Optimizing Language Outcomes for Young Adults With Intellectual and Developmental Disabilities: A Written Language Intervention Using Functional Texts
Phase: NA
Conditions: Intellectual Disability, Developmental Disability
Sponsor: Baylor University

 
04/03/2023 
 
 
1 
Optimizing Language Outcomes for Young Adults with Intellectual and Developmental 
Disabilities: A Written Language Intervention Using Functional Texts – Study Protocol and 
Statistical Analysis Plan 
 
BACKGROUND 
 
Purpose 
This study is designed to to examine the feasibility, acceptability, and initial effectiveness of a 
Written Language Intervention Using Functional Texts (WLIFT) for young adults with intellectual 
and developmental disabilities (IDD).  
 
Research Questions/Specific Aims 
AIM 1: To examine the effects of WLIFT intervention on use of reading comprehension 
strategies in functional texts by young adults with IDD. 
AIM 2: To examine the effects of the intervention on distal written language outcomes. 
AIM 3: To examine the effects of the intervention on distal spoken language outcomes. 
 
Dependent Variables (DV) 
Primary Outcome: Participant Use of Comprehension Strategies 
The primary DV for this study will be the total number of different reading comprehension 
strategies used during each probe. In the primary DV probe, the participant is prompted to read 
a functional text stimuli using a think-aloud to implement the reading comprehension strategies. 
Participants’ use of the reading comprehension with a graphic organizer will be measured 
across the various functional literacy stimuli.  
 
Step 
Operational definition 
No credit 
1. Review 
strategy 
Naming the “reading strategies”; mention 
completing tasks before, during, and after 
reading; name each step or at least 4/10 steps, 
ten steps 
No review of strategy, 
reading strategy 
2. Identify type of 
text 
Identifying whether the text is text message, 
GroupMe message, email, assignment, etc. 
Vague description 
3. Identify context 
of text 
Name person(s) or role (e.g., boss, friend) or 
identify context (e.g., bank, transportation) 
No response 
4. Read text 
(NOT SCORED) 
Read text aloud or to themselves (e.g., looking 
at screen, eyes scanning text, silent pause, “I’m 
done”) 
If don’t finish text in its 
entirety, no reading 
5. Look for words 
I need help with 
 
Identify a word they don’t know, acknowledge 
(verbally or nonverbally) that they know all the 
words or that they looked at back at the text 
Very quick scan of 
text, don’t look at text 
6. Re-read  
Repeat any part of the text 
Summarize and not 
read directly 
7. Ask “Do I 
understand what I 
just read?” 
Verbalize the question, acknowledge that they 
understand everything (e.g., “I’ve got it!”) 
No self-monitoring, 
obvious lack of 
comprehension 
8. Summarize 
what I read 
 
Verbal (mostly correct and complete) summary 
of text, list notes 
Vague or incomplete 
summary 

 
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9. Ask “Do I need 
more 
information?” 
Verbalize the question and acknowledge that 
they don’t need more information (e.g., “I’m 
good”) 
No check for missing 
information 
10. Decide what 
to do next 
State what to do next  
No verbal comment or 
unrelated comment 
 
Secondary Outcomes: Reading Comprehension (Written Language) and Spoken Language 
• 
Reading Comprehension of Functional Texts: After reading a functional text, across 
multiple domains (e.g., social, vocational), the participant (a) answers multiple choice 
comprehension questions which are scored based on the percent answered correctly 
and (b) provides a written response to the functional text (e.g., text message or email 
reply) that is scored using a rubric rating. 
• 
Spoken Language: After reading a functional text, across multiple domains (e.g., social, 
vocational), the participant provides a spoken response to the functional text (e.g., 
phone call reply to text message) that is scored using a rubric rating. 
 
Intervention Development 
The Written Language Intervention for Functional Texts (WLIFT): (a) utilizes functional texts—
activities of daily living that involve written language (e.g., text messages), (b) is specifically 
designed based on the phenotype of commonly occurring IDDs and is delivered at a critical time 
as young adults transition to independence, (c) involves teaching and assessing comprehension 
strategies implemented before, during, and after reading that have been previously shown to be 
associated with stronger written and spoken language skills in struggling readers, and (d) is 
implemented via telepractice to promote service delivery in meaningful contexts for the 
individual with IDD. 
 
The WLIFT components are summarized in Table 1. WLIFT includes reading comprehension 
strategies which are known to be effective for struggling readers that are explicitly taught to be 
implemented before, during, and after reading. WLIFT was developed using a novel approach in 
which empirical evidence on the behavioral phenotype of commonly occurring IDDs informed 
reading comprehension strategy selection.30,31 Given deficits in working memory and executive 
functioning among individuals with IDD, reading comprehension strategies that directly and 
explicitly address these areas of need (graphic organizer and comprehension monitoring, 
respectively) are taught. To increase the likelihood for generalization and enhance participants’ 
motivation, reading comprehension strategies are taught and practiced using researcher-
developed functional literacy stimuli (e.g., text messages, emails) which closely reflect 
participants’ daily written communications. 
 
Table 1. WLIFT Components for Young Adults with IDD 
When 
Implemented 
Strategy 
Description 
Before, 
during, after 
Graphic 
organizer 
Visual display of reading comprehension strategies. Provides 
visual and working memory support. 
Before 
Activate prior 
knowledge 
Brainstorm what is already known about the literacy context 
(e.g., review strategies, identify context, identify person 
corresponding with). Makes explicit connection between old 
and new knowledge. 
During 
Word-solving 
(decoding) 
Identify unknown words, read again, sound out, and/or parse 
into smaller parts. Facilitates accurate decoding. 

 
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Comprehension 
monitoring 
Detect breakdowns in comprehension by drawing on literacy 
and language knowledge to evaluate whether one 
understands what is read and if not, react effectively by 
problem solving. Provides executive functioning support. 
Repeated 
reading 
Re-read text. Facilitates reading accuracy and speed which 
enables comprehension. 
Visualization & 
summarization 
Differentiate important from unimportant ideas and then 
synthesize and create a mental image of important details. 
Facilitates efficient use of meta-cognitive skills using 
multimodal sensory support to visualize important details so 
cognitive resources are not expended on irrelevant details. 
After 
Planning 
Clarify ambiguous ideas by asking self if more information is 
needed which informs deciding what to do next in the 
functional literacy context (e.g., respond to message, 
complete assignment, add work shift to calendar). Provides 
executive functioning support. 
Note. This table is informed by the work of the National Reading Panel (2000) and Shanahan et al. (2010).  
 
From the outset of the intervention, the young adults with IDD are individually taught all of the 
strategies using a graphic organizer as visual support. The interventionist: (a) defines the 
reading comprehension strategies, (b) describes and models how to use the strategies before, 
during, and after reading, and (c) and answers any questions about the strategies. The 
participant practices all the strategies during the twice weekly sessions. Each session follows 
the components of the teach-model-coach-review format as described below. During the think-
alouds, the participant is encouraged to tell the interventionist everything that they are doing as 
they implement the comprehension strategies. In addition to working directly with each 
participant with IDD to schedule all study sessions, we will also include parents/caregivers in all 
written communications or as needed to assist with scheduling logistics. Parents/caregivers are 
not required to be present during the intervention sessions. 
 
Intervention Lesson Structure 
1. Teach (introduction/review; 5 min) 
a. The interventionist reviews the intervention strategies previously taught.  
2. Model (10 min) 
a. The interventionist models the intervention strategies using a think-aloud. The 
interventionist demonstrates the strategy via explicit modeling. The student is 
observing but not implementing in this step. This step is faded as the student 
requires reduced support to use the strategy and eliminated when the student 
can practice the strategy proficiently. The interventionist judges when explicit 
modeling is no longer needed. 
3. Coach (15 min + 10 min) 
a. The young adult with IDD practices the strategies with support from the 
interventionist across multiple functional literacy stimuli. The interventionist 
guides the student to use the strategy when reading aloud. The interventionist 
and the student work together to implement the strategy. The interventionist 
models and prompts the student to use the strategy with multiple opportunities 
for practice. This step is faded (i.e., decreased time allotted and then eliminated) 
as the student demonstrates independence. 
b. The young adult with IDD uses a think-aloud to practice the strategies 
independently using one functional literacy text.  
 

 
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4. Review (5 min) 
a. The interventionist reviews the strategies, summarizes the session, and answers 
any questions. The participant practices the strategy and the interventionist 
provides positive reinforcement and feedback to encourage the student and to 
acknowledge accurate implementation of the strategy. The interventionist 
provides scaffolds only as needed, for example, when the student is not accurate 
in employing the strategy. It is anticipated that this step will be deployed with 
increasing independence over the course of the intervention phase.  
 
Functional Literacy Text Development 
• 
The following text parameters are analyzed using the Readability Test Tool for each 
functional literacy text used in the study (https://www.webfx.com/tools/read-able/): 
o Total number of sentences 
o Total number of words 
o Number of complex words 
o % Complex words 
o Average number of words per sentence 
o Average number of syllables per word 
o Flesch reading ease 
o Flesch-kincaid grade level 
• 
Three text samples across the following domains were gathered to develop text 
readability guidelines: Social-GroupMe, Academic-Email (program and instructor), 
Academic-assignments, Academic-Syllabus (only 2 samples). 
• 
The following parameters are used to develop additional functional literacy texts: 
 
Text 
TNS 
TNW 
# Complex 
words 
% Complex 
words 
Avg # 
Words/Sent 
Avg # 
Syll/Word 
Flesch 
Rdg Ease 
Flesch-
Kincaid Gr  
Notes 
All texts 
4-12 
25-120 
2-12 
4-15 
5-15 
1-2 
60-100 
1.7-5.0 
Include 2-10 
exchanges in social 
texts (text msgs, 
GroupMe) 
Note. TNS = total number of sentences, TNW = total number of words 
 
 
STATISTICAL ANALYSIS PLAN 
 
Primary research aim: 
1. To examine the effects of the WLIFT intervention on use of reading comprehension 
strategies in functional texts by young adults with IDD.  
 
Secondary research aims:  
 
1. To examine the effects of the intervention on distal written language outcomes. 
2. To examine the effects of the intervention on distal spoken language outcomes. 
 
Data in both experimental conditions will be analyzed using t tests to compare average gain 
scores between treatment and control groups for each of the primary and secondary outcomes. 
Covariates (e.g., nonverbal cognition, socioeconomic status) will be included in ANCOVA 
analyses as necessary to correct for average group differences at pretest on key variables.  
Appropriate non-parametric methods (Wilcoxon rank sum tests) will be used if there are issues 
with model assumptions due to the nature of the data.