Overview promotes early intervention over ’wait-to-fail approach’

Kids generally don’t get a dyslexia diagnosis until well into their elementary school years; however, routine dyslexia screening by pediatricians can help identify at-risk children early and mitigate adverse outcomes, researchers reported.

According to an overview of current evidence on precursors of reading, 56% to 92% of at-risk beginning readers who received intensive early reading intervention achieved average reading ability, stated Nadine Gaab, PhD, from Boston Children’s Hospital in Boston, and co-authors.

“However, many children are diagnosed with dyslexia long after they first demonstrate recognizable struggles with preliteracy milestones,” they wrote in Pediatrics.

They pointed out that children are typically diagnosed with dyslexia at the end of second or beginning of third grade, which is after they have failed to learn to read over a long period of time and have fallen behind their peers academically.

“This wait-to-fail approach fails to capitalize on the most effective window for intervention, which is during an earlier period of heightened brain plasticity in kindergarten and first grade,” the authors stated.

Gaab’s group also highlighted that children with dyslexia are more likely to suffer from generalized anxiety and exhibit higher rates of depression, so pediatricians should screen their patients for dyslexia risk although that is not the current standard of practice.

They stressed that screening is not a formal dyslexia diagnosis, which occurs after reading instruction has begun and requires a more comprehensive neuropsychological evaluation, but is rather a “brief assessment that determines the risk of having or developing dyslexia, which can be undertaken at an early age before school entry.”

“In the case of dyslexia, screening children individually for risk can be accomplished quickly and inexpensively through a consideration of family history and through short behavioral assessments of early literacy abilities,” Gaab’s group stated.

They suggested pediatricians keep the following in mind for early dyslexia screening:

  • Review the child’s family history of dyslexia as a positive family history requires closer monitoring.
  • Document the extent to which a child can recognize rhyming sounds, repeat nonsense words, or report the sound that a letter makes.
  • Remember that “phonological deficits can present differently in different children, and children with dyslexia will vary in the specific tasks with which they show difficulty.”
  • Consider hosting “screening days” to look for early predictors of dyslexia and promote literacy, as is the case with the successful “Reach Out and Read” program.
  • Realize that not all children who struggle with reading meet the criteria for a dyslexia diagnosis, but most of these children will still benefit from interventions for dyslexia.

Unlike with depression or attention-deficit hyperactivity disorder, there are no two-to-three-questions standardized questionnaires for dyslexia risk assessments, the authors acknowledged.

However, questionnaires such as the Ages & Stages Questionnaires “can be helpful as a starting point,” they said. Gaab and co-authors referred pediatricians to screen tool charts from the National Center on Intensive Intervention at American Institutes for Research.

The authors concluded that, if screening indicates the potential for dyslexia, further evaluation, monitoring, and educational supports can be provided, including referral to outside consultants, such as a speech and language pathologist who specialize in early literacy.

In a commentary accompanying the overview, Iliana I. Karipidis, PhD, and David S. Hong, MD, of the Center for Interdisciplinary Brain Sciences Research at Stanford Medicine in California, said that “Moving forward, there is a pressing need to make early interventions available to all children at risk for developing reading problems to mitigate longer-term adverse outcomes.”

They also stressed that “basic research findings on neurobiological mechanisms associated with poor reading are still needed to inform the development of more precise, symptom-specific cognitive-behavioral screeners.”

Karipidis and Hong also pointed out that children from low socioeconomic backgrounds, who do not have a dyslexia diagnosis, may still gain from reading interventions that target dyslexia, although “it remains unclear if response to such interventions is related to its content (e.g., multisensory approach) or merely is an effect of increased exposure to learning activities.”

  1. Pediatricians can help flag early dyslexia before school entry and during a period of heightened brain plasticity when interventions are more likely to be effective.

  2. Screening at-risk children can be accomplished through a consideration of family history and with short behavioral assessments of early literacy abilities.

Shalmali Pal, Contributing Writer, BreakingMED™

Gaab and co-authors, as well as Karipidis and Hong, reported no relationships relevant to the contents of this paper to disclose.

Cat ID: 138

Topic ID: 85,138,130,138,192,925