The Why, When, Whom, How, and Where

by Dr. Nadine Gaab and Dr. Yaacov Petscher

WHY Should We Screen?

Every child has the right to learn to read. Proficiency in reading has been shown to be closely related to academic, vocational, economic, and social outcomes (Irwin et al., 2007). Difficulties learning to read have been linked to socialemotional and mental health challenges, and struggling readers are at greater risk for developing anxiety and depression (Dahle & Knivsberg, 2014; Hendren et al., 2018; Mugnaini et al., 2009).

Dyslexia Testing and Early Literacy Screening

How much education a person receives is highly dependent on reading proficiency and has been shown to be a crucial predictor of overall health and longevity (Johnston, 2019; Vernon et al., 2007). Students with dyslexia are less likely to enroll in postsecondary education programs (Horn & Berktold, 1999) and more likely to enter the justice system (Moody et al., 2000). It has been reported that up to 75% of incarcerated individuals do not complete high school and/or show low literacy skills, and incarcerated individuals who attend educational programming in the justice system are less likely to recidivate once released (Davis et al., 2013). Overall, the U.S. Department of Labor estimates that illiteracy costs the American economy about $225 billion a year in lost human productivity, and it has been estimated that bringing all adults in the U.S. to an equivalent of a sixth-grade level would increase the Gross Domestic Product by 10%, or approximately $2.2 trillion (Rothwell, 2020).

Despite the importance of reading proficiency, approximately 65% of fourth-graders are not reading at grade level, and the data look similar for later grades (National Assessment of Educational Progress, 2019). Struggling readers are four times more likely to drop out of school and African-American and Latinx/Hispanic children who are struggling readers are twice as likely as their White peers to drop out before high school (e.g., Hernandez, 2011).

“When it comes to learning differences, including dyslexia, we are still primarily focused on a reactive, deficit-driven, “wait-to-fail” model instead of on the development and implementation of preventive approaches.”

However, not all of these children qualify for a dyslexia diagnosis, which has been suggested to have a prevalence of 5-17% (Grigorenko et al., 2020) but it is important to note that this prevalence is highly dependent on the employed diagnostic criteria. Dyslexia can be defined as severe word reading deficits, and its developmental progression suggests early difficulties with the “mechanics” of learning to read. This includes early difficulties with the ability to manipulate the sounds of one’s language (phonological or phonemic awareness), print awareness, and severe difficulties with mapping the sounds of language onto print, namely letters and letter patterns (grapheme-phoneme mapping) (see Ozernov-Palchik & Gaab 2016a,b,c for an overview). These challenges then progress developmentally into difficulties with blending, which is the ability to pronounce individual speech sounds (phonemes) joined together to make a word. Subsequently, children are learning decoding skills, which require the ability to apply the acquired knowledge of these letter-sound relationships to pronounce written words correctly. It is important to note that mastering just the mechanics of reading is not sufficient to develop into a proficient reader. A child can be an excellent decoder, but a lack of oral language skills (e.g., vocabulary, syntactic complexity, and listening comprehension) can severely limit the development of reading fluency and reading comprehension (Adlof & Hogan, 2018; Alonzo et al., 2020; Catts et al., 2016; Snowling & Hulme, 2021). This illustrates the importance of a comprehensive approach when a) choosing appropriate early reading curricula b) screening children who are at risk for the development of deficient reading skills, and c) planning and delivering intervention approaches.

Struggling readers and people with dyslexia process some reading-related information at the brain level differently than do people who are not struggling readers (Ozernov-Palchik & Gaab, 2016a,b,c; Richlan, 2012). Compared to typically developing readers, struggling readers show reduced gray matter in certain brain regions that process reading and reading-related information, different long-range connections between brain areas that process reading-related information, and reduced activation in these brain areas while performing prereading and reading-related tasks, as well as differences in how these brain areas communicate with each other (Grigorenko et al., 2020; Ozernov-Palchik & Gaab, 2016a,b,c). We now know that some of these brain differences are present before a child begins learning to read and may start developing differently as early as infancy (Ozernov-Palchik & Gaab, 2016a,b,c for an overview). As a result…

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Screening for Early Literacy Milestones and Reading Disabilities


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