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Case study of Amelia, a five-year-old reader who enjoys reading at home

Felicity holt-goldsmith.

• Case Studies of young readers / 

Amelia* is a middle ability pupil in a mixed ability class of thirty one children, with a ratio of eighteen boys and eleven girls. The school is average size for a primary school and most of the pupils are drawn from the immediate neighbourhood. When I met Amelia she was graded at Level 1c for her reading, slightly below average for the class. The school endeavours to provide an atmosphere where the enjoyment of reading is promoted and nurtured. Children have reading books from the Oxford Reading Scheme which they take home every day and home and school links are made through reading journals. There is also a selection of books in the classroom and the school is in the process of renovating the library.

Comprehension

To try and gain an understanding of Amelia as a reader I undertook a reading conference and made observations of her reading in a range of different contexts. However, the limited amount of time spent at the placement means that only a speculative analysis can be made. Amelia was still learning to decode but she was able to utilise higher order reading skills such as comprehension. She was an able meaning maker and engaged with a variety of texts. In terms of The Simple View of Reading (Rose, 2006: 40) she would be placed in the section of ‘poor word recognition; good comprehension’ although her skills of decoding words improved quite significantly even during the short time I was at the school. Cain (2010) argues that to understand a text’s meaning a reader needs to establish local and global coherence. Local coherence is described as the ability to make links between adjacent sentences and global coherence is described as the ability to make sense of a text as a whole and relate this to personal experiences (p. 52). Amelia was able to understand the narrative of a story and could relate stories to her own life and other texts. During the reading conference I asked her about a book that she had read a few weeks ago; she was able to retell the story in great detail and described which parts were her favourite. There was also evidence that Amelia was able to engage with the meanings of individual words. For example, when reading aloud to me she read the word ‘buggy’ and said that ‘pram’ could be used as an alternative. It would be important to encourage this interest in the meanings of words in order for Amelia to progress with her comprehension skills. As Cain (2010) suggests, vocabulary knowledge is strongly associated with good reading comprehension.

Phonics and other strategies

Amelia was still learning to decode and used a number of different strategies. She used her knowledge of phonics as one way to decode words. She would split a word up into individual phonemes and then blend these together to read the word aloud. She often used her finger to cover up parts of the word in order to try and make this process easier. However, for some words she did not use this strategy. She struggled to read the word ‘children’ and said that it was too difficult to sound out because it was too long. However, when we read a different book the week after she did not have any trouble reading this word. She explained that she was able to read it because she recognised it and not because she sounded it out, suggesting that she read it from sight. Amelia did use her knowledge of phonics to read although this strategy was used in addition to others. On several occasions she looked at the pictures before attempting to read the text and would subsequently make predictions of what was going to happen in the story. She was also receptive to learning new reading strategies. When she struggled to read the word ‘snowball’ I suggested she split it into two words that she may recognise: ‘snow’ and ‘ball’. The next week we read the same book again and she used the same strategy. Amelia’s use of different reading strategies appeared to be effective and it would be important to encourage her to continue to use a variety of strategies in order for her reading to progress.

Taking it further

Amelia is an enthusiastic reader and enjoys reading at home. She reads to her mother and father on a daily basis and explained that her father reads to her and her sister every night before bed. It appeared that her home life fosters a positive attitude to reading and this was arguably beneficial to her reading progress. Clark (2011) has found that there is a positive relationship between the number of books a child has at home and their reading attainment level. Goouch and Lambirth (2011) also suggest that children who read at home would have a head start at school ‘with their knowledge of how stories work, patterns and tunes in stories, the relationship between illustration and print as well as some clear information about print drawn from reading and re-reading favourite tales’ (p. 8). As previously discussed Amelia seemed to be an able meaning maker and this could partly be due to the fact that reading is a part of her daily routine at home.

It would be crucial to encourage Amelia’s enthusiasm and enjoyment of reading in order for her reading to progress further. Ofsted reports have consistently argued for a greater emphasis on reading for pleasure within the taught curriculum in both primary and secondary schools (Ofsted, 2012: 42). Amelia enjoys reading books about animals and it would be important to consider her interests and try and incorporate this when suggesting reading books. Lockwood (2008) argues that it is important to discuss children’s reading choices and reflect this when updating book stocks. This would be a way of promoting reading for pleasure not only for Amelia but for all the children in the class.

In conclusion, Amelia appeared to have good comprehension skills and her ability to decode was developing. She engaged with texts and was able to express opinions on books that she had read. She used her knowledge of phonics to decode words but did not rely on this strategy alone. Amelia enjoys reading and reads in a variety of different contexts. It would be crucial to encourage this positive attitude to reading in order for her reading to develop further. This could be done in various ways, including ensuring that her interests were reflected in the books that were available to read in the classroom. It would also be important to provide choice and to demonstrate the joy of reading by reading stories together as a class. Trying to promote reading for pleasure would be beneficial not only for Amelia but for all the children in the class.

* A pseudonym

Cain, K. (2010) Reading Development and Difficulties West Sussex: Blackwell Publishing Ltd.

Clark, C. (2011) Setting the Baseline: The National Literacy Trust’s first annual survey into reading London: National Literacy Trust.

Goouch, K. and Lambirth, A. (2011) Teaching Early Reading and Phonics London: Sage.

Lockwood, M. (2008) Promoting reading for pleasure in the primary school London: Sage.

Ofsted (2012) Moving English Forward. Available at:

http://www.ofsted.gov.uk/resources/moving-english-forward  (Accessed: 3rd March 2014).

Rose, J. (2006) Independent review of the teaching of early reading. Available at: http://webarchive.nationalarchives.gov.uk/20130401…

https://www. education.gov.uk/publications/eOrderi… (Accessed: 5th March 2014) 

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ORIGINAL RESEARCH article

Teaching reading: a case study through mixed methods.

• 1 Departamento de Didácticas Específicas, Universidad de la Laguna, San Cristóbal de la Laguna, Spain
• 2 Departamento de Psicología Evolutiva y de la Educación, Universidad de la Laguna, San Cristóbal de La Laguna, Spain
• 3 Departamento de Psicología Clínica, Psicobiología y Metodología, Universidad de La Laguna, San Cristóbal de La Laguna, Spain

The present study analyzes the relationship between teachers’ beliefs about learning to read, teaching practices, and discourse. To carry out this study, we benefited from the collaboration of six teachers in kindergarten and the first levels of primary education. First, an attribution questionnaire was used to analyze beliefs about learning to read ( Jiménez et al., 2015 ). Secondly, to study teaching practices, an observation tool was used ( Suárez et al., 2018 ). Thirdly, in order to know the opinion of teachers about how to teach reading, we adapted the instrument to assess teaching perspectives elaborated by Clark and Yinger (1979) . Finally, all the information was triangulated and analyzed using mixed methods. The results indicated that the relationship between beliefs, practices, and discourse is not always consistent. In all teachers, a relationship was found between some of their beliefs, practices, and discourse. At the level of beliefs, all teachers presented one predominant attributional profile, although to a lesser extent, their beliefs were also attributable to other learning theories. The results indicated that all the teachers carried out teaching practices associated with the different learning theories. Similarly to their discourse, all teachers showed diverse opinions about the learning processes involved in reading. These results indicate that teachers maintain eclectic approaches, both when they carry out activities in the classroom and when they think about learning to read.

Introduction

For almost three decades, research has documented the influence of teachers’ beliefs on educational practice ( Berthelsen and Brownlee, 2007 ; Kuzborska, 2011 ; Barrot, 2015 ). Teacher’s beliefs are thoughts, perceptions, and values about their roles as educators, education, and how students learn ( Vartuli, 2005 ). It has even been shown that if teachers are aware of their own beliefs, the repertoire of teaching skills can be increased ( Tracey and Mandel, 2012 ), leading to a change in classroom decision making, and teaching strategies and evaluation. If we want to achieve improvements in teaching, it is necessary to examine the teachers’ beliefs and modify them ( McAlpine and Weston, 2002 ). A great deal of research in this direction has shown that instructional events can be catalysts for changing beliefs ( Stevens, 2002 ; Theurer, 2002 ; Fazio, 2003 ), since beliefs are permeable mental structures susceptible to change ( Thompson, 1992 ), although there appears to be no consensus on this ( Block and Hazelin, 1995 ; Richardson, 1996 ).

More recent studies have provided us with more detailed information on how beliefs and implicit knowledge influence teachers’ instructional practices ( Cunningham and Zibulsky, 2009 ), actions, and strategies that they implement to teach reading in the classroom. The research carried out in this regard has focused on differentiating three traits appearing in the teaching and learning of reading. Thus, Tolchinsky and Ríos (2009) analyzed the relationship between what teachers say and do (2.250), teaching practice ( N = 2), and students’ knowledge ( N = 814). To do this, they used a self-report questionnaire of 30 questions, with high reliability (α = 0.81) and a Likert scale (0–6). Through a cluster analysis, they detected three differentiated profiles: instructional practices focused on teaching the names of letters, letter–sound relationships, as well as the importance of learning products; a situational approach to activities arising from classroom situations, where students look for the means to understand texts that they do not know; and multidimensional activities such as letter knowledge, recognition, and letter–sound association, as well as reading and writing work from situations that arise in the classroom. The results showed the following distribution: instructional (33.87%), situational (37.06%), and multidimensional (29.06%). Also, they found that 30% of the children were able to recognize unknown words and did not seem to have difficulty in mastering the code, and that teachers used explicit, early, and systematic teaching practices.

Also, in Spain, Barragán and Medina (2008) , analyzed the practices teachers use through questionnaires. They found significant differences depending on the profile and educational level. Thus, nursery/kindergarten teachers showed a higher profile of situational practices (50%), compared to elementary school teachers who showed a profile of instructional practices (70%). Subsequently, they analyzed the profile of practices according to geographical area, finding that the teachers who carried out the greatest number of situational practices were those of the Basque country, followed by teachers from Almería, Cantabria, Catalonia, and the Community of Madrid (more than 50%). Catalonia and Cantabria showed a lower frequency of instructional practices (less than 20%); however, the teachers from León and Asturias used these practices more frequently (more than 55%). The same authors also observed six Early Childhood Education classrooms in Almeria. The results showed a relationship between the declared belief profile and its practices in the classroom. In another study, Ríos et al. (2010) demonstrated the relationship between the knowledge learned and the practices in teaching reading of two Infant Education teachers. They found that the contents worked on by the teacher with a situational profile were reading and writing functions, identification of words in reading, and letter names and sound values.

The teacher with an instructional profile used word identification and word reading. In the study carried out by Baccus (2004) , a direct relationship was found between the teachers’ beliefs and the instructional time dedicated to the teaching of reading. In addition, Rapoport et al. (2016) focused on analyzing the beliefs that teachers maintain ( N = 144) regarding the contribution of executive functions in reading performance and their teaching practice. Their results showed a positive relationship between these two variables ( r = 0.512, p < 0.01).

Ethnicity has been another feature highlighted in studies assessing the dyad of beliefs and practices in teaching. The Center for the Improvement of Early Reading Achievement [CIERA] (2001) examined the beliefs and practices of 250 early childhood teachers. Their results showed a relationship between beliefs (based on the importance of the development of alphabetic knowledge, word recognition, stories, and oral language) and practices. Differences in relation to beliefs were found based on the ethnicity of teachers. African American teachers tended to believe that it was more important for the child to learn to read through teaching the alphabet (e.g., naming letters, saying their sounds), while white teachers thought it was more important for children to learn to read from teaching oral language activities (e.g., answering questions about a story or telling a story from a drawing). On the other hand, they found significant differences depending on the academic training received, so teachers with a higher academic level believed that teaching of oral language was more important, while teachers with lower academic levels did not share this belief.

Also, the report presented by the Teaching and Learning International Survey (TALIS) ( OCDE, 2009 ) provides detailed information on the development of variables involved in the teaching and learning process. This report analyzed the beliefs of secondary school teachers in several countries. Their results indicated that most countries (Northeastern Europe, Scandinavia, Australia, and Korea) showed constructivist positions ( p < 0.05). Humanities teachers presented more structured beliefs and were little oriented toward students ( p < 0.05), also with differences depending on teaching experience, so the teachers with more years of experience thought and performed more structured practices ( p < 0.05). The analyses also revealed a positive correlation between constructivist beliefs and practices in teachers from different countries ( p < 0.05), except in Korea, where a weak relationship was found between beliefs and practices with a direct style. Finally, they found that positioning depended largely on the quality of the learning environment and job satisfaction ( p < 0.05). In subsequent reports ( OCDE, 2013 ), an average 95% of OECD teachers stated that they agree with constructivist practices.

Other lines of research have not found a bidirectional relationship between the teachers’ thinking and their action in the classroom. An example is the study carried out by Miglis et al. (2014) with 90 Norwegian teachers. They used a 130-item questionnaire to measure beliefs (e.g., their role as teachers, the role of teachers in teaching reading, consistency with current research about the importance of early literacy) and teaching practices (e.g., books, book contents, alphabetic knowledge, phonological awareness, and reading and writing). They found that teachers reported moderately positive beliefs about their role as a teacher in their students’ reading success, and they “agreed” with the idea that research has found that early literacy is necessary. These beliefs were not related to their practices, since the time devoted to this type of instruction was minimal. However, they discovered that the most widely used practice was “shared reading and reading aloud for 10 min a day” (29.3%). There are numerous studies that have not found a relationship between these two variables ( Wilcox-Herzog, 2001 ). Thus, for example, through two teachers’ collaboration, Pérez-Peitx (2013) was able to observe classroom practices and analyze interviews. Their results also indicated that there was no relationship between these two variables. Along the same lines, another recent study ( Utami et al., 2019 ) based on socio-cognitive theory studied teacher beliefs and practices in reading comprehension tasks. They found that the practices were not always consistent with their beliefs.

To our knowledge, there is no research assessing the profile of the teacher and teaching practices, in relation to all the theoretical principles that govern the teaching and learning processes of reading (i.e., innatist, maturationist, corrective, repetition, sociocultural, constructivist, psycholinguistic approaches).

The objective of this study is to find out whether or not there is a relationship between the beliefs, practices, and discourse used in teaching reading in the classroom, in order to propose more effective teaching strategies.

Materials and Methods

The study was carried out from a mixed methods perspective, integrating qualitative and quantitative sources of information through “merge” ( Creswell and Plano-Clark, 2007 ). The proposed design was triangulation ( Morse, 2003 ; Creswell and Plano-Clark, 2007 ; Tashakkori and Teddlie, 2010 ; Anguera et al., 2012 , 2018 ; Creswell, 2014 ), which was found suitable for the aims. A direct observation of teaching reading practices was carried out. The observational study was configured based on three criteria: study’s units, temporality, and dimensionality ( Anguera et al., 2011 ). The observational design can be classified as Nomothetic/Follow-up/Multidimensional (N/F/M) ( Sánchez-Algarra and Anguera, 2013 ; Portell et al., 2015 ). Frequency was analyzed. In order to analyze the relationship between teacher’s beliefs, practices, and discourse, a Pearson’s correlation was carried out.

Participants

Six teachers with an age between 25 and 50 years participated. The teachers’ years of experience ranged from 10 to 35 years. They belonged to different Infant and Primary Education units on the island of Tenerife (Canary Islands, Spain). The selection criteria were based mainly on the fact that the staff member taught the subject Spanish Language and Literature, devoting an average time period of 1 h a day to the teaching of reading.

To carry out this study, three fundamental tools were used: a questionnaire to know the teachers’ beliefs, an observation tool to analyze their practices, and a semi-structured interview to analyze the teachers’ speech about teaching and learning to read.

– Questionnaire on Beliefs about Learning and Teaching Reading , composed of 60 items (see Suárez et al., 2013 ; Jiménez et al., 2014 , 2015 ) corresponding to the basic postulates of each learning theory: innatist, maturationist, sociocultural, constructivist, corrective, repetition, and psycholinguistic (see for review Tracey and Mandel, 2012 ). Teachers had to respond according to their degree of agreement or disagreement using a Likert scale of 0–10, where 0 means strongly disagree, and 10, strongly agree. Cronbach’s Alpha was 0.88.

Observation Tool on Reading Teaching Practices. This tool used here was developed by Suárez et al. (2018) and combines a field format and systems of categories. This consists of 14 criteria—alphabetic knowledge, phonological awareness, use of teaching resources, prior knowledge of children, reinforcement, feedback, modeling, direct instruction, guided oral instruction, extracurricular tasks, reading and writing, psychomotor skills, functional reading skills, and vocabulary—and 77 categories on practices in teaching reading. For the measurement plan, the results showed that the absolute and relative generalizability measures were acceptable (at 0.970 and 0.989) at 30 sessions and that 40 sessions were needed to reach 0.977 and 0.992, respectively. For the generalizability indexes to measure inter- and intraobserver reliability, a four-faceted SRC/O (Session, Criterion, Category/Observer) design was used, and analysis showed the greatest percentage of variability to be related to the Criterion facet (33%), while the Observer facet showed no variability at all. The absolute generalizability coefficient was 0.999, and the relative coefficient was also 0.999. With respect to the intra-rater reliability, using a four-faceted SRC/M (Session, Criterion, Category/Moment) design, analysis showed that 32% of variability corresponded to the Session facet and 33% corresponded to Criterion, while Moment showed no variability. The absolute and relative generalizability coefficients obtained for Observer 1 were both 0.999. The absolute and relative coefficients for Observer 2 were both 0.997, facet showed no variability at all. The absolute generalizability validity using a two-faceted model [Observation (2) and Criterion (74)] showed a value of 0.000 (absolute and relative validity).

– Four digital video cameras and Match Vision 3.0 software ( Perea et al., 2006 ) were used for the sessions to record teaching practices. Data quality was analyzed using the Generalizability Study (GT) version 2.0.E program ( Ysewijn, 1996 ) and the SAS 9.1 statistical package. Teacher discourse was analyzed using Atlas.ti 6.0 ( Friese, 2011 ).

– Structured Teacher Interview on Teaching Practices . We adapted the interview on teaching perspectives elaborated by Clark and Yinger (1979) , composed of 28 questions on aspects related to teaching and learning: general questions about teaching, daily classes, teaching and learning, curriculum, time, and teachers’ “philosophy.” Changes were included in the nomenclature of the subjects of the curriculum and in the section on teacher philosophy (F), where the questions were guided toward the field of reading (see Table 1 ).

Table 1. Interview adapted from Clark and Yinger (1979) .

– For the interviews, a video camera and two Panasonic recorders, model RR-US455 (with 66 h of recording capacity), were used to ensure safe information storage.

– To transcribe information, the program Naturally Dragon Speaking ( Baker, 1975 ), version 12 was employed, and Atlas.ti, version 6, for information analysis ( Friese, 2011 ).

Before the recordings were made, authorization was obtained from both the teachers and the pupils’ parents. All participants provided written informed consent prior to their participation. Likewise, a schedule was agreed on for when the study would be carried out. On the day indicated, the belief questionnaire was applied to the participating teachers, their doubts in this regard were clarified, and approximately an hour was spent to complete it. Seven recording sessions per teacher (twice a week for 1 h each day) led to total of 42 h of recording (see Suárez et al., 2018 ). The interviews were held with the participating teachers and recorded in classrooms devoid of noise. Cameras were located in front of each teacher, and the furniture was arranged in an interview layout. The interviews of the six teachers were recorded, each lasting approximately 1 h. The audio was later transferred to the computer for the literal transcription of the interviews. Subsequently, the available information was collated and all the material subject to data processing organized. To conclude this phase, each interview was reviewed to gain an overall impression of the information provided by each teacher.

In the next phase, the document was segmented and coded through the Atlas.ti 6.0 program. The data were processed using the thematic analysis technique, according to the proposal of Braun and Clarke (2006) . Initially, the hermeneutic units were defined according to the interview questions, taking into account the theories about learning to read. Subsequently, the primary documents were worked on and information segmented. In this case, we focused on words as well as phrases/sentences and texts. The relevant information was then selected, and these units were encoded. Later, we established code families composed of the different variables affecting teaching and its context. Teachers’ opinions about learning to read were categorized. The code families structured the relationship between the previously identified categories and theories on the learning of reading (e.g., innatist, maturationist, sociocultural, constructivist, corrective, repetitive, and psycholinguistic).

In order to classify each teacher according to his/her attributional profile, factor scores for each theoretical approach defined the teachers’ beliefs according to the percentiles (see Table 2 ).

Table 2. Teachers’ profiles in each theory in percentiles.

To determine which theory should be attributed most to each teacher, the score was set around the percentile ≥75, and to determine which theories fitted less, around percentile ≥50 (see Figure 1 ).

Figure 1. Example teacher F. profile.

Although all teachers were characterized by a predominant attributional profile that defined their particular beliefs, we found that their reading teaching behavior could also be attributed to any of the other theories to a lesser extent (see Table 3 ).

Table 3. Summary of teachers’ profiles.

Regarding teaching reading practices, it was found that the most used was feedback (praising or correcting the student), followed by the use of teaching resources (e.g., stories, songs, or poetry), direct instruction (e.g., individual–group reading, aloud or silent, with or without intonation, and fluency) and functional knowledge of reading (e.g., summary, questions, comprehension exercises). To a lesser extent, they used literacy activities, reinforcement through praise (e.g., tangible or verbal), reading and writing, and work on alphabetic knowledge.

The latter strategy indicated that teachers mostly referred to constructivist theory, except teacher M.C., who chose to position herself in psycholinguistic theory. Similarly, teacher F. emphasized that students should build their learning and that teachers should function as a guide. To a lesser extent, she commented on aspects of the maturation and behaviorist theory (see Figure 2 ). Teacher M. also focused on the foundations of constructivism (e.g., prior knowledge, children discover their learning). She also talked about the importance of psychomotor skills, correctness in reading, as well as the involvement of parents. Teacher C. commented that students learn through construction and must discover reading autonomously through the support offered by the teacher. She also emphasized the role that parents play in reading, the importance of resources, oral language work, phonological awareness, as well as maturity in the development of reading. Teacher M.C. placed greater emphasis on the development of phonological awareness and oral language to teach reading. However, teacher S. focused more on student autonomy in the learning process and to a lesser extent on oral language, use of resources, and correction during reading (feedback). Teacher I. focused mostly on the construction of learning and less so on the role of oral language and the use of resources (library).

Figure 2. Teacher F. Network summarizing key concepts associated with the teaching process.

Subsequently, the information was triangulated after analyzing the beliefs, practices, and discourse of the teachers. For this, several researchers who are experts in the learning and teaching of reading skills agreed on the following relationship, in accordance with the basic postulates of each of the theories considered (see Table 4 ).

Table 4. Triangulation between theoretical profile, teaching practices, and teacher discourse.

Then the teachers’ scores were compared in relation to their beliefs, teaching practices (in terms of frequency), as well as teacher discourse, previously analyzed through its categorization into teaching–learning processes and their context (see Table 5 ). Finally, the results were interpreted according to Pearson’s correlation analysis. The results showed a high correlation ( r = 0.72, p < 0.05) in teacher F. and in teacher I. ( r = 0.71, p < 0.05) and a negative and high correlation in teacher M. ( r = −0.81, p < 0.05) between beliefs and practices. Moreover, they showed a moderate correlation in teacher C. ( r = 0.52) and in teacher M. ( r = 0.45) between beliefs and discourse. Finally, the results showed a negative and high correlation in teacher I. ( r = −0.74, p < 0.05) and in teacher M.C. ( r = −0.76, p < 0.05) between practices and discourse.

Table 5. Percentages of teachers’ beliefs, reading practices, and discourse.

Teacher F. showed links between his theoretical profile and his practices. A relationship between corrective beliefs (27.8%) and practices (29.2%) was found. On the other hand, we observed that in his practices, he used activities associated with other theories: repetition (23.5%), constructivism (19.9%), and psycholinguistic (16%). This also happened when he thought about how children learn to read, since he considered that the construction of learning (77.8%), maturation (11.1%), and providing feedback (11.1%) were fundamental. Other discourse makers, teacher M. did not show a link between her sociocultural (22%) and maturationist (23.4%) theoretical profile and her practices (5.7% and 0.6%). However, the results indicated that her maturationist (23.4%), sociocultural (22%) beliefs were related only to her discourse. So, she thought that the use of psychomotor skills (21.4%), teaching resources such as stories, stories, poems, and texts (14.3%), and teaching previous knowledge (50%) were important. However, practices based on other currents were observed: corrective reading (32.6%) and repeated reading (25.2%), as well as constructivism (19.1%), such as working previous knowledge or reading and writing and psycholinguistic skills (16.6%) [e.g., alphabetic knowledge: teaching letter names and sounds, rules with support rhymes, etc.; phonological awareness: stimulating children to become aware of letter sounds, saying words that begin with a certain sound, separating words into syllables, playing the game veo-veo (I spy.); vocabulary: teaching the meaning of words]. During the interview, opinions related to other theories were also found (i.e., corrective).

As for teacher C., there was a bidirectional relationship between her sociocultural theoretical profile (39.6%) (e.g., use of teaching resources such as stories, songs, writings from different sources, etc.) and her discourse (33.3%). Also, it was found that her psycholinguistic profile (28.9%) was related to her discourse (11.1%) (e.g., oral language or phonological awareness). However, the results indicated that this teacher carried out other practices not related to her theoretical beliefs, such as: feedback (50.8%) and repetition (16.9%). The same occurred with her discourse; she thought that maturation was also important (22.3%).

Regarding teacher M.C., a negative relationship was found between her psycholinguistic discourse (59.3%) and her teaching practices (4.1%). The same happened with her corrective practices (37.6%) and her discourse (14.8%) (e.g., correct when the child is wrong, point out, provide examples, deny). However, when we analyzed her practices, we found activities justified by other theories, such as functional knowledge of reading or use of teaching resources (13%) or repetition (19.6%) and constructivism (13%) (e.g., previous reading and writing, and likewise when we asked her opinion about how children learn to read (e.g., constructivism).

Regarding teacher S., she showed a corrective (17.6%), innatist (17.6%), sociocultural (17.6%), maturationist (16.6%), and constructivism (15.3%) profile. Then, she carried out corrective (35.1%) practices (e.g., feedback, direct instruction). During her discourse, opinions were also found that were constructivist (47.9%) and psycholinguistic (20%). Nevertheless, repetition practices (36%) were observed that had nothing to do with her expressed beliefs.

A relationship was found between the constructivism profile (23%) of teacher I. and her practices (19.3%). Then the result showed a relationship between corrective (12.6%) and repetitive (12.6%) beliefs and practices. Furthermore, this teacher used other practices unrelated to any of her attributed beliefs, such as: sociocultural (10.6%). No relationship between corrective (23%) and repetition (25.3%) practices and discourse were found. In the same way, she referred to the implication of other (e.g., sociocultural and psycholinguistic) theories in infant readers’ learning. The innatist profile of teacher I. was not related to her practices or discourse.

The results of the present study are congruent with previous study results that showed that teachers hold eclectic positions ( Clemente, 2008 ; Jiménez and O’Shanahan, 2008 ; Clemente et al., 2010 ; Rodríguez and Clemente, 2013 ). Other research has shown quite different results, from studies finding a relationship between beliefs and teaching practices in reading learning ( Cunningham and Zibulsky, 2009 ; Tolchinsky and Ríos, 2009 ; Rapoport et al., 2016 ) to studies which indicated a moderate correlation ( Baumann et al., 1998 ). On the opposite side, other authors found no such relationship ( Pérez-Peitx, 2013 ; Miglis et al., 2014 ; Enyew and Melesse, 2018 ; Utami et al., 2019 ).

The data extracted from the belief questionnaires have been complemented with the analysis of teaching practices and each teacher’s interviews, which allowed us to provide additional information ( Castañer et al., 2013 ). In our case, the interview helped us complete the teacher’s profile. We found that the teaching and learning processes are mediated by multiple contextual variables that were not identified by the questionnaire or recorded observations.

Analysis of the practices allowed us to identify not only what activities the teachers performed in their real teaching context but also how their sequence of instruction was oriented in all cases toward the use of their own multiple resources, applying other theories. The relationship found between some beliefs and practices in this study suggests that if teachers are aware of their own beliefs, the repertoire of teaching practices can be increased ( Tracey and Mandel, 2012 ), causing changes in decision making in the classroom and in teaching and evaluation strategies. In addition, as all teachers used many activities characteristic of other theories they did not explicitly hold, we focused on the opposite process, modifying their practices to cause a change in their beliefs ( Fazio, 2003 ), since these are permeable mental structures that can be modified ( Thompson, 1992 ). But how can we achieve this? Some studies confirm that people form their implicit theories through the knowledge they acquire ( Suárez and Jiménez, 2014 ).

The first step is to achieve the teacher’s predisposition to change, always through invitation ( Baena, 2000 ), by encouraging reflection. To do this, they should become aware how their own beliefs are involved in their teaching practice and how they influence student performance. In addition, the false myths about learning to read and teaching practices should be recognized, as prescribed by the National Reading Panel [NRP] (2000) . The question remains whether teachers have received training based on the latest advances in scientific research on the teaching of reading, in order to provide young students (who may or may not have difficulties) with the tools necessary for their learning to proceed optimally.

Online training offers teachers the opportunity to recycle their knowledge ( Costi et al., 2005 ; Jiménez, 2015 ; Jiménez et al., 2015 ; Jiménez and O’Shanahan, 2016 ), which generates an important pillar supporting success, integration, and sustainability in education ( Haydon and Barton, 2007 ; Somekh, 2008 ). It is also an alternative solution to the lack of time and difficulties in reconciling work and family life. It has been found that experience with these resources plays a fundamental role, since it favors a positive attitude of teachers and also confidence in the use of these tools for education ( BECTA, 2009 ). Joshi et al. (2009) found that the training teachers receive is inadequate because textbooks and courses in education reflect superstitions, anecdotes, and beliefs that are not based on scientific evidence. Research has also found that teachers do not properly use the practices that are based on scientific evidence ( Moats, 2009 ). If the learning environment is effective, it can even happen that only a small percentage of students present difficulties in learning to read ( Cunningham and Zibulsky, 2009 ).

The updating of knowledge according to research conclusions is proposed as an alternative for teachers who specialize in teaching reading, since teaching quality is one of the main factors determining the academic success of students ( European Council, 2008 ). For teachers to learn good practices, it is important that they have the following knowledge at their disposal: (1) fundamental research and theories about the development of language and reading; (2) strategies for use in the classroom to teach word recognition, vocabulary, text comprehension, and fluency; (3) tools to work on reading and writing at the same time; (4) the best strategies to teach reading and the materials to use; (5) different techniques for student evaluation; (6) how to maintain a good balance between theory, practice, and information technologies; (7) knowledge of dyslexia and other learning disorders ( IRA, 2007 ); and (8) how to interpret and administer assessment tests to plan teaching ( IDA, 2010 ). In addition, they must learn to ask more complex questions to help students make inferences and more elaborate reflections, as well as work with students’ prior knowledge ( RAND, 2002 ). However, the teacher alone should not be responsible for this process, because we have confirmed that in the teaching environment, there are other strong factors such as society or culture ( Quintana, 2001 ). The challenge now consists of achieving a change in the ways of thinking of those responsible for educational administration. The necessary means should also be provided to facilitate refresher courses and ongoing e-learning for teachers, with training programs that include content based on scientific evidence. One limitation is that the study consisted of six teachers and is not generalizable to a greater audience.

In general terms, we can conclude that the relationship between beliefs, practices, and discourse varies according to certain nuances. Thus, of the two beliefs attributed to teacher F., only one (corrective) was related to his form of instruction and his opinion. Among the four beliefs attributed to teacher M. (sociocultural, maturationist, repetition, and psycholinguistic), a relationship was found only between her maturationist and sociocultural profile and her discourse. Both beliefs attributed to teacher C. (sociocultural and psycholinguistic) were related to the discourse content. Of the two beliefs attributed to teacher M.C. (corrective and psycholinguistic), neither of them was related to her actions and reflections. Among the five beliefs attributed to teacher S. (sociocultural, innatist, corrective, maturationist, and constructivist) only two (corrective and sociocultural) were related to her active practices and discourse comments. Finally, of the two beliefs of teacher I. (innatist and constructivist), only constructivism was related to her practices or her opinion.

Although it is true that a relationship was found in all the teachers between some of their beliefs, practices, and discourse, as revealed in their discursive talks, all the teachers thought that learning to read depended on factors underlying other theories not related to their attributional profile. Therefore, despite attributing to them certain beliefs when they teach children to read and when they think of learning to read, it can be concluded that all teachers maintain an eclectic approach.

Data Availability Statement

All datasets generated for this study are included in the article/supplementary material.

Ethics Statement

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.

Author Contributions

NS: this author’s grant was used to run the project Integrando creencias y prácticas de enseñanza de la lectura (Integrating beliefs and practices about teaching reading), ref: PSI2009-11662. She participated actively in the research, analyzed the teaching practices and discourse, and was responsible for the literature review and drafting of this manuscript. JJ: supervised the project and the preparation of the study, offered theoretical guidance, and was responsible for reviewing the manuscript. CS: supervised the design and preparation of the study, offered guidance on methodology, and helped review the manuscript. All authors approved the final version of this article.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

This research has been funded through the Plan Nacional I + D + i (R+D+i National Research Plan of the Spanish Ministry of Economics and Competitiveness), project ref: PSI2009-11662 and project ref: PSI2015-65009-R, with the second author as the principal investigator. We also gratefully acknowledge the support of a Spanish Government subproject, Integration ways between qualitative and quantitative data, multiple case development, and synthesis review as main axis for an innovative future in physical activity and sports research (PGC2018-098742-B-C31) (2019–2021) (Ministerio de Ciencia, Innovación, y Universidades/Agencia Estatal de Investigación/Fondo Europeo de Desarrollo regional), that is part of the coordinated project New approach to research in physical activity and sport from a mixed methods perspective (NARPAS_MM) (SPGC201800 × 098742CV0).

Key Concepts

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Keywords : beliefs, teaching practices, reading, teacher discourse, triangulation, mixed methods

Citation: Suárez N, Jiménez JE and Sánchez CR (2020) Teaching Reading: A Case Study Through Mixed Methods. Front. Psychol. 11:1083. doi: 10.3389/fpsyg.2020.01083

Received: 30 November 2019; Accepted: 28 April 2020; Published: 10 June 2020.

Reviewed by:

Copyright © 2020 Suárez, Jiménez and Sánchez. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Natalia Suárez, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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15.7 Evaluation: Presentation and Analysis of Case Study

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• Revise writing to follow the genre conventions of case studies.
• Evaluate the effectiveness and quality of a case study report.

Case studies follow a structure of background and context , methods , findings , and analysis . Body paragraphs should have main points and concrete details. In addition, case studies are written in formal language with precise wording and with a specific purpose and audience (generally other professionals in the field) in mind. Case studies also adhere to the conventions of the discipline’s formatting guide ( APA Documentation and Format in this study). Compare your case study with the following rubric as a final check.

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15.4: Annotated Sample Reading- Case Study on Louis Victor "Tan" Leborgne

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Learning Objectives

By the end of this section, you will be able to:

• Apply critical thinking and communication in varying rhetorical and cultural contexts.
• Identify and describe the genre conventions and rhetorical situation of case studies.
• Analyze relationships between ideas and patterns of organization.

Introduction

Figure \(15.4\) Pierre Paul Broca (credit: “Paul Broca” by Anonymous/Wikimedia Commons, Public Domain)

French physician Pierre Paul Broca (1824–1880), an early researcher of brain science, is credited with developing theories about how the brain controls motor functions such as language. One of his patients, Louis Victor Leborgne, suffered from a continuing loss of speech that resulted in an inability to form any syllables other than tan. Following Leborgne’s death, Broca examined Leborgne’s brain and observed some abnormalities in the left frontal lobe. These observations would eventually lead to the larger discovery that different areas of the brain control different motor functions.

This sample case study imagines what Broca might have written about Leborgne. The contemporary references at the end of the study are those used by the actual writer of the case study, not Pierre Paul Broca.

Living By Their Own Words

Patient admission.

This 50-year-old Caucasian male was transferred from the psychiatry division to the surgical ward of Bicêtre Hospital in Paris on 11 April 1861. I performed a thorough physical examination upon his admission. The presenting diagnosis is diffuse gangrenous inflammation and infiltration of connective tissue of the entire lower right extremity, extending from the instep upward to the buttock. The patient shows complete paralysis of his right-side limbs. The left limbs are mobile with adequate control and power. Both bowel and bladder control are intact. The eyes are equally focused and reactive to light, although the vision in the left eye has deteriorated more than in the right eye. The patient exhibits difficulty in swallowing food, but the tongue is not paralyzed, and voice is normal.

Introduction. Broca first orients readers to the details of the case study: the participant, Leborgne, and how Leborgne came to be under his care.

Background and Context. Broca gives a detailed description of the case study participant. He notes physical details of Leborgne’s paralysis so that readers understand that Leborgne retains control over his voice and tongue. This knowledge allows Broca to eliminate paralysis as a cause of the subject’s inability to use language.

The patient is completely unable to form words other than the single syllable tan , which he most often repeats twice in rapid succession: “tan-tan.” This is said in varying tones and inflections. Paralysis of the patient’s dominant arm prevents writing. Nevertheless, the patient can communicate to a surprising extent through facial expressions and gestures with his left hand. His intellect appears normal, and he shows no signs of head trauma.

Research Question. In this paragraph, Broca further describes his participant and begins to bring the case study into focus. The details he provides about Leborgne’s ability to communicate and use language will be the focus of the study. Broca observes that Leborgne can communicate nonverbally, and no physical signs indicate that his brain may be affected. Broca wants to understand why Leborgne communicates as he does.

Patient History

Personal History. My personal interviews with family members revealed that Louis Victor Leborgne was born 21 July 1809, in Moret-sur-Loing. The town has many tanneries, a fact that may account for his use of the syllable tan . His father is an elementary school teacher. The patient is one of six siblings. His previous occupation was formier [artisan who made forms for shoemakers]. He is unmarried and has no children. Members of his immediate family visit but have been unable to provide care for him at home, resulting in an extended hospital stay of 21 years. Interviews with other patients in the ward have indicated that the patient is unfavorably viewed as egotistical and vindictive.

Description of Research Methods. In this section, Broca notes that he interviewed Leborgne’s family and other patients in the hospital and provides a hypothesis as to why Leborgne uses the syllable tan to communicate.

Organization. The author uses headings to organize the different sections of the case study. Main headings are centered; subheadings are left-justified.

Medical History. My interviews with family members and hospital staff responsible for his care yielded only a cursory medical history. They did, however, reveal that the patient developed epilepsy in his childhood or youth; the exact age is unknown.

At age 30, the patient lost the ability to speak but did not immediately seek medical attention. When the condition persisted, he came to Bicêtre Hospital and was admitted to the psychiatry division in 1840 (exact date not recorded).

Limitations of Research. Broca again notes the use of personal interview data as a research method / primary source. He acknowledges the limitations of this method (“only a cursory medical history”) but was able to gather relevant details, such as when Leborgne developed epilepsy, when he lost the ability to speak, and when he was first admitted to the hospital.

Approximately 10 years after the onset of his first symptoms, Leborgne experienced gradual weakness of his right arm, which developed into complete paralysis in that limb. This condition was followed by weakness in his right leg and foot. Apparently, it took four years from the start of the paralysis of his right arm until the patient completely y lost the ability to stand. In these years, his vision and mental faculties also deteriorated.

The patient remains in bed, having refused to leave it for the past seven years. During this time, his clothing was changed once a week. The infrequent change of clothes caused a delay in discovering the extent of his gangrenous inflammation and infection. At this point, the patient could hardly move and was transferred to the surgical unit, where I first met him.

Background and Context. More details of Leborgne’s medical history are given. Broca concludes the patient history by relating the circumstances leading to his treatment of Leborgne. This section provides a detailed account of everything known about the participant and his condition. Broca doesn’t rely only on records to gather this history, though. He interviews hospital staff to try to gather additional information not recorded.

The gangrene being too extensive for surgery, I confined myself to testing his mental faculties and language comprehension. By using his fingers, the patient was able to respond accurately to mathematical questions. He understood and responded to verbal questions as well. At times, his answers were incorrect, such as claiming to have children; I attribute these lapses to sepsis, which by now was far advanced.

Research Methods. In this section, Broca begins to relate how he observed Leborgne’s ability to communicate.

Analysis of Results. Broca tries to explain the reason for Leborgne’s incorrect responses.

Lacking any physical irregularities that would cause his loss of speech, I conclude the condition must be related to brain function. This condition is so singular that it seems useful to assign it a special name. I will designate it, therefore, as aphemia , or loss of speech.

The patient expired on 17 April 1861 at 11:00 a.m. Cause of death was gangrenous infection and sepsis.

Broad Theory. Broca poses a theory about Leborgne’s limited ability to communicate: “the condition must be related to brain function.” This theory will be tested later in the case study and, if correct, might be applicable to how the brain works for everyone.

Autopsy Findings

I performed an autopsy 24 hours postmortem and found a number of irregularities in the patient’s brain. A softened area over the perisylvian region contained a cavity the size of a chicken’s egg, filled with serous fluid. Volume loss affected the gyri, subcortical perisylvian area, insula, and part of the striate nucleus. I weighed the brain and discovered it to be lighter than normal. I attribute the low weight to the loss of volume in the left cerebral hemisphere.

I observed a significant malformation on the left frontal lobe, which I believe to be the source of the patient’s aphemia and, therefore, the brain location controlling speech production. Wishing to preserve the brain, I performed a surface examination only, without a full dissection. I have placed the preserved brain at the Musée Dupuytren in Paris.

Research Methods. Broca provides details of the autopsy and describes the abnormalities he found in Leborgne’s brain. These details are crucial to the study because of Broca’s earlier comment about Leborgne’s inability to communicate resulting from brain function.

Analysis of Results. Broca further hones his theories based on his observations of Leborgne’s brain. Broca hypothesizes that this malformation is the cause of Leborgne’s condition and, therefore, is located in the part of the brain that is related to speech.

I presented Leborgne’s case at the meeting of the Société d’Anthropologie de Paris on 18 April 1861, where it generated considerable controversy. My former teacher Jean-Baptiste Bouillaud had previously advanced the idea that the language function is localized in the frontal lobes, with which, based on my autopsy of Leborgne’s brain, I concur. Anatomist Louis Pierre Gratiolet opposed the idea that there could exist a specific area responsible for speech, arguing that the brain functions as a whole. Esteemed physician Ernest Auburtin asserted that specific areas of the brain have specific functions and further stated that motor articulation is not directly relevant to the ability to conceive words and ideas.

Advancing Knowledge. Broca uses his case study to contribute to the research on brain functions.

Limitations of the Research. Broca notes that not all attending the meeting are in agreement, suggesting that further research is needed to learn more about the brain and whether specific parts control specific functions.

Given my patient Leborgne’s success at responding to verbal and mathematical questions despite his loss of speech, I am convinced that brain function is localized. Auburtin’s theory of more compartmentalized specificity is intriguing, and I intend to pursue this idea. Leborgne’s preserved brain remains at the Musée Dupuytren, where it is available for further study.

What’s Next. Inviting additional research, Broca calls on his audience to research localized brain function. He notes that Leborgne’s brain is available for researchers to observe.

Domanski, C. W. (2013). Mysterious “ Monsieur Leborgne ”: The mystery of the famous patient in the history of neuropsychology is explained. Journal of the History of the Neurosciences , 22(1), 47–52. https://www.tandfonline.com/doi/abs/...4X.2012.667528

Konnikova, M. (2013, February 8). The man who couldn’t speak and how he revolutionized psychology. Scientific American . https://blogs.scientificamerican.com...ed-psychology/

Mohammed, N., Narayan, V., Patra, D. P., & Nanda, A. (2018). Louis Victor Leborgne (“Tan”). World Neurosurgery , 114, 121–125. https://doi.org/10.1016/j.wneu.2018.02.021

Ruane, M. (2013, July). Discovering the identity of a 150-year-old patient. Smithsonian . https://www.smithsonianmag.com/histo...tient-4563869/

Discussion Question

• What methods does Broca use in his case study?
• What are Broca’s field observations?
• What types of evidence does Broca gather for his case study?
• How does Broca analyze his data? What conclusion does he reach?
• If Leborgne had lived longer, what are some ways Broca could have expanded his study on his patient’s use of language?

Language and Expression

Language & culture lens icons.

One significant finding of Broca’s case study was that Leborgne grew up in the town of Moret-sur-Loing. The town had many tanneries, leading Broca to theorize that Leborgne’s use of the syllable tan was related to his home. Why is this theory important? It illustrates how personal history affects people. It is possible that Leborgne used language in this way because of his history and cultural association with his hometown. Culture and identity have a big impact on how people use language, even among people who speak the same language.

Figure \(15.5\) The Broca area—named for French anthropologist and pathologist Pierre Paul Broca (1824–1880), who discovered its function—is the part of the brain that controls articulate speech. The Wernicke area—named for German neurologist Carl Wernicke (1848–1905), who first described the area—is the part of the brain that controls the comprehension of speech. (credit: “BrocasAreaSmall” by NIH publication 97-4257/Wikimedia Commons, Public Domain)

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Study Suggests Genetics as a Cause, Not Just a Risk, for Some Alzheimer’s

People with two copies of the gene variant APOE4 are almost certain to get Alzheimer’s, say researchers, who proposed a framework under which such patients could be diagnosed years before symptoms.

By Pam Belluck

Scientists are proposing a new way of understanding the genetics of Alzheimer’s that would mean that up to a fifth of patients would be considered to have a genetically caused form of the disease.

Currently, the vast majority of Alzheimer’s cases do not have a clearly identified cause. The new designation, proposed in a study published Monday, could broaden the scope of efforts to develop treatments, including gene therapy, and affect the design of clinical trials.

It could also mean that hundreds of thousands of people in the United States alone could, if they chose, receive a diagnosis of Alzheimer’s before developing any symptoms of cognitive decline, although there currently are no treatments for people at that stage.

The new classification would make this type of Alzheimer’s one of the most common genetic disorders in the world, medical experts said.

“This reconceptualization that we’re proposing affects not a small minority of people,” said Dr. Juan Fortea, an author of the study and the director of the Sant Pau Memory Unit in Barcelona, Spain. “Sometimes we say that we don’t know the cause of Alzheimer’s disease,” but, he said, this would mean that about 15 to 20 percent of cases “can be tracked back to a cause, and the cause is in the genes.”

The idea involves a gene variant called APOE4. Scientists have long known that inheriting one copy of the variant increases the risk of developing Alzheimer’s, and that people with two copies, inherited from each parent, have vastly increased risk.

The new study , published in the journal Nature Medicine, analyzed data from over 500 people with two copies of APOE4, a significantly larger pool than in previous studies. The researchers found that almost all of those patients developed the biological pathology of Alzheimer’s, and the authors say that two copies of APOE4 should now be considered a cause of Alzheimer’s — not simply a risk factor.

The patients also developed Alzheimer’s pathology relatively young, the study found. By age 55, over 95 percent had biological markers associated with the disease. By 65, almost all had abnormal levels of a protein called amyloid that forms plaques in the brain, a hallmark of Alzheimer’s. And many started developing symptoms of cognitive decline at age 65, younger than most people without the APOE4 variant.

“The critical thing is that these individuals are often symptomatic 10 years earlier than other forms of Alzheimer’s disease,” said Dr. Reisa Sperling, a neurologist at Mass General Brigham in Boston and an author of the study.

She added, “By the time they are picked up and clinically diagnosed, because they’re often younger, they have more pathology.”

People with two copies, known as APOE4 homozygotes, make up 2 to 3 percent of the general population, but are an estimated 15 to 20 percent of people with Alzheimer’s dementia, experts said. People with one copy make up about 15 to 25 percent of the general population, and about 50 percent of Alzheimer’s dementia patients.

The most common variant is called APOE3, which seems to have a neutral effect on Alzheimer’s risk. About 75 percent of the general population has one copy of APOE3, and more than half of the general population has two copies.

Alzheimer’s experts not involved in the study said classifying the two-copy condition as genetically determined Alzheimer’s could have significant implications, including encouraging drug development beyond the field’s recent major focus on treatments that target and reduce amyloid.

Dr. Samuel Gandy, an Alzheimer’s researcher at Mount Sinai in New York, who was not involved in the study, said that patients with two copies of APOE4 faced much higher safety risks from anti-amyloid drugs.

When the Food and Drug Administration approved the anti-amyloid drug Leqembi last year, it required a black-box warning on the label saying that the medication can cause “serious and life-threatening events” such as swelling and bleeding in the brain, especially for people with two copies of APOE4. Some treatment centers decided not to offer Leqembi, an intravenous infusion, to such patients.

Dr. Gandy and other experts said that classifying these patients as having a distinct genetic form of Alzheimer’s would galvanize interest in developing drugs that are safe and effective for them and add urgency to current efforts to prevent cognitive decline in people who do not yet have symptoms.

“Rather than say we have nothing for you, let’s look for a trial,” Dr. Gandy said, adding that such patients should be included in trials at younger ages, given how early their pathology starts.

Besides trying to develop drugs, some researchers are exploring gene editing to transform APOE4 into a variant called APOE2, which appears to protect against Alzheimer’s. Another gene-therapy approach being studied involves injecting APOE2 into patients’ brains.

The new study had some limitations, including a lack of diversity that might make the findings less generalizable. Most patients in the study had European ancestry. While two copies of APOE4 also greatly increase Alzheimer’s risk in other ethnicities, the risk levels differ, said Dr. Michael Greicius, a neurologist at Stanford University School of Medicine who was not involved in the research.

“One important argument against their interpretation is that the risk of Alzheimer’s disease in APOE4 homozygotes varies substantially across different genetic ancestries,” said Dr. Greicius, who cowrote a study that found that white people with two copies of APOE4 had 13 times the risk of white people with two copies of APOE3, while Black people with two copies of APOE4 had 6.5 times the risk of Black people with two copies of APOE3.

“This has critical implications when counseling patients about their ancestry-informed genetic risk for Alzheimer’s disease,” he said, “and it also speaks to some yet-to-be-discovered genetics and biology that presumably drive this massive difference in risk.”

Under the current genetic understanding of Alzheimer’s, less than 2 percent of cases are considered genetically caused. Some of those patients inherited a mutation in one of three genes and can develop symptoms as early as their 30s or 40s. Others are people with Down syndrome, who have three copies of a chromosome containing a protein that often leads to what is called Down syndrome-associated Alzheimer’s disease .

Dr. Sperling said the genetic alterations in those cases are believed to fuel buildup of amyloid, while APOE4 is believed to interfere with clearing amyloid buildup.

Under the researchers’ proposal, having one copy of APOE4 would continue to be considered a risk factor, not enough to cause Alzheimer’s, Dr. Fortea said. It is unusual for diseases to follow that genetic pattern, called “semidominance,” with two copies of a variant causing the disease, but one copy only increasing risk, experts said.

The new recommendation will prompt questions about whether people should get tested to determine if they have the APOE4 variant.

Dr. Greicius said that until there were treatments for people with two copies of APOE4 or trials of therapies to prevent them from developing dementia, “My recommendation is if you don’t have symptoms, you should definitely not figure out your APOE status.”

He added, “It will only cause grief at this point.”

Finding ways to help these patients cannot come soon enough, Dr. Sperling said, adding, “These individuals are desperate, they’ve seen it in both of their parents often and really need therapies.”

Pam Belluck is a health and science reporter, covering a range of subjects, including reproductive health, long Covid, brain science, neurological disorders, mental health and genetics. More about Pam Belluck

The Fight Against Alzheimer’s Disease

Alzheimer’s is the most common form of dementia, but much remains unknown about this daunting disease..

How is Alzheimer’s diagnosed? What causes Alzheimer’s? We answered some common questions .

A study suggests that genetics can be a cause of Alzheimer’s , not just a risk, raising the prospect of diagnosis years before symptoms appear.

Determining whether someone has Alzheimer’s usually requires an extended diagnostic process . But new criteria could lead to a diagnosis on the basis of a simple blood test .

The F.D.A. has given full approval to the Alzheimer’s drug Leqembi. Here is what to know about i t.

Alzheimer’s can make communicating difficult. We asked experts for tips on how to talk to someone with the disease .

Kendrick Lamar Drops Yet Another Drake Diss Track, ‘Not Like Us’

By Jem Aswad

Executive Editor, Music

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Kendrick Lamar continued to ramp up his increasingly personal musical battle with Drake by releasing “Not Like Us,” his third song in 36 hours, early Saturday evening. The song is posted on Lamar’s official YouTube channel — which essentially guarantees its authenticity in an era when an AI deepfake must always be considered — and features an aerial view of Drake ‘s mansion outside Toronto, with sex-offender map symbols on it.

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As usual, there are so many lyrics that we’ll leave the deep analysis to the experts, but there’s not much mystery about the Atlanta-themed lines that close the song, which lists a number of the A-town rappers Drake has worked with (Future, 21 Savage, Lil Baby) and finishes with a dig at both Drake’s diss track against Lamar (“Family Matters”) and his 2018 song, “God’s Plan.”

“You run to Atlanta when you need a few dollars/ You not a colleague, you a fuckin’ colonizer/ The family matter, and the truth of the matter/ It was God’s Plan to show you’re a liar.”

The song fades out with Lamar leading a female chorus chanting “O-vee-ho” — a play on Drake’s company, OVO — and making fun of his hit “Toosie Slide” again.

Kendrick dropped 3 different songs in 24 hours. pic.twitter.com/6t5B4F0KJY — . (@tsnmknd) May 5, 2024

In just the past 36 hours, Lamar released a diss track titled “6:16 in LA” on Friday morning, then both rappers dropped response tracks , one after the other, on Friday evening, with Drake putting out “Family Matters” and Lamar releasing “Meet the Grahams.”

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