Received: 11 February 2019 Revised: 3 August 2020 Accepted: 6 September 2020

DOI: 10.1111/jcal.12504

ARTICLE

A supplemental computer-assisted intervention programme

to prevent early reading difficulties in Spanish learners:
A stratified random control trial

Almudena Giménez1 | Soraya Bordoy2 | Auxiliadora Sánchez3 |

1 4 1
Miguel López-Zamora | Josep M. Sopena | Juan L. Luque

1
Facultad de Psicología y Logopedia,
Universidad de Malaga, Campus de Teatinos, Abstract
Málaga, Spain Difficulties in implementing effective instruction for at-risk students arise from two
2
UBinding, Universitat de Barcelona,
challenges: the transfer of evidence-based knowledge and the lack of economic
Barcelona, Spain
3
Consejería de Educación, Junta de Andalucía resources. Computer-assisted programmes offer a suitable solution, providing quality
4
Facultad de Psicología, Universidad de instruction using low-cost resources. Thirty-two first-grade students with early learn-
Barcelona, Barcelona, Spain
ing difficulties were identified and paired based on at least three of the pre-
Correspondence intervention reading measures (reading efficiency of monosyllabic and disyllabic
Juan L. Luque, Facultad de Psicología y
items, words, pseudowords and text reading speed). Each pair was assigned to one of
Logopedia, Universidad de Malaga, Campus de
Teatinos s/n, Málaga, CP 29071, Spain. two different intervention programmes: a computer-assisted intervention programme
Email: juan.luque@uma.es
(CAIP) focused on syllables or the programme provided by the Spanish State School
Funding information Assistance Services (SSAS). Every week, the CAIP participants received in pairs four
European Regional Development Fund, Grant/
15-min training sessions on syllable decoding plus one 30-min group comprehension
Award Number: UNMA15-CE-3657;
Secretaría de Estado de Investigación, session. The CAIP was delivered by trainee students. The SSAS programme typically
Desarrollo e Innovación, Grant/Award
consisted of a 1-hr individual or in small groups sessions per week delivered by
Number: PSI2015-65848-R; Consejería de
Innovación, Ciencia y Empresa, Junta de trained practitioners. Both programmes were administered for 11 weeks. The CAIP
Andalucía, Spain: P18-RT-1624
intervention showed better results than the SSAS intervention for both decoding and
comprehension, with moderate to large effect sizes.

KEYWORDS

computer-assisted intervention programme, randomized controlled trial, reading difficulties

1 | I N T RO DU CT I O N proven evidence in natural contexts (Snowling & Hulme, 2011).

There is general agreement in that the difficulties of dyslexic
individuals in learning to read derive of a deficit in phonological
decoding. They are characterised by slow, effortful and inaccurate
word recognition and spelling (Liberman, Shankweiler,
Liberman, 1989; Lyon, Shaywitz, & Shaywitz, 2003; Perfetti, 1985;
Torgesen, 1999). They can also exhibit comprehension difficulties dur-
ing text reading (Shaywitz, Morris, & Shaywitz, 2008).
Scientific research on the treatment of these difficulties has
emphasized the need for a well-founded theoretical framework to
plan any intervention, along with well-contrasted and scientifically
However, there is still a lack of intervention experiences assessing the
conditions that make a programme have positive effects on struggling
students. Interventions to prevent early difficulties in word decoding
in most students with phonological deficits have shown notable effect
& sizes (up to 0.70) regardless of the strategy used (Torgesen, Wagner,
Rashotte, Herron, & Lindamood, 2009), although training in phonolog-
ical skills seems crucial (Snowling, 2012). The duration of the interven-
tion has also generated considerable debate. Finally, a cost–benefit
approach will lead to the analysis of the effectiveness of teaching
assistants in implementing programmes. These issues are addressed
by comparing the effects of a computer-assisted intervention

510 © 2020 John Wiley & Sons Ltd wileyonlinelibrary.com/journal/jcal J Comput Assist Learn. 2021;37:510–520.

GIMÉNEZ ET AL.
programme with the treatment as normal provided by the school on
children at risk of reading difficulties.
Since the results of the National Reading Panel were published
in 2000 (National Institute of Child Health and Human
Development, 2000), remediation programmes, especially in the
United States, began to include training on five basic skills: phonemic
awareness, decoding (alphabetic principle), fluency, vocabulary and
comprehension. After reviewing various programmes, Scammaca,
Vaughn, Roberts, Wanzek, and Torgesen (2007) observed that suc-
cessful interventions included explicit training on phonemic aware-
ness and decoding (phonics) (e.g., Bowyer-Crane et al., 2008).
However, the effects of these two components could be over-
estimated (Camilli, Vargas, & Yurecko, 2003; Stuebing, Barth, Cirino,
Francis, & Fletcher, 2008) since students could also receive training
on other abilities, that is, text reading and comprehension (Torgesen
et al., 2009; Torgesen & Hudson, 2006), within the application of a
programme (Duff & Clarke, 2011).
Two main difficulties may explain why the application of such sci-
entific knowledge has been the exception rather than the rule in Spain.
One is the cost of training teachers or professionals to apply the basic
curriculum and/or individualized intervention programmes (Moats,
1999). The other difficulty derives from the amount of human and
material resources required to implement increasingly more intense and
individualized programmes (Fielding, Kerr, & Rosier, 2007). Surprisingly,
despite the enormous difference in the allocated resources, Torgesen
et al. (2009) describe the same problems in the United States.
A low-cost solution to overcome difficulties and economic restric-
tions could come through computer programmes. Computer
programmes allow the systematic implementation of scientific knowl-
edge and offer the possibility of individualized and gradually more
intensive practise. Moreover, a programme that incorporates scientific
advances avoids or at least reduces the cost of continuous profes-
sional training.
Several pioneering studies involving computer programmes have
found positive effects in the development of the skills necessary for
decoding words in children at risk of or with learning difficulties
(Olson, Wise, Ring, & Johnson, 1997; Torgesen & Barker, 1995). For
example, in the studies by Gustafson, Fälth, Svensson, Tjus, and
Heimann (2011, see also Fälth, Gustafson, Tjus, Heimann, &
Svensson, 2013), 130 second grade children with learning difficulties
were randomly assigned to five groups: phonological training, compre-
hension training, combined training, ordinary special instruction and
typical instruction. After 25 training sessions, the combined phonolog-
ical and reading comprehension group showed the highest gains that
persisted over a 1-year follow-up period. Phonological training was
also highly effective, indicating that children benefited from training
focused on the basic skills for reading acquisition they might be lac-
king. The effectiveness of computer programmes based on phonologi-
cal awareness and decoding to improve reading skills was
corroborated in a series of studies. Some examples are the programme
developed by Macaruso, Hook, and McCabe (2006), which targets
word attack; Magnan and Ecalle's (2006) study, which focused on
phonetic features; Regtvoort and van der Leij's (2007) approach,
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511
which trained children in phonemic awareness and letter–sound rela-
tionships; or the programme designed for the study by Saine,
Lerkkanen, Ahonen, Tolvanen, and Lyytinen (2011) based on
decoding, phonemic awareness, and vocabulary learning.
Another strategy to optimize resources is to develop interven-
tions that produce the greatest gains in the shortest period. Case
et al. (2010) reviewed the evidence concerning short supplementary
interventions for first-grade students lasting no more than 12 weeks
or not exceeding 25 hr. There were basically two types of studies:
(a) those comparing students receiving additional interventions with a
regular-class group used as a non-treatment control group and
(b) studies comparing more than two types of additional intervention.
They concluded that interventions focused on phonological aware-
ness, the alphabetical principle, decoding and fluency produced
greater gains in children at risk of reading difficulties than typical or
improved class instruction. In addition, the results were similar regard-
ing whether interventions were organized as individualized tutoring
(Allor & McCathren, 2004; McMaster, Fuchs, Fuchs, &
Compton, 2005) or in small groups (Berninger et al., 2000; Fuchs,
Compton, Fuchs, Bryant, & Davis, 2008; Hatcher, Hulme, &
Snowling, 2004; Ryder, Tunmer, & Greaney, 2008). In this vein, in one
of the most encouraging studies, Hatcher et al. (2004) found that a
group of 5- to 6-year-old children who received 10 weeks of training
(25 20-min group sessions and 25 20-min individualized sessions with
a teaching assistant, for a total of 16.6 hr) obtained equivalent gains
compared with a group that trained for 20 weeks (50 20-min group
sessions and 50 20-min individualized sessions, for a total of 33.3 hr).
This finding suggests that short-term additional instruction adminis-
tered at the right time may be as effective as long-term programmes.
However, not all studies obtained such remarkable improvements,
especially regarding the generalization and persistence of results. For
example, Duff et al. (2014) showed less than moderate short-term
effects on the experimental group in an 18-week intervention. Every
week, the experimental group received three 20-min sessions plus
two 30-min sessions in groups of 2–4 children. All sessions were
adapted to children's needs. The control group received 9 weeks of
standard education followed by 9 weeks of training on vocabulary
and narrative using story books. The authors suggested that the con-
trol children could have been exposed to some kind of explicit instruc-
tion in the classroom that reduced differences with the experimental
group. If this is the case, it could be indicating the relevance not only
of adjusting the intervention to the child's needs but also of tunning it
with the instruction received in the classroom. Despite the promise of
such short interventions, there are not enough studies that meet
methodological requirements to draw firm conclusions, and we are
aware of none in Spanish.
The reported evidence about the use of computer programmes in
Spain, although promising, is scarce. Gómez-Zapata, Defior, and Ser-
rano (2011) developed a programme for the improvement of reading
fluency adapted to 8- to 11-year-old children based on the repeated
exposure of units of increasing length (syllables, words and texts); the
results have not been published. Jiménez et al. (2007) contrasted the
effect of four different interventions (Phoneme, Whole Word,
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512 GIMÉNEZ ET AL.

Syllable, Onset-Rime) supported by computer instruction on 7- to
10-year-old poor decoders. Children received 15 sessions of
30–40 min training 40 words per session (600 words). The control
group followed the standard reading programme that included listen-
ing comprehension, spelling, reading aloud and reading comprehen-
sion activities. After training, participants assigned to the syllable and
phoneme groups obtained the best results in reading words and
pseudowords. These results highlight the role of syllable and phoneme
in learning consistent orthographies.
Given the difficulties of the State Services in Spain to change their
practises, it is necessary to design scientifically validated strategies that
offer a realistic way to optimize the available resources. The aim of this
study was to compare the effectiveness of an evidence-based
computer-assisted intervention programme (CAIP) with the intervention
normally provided by the State School Assistance Services (SSAS) in a
group of children at risk of reading disabilities. The two interventions
have comparable purposes, both offer a phonologically oriented practise
complementary to the basic curriculum taught in the classroom, include
small group work, and have similar duration. However, the interventions
differ in two aspects that are crucial for their effectiveness: the structure
of the contents and the time distribution of the training sessions.
Three core features define the intervention offered by the CAIP:
(a) it is based on findings that demonstrated the key role of decoding
in learning to read (NICHD, 2000); (b) it is focused on syllables, a regu-
lar and consistent structure in Spanish; and (c) it is tightly organized.
There is abundant empirical evidence that syllables play a privileged
role in the recognition of Spanish words at the early stages of reading

acquisition in normal readers (Alvarez, García-Saavedra, Luque, &
Taft, 2017; Goikoetxea, 2005; Jiménez, García, O'Shanahan, &
Rojas, 2010), in readers with specific learning difficulties (Luque,

López-Zamora, Alvarez, 
& Bordoy, 2013) and in adults (Alvarez,
Carreiras, & de Vega, 2000). Syllabic awareness has also proven to be
a good predictor of Spanish reading acquisition (Carrillo, 1994 ). More
importantly, the mastery of syllable assembly marks the transition
towards an autonomous learning ability (Doignon-Camus &
Zagar, 2014; Share, 1999) and consequently towards fluency in word
reading.
The implementation of intervention in older children requires
instructors with a high level of skill because, as interventions in older
children often need a tailor made strategy, their implementation
requires instructors with a high level of skill. In contrast, early and pre-
ventive interventions have shown a high impact even with poorly indi-
vidualized or non-individualized programmes. Early interventions have
consistent and large effect sizes (>0.70 on average), reducing at-risk
students to below 5% (e.g., Shaywitz et al., 2008). The CAIP resembles
these systematic and tightly organized early intervention programmes.
It is structured as lessons of increasing difficulty, and the step to the
next level is determined by the achievement of objectives clearly
defined in the programme. In this way, the instructor does not need
to make decisions. This last feature makes it possible for the CAIP to
be administered by semi-professionals. Table 1 presents a comparison
of the treatments along seven dimensions.

TABLE 1 Means, standard deviations, group differences and effect sizes for the SSAS and CAIP groups

Tasks SSAS mean CAIP mean Student's t Mean differences SD Effect size
Age 67.36 67.31 0.43 0.45 0.48 0.018
Reading
Letters 18.72 18.67 0.49 0.046 7.64 0.006
Monosyllable reading 17.98 16.4 0.29 1.58 8.09 0.195
Disyllable reading 3.83 5 0.23 −1.17 4.39 −0.27
Word reading 9.72 10.56 0.33 −0.84 5.18 −0.16
Pseudoword reading 8.63 8.31 0.43 0.31 4.56 0.068
Text reading speed 5.88 8.03 0.22 −2.16 7.66 −0.28
Phonological processing
Syllable deletion 8.31 7.38 0.28 0.94 4.47 0.21
Phoneme deletion 1.38 1.5 0.41 −0.13 1.54 −0.08
RAN digits 57 60.44 0.15 −3.44 9.078 −0.38
RAN letters 52.50 50.31 0.22 2.19 7.75 0.28
RAN colours 28 30.81 0.09 −2.81 5.97 −0.47
RAN objects 106.75 94.44 0.19 12.31 39.73 0.31
Verbal memory 34.94 34.635 0.47 0.31 11.59 0.027
Language
Speech rate 31.94 32.94 0.38 −1 8.9 −0.11
Morphosyntax 2.31 1.063 0.008 1.25 1.51 0.83
Vocabulary 13.13 14.38 0.14 −1.25 3.24 −0.39
Oral comprehension 9.63 10.06 0.39 −0.44 4.41 −0.1

GIMÉNEZ ET AL.
On the other hand, the SSAS intervention (a) lacks any systematic
pattern and (b) although it is guided by phonics, there is no specific
focus. It is run by professionals with training in oral and written lan-
guage disorders. The practitioners are responsible for the selection of
the materials and contents for each session according to their own
criteria and to the particular conditions of each school. Finally, CAIP
group and individual sessions were coordinated in such a way that the
participants practised, for example, the same target syllables in both
sessions. This collaboration is infrequent, even absent, practise in the
SSAS intervention.
Our main hypothesis was that the experimental CAIP intervention
would have a significantly better impact than the control SSAS inter-
vention on decoding skills, measured by monosyllable, disyllable, and
word and pseudoword reading tasks. It is also expected that the CAIP
intervention would produce better results than the SSAS intervention
to enable students to move out of the risk area marked by the 30th
percentile.
In this study, a randomized controlled trial (RCT) was used to test
the effectiveness of the two remedial interventions in the context of
the Spanish educational system. An RCT is a suitable methodology for
contrasting interventions that has been successfully administered in
the area of reading disorders (Clarke, Snowling, Truelove, &
Hulme, 2010; Hatcher et al., 2004; Saine et al., 2011).
2 | METHOD
2.1 | Participants and sample selection
Participants of this study were selected from a sample of 293 first-
grade children attending of from six schools in Malaga (Andalusia,
Spain). All first grade children were screened using the pre-
intervention tests. To be included in the study, participants had to be
below the 30th percentile in at least three of the five reading mea-
sures used in the pre-intervention assessment (syllable, disyllable,
word, pseudoword reading and text reading speed). This procedure
resulted in the selection of 44 students (mean age 67.3 months at the
beginning of the intervention). Most of the selected children (78%)
were below this level in four or more tests. Schools were within a
range of socio-economic levels: one with a medium-high level, three
with a medium level and two with a medium-low level. In all the
schools, synthetic reading methods (similar to phonics) were used.
A stratified randomization procedure was use to allocate children
to any of the two treatments. The selected children were ordered
according to their level of performance. The first pair of each class
was formed with the two lowest-achieving children, the second pair
was constituted by the two children with the following lowest scores
and so on until completing the 22 initial pairs. Each member of the
pair was randomly allocated to one of the two interventions:
13 females, 9 males (mean age 67.36) to the CAIP group and
14 females, 8 males (mean age 67.31) to the SSAS group. Once the
participants were distributed in treatments, they were paired again to
form the pairs that participated together in each individualized
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513
session. The child with the lowest scores was paired with the child
with the second lowest score and so on until the 11 pairs of children
assigned to each intervention were established. If a child failed to
attend 25% of the sessions, this child and the other component of the
pair were excluded from the analyses. As 6 children had poor school
attendance, the final sample consisted of 16 pairs (32 participants).
The procedure was approved by the regional government (Junta de
Andalucía). Teachers asked parents for informed written consent.
2.2 | Assessment materials and procedure
Children, who were tested individually, spent approximately 30 min in
completing the pre-intervention tests and 20 min in the post-
intervention assessment. The reading comprehension test was
responded in a group session in the main class. Two trainee students
of Psychology, who received specific training, were in charge of the
assessment and the CAIP training sessions. The pre-intervention
assessment included (a) six tasks measuring reading abilities (letter,
monosyllable, disyllable, word, pseudoword reading and text reading
speed), (b) six tasks assessing phonological skills (phoneme and syllable
deletion, four RAN tests and verbal memory) and (c) four tasks testing
oral skills by assessing speech rate, morphosyntax, vocabulary and oral
comprehension. The post-intervention assessment included (a) the six
same reading tasks used for screening, (b) one oral comprehension
task and (c) two tasks of the EDICOLE reading comprehension test
(Evaluación Diagnóstica de la Comprensión Lectora; Gómez-Veiga
et al., 2019; the Spanish version of DARC: August, Francis, Hsu, &
Snow, 2006; Francis et al., 2006). No phonological processing or oral
skills measures, except oral comprehension, were included in the
post-intervention assessment.
Since standardized tests were not available for the ages to be
evaluated, short tasks were specifically designed for this study. There-
fore, we designed short test sessions that allowed us to assess the
large number of children that made up the total sample. Two versions
of the tasks were elaborated. Task version and the order of task appli-
cation were counterbalanced. Children spent approximately 30 min in
completing the pre-intervention tests and 20 min in the post-
intervention assessment.
2.3 | Reading
The reading tasks, except reading comprehension, were used in the
pre- and the post-intervention assessment.
1. Letter reading. The 27 letters of the Spanish alphabet were pres-
ented one at a time in random order on the computer screen, and
the participant had to say the name of each letter—not its sound.
The test was discontinued if the child made five consecutive
errors.
2. Monosyllable reading. This test consisted of four activities com-
posed of 10 items of increasing difficulty. Activities 1–3 included

514
direct (CV) and mixed syllables (VC, CVC). Activity 4 contained syl-
lables with initial two-consonant clusters (CCV). An efficiency mea-
sure was computed by calculating the time taken to produce the
total of correct answers.
3. Disyllable reading. This test consisted of three activities comprising
eight items with a syllabic structure of increasing difficulty. The
first two activities included CV and CVC items, and the third
included CCV items. The total measure of disyllable reading was
the sum of the scores in each of the three activities. Time and cor-
rect answers were counted to calculate an efficiency measure.
4. Word and pseudoword reading. Two lists of 40 and 60 words and
two lists of 40 and 60 pseudowords (based on the list of words)
were used. Each list was shown on a sheet of paper. Participants
were asked to read as quickly as they could. The task was discon-
tinued after 60 s. If the participant read the whole list before 60 s,
the time was recorded. The sum of correct answers was used to
calculate an efficiency measure for word and pseudoword reading,
respectively.
5. Text reading speed. Children were asked to read two 118-word
long texts as quickly as possible without making mistakes in fewer
than 60 s. The total number of words read, the number of words
read correctly or incorrectly and the word or line reached at 60 s
were recorded. A composite measure of reading speed was calcu-
lated by adding the scores on the two texts.
6. Reading comprehension. To adapt to first-grade students, only two
of the three texts from EDICOLE were used to evaluate text com-
prehension during the post-intervention assessment. In a group
testing session, children were asked to read silently two short text
passages with a new word (pseudoword) whose properties had to
be deduced from its relation with other well-known concepts
(i.e., Eduardo likes lollipops. He also likes chupas. Chupas are like
lollipops, but they are bigger). After completing each passage, the
child was required to answer some questions intended to assess
four basic processes involved in comprehension: prior knowledge
activation (e.g., what lollipops are), storing the ideas from the text
(e.g., Eduardo likes chupas), inference making (e.g., lollipops are
smaller than chupas) and integrating new ideas with prior knowl-
edge (e.g., chupas are sweet).
2.4 | Phonological processing
These tasks were included for screening purposes only in the pre-
intervention assessment.
7. Syllable deletion. The instructor read a word aloud. The child was
required to repeat it and then say it while dropping the first sylla-
ble. A list of eight disyllabic words containing CV/CCV syllables
and four trisyllabic words with CV/CVC structures was used.
8. Phoneme deletion. The instructions were the same as for the
above activity, only that the participant had to drop the first pho-
neme of a list of disyllabic words with CV and CCV syllabic
structures.
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GIMÉNEZ ET AL.
9. Rapid automatized naming (RAN) digits. The children were pres-
ented with two separate sheets containing an array of 18 and
50 digits and asked to name each of the stimuli (moving from left
to right) as quickly as possible. RAN letters followed the same
procedure, but the items were letters. RAN colours contained an
array of 25 items. RAN objects consisted of four different arrays
of 18 pictures each. RAN objects consisted of four different
arrays of 18 pictures each that resulted of the combination of
two variables: the length of the items names (short vs. long) and
number of presentation of the items (repeated vs. not repeated).
The resulting arrays contained different short items, different
long items, short repeated items and long repeated items. The
total time taken by the student to name all the items and the cor-
rect/incorrect responses were recorded.
10. Short-term verbal memory. The instructor delivered aloud with no
intonation and at a constant speed a sequence of syllables that
do not make up a word. The student had to repeat the syllables
in the same order. The correct and incorrect repetitions were
counted. The sequences were divided into five blocks according
to the number of syllables, beginning with one and ending with
five syllable(s). The task consisted of two phases: Phase 1 with
five blocks of CV syllables and Phase 2 with five blocks of CVC
syllables. The test finished when the child made three errors in a
block (maximum score = 45 + 45).
2.5 | Oral language
Speech rate, morphosyntax and vocabulary were only included in the
pre-intervention assessment.
11. Word and pseudoword repetition rate (speech rate). The child had
7 s to repeat as quickly and as many times as possible a sequence
of two words (e.g., tela-bola) or two pseudowords (e.g., pina-
tesmi) spoken by the assessor. There were four word–word and
four pseudoword–pseudoword sequences. The number of cor-
rect repetitions was recorded.
12. Morphosyntax. In Spanish the last syllable of a conjugated verb
agree with the person/tense. For example, in saltas the
morpheme—as indicates second person singular you jump),
escribo—o indicates first person singular (I write). The assessor
spoke a conjugated verb in present, and the child was required to
provide the pronoun that agrees with the person indicated in the
verb. The test finished after 1 min 30 s or when the child made
three consecutive errors. The correct and incorrect responses
and time were recorded to calculate an efficiency measure.
13. Vocabulary. In this task the experimenter read aloud the name of
familiar words and encouraged the child to point to the
corresponding image. For example, Cama (bed), saludo (greeting).
The computer screen showed four images for each item (the object
image, two semantic distractors and one unrelated image). The test
comprised 2 examples and 24 test items. The number of correct
answers and the time taken to complete the task were recorded.

GIMÉNEZ ET AL.
14. Oral comprehension. The following two texts were administered
during pre- and post-intervention but were not considered for
screening. Test 1: The examiner read a short story divided into two
parts. The child responded to 4 questions after the first part and
10 after the second. Test 2: The examiner read three texts that
included brief dialogues between characters. Each text was read
once before asking five questions. In both tests, questions were
repeated if requested by the child. Answers were classified as cor-
rect, incorrect and no reply. In the case of ambiguity, the examiner
asked for more information to correctly classify the response.
3 | TRAINING PROCEDURES
3.1 | The (experimental) CAIP
Individualized and group sessions were administered by the same two
trainee Psychology students who carried out the assessment. These
students were monitored by the authors to ensure adherence to
protocol.
3.1.1 | Individualized sessions
Children were divided into pairs for individualized 15-min sessions in
a room in the same school they attended. The content of each session
was selected according to the current skill level of one of the partici-
pants. The other child of the pair participated as an observer. Each
session was intended as a training activity for the targeted child and a
review, or an advanced lesson, for the observer. Individualized ses-
sions consisted of 22 training and assessment activities organized in
order of syllable difficulty. Training included reading, decision or mem-
ory activities. For any training lesson, two simplified versions (half of
the items each) were designed. In the reading activities, the child was
asked to read words, non-words, noun and verb phrases, or short sen-
tences containing the targeted syllables. Items could appear on a
background representing a blackboard or include game-like tasks. For
example, in a simulated car race, the speed of one car was determined
by the child's reading speed, while the speed of a second car repre-
sented the reading speed of the same child in the previous session. In
the decision tasks, the child first read aloud the items shown on the
screen. Then, he/she was required to decide if the item was a vowel
or consonant; a word or a non-word, or to take semantic decisions
(categorization, thematic relations, synonymy etc.). Finally, the memory
activities trained repetition, order and comparison between items. For
example, given the sequence PA-DO-LE children were asked to repeat
it, to name the second syllable or say if it were same or different to
the previous sequence.
At the end of the session, two simple reading tasks were used to
assess the level achieved by the child and to decide the following ses-
sion. The first task included items from the previous session, and the
second task included the items of the just finished session. If the
targeted child made fewer than 20% errors, a lesson at the next level
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515
was administered in the following session. In contrast, if the child made
more than 20% errors, he/she received a simplified lesson at the same
level. Thus, statistical criteria avoided the need for clinical decisions. A
laptop was used for stimuli presentation and data collection. The trainee
students were instructed to run the programme and record the child's
response, without the provision of feedback or assistance in the task.
3.1.2 | Group sessions
The group instruction consisted of 20 30-min sessions of computer-
presented activities in the mainstream class (a mean of 25 children
per class). The programming of these sessions was coordinated with
the teacher so they took place when children assigned to the SSAS
intervention were receiving their treatment sessions. In this way, only
the CAIP children and their classmates not assigned to any interven-
tion participated in the group sessions.
In the decoding reinforcement sessions, children practised the sylla-
bles they had been trained on during that same week in the paired
sessions. In the vocabulary and comprehension sessions, the teacher
used projected images to tell a story, asking questions, stimulating
attention, helping the children recognize the emotions and motives of
the characters depicted etc. The use of polysemic words, homonyms,
differences between facts and opinions was encouraged. Finally, exer-
cises to stimulate short-term memory were provided.
In sum, for 11 weeks, every child made a weekly participation in
two 15-min target sessions, two 15-min sessions as an observer and
one 30-min group session. The total intervention time was 16 hr and
30 min.
3.1.3 | The (control) SSAS intervention
The SSAS intervention was administered in groups of two to three
children by five different school speech therapists. The children ran-
domly assigned to the SSAS intervention were grouped according to
their difficulties or their level of achievement. The procedures used
were based on phonics. Letter-sound associations, manipulations such
as phoneme or syllable deletion, synthesis into syllables and words, or
word segmentation, training on fluency, vocabulary learning, word
and pseudoword reading are some examples of the activities devel-
oped. Each session in the SSAS intervention was planned by the ther-
apist according to her/his own criterion to adapt to the children's
needs. For 11 weeks, children attended sessions lasting approximately
1 hr and a half once or twice a week, depending on the availability of
the speech and language therapist. Each child received between
15 and 17 hr of intervention.
4 | RE SU LT S
The aim of this study was to examine the effectiveness of a computer-
ized programme (CAIP) to improve reading achievement for a group
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516 GIMÉNEZ ET AL.

of children at risk of reading difficulties. Results attained by children
following the computerized programme were compared with the out-
comes obtained by the standard instructional intervention carried out
in public schools (SSAS). The participants in this study were children
who performed below the 30th percentile on at least three of five
reading tasks (syllable, disyllable, word, pseudoword reading and text
reading speed). These five measures were administered again during
the post-intervention phase to assess instruction effectiveness.
Differences between groups were analysed using Student's t test.
As shown in Table 1, there were no statistically significant differences
between groups on the pre-intervention measures with one excep-
tion. The SSAS group outperformed the CAIP group on the mor-
phosyntax scores.
The post-intervention results are shown in Table 2. There
were significant differences between the groups in 10 of the
12 tasks: monosyllable (0.014) and disyllable (0.041) reading,
comprehension-previous knowledge (0.04), comprehension-memory
(0.01), comprehension-inferences (0.01) and overall comprehension
(0.006). There were also marginal differences in word (0.056),
pseudoword (0.083) reading, text reading speed (0.068) and
comprehension-integration (0.096).
The effect size was calculated using Cohen's d. The values
obtained (see Table 2) point to a significantly greater impact of the
CAIP intervention compared with the SSAS in all tasks. There was a
moderate effect size for disyllable reading (−0.61), word reading
(−0.56), pseudoword reading (−0.49), text reading speed (−0.53),
comprehension-prior knowledge (−0.62) and comprehension-
integration (−0.49). The effect size was particularly large for monosylla-
ble reading (−0.76), comprehension-memory (−0.79), comprehension-
inferences (−0.79) and comprehension (−0.86).
Table 3 offers a comparison between children's performance on
pre- and post-intervention tasks. A significant impairment was defined
by a performance below the 30th percentile on at least three out of
the five measures. To determine the efficacy of the two intervention
programmes, the results will be expressed in percentages.
Post-intervention results show that while 11 (68.75%) of the
CAIP participants moved out of the area defined as impaired (below
the 30th percentile), compared to only 7 (43.7%) of the SSAS partici-
pants. This means that the CAIP improved decoding skills for 25%
more children than the SSAS.
Outcomes for reading comprehension also showed remarkable
differences between programmes. After participating in the CAIP, all
the participants with gains in decoding showed good comprehension.
This gain was only observed in two SSAS participants. Unexpectedly,
three CAIP and three SSAS participants who were still struggling with
decoding were above the 30th percentile on reading comprehension.
Altogether, there were 14 participants from the CAIP and 5 from the
SSAS intervention who had good reading comprehension, rep-
resenting 87.5% and 25% of the participants, respectively. These per-
centages revealed that the CAIP produced an easier transfer from
decoding to reading comprehension than the SSAS intervention. The
overall scores and three of the four measures were significantly higher
in the CAIP than those obtained in the SSAS condition and provided
large effect sizes. Only the measure of integration (the most difficult
process during reading) showed marginally significant differences and
yielded a moderate effect size.
5 | DI SCU SSION AND CO NCLUSIO NS
The goal of this study was to compare the effectiveness of a short
CAIP to improve reading skills in children with identified difficulties in
the acquisition of literacy, with the treatment as normal provided by
the Spanish State School Assistance Services (SSAS). The outcomes

T A B L E 2 Post-test mean scores and

Tasks SSAS CAIP t Mean differences SD Effect size
differences between SSAS and CAIP
Reading conditions
Letters 35.33 37.51 0.28 −2.18 10.48 −0.21
Monosyllable reading 45.52 55.38 0.014** −9.86 12.96 −0.76
Disyllable reading 24.31 30.60 0.041** −6.29 10.25 −0.61
Word reading 32.60 39.08 0.056* −6.48 11.52 −0.56
Pseudoword reading 28.26 32.5 0.083* −4.21 8.53 −0.49
Text reading speed 48.49 60.69 0.068* −12.19 23.02 −0.53
Language
Oral comprehension 15.38 16.13 0.32 −0.75 4.44 −0.17
Reading comprehension
Previous knowledge 3.13 3.69 0.04** −0.57 0.91 −0.62
Memory 1.75 2.75 0.01** −1 1.27 −0.79
Inferences 1 1.86 0.01** −0.86 1.1 −0.79
Integration 2.38 3.13 0.096* −0.75 1.6 −0.47
Total 8.25 11.48 0.006** −3.19 3.69 −0.86

*Marginal p ≤ .1.
**p ≤ .05.
 TABLE 3 Resistance to treatment in both intervention conditions

Pre-test Post-test

Texts Texts Resistance to Reading

GIMÉNEZ ET AL.

Subjects Monosyllables Disyllables Words Pseudowords speed Monosyllables Disyllables Words Pseudowords speed treatment comprehension
Condition 1 − − − − − − − − − − 0 −
SSAS 2 − − − − − − − − − − 0 −
3 − − − − − − − − − − 0 −
4 − − − + − + + + + + 1 −
5 − − − − − + + + + + 1 +
6 − − − − − + + + + + 1 −
7 − − − − − − − − − − 0 −
8 + + − − − + + − − − 0 +
9 + − − − − + + + + + 1 −
10 − + − − − + − − − − 0 −
11 − − − − − + + + + + 1 +
12 − − − − − + + + + + 1 −
13 − − − − − − − − − − 0 +
14 − − − − − − − − − − 0 −
15 − − − − − + + − − − 0 +
16 + − − − − + + + + + 1 −
Condition 17 − − − − − − − + + + 1 +
CAIP 18 + − − + − − − − − − 0 −
19 − − − − − + − − − − 0 −
20 + + − − − + + + + + 1 +
21 − − − − − + + + + + 1 +
22 − − − − − + + + + + 1 +
23 − + − − − + + + + − 1 +
24 + + − − − + + + + + 1 +
25 − − − − − + − − + − 0 +
26 − − − − − + + + − − 1 +
27 − − − − − + + + + + 1 +
28 − − − − − − + + + + 1 +
29 − − − − − − − − − − 0 +
30 − − − − − + + + + + 1 +
31 − − − − − + + + + + 1 +
32 − − − − + − − − − − 0 +
517

Notes: + = percentile >30; − = percentile ≤30; 0 = resistance; 1 = progress. A dash indicates scores below the 30th percentile, a cross scores above this limit.

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518
showed that after 11 weeks of intervention, the CAIP children out-
performed the SSAS children on all measures. Improvements were sig-
nificant in monosyllable and disyllable reading and marginal in words,
pseudowords and text reading speed. All tasks showed moderate
effect sizes comparable to those obtained in other studies using com-
puter assistance (e.g., Torgesen et al., 2009), confirming that training
on decoding, specifically using syllables as core units, is of crucial rele-
vance at the first stages of reading (Hatcher et al., 2004; Scammaca
et al., 2007). SSAS children also made gains but to a lesser extent than
the CAIP group. More specifically, although both groups had partici-
pants who were resistant to treatment, 25% more children moved out
from the 30th percentile and caught up with their peers' reading level
among children receiving the CAIP compared with those in the SSAS
intervention.
The CAIP's effectiveness in facilitating literacy skills might have
arisen from three key properties. First, according to the most suc-
cessful interventions (phonics; e.g., Bowyer-Crane et al., 2008),
training was focused on phonemic awareness and decoding. In this
case, the predominant role of syllables in reading and accessing the
Spanish lexicon led us to promote the learning of the different sylla-
ble types graded by complexity. Another significant aspect of the
intervention was the coordination between individualized and main-
classroom sessions. Thus, children were exposed to the same type
of syllables in different contexts, having also the opportunity to
expand their vocabulary (Torgesen et al., 2009). A third strength of
the CAIP is that training was adapted to the child's skills level and
systematically scheduled to achieve progressively higher levels of
complexity.
An unexpected outcome was that the CAIP children showed
higher scores in reading comprehension than the SSAS group, and
that we obtained larger effect sizes than previous studies that, con-
trary to the CAIP, included explicit training in reading comprehension
(Clarke et al., 2010; Gustafson et al., 2011). Unfortunately, any con-
clusion should be taken with caution because a number of reasons led
to not including reading measures in the pre-test. First, the partici-
pants, who had just started reading (with an average age of 5.5 years),
had scores below the 30th percentile in the more basic reading skills.
If they could barely read, there was no point in evaluating reading
comprehension. Furthermore, the programme was addressed to
improve decoding, not reading comprehension. Therefore, it was not
expected to find significant individual differences in the pre-test
phase. Nevertheless, given the interest of this result, it is worth con-
sidering the set of variables assessed in both phases, mainly with the
aim of designing future research.
As the Simple View Model states (Tunmer & Chapman, 2012),
reading comprehension involves two types of components: those
leading to word recognition (through decoding) and processes of com-
prehension based on oral language abilities. Then, the effect on read-
ing comprehension might have been mediated by the training in
vocabulary and oral comprehension received in the main class. A large
body of research suggests that vocabulary knowledge plays a key role
in the development of reading skills (e.g., Hulme & Snowling, 2014).
Vocabulary contributes to word recognition but also has an additional
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GIMÉNEZ ET AL.
influence on phonological awareness and decoding (e.g., Metsala &
Walley, 1998; Ziegler & Goswami, 2005).
Consistent with this claim, group sessions designed to learn new
vocabulary and to enhance the ability to retrieve and relate informa-
tion from words might explain why CAIP children exhibited better
reading comprehension (Perfetti, 2007). However, the fact that the
two groups did not differ in their performance on oral comprehension
in either the pre- or the post-intervention phase certainly argues
against such an interpretation. Following the Simple View Model, the
alternative hypothesis is that there was a causal connection between
the advances in decoding and the performance in reading skills
(e.g., Carrillo, 1994). Note that EDICOLE was chosen to assess reading
comprehension for its low loading on decoding. The performance
depends on the child's ability to establish connections among the con-
cepts within the text. Therefore, although differences in decoding
were medium size, this increase could have been enough to free up
processing resources that might be allocated to the task of under-
standing the text. In line with this prediction, all the CAIP children
who moved out from the 30th percentile in decoding also achieved
good performance in reading comprehension.
In conclusion, CAIP has shown to be a suitable tool for attaining
two main objectives: the transfer of scientific knowledge into school
practise and a reduction in teaching resources. The findings replicate
the positive effects of pioneering computer programmes (Olson
et al., 1997; Torgesen & Barker, 1995), especially programmes
designed for early intervention in children with reading difficulties
(Macaruso et al., 2006; Magnan & Ecalle, 2006; Regtvoort & van der
Leij, 2007; Saine et al., 2011). The results indicate that computer-
assisted training on decoding in pairs combined with regular class-
room instruction on vocabulary and language comprehension proved
to be effective in improving reading skills. Finally, an interesting impli-
cation of the systematic instructional model proposed by the CAIP is
that instructors do not need to make decisions about timing or con-
tent. Consequently, people without professional training—even family
members1—may be able to administer the training with minor guid-
ance, although efficacy when delivered by non-professionals would
need to be tested.
The small size of the sample, the lack of a follow up to inform the
maintenance of gains, the absence of a reading comprehension test
during the pre-intervention assessment and insufficient control over
the SSAS administration might have limited the scope of this study.
However, these limitations should not lead to the conclusion that the
findings are invalid. The encouraging results show that a tightly tem-
poral organization and a careful selection of the contents lead to nota-
ble results. This study demonstrates that scientific evidence could be
easily transferred to practise through computer programmes without
this implying a greater workload or costly training for the profes-
sionals in charge of the intervention.
AC KNOWLEDG EME NT S
This research was supported by the PSI2015-65848-R and
UNMA15-CE-3657 Grants from the Spanish government (MINECO)
and European Regional Development Fund (ERDF).

GIMÉNEZ ET AL.
P EE R R EV I E W
The peer review history for this article is available at https://publons.
com/publon/10.1111/jcal.12504
DATA AVAI LAB ILITY S TATEMENT
The data that support the findings of this study are available from the
corresponding author upon reasonable request.
CONF LICT OF IN TE RE ST S
The authors declare no conflict of interest.
ORCID
Almudena Giménez https://orcid.org/0000-0003-2666-0659
Soraya Bordoy https://orcid.org/0000-0002-5817-1318
Auxiliadora Sánchez https://orcid.org/0000-0003-2204-690X
Miguel López-Zamora https://orcid.org/0000-0003-3466-4465
Juan L. Luque https://orcid.org/0000-0002-3199-4808
ENDNOTE
1
The computer programme and the materials were obtained from two
systems developed and marketed the first, BINDING, by the University
of Barcelona, (https://uditta.com/index.php/es/servicios/binding), and
the second, LEEDUCA, by the University of Málaga (http://www.
leeduca.uma.es/leeduca/). These programmes are currently being admin-
istered at home by parents under direct supervision of a speech thera-
pist that designs and adapts the sessions to the child's needs.
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How to cite this article: Giménez A, Bordoy S, Sánchez A,
López-Zamora M, Sopena JM, Luque JL. A supplemental
computer-assisted intervention programme to prevent early
reading difficulties in Spanish learners: A stratified random
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doi.org/10.1111/jcal.12504