Running Head POLITICS AND HEALTH CASE SYSTEMS IN USPOLITICS AND.docx

Running Head: POLITICS AND HEALTH CASE SYSTEMS IN
US
POLITICS AND HEALTH CARE SYSTEM IN US.
5
Politics and Healthcare System in USComment by James A
Love: This is a good first outline. Please read the comments I
have inserted below, and let me know if you have questions.
Name
School/College
September 11, 2015
Outline
Title: Politics and Healthcare System in US
Thesis: The healthcare delivery system in the US has undergone
noticeable gradual improvements from the financing sector,
insurance sector, delivery and quality sector even though many
politicians politicize the gaps in healthcare for their own
benefits with the pretense of initiating reforms to the sector.
I. Introduction
A. Politics started intervening in the healthcare sector between
the years 1930 and 1960.Comment by James A Love: Were
politics not involved in healthcare prior to the 1930s and 1960s?
Be prepared to cite this assertion. What changed in the 1930s?
B. Thesis: The healthcare delivery system in the US has
undergone noticeable gradual improvements from the financing
sector, insurance sector, delivery and quality sector even though
many politicians politicize the gaps in healthcare for their own
benefits with the pretense of initiating reforms to the
sector.Comment by James A Love: This claim will need citing

for support.Comment by James A Love: This claim will need to
supported with specific citations.
II. Background Comment by James A Love: The ‘background’ is
appropriate here. It is essentially your ‘literature review’. I
think you can use either section title, but you should include
multiple citations of articles that discuss “politics in healthcare”
spanning history.
A. The aim is to discuss the association between politics and
healthcare and to try and find out the roles politics has played
in reforming the healthcare sector.
III. Formation of acts to offer medical securityComment by
James A Love: Section III, IV, and V seem like they should be
the major subsections within section II.
A. Formation of social security act of 1935
a. Provide unemployment compensationComment by James A
Love:
b. Provide old-age pensions
c. Other benefits
1. Provision of federal funds for hospital construction
B. Kerr-mills act of 1960
a. Federal matching payments
b. Elderly disabled and poor
IV. The election of some prominent leaders in the US
A. Kennedy, 1961
a. Kennedy kept the issue of elderly healthcare needs alive
B. Lyndon Johnson 1963
a. Initiated the Great Society’s War on Poverty Program
b. Medicare
C. Nixon
a. He signed various acts to extend community mental health
centers
b. National Health Insurance Partnership Act
1. Family Health Insurance Plan
i. Offers health insurance to low income families
2. National Health Insurance Standards Act

i. Developing Health Maintenance Organizations
D. Jimmy carter
a. Supported national health insurance program
E. Clinton
a. He made changes in health insurance coverage
b. Introduced National Health Reform
F. Harris Wofford
a. He formed democratic debates
b. He insisted on health insurance
G. Barrack Obama
a. Introduced the Affordable Care Act
1. The purpose is creating more tax revenue
2. Condemning citizens to vote for their health care services
V. Introduction of the managed care plan
A. A way of containing health care costs
· [INCLUDE FINDINGS, ANALYSIS, DISCUSSION
SECTIONS HERE]Comment by James A Love: After you give a
solid review, you will need some additional sections to add in
your “new” contributions to the existing literature. Basically,
try to find some meaning from all of the research your studied
to support your thesis. This is typically in the “findings”
section. You may need to revise your thesis if research
indicates something else. That is okay. It is part of iteration
process of making your paper better. Then, a separate
“discussion” section, will include your interpretation of the
findings.
These sections are the important contributions that make this
paper more than simply a review paper. You can choose to
make the paper a “literature review” paper, but you will need to
have many citations and still synthesize some meaning from the
review in a “findings” and “discussion” sections.
VI. ConclusionComment by James A Love: The conclusion will
end up being a summary of what all you did in the previous

sections.
Liberals and conservative are in constant conflicts and their
differences is the main cause of the failures and successes in the
health care sector
Abstract
It should be noted that the U.S health care delivery system is
constantly undergoing transformation through new legislation or
improvement and amendments of the existing legislations. Some
of the most common areas that are often improved concern the
financing sector, insurance sector, delivery sector and quality
sector. New laws are often introduced in these sectors with the
purpose of ensuring that the resultant health care is of high
quality and that it is cheaper and accessible to many.
Affordability is another crucial component of health care
delivery system. The four basic functional components of the
U.S. health care delivery system include financing, insurance,
delivery and quality would be discussed.
The paper will explore and analyze the association between the
politics and the health care reforms in the United States. The
analysis will try to find out the role of politics in the key
healthcare reforms such as Medicare, Medicaid, Managed care
and even the most current act called Affordable Care Act. The

paper will demonstrate that politicians have been using gaps in
the healthcare system to campaign for their consideration for
being elected as Congress or senators. It will also demonstrate
that some politicians such as Clinton plan to initiate reforms to
suit their political interest. The paper will conclude by
indicating how the politics and politicians manipulate the health
care reform as their campaign strategies of winning voters.
Politics and healthcare system in USA
A closer look at the health care reform in United States reveals
that any reform is politically orchestrated. In fact it is as if one
of the campaign strategies of most of the politicians is to come
up with a reform that can improve cost of care, quality of care
and access to care. A closer look at the history of the United
States reveals that politics started intervening in health care
between 1930s and 1960s (Patel & Rushefsky, 1999). During
this time, there was depression, unemployment insurance and
hence the government was in pressure to provide cheaper if not
free medical care or reimbursement for its cost (Patel &
Rushefsky, 1999).
In 1935, the Social Security Act of 1935 was formed to provide
for unemployment compensation, old-age pensions and other
benefits (Patel & Rushefsky, 1999). It should be noted that the
political party in leadership had to be careful on how it handles
the issue of health care lest it lose the confidence in people.
Before the idea of insurance was introduced, the American
Medical Association was strongly opposing it.
On the other hand, the politicians and the ruling political
government had to force it happen because that was the only
option in which politicians could help its citizens and possibly
get reelected. After World War II, the Truman administration
initiated the expansion of hospitals, increased support for public
health and federal aid for medical research and education. This
was reinforced by the passage of Hill-Burton Act in 1946,
which provided federal funds to subsidize construction of
hospitals in areas of bed shortages.

In 1960, Kerr-Mills Act, which is also known as Medical
Assistance Act was passed by Congress. This provided federal
matching payments to states and allowed the state to include
medically needy or vulnerable groups such as the elderly, the
disabled and the poor. However, the act failed to offer
significant relief for the substantial portion of the elderly
population. This is because it was found that only one percent
of the nation’s elderly received help under the program. The
program was curtailed by stringent eligibility rules and high
administrative costs of state government. The issue therefore
remained on political agenda.
When Kennedy became president in 1961, one of his political
agenda was to increase access to health care for millions of
Americans. However, it is indicated that Kennedy won a narrow
victory and was not in a position to push for a universal
insurance program. This is because he had a Congress that was
not very amenable to his legislative proposals. Kennedy’s key
achievement is that he was able to keep the issue of healthcare
needs of elderly alive and on political agenda.
However, his assassination in 1963 left the task of carrying on
the fight for Medicare to Lyndon Johnson, who adopted most of
Kennedy’s unfinished legislative proposals. He also initiated
the Great Society’s War on Poverty program (Patel, Rushefsky
& McFarlane, 2005). It should be noted that after civil rights,
Medicare was second in priority with the Johnson
administration.
Johnson recognizes Medicare as crucial part of his fight on
poverty. As a result, he won a landslide victory, which enabled
him carry out his political agendas successfully (Patel,
Rushefsky & McFarlane, 2005). It is also important that during
that time, the Democrats won major victories in congressional
elections. This means that the administration had enough votes
in the House and the Senate for the passage of its health care
proposals.
When Nixon took the leadership, he proposed moderate changes
in the health care programs (Patel, Rushefsky & McFarlane,

2005). He signed into law various acts meant to extend
community mental health centers, migrant health centers and
programs designed to support training of health care personnel
(Patel, Rushefsky & McFarlane, 2005). It should be noted that
Nixon was interested in vying for the president in 1972 again.
He felt compelled to respond to Kennedy’s political challenge
(Patel, Rushefsky & McFarlane, 2005).
Nixon proposed the National Health Insurance Partnership Act.
This comprises of the Family Health Insurance Plan, which is
federally financed to offer health insurance for all low-income
families. The second component of this act is the National
Health Insurance Standards Act. This act is financed by private
funds. Its goal is to set standards for employer health insurance
and expected coverage of employees.
Another one of Nixon’s proposal was to provide federal funds
for the development of health maintenance organizations (HMO)
(Patel, Rushefsky & McFarlane, 2005). In this system, enrollees
are allowed to pay a fixed fee in advance, and in return,
received a comprehensive set of health care services. Such
organizations promote competition with traditional health care
delivery system. This is because they create incentives for
shifting health services utilization from more costly impatient
services such as hospitals and skilled nursing facilities to less
costly outpatient services such as visits to doctor’s offices
(Patel, Rushefsky & McFarlane, 2005).
Jimmy Carter, on the other hand, pledged his support for a
comprehensive national health insurance program (Morone &
Belkin, 1994). This was a response to his opponent, who was
also seeking the Democratic Party’s nomination. However,
when he finally assumes the office in 1977, he could not meet
his pledges because he was hindered by financial constraints
(Morone & Belkin, 1994).
Roosevelt administration did not want to jeopardize the
enactment of Social Security Act. The 1980’s political
leadership; which was under the leadership of Reagan and Bush
healthcare system targeted mostly on the cost of health care

(Morone & Belkin, 1994). They use such to influence voters.
Ironically, during that time, the key reforms that were expected
especially by various experts and policy makers’ concerned
access to care and quality of care delivered. However, because
of the political influence, a number of legislation meant to cut
the cost of health care was passed (Morone & Belkin, 1994). In
fact it is during this period that the legislations related to the
Medicare and Medicaid programs were implemented. They both
focus on how to control rising health care costs. The impact of
this was positive because it is indicated that there was a
reduction in health care costs in 1990s (Shi & Singh, 2010).
When Clinton was elected as the present, the politics targeted at
ensuring access to health care insurance and health care
services. The Clinton administration really pushed for this. The
poll that was conducted in 1992 reveals that most of American
was in favor or reforming the health care system. George Bush
announced new health care initiatives. He proposed a series of
reforms. Under the proposal, the self-employed were to receive
a tax deduction equal to the size of the premiums and that small
business would receive tax inducement.
A closer look at Bush initiative reveals that it was in response
to the coming presidential election and was a way of assuring
Bill Clinton that he would offer a plan for comprehensive
reform of the U.S. healthcare system. The Bush government
and Clinton later endorsed managed care. The Clinton’s
administration was doing this as one of his pledges he made
during election. It is apparent that during the campaign of
1990s, the Clinton was convicted that health care was an issue
which could allow him go back to the White House for a
Democrat. During this time, the political analysts were certain
that health care was an aspect that could define a presidency
(Jacobs & Skocpol, 2012). In fact it has been established that it
is during the Clinton’s time when the United States experienced
a push for major health care reform. It was during this time
when the health care reform began to take shape seriously.
There are a number of politically motivated reforms that took

place during the Clinton’s time (Jacobs & Skocpol, 2012). The
first reform that is as a result of the political motivation is the
changes in health insurance coverage. Health insurance
coverage was one way of increasing the access to health care
services in the United States. Politicians were looking at every
possible way in which they can improve the healthcare system
in the United. For example, after the initiation of private
insurance, the problem of lack of healthcare of lack of health
insurance coverage became a problem of special groups such as
the aged, the poor, and more recently, the unemployed (Jacobs
& Skocpol, 2012).
A closer analysis of the health care system and reforms in the
United States reveals that the exact time when the healthcare
reform was politicized is in 1990s. It is during this time that
most of the trends such as the rising numbers of Americans
without health insurance and the rising fears of the middle class
about not having health insurance. The change started in 1991,
when Harris Wofford aired a television commercial during the
campaign that argued “if every criminal in America has the
right to a lawyer, then I think every working individuals or
citizens have the right to see a doctor when they are ill.
Using this as campaign strategy, Harris managed to defeat his
opponent. It is envisaged that it was during this time that the
Democratic Party started realizing that access to health care was
an issue on the minds of the public (Jacobs & Skocpol, 2012).
In fact during the following Democratic debates, health
insurance was one of the issues that were given a lot of weight.
The different candidate from the different states started
developing well-thought and comprehensive proposals related to
health reform (Jacobs & Skocpol, 2012). For example, history
shows that Senator Robert Kerry introduced a comprehensive
plan in mid-1991. Kerry proposed a government-financed and
government-run plan. However, other Democratic competitors
and contenders adopted less comprehensive reforms positions.
Paul Tsongas, for example pushed an approach which later
became publicly identified as the Jackson Hole Plan. This plan

was partly contributed by Paul Ellywood. It resembles the
managed care (Jacobs & Skocpol, 2012). It was proposed that
managed competition envisioned a health care system that relied
largely on market forces of supply and demand. It was during
this time that an agreement was made that it is better if
employers can pay a portion of their workers’ coverages, but
not necessarily pay the whole insurance amount (Jacobs &
Skocpol, 2012).
Another major significant reform took place when Clinton
became president. It is shown that President Clinton initiated a
reform led by the President’s Task Force on National Health
Reform. The goal of the reform was to make health care reform
legislation that could be submitted to Congress within 100 days
(In Selker & In Wasser, 2014).
The Task force was headed by Clinton’s wife. Clinton,
according to analysts, wanted to tackle the entire issue of health
care reform. He wanted a comprehensive proposal from the task
force (In Selker & In Wasser, 2014). The idea that Clinton
chooses his wife to head the task force is an indication of
political intentions. It is also shown that the way the
commission was created and the secrecy around its actions leave
a lot of questions related to the task force and the Clinton’s
administration (In Selker & In Wasser, 2014).
Medicare is another health care program that has some political
elements. It was initiated during the Clinton’s administration.
It should be noted that Medicare is a very crucial reform as far
as health care is concerned (In Mason, In Leavitt, & In Chaffee,
2014). This is because it currently serves more than 39 million
people, who get insurance and health care through Medicare (In
Selker & In Wasser, 2014).
Although Medicare is meant to reduce the cost of health care,
there is evidence that the Medicare costs have been growing
even faster than general health care costs since it was formed.
This is attributable to the increase in the share of population
over 65 years. It was agreed that the only way of reducing the
Medicare cost is to control the rate of growth in costs per

beneficiary (Faguet, 2013). It was also proposed that the cost
reduction can only be accomplished by a fundamental
restructuring of incentives for beneficiaries, and also adoption
of fee-for-service Medicare (In Selker & In Wasser, 2014). Two
key proposals were thus made. The first proposal is Breaux-
Frist proposal. This comprises of the Bi-Partisan Commission’s
plan and President Clinton’s plan.
Managed care plan is also envisaged to have some political
association. This plan was developed as a way of containing the
costs in 1970s and 1980w. This was the time when the health
care costs increased rapidly.
The last form of healthcare reform is the Affordable Care Act,
which was recently passed under the Obama administration
(Pratt, 2012). A closer look at the act reveals that it is a
political document. It is not a healthcare document (Pratt,
2012). In fact the main reason why the Act was initiated is to
create more tax revenue to support a bigger government, and to
create a large voting block dependent on government for their
healthcare services (Pratt, 2012). It is apparent that the public
dependency related to the act provides politicians enormous
political power (Pratt, 2012).
Depoliticizing the healthcare system can result in poor quality
reforms. This is because the politicians compete based on how
best they can improve the health care. However, care should be
taken to analyze any given policy before it is amended because
some policies such as Affordable Care Act may appear good
superficially, but is not actually good.
Solution
to the problem
As indicated in the foregoing discussion and analysis, it is clear

that the development of healthcare system is not always for the
interests of the people, but just a way of getting votes. Such
approach is always not good because it means that the
politicians are just to impress the voters. Let us consider the
healthcare system during Kennedy’s era.
As indicated earlier, when Kennedy became president in 1961,
one of his political agenda was to increase access to health care
for millions of Americans. However, it is indicated that
Kennedy won a narrow victory and was not in a position to push
for a universal insurance program. This is because he had a
Congress that was not very amenable to his legislative
proposals. This clearly indicates that politics may not always
deliver good thing because it requires that the issue of proposal
goes through the Congress. This means that even if the proposal
is good and the Congress is divided on whether to adopt or not,
such proposal may fail. This means that it is high time to have
independent body responsible for proposal and amendment of
healthcare system.
Another problem related to politicizing of healthcare system is
that some bills passed are appealing at the superficial level, yet
in reality, they are costly to the citizens. A good example is the
Affordable Care Act, which was proposed by President Barrack
Obama. When one looks at this act, it appears that it is indeed
affordable. However, the truth is that the act is controversial
and highly political. Ezekiel Emanuel, who is a professor of

medical ethics and health policy at the University of
Pennsylvania, refers it as a signature piece of legislation for
President Obama’s first term, and also a ball and chain for his
second. Principally, the act’s main aim is on providing more
Americans with access to affordable health insurance,
improving the quality of health care and health insurance,
regulating the health insurance industry and reducing health
care spending.
The research reveals that ACA is a political document. It is not
a healthcare document (Pratt, 2012). In fact the main reason
why the Act was initiated is to create more tax revenue to
support a bigger government, and to create a large voting block
dependent on government for their healthcare services (Pratt,
2012). The citizens or rather voters may be happy that their
healthcare services are taken care of, yet in reality, they are the
one taking care of them.
A solution to this problem is that the trusted bodies such as
Supreme Court should always be ready to defend the citizens by
providing right interpretation of the Acts passed. This means
that there is need of independent, neutral and accountable body
that can help interpret the bill before it is passed as a law. Such
bodies will enable the citizens/ voters make a sound decision
based on pro and cons of the bill. This is because most
politicians are very cunning such that they can easily coerced
the voters into believing that a given bill is right

Conclusion
It should be noted from the foregoing discussion that failure or
success to provide universal health insurance coverage can be
attributed to fundamental political ideological differences
between liberals and conservatives. The two are in conflict
about the role of the public and private sector in health care. It
is apparent that one of the factors that determine whether a
given candidate would become president is the nature and the
role of the health care act he or she initiates.
References
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Faguet, G. B. (2013). The Affordable Care Act: A missed
opportunity, a better way forward. New York: Algora Pub.
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In Mason, D. J., In Leavitt, J. K., & In Chaffee, M. W. (2014).
Policy & politics in nursing and health care.
In Selker, H. P., & In Wasser, J. S. (2014). The Affordable Care
Act as a National Experiment: Health Policy Innovations and
Lessons.
Jacobs, L. R., & Skocpol, T. (2012). Health care reform and
American politics: What everyone needs to know. New York:

Oxford University Press.
Morone, J. A., & Belkin, G. S. (1994). The politics of health
care reform: Lessons from the past, prospects for the future.
Durham: Duke University Press.
Patel, K., & Rushefsky, M. E. (1999). Health care politics and
policy in America. Armonk, NY [u.a.: M.E. Sharpe.
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Patel, K., Rushefsky, M. E., & McFarlane, D. R. (2005). The
politics of public health in the United States. Armonk, N.Y:
M.E. Sharpe.
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Pratt, L. L. (2012). Let's fix medicare, replace medicaid, and
repealthe affordable care act: Here is why and how.
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Shi, L., & Singh, D. A. (2010). Essentials of the U.S. health
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Bottom of Form
LSHSS
Research Article
Linguistic Feature Development Across
Grades and Genre in Elementary Writing
Shannon Hall-Millsa and Kenn Apela

Purpose: As children develop skills in writing across
academic contexts, clinicians and educators need to have
a fundamental understanding of typical writing development
as well as valid and reliable assessment methods. The
purpose of this study was to examine the progression of
linguistic elements in school-age children’s narrative and
expository writing development.
Method: Narrative and expository writing samples
produced by 89 children in Grades 2 through 4 were
analyzed at the microstructure and macrostructure levels.
Measures of receptive vocabulary, word-level reading, and
reading comprehension were obtained.
Results: Exploratory factor analyses revealed
4 microstructure factors (e.g., productivity, grammatical
complexity, grammatical accuracy, and lexical density)
and 1 macrostructure factor (e.g., a combination of
organization, text structure, and cohesion). Multivariate
analyses of covariance with reading comprehension as a
covariate showed that productivity and macrostructure
were sensitive to grade-level and genre differences and that
expository grammatical complexity was sensitive to grade-
level differences.
Conclusions: Findings are discussed in light of grade-level
standards for narrative and expository writing and

current practices in writing assessment. Multiple
suggestions are offered for clinical and educational
implications, and specific directions are provided for future
research.
S
peech-language pathologists (SLPs) working with
school-age children and adolescents have important
roles in prevention, identification, assessment, and
intervention for problems involving oral and written lan-
guage (American Speech-Language-Hearing Association
[ASHA], 2010). The school context is heavily influenced by
the established curricular standards, and SLPs contribute
their knowledge of language development to support stu-
dents who struggle with the prerequisite language skills to
achieve those standards. A majority of states have adopted
the Common Core State Standards (Common Core State
Standards Initiative, 2010), which include many rigorous
and integrated written language competencies across grade
levels and content areas. Given their specialized knowledge
base in the normal development of writing in the context
of the general education curriculum (ASHA, 2002), SLPs
can inform the assessment, instruction, and intervention of

children’s written discourse skills. There is a need to docu-
ment the nature of children’s written discourse skills across
the elementary grades when children are learning to write.
There is also a need for validated assessment methods to
elicit and analyze children’s writing products. Therefore,
the purpose of this study was to examine dimensions of
written language produced by children in Grades 2 through
4 with typical language development within two common
academic discourse genres (i.e., narrative, expository)
using multiple levels of analysis (i.e., microstructure and
macrostructure).
Academic Discourse Genres
Written discourse genres represent different forms and
styles of writing and reflect a range of purposes and contexts
for writing (e.g., Graham & Harris, 2003; Graham & Perin,
2007). In the school environment, narrative and expository
genres are the most commonly encountered discourse genres
in elementary grades (Donovan & Smolkin, 2006). A fre-
quently employed assessment method to elicit narrative and
expository writing from students in the elementary grades is
with predetermined topic prompts given by the teacher or
examiner. The majority of state writing assessment programs

aFlorida State University, Tallahassee
Correspondence to Shannon Hall-Mills: [email protected]
Kenn Apel is now at the University of South Carolina,
Columbia.
Editor: Marilyn Nippold
Associate Editor: Lynne Hewitt
Received April 5, 2014
Revision received August 21, 2014
Accepted April 6, 2015
DOI: 10.1044/2015_LSHSS-14-0043
Disclosure: The authors have declared that no competing
interests existed at the time
of publication.
Language, Speech, and Hearing Services in Schools • Vol. 46 •
242–255 • July 2015 • Copyright © 2015 American Speech-
Language-Hearing Association242
utilize this approach to eliciting student writing. In the basic

procedure, a set of writing prompts is provided to the stu-
dent. Students may have a choice of prompts for narrative,
expository, and persuasive discourse, depending on their
grade level. In some state writing assessment programs, only
one set of prompts is provided (i.e., no student choice). The
students have an established amount of time to write and
most often use paper and pencil to complete the task (with
the exception of allowable accommodations for students
with disabilities). The students’ written work is later evalu-
ated based on criteria established by the state education
agency, taking into account grade-level curricular standards
for writing and multiple features that are thought to reflect
writing proficiency. The prompt-based elicitation method
also has been infused in writing instruction in the classroom.
Therefore, writing prompts provided to elementary school-
age students frequently are intended to elicit either narrative
or expository texts.
Narrative discourse involves telling a story, often about
personal events or other life experiences (e.g., novels, personal
letters, and short stories). Expository discourse involves con-
veying facts or describing procedures, sharing basic informa-
tion, relating cause–effect relationships, or arguing a point of
view (e.g., essays, editorials). The ability to write proficiently
in both narrative and expository genres is a language skill

directly linked to academic success (e.g., Beers & Nagy,
2011; Nelson, Bahr, & Van Meter, 2004; Singer, 2007). By
the fourth grade, expository discourse is the principal genre
of instruction (Common Core State Standards Initiative,
2010; Nippold & Sun, 2010).
Knowledge of discourse genres is acquired in a devel-
opmental progression and is related to reading comprehen-
sion and writing achievement (e.g., Olinghouse & Graham,
2009; Shanahan, 2006). Awareness and use of narrative
discourse in written language typically develops first, often
through storytelling experiences (e.g., Nelson et al., 2004).
Compared with narrative discourse, expository discourse
structure typically is mastered later in the school years
and, as a consequence, is more difficult to produce and
comprehend for many students (Berman & Verhoeven,
2002). Much of the recent research regarding discourse
genres in written language has centered on text compre-
hension; in contrast, fewer studies have focused on text
production (i.e., writing). Furthermore, when researchers
have examined linguistic features at the discourse level in
written language, their investigations often have been re-
stricted to narrative discourse. There is a need, then, to ex-
amine students’ writing skills across additional discourse
genres, such as expository, especially considering that 60%

of writing assignments are expository in nature by the fourth
grade (Graham & Perin, 2007). In this study, we investigated
students’ developing written language skills in both narra-
tive and expository genres.
When examining students’ written language skills, re-
searchers have analyzed their writing samples for microstruc-
ture (i.e., the text base where the writer’s conveyance of
meaning is structured at the word, sentence, and discourse
levels) and macrostructure (i.e., the general idea of the
writer’s meaning at the discourse level reflected through
cohesion, organization, and genre structure). Both micro-
structure and macrostructure are important characteristics
to inspect because they reflect different levels of linguistic
prowess in the writing task. There are important implica-
tions from previous investigations. Herein, we present a
summary of the findings related to the development of
writing skills in school-age children.
Microstructure
Limited research on the development of narrative mi-
crostructure has revealed developmental changes in chil-
dren’s and adolescents’ use of literate words and complex

syntax in narrative discourse across age groups (Sun &
Nippold, 2012). Investigations of the development of expos-
itory microstructure have shown that commonly employed
measures such as mean length of T-unit (MLTU), type–
token ration (TTR), and Syntactic Density Score (T-unit
and clause length, number of subordinate clauses, embed-
dings, and verb expansions) were sensitive to differences
in grammatical complexity and lexical diversity between
successive age levels, beginning with children ages 9 years
and older (Morris & Crump, 1982). Furthermore, dev-
elopmental changes in writing productivity (e.g., total
words, total T-units) and syntax (e.g., MLTU) have been
detected between Grades 5 and 8; students in Grade 8 were
more likely to produce a greater number of subordinate
clauses and to embed subordinate clauses within other sub-
ordinate clauses in their sentences (Nippold & Sun, 2010).
In a comprehensive analysis of expository microstruc-
ture, Puranik, Lombardino, and Altmann (2008) examined
the development of expository writing of 120 children in
the third through sixth grade, targeting 13 variables of mi-
crostructure at the word, T-unit, sentence, and discourse
levels. Measures of productivity and grammatical complex-
ity increased with age. Significant differences were evident
between the third and fourth grade groups for total words,

total ideas, number of T-units, number of clauses, number
of sentences, sentence complexity, and number of different
words (NDW). In addition, factor analysis confirmed that
the 13 microstructure variables examined clustered into four
dimensions of written language microstructure: productiv-
ity, complexity, accuracy, and mechanics.
Investigators have examined microstructure perfor-
mance across more than one discourse genre. These studies
have revealed genre effects in favor of the narrative genre
across productivity and writing fluency measures when com-
pared with the expository genre (Scott & Windsor, 2000),
including a trend for children with a mean age of 11;5
(years;months) to include more clauses per T-unit in narra-
tive products but more words per T-unit in expository prod-
ucts. In a comparison of microstructure features across
four genres (narrative, descriptive, compare/contrast, per-
suasive), Beers and Nagy (2011) noted that children in the
third, fifth, and seventh grades produced more subordinate
clauses in persuasive products than in descriptive products,
and more words per clause in descriptive products than in
Hall-Mills & Apel: Writing Development, Genre 243

persuasive products. Compare/contrast texts were shorter
(in number of words) than persuasive texts at each grade
level, and narratives were shorter than persuasive texts at
Grades 5 and 7. Beers and Nagy’s (2011) study docu-
mented an important interaction between syntactic com-
plexity and genre, indicating that syntactic- and text-level
requirements vary by the genre structure.
In a cross-linguistic study of seven languages, includ-
ing English, comparing four age levels (Grades 4, 7, 11, and
adult), two genres (narrative and expository), and two mo-
dalities (spoken and written), Berman and Verhoeven (2002)
examined multiple aspects of the development of narrative
and expository microstructure. Measures included lexical di-
versity, productivity, and syntactic complexity. Like Morris
and Crump (1982), Berman and Verhoeven found that
measures of microstructure were sensitive to developmen-
tal change across elementary, middle, and high school
age levels. Furthermore, when considering the potential
influence of genre in the development of microstructure,
Berman and Verhoeven noted little to no effect of genre
on fourth grade narrative and expository lexical diversity,
a result that was similar to Scott and Windsor’s (2000)
findings for NDW.

In summary, analysis of elements of microstructure
in a written product can occur at the word, sentence, and
discourse levels. Microstructure analysis generally includes
measures of productivity (e.g., number of words, T-units, or
ideas), grammatical complexity (e.g., MLTU, clausal den-
sity [CD]), and lexical diversity (e.g., TTR, NDW; Nelson
et al., 2004; Puranik, Lombardino, & Altmann, 2007, 2008).
Taken together, the results of previous investigations sug-
gest that measures of productivity, grammatical complexity,
and lexical diversity are sensitive to age and grade-level dif-
ferences. However, less is known specifically about chil-
dren’s development of certain microstructure elements (e.g.,
productivity, grammatical complexity, lexical diversity) in
early grades (second through fourth), particularly across
genres (e.g., narrative, expository).
Macrostructure
In contrast to microstructure analysis, macrostructure
analysis occurs mainly at the discourse level (Scott, 2009).
Macrostructure is the “abstract representation of the global
meaning structure” which represents the “gist” of the text
(Sanders & Schilperood, 2006, p. 387). Macrostructure
analysis examines a writer’s expression of meaning at the

discourse level and may include measures of organization,
cohesion, and genre-specific text structure. Elements of
macrostructure often are included in qualitative writing
analyses, such as in holistic or analytic scoring systems, or
can be depicted quantitatively by counting cohesive ties or
genre-specific text structure elements present in a written
product (e.g., counting story grammar elements in a narra-
tive text, or marking whether an introduction, body, and
conclusion are present in an expository text).
Researchers have examined the development of ele-
ments of macrostructure in products written in either a
narrative or an expository genre. These studies revealed
the following:
• Approximately half of third and fourth grade students
exhibiting typical development produced complete
stories on the basis of story grammar analysis
(Laughton & Morris, 1989).
• There were no developmental differences between
scoring procedures for narrative macrostructure when
comparing a procedure for parsing and categorizing
propositions versus a holistic rating of cohesion,

organization, and episodic structure of the story
on a 5-point Likert scale (Montague, Maddux, &
Dereshiwsky, 1990).
• Fourth and fifth grade students were better able to
organize compare/contrast expository compositions
than explanation products and included a higher total
number of ideas in the explanation genre (Englert,
Raphael, Anderson, Gregg, & Anthony, 1989).
Due to the emphasis of curricular standards on
learning to write in a variety of academic discourse genres,
there is value in examining how macrostructure develops
in the writing produced by the same children across more
than one genre. When investigators have examined the
development of macrostructure features across more than
one discourse genre, they have found the following:
• Relations among reading performance and cohesion
in writing produced by students in the third and
fifth grades, grade effects for use of cohesive ties,
and genre effects in favor of the narrative genre for
developmental changes in cohesive harmony (i.e.,
reflection of functional relations through noun and
verb chains; Cox, Shanahan, & Sulzby, 1990)

• Possible age effects between students in the fifth and
eighth grades were detected by using a trait scoring
system for ideas, organization, sentence fluency,
and conventions for written narrative, imaginative,
persuasive, and expository products (Crawford,
Helwig, & Tindal, 2004)
Although it is important to consider students’ per-
formance in a variety of genres, looking solely at macro-
structure development across genres ignores the role of
microstructure features. In many instances, investigators
have sought to document developmental trends across
both microstructure and macrostructure variables within
a single genre (e.g., Gillam & Johnston, 1992; Mackie
& Dockrell, 2004; Nelson & Van Meter, 2007; Nodine,
Barenbaum, & Newcomer, 1985). The results revealed
differences between grade-level groups (e.g., Grades 1
and 2 vs. Grades 4 and 5) and nonadjacent grade-level
groups (e.g., Grades 4, 8, and 11) and suggested a rela-
tion among features of microstructure (e.g., productivity,
grammatical complexity, lexical diversity) and macrostruc-
ture (e.g., story grammar, coherence, cohesion). To date,
only one investigation has been conducted to examine the
development of linguistic features by using a combination

244 Language, Speech, and Hearing Services in Schools • Vol.
46 • 242–255 • July 2015
of microstructure and macrostructure measures across two
or more discourse genres. Koutsoftas and Gray (2012) mea-
sured microstructural elements (e.g., productivity, lexical
diversity, grammatical complexity, spelling accuracy) by
using an analytic scale within narrative and expository
writing samples of fourth and fifth grade students (30 stu-
dents exhibiting typical language development, 26 students
with language-learning disabilities). The researchers also
examined story grammar elements in the narrative sam-
ples (a measure of macrostructure). Significant differences
were found between the students with typical language
versus those with language-learning disabilities on mea-
surement type (e.g., analytic vs. holistic scales) as well as
genre (e.g., narrative vs. expository). Students with language-
learning disabilities received lower holistic scores in both
genres and lower scores on all six analytic measures used
for narrative and three of five analytic measures used for
expository writing. Results also reflected a significant rela-
tionship between analytic scores for productivity, sentence

complexity, and lexical diversity with overall holistic
scores. It is important to note that the analytic measures
for expository writing did not measure expository macro-
structure specifically. Therefore, macrostructure differences
could not be examined across genres, an important level
of analysis.
In our attempts to understand what is known about
children’s development of microstructure and macrostruc-
ture features in a variety of academic discourse genres, we
must consider some important limitations in the current
body of literature: examination of a limited range of vari-
ables, inclusion of small sample sizes, analysis on only one
level of the written product (microstructure vs. macrostruc-
ture), focus on one discourse genre, and examination of
linguistic features in students in upper grades only (fourth
grade and above). Current curricular standards reflect the
expectations for students in Grades 2 through 4 to develop a
range of foundational skills that will lead to more advanced
academic discourse skills in the later grades (Common Core
State Standards Initiative, 2010). Given the heightened focus
on academic discourse skills in the earlier grades, more infor-
mation is needed about how children develop various lin-
guistic features through their narrative and expository writing
during these years of school. In addition, the literature sug-

gests that an association exists between the development of
microstructure and macrostructure. However, few investi-
gators have explored this relation systematically across
multiple genres.
Thus, the purpose of this study was to document the
progression of linguistic elements of microstructure and
macrostructure that students in second, third, and fourth
grade use in their written narrative and expository compo-
sitions. The following research questions guided the present
study:
1. Are there differences among grades and between
genres in written linguistic microstructure elements?
2. Are there differences among grades and between
genres in written macrostructure elements?
3. To what degree is development of microstructure
elements related to development of macrostructure
elements?
We hypothesized that there would be grade-level dif-
ferences for narrative and expository productivity and gram-
matical complexity. Performance in the narrative genre was

anticipated to be superior to expository performance, espe-
cially for students in the second and third grades who gen-
erally possess less knowledge of and experience with the
expository genre (Duke, 2000). A grade effect was antici-
pated for narrative and expository macrostructure on the
basis of variables of organization, coherence, and text struc-
ture. Levels of macrostructure were expected to be superior
for the fourth grade students. The potential genre effects
were more difficult to anticipate given the range of findings
in previous investigations. However, we anticipated that
performance on macrostructure measures would be similar
in both genres for the oldest students (fourth grade), if the
assumption held true that experience and knowledge of var-
ious text structures and text cohesion increase with age.
Few researchers have directly examined the potential rela-
tion between microstructure and macrostructure. As such,
we expected that development of these elements would be re-
lated in the sense that increased productivity (more words
per written product) allows more opportunities for a writer
to incorporate the necessary text structure elements and
genre-specific organizational structure.
Method
Participants

Participants were recruited from a public elementary
school located in a mid-sized city, with a student body that
was representative of the state through the school’s use of
stratified sampling. Participants were recruited in conjunc-
tion with a larger investigation examining an experimen-
tal spelling intervention. Approval was obtained from
the University Institutional Review Board and the school
for the procedures and consent forms for this study. Consent
forms were sent home to all second, third, and fourth grade
students. Participants had to be monolingual English-
speaking, enrolled in general education, with no history of
sensory impairments as determined by school records. Con-
sultation between the first author and school administrators
confirmed whether participants with parental consent met
the inclusionary criteria. School records confirmed partici-
pants’ language status on the basis of the state-required
Home Language Survey (Florida Department of Education,
1990) and related language proficiency testing to identify
students who were bilingual or who were determined to be
English language learners.
A total of 93 participants enrolled in general educa-
tion were recruited, 89 of whom completed the writing
samples (e.g., four left due to transferring out of the school).
The final sample included 37 boys (41.6%) and 52 girls

(58.4%): 28 participants were in the second grade, 28 par-
ticipants were in the fourth grade, and 33 participants were
in the third grade. Participants ranged in age from 7;0 to
10;11 (M = 8;6, SD = 10;9) and represented a range of eth-
nic backgrounds, including 55% White, 20.2% African
American, 11.2% Hispanic, 3.4% Asian American, 7.9%
multiethnic, and 2.2% unreported ethnic backgrounds. The
participants had average receptive vocabulary skills (M =
101.10, SD = 14.14), as a proxy for general language skills,
as measured by the Peabody Picture Vocabulary Test–
Fourth Edition (PPVT-4; Dunn & Dunn, 2007).
Measures
Reading Task
The Group Reading Assessment and Diagnostic
Evaluation (GRADE; K. T. Williams, 2001) was adminis-
tered to obtain participants’ reading levels. The GRADE
is a norm-referenced assessment that may be administered
in groups. Grade-level forms of the Word Reading,

Sentence Comprehension, and Passage Comprehension
subtests were administered, and standard scores were cal-
culated. According to the test manual (Williams, 2001),
the GRADE has an internal consistency of .95 to .99
(coefficient alpha [a]), and test–retest reliability of .89 to .98.
Receptive Vocabulary Task
The PPVT-4 was administered to determine partici-
pants’ receptive vocabulary levels and to corroborate teacher
report of receptive language skills within typical limits. The
test manual indicates that the PPVT-4 has an internal consis-
tency (split-half reliability) of .94 and test–retest reliability of
.92 to .96 (M = .93).
Writing Tasks
Each participant produced one narrative and one ex-
pository writing sample (15 min each). Writing samples
were elicited during group sessions by the first author and
by trained research assistants. Prompts were selected in
accordance with parallel forms of the state-mandated writ-
ing assessment system protocol (Florida Comprehensive
Assessment Test [FCAT]; Florida Department of Educa-
tion, 2010) and the topical interests of the children enrolled

in the classrooms. The prompts provided for narrative and
expository genres, respectively, were as follows:
• Tell me about a time that someone surprised you and
what happened.
• Pretend you are a super hero and you are being
interviewed on the news. Tell everyone what special
powers you would have. Also, explain what you would
do with them to help the world.
Writing sample elicitation procedures mirrored those
of the state’s writing assessment program for elementary
grades (FCAT–Writing; Florida Department of Education,
2010), which follows a scripted, generated elicitation method.
The writing scale designed for this study, consisting of
nine items for microstructure and three for macrostructure,
had good internal consistency, with a Cronbach’s a coefficient
of .80.
Procedure
Reading (GRADE subtests) and writing tasks were
completed in two classroom-wide sessions, and receptive
vocabulary was measured per participant in one individual

session. Assessments were altogether completed in 6 weeks
in the fall of the academic year. Individual sessions were
completed first in a quiet testing room on the school cam-
pus and lasted approximately 20 min. Group sessions were
counterbalanced for writing genre (e.g., expository, narra-
tive). Evaluators were graduate students in speech-language
pathology who were trained for each task in small groups by
the authors.
Coding and Scoring
The first author transcribed the writing samples into
a computer database according to Systematic Analysis of
Language Transcript (SALT, Version 8; Miller & Chapman,
2005) conventions. The unit of segmentation was the T-unit,
as suggested by Nelson et al. (2004) and consistent with
previous investigations (e.g., Nelson & Van Meter, 2007;
Puranik et al., 2007, 2008; Scott & Windsor, 2000). A
T-unit contains one main clause and any subordinate
clauses. Examples of coded writing samples for narrative
and expository writing in all three grades are provided in
the Appendix.
Microstructure
Nine microstructure elements were calculated, rep-

resenting measures of productivity, grammatical complexity,
and lexical diversity. The microstructure productivity mea-
sures of number of total words and T-units were calculated
automatically in SALT, as was the microstructure gram-
matical complexity element of MLTU. Another measure
of grammatical complexity, the total number of clauses,
was calculated by the first author using SALT to compute
CD. Both measures have been used in previous examina-
tions of the written product (e.g., Puranik et al., 2007, 2008;
Scott & Windsor, 2000). CD was calculated by dividing
the total number of clauses (main and subordinate) in the
sample by the total number of T-units across the sample.
In addition, the number of clauses per sentence (CPS) was
measured to capture grammatical complexity at the sen-
tence level. Transcripts within the SALT program were
coded for sentence type (complex vs. simple, correct vs.
incorrect) and presence of grammatical errors. A simple
sentence consisted of one main clause and only one verb,
whereas a complex sentence included one main clause
plus one or more embedded/subordinate clauses, two main
clauses, or one main clause and a verb phrase joined by a
coordinating conjunction. Grammatical errors were de-
fined as errors occurring in verb or pronoun tense, agree-
ment or case, omitted or incorrect inflection, omitted or

substituted grammatical elements, and violated word order.
A sentence without any grammatical errors was considered
correct, whereas a sentence with one or more errors was
deemed incorrect.
46 • 242–255 • July 2015
Two final grammatical complexity measures calcu-
lated were the number of grammatical errors per T-unit
(GET) and percentage of grammatically correct sentences
(% GS; e.g., Mackie & Dockrell, 2004; Nelson & Van Meter,
2007; Puranik et al., 2007, 2008). The training manual for
coders included resources for identifying grammatical errors
that may have been attributable to nonstandard dialect use
so that considerations were made regarding the potential in-
fluence of participant dialect on calculation of grammatical
errors.
Two of the three microstructure elements representing
lexical diversity—the NDW in the written text and the TTR
(ratio of different word types to overall words)—were auto-
matically calculated by SALT. However, previous researchers

have suggested that NDW or TTR are most accurately inter-
preted when sample size is controlled for (Scott, 2009; Scott
& Windsor, 2000). For this reason, an additional related
measure of lexical properties was used that was not con-
founded by writing sample size. Lexical density (LXD) was
the proportion of content words (e.g., nouns, verbs, adjec-
tives) to total words (Scott, 2009). By taking a proportion of
content words to total words, each sample was then mea-
sured for LXD on the same scale regardless of overall sam-
ple length, thereby reducing the impact of sample size.
Macrostructure
Each writing sample was reviewed and scored for the
dependent measures related to macrostructure variables
(organization, genre-specific text structure, cohesion) on
the basis of an analytic scoring system (see Hall-Mills,
2010 for operational definitions and protocol). The opera-
tional definitions for examining levels of organization, text
structure, and cohesion were formed on the basis of key
features of informal writing inventories used in previous
investigations (Crawford et al., 2004; Moats, Foorman, &
Taylor, 2006; Nelson et al., 2004). Organization was exam-
ined within the introduction, body, and conclusion of the
product. Writing samples also were examined for use of an

appropriate text structure (genre-specific), and overall cohe-
sion. Each item (organization, genre-specific text structure,
cohesion) received a score ranging from 1 to 4. The indi-
vidual trait scores were combined for an overall macro-
structure composite score.
Reliability
Coding reliability of the microstructure and macro-
structure measures was established by using a randomly
selected subsample of writing samples equaling 25% of the
total number of samples collected, balanced across genre
and grade level. Percent agreement and Cohen’s kappa co-
efficients were calculated for the following variable charac-
teristics that required coding in SALT to produce the scores
for each of the dependent variables: T-unit segmentation,
clauses per T-unit, CPS, sentence codes to indicate gram-
matical complexity (simple vs. complex) and accuracy
(correct vs. incorrect) of the sentence structure, identifica-
tion of content words, and identification of grammatical
errors. Percent agreement ranged from 83% to 98% for
the microstructure variables, and from 84% to 93% for
macrostructure variables. Kappa coefficients of >.6 were
required to establish adequate reliability. Kappa values

may be interpreted as follows: .41 to .60 is fair, .61 to .80
is good, and > .80 is very good reliability among raters
(Warner, 2008). Kappas ranged from .80 to .98 for micro-
structure variables and from .72 to .90 for macrostructure
variables, thus indicating suitable reliability for all coded
dependent measures.
Results
In our preliminary analyses, we surveyed the data
for normality (including a search for outliers) and assump-
tions of the statistical models we employed to answer the
research questions. In particular, we considered conformity
with four assumptions for multivariate analysis of covari-
ance (MANCOVA) due to potential effects on Type I errors
rate and power (e.g., independent observations, multivariate
normal distribution in each group, covariance matrices for
all dependent variables, and homogeneity of regression slopes
(Field, 2005; Stevens, 1997). Multivariate normality could
not be checked in the Predictive Analytic Software (PASW)
program, so the assumption of univariate normality was
checked for each dependent variable by using the Shapiro–
Wilk test (Stevens, 1997). To determine whether the assump-
tion of homogeneity of covariance matrices was met, the
univariate tests of equality of variances between groups was

checked by using Levene’s test for each of the dependent
variables (Field, 2005). Due to unequal group sizes, the ho-
mogeneity of the variance–covariance matrices was checked
by using Box’s test (Field, 2005).
Two exploratory factor analyses (EFAs) were con-
ducted for the purposes of data reduction for the microstruc-
ture variables (nine variables) and macrostructure variables
(three variables) and to confirm a priori association of de-
pendent writing variables with factors that are conceptually
meaningful to clinicians. The resulting factor scores were
used in two separate MANCOVAs to address the research
questions. We used a principal component analysis factor
extraction method. Based on the scree plots and presence of
eigenvalues over 1.0, four factors were rotated by using di-
rect oblimin (d = 0), an oblique rotation technique, yielding
a four-factor solution for microstructure. The results for
the microstructure factors are reported in Table 1. For both
genres, three variables loaded on the first factor of produc-
tivity (total words, total T-units, NDW), three variables
loaded onto the second factor of grammatical complexity
(CD, CPS, MLTU), two variables loaded onto the third
factor of grammatical accuracy (percent grammatical sen-
tences, GET), and one variable loaded onto the fourth fac-
tor of lexical diversity (LXD). Two grammatical factors

(Factor 2, grammatical complexity; Factor 3, grammatical
accuracy) were identified. In comparison to previous re-
search, the second factor in the present analysis resembles
the accuracy factor (including variables of syntactic errors
per T-unit and % GS identified by the factor analysis re-
ported by Puranik et al. (2008). As such, it was determined
that the two grammatical variables loading onto the second
factor in the present study could actually serve as a fourth
factor measured within the microstructure measure. There-
fore, this fourth factor level was named grammatical
accuracy. The results also indicated that NDW, initially
proposed as a measure of lexical diversity, actually loaded
onto the first factor, with total words and total T-units as
measures of productivity.
The dependent variables for the macrostructure mea-
sure (organization, text structure, and cohesion) were se-
lected initially on the basis of review of previous research to
examine the macrostructure of written language. An EFA
utilizing a principal component analysis factor extraction

method resulted in the extraction of only one factor for
both genres. Examination of a bivariate correlation matrix
confirmed that each of the three macrostructure variables
was strongly intercorrelated; however, none were greater
than .90 where multicollinearity would be of concern. For
both genres, all three macrostructure variables loaded on
the identified macrostructure factor (organization, text
structure, and cohesion). The factor loadings aligned with
predictions that the macrostructure measure was in fact
unidimensional and yielded one factor measuring macro-
structure with three variables (range of narrative loadings =
.88–.92, range of expository loadings = .87–.89).
Effects of Grade and Genre on Microstructure
and Macrostructure
The GRADE Comprehension Composite scores, af-
ter being converted to z scores, were used as a covariate for
MANCOVA because reading comprehension is strongly
associated with writing skills (e.g., Cox et al., 1990; G. J.
Williams, Larkin, & Blaggan, 2013). A preliminary analysis
to evaluate the homogeneity of slopes assumption indicated
that the relationship between the covariate (z score for
GRADE Comprehension Composite) and the dependent
variables did not differ significantly as a function of the

independent variable (grade level) in either the narrative
genre, F(3, 82) = 0.25 to 1.6, p = .19 to .86, h2 = .01 to .06,
or the expository genre, F(3, 79) = 0.16 to 3.03, p = .03 to
.92, h2 = .01 to .10.
Two MANCOVAs were conducted to measure the
effects of grade level within each genre on the various
microstructure and macrostructure variables, controlling for
reading comprehension scores. Table 2 shows the final fac-
tors of analysis (i.e., resulting from EFA) with the respec-
tive dependent variables. Factor scores of productivity,
grammatical complexity, grammatical accuracy, lexical di-
versity, and macrostructure were examined in each genre
for differences between grade levels. Within the factor of
productivity, there were three variables (total words, total
T-units, NDW); the factor of grammatical complexity in-
cluded three variables (CD, CPS, and MLTU); grammatical
accuracy had two variables (percent grammatical sentences,
GET); lexical diversity was represented by one variable
(LXD); and macrostructure factor was represented by three
variables (organization, text structure, and cohesion).
Tables 3 and 4 contain the grade-level means and stan-
dard deviation for the dependent measures for each genre.

Two separate, one-way MANCOVAs were conducted
to determine the effect of grade in both genres (narrative,
Table 1. Factor loadings for exploratory factor analysis with
oblique rotation.
Microstructure variables
Factor
1 2 3 4
Narrative, expository
Total words .96, .98 .09, .12 −.01, .01 −.01, .05
Total T-units .97, .97 −.22, −.25 −.01, .04 −.02, −.06
Lexical density .02, −.39 .05, .24 −.13, −.03 .96, .84
Number of different words .96, .97 .12, .13 .01, −.03 .05, .02
Clausal density .02, .01 .92, .90 .02, −.01 .05, −.01
Clauses per sentence .02, .01 .72, .70 −.23, .02 −.42, −.34
Mean length of T-unit −.01, −.02 .86, .87 .21, −.04 .14, .21
Percent grammatical sentences .02, −.02 .05, −.05 −.92, .86 .11,
.19
Grammatical errors per T-unit −.01, −.02 .13, −.04 .92, −.94
−.01, .14

Note. Each variable (e.g., total words, total T-units, etc.) has
two scores: the narrative score and the expository score. Factor
loadings > .60
are in boldface. Factor 1 = productivity; Factor 2 = grammatical
complexity; Factor 3 = grammatical accuracy; Factor 4 = lexical
density.
Table 2. Factors and respective dependent variables analyzed
via
multivariate analyses of covariance.
Factor Dependent measure
Productivity Total words
Total T-units
Number of different words
Grammatical
complexity
Mean length T-unit
Clauses per sentence
Clausal density (no. of clauses per T-unit)
Grammatical

accuracy
Percentage of grammatical sentences
Grammatical errors per T-unit
Lexical diversity Lexical density
Macrostructure Organization trait score
Text structure trait score
Cohesion trait score
46 • 242–255 • July 2015
expository) on the identified factor scores for the five factors
of productivity, grammatical complexity, grammatical ac-
curacy, lexical diversity, and macrostructure. The Box
M test (using a = .01 as the criterion for significance) satis-
fied the assumption of homogeneity of variance/covariance
matrices. Intercorrelations between measures ranged from
.01 to .52 for the narrative genre and −.08 to .40 for the
expository genre. None of the correlations among outcome
variables was sufficiently large to raise concerns about

multicollinearity. Pillai’s trace was selected as the multivar-
iate test statistic due to unequal group sizes (Field, 2005).
Pairwise comparisons were conducted to compare perfor-
mance across grades, utilizing an adjustment for multiple
comparisons and corrected for Type I error rate using a
Bonferroni correction (p < .003).
The MANCOVAs (one for each genre) to examine
the effects of grade level revealed a significant multivariate
effect of grade for both the narrative genre, Pillai’s trace =
.60, F(10, 154) = 6.623, p < .001, hp
2 = .30, and the exposi-
tory genre, Pillai’s trace = .55, F(10, 148) = 5.583, p < .001,
hp
2 = .27, with large effect sizes. By analyzing the compo-
nent measures, a significant main effect was observed for
the narrative productivity factor, F(2, 80) = 30.745, p < .001,
hp
2 = .44, with a large effect size. This main effect was indi-
cated by an overall increase in productivity at every grade
level, as reflected by total words, total T-units, and NDW.
Pairwise comparisons revealed that children in second grade

scored significantly lower on productivity (M = −0.86)
relative to the third (M = 0.05) and fourth (M = 0.77)
grade groups. The third and fourth grade groups differed
Table 3. Descriptive statistics for dependent measures; narrative
genre.
Measure
Grade 2 Grade 3 Grade 4
M SD M SD M SD
Productivity
Total words 24.27 12.22 53.24 25.57 77.59 34.56
Total T-units 3.46 1.75 6.45 3.28 9.59 4.42
NDW 18.31 7.05 36.88 14.58 47.33 17.06
Grammatical complexity
Mean length T-unit 7.51 2.87 8.49 2.39 7.98 2.02
Clauses (per sentence) 1.83 0.77 1.96 0.55 1.74 0.50
Clausal density 1.40 0.40 1.43 0.34 1.46 0.29
Grammatical accuracy
% grammatical sentences 0.81 0.29 0.84 0.19 0.82 0.19

Grammar errors per T-unit 0.22 0.29 0.23 0.40 0.23 0.19
Lexical density 0.52 0.08 0.53 0.05 0.55 0.05
Macrostructure
Organization 4.92 1.29 6.79 1.59 6.78 1.39
Text structure 1.54 0.86 2.76 0.83 2.52 0.85
Cohesion 1.31 0.47 2.00 0.88 1.93 0.68
Note. NDW = number of different words.
Table 4. Descriptive statistics for dependent measures;
expository genre.
Measure
Grade 2 Grade 3 Grade 4
M SD M SD M SD
Productivity
Total words 27.77 12.00 53.97 22.11 73.46 29.55
Total T-units 3.73 1.22 6.62 2.96 8.84 4.20
NDW 20.85 7.59 37.56 12.71 47.85 16.92
Grammatical complexity

Mean length T-unit 7.58 3.05 8.58 2.23 8.33 1.87
Clauses (per sentence) 1.49 0.59 1.83 0.44 2.05 0.58
Clausal density 1.25 0.32 1.58 0.30 1.61 0.43
Grammatical accuracy
% grammatical sentences 0.78 0.27 0.85 0.21 0.76 0.25
Grammar errors per T-unit 0.29 0.29 0.29 0.27 0.27 0.25
Lexical density 0.62 0.09 0.60 0.07 0.61 0.06
Macrostructure
Organization 4.04 1.25 4.66 1.49 4.85 1.40
Text structure 1.31 0.55 1.81 0.78 1.92 0.79
Cohesion 1.15 0.46 1.34 0.48 1.46 0.58
Note. NDW = number of different words.
significantly from each other in productivity as well, with
increased productivity levels in fourth grade. A significant
main effect also was observed for narrative macrostructure,
F(2, 80) = 16.358, p < .001, hp

2 = .29, with a large effect
size. Second grade scored significantly lower in narrative
macrostructure (M = −0.79) than both third (M = 0.39) and
fourth (M = 0.30) grades; however, third grade did not dif-
fer significantly from fourth. In the narrative genre, there
were no significant differences among the three grade-level
groups in scores on grammatical complexity, grammatical
accuracy, and lexical diversity.
Similar results were obtained in the expository genre,
with a significant main effect for productivity, F(2, 77) =
32.318, p < .001, hp
2 =.46, with a large effect size. Pairwise
comparisons indicated that second grade students scored
significantly lower on expository productivity (M = −0.83)
than did third (M = 0.08) and fourth grades (M = 0.75).
The third and fourth grade groups differed significantly
from each other in expository productivity as well, with
greater productivity in the fourth grade. In addition, there
was a significant main effect for expository macrostructure,
F(2, 77) = 4.961, p < .01, hp
2 = .12, with a medium effect
size. Second grade (M = −0.43) scored significantly lower

than both third (M = 0.11) and fourth grade (M = 0.30).
Even though there was a trend for fourth grade students to
score higher on macrostructure, there was not a significant
difference between third and fourth grades. Furthermore,
a significant main effect was detected for grammatical
complexity, F(2, 77) = 4.922, p < .01, hp
2 = .13, with a
medium effect size. Second grade (M = −0.51) scored
lower in expository grammatical complexity than did
third (M = 0.18) and fourth grade (M = 0.29). Third and
fourth grades were not significantly different from each
other. There were no significant differences among the
three grade-level groups in scores on grammatical accuracy
and lexical diversity in expository samples.
Discussion
Effect of Grade Level on Microstructure
The first research goal was to determine whether
there were differences among grades and between genres in
linguistic microstructure elements. As hypothesized, differ-
ences were found between grade levels (second and third,
second and fourth, and third and fourth) for microstructure
productivity in both genres. Participants in each successive

grade used more words, produced more T-units, and had
greater numbers of different words than did students in
the previous grade. These findings are consistent with re-
sults from previous investigations showing that measures
of productivity are sensitive to changes in grade and age
levels in more than one genre (Berman & Verhoeven, 2002;
Nelson & Van Meter, 2007; Puranik et al., 2008).
Partially confirming the hypothesis for grammatical
complexity, differences were found between two adjacent
grade levels (second and third), as well as between second
and fourth grades, in the expository genre. However,
similar to the findings of Puranik et al. (2008), no significant
differences in grammatical complexity were indicated be-
tween third and fourth grade levels. Levels of expository
grammatical complexity, as measured by MLTU, CPS, and
CD, may plateau at third grade, at least on writing assign-
ments similar to those used in this study and in Puranik et al.
(2008).
In contrast to expectations, no grade-level differences
were found for grammatical complexity in the narrative
genre. This result is dissimilar from the results of Nelson
and Van Meter (2007), who found a significant difference

on MLTU between second and third grades in a narrative
genre. Examination of grade-level means in Table 4 for
CD and CPS clearly indicates nearly the same scores across
the three grade levels. Therefore, it may be that CPS and
CD were not sensitive enough to detect differences between
subsequent grade levels in grammatical complexity in a
narrative genre. These values for CPS and CD may have
masked the effects of MLTU when these variables were
combined into one factor score that was subsequently used
in the MANCOVA to detect grade differences. However,
previous research with older students suggests that devel-
opment of CD in younger students consists of multiple
periods of slower, sometimes plateaued growth prior to the
eighth grade and may be a useful measure for detecting
grade effects in later years (Nippold, Ward-Lonergan, &
Fanning, 2005). It might be useful in future studies to com-
pare measures of grammatical complexity to determine
their utility for detecting significant differences among ele-
mentary grade-level groups.
No grade-level differences were found for either gram-
matical accuracy or lexical diversity. This finding is similar
to Puranik et al. (2008), although they utilized different
measures for this dimension of microstructure (percentage
of grammatically correct T-units, proportion of spelling

errors, conventions) and is in alignment with Nelson and
Van Meter’s (2007) finding for grammatical error rates
among Grades 1 through 5. In the present investigation,
grammatical accuracy was measured by the % GS and the
number of GET. Puranik et al. (2008) posited that older
children may attempt to produce more complex sentence
structures and as a result could generate more errors than
expected, making their grammatical accuracy scores more
parallel with those of younger participants. We did not find
a statistically significant pattern between grade levels in
grammatical accuracy. However, the nature of the rela-
tionship between grammatical accuracy and grade level
warrants further exploration. Therefore, future investiga-
tors may want to increase the number of items, or vari-
ables, measured for both grammatical complexity and
accuracy factors and compare the relations among them
under varying contexts and task demands.
Effect of Genre on Microstructure
In contrast to expectations, mean performance on
all four microstructure measures was rather stable within
grades and across genres. This finding initially appeared

46 • 242–255 • July 2015
different from previous studies that indicated greater pro-
ductivity and grammatical complexity in a narrative versus
an expository genre among elementary school children
(Berman & Verhoeven, 2002; Scott & Windsor, 2000);
however, a direct comparison to students in the present
study cannot be made to Berman and Verhoeven’s (2002)
and Scott and Windsor’s (2000) samples. The finding of
no genre effect for either lexical diversity or grammatical
accuracy is similar to previous findings for elementary
students (Berman & Verhoeven, 2002; Scott & Windsor
2000). The developmental progression of lexical diversity
and grammatical accuracy may be slower overall, regard-
less of genre, and therefore more challenging to detect
differences between subsequent elementary grades.
Effect of Grade Level on Macrostructure
As hypothesized, we found grade-level differences in
both genres for macrostructure between second and third
grades, and between second and fourth grades. Second
grade students scored lower on narrative and expository

organization, text structure, and cohesion than third and
fourth grade students. However, in contrast to expecta-
tions, third and fourth grade students did not differ signifi-
cantly from each other in either genre. In examining the
grade-level means in the narrative genre, a trend was noted
for the third grade mean to exceed fourth in text structure
and cohesion, although these differences were not statisti-
cally significant. In the expository genre, grade-level means
indicated a slight trend between third and fourth grades on
organization, text structure, and cohesion.
Upon further analysis, the grade-level trends in mac-
rostructure observed in the expository genre between sec-
ond and third, and second and fourth appear to be due to
text structure scores more so than organization or cohesion
scores. It may be that an expository writing sample could
be somewhat organized and cohesive yet not reflect the
targeted genre structure. This is understandable, especially
for second grade students, whose knowledge of expository
text structure is thought to be less established than for
older students (e.g., Berman & Verhoeven, 2002; Nelson
et al., 2004). A single second grade participant scored at a
Level 3 for expository text structure on the macrostructure
rubric, whereas the remaining second grade students scored
at Level 1 (n = 19) or Level 2 (n = 6). This was in contrast

to the number of third grade students (n = 5) and fourth grade
students (n = 5) scoring at a Level 3 or higher and also
was dissimilar from the number of students in the third and
fourth grades scoring at a Level 2 (third grade, n = 15;
fourth grade, n = 13). Thus, the grade-level trends appeared
to be impacted by floor effects for the second grade students
on measures of macrostructure. In the future, researchers
may want to develop more sensitive measures to examine
young children’s knowledge of genre-specific text structures
across grade levels, particularly their knowledge of text
structure requirements for the genres most commonly
assessed in the classroom, to help further define this devel-
opmental progression.
Effect of Genre on Macrostructure
In contrast to expectations, our results did not reveal
any cross-genre differences for performance on the macro-
structure measure. The mean macrostructure values were
very similar across genres for each grade level. The potential
genre effects on macrostructure were difficult to anticipate
given the range of findings in previous investigations. How-
ever, we had anticipated that performance on macrostruc-
ture measures would be similar in both genres for the oldest
students (fourth grade) on the basis of the assumption that

experience and knowledge of various text structures and text
cohesion increase with age.
The lack of significant differences in macrostructure
scores between the narrative and expository genres may be
due to the type of writing prompts utilized to elicit the
samples. It is possible that the prompts selected may not
have fully represented one genre versus another. With this
issue in mind, we conducted a post hoc analysis to deter-
mine the degree of match between intended text structure
on the basis of the prompts and the text structure produced
in the children’s writing samples. We recruited three
blind raters (i.e., blind to each other as well as the writing
prompts, previous transcription, coding, and scoring of
writing samples for this investigation) and asked them to
review a randomly selected subset of writing samples (25%
of the entire sample; equal proportions by genre and
grade) to identify which genre structure the sample most
closely resembled, given a set of standard definitions and fea-
tures for each genre. Raters were instructed to identify a
writing sample with the following features as having a nar-
rative text structure (e.g., telling a story, often about per-
sonal events or other life experiences; it may be fictional or
nonfictional and can include novels, personal stories, and
short stories), an expository text structure (e.g., conveying

facts, describing procedures, explaining something, sharing
basic information, relating cause–effect, compare/contrast,
problem–solution structures, and may include reports, term
papers, procedural documents, manuals, essays, and edito-
rials), or an ambiguous text structure (e.g., combination
of narrative and expository features, or cases where the text
structure cannot be readily identified given standard aca-
demic definitions of genre). The post hoc analysis with the
genre identification task revealed that 72% of the samples
were coded reliably, with consensus for genre type by three
naive raters (k = .67). Thus, it appears the majority of writ-
ing samples reflected their intended genre structure. When
coders did not reach consensus on some of the samples
reviewed (18%), they noted instances of “ambiguous struc-
tures.” On closer examination, the text structure ambiguity
in writing samples was observed equally across narrative
and expository topics and thus was not wholly attributable
to either the narrative or the expository prompt on the
analytic scale. Some children may have produced text in a
structure other than the elicited genre, and there are a vari-
ety of possible explanations for this occurrence. It may
be the case that these children utilized inconsistent or limited
genre structures in their writing as they were learning to

write. This issue is addressed further below among impor-
tant clinical and educational implications. It remains to be
determined within a larger sample of school-age students
whether writing that contains features of more than one
genre reflects maturity versus instability of academic dis-
course forms. The lack of significant differences in macro-
structure also may be due to the use of “hybrid” genres that
incorporate a variety of text structure features from one or
more genres. In situations such as this, the scoring rubric de-
signed for this investigation would need to be altered to bet-
ter capture occurrences of “mixed” or hybrid genres.
Further exploration is warranted to establish how adequately
writing prompts elicit the intended genre.
Limitations and Future Research
One potential limitation to our study was the method
used to elicit writing samples. In this investigation, a single
elicitation technique was incorporated (i.e., response to
writing prompt). Although this method reflects standard
educational practice, it is important to consider that grade
and genre effects may vary as a result of differences in

prompting procedures and targeted genre structure. More
work is needed in this area to compare the value of vari-
ous elicitation techniques to capture the possible relations
between elicitation method and writing outcomes. Fur-
thermore, the degree of the relations among elements of
microstructure and macrostructure may be shaped by the
actual genre structure produced. In our investigation, the
post hoc analysis revealed that a small portion of the writing
samples could not be characterized specifically as having a
narrative or expository text structure due to either mixed
text structure elements of both genres or an ambiguous
genre structure. Although the occurrence of mixed elements
can be expected to some degree in early writing develop-
ment, it is possible that the expository prompt may have
misled some students to compose a fictional narrative in-
stead. The central characteristics of the expository prompt
that would cue students to engage in expository discourse
were the key words tell and explain. The word pretend (e.g.,
pretend you are a superhero) may have steered students in
a different direction if they did not process the exposition cue
words. Given all of the data collectively, including the post
hoc analysis, we did not have enough evidence to state that it
was the nature of the prompts alone that attributed to the
occurrence of mixed genre features or ambiguous structures for
a small portion of the sample. Yet, the expository prompt we

selected warrants caution for use in future writing activities.
Prompt selection has important implications for re-
search and clinical or instructional practices. Investigators
planning future studies may elect to first establish the reli-
ability of selected prompts to elicit the intended genre and
plan in advance an analysis to verify the reliability of se-
lected prompts within their sample. Likewise, educators
and clinicians need to select prompts for writing assessment
carefully. As they plan and conduct writing assessments, they
should know the reliability of selected or created prompts
to elicit the genre of interest. Otherwise, the likelihood of
eliciting the appropriate genre and therefore the opportu-
nity to comprehensively evaluate the child’s writing perfor-
mance across microstructure and macrostructure features
may be compromised.
One controversy that remains in writing assessment
is the utility of holistic versus analytic measures of writing
performance. The fact that the macrostructure measure
was unidimensional (according to the EFA results) would
seem to be contradictory to some authors’ recommendations
against the use of holistic score ratings of writing performance
to inform instruction and monitor growth (Nelson & Van

Meter, 2007). However, as noted in the present investiga-
tion, a holistic rating scale for macrostructure was a useful
method to compare a particular student’s or grade level’s
performance in comparison to peers or comparison groups.
In contrast, EFA results indicated that the microstructure
measure consisted of four distinct factors. As such, micro-
structure, in contrast to macrostructure, would be best ex-
amined with an analytic scoring method, utilizing more
than one factor or score. Either way, the purpose for the
writing assessment, as well as the reliability of a particular
scale to fulfill that purpose (see Koutsoftas & Gray, 2012),
should be the focus at the outset. In some states, the state-
wide progress monitoring measure of writing in the elemen-
tary grades is administered multiple times per school year
and yields only a holistic score. Four factors often consid-
ered in the students’ text are focus, organization, support,
and conventions. Educators are first cautioned against
using this single score as the sole determinant of a student’s
writing proficiency and are encouraged to interpret this
score in light of the student’s performance in other writing
tasks and contexts.
A second limitation of our investigation is the lack of
an independent measure of participants’ dialect of speech.
The influence of cultural–linguistic factors on writing per-

formance (e.g., ethnicity and dialect) is important to con-
sider. We did not assess dialect directly in the present study.
We know from the participant demographics that there
were similar numbers of children across ethnic categories
within each grade in our sample. However, one must ac-
knowledge that ethnicity and dialect are not equivalent, and
each factor warrants separate consideration. Regardless of
reported ethnicity of participants, it is possible that dialectal
influences may have existed for individual children and
could have affected the outcome measures of grammatical
accuracy. The dialect-shifting–reading achievement hypoth-
esis suggests that students who successfully shift from non-
mainstream to standard dialectal forms in different literacy
tasks (including writing) demonstrate better reading out-
comes than students who do not make the shift as adequately
(Craig, Zhang, Hensel, & Quinn, 2009). Investigations
employing larger samples of participants with ethnically
diverse backgrounds, and incorporating distinct a priori
measures of dialect (e.g., dialect density measures), may
have better chances of detecting possible differences. If dif-
ferences are indeed detected in this manner, investigators
can recode the SALT files to capture features of a specific
dialect that has been observed in the sample. It would be

46 • 242–255 • July 2015
worthwhile to compare results for written grammatical
and lexical microstructure variables, as well as text struc-
ture influences, of dialectal speakers to capture the weight
of influence that dialectal differences may exert on depen-
dent writing measures for both microstructure and macro-
structure (Terry, 2006; Thompson, Craig, & Washington,
2004). Clinicians should utilize dialect coding procedures
as well.
Educational and Clinical Implications
Results of the present investigation extend findings
from previous studies and add to the existing literature re-
garding development of and relations among written mi-
crostructure and macrostructure features within and across
grade levels and genre types. Educators and clinicians are
encouraged to consider the lack of differences between grade
levels for some of the dependent measures in light of estab-
lished grade-level expectations that are reflected in state
standards for writing. For example, the Common Core
Standards for writing (Common Core State Standards Ini-

tiative, 2010) require second grade students to write in a va-
riety of genres, including expository and narrative forms.
Third and fourth grade students are expected to write rou-
tinely in multiple genres with increasing detail, genre-specific
organization, and cohesion. In reviewing the present data,
it is clear that not all of the writing samples that we collected
reflected mastery of the previous grade level’s standards for
writing. This raises the question: If the established grade-
level expectations are considered reasonable and the Common
Core State Standards are evidence based, then how well are
current assessment and instructional practices designed to
support student achievement of these standards?
The nature of the writing standards is a substantial
factor in how writing assignments and assessments are struc-
tured within the school context. In particular, the selection
of writing prompts and the method by which the examiner
chooses to evaluate the written product are influenced by
curricular standards for writing across grade levels. Prompts
to elicit writing from students often are crafted on the basis
of specific curricular standards for the grade level or grade-
level group of interest. For example, students in Grade 2 are
expected to “Write narratives in which they recount a well-
elaborated event or short sequence of events, include details
to describe actions, thoughts, and feelings, use temporal

words to signal event order, and provide a sense of closure”
(Common Core State Standards Initiative, 2010, CCSS.
ELA-Literacy.W.2.3). Therefore, a narrative writing prompt
for a second grade writing assessment would need to be
designed or selected to ensure that it would cue the students
to write a basic story. General assessment prompts provide
the topic and the basic purpose of the writing activity but
rarely include any additional instructions nor details or lists
of components to be included. For instructional or inter-
vention purposes, however, these additional details can be
included to provide a greater level of support to students
learning to write. For example, clinicians and educators
have found it useful to provide graphic organizers, story
grammar or exposition checklists, and related resources to
young writers to further support their efforts in incorporating
a variety of narrative and expository elements in their work.
The method by which the examiner evaluates the
written product is also influenced by curricular standards
for writing. In the example given above from a second grade
writing standard, there would need to be analysis of micro-
structure features (e.g., lexical properties such as words to
signal temporal relations among events) as well as macro-
structure features (e.g., story grammar elements: a plot

occurring in a sequence; details about characters’ actions,
thoughts, and feelings; and a resolution to provide a sense
of closure) to comprehensively measure a student’s mas-
tery of the standard. Not all writing assessment methods
are designed to measure both levels of children’s written
work. The risk is that there can be misalignment of stan-
dards, assessment techniques, and instructional or interven-
tion approaches implemented with the school-age population.
Clinicians and educators should be encouraged to make
these important alignment considerations in their practice
of supporting the development of writing proficiency among
their school-age students. Moreover, future research needs
to determine the extent to which writing instruction, assess-
ment, and progress monitoring adhere to grade-level stan-
dards for writing performance. In the meantime, state writing
standards that are being developed or revised need to be
research based, and educators, clinicians, researchers, and
policymakers need to work collaboratively to design assess-
ment and instruction that are reflective of research-based
standards for writing.
Acknowledgments
This research was partially funded by a grant from the
U.S. Department of Education, Office of Special Education and

Rehabilitative Services (H8435D030046), awarded to the first
author, and a Florida State University Dissertation Research
Grant, also awarded to the first author.
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