Smail Layes

Robert Lalonde

Mohamed Rebai

Effects of an Adaptive Phonological Training Program on Reading and Phonological Processing Skills in Arabic-Speaking Children With Dyslexia

Keywords: developmental dyslexia, adaptive phonological training, phonological processing, phonological awareness, rapid automatized naming, verbal short-term memory

Introduction

Developmental dyslexia is a neurodevelopmental disorder that primarily affects accurate and fluent word reading and spelling [START_REF] Lyon | Defining dyslexia, comorbidity, teachers' knowledge of language and reading: A definition of dyslexia[END_REF]Peterson & Pennington, 2012). The main difficulties encountered are related to phonological processing, which refers to the ability to perceive, store, and manipulate speech sounds [START_REF] Moll | Cognitive mechanisms underlying reading and spelling development in five European orthographies[END_REF]. It is widely accepted that the phonological processing deficit is a core contributor to reading disability in Indo-European languages [START_REF] Lyon | Defining dyslexia, comorbidity, teachers' knowledge of language and reading: A definition of dyslexia[END_REF][START_REF] Snowling | Dyslexia[END_REF][START_REF] Vellutino | Specific reading disability (dyslexia): what have we learned in the past four decades?[END_REF][START_REF] Wagner | Changing causal relations between phonological processing abilities and word-level reading as children develop from beginning to fluent readers: A five-year longitudinal study[END_REF] and Semitic languages such as Arabic [START_REF] Abu-Rabia | Word recognition and basic cognitive processes among reading-disabled and normal readers in Arabic[END_REF][START_REF] Al Mannai | Phonological processing skills as predictors of literacy amongst Arabic speaking Bahraini children[END_REF][START_REF] Layes | Reading speed and phonological awareness deficits among Arabic-speaking children with dyslexia[END_REF][START_REF] Saiegh-Haddad | Phonological processing in diglossic Arabic: The role of linguistic distance[END_REF], perhaps a universal hallmark [START_REF] Goswami | Phonological representations, reading development and dyslexia: Towards a cross-linguistic theoretical framework[END_REF][START_REF] Ziegler | Reading acquisition, developmental dyslexia, and skilled reading across languages: A psycholinguistic grain size theory[END_REF]. Dyslexic children require explicit and intense phonological training to mitigate their deficits [START_REF] Torgesen | Intensive remedial instruction for children with severe reading disabilities: Immediate and long-term outcomes from two instructional approaches[END_REF]. In the present study, we investigated the potential positive effects of adaptive phonological training on reading and phonological processing skills in Arabic-speaking children with dyslexia.

The three main components of phonological processing are phonological awareness (PA), phonological memory, and phonological recoding in lexical access or phonological retrieval, often known as rapid automatized naming (RAN) [START_REF] Torgesen | Longitudinal studies of phonological processing and reading[END_REF][START_REF] Torgesen | Preventing reading failure in young children with phonological processing disabilities: Group and individual responses to instruction[END_REF][START_REF] Wagner | The development of young readers' phonological processing abilities[END_REF]. PA includes one's ability to identify and manipulate individual phonemes; RAN includes one's ability to retrieve phonemes rapidly/automatically from long-term memory; phonological memory refers to short-term memory (STM) for phonetically coded material. Among the three constructs, PA is the most powerful construct to predict reading development [START_REF] Fletcher | Cognitive profiles of reading disability: Comparisons of discrepancy and low achievement definitions[END_REF]. Research by Nelson et al. (2012) supports the idea that these skills are best conceived as three separate but correlated abilities rather than highly overlapping measures of one or two underlying constructs.

Impairments occur in phonological representations of the mental lexicon (e.g., [START_REF] Farquharson | Phonological and lexical influences on phonological awareness in children with specific language impairment and dyslexia[END_REF]. According to one theory, a phonological processing deficit is a primal cause of reading difficulties [START_REF] Stanovich | Refining the phonological core deficit model[END_REF], manifesting itself in a variety of skills including PA, storage, and retrieval of speech sounds as well as phonological STM. The deficit hinders the learning of letter-sound associations and negatively affects reading development [START_REF] Ramus | Theories of developmental dyslexia: Insights from a multiple case study of dyslexic adults[END_REF][START_REF] Goswami | Dyslexia -in tune but out of time[END_REF]. In support of this hypothesis, robust behavioral evidence shows that dyslexic readers perform poorly on a variety of phonological tasks requiring verbal STM (e.g. digit span), PA (e.g. phoneme deletion and blending), and phonological decoding (e.g. pseudo-word reading) (Wagner, Torgesen, & Rashotte, 1994;[START_REF] Ramus | Theories of developmental dyslexia: Insights from a multiple case study of dyslexic adults[END_REF]. Inadequate PA has been suggested to be one of the most reliable diagnostic indicators of reading disabilities [START_REF] Goswami | Phonology, reading development and dyslexia: A cross-linguistic perspective[END_REF]Torgesen & Mathes, 2002;[START_REF] Snowling | Dyslexia[END_REF]. Similar to other languages, a PA contribution to reading development was also documented in Arabic [START_REF] Abu-Rabia | The role of phonology and morphology in the development of basic reading skills of dyslexic and normal native Arabic readers[END_REF][START_REF] Asaad | Learning to read in Arabic: The long and winding road[END_REF][START_REF] Saiegh-Haddad | Phonological processing in diglossic Arabic: The role of linguistic distance[END_REF].

Phonological recoding in lexical access, commonly labelled RAN, is the time taken to process familiar verbal information (e.g. objects, letters, colors and digits), which requires rapid retrieval of phonological forms (names) of items [START_REF] Wolf | The double-deficit hypothesis for the developmental dyslexias[END_REF]. RAN has been shown to be a strong predictor of reading ability and a significant symptom of reading difficulty across languages [START_REF] Di Filippo | Rapid naming, not cancellation speed or articulation rate, predicts reading in an orthographically regular language (Italian)[END_REF][START_REF] Ding | Rapid automatized naming and immediate memory functions in Chinese Mandarin-speaking elementary readers[END_REF][START_REF] Furnes | Phonological awareness and rapid automatized naming predicting early development in reading e spelling: Results from a cross-linguistic longitudinal study[END_REF][START_REF] Georgiou | Rapid naming speed components and early reading acquisition[END_REF]. Consequently, PA and RAN have gained importance in understanding poor reading as well as guiding programs aimed at remediation of reading difficulties (e.g. [START_REF] Kirby | Naming speed and phonological awareness as predictors of reading development[END_REF][START_REF] Powell | An experimental comparison between rival theories of rapid automatized naming performance and its relationship to reading[END_REF][START_REF] Wolf | The double-deficit hypothesis for the developmental dyslexias[END_REF].

Phonological STM is a component of working memory used to store verbal information for a small amount of time (Baddeley, 1986;[START_REF] Baddeley | A developmental deficit in short-term phonological memory: Implications for language and reading[END_REF]. Studies across languages have reported limitations in verbal memory skills in children with reading disabilities [START_REF] Griffiths | Predictors of exception word and nonword reading in dyslexic children: The severity hypothesis[END_REF][START_REF] Seigneuric | Working memory resources and children's reading comprehension[END_REF]. Because phonological memory is dependent on the activation of phonological codes, children with reading disabilities perform poorly on memory span tasks [START_REF] Kibby | Memory Functioning in Children with Reading Disabilities and/or Attention-Deficit/Hyperactivity Disorder: A Clinical Investigation of Their Working Memory and Long-term Memory Functioning[END_REF]. It has been claimed that a defective phonological memory may result from poorly specified phonological representations and the phonological features of sounds [START_REF] Long | Dyslexia Limits the Ability to Categorize Talker Dialect[END_REF].

Several Arabic-based studies have underscored the role of phonological processing. [START_REF] Abu-Rabia | Word recognition and basic cognitive processes among reading-disabled and normal readers in Arabic[END_REF] noted that, consistent with their monolingual English-speaking counterparts, dyslexic Arabic readers showed poor phonological decoding abilities and PA in comparison to age-matched typical readers and younger reading-matched readers. More recently, consistent findings with Abu-Rabia and colleagues (Abu-Rabia, 2003;[START_REF] Abu-Rabia | Reading skills in three orthogra-phies: The case of trilingual Arabic-Hebrew-English-speaking Ara-bic children[END_REF] were reported by [START_REF] Layes | Effectiveness of a phonological awareness training for Arabic disabled reading children: insights on metalinguistic benefits[END_REF], who demonstrated that the most marked differences between typical and dyslexic readers were evident in PA and RAN explained mainly through differences in language sound structure. However, descriptive studies may simply show correlational evidences between phonological processing and reading rather than providing evidence in favor of a causal link between them. Hence, the strongest argument in support of a role of phonological processing in reading acquisition comes from training studies [START_REF] Castles | Is there a causal link from phonological awareness to success in learning to read?[END_REF] concerning the impact of PA on reading [START_REF] Torgesen | Intensive remedial instruction for children with severe reading disabilities: Immediate and long-term outcomes from two instructional approaches[END_REF][START_REF] Wise | Training phonological awareness with and without explicit attention to articulation[END_REF].

Although many studies have investigated the impact of training programs on PA and reading competence [START_REF] Blachman | Effects of intensive reading remediation for second and third graders[END_REF], little is known about the effect on RAN and phonological STM. Only a small number have investigated generalization training effects of PA, RAN, or STM [START_REF] Schneider | Short-and long-term effects of training phonological awareness in kindergarten: Evidence from two German studies[END_REF][START_REF] Van Kleeck | Training in phonological awareness generalizes to phonological working memory: A preliminary investigation[END_REF]. Schneider et al. (1997) examined whether PA training generalizes to other phonological processing skills such as verbal working memory in a cohort of normally developing children. The training of German kindergarten children on a set of PA skills for six months improved scores on PA, reading, and spelling at the end of the first and second grade; however, no improvement was found on a word span task.

Although a phonological processing deficit is a main manifestation of developmental dyslexia across scripts, the relative contribution of phonological processing skills to reading development is greatly affected by the regularity of grapheme-phoneme correspondence (e.g. [START_REF] Goswami | Phonological representations, reading development and dyslexia: Towards a cross-linguistic theoretical framework[END_REF][START_REF] Ziegler | Reading acquisition, developmental dyslexia, and skilled reading across languages: A psycholinguistic grain size theory[END_REF]. This issue may represent an important area for investigation to provide a causal relation between phonological processing and word reading, particularly in shallow orthographies that greatly rely on phonological processing such as Arabic (Abdelhadi, [START_REF] Abdulhadi | Perceptual load in the reading of Arabic: Effects of orthographic visual complexity on detection[END_REF]. While Arabic letters represent consonants, vowels occur in print as a set of diacritical marks which facilitate reading accuracy. In un-vowelized Arabic, all diacritical marks are absent and vowel identity must be restored as an integral part of word identification [START_REF] Ibrahim | Beginning Readers in Arabic and the Distance between Literary and Spoken Arabic[END_REF]. Beginners need to read diacritic signs before developing a lexical strategy relying less and less on the diacritic system after three years of schooling.

In a previous study [START_REF] Layes | Effectiveness of a phonological awareness training for Arabic disabled reading children: insights on metalinguistic benefits[END_REF], a phonological training program was effective in promoting gains in PA, word reading, and RAN in Arabic children with dyslexia. It was suggested that more phonological processing skills could provide further evidence for the effectiveness of phonological training. The present study includes phonological STM in addition to PA and RAN as key components in phonological processing. We hypothesized that phonological training enhances PA and improves RAN and verbal STM as well as word reading and pseudo-word decoding.

Method

Participants

Participants were initially recruited as poor readers (n = 87) by teachers and then by poor performances on word and pseudo-word reading. After eliminating two cases whose profiles did not match with exclusive criteria detailed bellow, we included forty children diagnosed with dyslexia on the basis of at least one standard deviation below their age (Berninger et al., 2008). Participants were then equally divided into two groups following a randomized design in which children were assigned to each condition individually, an experimental group (n=20) with a mean age of 122.9 months (SD=11.40) and a control group (n =20) aged 124.65 months (SD=10.08).

All participants were native Arabic speakers exposed to Standard Arabic in regular classes and exempt from any oral language disability based on teacher reports. Children were excluded if they had a history of hearing or visual impairment, had below average scores on Raven Standard Matrices, repeated a school grade level, and had a developmental disorder such as hyperactivity. Independent t-tests showed no difference between the two groups on age and Raven scores (Table 1).

Design and Procedure

Before being trained or not, all participants were tested individually on criterion-referenced reading tests after consent by parents informed about the general aim of the study. The phonological program involved face-to-face interactive training carried out in a quiet room inside a school building but outside regular classroom hours over a period of 12 weeks, 3 sessions per week, each training session lasting approximately 40 min. The duration and frequency of training sessions seemed to be relevant to the age group [START_REF] Griffiths | Reviewing evidence-based practice for pupils with dyslexia and literacy difficulties[END_REF]. As in most phonological training programs, we used an adaptive training procedure that gradually adjusts task difficulty with individual performance. If an individual had more than 70 % correct, we increased the number of items in the task.

Measures

Pre and Post training measures

Non-verbal IQ Test

The Raven Standard Progressive Matrices is a non-verbal test of reasoning ability and general intelligence. We used the shortened form (Bouma et al., 1996) comprising 36 items (Sets A, B, and C) consisting of a target matrix with one missing part. The children selected from six to eight alternatives to fill the missing patch.

Word and pseudo-word reading tasks

A list of eighty words (α = .82) was given and read aloud (40 frequent words and 40 infrequent words). The words varied in length (disyllabic and trisyllabic) and frequency (high and low). In addition, 40 pseudo-words (α = .90) controlled for orthographic length were used [START_REF] Layes | Reading speed and phonological awareness deficits among Arabic-speaking children with dyslexia[END_REF]Layes et al., 2015a, b).

Phonological awareness:

The phoneme blending task (test-retest reliability, r =. 48) Phoneme blending is described as the ability to connect phonemes in spoken language (Perez, 2008). Phoneme blending was highly correlated with future reading success primarily because of the importance of decoding (Adams, 1990;Perez, 2008). When a child encounters an unfamiliar word in print, his ability to identify and blend the phonemes that correspond with each letter or letter combination helps him successfully read the word and increases the probability he or she will recognize the word the next time. Twenty pairs of words were presented orally and participants isolated the initial syllables from each word to pronounce the new combination. Words included clusters of consonants (CVCVC), since Arabic words are trilateral.

Rapid Automatized Naming task: RAN objects (test-retest reliability, r =. 51)

The RAN task, used to assess the speed of processing in naming objects [START_REF] Wolf | The double-deficit hypothesis for the developmental dyslexias[END_REF], was elaborated in a previous study and highly related with reading in Arabic-speaking children [START_REF] Layes | Phonological and cognitive reading related skills as predictors of word reading and reading comprehension among Arabic dyslexic children[END_REF]. Prior to timed naming, each participant was asked to name the stimuli in a practice trial to ensure familiarity. Participants then named as quickly as possible recurring objects (scissors, cat, book, pen, and hand) arranged semi-randomly in eight rows and repeated 10 times. The time needed to name all the stimuli was measured.

Phonological STM test (test-retest reliability, r =. 53)

We opted for the pseudo-words span test because of its attested validity in assessing phonological STM capacity [START_REF] Baddeley | Working memory and language: an overview[END_REF][START_REF] Gathercole | Non-word repetition and word learning: the nature of the relationship[END_REF]. It comprised 24 pseudo-words varying in length. The items were presented one by one according to their length from 3 to 6 syllables, composed of six items for each length, in which participants repeated pseudo-words as accurately as possible with no time constraint. The pseudo-words were presented in a specific order, and participants must repeat them one by one.

The phonological training program: Background and content

Based on a previous phonological training study for Arabic-speaking children [START_REF] Layes | Effectiveness of a phonological awareness training for Arabic disabled reading children: insights on metalinguistic benefits[END_REF], this program was designed as an explicit interactive training focusing on phoneme manipulation and involving a multitude of activities that aid children in identifying beginning, middle, and end phonemes as well as blending, segmenting, and deleting sounds in spoken words [START_REF] Joseph | Best practices in planning interventions for students with reading problems[END_REF] (bee-palm)

Since PA requires oral presentations, children were instructed with the aid of the trainer to pronounce the word indicating the name of each image (object) before executing the task.

Results

Baseline assessment

With regard to inclusion criteria, comparison between training and control groups are presented in Table ( 1), including scores for reading and phonological tasks, showing similar performances at baseline assessment, as well as those for age and Raven scores.

Insert table 1

Training Effects

Post-training comparisons between the two groups shown in Table (2) revealed intergroup differences on all reading and phonological processing tasks except RAN. Children with dyslexia taking phonological training also had higher total scores while reading words and pseudo-words (M = 43.35, SD = 4.56) than did controls [(M = 33.75, SD = 2.63), t (2.02) = 8.14, p < .000].

Insert table 2

To examine further the potential effects of the phonological training program, we compared pre-versus post-training periods for each group separately with the paired t-test for dependent samples (Table 3). Results for the experimental group indicate significant improvements for posttraining measures over pre-training measures except RAN. On the contrary, results show nonsignificant differences between the two assessment periods for the control group (Table 4).

Insert table 3

A one-way multivariate analysis of covariance (MANCOVA) controlling for pre-training measures was conducted on reading and phonological processing scores. For the total reading score and phonological processing tasks, the analysis output revealed an omnibus group factor effect [F (6, 29) = 14.18, p=0.000, Pillai's trace= .746; partial η² = .746], indicating significant differences between the pre-and post-training periods in the training group.

Insert table 4

Follow-up univariate analyses (ANOVAs) show significant differences based on group factor in frequent word [F(1,34) = 28.07, p < .000, partial η Insert Figure 1

Discussion

The aim of the current study was to investigate the effects of a phonological training program on word and pseudo-word reading efficiency as well as on PA, verbal STM, and RAN in Arabic speaking children with dyslexia. Positive effects of the program replicate previous findings in an Arabic speaking cohort with dyslexia [START_REF] Layes | Effectiveness of a phonological awareness training for Arabic disabled reading children: insights on metalinguistic benefits[END_REF]. More specifically, our findings demonstrate that phonological training results in gains in each of the three phonological processing components. These results are consistent with previous meta-analyses of phonological training [START_REF] Bus | Phonological Awareness and Early Reading: A Meta-Analysis of Experimental Training Studies[END_REF], suggesting that phonological training increases speech sound awareness and ameliorates reading achievement. Findings support the notion that phonological processing is a core contributor to reading ability regardless of orthography [START_REF] Kibby | Reading performance is predicted by more than phonological processing[END_REF].

Effects of phonological training on phonological processing

The children with dyslexia receiving phonological intervention outperformed age and reading matched controls on all phonological measures after MANCOVA and univariate analyses.

These results lead us to infer that phonological intervention improves not only PA typically observed in children with reading disability but also retrieval of the phonological code (RAN) and verbal STM. The persistent defect of phonological processing on the 4 th and 5 th grade cohort may indicate that learning to read in Arabic is challenged by the transition from the vowelled script (transparent) to a less transparent form when children learn unvowelized words. This transition may make more complicated the process of establishing precise phonological representations in readingdisabled children, hindering grapheme to phoneme conversion. The most potent effect occurred for PA assessed by the blending phoneme test, as in previous investigations (Fälth, Idor, & Tomas, 2011;Lyster, 2002;[START_REF] Snowling | Evidence-based interventions for reading and language difficulties: Creating a virtuous circle[END_REF]Torgeson, 2006), including Arabic [START_REF] Dallasheh-Khatib | Longitudinal data on the relations of morphological and phonological training to reading acquisition in first grade: the case of Arabic language[END_REF], demonstrating that awareness of word structure is related to reading acquisition across languages. This finding provides additional evidence that phonological intervention may apply qualitative changes on the underlying phonological representations which, in turn, make phonological processing processes more efficient.

Phonological intervention was also effective regarding RAN, indicating that RAN taps into basic skills involved in phonological and reading processes (Plaza & Cohen, 2003). This agrees with data published by [START_REF] Wang | Effects of Phonological Training on the Reading and Reading-Related Abilities of Hong Kong Children with Dyslexia Front[END_REF], who found significant improvements after PA training on rapid digit naming of Chinese. The phonological training program concerns the exclusive use of images rather than audition, which seems to have a positive impact on retrieval speed of verbal representations.

A major debate concerns whether impaired rapid naming and phonological processing deficits in dyslexics are independent factors or not. The positive impact of phonological intervention on PA and RAN favors the theoretical position that naming speed deficits reflect inefficient phonological recoding in lexical access [START_REF] Wagner | The Nature of Phonological Processing and Its Causal Role in the Acquisition of Reading Skills[END_REF] as a natural consequence of poor phonological representations [START_REF] Snowling | Dyslexia[END_REF]. Therefore, RAN should be part of the phonological processing construct along with PA and phonological memory (Araújo, Faísca;Petersson, Reis, 2011). The present findings support the view that the slower speed in naming tasks found in dyslexic subjects is caused by difficulties in retrieving phonological representations for matching to a visual symbol [START_REF] Wagner | Changing causal relations between phonological processing abilities and word-level reading as children develop from beginning to fluent readers: A five-year longitudinal study[END_REF]Wagner, Torgesen, & Rashotte 1994).

The present study also revealed a significant impact of the phonological intervention program on verbal STM. We cannot exclude a positive impact of the phonological similarity decision task involved in the program, based on the activation of short-term retention of phonemic sequences until the decision on phonemic structure similarity is made. These findings indicate that impaired verbal STM may reflect poor phonological representations in memory and inadequate recall of phonological items leading to inaccurate application of grapheme-phoneme correspondences [START_REF] Thomson | Phonological similarity neighborhoods and children's short-term memory: Typical development and dyslexia[END_REF]. [START_REF] Wagner | Changing causal relations between phonological processing abilities and word-level reading as children develop from beginning to fluent readers: A five-year longitudinal study[END_REF] argued that efficient phonological encoding enables the beginning reader to maintain an accurate representation of phonemes associated with letters or parts of words. The phonological encoding and retrieval deficits are thought to be underlying sources of reading difficulties in subjects with dyslexia because speech sounds are poorly represented, stored, or retrieved, and consequently learning grapheme-phoneme correspondences will be affected [START_REF] Vellutino | Developmental dyslexia[END_REF]. [START_REF] Majerus | The nature of verbal short-term impairment in dyslexia: the Importance of serial order[END_REF] stated that if linguistic representations are poorly developed, verbal STM will be directly affected. In the case of dyslexia, the verbal STM impairment could be a consequence of the phonological processing impairment. This finding may partially, at least, support the conception stipulating that deficits in phonological memory and PA stem from a common source, namely deficiencies in the quality of phonological representations [START_REF] Torgesen | Longitudinal studies of phonological processing and reading[END_REF]Wagner, Torgesen, & Rashotte, 1994). Therefore, phonological STM may be important in the acquisition of letter-phoneme correspondences by the storage of phonological information which involves creating a sound-based representation of written words in memory (Brunswick, Neil Martin and Rippon, 2012). The current evidence suggests that although verbal STM improves, its role as part of the phonological processing construct cannot be the cause of reading abilities [START_REF] Wagner | Changing causal relations between phonological processing abilities and word-level reading as children develop from beginning to fluent readers: A five-year longitudinal study[END_REF].

The effects of phonological training on decoding words and pseudo-words

By the end of the training program, participants in the experimental group performed better in reading words and pseudo-words, suggesting that it helped participants in identifying the internal phonological structure of words leading to more precise mapping of sounds to letters and targeting the awareness of individual sounds (phonemes) in word composition [START_REF] Ehri | Systematic phonics instruction helps students learn to read: Evidence from the National Reading Panel's meta-analysis[END_REF]. In agreement with previous studies, our results show that improvements in PA lead to improved reading skills [START_REF] Høien-Tengesdal | The relationship between phonological skills and word decoding[END_REF][START_REF] Nithart | Early contribution of phonological awareness and later influence of phonological memory throughout reading acquisition[END_REF], improving the ability of sounding out words in struggling readers [START_REF] Roman | Toward a comprehensive view of the skills involved in word reading in Grades 4, 6, and 8[END_REF]. Similar findings were reported in another Arabic-based study [START_REF] Makhoul | Fostering Phonological Awareness in a Computerized-Tutored Environment for Arabic Speaking First Graders At-Linguistic Risk[END_REF] examining the potential impact of phonological skills on reading acquisition and prevention of reading failure in second grade atlinguistic risk readers. Our findings agree with research demonstrating the influence of PA on reading ability up to at least the fourth grade [START_REF] Catts | Are specific language impairment and dyslexia distinct disorders?[END_REF][START_REF] Wagner | Changing causal relations between phonological processing abilities and word-level reading as children develop from beginning to fluent readers: A five-year longitudinal study[END_REF]. The amount of PA a child possesses affects reading development such that exposure to phonological instruction can impact reading growth [START_REF] Hatcher | Evidence for the effectiveness of the Early Literacy Support programme[END_REF][START_REF] Wagner | Development of reading-related phonological processing abilities: New evidence of bidirectional causality from a latent variable longitudinal study[END_REF].

In support of the phonological deficit hypothesis stating that the reading disorder is caused by a specific deficit in phonological processing [START_REF] Vellutino | Phonological coding, phonological awareness, and reading ability: Evidence from a longitudinal and experimental studyMerrill-Palmer Quarterly33321363 Von Bastian CC1[END_REF][START_REF] Ramus | Theories of developmental dyslexia: Insights from a multiple case study of dyslexic adults[END_REF], our dyslexic subjects who performed poorly on PA, pseudo-word decoding, and phonological retrieval benefit from phonological training focusing on phoneme representation, which may generalize to phonological processing skills, providing support of a causal link between PA and reading acquisition [START_REF] Hulme | Phonological skills are (probably) one cause of success in learning to read: A comment on Castles and Coltheart[END_REF]Wagner, Torgesen, & Rashotte, 1994). It is likely that phonological processing limitations hinders children with reading difficulties to develop fully specified phonological and orthographic representations of words [START_REF] Goswami | Phonology, reading development and dyslexia: A cross-linguistic perspective[END_REF].

Conclusions

Our findings add evidence to studies in several languages concerning the impact of phonological training on reading proficiency, addressing several sub-skills at phonologic and phonemic levels, pointing to the contribution of phonological training in facilitating the development of phonological processing abilities in children with reading disabilities (e.g. [START_REF] Høien-Tengesdal | The relationship between phonological skills and word decoding[END_REF]Schneider et al., 1997). These findings support the view that dyslexia is caused by a phonological processing deficit and emphasize the importance of establishing phonological representations of words and phonemes in reading Arabic [START_REF] Asaad | Learning to read in Arabic: The long and winding road[END_REF][START_REF] Saiegh-Haddad | The impact of phonemic and lexical distance on the phonological analysis of words and pseudowords in a diglossic context[END_REF][START_REF] Saiegh-Haddad | Correlates of reading fluency in Arabic: Diglossic and orthographic factors[END_REF]. Our findings have practical implications for instructional methods applied in learning to read: better understanding of PA, RAN, and verbal STM may help in basic reading skills, supporting early screening of phonological processing as a way to identify children at risk [START_REF] Wagner | Changing causal relations between phonological processing abilities and word-level reading as children develop from beginning to fluent readers: A five-year longitudinal study[END_REF].

Theoretical implications could also be drawn about whether PA, RAN, and verbal STM reflect separate but correlated abilities (e.g. Nelson et al., 2012) or overlap on one underlying construct (e.g. [START_REF] Wagner | The development of young readers' phonological processing abilities[END_REF]. Our findings are consistent with the latter position in that all three measures improved in the experimental group.

  as highly inter-correlated sub-skills. Particular consideration was given to phonological representation as a basic skill in word recognition. Unlike the previous program, it did not explicitly comprise letter sound correspondence. The central goal is to improve the performance of phonological processing with direct implication of verbal memory as two intertwined skills underlying the reading process. The tasks involved the mental segmentation of words, the identification of the same initial and final phonemes in different words based on their graphical illustrations (images), and the detection of similarity/dissimilarity in sequences of phonemes. The training took place in small group settings with an average of seven children and was conducted by one of the researchers and two assistants. Assistant trainers attended each training session provided by the researcher to ensure training quality including time control, content delivery, and material presentations. The main sub-skills targeted over the course of the sessions were: 1 -The phonological representation (word and phoneme) via recognition and identification of phonemes and word position: -Identification of phonemes composing the word -Identification of images based on the shared phonemic construction -Identification of images via phonemes in different positions in the word 2 -Phoneme manipulation: -Blending phonemes extracted from given words -Phoneme deletion from different positions in the word 3-Auditory discrimination of phonemes (auditory verbal information processing and memory) -Auditory identification of the similarity between strings of phonemes -Auditory identification of the similarity between pseudo homophones. Ex [ ﺑﻨﺎت ﻧﺒﺎت nabatbanat ] (plant-girls) 4-Visual discrimination of letters: (visual verbal information processing and memory) -Visual identification of the similarity between strings of letters -Visual identification of the similarity between pseudo homographs [ ﻧﺤﻠﺔ -ﻧﺨﻠﺔ nakhla-nahla]

  2 = .45], infrequent word [F(1,34) = 38.58, p < .000, partial η 2 = .53], pseudo-word [F(1,34) = 5.97, p < .02, partial η 2 = .15], PA [F(1,34) = 8.28, p < .007, partial η 2 = .20], verbal STM [F(1,34) = 14.09, p < .001, η 2 = .30], and RAN [F(1,34) = 12.26, p < .001, partial η 2 = .25].

Figure 1 .

 1 Figure 1. Differences between training and control groups in post training measures

Table 1 .

 1 However, we cannot rule out motivational gains or other factors potentially confounding treatment effects. Future studies should incorporate in the experimental design active control groups unrelated to phonological training (von Bastian, Oberauer, 2014). Long-term monitoring is necessary to demonstrate maintenance effects by conducting follow-up assessment. A long-term phonological training study is needed to examine more deeply the bidirectional relation between PA and reading acquisition (e.g.[START_REF] Castles | Is there a causal link from phonological awareness to success in learning to read?[END_REF]. Comparison between experimental and control groups in pre-training measures

	Measures	Experimental group Control group Mean SD Mean SD	t= (2.02) Sig.
	Age	122.90	11.40	124.65	10.08	0.51	>.05
	Raven	10.85	1.08	10.70	.80	0.49	>.05
	Freq. word	15.40	2.08	14.90	1.94	0.78	>.05
	Infreq. word	13.15	3.23	12.10	3.22	1.02	>.05
	Pseudo word	5.05	1.73	6.00	2.24	-1.47	>.05
	Total word reading 28.55	3.56	27.00	2.95	1.49	>.05
	Total reading	33.60	3.63	33.00	3.58	0.52	>.05
	PA	6.55	1.572	7.15	1.182	-1.36	>.05
	VSTM	7.95	1.669	8.65	.587	-1.76	>.05
	RAN	23.95	2.800	22.75	2.074	1.54	>.05

Table 3 .

 3 Comparison between pre-and post-training measures for the experimental group

	Measures	Mean	SD	t-test value Sig.	Cohen's d
	Frequent word	-4.80	3.31	-6.46	< .000	-1.89
	Infrequent word	-2.55	4.28	-2.66	< .01	-.63
	Pseudo word	-2.40	2.28	-4.70	< .000	-1.26
	Total word reading	-7.35	4.83	-6.79	< .000	1.89
	Total reading	-9.75	5.48	-7.94	< .000	2.21
	PA	-2.05	1.31	-6.96	< .000	-1.89

Table 4 .

 4 Comparison between pre and post-training measures for the control group

	VSTM	-1.75	1.77	-4.41	< .000	-1.26
	RAN	3.25	2.84	5.10	< .000	1.58


Combined phonological awareness and print knowledge training improves reading accuracy and comprehension in children with reading disorders

Keywords: Combined training, phonological awareness, print knowledge, reading accuracy, reading comprehension

We examined the effects of a combined phonological and print intervention program on the enhancement of phonological awareness, text reading accuracy and comprehension in fourth grade Arabic-speaking children with severe difficulties in reading accuracy (dyslexia) and reading comprehension. We compared an experimental group (n=22; mean age =122.9 months) to a control group (n=22; mean age=124.65months). The training program focused on two domains: phonological awareness and print knowledge. The results showed that the experimental group performed better in the post and follow-up assessments than in baseline assessment on phonological awareness, reading accuracy, and comprehension. We discuss findings indicating the positive impact of phonological awareness and print knowledge on reading development in terms of decoding and comprehension abilities.

Introduction

The two most common aspects among reading development disorders are dyslexia, a specific learning disability characterized by inaccurate decoding, and reading comprehension impairment [START_REF] Lyon | A definition of dyslexia[END_REF][START_REF] Snowling | The nature and classification of reading disorders. A commentary on proposals for DSM-5[END_REF]. Reading development not only involves the acquisition of accurate and fluent word decoding but also the acquisition of reading comprehension. Thus, the process of reading comprehension goes beyond decoding and requires not only the access to the meaning of single words but also the meaning of written language at the sentence or text level [START_REF] Hoover | The simple view of reading[END_REF]). Reading comprehension is a complex process that depends on oral language and reading skills and typically with reading accuracy. A substantial body of research examining the neurocognitive basis of developmental dyslexia shows word decoding and recognition to be the locus of difficulty and the strongest predictor of reading comprehension [START_REF] Pennington | Diagnosing learning disorders: A neuropsychological framework[END_REF]. Therefore, reading developmental disorders require particular attention focused on interventions strategies designed to improve difficulties in decoding and reading comprehension [START_REF] Snowling | Interventions for children's language and literacy difficulties[END_REF].

Although children with dyslexia are defined by their reading inaccuracy and decoding difficulties, some have problems with reading comprehension unrelated to an underlying oral language disorder (Shaywitz, Morris, & Shaywitz, 2007). Rather, they are attributable to slow and inaccurate word reading, leaving few attentional resources available for comprehension.

However, reading comprehension impairments can occur in the absence of poor decoding, suggesting that it is a distinct disorder [START_REF] Snowling | Early identification and interventions for dyslexia: a contemporary view[END_REF]. Research has shown that a relatively large group of readers show problems with reading comprehension despite fluent word decoding. This group often called poor comprehenders, has been estimated at 10-15% of children aged 7-10 years [START_REF] Cain | Reading comprehension difficulties: Correlates, causes, and consequences[END_REF][START_REF] Snowling | Interventions for children's language and literacy difficulties[END_REF]. The distinction between dyslexia and reading comprehension impairment is consistent with the simple view of reading (Gough & Tumner, 1986), according to which reading comprehension is the product of decoding and listening comprehension. Thus, three kinds of poor readers have been identified: those with poor decoding (dyslexia), those with poor listening comprehension (poor comprehenders), and those with impairments in both [START_REF] Snowling | Early identification and interventions for dyslexia: a contemporary view[END_REF].

The core of reading and reading difficulties that has attracted much attention over the last two decades is phonological awareness (PA) (e.g. [START_REF] Torgesen | A basic guide to understanding, assessing, and teaching phonological awareness[END_REF]. PA refers to an individual's implicit and explicit sensitivity to the sub-lexical structure of oral language.

Additional indicators of the advent of PA include word awareness (understanding that sentences contain words) and syllable awareness (understanding that words comprise syllables). A lack of this awareness may impede an individual's ability to acquire accurate and fluent word reading skills, and, as such, is a primary source of difficulty for children with reading disabilities across languages [START_REF] Lyon | A definition of dyslexia[END_REF][START_REF] Vellutino | Specific reading disability (dyslexia): What have we learned in the past four decades[END_REF], including Semitic languages such as Arabic (Abu-Rabia, [START_REF] Abu-Rabia | Word recognition and basic cognitive processes among reading-disabled and normal readers in Arabic[END_REF][START_REF] Saiegh-Haddad | Linguistic constraints on children's ability to isolate phonemes in Arabic[END_REF]. The primary difficulty with word recognition in children with developmental dyslexia is related to a deficit in encoding phonologically the translation of sub-vocal units of print into sound, making reading less automatic and thus interfering with reading comprehension. Problems with slow and inaccurate word reading can impede adequate reading comprehension. It follows that dyslexia can be associated with poor reading comprehension, but this is by no means inevitable.

Although PA is necessary to the development of skilled decoding, it is insufficient for acquiring the ability to read words (NRP, 2000). Instead, decoding development is initiated by PA in combination with print knowledge [START_REF] Stuart | Does reading develop in a sequence of stages?[END_REF]. Two major domains of emergent literacy were identified as important predictors of reading ability: PA, which require direct instruction, and print awareness (knowledge), learned primarily by experience prior to systematic literacy instruction (NRP, 2000). Print knowledge is an umbrella term that encompasses children's concepts of print and their alphabetic knowledge. This term typically refers to one's understanding of the forms and functions of written language and of letters and their corresponding sounds [START_REF] Justice | Measuring preschool attainment of printconcept knowledge: a study of typical and at-risk 3-to 5-year-old children using item response theory[END_REF].

Although print knowledge has a reciprocal relationship with PA, there is evidence that it represents a separate construct [START_REF] Lonigan | Development of emergent literacy and early reading skills in preschool children: evidence from a latent-variable longitudinal study[END_REF]. Each construct uniquely predicts later reading competency, indicating that a deficit in either may put a child at risk for limited literacy achievement [START_REF] Catts | Estimating the risk of future reading difficulties in kinder-garten children: A research-based model and its clinical implementation[END_REF]. [START_REF] Jones | Enhancing alphabet knowledge instruction: Research implications and practical strategies for early childhood educators[END_REF] stated that students' knowledge of the names, sounds, and symbols of the letters or alphabetic knowledge is essential for learning to read and write. Skills related to print knowledge (i.e. alphabet knowledge, concepts about print, etc.) were moderate to strong predictors of all conventional literacy skills.

As the phonological deficit theory has been widely considered in recent years, the development of training programs has focused primarily on this component for children with reading disability [START_REF] Defior | How to facilitate initial literacy acquisition: the role of phonological skills[END_REF][START_REF] Jiménez | Metalinguistic awareness and reading acquisition in the Spanish Language[END_REF]. However, PA based interventions are specifically designed to improve PA and decoding, but its impact on reading comprehension deserves full consideration [START_REF] Snowling | The nature and classification of reading disorders. A commentary on proposals for DSM-5[END_REF]. Several studies concerned with consistent orthographies suggest that PA plays an important role not only in the development of basic reading skills, but also in reading comprehension throughout primary school ages. [START_REF] Engen | Phonological skills and reading comprehension[END_REF] examined the role of PA on reading comprehension in a large sample of children from Grade 1. The results showed that in both average and poor decoders, PA had a direct impact on reading comprehension, indicating that phonological factors play an independent role in reading. According to the authors, vocabulary and short-term memory factors are both determined in part by phonological ability. However, it is unclear whether this positive impact of PA training goes through the improvement of reading accuracy (word recognition) or not and whether such a training program includes, and to what extent, print knowledge components such as letter knowledge.

Research workers advocate that effective training programs should include explicit instruction in PA skills, including the connection between sound and print [START_REF] Lundberg | Effects of an extensive program for stimulating phonological awareness in preschool children[END_REF]. This suggests that intervention programs that have utilized training of sounds and letters simultaneously have produced larger gains than training PA alone [START_REF] Ball | Phoneme segmentation training: Effect on reading readiness[END_REF]. Meta-analytic studies on the effects with preschool and older children suggest that PA interventions that include those involving print have larger effects than PA interventions alone [START_REF] Bus | Phonological awareness and early reading: A meta-analysis of experimental training studies[END_REF]Ehri, Nunes, Willows, et al., 2001).

To date, the preponderance of awareness training studies have focused on word-level reading, and were repeatedly found to play an important role in word reading across different orthographies (e.g., O'Connor, [START_REF] Harty | Report of the National Reading Panel: Teaching children to read: An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction: Reports of the subgroups[END_REF]. Only a few studies have to do with the effects of PA combined with print training in children with reading decoding and comprehension disabilities (Sénéchal, Ouellete, Pagan, & Lever, 2012). Based on the lack of such combined training for Arabic speaking children with reading disabilities, the intervention program in the current study comprises different components, such as training in PA including grapheme-phoneme decoding, and print knowledge including letter knowledge to enlarge the potential effects to both reading accuracy and comprehension.

The major goal of the present study was to investigate, whether PA training is an effective intervention to improve reading accuracy in Arabic fourth graders with reading accuracy and comprehension disorders, and whether these children can equally benefit from this program to improve reading comprehension. The research questions raised are: does combined PA and print knowledge training produce measurable effects on reading accuracy? Are such effects replicated on reading comprehension?

Method Participants

Participants were initially recruited as poor readers (n= 77) based on teachers' opinions. Quick screening was performed using Raven's colour matrices for word and pseudo-word reading test to exclude cases failing to meet diagnosis criteria. Afterwards, we eliminated 14 cases whose profiles did not match the exclusive criteria detailed below; we included 63 children diagnosed with dyslexia based on at least -1.5 SD below the standardized score of their age as well as word and pseudo-word reading accuracy. After the reading comprehension test was administered, only subjects having -1 below the mean were retained for the purpose of this study (n=44). This process was necessary to ensure that all participants had both reading accuracy and comprehension deficiencies. We divided participants equally into two groups following a randomized design in which children were assigned to each condition individually: an experimental group (n=22) with a mean age of 122.68 months (SD = 5.79) and a control group (n=22) age 123.82 months (SD =3.82). Independent t tests showed no differences between the two groups on age and Raven scores (Table 1). All participants were native Arabic speakers exposed to standard Arabic in regular classes and exempt from any oral language disability, history of hearing or visual impairment, and any developmental disorder such as hyperactivity.

Materials

Non-verbal mental ability

Raven's Standard Progressive Matrices is a nonverbal test of reasoning ability and general intelligence. We used the shortened form comprising 36 items (Sets A, B, and C) and consisting of a target matrix with one missing part. The children selected from six to eight alternatives to fill the missing patch.

Word reading test

The reading test consisted of a set of 80 stimuli (40 frequent words and 40 infrequent words) varying in length (di-syllabic and tri-syllabic) and frequency of usage (high and low) in addition to a list of 20 pseudo-words varying in orthographic length (Authors, 2014;Authors, 2015Authors, , 2017Authors, , 2019)). A set of 20 stimuli per list was given, frequent words and infrequent words. A list of 40 pseudo-words varied in orthographic length (CVCV/CVCVC), whereas 20 items were derived from real words by altering the position of two letters, the other 20 pseudowords were randomly composed by consonants and vowels with no existing root in the Arabic language. Participants were required to read aloud the item correctly without any time limit. Scores included total number of words correctly read. The internal consistency reliability was α = .89.

Reading comprehension test

This test was designed to evaluate reading accuracy and comprehension in children of the 4 th grade (Athors, 2005). The text was a short story that narrates well known events and was divided into three paragraphs, each consisting of three to four lines. The text was elaborated from a textbook of grade 3 and 4 that may ensure its appropriateness for the participants and includes familiar and non-familiar words [START_REF] Zwobada | La lecture en langue arabe chez l'enfant algérien[END_REF]. The text consisted of 125 words measuring the reading accuracy and six questions that measure reading comprehension. Linguistic categories of the words include: relationships (e.g. with, behind), action verbs (e.g. take), abstract verbs (e.g. want), familiar and unfamiliar vocabulary. Participants were instructed to read the text aloud clearly and as accurately as possible. The text was presented individually without prior time limit. The child had the possibility of self-correction and was encouraged to continue even if he/she finds it difficult.

A content validity test was done with Pearson's product moment correlations between the three paragraphs and the total score of reading accuracy (ranging from 0.72 and .77), considered as acceptable values. Based on a sample of 20 students, the test-retest reliability of reading accuracy was r = .83 and r =. 81 for reading comprehension.

Phonological awareness: syllable blending task

The purpose of the phonological blending task was to measure the child's ability to blend syllables together to form a word when syllables were extracted from orally presented words. Twenty series of three words each were presented orally one at a time, and participants were instructed to isolate the initial syllable from each word and pronounce the new combination, producing a new word (Authors, 2017). The examiner paused for 3 sec between words. The child was to respond with the target word without pausing or altering the pronunciation or order of presentation of the syllables. Each child was given three practice items prior to the administration of the test items. The child's score was based on the total number of correct responses on the test items only when giving the correct target word. The test-retest reliability of this task was r =.71.

Phonological awareness and print knowledge intervention

As reviewed, it is widely established that poor decoding hinders the process of understanding in many children with word recognition problems. Therefore, an intervention to promote the development of word level decoding skills is entirely needed [START_REF] Pullen | Enhancing phonological awareness, print awareness, and oral language skills in preschool children[END_REF]. The central goal of this study was to improve performance in PA with direct implications for print knowledge as two intertwined skills underlying the reading processes.

Based on previous phonological training studies for Arabic-speaking children (Authors, 2015;2019), this intervention program was designed to improve children's awareness of the sound structure of spoken language focusing on phoneme manipulation and segmenting, and to develop their conscious knowledge of the links between the spoken form of print (letters, syllables, and words) and its written representations. Blending and segmenting activities have been shown to improve the skills of children with low PA [START_REF] O'connor | Transfer among phonological tasks in kindergarten: Essential instructional content[END_REF].

The key principles that formed the basis for the program content and implementation procedure focus on the development of the phonemic level [START_REF] Brady | Training phonological awareness: A study with inner-city kindergarten children[END_REF] integrated with letter-sound knowledge [START_REF] Hatcher | Ameliorating early reading failure by integrating the teaching of reading and phonological skills: The phonological linkage hypothesis[END_REF], with particular attention given to segmentation abilities [START_REF] Torgesen | Effects of two types of phonological awareness training on word learning in kindergarten children[END_REF]. Furthermore, the combinations of letter knowledge and letter-sound associations with PA activities may engage children to reflect deeply on the print code [START_REF] Cunningham | Explicit versus implicit instruction in phonemic awareness[END_REF]. The main components of the training program designed to promote word level decoding and text comprehension, associate training in PA with training in letter-sound knowledge linked with the concepts of print knowledge, i.e. directionality, awareness of word, syllables and letters. Such an approach goes beyond the abstract phonic level by ensuring that children have adequate PA skills experienced in context [START_REF] Snowling | The nature and classification of reading disorders. A commentary on proposals for DSM-5[END_REF].

The order of the activities in this program is based on the well-established acknowledgment that PA is a multi-level skill that involves the segmentation of words into increasingly smaller linguistic units, i.e. from syllabic to sub-syllabic units [START_REF] Anthony | Phonological sensitivity: A quasi-parallel progression of word structure units and cognitive operation[END_REF]. The program provides two main training units where the activities are sequenced in a pseudo-hierarchical order. Each of the units predominantly consists of a variety of unit sizes from short vowels to letters, syllables and words. The main program content and activities are:

Design and procedure

All participants were tested individually on a Raven and word and pseudo-word reading tests. This testing took place after consent was received from parents informed about the general aim of the study but before participants were tested. Following a pre-test/post-test experimental design, we randomly assigned participants to the group that received the phonological training program (experimental group) or to the comparison group that did not receive the training (control group) after collecting baseline assessment data.

The training sessions involving face-to-face interactive training took place in a quiet room inside a school building but outside of regular classroom hours over a period of 13 weeks. The program was implemented collectively in small groups of 11 participants each following intensive small group service delivery (Torgesen, Wagner, & Rashotte, 1994), and the activities were executed individually to be mastered within several times if necessary.

Results

The major goal of the present study was to investigate whether combined PA and print knowledge intervention is effective to improve significantly PA in children with severe difficulties in reading accuracy (dyslexia) and comprehension and whether these children can equally benefit from this training in reading accuracy and comprehension. Pre-intervention comparisons between the two groups with independent-sample t tests are shown in Table 1.

Results revealed statistically significant intergroup differences on PA, reading accuracy in post and follow-up assessments in the experimental group. However, reading comprehension showed a significant improvement only on follow-up.

Table 1 To examine mean differences between the three times of assessment regarding the group variable, we performed two-way (group x times) repeated analysis of variance (ANOVA) for the outcome variables (PA, reading accuracy and reading comprehension) separately (see Table 2 and Figure 1). The statistical analysis (output 1) yielded a significant main effect for PA [F (2,41) =5.70,p=.007,Wilks' Lambda=.782,ηp²=.21] along with a significant interaction between factor and group [F (2, 41) = 4.14, p =.02, Wilks' Lambda=.832, ηp²=.16], a significant main effect for reading accuracy [F (2, 41) = 9.94, p=.000, Wilks' Lambda =.673, ηp²=.327] along with an interaction between factor and group Table 2 here Figure 1 here

Discussion

We examined the effects of a combined phonological and print intervention program on PA, reading accuracy, and comprehension in 4 th grade Arabic speaking children with reading accuracy and comprehension disorders. The main finding was that the experimental group benefited from the program in terms of directly improved PA and reading accuracy.

Training also had an impact on reading comprehension, which persisted for a considerable amount of time after program implementation.

With respect to the first research question regarding the potential positive impact of the intervention program on PA and reading accuracy, children who received the intervention program outperformed the control group on PA and reading accuracy. Intra-group comparison showed that the experimental group performed better in post-and follow-up intervention assessments (T2 and T3) than in the pre-assessment (T1). The most potent effect occurred for PA, assessed by the blending phoneme test through both post-measurement times. In this combined phonological and print training, the explicit practice of grapheme-phoneme association and the segmentation of words into syllables were taught repeatedly. Positive effects of the intervention program replicate previous investigations in Swedish (Fälth, Idor, & Tomas, 2011), English [START_REF] Snowling | Early identification and interventions for dyslexia: a contemporary view[END_REF][START_REF] Snowling | Interventions for children's language and literacy difficulties[END_REF]Arabic (Dallasheh-Khatib, Ibrahim, &[START_REF] Dallasheh-Khatib | Longitudinal data on the relations of morphological and phonological training to reading acquisition in first grade: The case of Arabic language[END_REF], demonstrating that acquired awareness of word structure is related to reading performance across languages. Likewise, in numerous studies on kindergarten children, blending and segmenting activities improved the skills of children with low PA on PA tasks and on a reading task [START_REF] O'connor | Transfer among phonological tasks in kindergarten: Essential instructional content[END_REF][START_REF] Torgesen | Effects of two types of phonological awareness training on word learning in kindergarten children[END_REF]. Our results showed that PA had slightly greater improvement in T3 than in T2 in the experimental group, indicating that more PA instructions potentiates reading accuracy, which in turn can boost PA development, as many authors have argued that there is a bidirectional influence between PA and reading (e.g. Wagner, Torgesen, & Rashotte, 1994).

Awareness of the sub-lexical structure of oral language may promote students' reading development as well as their sensitivity to phonemes. In turn, an awareness of phonemes will increase rapidly while learning to read [START_REF] Goswami | Causal connections in beginning reading: The importance of rhyme[END_REF].

By the end of the intervention program, better reading accuracy suggests that the intervention helped them identify efficiently the internal phonological structure of words, leading to more precise mapping of sounds to letters and targeting the awareness of individual sounds (phonemes) in the words (Ehri et al., 2001). The intervention seems to improve not only PA typically observed in children with reading disability but also text reading accuracy.

The improvement in PA may lead to improved reading accuracy in dyslexic children who benefited from the phonological training program, in line with previous findings in Arabic (Authors, 2019). The authors examined the potential impact of phonological training on enhancing phonological processing and word and pseudo-word reading in children with dyslexia. All post-training measures for reading words and pseudo-words as well as phonological processing improved. It is likely that the practice and the repeated exposure of grapheme-phoneme correspondences become consolidated into larger units that are easily activated when read [START_REF] Ehri | Development of sight word reading: Phases and findings[END_REF]. Al [START_REF] Otaiba | Assessment and instruction in phonemic awareness and word recognition skills[END_REF] argued that PA helps children understand the alphabetic principle and develops alphabetic knowledge. It also helps children notice the systematic ways that letters represent sounds of words allowing them to decode even unfamiliar words.

The second research question addressed a potential improvement in reading comprehension as a result of enhanced PA and reading accuracy. By the end of the intervention program, findings revealed a positive impact on reading comprehension performance at T3, though not at T2. Participants in T2 may not have been fluent enough in decoding. During the period following the intervention program, children were likely to be more able to apply constantly the acquired knowledge in PA and print knowledge, leading to a growing ability in decoding and word recognition. This would allow children to acquire more decoding automacity and reading fluency.

Cognitive psychologists have highlighted the important link between word analysis fluency and comprehension [START_REF] Chafouleas | Fluent reading as the improvement of stimulus control: Additive effects of performance-based interventions to repeated reading on students' reading and error rates[END_REF]. A comprehensible explanation was outlined by [START_REF] Perfetti | Reading ability[END_REF] in the bottle-neck theory of automaticity. It states that within a limited capacity system, decoding skills must be automatized such that capacity can be allocated to higher-order level processes necessary for successful reading comprehension. It is well established that fluent reading allows expending less mental effort in identifying words to apply more effort in understanding the text more thoroughly. Proficiency regarding fluency is one of the most powerful indicators of successful reading and obtaining meaning [START_REF] Fuchs | Oral reading fluency as an indicator of reading competence: a theoretical, empirical, and historical analysis[END_REF]. [START_REF] Snowling | The nature and classification of reading disorders. A commentary on proposals for DSM-5[END_REF] found that children who received the combined program (phonology with reading) were significantly ahead of the other group who received the phonology alone for reading accuracy, spelling, and reading comprehension. The gains in reading were maintained 5 months after the intervention ended. The authors asserted that those findings challenged the theory that phonological deficits alone cause reading impairment, since it was only when PA was trained in orthography that the impact on reading was significant. Similarly, [START_REF] Müller | Effects of a syllable-based reading intervention in poor-reading fourth-graders[END_REF] examined a syllable-based word recognition intervention for German fourth graders with reading difficulties. Basic word reading skills were administered followed by testing the effects of this training on the efficiency of written word recognition and the potential transfer effects on reading comprehension skills at the text level. Quels sont les résultats?

The positive impact of PA training on reading comprehension in our study is consistent with findings in languages with transparent orthography, suggesting that PA plays an important role in the development of reading comprehension throughout primary schooling (e.g. Schiffn Schwartz-Nahshon, Nagar, 2011), perhaps mediated by the effect of PA on decoding. This is in line with the result of a study that explored the impact of PA on reading comprehension in 1300 Norwegian first graders (Engen & Hoien 2002). The study involved syllable awareness, phoneme awareness, word decoding, and reading comprehension. PA had a direct impact on reading comprehension above the indirect phonological effect mediated by decoding skills, indicating that phonological factors play an independent role in processing text. They proposed that the direct effect of PA on reading comprehension is due to the fact that PA is related to other skills such as vocabulary knowledge and short-term memory, both determined in part by phonological ability. PA might partly reflect metacognitive processes assumed to be involved in reading comprehension. The findings of this study indicate that children who have better abilities in analyzing and manipulating syllables and phonemes with the ability to identify words and their inflected or derived forms are better at learning to read than children who have difficulties in acquiring these skills.

The improvement in reading comprehension seen in our study may also be mediated by morphological awareness as a direct impact of the intervention program. Indeed, Authors (2015) showed that PA training produced significant gains in morphological awareness in an Arabic dyslexic cohort. The ability to manipulate the sound structure of words facilitated the development of morphological awareness and highlights a reciprocal relation between the faculty and PA, though scores of each contributed an independent part of the variance found in word reading. In Arabic, morphological awareness involves the ability to identify word roots and their inflected or derived forms to understand the structure and meaning of a word and the different combinations of its morphemes. Indeed, the contribution of morphological awareness to reading comprehension may occur via accurate and rapid reading of words, enabling individuals to analyze the internal structure of words and decode them more quickly and accurately [START_REF] Deacon | Morphological awareness: just "more phonological"? The roles of morphological and phonological awareness in reading development[END_REF][START_REF] Nagy | Contributions of morphology beyond phonology to literacy outcomes of upper elementary and middle-school students[END_REF].

Conclusions

The present study demonstrated that combined PA and print knowledge training can be an effective intervention to improve reading accuracy and comprehension in Arabic speaking children fourth graders with reading accuracy and comprehension disorders. A follow-up assessment was suitable to demonstrate maintenance effects on reading skills (e.g., [START_REF] Castles | Is There a Causal Link from Phonological Awareness to Success in Learning to Read[END_REF]. Although PA training is widely carried out across languages, this is the first set of data to demonstrate both direct and transfer effects of a combined phonological and print knowledge intervention in Arabic speaking children. Improvements in PA enabled children with reading accuracy disorder to decode words [START_REF] Share | Phonological recoding and self-teaching Sine qua non of reading acquisition[END_REF], allowing them to access a greater amount of information in the written text. These findings support the view that dyslexia is mainly related to a phonological deficit, manifested in problems with PA and emphasize the importance of establishing phonological representations of phonemes and print in reading Arabic [START_REF] Asaad | Learning to read in Arabic: The long and winding road[END_REF][START_REF] Saiegh-Haddad | Correlates of reading fluency in Arabic diglossic and orthographic factors[END_REF].

Our findings add evidence to studies in other languages concerning the impact of combined phonological training on reading proficiency, addressing several subskills at the phonologic and print levels and pointing to the contribution of such training in facilitating the development of PA in children with reading disabilities (e.g., [START_REF] Høien-Tengesdal | The relationship between phonological skills and word decoding[END_REF]. Findings of the current study have important practical implications. Practitioners and teachers need to know whether PA and print knowledge tasks are necessary for children in primary school. Accordingly, better understanding of the effects of PA and print knowledge may help in basic reading skills and early screening of children at risk for reading disabilities [START_REF] Wagner | Changing relations between phonological processing abilities and word[END_REF].

•

  Identification of the first phoneme in words presented orally then by images • Identification of images whose names share the same first phoneme • Word segmentation into syllables (orally presented then illustrated by images) • Phoneme deletion and presentation of the remaining segment of the word • Graphemic sequence segmentation into meaningful words • Syllable repetition supported with hand movements • Segmentation of words into syllables 3. Print knowledge: includes: 3.1. Letter Knowledge • letter names and sounds • letter counting in words and association with the corresponding sounds • letter identification based on form and sound similarities • letter identification in the word • categorizing pictures by the initial sound in the word 3.2. Word processing • Letter position manipulation: reordering the letters in the word for creating a new one • supplementing the missing letter in the word • corresponding images-words association

  There were two sessions per week for each sub-group, with each training session lasting approximately 50 min. The participants received a detailed description of each task session and then provided responses individually following the specific instruction of the task. We moved throughout the program content as indicated above. If ≥ 80% of trained activity had been performed accurately, the next training activity was administered. Pre-training and post-training comparisons were performed for both groups to check for potential improvement over times. To evaluate the effectiveness of the program, two posttraining measurements were applied for both groups within the same periods, post-training and follow-up assessments. After data collection in the pre-training period, both groups received regular lessons in school. The follow-up assessment was implemented 3 months after the post-training assessment.

  [F (2, 41) = 4.58, p =.01, Wilks' Lambda=.817, ηp²=.18], and a main effect for reading comprehension [F (2, 41) = 4.25, p=.02, Wilks' Lambda =.828, ηp²=.172] along with with an interaction between factor and group [F (2, 41) = 5.61, p =.007, Wilks' Lambda=.785, ηp²=.215].

  Developmental Psychology, 33,[468][469][470][471][472][473][474][475][476][477][478][479]. Differences between groups in pre-intervention measurements Table2. Differences across the three times of assessment for the