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Effectiveness of a Comprehensive Game-Based Intervention for Writing Skills

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Title: Effectiveness of a Comprehensive Game-Based Intervention for Writing Skills
Language: English
Authors: María Carmona (ORCID 0009-0007-3981-6567), Macarena De los Santos-Roig (ORCID 0000-0003-0566-743X), Sara Mata (ORCID 0000-0002-4648-013X), Francisca Serrano (ORCID 0000-0001-9000-6892)
Source: Reading and Writing: An Interdisciplinary Journal. 2026 39(1):121-139.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 19
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Education Level: Elementary Education
Descriptors: Game Based Learning, Writing Skills, Writing Improvement, Spanish, Elementary School Students, Foreign Countries, Reading Difficulties, Writing Difficulties, Writing Instruction, Intervention, Feedback (Response), Direct Instruction, Instructional Effectiveness, Suprasegmentals, Psychoeducational Methods, Phonological Awareness
Geographic Terms: Spain
DOI: 10.1007/s11145-025-10636-w
ISSN: 0922-4777
1573-0905
Abstract: This study explores the effectiveness of a comprehensive intervention program for improving writing skills in Spanish. Participants were 167 Spanish children (3rd to 6th Grades) with reading and writing difficulties and typical development. Children exhibited problems in writing, reading, and related skills, like phonological and prosodic skills. The intervention targeted the reinforcement of orthographic patterns, decoding activities based on meta-analytical strategies; meta-phonological, morphological, and prosodic activities; visual vocabulary; sentence building, and reading, considering the reciprocity between both skills in literacy development. It was a paper-and-pencil program, considering the main approaches of writing intervention (cognitive and multisensorial), the relevance of frequent and direct feedback, the use of explicit instructions, the recommended levels of intervention (sub-lexical, lexical, and sentence levels), and the use of motivating activities through a game-based design. Sixteen individualized sessions of direct, systematic, and explicit training were conducted with the support of a trainer who provided immediate and continuous feedback. A quasi-experimental non-equivalent waiting control group pre-post intervention design, with three groups (intervention group; waiting-control group; and typical development group), was applied. Results showed that the intervention had a positive impact on writing-related skills. Specifically, children who received the intervention performed close to peers without difficulties in several tasks after the intervention program, especially those involving phonological and prosodic processing. These findings support that phonological and prosodic training is related to writing performance and its development. Furthermore, this study presents psychoeducational implications because it supports that explicit and supplemental meta-phonological strategies could play an important role in teaching writing to children with reading and writing difficulties.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1505332
Database: ERIC
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  Value: <anid>AN0191377946;2ap01jan.26;2026Feb09.04:28;v2.2.500</anid> <title id="AN0191377946-1">Effectiveness of a comprehensive game-based intervention for writing skills </title> <p>This study explores the effectiveness of a comprehensive intervention program for improving writing skills in Spanish. Participants were 167 Spanish children (3rd to 6th Grades) with reading and writing difficulties and typical development. Children exhibited problems in writing, reading, and related skills, like phonological and prosodic skills. The intervention targeted the reinforcement of orthographic patterns, decoding activities based on meta-analytical strategies; meta-phonological, morphological, and prosodic activities; visual vocabulary; sentence building, and reading, considering the reciprocity between both skills in literacy development. It was a paper-and-pencil program, considering the main approaches of writing intervention (cognitive and multisensorial), the relevance of frequent and direct feedback, the use of explicit instructions, the recommended levels of intervention (sub-lexical, lexical, and sentence levels), and the use of motivating activities through a game-based design. Sixteen individualized sessions of direct, systematic, and explicit training were conducted with the support of a trainer who provided immediate and continuous feedback. A quasi-experimental non-equivalent waiting control group pre-post intervention design, with three groups (intervention group; waiting-control group; and typical development group), was applied. Results showed that the intervention had a positive impact on writing-related skills. Specifically, children who received the intervention performed close to peers without difficulties in several tasks after the intervention program, especially those involving phonological and prosodic processing. These findings support that phonological and prosodic training is related to writing performance and its development. Furthermore, this study presents psychoeducational implications because it supports that explicit and supplemental meta-phonological strategies could play an important role in teaching writing to children with reading and writing difficulties.</p> <p>Keywords: Learning difficulties; Writing skills; Intervention program; Phonological awareness; Prosodic awareness; Psychology and Cognitive Sciences Psychology Medical and Health Sciences Public Health and Health Services</p> <hd id="AN0191377946-2">Effectiveness of a comprehensive game-based intervention for writing skills</hd> <p>Writing, along with reading, are essential tools for cognitive development and academic progress. In Spain, 8.5% of students in primary school present specific Learning Difficulties (LD) in reading and writing (Ministry of Education and Vocational Training, [<reflink idref="bib30" id="ref1">30</reflink>]), limiting individuals' ability to access information and affecting employment opportunities, health outcomes, and civic engagement (Ezpeleta Aguilar, [<reflink idref="bib12" id="ref2">12</reflink>]). The Education Indicators in Focus (EDIF) reports highlight that Language and Mathematics make up 50% of the school curriculum's hours, stressing the relevance and need of these abilities for successful academic performance (National Institute of Statistical Education, [<reflink idref="bib33" id="ref3">33</reflink>]). Moreover, the Progress in the International Reading Literacy Study (PIRLS) report (2021) states that early optimal literacy-related skills learning is related to academic achievement in higher grades (Mullis & Martin, [<reflink idref="bib32" id="ref4">32</reflink>]).</p> <p>Enhancing literacy strategies improves communicative competence aiding in addressing LD, and ties into educational goals like fostering critical and creative thinking, which is essential for students to adapt and progress in diverse environments (Jiménez-Pérez, [<reflink idref="bib25" id="ref5">25</reflink>]). Interventions should be meaningful and engaging for enhancing active participation and designed to promote enriching learning environments (Montes-Miranda, [<reflink idref="bib31" id="ref6">31</reflink>]; Jarpa-Azagra et al., [<reflink idref="bib23" id="ref7">23</reflink>]). Active class participation helps a more conducive learning environment that fosters communication (Pillajo et al., [<reflink idref="bib34" id="ref8">34</reflink>]). Moreover, high-quality subject matter instruction alone is less effective for developing critical ability compared to skill sequencing (Jarpa-Azagra et al., [<reflink idref="bib23" id="ref9">23</reflink>]).</p> <p>Research has developed several proposals focused on different academic and language levels (syllable, word, text), and LD typologies for reading and writing skills reinforcement; however, proposals have mainly targeted reading more than writing (Al Otaiba et al., [<reflink idref="bib2" id="ref10">2</reflink>]). In Spanish, there is no agreement on validated comprehensive intervention proposals due to these different perspectives and the difficulty of accessing representative samples (Gutiérrez & Díez, [<reflink idref="bib18" id="ref11">18</reflink>]). There is a need for evidence-based and comprehensive intervention programs that consider the complexity of both skills and the interrelated processes between them (Andersen et al., [<reflink idref="bib4" id="ref12">4</reflink>]; Graham et al., [<reflink idref="bib16" id="ref13">16</reflink>]).</p> <p>Intervention procedures focused on reinforcing the underpinning skills related to these processes provide significant effectiveness in children with LD (Gillespie & Graham, [<reflink idref="bib14" id="ref14">14</reflink>]). In a didactic context, the relationship between writing instruction and reading practice is essential for orthographic development (Andersen et al., [<reflink idref="bib4" id="ref15">4</reflink>]). When students read, they internalize correct spelling patterns, recognize familiar words, and develop an understanding of spelling conventions. Conversely, when they write and encounter spelling errors, they may seek corrections through reading, reinforcing correct orthographic knowledge. Knowing how words are spelled can aid in recognizing word families, prefixes, suffixes, and morphemes, which results in understanding the meaning of unfamiliar words (Rueda-Sánchez & López-Bastidia, [<reflink idref="bib37" id="ref16">37</reflink>]). Moreover, proficiency in spelling and understanding orthographic rules enhances reading comprehension (Jiménez et al., [<reflink idref="bib24" id="ref17">24</reflink>]).</p> <hd id="AN0191377946-3">Evidence-based practices for writing instruction</hd> <p>Writing encompasses a wide range of processes and skills that enable individuals to effectively communicate through written language (Berninger, [<reflink idref="bib6" id="ref18">6</reflink>]). Therefore, intervention in writing skills should consider the complexity of processes and skills. The 'simple view of writing' states that writing proficiency can be understood through the correlation between transcription skills (spelling) and ideational skills (generating and organizing ideas) (Juel et al., [<reflink idref="bib27" id="ref19">27</reflink>]). Additionally, the 'triangle model' conceptualizes the writing process as a set of cognitive, linguistic, and motor competencies dependent on higher-order processes (Berninger & Swanson, [<reflink idref="bib7" id="ref20">7</reflink>]). A strong foundation in sub-lexical skills predicts higher-level writing competencies (Andersen et al., [<reflink idref="bib4" id="ref21">4</reflink>]); thus, meta-analytic studies propose multicomponent writing instruction, including the writing process and skills-based programs (Berninger et al., [<reflink idref="bib8" id="ref22">8</reflink>]).</p> <p>Several treatments aimed at strengthening underlying skills play a fundamental role in both writing and reading processes for writing instruction support. This encompasses different perspectives and strategies varying from explicit training in handwriting production and spelling to phonologic, morphologic, lexical, and prosodic skills, combining different theoretical perspectives, being the cognitive and multisensorial approaches the main (Santangelo & Graham, [<reflink idref="bib38" id="ref23">38</reflink>]).</p> <p>Handwriting production, including dictation and tracing tasks, contributes to improving writing and reinforcing writing and reading associations (López-Escribano et al., [<reflink idref="bib28" id="ref24">28</reflink>]). Jiménez et al. ([<reflink idref="bib24" id="ref25">24</reflink>]) found improvement in transcription skills in Spanish students in 1st and 2nd Grades, by employing handwriting and spelling exercises (words and pseudowords dictation and sentence writing). The intervention was applied in small groups (3–5 students) for five months (3–4 sessions per week of 45–55 min). Bazis et al. ([<reflink idref="bib5" id="ref26">5</reflink>]) showed reciprocal benefits of teaching handwriting and phonological awareness (PA) in an intervention program for English-speaking students in the 2nd and 3rd Grades. The intervention was applied in small groups (3–4 students) for two months (4 sessions per week of 15 min). Sessions focused on tracing, copying, and dictation tasks with repeated practice, supporting the potential benefits of reciprocal reading-and-writing reinforcement approaches. Graham et al. ([<reflink idref="bib17" id="ref27">17</reflink>]) found greater gains in writing skills after applying supplemental PA training to English-speaking children in 1st Grade. The intervention was individually applied for two months (3 sessions per week of 20 min). Those students receiving meta-phonological activities compared to the children who only received writing-skills training, reported greater performance in spelling accuracy and handwriting fluency.</p> <p>In Spanish, the works of Rueda et al. ([<reflink idref="bib36" id="ref28">36</reflink>]) and Rueda and Sánchez ([<reflink idref="bib35" id="ref29">35</reflink>]) reported positive results in writing performance and transfer to uninstructed tasks, in dyslexic children in 3rd Grade, after applying meta-phonological skills training. The intervention was individually applied for five months (3 sessions per week of 45 min). Gutiérrez and Díez ([<reflink idref="bib18" id="ref30">18</reflink>]) also reported greater benefits in writing performance than in reading performance by applying a PA-based intervention program to students in 1st Grade. The intervention was individually applied for six months (4 sessions per week of 45 min). Participants improved their ability to encode pseudowords and to construct sentences with correct word segmentation. Taken together, decoding skills training contributes to writing performance (Graham et al., [<reflink idref="bib16" id="ref31">16</reflink>]), and combining PA and decoding training, makes them add up to the effects of intervention (Graham et al., [<reflink idref="bib16" id="ref32">16</reflink>], [<reflink idref="bib17" id="ref33">17</reflink>]).</p> <p>Other evidence-based practices include morphological awareness training, which supports the enhancement of decoding and spelling skills, and vocabulary and lexical knowledge (Rueda-Sánchez & López-Bastidia, [<reflink idref="bib37" id="ref34">37</reflink>]). Teaching students morphemic and contextual analysis can improve their writing skills, while morphological instruction has been shown to enhance vocabulary acquisition (Afonso et al., [<reflink idref="bib1" id="ref35">1</reflink>]). Meta-analytic studies report positive outcomes, when including morphology training in primary school (Rueda-Sánchez & López-Bastidia, [<reflink idref="bib37" id="ref36">37</reflink>]). Improvements have been found across writing, reading, comprehension, and vocabulary, regardless of the length of the intervention.</p> <p>Other proposals have focused on training prosodic features, often represented through punctuation (Gutiérrez-Palma et al., [<reflink idref="bib19" id="ref37">19</reflink>]), sentence structure, and word choice depending on the suprasegmental features of meaning, word grammatical category, and lexical stress rules in Spanish (Jordán et al., [<reflink idref="bib26" id="ref38">26</reflink>]). Incognito et al. ([<reflink idref="bib21" id="ref39">21</reflink>]) focused on enhancing lexical competence through narrative and metacognitive exercises, reporting better spelling accuracy, reading comprehension, and lexical competence in 2nd Grade. The intervention was applied for six months (once a week for 2–3 h).</p> <p>Finally, vocabulary training, the integration of word memory games, word search puzzles, and completing sentence tasks also reinforce writing abilities and facilitate access to the orthographic lexicon (Afonso et al., [<reflink idref="bib1" id="ref40">1</reflink>]).</p> <p>Overall, holistic approaches have demonstrated significant improvements in writing skills by integrating reading, vocabulary knowledge, PA (González-Valenzuela & Martín-Ruiz, [<reflink idref="bib15" id="ref41">15</reflink>]), and orthographic and morphological training (Berninger et al., [<reflink idref="bib8" id="ref42">8</reflink>]).</p> <hd id="AN0191377946-4">The present study</hd> <p>Research has predominantly focused on enhancing targeted writing skills, overlooking other abilities that are integral to overall writing development (Graham et al., [<reflink idref="bib16" id="ref43">16</reflink>]). This paper focuses on assessing the effectiveness of a comprehensive program aimed at improving writing skills in Spanish primary school children with LD (Iniesta & Serrano, [<reflink idref="bib22" id="ref44">22</reflink>]). The main goal is to address the combination of all those underlying skills mentioned above in a comprehensive intervention program since research highlights that all of them contribute to reinforcing reading and writing associations and positively drive writing skills performance.</p> <p>Following meta-analytic findings, the intervention was designed to comprise multiple evidence-based instructional practices such as explicit, systematic, and intensive training, repeated practice, meta-phonological strategies (Graham et al., [<reflink idref="bib16" id="ref45">16</reflink>]), and cognitive and multisensorial approaches (Santangelo & Graham, [<reflink idref="bib38" id="ref46">38</reflink>]). Furthermore, it is essential to consider the type of word, word frequency, word length, word and syllable complexity, and, especially, transparency of the language because of the significant relationship with writing performance (Afonso et al., [<reflink idref="bib1" id="ref47">1</reflink>]). This intervention program considers the main complexities and characteristics of the Spanish language, and it is aimed at strengthening lexical and sub-lexical processing (Iniesta & Serrano, [<reflink idref="bib22" id="ref48">22</reflink>]).</p> <p>The main hypothesis is that children with LD who received the intervention will show greater performance in writing tasks compared with their LD peers, who did not receive it, reporting fewer errors and more accuracy in tasks' performance. Additionally, children receiving the intervention will approach their performance levels to those of children without difficulties, reducing the academic gap caused by LD.</p> <p>The first objective is, on the one hand, to analyze pre-intervention scores of children with LD to study the equivalence in performance among them; on the other hand, to compare pre-intervention scores of the children with LD who received the intervention and the children with typical development (TD), who did not receive it, to study the differences in performance.</p> <p>The second objective is to test the effectiveness of the intervention program. A significant progression in post-intervention scores is expected in children who received it, compared with children with LD from the waiting control group.</p> <p>The third objective is to compare the post-intervention scores of children with LD who received the intervention and children with TD. It is expected to observe a narrowing of the performance gap between both groups.</p> <hd id="AN0191377946-5">Method</hd> <p></p> <hd id="AN0191377946-6">Design</hd> <p>This study presents a quasi-experimental non-equivalent waiting control group pre-post intervention design with three groups: intervention group (LD-i), waiting control group (LD-w), and typical development group (TD).</p> <p>The dependent variables were the measures of writing skills (pseudoword, unregulated, and regulated word dictation tasks), literacy-related skills (phonemic awareness – blending phonemes and counting sounds tasks – and prosodic awareness – lexical stress awareness task–), and reading comprehension. The independent variable was the intervention program. Finally, age, grade, sex, and working memory (WM) were controlled.</p> <hd id="AN0191377946-7">Participants</hd> <p>Participants were recruited using a non-probabilistic procedure. They were 167 Spanish children, ranging from 3rd to 6th Grades, with reading and writing difficulties (Learning Difficulties – LD) or without any difficulty (Typical Development – TD), selected from 11 different primary school centers (public, private, and semi-private schools). Sociodemographic information is shown in Table 1.</p> <p>Children with LD were previously diagnosed by the Regional Educational Authorities (REA), responsible for the diagnosis of students' educational profiles in Spain, following Specific Educational Support Needs (SESN) criteria (Department of Educational Development and Vocational Training, [<reflink idref="bib11" id="ref49">11</reflink>]). The students presented difficulties in decoding and reading fluency, writing (orthographic and spelling skills), and related skills like phonological and prosodic skills, grammar, and/or graphomotor processes. REA's diagnosis followed DSM-5 (American Psychiatric Association, APA, [<reflink idref="bib3" id="ref50">3</reflink>]) guidelines, which identify LD in reading and writing as Specific Learning Disorders with difficulties in reading (reading accuracy, speed or fluency, and reading comprehension) or writing (correctness of spelling, grammar, and punctuation, and clarity of written expression). Criteria include that performance in standardized reading and writing tests is substantially below average, considering that overall age and academic level are normative. These difficulties significantly interfere with academic or daily activities and are not better explained by inadequate schooling issues, developmental, neurological, sensory (vision or hearing), or motor disorders (APA, [<reflink idref="bib3" id="ref51">3</reflink>]).</p> <p>The selection and composition of groups were made in coordination with the REA. LD participants were divided into two groups: children with LD in reading and writing who received the intervention (LD-i group), and children with LD in reading and writing who received the intervention two months after the other group, considering the scholar calendar (waiting control group, LD-w group). Following ethics principles, LD groups were divided in order of arrival of the informed consent. Typical developing children (TD group) were selected among the classroom peers, and matched in age, sex, and academic level to the LD-i and the LD-w groups. LD and TD children were classmates in the 3rd to 6th Grades, thereby ensuring similar sociodemographic and academic conditions.</p> <p>Inclusion criteria encompassed Spanish primary-school children with LD and TD from middle/high socioeconomic status (SES). SES was determined following the REA's criteria, responsible for information about students' personal conditions, SES, and cultural context (contained in the Instructions of March 8th, 2017, and Decree 97/2015).</p> <p>The exclusion criteria excluded those children who presented sensory impairments, behavioral issues, or any medical conditions (such as ADHD or epilepsy), also according to REA's criteria.</p> <p>There were no statistically significant differences between the three groups in age, grade, or sex (see Table 1).</p> <p> <emph>Direct/Reverse Digits</emph> and <emph>Letters and Numbers</emph> subtests (Weschler et al., [<reflink idref="bib40" id="ref52">40</reflink>]) were applied to evaluate the sample's WM and memory span. No statistically significant differences were found between the LD-i and the LD-w groups, but statistically significant lower performance was found between the LD-i and the TD groups in both <emph>Digits</emph>, <emph>t</emph> (<reflink idref="bib71" id="ref53">71</reflink>) = -4.196, <emph>p</emph> <.001, and <emph>Letters and Numbers</emph>,<emph> t</emph> (<reflink idref="bib71" id="ref54">71</reflink>) = -4.855, <emph>p</emph> <.001, subtests (see Table 1).</p> <p>Table 1 Sociodemographic information and control variables</p> <p> <ephtml> <table rules="groups"><thead><tr><th align="left" /><th align="left"><p>LD-i group</p></th><th align="left"><p>LD-w group</p></th><th align="left"><p>Test</p></th><th align="left"><p><italic>p</italic></p></th><th align="left"><p>TD group</p></th><th align="left"><p>Test</p></th><th align="left"><p><italic>p</italic></p></th></tr><tr><th align="left" /><th align="left"><p>(<italic>n</italic> = 43)</p></th><th align="left"><p>(<italic>n</italic> = 58)</p></th><th align="left" /><th align="left" /><th align="left"><p>(<italic>n</italic> = 66)</p></th><th align="left" /><th align="left" /></tr></thead><tbody><tr><td align="left"><p>Grade</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>3rd</p></td><td align="left"><p>21 (48.8)</p></td><td align="left"><p>22 (37.9)</p></td><td align="left" /><td align="left" /><td align="left"><p>21 (31.8)</p></td><td align="left"><p><italic>χ</italic><sup>2</sup><sub>6</sub> = 4.864</p></td><td align="left"><p>0.561</p></td></tr><tr><td align="left"><p>4th</p></td><td align="left"><p>13 (30.2)</p></td><td align="left"><p>16 (27.6)</p></td><td align="left" /><td align="left" /><td align="left"><p>20 (30.3)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>5th</p></td><td align="left"><p>5 (11.6)</p></td><td align="left"><p>10 (17.2)</p></td><td align="left" /><td align="left" /><td align="left"><p>11 (16.7)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>6th</p></td><td align="left"><p>4 (9.3)</p></td><td align="left"><p>10 (17.2)</p></td><td align="left" /><td align="left" /><td align="left"><p>14 (21.2)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Sex</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Male</p></td><td align="left"><p>27 (62.8)</p></td><td align="left"><p>28 (48.3)</p></td><td align="left" /><td align="left" /><td align="left"><p>38 (57.6)</p></td><td align="left"><p><italic>χ</italic><sup>2</sup><sub>2</sub> = 2.266</p></td><td align="left"><p>0.322</p></td></tr><tr><td align="left"><p>Female</p></td><td align="left"><p>16 (37.2)</p></td><td align="left"><p>30 (51.7)</p></td><td align="left" /><td align="left" /><td align="left"><p>28 (42.4)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Age</p></td><td align="left"><p>115.16 ± 16.12</p></td><td align="left"><p>117.19 ± 15.59</p></td><td align="left" /><td align="left" /><td align="left"><p>118 ± 14.91</p></td><td align="left"><p><italic>h</italic><sub>2</sub> = 2.261</p></td><td align="left"><p>0.323</p></td></tr><tr><td align="left"><p>WM</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Digits</p></td><td align="left"><p>8.57 ± 2.15</p></td><td align="left"><p>9.14 ± 2.55</p></td><td align="left"><p><italic>t</italic><sub>79</sub> = -0.950</p></td><td align="left"><p>0.345</p></td><td align="left"><p>11.7 ± 3.26</p></td><td align="left"><p><italic>t</italic><sub>71</sub> = -4.196</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left"><p>Letters and Numbers</p></td><td align="left"><p>12.74 ± 3.44</p></td><td align="left"><p>12.86 ± 3.91</p></td><td align="left"><p><italic>t</italic><sub>79</sub> = -0.132</p></td><td align="left"><p>0.895</p></td><td align="left"><p>16.80 ± 3.26</p></td><td align="left"><p><italic>t</italic><sub>71</sub> = -4.855</p></td><td align="left"><p>< 0.001</p></td></tr></tbody></table> </ephtml> </p> <p>Note. Data are given as n (%), mean ± <emph>SD</emph>, and <emph>p</emph>-values were calculated using Student's <emph>t</emph>-test, Pearson's Chi-square test, or Kruskal-Wallis' <emph>h</emph> test</p> <hd id="AN0191377946-8">Instruments</hd> <p></p> <hd id="AN0191377946-9">Assessment</hd> <p> <bold> <emph>Pseudoword Dictation</emph> </bold> task [writing skills assessment] (Serrano, [<reflink idref="bib39" id="ref55">39</reflink>]). This is a non-standardized test that assesses phoneme-grapheme correspondence rules knowledge, phonological writing rules, and regulated orthography. Participants had to write down 25 pseudowords (2–5 syllables), dictated twice (three times if the participant demanded it). The last 15 pseudowords depended on regulated orthography rules in Spanish. Correct answers score 1 point (maximum punctuation, 25 points).</p> <p> <bold> <emph>Unregulated Orthography Word Dictation</emph> </bold> task [writing skills assessment] (Serrano, [<reflink idref="bib39" id="ref56">39</reflink>]). This is a non-standardized test that assesses knowledge of inconsistent graphonemes[<reflink idref="bib1" id="ref57">1</reflink>] writing, lexical knowledge, and phoneme-grapheme correspondence rules. Participants had to write down 25 unregulated words (2–4 syllables), dictated twice (three times if the participant demanded it). Each word includes an inconsistent graphoneme, which requires lexical knowledge to be correctly written. For example, /b/ can be written with /b/ or /v/ (e.g., <emph>bello</emph> – handsome – or <emph>vello</emph> – hair), and there is no rule to determine the right grapheme. Correct answers score 1 point (maximum punctuation, 25 points).</p> <p> <bold> <emph>Regulated Orthography Word Dictation</emph> </bold> task [writing skills assessment]. This is a subtest of the <emph>Test de Evaluación del Potencial de Aprendizaje para la Lecto-escritura</emph> (EPALE) [Learning Potential for Reading and Writing Assessment Test] (Mata & Serrano, [<reflink idref="bib29" id="ref58">29</reflink>]), which assesses orthographic knowledge. Participants had to write down 25 words (2–5 syllables) that follow regulated orthographic rules, dictated twice (three times if the participant demanded it). All words can be written following established phonological and orthographic rules (e.g., /n/ is written with /m/ and not /n/ before /p/ and /b/, like in <emph>campo</emph> – field). Correct answers score 1 point (maximum punctuation, 25 points). The test's reliability (Cronbach's alpha) is α = 0.83.</p> <p> <bold> <emph>Blending Phonemes</emph> </bold> task [literacy-related skills]. This is a subtest of the <emph>Test de Evaluación del Potencial de Aprendizaje para la Lecto-escritura</emph> (EPALE) [Learning Potential for Reading and Writing Assessment Test] (Mata & Serrano, [<reflink idref="bib29" id="ref59">29</reflink>]). It assesses phonological awareness (synthesis skills) at the phoneme level. Children had to enunciate the complete word after listening to three examples and 14 phoneme-segmented words (2–6 phonemes), dictated at a range of one second. Lips should be hidden so that the participant does not support on phonomimic movements. Correct answers score 1 point (maximum punctuation, 14 points). The test discontinues after 3 consecutive mistakes or if the participant does not know the answer. The test's reliability (Cronbach's alpha) is α = 0.89.</p> <p> <bold> <emph>Counting Sounds</emph> </bold> task [literacy-related skills] (Gutiérrez-Palma et al., [<reflink idref="bib19" id="ref60">19</reflink>]). This non-standardized test assesses phonological awareness (analysis skills) at the phoneme level. It involves a two-phase task. In the first phase, participants had to count the number of sounds within each word (3 examples and 18 trisyllabic words with 5–9 sounds) (e.g., <emph>/h/a/m/a/c/a</emph> – hammock – has 5 sounds). The second phase is a dictation task consisting of writing down the same words; the main aim of this phase is to explore the strategy used by participants in phase one, whether they follow a phonological (counting sounds/phonemes) or an orthographic (counting letters) method. While doing the dictation task, participants should not see the answers given in the first phase. Words are dictated to the participant twice in both phases and should be slowly and correctly enunciated. Correct answers score 1 point (maximum punctuation, 18 points in each phase). The test's reliability (Cronbach's alpha) is α = 0.68.</p> <p> <bold> <emph>Lexical Stress Awareness</emph> </bold> task [literacy-related skills]. This is a subtest of the <emph>Test de Evaluación del Potencial de Aprendizaje para la Lecto-escritura</emph> (EPALE) [Learning Potential for Reading and Writing Assessment Test] (Mata & Serrano, [<reflink idref="bib29" id="ref61">29</reflink>]) that assesses prosodic awareness skills and lexical stress knowledge. Trisyllabic pseudowords (3 examples and 18 pseudowords) are dictated twice (three times if the participant demanded it). The participant had to cross-mark one out of the three blank gaps to indicate the syllable where the accent is located. Correct answers score 1 point (maximum punctuation, 18 points). The test's reliability (Cronbach's alpha) is α = 0.87.</p> <p> <bold> <emph>Test Colectivo de Eficacia Lectora</emph> </bold> <bold>(TECLE)</bold> [Collective Test of Reading Efficiency] [Reading efficiency and comprehension assessment] (Carrillo & Marín, [<reflink idref="bib9" id="ref62">9</reflink>]). Based on Lobrot's D-OR-LEC (1980), it assesses the accuracy and speed of decoding skills and reading comprehension. The participants were exposed to 64 sentences with four alternative answers: one pseudoword, one visually similar word, one phonologically similar word, and the correct answer. Administration time was 3 min (instead of 5 used by Lobrot). Correct answers score 1 point. Test-retest Pearson's correlation coefficients range from <emph>r</emph> =.87 to <emph>r</emph> =.91 in Spanish populations (Carrillo et al., [<reflink idref="bib10" id="ref63">10</reflink>]).</p> <p> <bold> <emph>Direct/Reverse Digits subtest of WISC-IV</emph> </bold> [Control measure – Working Memory assessment test] (Weschler et al., [<reflink idref="bib40" id="ref64">40</reflink>]). The test measures memory span (direct) and attention (reverse). Participants had to repeat several chains of digits (1 example and 14 items), increasing in quantity and difficulty, in the same (direct) or reverse order (reverse). Each item has two trials with a different digit chain. The test discontinues when both trials are failed. Correct answers score 1 point (maximum 14 points for direct and 14 for reverse). Reliability studies conducted in Spain show ranges between 0.75 and 0.91 (General Council of Official Colleges of Psychologists, [<reflink idref="bib13" id="ref65">13</reflink>]).</p> <p> <bold> <emph>Letters and Numbers subtest of WISC-IV</emph> </bold> [Control measure – Working Memory assessment tests] (Weschler et al., [<reflink idref="bib40" id="ref66">40</reflink>]). The test measures working memory. Participants had to repeat the digits and numbers dictated, telling, in the first place, the numbers in increasing order and, in the second place, the letters in alphabetical order. The test is composed of several chains of digits and numbers combined (2 examples and 30 items), increasing in quantity and difficulty. The test is discontinued after three consecutive fails. Correct answers score 1 point (maximum punctuation is 30). Reliability studies conducted in Spain show ranges between 0.75 and 0.91 (General Council of Official Colleges of Psychologists, [<reflink idref="bib13" id="ref67">13</reflink>]).</p> <hd id="AN0191377946-10">Intervention</hd> <p>This study applies Iniesta and Serrano's ([<reflink idref="bib22" id="ref68">22</reflink>]) intervention based on direct, explicit, and sequential instruction, immediate and continuous feedback, repeated practice, and game-based techniques for task management. The program is an individualized training of 16 sessions, based on three intervention approaches: the behavioral/cognitive approach, which uses the well-validated techniques of modeling, imitation, facilitation, and transfer, with the support of a trainer for learning and feedback monitoring; a multisensory approach that gives children the opportunity of using a variety of tools of daily practice, writing on different surfaces, varied and repeated practice, and to foster generalization; and finally, the focus on visual vocabulary skills to facilitate access to the orthographic lexicon.</p> <p>The first 14 sessions were structured in 6 phases. Phase 1 started with narrative texts guided reading, 22 isolated words reading, and 5 graphonemes tracing. Phase 2 presented a cloze activity with two options and 3 graphonemes tracing. Phases 3 and 4 alternated meta-phonological, prosodic, morphological, and spelling games and activities. Phase 5 was a dictation of the preselected words from Phase 1. Finally, Phase 6 consisted of reviewing 6 orthographic rules trained throughout the session. Sessions 15 and 16 focused on sentence building, sentence conjugation, and handwriting (morphological training). An in-depth description of activities is shown in Appendix 1.</p> <hd id="AN0191377946-11">Procedure</hd> <p>Researchers proposed the intervention program to the REA of 11 school centers. Evaluation and intervention procedures were conducted in the schools during the scholar schedule. The sessions were individually applied in private classrooms by an instructor with specialized training in psychoeducational evaluation and intervention techniques (trained psychologists and speech therapists). The specialized trainers received instruction on the protocols, tests, and intervention program (30 h) and were unaware of the group's assignment. These procedures were supervised by the main researchers of the study.</p> <p>All participants received standardized instructions for the evaluation and intervention phases. Pre-intervention measurements were administered to all groups at the same time (3 sessions of 30/40 minutes). The intervention was applied for one month for the LD-i group, while the LD-w and the TD groups received typical school instruction. A total of 16 sessions were carried out (4 consecutive weekly sessions of 40/50 minutes). Finally, post-intervention measurements were administered to all groups at the same period (2 sessions of 20/30 minutes). All tests applied were counterbalanced throughout the sessions. Children from the LD-w group received the intervention after the completion of the study.</p> <hd id="AN0191377946-12">Informed consent</hd> <p>was obtained from families and the Teaching and School Guidance teams to ensure the confidentiality of the data collected, following the principles of Human Research Ethics of the University of Granada (certificate nº: 1814/CEIH/2020).</p> <hd id="AN0191377946-13">Data analyses</hd> <p>The statistical package IBM SPSS Statistics version 25.0 was used. As the data did not meet the normality criteria, non-parametric analyses were conducted to compare the initial equivalence of groups, according to sociodemographic and control variables, and to verify the hypothesis.</p> <p>Pearson's Chi-square test was used to test grade and sex variables among the three groups in the pre-intervention phase. The Kruskal-Wallis' h-test was used to test age differences among the three groups in the pre-intervention phase. Student's t-test was used to assess differences in WM between LD-i and LD-w groups and between the LD-i and the TD groups in the pre-intervention phase. Additionally, the Kruskal-Wallis test was used to assess the intervention effect. Mann-Whitney U was used to test the <emph>post-hoc</emph> comparisons. Regarding this and to counteract the problem of multiple dependent variable comparisons, the Holm-Bonferroni alpha level adjustment was applied when interpreting Mann-Whitney U <emph>p</emph>-values (Holm, [<reflink idref="bib20" id="ref69">20</reflink>]).</p> <hd id="AN0191377946-14">Results</hd> <p>The first objective was to analyze the initial equivalence of performance levels between the LD groups and to study the differences between children who received the intervention and children with TD. Results from the Kruskal-Wallis's test showed differences between the three groups (<emph>p</emph> <.01) in all tasks. In the <emph>post-hoc</emph> comparisons after Holm-Bonferroni's adjustment, results from Mann-Whitney U showed no statistically significant differences between the LD-i group and the LD-w group in any writing skills, literacy-related skills, or reading comprehension tasks. On the contrary, the Mann-Whitney U test showed statistically significant differences between the LD-i and the TD groups in all performed tasks (see Table 2).</p> <p>Regarding the second objective, testing the effectiveness of the intervention, the Kruskal-Wallis's test showed differences between the three groups in all tasks (<emph>p</emph> <.01). <emph>Post-hoc</emph> comparison tests (adjusted) showed higher scores in children from the LD-i group than in children from the LD-w group (see Table 3). This tendency was observed in all tasks, although the differences were statistically significant in the pseudoword dictation task [total pseudowords (<emph>z</emph> = -4.288, <emph>p</emph> <.005), last 15 pseudowords (<emph>z</emph> = -3.937, <emph>p</emph> <.006)], and lexical stress awareness task (<emph>z</emph> = -2.747, <emph>p</emph> <.007). There were no statistically significant differences between the LD-i and the LD-w groups in the unregulated orthography word dictation task, the regulated orthography word dictation task, the blending phonemes task, and the sound and the word dictation subtasks of the counting sounds task (see Table 3).</p> <p>As observed in Table 3, regarding the comparison between the LD-i and the TD groups (post-intervention measures), results revealed that both groups' performance levels showed no differences in the pseudoword dictation task (both total pseudowords, and last 15 pseudowords measures), the blending phonemes, and the sound subtask of the counting sounds task. This indicates that the performance levels in these tasks were equalized between children with LD and children with TD after the application of the intervention program. Nevertheless, differences between the means of both groups were smaller after the application of the intervention in all performed tasks, as <emph>z</emph> scores showed (see Table 3).</p> <p>Table 2 Pre-intervention differences between groups (LD-i vs. LD-w groups and LD-i vs. TD groups)</p> <p> <ephtml> <table rules="groups"><thead><tr><th align="left" /><th align="left"><p>LD-i</p></th><th align="left"><p>LD-w</p></th><th align="left" colspan="2"><p>U</p></th><th align="left"><p>LD-i</p></th><th align="left"><p>TD</p></th><th align="left" colspan="2"><p>U</p></th></tr><tr><th align="left" /><th align="left"><p><italic>n</italic> = 43</p></th><th align="left"><p><italic>n</italic> = 58</p></th><th align="left" /><th align="left" /><th align="left"><p><italic>n</italic> = 43</p></th><th align="left"><p><italic>n</italic> = 66</p></th><th align="left" /><th align="left" /></tr><tr><th align="left" /><th align="left"><p><italic>M (SD)</italic></p></th><th align="left"><p><italic>M (SD)</italic></p></th><th align="left"><p><italic>z</italic></p></th><th align="left"><p><italic>p</italic></p></th><th align="left"><p><italic>M (SD)</italic></p></th><th align="left"><p><italic>M (SD)</italic></p></th><th align="left"><p><italic>z</italic></p></th><th align="left"><p><italic>p</italic></p></th></tr></thead><tbody><tr><td align="left"><p>Pseudowords Dictation</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Total pseudowords</p></td><td align="left"><p>13.33 (4.62)</p></td><td align="left"><p>12.74 (3.30)</p></td><td align="left"><p>-1.041</p></td><td align="left"><p>0.298</p></td><td align="left"><p>13.33 (4.62)</p></td><td align="left"><p>16.92 (3.35)</p></td><td align="left"><p>-3.844</p></td><td align="left"><p>< 0.005</p></td></tr><tr><td align="left"><p>Last 15 pseudowords</p></td><td align="left"><p>7.07 (2.93)</p></td><td align="left"><p>6.67 (2.37)</p></td><td align="left"><p>-0.858</p></td><td align="left"><p>0.391</p></td><td align="left"><p>7.07 (2.93)</p></td><td align="left"><p>9.83 (2.20)</p></td><td align="left"><p>-4.592</p></td><td align="left"><p>< 0.006</p></td></tr><tr><td align="left"><p>Unregulated Orthography Word Dictation</p></td><td align="left"><p>11.58 (3.90)</p></td><td align="left"><p>12.52 (3.94)</p></td><td align="left"><p>-1.173</p></td><td align="left"><p>0.241</p></td><td align="left"><p>11.58 (3.90)</p></td><td align="left"><p>19.29 (3.26)</p></td><td align="left"><p>-7.449</p></td><td align="left"><p>< 0.007</p></td></tr><tr><td align="left"><p>Regulated Orthography Word Dictation</p></td><td align="left"><p>14.42 (3.89)</p></td><td align="left"><p>15.26 (4.00)</p></td><td align="left"><p>-1.220</p></td><td align="left"><p>0.223</p></td><td align="left"><p>14.42 (3.89)</p></td><td align="left"><p>20.62 (3.20)</p></td><td align="left"><p>-6.828</p></td><td align="left"><p>< 0.008</p></td></tr><tr><td align="left"><p>Blending Phonemes</p></td><td align="left"><p>7.05 (2.72)</p></td><td align="left"><p>6.84 (3.80)</p></td><td align="left"><p>-0.766</p></td><td align="left"><p>0.444</p></td><td align="left"><p>7.05 (2.72)</p></td><td align="left"><p>11.08 (3.45)</p></td><td align="left"><p>-5.714</p></td><td align="left"><p>< 0.010</p></td></tr><tr><td align="left"><p>Counting Sounds</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Sounds</p></td><td align="left"><p>8.65 (4.23)</p></td><td align="left"><p>9.12 (3.15)</p></td><td align="left"><p>-0.385</p></td><td align="left"><p>0.701</p></td><td align="left"><p>8.65 (4.23)</p></td><td align="left"><p>10.79 (3.16)</p></td><td align="left"><p>-2.692</p></td><td align="left"><p>< 0.050</p></td></tr><tr><td align="left"><p>Word Dictation</p></td><td align="left"><p>11.63 (2.80)</p></td><td align="left"><p>11.14 (3.27)</p></td><td align="left"><p>-0.872</p></td><td align="left"><p>0.383</p></td><td align="left"><p>11.63 (2.80)</p></td><td align="left"><p>14.82 (1.70)</p></td><td align="left"><p>-6.478</p></td><td align="left"><p>< 0.012</p></td></tr><tr><td align="left"><p>Lexical Stress Awareness</p></td><td align="left"><p>11.40 (3.99)</p></td><td align="left"><p>11.31 (2.82)</p></td><td align="left"><p>-0.124</p></td><td align="left"><p>0.901</p></td><td align="left"><p>11.40 (3.99)</p></td><td align="left"><p>15.70 (3.38)</p></td><td align="left"><p>-5.473</p></td><td align="left"><p>< 0.016</p></td></tr><tr><td align="left"><p>Reading Comprehension</p></td><td align="left"><p>12.09 (5.12)</p></td><td align="left"><p>13.62 (6.05)</p></td><td align="left"><p>-1.310</p></td><td align="left"><p>0.190</p></td><td align="left"><p>12.09 (5.12)</p></td><td align="left"><p>24.95 (6.53)</p></td><td align="left"><p>-7.711</p></td><td align="left"><p>< 0.025</p></td></tr></tbody></table> </ephtml> </p> <p>Note. When <emph>p</emph> <. is noted, the result is statistically significant considering the Holm-Bonferroni specific <emph>p</emph>-value correction</p> <p>Other trends are worth mentioning considering within groups´ performance change from pre-intervention to post-intervention phases. Figures 1 and 2 show the change in task performance in the three groups over time. The LD-i group showed greater improvement than the LD-w group in all performed tasks. While children from the LD-w group increased their performance level, children's means from the LD-i group improved to a greater extent. Additionally, while the TD group's scores remained very similar during the 4 weeks of the intervention program, those children who received it increased their performance above the LD-w group in all tasks.</p> <p>Finally, the evaluation and intervention procedures were applied in controlled environments (the school centers) during the scholar schedule. This ensured that participants received all intervention sessions (or recovered a missing session in case of absence); thereby there was no attrition between the two time points.</p> <p>Table 3 Post-intervention differences between groups (LD-i vs. LD-w groups and LD-i vs. TD groups)</p> <p> <ephtml> <table rules="groups"><thead><tr><th align="left" /><th align="left"><p>LD-i</p></th><th align="left"><p>LD-w</p></th><th align="left" colspan="2"><p>U</p></th><th align="left"><p>LD-i</p></th><th align="left"><p>TD</p></th><th align="left" colspan="2"><p>U</p></th></tr><tr><th align="left" /><th align="left"><p><italic>n</italic> = 43</p></th><th align="left"><p><italic>n</italic> = 58</p></th><th align="left" /><th align="left" /><th align="left"><p><italic>n</italic> = 43</p></th><th align="left"><p><italic>n</italic> = 66</p></th><th align="left" /><th align="left" /></tr><tr><th align="left" /><th align="left"><p><italic>M (SD)</italic></p></th><th align="left"><p><italic>M (SD)</italic></p></th><th align="left"><p><italic>z</italic></p></th><th align="left"><p><italic>p</italic></p></th><th align="left"><p><italic>M (SD)</italic></p></th><th align="left"><p><italic>M (SD)</italic></p></th><th align="left"><p><italic>z</italic></p></th><th align="left"><p><italic>p</italic></p></th></tr></thead><tbody><tr><td align="left"><p>Pseudowords Dictation</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Total pseudowords</p></td><td align="left"><p>17.60 (3.66)</p></td><td align="left"><p>14.24 (3.05)</p></td><td align="left"><p>-4.288</p></td><td align="left"><p>< 0.005</p></td><td align="left"><p>17.60 (3.66)</p></td><td align="left"><p>17.92 (2.78)</p></td><td align="left"><p>-0.368</p></td><td align="left"><p>0.713</p></td></tr><tr><td align="left"><p>Last 15 pseudowords</p></td><td align="left"><p>9.60 (2.84)</p></td><td align="left"><p>7.29 (1.92)</p></td><td align="left"><p>-3.937</p></td><td align="left"><p>< 0.006</p></td><td align="left"><p>9.60 (2.84)</p></td><td align="left"><p>10.76 (2.17)</p></td><td align="left"><p>-1.89</p></td><td align="left"><p>0.059</p></td></tr><tr><td align="left"><p>Unregulated Orthography Word Dictation</p></td><td align="left"><p>15.02 (3.84)</p></td><td align="left"><p>14.55 (4.01)</p></td><td align="left"><p>-0.424</p></td><td align="left"><p>0.672</p></td><td align="left"><p>15.02 (3.84)</p></td><td align="left"><p>20.20 (2.93)</p></td><td align="left"><p>-5.837</p></td><td align="left"><p>< 0.005</p></td></tr><tr><td align="left"><p>Regulated Orthography Word Dictation</p></td><td align="left"><p>17.16 (3.91)</p></td><td align="left"><p>16.16 (4.25)</p></td><td align="left"><p>-1.337</p></td><td align="left"><p>0.181</p></td><td align="left"><p>17.16 (3.91)</p></td><td align="left"><p>21.46 (2.89)</p></td><td align="left"><p>-5.301</p></td><td align="left"><p>< 0.006</p></td></tr><tr><td align="left"><p>Blending Phonemes</p></td><td align="left"><p>10.70 (2.38)</p></td><td align="left"><p>9.16 (3.61)</p></td><td align="left"><p>-1.876</p></td><td align="left"><p>0.061</p></td><td align="left"><p>10.70 (2.38)</p></td><td align="left"><p>11.44 (3.22)</p></td><td align="left"><p>-2.163</p></td><td align="left"><p>.031<sup>n.s</sup>.</p></td></tr><tr><td align="left"><p>Counting Sounds</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Sounds</p></td><td align="left"><p>10.35 (3.79)</p></td><td align="left"><p>9.55 (2.42)</p></td><td align="left"><p>-0.769</p></td><td align="left"><p>0.442</p></td><td align="left"><p>10.35 (3.79)</p></td><td align="left"><p>11.86 (3.37)</p></td><td align="left"><p>-2.232</p></td><td align="left"><p>.026<sup>n.s</sup>.</p></td></tr><tr><td align="left"><p>Word Dictation</p></td><td align="left"><p>13.33 (2.23)</p></td><td align="left"><p>12.10 (2.40)</p></td><td align="left"><p>-2.329</p></td><td align="left"><p>.020<sup>n.s</sup>.</p></td><td align="left"><p>13.33 (2.23)</p></td><td align="left"><p>14.86 (1.60)</p></td><td align="left"><p>-3.226</p></td><td align="left"><p>< 0.008</p></td></tr><tr><td align="left"><p>Lexical Stress Awareness</p></td><td align="left"><p>14.93 (2.85)</p></td><td align="left"><p>13.14 (3.23)</p></td><td align="left"><p>-2.747</p></td><td align="left"><p>< 0.007</p></td><td align="left"><p>14.93 (2.85)</p></td><td align="left"><p>16.22 (2.90)</p></td><td align="left"><p>-2.680</p></td><td align="left"><p>< 0.010</p></td></tr><tr><td align="left"><p>Reading Comprehension</p></td><td align="left"><p>16.98 (6.76)</p></td><td align="left"><p>16.50 (6.68)</p></td><td align="left"><p>-0.272</p></td><td align="left"><p>0.786</p></td><td align="left"><p>16.98 (6.76)</p></td><td align="left"><p>28.56 (7.65)</p></td><td align="left"><p>-6.482</p></td><td align="left"><p>< 0.007</p></td></tr></tbody></table> </ephtml> </p> <p>Note. When <emph>p</emph> <. is noted, the result is statistically significant considering Holm-Bonferroni specific <emph>p</emph>-value correction; n. s. <emph>=</emph> non-significant considering Holm-Bonferroni specific <emph>p</emph>-value correction</p> <p>Graph: Fig. 1 Differences before (pre-intervention) and after (post-intervention) the intervention program between the three groups</p> <p>Graph: Fig. 2 Differences before (pre-intervention) and after (post-intervention) the intervention program between the three groups</p> <hd id="AN0191377946-15">Discussion</hd> <p>This study aimed to assess the effectiveness of an intervention program for Spanish children in primary school with LD in reading and writing. The intervention provided specific training in writing skills, considering all key components and procedures for improving children's performance in Spanish, resulting in a comprehensive tool for treatment.</p> <p>Overall, children who received the intervention program improved their performance levels in all tasks, compared with LD children who did not receive it. The intervention program had a positive impact on the pseudowords tasks, and on those underlying writing skills that are on the basis of LD which are crucial for writing in Spanish: phonological skills (Gutiérrez & Díez, [<reflink idref="bib18" id="ref70">18</reflink>]) and prosodic skills (Jordán et al., [<reflink idref="bib26" id="ref71">26</reflink>]).</p> <p>On the one hand, improvement in pseudoword writing entails that children who received the intervention enhanced their phoneme-grapheme correspondence rules knowledge, their phonological writing rules knowledge, and their regulated orthography knowledge. Pseudoword writing involves adhering to the phonological rules of the language, given that they are like invented words in which lexical and orthographic knowledge cannot help. The mechanisms implicated in these processes support children's meta-phonological abilities, supplying stronger strategies for optimal writing performance (Andersen et al., [<reflink idref="bib4" id="ref72">4</reflink>]).</p> <p>Likewise, the intervention enhanced prosodic awareness skills and lexical stress knowledge, which can account for effects on expressive reading and better coordination between prosodic knowledge and decoding skills (Jordán et al., [<reflink idref="bib26" id="ref73">26</reflink>]). Adequate prosodic skills are fundamental for both oral and written language development, affecting the meaning and grammatical category of words (Gutiérrez-Palma et al., [<reflink idref="bib19" id="ref74">19</reflink>]). Concretely, the relationship between lexical stress awareness and orthographic stress has an impact, especially in transparent languages, on reading fluency and comprehension, the automatization of decoding skills, and the relief of cognitive load in writing and reading processes (Jordán et al., [<reflink idref="bib26" id="ref75">26</reflink>]). The generalization of the intervention effects in these areas is expected as well, although further follow-up is required to test them.</p> <p>Additionally, a noteworthy finding is that children who received the intervention program approached their performance to that of children without difficulties in the pseudowords task, the blending phonemes, and the sounds (counting sounds' subtask) tasks. That is, the intervention program is useful for improving phonological skills, which are the main deficit in children with LD (Rueda et al., [<reflink idref="bib35" id="ref76">35</reflink>]).</p> <p>Furthermore, the intervention program shows a positive trend that can be considered as a hint of effectiveness. When looking up the prosodic skills, the performance after the intervention is nearer to those of children without difficulties than peers with difficulties, who did not receive the treatment. Thus, the lexical stress awareness training may have helped to reinforce children's performance.</p> <p>The findings agree with previous research; explicit underlying writing skills instruction contributes to writing performance when treatments combine reading and handwriting production situations with meta-phonological (Bazis et al., [<reflink idref="bib5" id="ref77">5</reflink>]; Graham et al., [<reflink idref="bib17" id="ref78">17</reflink>]), morphological (Rueda-Sánchez & López-Bastidia, [<reflink idref="bib37" id="ref79">37</reflink>]) and prosodic (Jordán et al., [<reflink idref="bib26" id="ref80">26</reflink>]) tasks.</p> <p>Likewise, the lack of statistically significant improvement in certain areas underscores the complexity of writing skills development (Berninger & Swanson, [<reflink idref="bib7" id="ref81">7</reflink>]). For instance, orthographic skills require longer periods for optimal consolidation. Multicomponent interventions aimed at handwriting, spelling, and phonological skills ranged from 2 to 6 months (Bazis et al., [<reflink idref="bib5" id="ref82">5</reflink>]; Graham et al., [<reflink idref="bib17" id="ref83">17</reflink>]; Jiménez et al., [<reflink idref="bib24" id="ref84">24</reflink>]). Furthermore, the treatments' intensity and duration, and the developmental stage of participants, generally correlate with the interventions' effectiveness (Andersen et al., [<reflink idref="bib4" id="ref85">4</reflink>]). This program integrated multiple components and strategies to address the diverse aspects of writing proficiency and was individually applied for one month to children in 3rd to 6th Grades. Psychoeducational interventions should be designed to attend to each student's individual needs and learning profiles (Iniesta & Serrano, [<reflink idref="bib22" id="ref86">22</reflink>]); thus, writing complexity necessitates a comprehensive approach to foster synergy among reading and writing skills, leading to mutual reinforcement and contributing to greater effectiveness in improving writing performance.</p> <p>Moreover, reinforcing underlying literacy skills is fundamental for communicative competence (Jiménez-Pérez, [<reflink idref="bib25" id="ref87">25</reflink>]) and for enhancing the higher-order process of writing (Berninger & Swanson, [<reflink idref="bib7" id="ref88">7</reflink>]). By developing these skills, writers can expand their vocabulary knowledge, grammatical structures, and linguistic resources and gain confidence to face challenging writing tasks. The intervention was designed through evidence-based approaches and game-based techniques for contributing to different opportunities to learn (Iniesta & Serrano, [<reflink idref="bib22" id="ref89">22</reflink>]), fostering greater engagement (Montes-Miranda et al., [<reflink idref="bib31" id="ref90">31</reflink>]), and boosting active participation (Jarpa-Azagra et al., [<reflink idref="bib23" id="ref91">23</reflink>]). For instance, the manipulative materials employed (multisensory approach) or picture cards (visual approach) contributed to actively engaging children in the activities. While some students benefit from visualizations, others may benefit from auditory or kinesthetic learning (Iniesta & Serrano, [<reflink idref="bib22" id="ref92">22</reflink>]), and integrating multisensory modalities can cater to different learning styles. Thus, educators can ensure that students have more opportunities to understand writing concepts, reinforce orthographic lexicon, and develop writing skills by learning from different methods in parallel. Additionally, the positive trends shown in the performance levels after the intervention highlight promising better performance if the intervention was implemented for a longer period.</p> <p>Some limitations should be considered in future research proposals. Firstly, the intervention was designed to be easily implemented into the daily school schedule, avoiding interruptions (like holidays), aiming to be an intensive treatment. However, because of that, the duration may be not long enough to get improvements in some processes (i.e., some orthographic skills which may require more practice than only one month). Future developments may include other sets of contents and intervention materials based on the same concept, which could be used in follow-up applications. Another limitation is that the sample size of this study prevented the performance of parametric statistics and the generalization of results because children were preliminarily selected considering that they may benefit from intervention, as an educational need, and not only according to statistics. Moreover, the follow-up results, and the evaluation of the waiting control group submitting the intervention program a posteriori, would have also provided valuable information about the intervention's effectiveness. Another limitation is that although we tested skills related to reading performance (phonemic awareness and prosodic awareness), considered good moderators of reading and writing association reinforcement, measures of word reading fluency would have provided a more comprehensive understanding of the intervention's effectiveness, especially taking into account that the sessions included reading practice. Furthermore, regarding reading comprehension, the test TECLE may not fully capture the performance in comprehension that can be observed in other studies (González-Valenzuela & Martín-Ruiz, [<reflink idref="bib15" id="ref93">15</reflink>]) and other reading comprehension measures should be considered. Both reading fluency and reading comprehension measurement need to be improved in future research. Finally, another limitation is that it was not possible to control whether children were receiving previous or simultaneous treatments. Nevertheless, all children who received this intervention improved to a greater extent in all tasks within only one month, than with any other previous or ongoing treatments. Future studies will take into account these limitations, trying to overcome them, also including the aim to address the impact on Grades.</p> <p>As further considerations, gamified formats are effective for supporting intervention procedures in reading and writing increasing students' motivation, providing immediate feedback, adapting to the child's developmental stage, and reducing the stress associated with test performance (Montes-Miranda, [<reflink idref="bib31" id="ref94">31</reflink>]). A digital format of this intervention program (i.e., mobile App format) could further increase children's engagement and track real-time progress, providing valuable information.</p> <p>Finally, we expect to contribute to children's academic progress by further validating the effectiveness of future multi-component comprehensive evidence-based procedures.</p> <hd id="AN0191377946-16">Conclusion</hd> <p>This intervention program for Spanish children with reading and writing LD helped to reinforce literacy-related skills; especially, phonological and prosodic skills, which are key components for writing acquisition and development in Spanish (Gutiérrez-Palma et al., [<reflink idref="bib19" id="ref95">19</reflink>]). Intervention procedures contributed to boosting the effectiveness, encompassing the integration of meta-phonological strategies, the use of explicit, systematic, and intensive instruction, repeated practice, and the application of the multisensory, cognitive/behavioral, and visual approaches and game-based techniques. Furthermore, the intervention was designed considering reading and writing skills as interrelated processes that support the reciprocal development of each other (Andersen et al., [<reflink idref="bib4" id="ref96">4</reflink>]). The integration of reading, handwriting, spelling, meta-phonological (Graham et al., [<reflink idref="bib17" id="ref97">17</reflink>]), morphological (Rueda-Sánchez & López-Bastidia, [<reflink idref="bib37" id="ref98">37</reflink>]), and prosodic (Jordán et al., [<reflink idref="bib26" id="ref99">26</reflink>]) tasks contributed to such effects.</p> <p>Implementation time was short-lived to be easily administered into the scholar schedule, however, some orthographic skills may require more training for optimal writing performance. Limitations include a small sample size, lack of specific reading measures, and the inability to control other simultaneous treatments. Future research should incorporate detailed reading measures and evaluate long-term impacts. Additionally, digital game-based formats could enhance engagement and track valuable real-time progress.</p> <p>In sum, this study emphasizes the importance of integrating reading and writing skills into training programs to enhance writing performance. These findings shed light on this supplemental training to be a comprehensive tool that contributes to writing skills performance. Psychoeducational interventions should be tailored to individual student's needs and address multiple areas simultaneously to promote a better understanding of writing processes.</p> <hd id="AN0191377946-17">Acknowledgements</hd> <p>This work is part of the Grant I + D + i PID2021-126589OB-I00 funded by MCIN/AEI/https://doi.org/10.13039/501100011033 and ERDF funding "A way of making Europe"; and the Grant C-SEJ-024-UGR23 funded by Consejería de Universidad, Investigación e Innovación and by ERDF Andalusia Program 2021–2027. María Carmona is a beneficiary of the Research Grant PRE2022-102516, associated with the I + D + i Project PID2021-126589OB-I00.</p> <hd id="AN0191377946-18">Funding</hd> <p>Funding for open access publishing: Universidad de Granada/CBUA.</p> <hd id="AN0191377946-19">Declarations</hd> <p></p> <hd id="AN0191377946-20">Conflict of interest</hd> <p>The authors state that there exists no actual or perceived conflict of interest in the conduct and reporting of the research reported in this article (e.g., financial interests in a test or procedure, or industry funding for research).</p> <hd id="AN0191377946-21">Publisher's note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0191377946-22"> <title> References </title> <blist> <bibl id="bib1" idref="ref35" type="bt">1</bibl> <bibtext> Afonso O, Suárez-Coalla P, Cuetos F. Writing impairments in Spanish children with developmental dyslexia. 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Pearson.</bibtext> </blist> </ref> <ref id="AN0191377946-23"> <title> Footnotes </title> <blist> <bibtext> Graphonemes refer to the combination of "graphemes" and "phonemes" and represent the correspondences between written letters and spoken sounds in a linguistic system.</bibtext> </blist> </ref> <aug> <p>By María Carmona; Macarena De los Santos-Roig; Sara Mata and Francisca Serrano</p> <p>Reported by Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib30" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib12" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib33" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib32" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib25" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib31" firstref="ref6"></nolink> <nolink nlid="nl7" bibid="bib23" firstref="ref7"></nolink> <nolink nlid="nl8" bibid="bib34" firstref="ref8"></nolink> <nolink nlid="nl9" bibid="bib18" firstref="ref11"></nolink> <nolink nlid="nl10" bibid="bib16" firstref="ref13"></nolink> <nolink nlid="nl11" bibid="bib14" firstref="ref14"></nolink> <nolink nlid="nl12" bibid="bib37" firstref="ref16"></nolink> <nolink nlid="nl13" bibid="bib24" firstref="ref17"></nolink> <nolink nlid="nl14" bibid="bib27" firstref="ref19"></nolink> <nolink nlid="nl15" bibid="bib38" firstref="ref23"></nolink> <nolink nlid="nl16" bibid="bib28" firstref="ref24"></nolink> <nolink nlid="nl17" bibid="bib17" firstref="ref27"></nolink> <nolink nlid="nl18" bibid="bib36" firstref="ref28"></nolink> <nolink nlid="nl19" bibid="bib35" firstref="ref29"></nolink> <nolink nlid="nl20" bibid="bib19" firstref="ref37"></nolink> <nolink nlid="nl21" bibid="bib26" firstref="ref38"></nolink> <nolink nlid="nl22" bibid="bib21" firstref="ref39"></nolink> <nolink nlid="nl23" bibid="bib15" firstref="ref41"></nolink> <nolink nlid="nl24" bibid="bib22" firstref="ref44"></nolink> <nolink nlid="nl25" bibid="bib11" firstref="ref49"></nolink> <nolink nlid="nl26" bibid="bib40" firstref="ref52"></nolink> <nolink nlid="nl27" bibid="bib71" firstref="ref53"></nolink> <nolink nlid="nl28" bibid="bib39" firstref="ref55"></nolink> <nolink nlid="nl29" bibid="bib29" firstref="ref58"></nolink> <nolink nlid="nl30" bibid="bib10" firstref="ref63"></nolink> <nolink nlid="nl31" bibid="bib13" firstref="ref65"></nolink> <nolink nlid="nl32" bibid="bib20" firstref="ref69"></nolink>
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  Data: <searchLink fieldCode="AR" term="%22María+Carmona%22">María Carmona</searchLink> (ORCID <externalLink term="http://orcid.org/0009-0007-3981-6567">0009-0007-3981-6567</externalLink>)<br /><searchLink fieldCode="AR" term="%22Macarena+De+los+Santos-Roig%22">Macarena De los Santos-Roig</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-0566-743X">0000-0003-0566-743X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sara+Mata%22">Sara Mata</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-4648-013X">0000-0002-4648-013X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Francisca+Serrano%22">Francisca Serrano</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-9000-6892">0000-0001-9000-6892</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Reading+and+Writing%3A+An+Interdisciplinary+Journal%22"><i>Reading and Writing: An Interdisciplinary Journal</i></searchLink>. 2026 39(1):121-139.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 19
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Elementary+Education%22">Elementary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Game+Based+Learning%22">Game Based Learning</searchLink><br /><searchLink fieldCode="DE" term="%22Writing+Skills%22">Writing Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Writing+Improvement%22">Writing Improvement</searchLink><br /><searchLink fieldCode="DE" term="%22Spanish%22">Spanish</searchLink><br /><searchLink fieldCode="DE" term="%22Elementary+School+Students%22">Elementary School Students</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Reading+Difficulties%22">Reading Difficulties</searchLink><br /><searchLink fieldCode="DE" term="%22Writing+Difficulties%22">Writing Difficulties</searchLink><br /><searchLink fieldCode="DE" term="%22Writing+Instruction%22">Writing Instruction</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Feedback+%28Response%29%22">Feedback (Response)</searchLink><br /><searchLink fieldCode="DE" term="%22Direct+Instruction%22">Direct Instruction</searchLink><br /><searchLink fieldCode="DE" term="%22Instructional+Effectiveness%22">Instructional Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Suprasegmentals%22">Suprasegmentals</searchLink><br /><searchLink fieldCode="DE" term="%22Psychoeducational+Methods%22">Psychoeducational Methods</searchLink><br /><searchLink fieldCode="DE" term="%22Phonological+Awareness%22">Phonological Awareness</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Spain%22">Spain</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s11145-025-10636-w
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0922-4777<br />1573-0905
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This study explores the effectiveness of a comprehensive intervention program for improving writing skills in Spanish. Participants were 167 Spanish children (3rd to 6th Grades) with reading and writing difficulties and typical development. Children exhibited problems in writing, reading, and related skills, like phonological and prosodic skills. The intervention targeted the reinforcement of orthographic patterns, decoding activities based on meta-analytical strategies; meta-phonological, morphological, and prosodic activities; visual vocabulary; sentence building, and reading, considering the reciprocity between both skills in literacy development. It was a paper-and-pencil program, considering the main approaches of writing intervention (cognitive and multisensorial), the relevance of frequent and direct feedback, the use of explicit instructions, the recommended levels of intervention (sub-lexical, lexical, and sentence levels), and the use of motivating activities through a game-based design. Sixteen individualized sessions of direct, systematic, and explicit training were conducted with the support of a trainer who provided immediate and continuous feedback. A quasi-experimental non-equivalent waiting control group pre-post intervention design, with three groups (intervention group; waiting-control group; and typical development group), was applied. Results showed that the intervention had a positive impact on writing-related skills. Specifically, children who received the intervention performed close to peers without difficulties in several tasks after the intervention program, especially those involving phonological and prosodic processing. These findings support that phonological and prosodic training is related to writing performance and its development. Furthermore, this study presents psychoeducational implications because it supports that explicit and supplemental meta-phonological strategies could play an important role in teaching writing to children with reading and writing difficulties.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1505332
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1505332
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      – Type: doi
        Value: 10.1007/s11145-025-10636-w
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 19
        StartPage: 121
    Subjects:
      – SubjectFull: Game Based Learning
        Type: general
      – SubjectFull: Writing Skills
        Type: general
      – SubjectFull: Writing Improvement
        Type: general
      – SubjectFull: Spanish
        Type: general
      – SubjectFull: Elementary School Students
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Reading Difficulties
        Type: general
      – SubjectFull: Writing Difficulties
        Type: general
      – SubjectFull: Writing Instruction
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      – SubjectFull: Intervention
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      – SubjectFull: Feedback (Response)
        Type: general
      – SubjectFull: Direct Instruction
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      – SubjectFull: Instructional Effectiveness
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      – SubjectFull: Suprasegmentals
        Type: general
      – SubjectFull: Psychoeducational Methods
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      – SubjectFull: Phonological Awareness
        Type: general
      – SubjectFull: Spain
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    Titles:
      – TitleFull: Effectiveness of a Comprehensive Game-Based Intervention for Writing Skills
        Type: main
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            NameFull: María Carmona
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            NameFull: Macarena De los Santos-Roig
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            NameFull: Sara Mata
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            NameFull: Francisca Serrano
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              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 0922-4777
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              Value: 1573-0905
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              Value: 39
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            – TitleFull: Reading and Writing: An Interdisciplinary Journal
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