Does Improving Music Reading Improve School Reading Scores

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Peer-reviewed

Research Article

Effectiveness of Music Education for the Improvement of Reading Skills and Academic Achievement in Young Poor Readers: A Pragmatic Cluster-Randomized, Controlled Clinical Trial

• Hugo Cogo-Moreira,
• Clara Regina Brandão de Ávila,
• George B. Ploubidis,
• Jair de Jesus Mari

ten

• Published: March 27, 2013
• https://doi.org/x.1371/journal.pone.0059984

Figures

Abstract

Introduction

Difficulties in word-level reading skills are prevalent in Brazilian schools and may deter children from gaining the noesis obtained through reading and academic achievement. Music education has emerged as a potential method to improve reading skills considering due to a mutual neurobiological substratum.

Objective

To evaluate the effectiveness of music teaching for the improvement of reading skills and bookish achievement among children (eight to ten years of age) with reading difficulties.

Method

235 children with reading difficulties in 10 schools participated in a five-calendar month, randomized clinical trial in cluster (RCT) in an impoverished zone inside the city of São Paulo to test the furnishings of music pedagogy intervention while assessing reading skills and academic achievement during the school year. Five schools were chosen randomly to incorporate music classes (north = 114), and five served as controls (n = 121). Two unlike methods of analysis were used to evaluate the effectiveness of the intervention: The standard method was intention-to-treat (ITT), and the other was the Complier Average Causal Effect (CACE) estimation method, which took compliance status into account.

Results

The ITT analyses were not very promising; just one marginal upshot existed for the charge per unit of correct real words read per minute. Indeed, considering ITT, improvements were observed in the secondary outcomes (slope of Portuguese = 0.21 [p<0.001] and gradient of math = 0.25 [p<0.001]). As for CACE estimation (i.e., complier children versus not-complier children), more than promising furnishings were observed in terms of the rate of right words read per minute [β = 13.98, p<0.001] and phonological sensation [β = nineteen.72, p<0.001] equally well every bit secondary outcomes (academic accomplishment in Portuguese [β = 0.77, p<0.0001] and math [β = 0.49, p<0.001] throughout the school year).

Conclusion

The results may exist seen as promising, simply they are not, in themselves, plenty to brand music lessons as public policy.

Citation: Cogo-Moreira H, de Ávila CRB, Ploubidis GB, Mari JdJ (2013) Effectiveness of Music Education for the Improvement of Reading Skills and Academic Achievement in Young Poor Readers: A Pragmatic Cluster-Randomized, Controlled Clinical Trial. PLoS ONE 8(iii): e59984. https://doi.org/10.1371/journal.pone.0059984

Editor: Jerson Laks, Federal University of Rio de Janeiro, Brazil

Received: Nov half-dozen, 2012; Accustomed: February twenty, 2013; Published: March 27, 2013

Copyright: © 2013 Cogo-Moreira et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in whatsoever medium, provided the original author and source are credited.

Funding: The ONGs were: Instituto ABCD (http://www.institutoabcd.org.br/portal) and the CNPq (http://world wide web.cnpq.br/) (chief funders). Regarding PhD scholarship, CAPES's URL is http://www.capes.gov.br/. The funders had no office in study design, data drove and analysis, conclusion to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Due to the demands of an increasingly technological society, reading failure has a major touch on cognitive development [i], [two]. Obtaining adequate reading comprehension of written cloth is the ultimate goal of reading, and achievement of give-and-take-level skills is used equally an initial indicator of success in learning to read [3]. In 2009, Brazil was ranked 53^rd among 65 participating countries in reading and scientific discipline accomplishment and 57^thursday in math via the Programme for International Student Assessment (PISA) past the Organisation for Economic Co-Performance and Development. Though PISA analyzed 15-year-old children (an older population when compared with our sample of 8- to ten-year -olds), these indicators warrant attention from regime non only in Brazil just too in other countries with depression accomplishment (e.g., Peru, Panama, Montenegro, Republic of bulgaria, and the Russian Federation).The nigh common arroyo to reading intervention has a theoretical motivation: Practiced phonological and metaphonological skills are important for success in learning to read. Children who have reading difficulties take deficits in these skills and training in phonological skills in the context of reading has repeatedly been shown to lead to improvement in reading, at to the lowest degree in English [iv].

Musical learning has emerged as a possible intervention due to the similarities between musical learning–a non-exact language–and verbal language itself. In particular, musical learning can assist in the processing of lexical skills [5] and in improving pitch bigotry abilities in both voice communication and reading among non-musician children [half dozen]. Cross-sectional studies take shown that the detection of pitch patterns (global structure) is predictive of performance on measures of phonological skills and reading ability [7]. Meanwhile, the structural development of the auditory cortex is influenced by early on musical feel [8]. Additionally, it has been pointed out that a link exists betwixt musical abilities and phonological skills [9]; however, the bases of these links are non clear [10].

The explanation of the causal paths to reading development via musical training may be referred to every bit "transfer" [11], [12]. The connectedness between musical learning and improving reading skills would be a "far transfer" because musical learning is not direct related to reading. Musical preparation is based on teaching and constant practice of non-exact structures such equally classical sheet music, while reading is verbal. An example of a "near transfer" would exist learning to play a instrument and consequently developing motor skills.

Neuroimaging studies have shown that some cognitive functions, such as the ability to organize isolated words into meaningful sentences and the ability to organize a diverseness of musical notes into a tune, may involve common neural pathways for both spoken communication and music [13].

Music education classes involve unlike cognitive functions that require complex auditory pattern-processing mechanisms, attention, retentivity storage and retrieval, motor programming, and sensory–motor integration [fourteen]. However, a recent systematic review of the effectiveness of music education used terms including "dyslexia" and "reading difficulties/disabilities" and returned 876 citations, from which no randomized clinical trials (RCT) were establish. Therefore, despite the fact that musical learning is pop and considered to be a benign intervention, in that location is no prove from randomized controlled trials that demonstrates the potential advantages of music education on reading skills and consequently on academic achievement [15].

This research used a pragmatic RCT to address the effectiveness of music instruction for improving reading skills and academic achievement in children with reading difficulties, anile viii to 10. The principal idea behind this businesslike RCT was to reflect the heterogeneity of children with reading difficulties in the full general public education system, minimizing, as a consequence, exclusion criteria and providing a more realistic scenario due its good external validity (generalizability of the results) [16].

The study aimed to examination the effectiveness of music education classes for improvement of academic accomplishment (based on Portuguese and math grades) and word-level reading skills among children with reading difficulties. This trial is registered at ClinicalTrial.gov under the number NCT01388881.

Method

Recruitment

School pick - inclusion criteria.

Two Brazilian non-governmental organizations, or NGOs (specifically, Partnerships of Education and Rukha's Institute) that worked in impoverished neighborhoods in Sao Paulo city (eastward.g., in slums) assisted in selecting 10 public schools on the outskirts of the city. These schools were chosen based on several logistical and social factors:

• At least, 1 room available for music lessons. This room would also exist needed for the team of psychologists, audiologists, and ophthalmologists to evaluate the children during the screening procedure and outcome assessments;
• The schools lacked music lessons in the curriculum.

Children's selection - inclusion criteria.

Teachers from the second to the 4th grades of these schools were asked to complete the Calibration of Assessment of Reading Competence by the Instructor (EACOL) which contains 27 dichotomous items with good divergent and concurrent validity, evaluates the loud (17 items) and silent reading abilities (10 items) of simple school children [17]. EACOL has a range of 29 to −29 points, where values closer to 29 correspond a skilful reader, and the following cutting-off scores were used to separate students into three categories: the poor reader (<−14.5), not-and then-good reader (from fourteen.v to −fourteen.5), and skillful reader (>xiv.five).

The post-obit instructions were given: "…for the children in your grade with a reading ability below the mean for the corresponding class, please fill out the EACOL." A full of 733 EACOLs from 48 teachers were returned, but merely 617 were considered valid. EACOLs were omitted if items were filled out inadequately– for example, there were more than two missing items or sequential answers in a single category, or teachers answered "yes" to all 27 items or "no" to all 27 items. The 617 valid children formed what we labeled the Sao Paulo Screening Sample (SP-Screening). On the basis of the SP-screening, the psychologists ranked the children who were classified equally poor readers or not-and so-skillful readers in lodge to identify a minimum of 24 and a maximum of 27 children with reading difficulties to participate in the (RCT) from each school. Because the 10 schools differed in their numbers of enrolled children, iv schools did not see the minimum criteria. In the other vi schools, where the numbers of eligible children exceeded 24, a total of 27 names were randomly selected via a lottery. We allocated a maximum number of students in social club to prevent likely dropouts during the bookish yr or loss due to exclusion benchmark, which is described below.

After identifying the eligible children via the EACOL, the inquiry team contacted the parents via a letter that described the objectives of the trial. The letter explained the study' aims, procedures, measurements, fugitive technical scientific vocabulary; together with it, it was requested the parents' written informed consent which was approved by Ethical Committee from Federal São Paulo University (CEP0433/10) for their children's participation. The Ethical Committee from Federal Sao Paulo Academy approved this consent procedure. Only the children whose parents gave the written consent were included in the study. All written informed consents were stored in the department of Psychiatry at São Paulo Federal Academy. This report was approved by the Ethical Committee from Federal São Paulo University.

Children's pick - exclusion criterion.

• To avoid bias related to cerebral problems, the included children were tested for non-exact intellectual ability using the Raven's Coloured Progressive Matrices [18], and children with scores below the 25^th percentile were excluded;
• To avoid confounders due to contamination or overlap of interventions, parents were asked if their children already were receiving any regular hearing or speech communication therapy and/or music classes (such as private music classes, social projects involving musical learning, or other music school experiences). Children participating in such programs were excluded from the study.

Sample Size

In total, 240 children were eligible for the study afterwards beingness chosen past their teachers; selected by the psychologists as having the worst reading scores; and authorized by their parents to participate in the study. This value was based on the sample size adding, with the following points taken into business relationship:

1. the cluster two-level construction (i.eastward., children who are nested in the schools);
2. the necessary number of children in each of the x schools selected to achieve the minimum statistical power (i−β) of 0.75;
3. 2 measures (pre- and post-test assessments of the primary upshot); and
4. the following parameters: ρ (rho – expected intraclass correlation coefficient (ICC)) = 0.025; the expected moderate effect size (δ = 0.45); α = 0.05; and J (number of clusters) = 10.

The number of children per school was 24, with 240 children in the total sample. From these 240 children, three were excluded because their parents retracted consent after the full assessment of main and secondary outcomes, and two changed schools earlier the full reading evaluation took identify. The in-cluster structure is likewise in accordance with pragmatic design, reflecting the reality of the educational organisation. Ultimately, a sample of 235 children (girls = 38.iii%) with an average historic period of 9.15 years (SD = .05) was obtained from the SP-screening. The description of the to a higher place cited process can exist found in the menstruation chart diagram.

Measures

Potential confounders.

Before the assessment of the main and secondary outcomes occurred, the following were assessed in society to avoid confounders:

• The visual acuity of the children (historic period-appropriate) under atmospheric condition of monocular viewing, conducted past an ophthalmology technician using Snellen'southward nautical chart. The children were classified equally either having visual alterations or not. Also, auditory processing was evaluated via the Simplified Auditory Processing Test (SAPT) [19] by a hearing and speech-linguistic communication pathologist. The following auditory abilities were tested: sound localization in v directions; exact and non-verbal sequential memory; and the elicitation of the auropalpebral reflex through instrumental sounds. The children were classified as having or not having problems in central auditory processing.
• The intelligence quotient (IQ) was measured past a trained psychologist using the complete Wechsler Intelligence Scale for Children–Tertiary Edition (WISC-III) [20], [21].
• School background variables were nerveless, including the number of classmates of each included child and the annual presence of children in official classes.

Primary and secondary effect.

To measure out children's' ability to analyze metaphonological skills, the Test of Phonological Awareness [22] was utilised. It consists of 10 subtests, each ane featuring 4 items used to verify synthesis, partitioning, manipulation, syllabic transposition, phonemic synthesis, rhyme, and ingemination. Therefore, the score range was from 0 to xl.

Phonological sensation strongly predicts reading skills [23] and is widely accepted to be an area of deficit among dyslexic children [24], [25]. Reading is a circuitous and multivariate process, and and so nosotros focused on variables related to lower-level cognitive skills (word-level reading) as our principal outcomes. The measured skills included the following:

• A word accuracy task (rate of correct real words read per minute),
• A not-word accuracy chore (rate of correct non-words read per infinitesimal) and
• An in-text accuracy task (rate of correctly read words per minute in the text).

The lists were used for the commencement time in this trial and included 88 words and 88 non-words. The words varied in occurrence frequency (high- and depression-frequency words), bi-directional regularity (regular and irregular words according to grapheme-phoneme/phoneme-grapheme correspondence); and length (curt, medium, and long words, as measured past the number of messages). The non-words were built with the same orthographic Brazilian Portuguese structure, and the same length of stimuli was used in the list of words. Psychometrically, the discussion and non-words tasks showed excellent indices, presenting high correlations (r = 0.92, p<0.001). In addition, both were correlated positively and moderately with phonological sensation (r _{word accuracy} = 0.40 and r _{non-word accuracy} = 0.37). As expected, the general Intelligence Caliber (IQ) was related poorly to discussion accuracy (r = 0.168; p = 0.01) and not correlated with non-word accurateness (r = 0.01; p = 0.131).

Regarding the text-reading task, 3 unlike texts were selected for the iii different historic period groups. The baseline in-text accuracy correlated highly with discussion accuracy (r = 0.916; p<0.001) and with non-give-and-take accuracy (r = 0.873; p<0.001).

In all of the in a higher place situations, the children'southward reading was sound-recorded for accuracy analyses. The researchers had intended to blind the speech communication-language pathologists who collected the primary upshot information, but during the 2nd evaluation, comments about the study allocation from teachers, directors and from the own children make the spoken language-linguistic communication pathologists find virtually the status of school as intervention or control.

The secondary outcome was academic achievement based on Portuguese and math grades. These were measured four times by the teachers during the school year, which begins in Feb and ends in November. The school directors were contacted at the end of school year to collect the Portuguese and math grades from the children in the trial. The grades were measured from 0 to 10, with 10 being the highest possible grade. None of the school directors or teachers were blinded to the randomization status of the school.

The Randomization Procedure

In July 2011 (the middle of the school year in Brazil), the 10 directors of the 10 schools were invited to participate in a lottery. Ii opaque boxes were used: The beginning contained assurance containing ordinal numbers from one to 10. The numbers that the directors picked corresponded with the sequence of the subsequent lottery. The second box contained 5 balls printed with the word "intervention," and five others were printed with "control." In a sequence determined by the brawl number picked in the first lottery, each director was called to choice one ball from the second box–either a "control" ball or an "intervention" ball. For example, the director who picked the ball with the number v in the kickoff lottery was the fifth to pick either a control or intervention ball from the second box. Because we worked with a purposeful sampling of the schools, the randomization procedure was important for excluding bias related to school selection.

Intervention

Music education (briefly divers here as a process of musical learning) was methodologically and educationally based on Brazil's National Curriculum Parameters (NCP) [26]. This plan focuses on a modern approach to music education in which the process of musical learning is not restricted to the domain of Western and classical sail music reading or to a high aptitude for a item musical instrument. Rather, the program focuses on musical improvisation, composition, and estimation in accordance with the National Association for Music Pedagogy [27].

Children were encouraged to create their own music and to perceive and place musical elements (rhythm, tune, harmony) during l-minute activities that occurred three times per week for five months starting at the end of June 2010 and ending the last calendar week of October 2010. Children were called to create and play music as well as to explore the sounds and history of non-traditional classical instruments made for avant-garde musical compositions and composers of the 20th century. Each school received soprano and contralto block flutes, keyboards, and ii music teachers.

All music teachers followed the same syllabus and musical activities to avoid educational bias and to make the classes every bit similar equally possible. The teachers were randomly allocated to the 5 intervention schools. Every ii weeks during the intervention menstruation, supervisions were bundled with the researchers, who systematically verified whether the music teachers were following the NCP'southward assumptions and educational structure. Two teachers were provided per class to improve children's level of attention and to guarantee that if any music teacher was absent, the other would follow the pedagogical programme. To provide a realistic and naturalistic scenario, the control schools were not encouraged to offer musical activities. This measure was in consonance with the logical perspective of pragmatic RCTs which may not utilise placebos [xvi].

Music education is a circuitous intervention, mainly in an educational RCT context. For example, it is impossible to standardize a day-by-day routine, equally each grade has a different reality, and the music education might involve a huge spectrum of activities. These activities include singing, exploration of rhythm (via corporal movement or corporal percussion), and instrumental practice (which could be the highly technical learning of a specific musical instrument, or using the instrument in an informal manner) [xv]. All of the procedures and activities described in a higher place are intended to: a) endeavor to systematize the same intervention based on the NCP, or b) endeavor to provide the same quality of intervention across various settings. Fifty-fifty with traditional educational methods such equally Kodaly (Hungarian method) or Orff (German language method), 24-hour interval-by-twenty-four hour period programs are non established.

Description of Blinding

This RCT is an open label because the children who were selected for the intervention knew that they were receiving music classes. At the same time, the selected intervention schools (and their scholar communities, i.e., teachers and directors who were responsible to collect the secondary outcomes) knew well-nigh the children who were allocated to receive intervention.

Statistical Assay

Two dissimilar types of analyses were used to evaluate the effectiveness of the music classes. The commencement (and standard) method was intention-to-care for (ITT), an arroyo that assumes that every child in the intervention schools actually received the music classes [28]. The other method, CACE interpretation method took into account the compliance status (children's adherence to the music classes) [29], [30]. The compliance status is divers hither as at least a i% presence in the music classes during the five months because with a presence of less than ane%, we are considering children who are never-takers. CACE estimation, therefore, provides a realistic result. Due to institutional, organizational, and schedule differences (i.e., start and terminate of holiday menstruum, holidays, children'southward regular examination period), the v intervention schools had different gross numbers of musical classes (two schools had 57 musical classes, i 55, and some other 50). Therefore, in lodge to have these differences into account in the CACE analysis, we considered the percentage as a reference, instead of the gross number, to summate the compliance criteria.

Post-obit the CACE estimation method, we have considered these assumptions: ane) the handling assignment is random (as described above); 2) potential outcomes for each child is unrelated to the handling status of other individuals; 3) for never-takers (children who exercise non receive the music classes even if they were assigned to this extra-curricular activity) and ever-takers, the distributions of the outcomes are independent of the handling assignment; four) there are no defiers (children who exercise the opposite of what they are assigned to do); and 5) the average causal issue of the treatment assignment on the treatment received is not equal to zero [31].

Although there is a practical issue motivating the using of cluster structure, a statistical advantage exists in this design: Information technology is very likely that private interaction exists between children from the same school weather condition, which leaves the treatment condition (control or intervention) less likely to be contaminated by other conditions. Therefore, comparison of unlike weather condition will be more valid [32].

The blazon of baseline distributions for the primary and secondary effect variables were considered (zero-inflated, normal, gamma). In addition, the standard errors were adjusted for the survey design (i.e., taking the clusters into account), thus generating robust standard errors (RSEs). Baseline significances tests comparing children from command and intervention schools on its outcomes (principal and secondary) and on potential confounders were conducted via t-Student or Mann-Whitney tests for continuous outcomes (depending on its variance homogeneity and normality distribution) and, for binary outcomes information technology was used the Chi-square.

Considering the CACE estimation method and ITT analysis, the primary consequence was controlled by the confounders (visual vigil and central processing assessment, IQ, and and so on) along with age, gender, and baseline values from the same outcome (i.east., word accuracy was controlled by word accuracy at baseline); the only exception was adding the model involving phonological awareness as an issue, as visual acuity was not included.

A linear growth model was built for the ITT analysis of Portuguese and math grades through the schoolhouse year; for the CACE, linear growth mixture modeling was used, allowing the incorporation of latent groups (complier and not-complier). Mplus version 6.12 was used to build all regressions and general mixture models.

Results

Every bit suggested past Consort [28] the participants' flow chart is described in Figure S1 and baseline measures comparing intervention and control schools with its respective significances tests are described in Table 1.

As suggested by Assmann [33], in Table 1, we report a tabular array of baseline data with an overall description of the characteristics of the patients rather than using significance tests. Although differences across groups at baseline were found, some authors pointed out that the use of significance tests for detecting baseline differences is questionable [34] and others that information technology is inappropriate [35], [36]. Senn argued that "this practice is philosophically unsound, of no practical value and potentially misleading" [35].

Considering ITT, accuracy of discussion (β = two.57, p = 0.047) has shown to be marginally pregnant. This means children in the intervention school correctly read 2.57 words per minute more than children in other schools do. Also in the ITT estimates, the slopes of Portuguese (β = 0.21, p = 0.01) and math accomplishment (β = 0.25, p<0.001) were statistically significant for the intervention schools. This it means that every ii measured months, children from intervention schools increased 0.21 in Portuguese and 0.25 in math grades. There was no observed improvement in phonological awareness (p = 0.35) and in-text accuracy (p = 0.23); non-word accuracy was negative and nonsignificant (β = −1.512, p = 0.xl) (Tabular array 2).

Regarding estimates for the complier group (using the CACE estimation method, where comparisons are made considering the complier versus non-complier groups and the effect of the control group is fixed at zero), estimates of word accuracy, in-text accuracy, and phonological awareness are statistically meaning; this ways that complier children read 13.98 more than correct words per minute than children who are non-complier. Indeed, positive slopes of Portuguese and math achievement showed to be statistically significant.

Comparing the CACE and ITT, the CACE estimates were mostly college than those obtained using the ITT analysis (except for in-text accuracy and intercepts of math and Portuguese). RSEs were lower in the CACE interpretation method for the primary issue.

The ICC–the degree of correlation that is realized among outcomes of participants in the same cluster–for each chief and secondary event, the pre- and mail-test results, and all respective standard errors and confidence intervals is shown in Table 3. There was a considerable loss in statistical power for phonological awareness variables due to an unexpectedly high degree of ICC variation. When the sample size was estimated, low values were expected (approximately 0.025). The ICC conviction intervals ranged from 0 to 0.596; the largest variation was observed in phonological awareness (lower jump = 0 and upper bound = 0.596).

A positive growing slope (β = 0.77, p = 0.005) in Portuguese means that, every two months, the grades in Portuguese increased 0.77 points for the complier group when compared with non-complier children. Because math (β = 0.49, p<0.001), each ii months, the grades for the complier grouping increased 0.49, when compared with non-complier grouping. The statistically significant and negative intercept indicates that the Portuguese intercept for the complier group at baseline is one.07 points lower than the non-complier group; in math, the complier is 1.25 points lower.

Word

The ITT analyses were rather unpromising: At that place was only i marginal meaning effect for the primary outcomes (accurateness of discussion reading) (p = 0.047), probably because if there is a real consequence of music didactics, it could be adulterate among the children who were allocated to be in the intervention and accept not taken information technology (absence in the music classes, or presence of less than 1%) and the children who had attained the music classes assiduously. All the same, taking into business relationship complier status via CACE interpretation, it is possible to discover more than promising effects in all primary outcomes, in instance of accuracy of discussion reading, it becomes six times bigger (from 2.57 to 13.98).

The simply negative exception was for non-give-and-take accuracy, which was not statistically meaning by either the CACE or ITT estimation. This finding may have resulted from the baseline rate of not-words per minute, which was superior in the intervention grouping using the ITT method (Tabular array 1). Although in-text accuracy with CACE was lower than with ITT, information technology showed statistical significance for the one-time but not the latter, corroborating to the idea that when we consider CACE estimation the furnishings of intervention become more apparent.

The negative estimations (CACE and ITT) for non-discussion accuracy are not explained by the baseline differences betwixt intervention and command schools (significance test showed p-value = 0.43) and were not significant at 0.05 for both analyses (for ITT, p-value = 0.40, and for CACE, the p-value = 0.18). Indeed, a possible interpretation for the unsettling negative value might exist related to the automatized process of word-level recognition, which was assimilated past children from intervention schools (i.e., children from intervention schools performed ameliorate in word-accurateness tasks). Maybe children were reading non-words as words (i.e., the more rapidly automatized and more correct children read words, less precise they read the non-words because children may read non-words as words). However, this hypothesis was not our focus, and it might only be assessed via the evaluation of not-word reading task errors' typology.

The positive slopes of Portuguese and math grades indicate that, throughout the academic year, children from schools allocated to be in the intervention (general effect via ITT analysis) and the complier children (CACE estimation) take trajectories that are not apartment, being music education effective for improvement of academic achievement.

For the secondary outcomes, there was a higher probability of estimating the effects when considering a power of 0.8 because more than two assessments of Portuguese and math grades were collected. This effect formed a third level in the hierarchical model (starting time level formed by the child, second represented by the school, and tertiary by the four equi-distant measures in grades throughout the school year). The ICC also was lower (ρ = 0.06).

Table 3 described unlike magnitudes of ICCs, which may be interpreted as the Pearson correlation coefficient between any 2 responses in the aforementioned cluster, measuring the degree of similarity amid responses within a cluster [37]. High (and non-predicable) ICC values were obtained and directly influence our results; every bit a consequence, our statistical power tends to be reduced in outcomes where ICCs were inflated (i.eastward., in a full general view, we underestimated the ρ value in the sample calculation [ρ = 0.025]). Values presented in Table iii are important to guide future RTC research involving scholar populations with measures related to learning and reading abilities. However, the underlying reasons for variation between cluster will differ from trial to trial, simply two points in a cluster randomized study, particularly one involving education strategies, might exist addressed, as stated by Donner & Klar [38]: 1) the consequence of personal interaction among cluster members who received the same intervention; and 2) the influence of covariates at the cluster level, where all individuals in a cluster are afflicted in a similar manner as a result of sharing exposure to a mutual environment.

Some important limitations must be highlighted. Get-go, due to issues which are inherent to pragmatic RCTs, when ITT is estimated, control schools may non accept an active placebo (i.e., a "non-agile" or placebo plan was non introduced). Consequently, part of the improvement in reading skills and in Portuguese and math grades, in the ITT assay, could result from the attention the music teachers paid to the students. Various developmental antecedents (social deprivation, socioeconomic condition, family size, maternal reading, a stimulating home environment, maternal depression, and child negligence) are small but significantly related to reading achievement [38].

Because our children came from impoverished neighborhoods in Sao Paulo city, they may be influenced by these non-measured developmental antecedent factors, and, as a event, the musical activity may have functioned in 2 different ways: one) as a psychological issue due to the "extra" attending from music teachers, and 2) as an ecology event due to the provided stimulation itself (e.g., dance classes as well would provide perceptions of rhythm). Therefore, to argue that the evolution of musical perception skills can account completely for the comeback in reading and academic achievement would be misleading in this experiment. Furthermore, because musical perception skills were not assessed throughout the total longitudinal study, nosotros cannot presume that the more than musical skills, the improve the improvement of reading skills in our population will be. However, this pragmatic RCT did not aim to evaluate what in music classes would improve reading and academic achievement, but to pragmatically evaluate the effectiveness of music teaching as an intervention for reading difficulties.

Considering estimates of CACE, considerations about placebo are irrelevant because, as it was pointed out almost the CACE assumptions, the effect of the control group is fixed at naught. The focus was exclusively on the complier and non-complier groups that were compared with one another.

Lately, the reading measures besides were limited to the decoding procedure and methaphonological skills (discussion-level reading skills); therefore, we did not written report reading skills beyond word-level decoding, such as comprehension.

Conclusion

Based on the ICCs obtained in this study, time to come researchers should consider at least 24 schools (12 intervention schools and 12 control schools) with 24 participating children per schoolhouse in order to reduce issues with power due to high variations in ICC, as was observed with the phonological awareness variable. Increasing the number of children per class does not significantly solve the power problem. At the aforementioned time, this increase would likely make it more hard for the music teachers to properly carry the musical activities. If some consequence "exists," the number of schools must be increased in order to increment the degree of power in hereafter enquiry for outcomes with loftier ICC variations. In hereafter models and exploratory trials, placebo interventions (e.g., cooking classes) also should be implemented, while measures related to developmental antecedents should exist evaluated and used every bit covariates.

Despite the noted limitations, this first RCT virtually music didactics is pragmatic and showed promising positive effects on reading skills and academic achievement considering CACE estimation, corroborating the theoretical rationale backside the music-based intervention, which absolutely is an unorthodox approach (for details see [39]). However, before recommending music classes as a public policy, more than investigation and information about the effectiveness of music education and theoretical models explaining the impact of music abilities on reading skills are necessary, particularly in countries/scholar populations with depression estimates of reading performance and academic achievement, also as loftier levels of disparity between public and private schools.

Supporting Information

Acknowledgments

We thank the National Quango for Scientific and Technological Evolution (CNPq – grant northward° 482321/2010-5) and the ABCD Institute [which is a not-governmental arrangement (NGO) that supports research on dyslexia in Brazil] for the grants that made this study possible.

Additionally, we thank all parents, children, school directors, psychologists, hearing and speech communication therapists and music teachers who helped in this trial.

Author Contributions

Conceived and designed the experiments: HCM JJM. Performed the experiments: HCM. Analyzed the information: HCM GBP. Contributed reagents/materials/assay tools: CRBA. Wrote the paper: CRBA.

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Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0059984

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