatively preserved ability in which the participants performed well. They were uent in word recognition comparably with second-grade typically developing children, and most of them were even more accurate in word recognition than 78-year-old children. Two participants made no reading errors in a list of 112 words and three of them made just three or four errors. Different results were obtained regarding non-word decoding: six participants read more than 30% of the items incorrectly. Most of the errors consisted in reading non-word items as if they were real words, suggesting that some of the participants persisted in using a visual route for reading even though it was inappropriate and they were informed that they had to read also nonsense words. In one years time the participants did not undergo any specic intervention, but participated in normal school activities, among which literacy, text reading and listening. Comparing the mean scores obtained in the two sessions, little improvement could be observed. A t-test compared the performance of participants at Time 1 and Time 2 in order to evaluate the amount of improvement occurring between the two times. As far as language comprehension is concerned, an improvement occurred in reading comprehension, even though not statistically signicant, whereas no improvement occurred in the one-year period for listening comprehension. As far as reading skills are concerned, participants improved both in speed and in accuracy of words and non-words reading (see effect sizes), but there was a signicant decrease in the number of errors only for non-words. This improvement had a fairly large effect size, namely 0.80. In order to evaluate whether the same pattern of relationships between the tasks emerged at the two time points, Pearsons zero-order correlations were carried out. Table 3 reports the results.

237 At both points in time, reading comprehension was correlated with listening comprehension, but not with any of the reading measures. Also, listening comprehension correlated only with reading comprehension, but not with any of the reading measures. On the other hand, the measures of reading ability showed a strong pattern of relationships between each other. This pattern of results is very similar to that reported by Roch and Levorato (2009), and suggests a dissociation between language comprehension and reading skill. The correlations observed at Time 1 and one year later are very similar, showing that the relations among the abilities measured are stable over a one-year period. In order to verify whether the pattern of correlations with reading comprehension might be interpreted as causal, a hierarchical linear regression analysis was carried out. The dependent variable was reading comprehension at Time 2 and the predictors were performance at Time 1 in reading comprehension, reading skill and listening comprehension. The order of entrance of the predictors was established a priori. At the rst step, the reading comprehension score at Time 1 had the function of autoregressor and it is particularly important for testing a causal hypothesis. In fact, this procedure allowed for a control of the variance not only explained by the autoregressor itself, as measured at time 1, but also of its correlations with the other components. According to de Jong and van der Leij (2002), any additional variance after the inclusion of the autoregressive effect can be taken as support for a causal relation between the predictors and the dependent variable. At the second step, word recognition speed at Time 1 was inserted. This variable was inserted because we wanted to test the role of listening comprehension on reading comprehension excluding the role of word recognition. Finally, at the third step, listening comprehension at Time 1 was entered. Table 4 illustrates the results of the regression analysis. Reading comprehension at Time 1 explained 57.4% variance in the performance of the same task one year later. Word recognition added 8% of the variance over and above the variance explained by the autoregressor,

Table 3. Correlations between performances at Time 1 (above the diagonal) and at Time 2 (below the diagonal) 1. 1. Reading comprehension 2. Listening comprehension 3. Speed (words) 4. Speed (non-words) 5. Errors (words) 6. Errors (non-words)
Note: p < 0.05; and p < 0.01.

2. 0.721 1 0.165 0.091 0.493 0.419

3. 0.158 0.132 1 0.662 0.254 0.150

4. 0.362 0.133 0.757 1 0.180 0.147

5. 0.223 0.018 0.376 0.587 1 0.937

6. 0.279 0.066 0.215 0.416 0.958 1

1 0.717 0.105 0.143 0.354 0.149

238
R 2 change 0.574
a

Maja Roch et al.

Table 4. Regression analysis on the reading comprehension score at Time 2: R 2 = 0.971 [F (3, 9) = 65.8, p < 0.001] Reading comprehension (T1) Reading comprehension (T1) Word reading speed (T1) Reading comprehension (T1) Word reading speed (T1) Listening comprehension (T1) 0.757 0.803 0.288 0.141 0.069 0.869

Predictors Step 1: Reading comprehension (T1) Step 2: Word reading speed (T1) Step 3: Listening comprehension (T1)

t 3.3 3.6 1.3 1.3 0.903 8.1

p <0.01 <0.01 n.s. n.s. n.s. <0.001

0.081b 0.316c

Notes: a F change (1, 8) = 10.8, p < 0.01. b F change (1, 7) = 1.6, not signicant (n.s.). c F change (1, 6) = 64.4, p < 0.001.

which did not yield statistical signicance. Listening comprehension explained a further 31.6% of unique variance. This variance emerged after controlling for the relation between reading and listening comprehension at Time 1, and the possible role of reading skills. Therefore, it may be argued that reading comprehension is strongly related to listening comprehension, which seems to be a causal factor in predicting reading comprehension one year later. In fact, we are able to rule out the possibility that the relation between listening comprehension at Time 1 and reading comprehension at Time 2 was simply due to its association with reading comprehension at Time 1. The next analysis was aimed at testing the causal hypothesis, excluding the possibility that such a relation might simply be due to the fact that the correlation between reading comprehension and listening comprehension was stable over time. An additional hierarchical regression analysis was carried out in order to compute the variance explained by the two predictors as they were evaluated at Time 2. In this analysis, therefore, reading comprehension at Time 2 was the dependent variable whereas the predictors were, in addition to reading comprehension at Time 1, reading

speed and listening comprehension at Time 2. The results, summarized in table 5, indicate that beside the 54.7% of variance explained by the autoregressor, word reading speed at Time 2 explained 4% variance, a proportion that was not signicant. The important result was that listening comprehension added 14.4% variance in explaining reading comprehension, and this proportion was signicant. Since this proportion is smaller than the proportion of variance explained by listening comprehension at time 1 (see the previous analysis and the table 4), it can be concluded that the relation between listening and reading comprehension is causal more than simply correlational.

Discussion The aim of the current study was to examine, in a group of individuals with Downs syndrome, the development over a one-year period of reading comprehension in relation to two component skills that, according to the Simple View of Reading, are necessary for reading comprehension: reading skills and listening comprehension.

Table 5. Regression analysis on the reading comprehension score at Time 2: R 2 = 0.761 [F (3, 9) = 6.4, p < 0.05] Predictors Step 1: Reading comprehension (T1) Step 2: Word reading speed (T2) Step 3: Listening comprehension (T1) R 2 change 0.574
a

Reading comprehension (T1) Reading comprehension (T2) Word reading speed (T2) Reading comprehension (T2) Word reading speed (T2) Listening comprehension (T2) 0.757 0.787 0.210 0.542 0.100 0.476

t 3.3 3.3 0.887 2.3 0.476 1.9

p <0.01 <0.05 n.s. n.s. n.s. n.s.

0.043b 0.144c

Notes: a F change(1, 8) = 10.8, p < 0.01. b F change (1, 7) = 0.786, not signicant (n.s.). c F change (1, 6) = 3.6, n.s.

Reading comprehension in Downs syndrome Before analysing these main ndings, it is worth considering the absence of any statistically signicant correlation between age, IQ and years of schooling, on the one hand, and any measures adopted in the current work, on the other hand. This lack of statistically signicant correlations, which has already been documented in a number of previous studies on people with Downs syndrome (Byrne et al. 2002, Roch and Levorato 2009, Levorato et al. 2009), suggests that the variability as to age, school experience and mental development may not inuence reading skills and comprehension level, at least not directly and not to the same extent as in typical development. In Italy, for part of the time individuals with Downs syndrome attend classes with their peers of similar chronological age; for the rest of the time they receive individualized teaching from a specially trained support teacher. Certainly, part of the daily school activities consist of reading and comprehending what is read. Although it is likely that the contents of literacy instruction and the quality of teaching itself inuence reading and related skills, at the moment we can only speculate that in the age range considered in this study, and given the skills already achieved by the participants, the quantity of instruction received, not necessarily reecting the quality of the teaching received, does not have any statistical inuence on the skills investigated in the current study. The main results obtained in the current study conrm that reading comprehension is supported by the two component skills that contribute to its development in a complex way. Three main ndings emerged: (1) reading skills, on the one hand, and comprehension, both listening and reading, on the other hand, are independent; (2) the development of reading comprehension is determined mainly by listening comprehension, which in this study proved to be very poor; and (3) participants improved their performances in all the abilities considered, except for listening comprehension which remained at the same level after a one-year period.

239 Laws and Gunn 2002, Roch and Levorato 2009), was supported by three ndings in the current study. First, the correlations between comprehension of a text, whether read or listened to by participants, and reading skills were quite low. Second, in comparison with what is expected in typically developing children, individuals with Downs syndrome were more advanced in word recognition than in reading and listening comprehension. Finally, reading comprehension development over a one-year period was only marginally affected by reading skills. In typical development, the mutual independence of reading skills and reading comprehension is particularly apparent in children characterized by dyslexia, on the one hand, and in children dened as poor comprehenders, on the other hand (Cain and Oakhill 2006). The latter, like the individuals with Downs syndrome in the present study, show poor reading comprehension and good reading skills. For individuals with Downs syndrome, as well as for poor comprehenders, it seems that uent and accurate word recognition is not per se a guarantee of adequate comprehension, indicating that access to the meaning of what is read is not as automatic as it seems on the basis of uency and accuracy in reading. This description leaves the question of the nature of the independence of reading skills from reading comprehension unanswered. We can conclude that the two abilities, reading and understanding, develop independently and even asynchronically. Presumably reading and understanding are not independent as processes while occurring during text reading: it might be hypothesized that there is some point where the two processes interact and share the results of their processing. We speculate that during text comprehension, the activities of decoding and getting access to the meaning occur in parallel and interact: Word recognition is also driven by the construction of the meaning of the previous word string (from meaning to decoding); alternately, successful word recognition triggers the access to word meaning (from decoding to meaning). Studies using on-line procedures might shed light on the interconnections between these two processes.

Independence of reading skills and language comprehension The results show the independence of reading skills from both listening and reading comprehension. This result is consistent with the model of the Simple View of Reading, according to which each of the two components provides a unique and specic contribution to reading comprehension. In individuals with Downs syndrome, reading skills and text comprehension seem to develop asynchronically, and differently from children with typical development. This conclusion, which is coherent with previous research (Byrne et al. 2002,

Causal role of listening comprehension on reading comprehension The current study showed a close relationship between listening and reading comprehension. This result was also documented in a previous study (Roch and Levorato 2009), but in the current study new evidence was added, namely that a causal relationship exists between the two: listening comprehension at Time 1 predicted reading comprehension one year later. This result may be explained by the Simple View of Reading: When

240 reading skills are automatized, listening comprehension becomes the stronger predictor of reading comprehension (Catts et al. 2006). This strong relationship, and the amount of shared variance between the two, suggests the importance of the comprehension process per se independently of how the text is presented. This conclusion stems from our regression analysis and in particular from the use of the autoregressor: this method allowed us to control both the correlation between reading comprehension with itself, and the correlation between reading and listening comprehension at Time 1. This analysis rules out the intervention of mediating variables in the relationship between listening comprehension at Time 1 and reading comprehension one year later: 30% of shared variance can be attributed uniquely to the level of text comprehension, namely to the processes which lead to the construction of the mental representation of the text meaning. Comprehension of a text, whether written or oral, is a complex ability that involves both cognitive and linguistic components, and occurs through various processes that have been dened as lower and higher level processes (Cain and Oakhill 2007). Among the lower level processes there are the recognition of word meanings and the construction of sentence meanings through the use of morpho-syntactic knowledge. These processes are necessary but not sufcient because the linguistic information contained in the text has to be integrated into a coherent semantic representation through inferential processes and the use of previously acquired world knowledge (Cain and Oakhill 2001). All these processes are common to reading and listening comprehension (Cain and Oakhill 2007). In a recent study it was demonstrated that also in Downs syndrome, both lower level abilities, such as receptive vocabulary and sentence comprehension, and higher level components, such as the ability to use the context, accounted for individual differences in listening comprehension (Levorato et al. 2009). What has still to be established is which factors, among those that underlie text comprehension in individuals with Downs syndrome, are shared by reading and listening comprehension, and which ones are, on the contrary, specic to each modality of text understanding. Speculatively, we could argue that short term and working memory may, at least in part, account for the unshared variance between listening and reading comprehension, and, therefore, be modality dependent. It is likely that in a reading comprehension task, where linguistic information is available for the time necessary to process it, short term memory plays a minor role; on the other hand, listening comprehension might rely more heavily on the ability to remember verbal information, and may be, therefore, a cause for a poorer performance in listening than in reading comprehension. Future investigation

Maja Roch et al. should control the effect of the modalitywritten versus oralon the involvement of short term memory in text comprehension, in particular in Downs syndrome individuals where short term memory represents an area of particular weakness (Jarrold and Baddeley 1997). The substantial inuence of poor listening comprehension explains, at least in part, the fact that reading comprehension lags behind reading skills in Downs syndrome. Listening comprehension is poor and develops very slowly, and this might also slow down the development of reading comprehension. The automatization of word recognition is a necessary prerequisite, but is not sufcient for the comprehension of written texts. The strong relationship between listening and reading comprehension, on one hand, and the relative independence of reading skills from reading comprehension, on the other, have important signicance for intervention: Training based on abilities related to comprehension of texts, whether written or oral, might be as useful as training in reading skills. Actually, the former has proven fruitful for children with typical development who have poor text comprehension abilities (Oakhill and Yuill 1996) and therefore exhibit a similar prole to that of our participants with Downs syndrome, for which the efcacy of such trainings has not yet been established. Asynchronies in improvements One of the advantages of follow-up studies is that they offer an opportunity to trace the improvements occurring over a given time period. In the current study the pattern of changes in reading comprehension and related skills during the one-year period of the study showed an improvement in all the abilities we examined, with the exception of listening comprehension, which remained stable. Reading comprehension showed some improvement although the effect size was low (0.19). Reading skills showed improvement with moderately high effect sizes (from 0.30 to 0.70), but only nonword-reading accuracy showed an increase that yielded statistical signicance and a high effect size (0.80). A slow improvement of reading and reading related skills was documented also by previous longitudinal studies (Byrne et al. 2002, Laws and Gunn 2002), in which it was demonstrated that, while reading skills show steady annual progress, two years are necessary in order to observe substantial changes in reading comprehension. The current evidence is in line with this result. We note that participants showed high performance on word reading at Time 1. We cannot say whether they would improve if the words were more difcult, or if the performance we observed mirrors the reading automatization level that the participants are able to attain. Actually, our participants, who did not perform

Reading comprehension in Downs syndrome at ceiling on non-word reading, during the year of the study, improved in accuracy. Decoding, namely the reading of non-words, is considered an area of particular weakness for individuals with Downs syndrome; this difculty is determined by very poor phonological awareness skills (Roch and Jarrold 2008). Therefore, if an improvement occurs in decoding during a one-year period, it could be suggested that boosting this ability and its underlying skills, may prove fruitful. With regards to text comprehension, some improvement in reading comprehension was documented, while listening comprehension remained stable and poor, over a one-year period. Therefore, it seems that the two abilities do not show the same rate of improvement in the same period, although they are highly interdependent. Tracing the developmental trajectories of reading and listening comprehension could contribute to a better understanding of how their development differs diachronically. Thomas et al. (2009) argue that there are at least three ways in which different improvements might be explained. The rst is that one ability develops at a slower rate than the other; the second possibility is that the two abilities follow different developmental trajectories and therefore do not show the same changes over the same period of time; the third is that both a slower rate of development and different developmental trajectories characterize the two abilities. Future studies, including participants within an appropriate age range, will have to test these different hypotheses with regards to listening and reading comprehension. Conclusions The current study shed light on important issues related to reading comprehension and its components in Downs syndrome. Nonetheless, the great portion of unexplained variance in reading comprehension suggests that while the Simple View of Reading represents a valid theoretical model of reading competence, it is not sufcient to capture the complexity of the abilities and processes involved in reading comprehension and literacy acquisition, especially in atypical development. For instance, this model does not take contextual and experience factors into consideration, and does not give any suggestion concerning the inuence of the quantity and quality of literacy teaching received. This matter is also neglected by previous studies on reading development in Downs syndrome, with the exception of very few studies that show better reading skills in children with Downs syndrome who attend mainstream schools compared with those attending special schools (Laws et al. 1995). Finally, some limits to the present study must be acknowledged, the most relevant being the number

241 of participants. Therefore, for the time being, our conclusions should be treated with caution. Nonetheless, we are condent that the pattern of results reported in the current work is quite reliable. In fact, the level reached in each ability, the pattern of relationships, the trend of improvements, and the portion of variance explained in reading comprehension are consistent with the results of a number of previous studies (Boudreau 2002, Byrne et al. 2002, Laws and Gunn 2002, Roch and Levorato 2009, Verucci et al. 2006), which, overall, support our conclusions. Acknowledgements
The authors are grateful to all the individuals with Downs syndrome who took part in this study; and to the schools for the collaboration in this work. They would also like to thank the Editor and two anonymous reviewers for their helpful suggestions. This research was nanced by a grant to the Chiara Levorato (Grant Number PRIN 2005 11 2005119758_005).

Notes
1. When we speak of reading skills, we refer to the reading of both words and non-words. To refer specically to non-word reading, we use the term decoding, whereas to refer to word reading, we use the expression word recognition. Participants are provided with the whole list of words and nonwords. Therefore, total reading time also includes the latencies between one item and another.

2.

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