The Process of Learning to Read From Preventing Reading Difficulties in Young Children
Evaluation of Children with Reading Difficulties
Am Fam Doctor. 2006 December fifteen;74(12):2079-2086.
This article exemplifies the AAFP 2006 Annual Clinical Focus on caring for children and adolescents.
Article Sections
- Abstract
- Prevalence
- Etiology
- Diagnosis
- Further Evaluation
- Interventions
- References
Reading difficulties are mutual and are associated with poor long-term bookish achievement. Evaluation of a child'south developmental, educational, and family histories in conjunction with standardized screening tests (e.g., Ages and Stages Questionnaires, Parents' Evaluation of Developmental Status, Safety Discussion Inventory and Literacy Screener) can increase recognition of risk factors for reading difficulties. Validated, part-based, standardized screening tests and school-administered standardized accomplishment tests (due east.yard., California Accomplishment Tests, Iowa Tests of Basic Skills, Metropolitan Accomplishment Tests, Stanford Achievement Examination) can be used to assess school-age children with reading difficulties. Reading difficulties in children frequently are acquired by environmental and organic take a chance factors. However, many children have reading or learning disabilities and volition accept lifelong difficulties with reading despite acceptable intervention. Children with substantial reading difficulties should receive a full educational cess. At that place is good bear witness that individualized education emphasizing increased phonologic awareness can have a favorable long-term result on bookish accomplishment.
At to the lowest degree ane in five children has significant difficulty learning to read.1 Evidence clearly demonstrates that almost school-age children with reading difficulties fail to catch upwardly with their peers.2 Although well-nigh of these children eventually become literate, many continue to have reading difficulties and never go fluent readers. Early development of reading skills is essential, and efforts should be made to identify children with reading disabilities and implement interventions at an early age.3,four A child's third-grade reading ability is reasonably predictive of overall long-term academic achievement.v Lxx-five percent of children with reading disabilities who are not identified before the third class continue to take reading disabilities in the ninth class, and fewer than ii pct proceed to participate in a four-twelvemonth educational program after high school.1
SORT: KEY RECOMMENDATIONS FOR Exercise
| Clinical recommendation | Evidence rating | References |
|---|---|---|
| Efforts should be fabricated to identify children with reading disabilities and to implement interventions at an early on historic period. | C | 3,4 |
| Children with issues in schoolhouse performance should exist evaluated for reading difficulties. | C | 3,four |
| Children with reading difficulties should receive individualized instruction emphasizing phonologic awareness. | B | ane,12 |
Because children with reading difficulties ofttimes perform poorly in other areas of school, parents and teachers may not identify reading as the source. Therefore, children who take problems with school performance in any surface area should be assessed for reading difficulties.three,4 Tabular array 1half-dozen lists warning signs that may signal a child is having bug in schoolhouse.
Tabular array ane
Parents' Concerns That Are Warning Signs of School Bug
| • Inconsistent performance/does better one-to-one |
| • Poor retention of information/has been retained |
| • Excessive parental involvement in homework/takes likewise long to complete homework |
| • Loss of cocky-esteem |
| • Dropping grades |
| • Does less well on tests than homework |
| • Short attending span/hyperactivity |
| • History of speech-language bug, therapy, otitis media with fluctuating hearing loss |
| • Frequent school absences |
| • Previously tested but not eligible for special didactics |
| • Hates school/schoolhouse phobic/psychosomatic symptoms |
| • Hides school work/lies about assignments/loses homework repeatedly |
| • Trouble with letter sounds or letter naming |
Prevalence
- Abstract
- Prevalence
- Etiology
- Diagnosis
- Further Evaluation
- Interventions
- References
The 2003 National Assessment of Educational Progress showed that 37 pct of U.S. 4th graders read below a basic proficiency level, and only 31 percent read with enough proficiency to draw inferential and literal pregnant from text.7 Reading difficulties are more common in boys than in girls and are essentially more common in minority children and those who qualify for gratuitous or reduced-price dejeuner programs.seven
Etiology
- Abstract
- Prevalence
- Etiology
- Diagnosis
- Further Evaluation
- Interventions
- References
Children with reading difficulties are idea to have a primal deficit in phonologic awareness8 (i.e., the ability to translate individual letters and letter combinations into sounds). Difficulty with phonologic sensation is a robust predictor of future reading problems in prereaders.3
Vision bug rarely cause reading difficulties4; however, fundamental nervous organisation pathology appears to exist a cause of dyslexia. Functional magnetic resonance imaging (MRI; i.e., imaging of the brain metabolism during response to a task) in children with dyslexia has revealed neural disruption in specific areas of the left side of the brain (east.g., Wernicke's area, angular gyrus, striate cortex).nine
Diagnosis
- Abstract
- Prevalence
- Etiology
- Diagnosis
- Farther Evaluation
- Interventions
- References
Approximately l percent of children with a history of voice communication and language impairment develop a reading disability during early on schoolhouse years; therefore, enhanced identification of these children will lead to amend identification of children at take a chance of reading difficulties.ten Considering of the proven value of early on intervention, physicians should place children with current reading difficulties and those with run a risk factors (Tabular array 211) for future difficulties.12 This tin be accomplished using developmental, educational, and family histories and standardized testing.
Table two
Factors in Preschoolers That Increase the Risk of Future Reading Difficulties
| Difficulty with rhyming games |
| Difficulty learning the alphabet |
| Difficulty learning to associate sounds with letters |
| Failure to recognize the letters of the alphabet by the start of kindergarten |
| Delayed or impaired speech or linguistic communication |
| Family unit history of learning disabilities or difficulty with speech, linguistic communication, spelling, or reading |
Run a risk FACTORS
Children who have difficulty with rhyming games, learning the alphabet, and associating sounds with letters, and those who fail to recognize the letters of the alphabet by the start of kindergarten are at chance of developing reading difficulties. Children with a family unit history of language, speech, or reading difficulties as well are at a higher adventure. Twin studies point that phonologic deficiency has an approximate sixty percent cyclopedia between identical twins.xiii Studies have shown that 23 to 65 percent of children with a parent who has a reading disability also will take the disability.eleven
Children who take significant difficulty associating sounds with messages by the end of kindergarten and those who cannot read past the eye to terminate of their beginning-class twelvemonth should be evaluated for the source of their reading difficulties. Children receiving intervention (eastward.g., speech and language therapy, Head Start programs) for identified gamble factors remain at a higher risk of reading difficulties than other children.xiv Premature nativity and low birth weight are take chances factors for reading and other learning disabilities.xv
Many children have reading difficulties because of ecology factors (e.g., poverty, low parental education, unstimulating dwelling surroundings, inadequate didactics). Organic causes (e.chiliad., mental retardation, low IQ score [75 to 90], hearing harm) tin can contribute to environmental factors or independently crusade reading difficulties.xvi
Still, significant and persistent reading difficulties can occur despite adequate instruction, intelligence, and socioeconomic status; learning disabilities (i.e., development disorders that can occur in areas such as math computation, reading, and written expression) are a common cause. Approximately l per centum of children in special educational activity programs (nearly 5 per centum of public school children) have a learning disability, and approximately lxxx pct of children with a learning inability take a reading disability.1
Reading disabilities can affect basic reading skills and comprehension. A disability in basic reading skills is defined equally difficulty sounding out words or acquiring a sight word vocabulary (i.east., the ability to instantly recognize a whole word). This type of reading disability often is referred to equally dyslexia (i.due east., difficulty in learning to read despite adequate teaching, normal intelligence, and sociocultural opportunity).17 A disability in reading comprehension, defined every bit the inability to brand sense of text, often is associated with delays in language comprehension.
VALIDATED SCREENING TESTS
Physicians should administer developmental screening tests to preschoolers to increment the detection of speech communication and language difficulties. Validated and price-effective screening tests are available and appropriate for use in primary intendance (Table three).xviii,xix For example, the Ages and Stages Questionnaires and the Parents' Evaluation of Developmental Status are tests dependent on parental reporting that tin can exist completed before the physician visit or in the waiting room. Each test requires less than five minutes for scoring and estimation.
Tabular array iii
Tests for Evaluating Children with Reading Difficulties
| Test | Ages | Publisher | Screening parameters |
|---|---|---|---|
| Ages and Stages Questionnaires | iv months to 6 years | Brookes Publishing Spider web site: http://www.brookespublishing.com | Developmental delays |
| PEDS | 0 to 8 years | Ellsworth & Vandermeer Printing Spider web site: http://www.pedstest.com | Developmental delays and emotional/behavioral problems |
| PEDS: Developmental Milestones | 0 to 8 years | Ellsworth & Vandermeer Printing Spider web site:http://www.pedstest.com | Developmental skills, including math and reading |
| Safety Word Inventory and Literacy Screener | vi to 14 years | Ellsworth & Vandermeer Printing Web site:http://www.pedstest.com/files/SWILS.pdf | Overall academic performance |
| Gray Oral Reading Tests* | six to xviii years | AGS Publishing Web site:http://ags.pearsonassessments.com | Oral reading skills (i.e., pronunciation, fluency, comprehension, reading rate) |
| Comprehensive Examination of Phonological Processing* | five to 24 years | AGS Publishing Web site:http://ags.pearsonassessments.com | Phonologic sensation, phonologic memory, rapid naming, rhyming words, and decoding skills |
| Woodcock Reading Mastery Tests* | 5 years and older | AGS Publishing Web site:http://ags.pearsonassessments.com | Individual strengths and weaknesses in reading skills |
Quick screening tools also are available for school-historic period children. The Safety Word Inventory and Literacy Screener is a validated examination that screens for overall bookish performance, with special focus on reading in children half-dozen to 14 years of age. The test tin be administered and scored in less than five minutes and has a sensitivity and specificity of approximately 80 percent for identifying children with academic operation beneath the 25th percentile (the point where children typically demand individualized remedial help).20
Farther Evaluation
- Abstract
- Prevalence
- Etiology
- Diagnosis
- Further Evaluation
- Interventions
- References
When a schoolhouse-age child is suspected of having significant reading difficulties, additional data about the educational, developmental, and family histories should be obtained. Parents should be asked to give details virtually their child'southward academic functioning in a range of skills (e.g., spelling, writing [punctuation and expression], math). Parents should exist asked if their child understands what he or she reads and if the child has difficulty understanding or following oral instructions. Areas of high performance also should exist discussed.
A complete clinical history and examination may detect medical conditions that could contribute to reading difficulties. Genetic conditions associated with learning disabilities include 22q11.2 deletion and Klinefelter, Down, frail X, Prader-Willi, Angelman'due south, and Rett syndromes. Other medical causes include prematurity, congenital hydrocephalus, meningitis, encephalitis, traumatic brain injury, and pb or methylmercury poisoning.21
During the exam, the doctor can observe how the child follows commands and can guess the quantity and quality of expressive language. Although in-office testing may reveal signs of neurodevelopmental immaturity (e.g., persistent atonic neck ref lex), the neurologic examination of a kid with reading disabilities unremarkably is normal.22 Laboratory testing, imaging studies, electroencephalography, and genetic testing are not indicated for patients with reading disabilities.xi Functional MRI offers insight into the neurophysiology associated with reading disabilities but is used but in research.
Physicians should work with the child's teacher and parents to review results of school testing and to ensure that the kid receives additional testing, if appropriate. Annual standardized achievement tests administered in schools can profile bookish achievement within various subjects. Common standardized accomplishment tests include the California Achievement Tests, the Iowa Tests of Basic Skills, the Metropolitan Achievement Tests, and the Stanford Accomplishment Test. Several states produce their ain versions of these tests. Physicians tin obtain examination results past request parents to bring a copy to their child's almanac wellness visits; past mailing a release form, signed by the parents, to the school with a asking for the results; or by calling the school, with the parents' permission, and asking for the results.23
Younger children are tested on prereading skills (e.grand., letter naming), whereas loftier school students are tested on study skills and utilise of reference materials. These tests are considered screening tests, non diagnostic instruments, and are designed to place children who need farther evaluation. Because schools practice not appear to consistently use the examination results to make up one's mind private operation, information technology is worthwhile for a physician to review them.23
If further evaluation is indicated, children should be referred for educational testing. This testing can occur in school or tin can exist administered by a psychologist trained in educational testing. The Individuals with Disabilities Pedagogy Human action requires public schools to provide gratis assessment and intervention. Typically, educational testing includes measures of intelligence and academic accomplishment. A commonly used instrument is the Comprehensive Examination of Phonological Processing, which measures phonologic sensation, phonologic memory, and rapid naming.24
Interventions
- Abstract
- Prevalence
- Etiology
- Diagnosis
- Further Evaluation
- Interventions
- References
Schoolhouse-age children with reading difficulties should receive individualized instruction to increase phonologic awareness, decoding skills, sight give-and-take vocabulary, and reading comprehension. Intervention should begin early, be provided by proficient teachers, and use detailed and intensive approaches emphasizing phonologic awareness and phonics instruction. A meta-analysis showed that phonologic awareness instruction during kindergarten significantly affects reading evolution during start grade.12 Children receiving phonologic awareness teaching performed almost i total standard deviation (0.86) to a higher place those in the control grouping.12 However, almost children with reading disabilities are not identified until the third or fourth grade and practise not receive appropriate and timely education.ane
Patients with reading disabilities require lifelong assistance, and optimal management strategies differ depending on the patient's age and circumstances. In early childhood, the focus is on remediation of reading, often with an accent on increasing phonologic sensation.ane,12 Other strategies include using audio books and modified homework assignments. For secondary and college students, intervention focuses on accommodations. These accommodations include extra fourth dimension for reading, tape recorders in the classroom, audiobooks or live readers, and educational activity in give-and-take processing and the apply of a spell-checker (poor phonemic clan likewise causes problems in spelling).
Learning a foreign language is excessively challenging for a person with a reading inability; therefore, changes in a student'south foreign language requirement may be appropriate. No quality empiric prove supports unconventional treatment of reading disabilities such as optometric training, medication for vestibular dysfunction, chiropractic manipulation, or dietary supplementation.11
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REFERENCES
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ii. Frances DJ, Shaywitz SE, Steubing KK, Shawywitz BA. Developmental lag versus deficit of reading disability: a longitudinal, private growth bend assay. J Ed Psych. 1996;88:3–17.
iii. Catts HW, Hogan TP. Language basis of reading disabilities and implications for early identification and remediation. Reading Psychol. 2003;24:223–46.
4. Learning disabilities, dyslexia, and vision: a subject review. Committee on Children with Disabilities, American Academy of Pediatrics and American Academy of Ophthalmology, American Association of Pediatric Ophthalmology and Strabismus. Pediatrics. 1998;102:1217–nine.
5. Lloyd DN. Prediction of school failure from third-grade data. Educ Psychol Meas. 1978;38:1193–200.
6. Glascoe FP, Robertshaw NS. PEDS: Developmental Milestones Professional person's Transmission [In printing]. Nashville, Tenn.: Ellsworth & Vandermeer Press, 2007:xc.
vii. Donahue PL, Finnegan RJ, Lutkus Advertizement, Allen NL, Campbell JR. The nation's report card: fourth-form reading 2000. Accessed November 1, 2006, at: http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2001499.
eight. Stanovich KE, Siegel LS. Phenotypic performance profile of children with reading disabilities: a regression-based test of the phonological-core variable-difference model. J Educ Psych. 1994;86:24–53.
9. Shaywitz BA, Shaywitz SE, Pugh KR, Mencl Nosotros, Fulbright RK, Skudlarski P, et al. Disruption of posterior encephalon systems for reading in children with developmental dyslexia. Biol Psychiatry. 2002;52:101–10.
10. Catts HW, Fey ME, Tomblin JB, Zhang X. A longitudinal investigation of reading outcomes in children with language impairments. J Spoken language Lang Hear Res. 2002;45:1142–57.
11. Shaywitz SE. Dyslexia. N Engl J Med. 1998;338:307–12.
12. National Reading Panel, National Constitute of Child Health and Human Evolution, National Institutes of Health. Teaching children to read. Reports of the subgroups. NIH publication no. 00–4754. Accessed September twenty, 2006, at: http://www.nichd.nih.gov/publications/nrp/study.cfm.
13. Wadsworth SJ, DeFries JC. Genetic etiology of reading difficulties in boys and girls. Twin Res Hum Genet. 2005;8:594–601.
fourteen. Rescorla Fifty. Language and reading outcomes to historic period ix in tardily-talking toddlers. J Oral communication Lang Hear Res. 2002;45:360–71.
15. Litt J, Taylor HG, Klein N, Hack M. Learning disabilities in children with very low birth weight: prevalence, neuropsychological correlates, and educational interventions. J Learn Disabil. 2005;38:130–41.
sixteen. Squires J, Bricker D, Potter 50. Revision of a parent-completed development screening tool: Ages and Stages Questionnaires. J Pediatr Psychol. 1997;22:313–28.
17. Glascoe FP. Evidence-based approach to developmental and behavioural surveillance using parents' concerns. Kid Intendance Health Dev. 2000;26:137–49.
18. Glascoe FP. Safety Words Inventory and Literacy Screener: standardization and validation. Clin Pediatr (Phila). 2002;41:697–704.
xix. Snow CE, Burns MS, Griffin P, for the Committee on the Prevention of Reading Difficulties in Young Children. Preventing Reading Difficulties in Young Children. Washington, D.C.: National University Press, 1998: 85–134.
20. Grigorenko EL. Developmental dyslexia: an update on genes, brains, and environments. J Child Psychol Psychiatry. 2001;42:91–125.
21. Gillberg C, Soderstrom H. Learning disability. Lancet. 2003;362:811–21.
22. McPhillips M, Sheehy N. Prevalence of persistent primary reflexes and motor problems in children with reading difficulties. Dyslexia. 2004;10:316–38.
23. Glascoe FP. Detecting developmental, behavioral and school problems. In: Wolraich ML, ed. Disorders of Development and Learning. 3rd ed. London, U.K.: BC Decker, 2003:73.
24. Wagner RK, Torgesen JK, Rashotte CA. CTOPP: Comprehensive Test of Phonological Processing. Austin, Tex.: Pro-Ed, 1999.
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