Identifying risk instead of failure

Reading impairments: Moving from a deficit-driven to a preventive model
IvanPais, Pixabay.com, CC0 1.0
IvanPais, Pixabay.com, CC0 1.0

The ability to read fluently and comprehend the meaning of a text is crucial for academic and vocational success. However, 63% of fourth graders in the U.S. are reading below grade level, and 80% of these children come from families of low socioeconomic status. The majority of districts are still employing a “wait-to-fail” approach, which means that many children are “flagged” by the school system only after they have repeatedly failed to learn to read over a prolonged period of time, often years.

This can be detrimental to children’s academic outcomes and even their mental health. Repeated failure to learn to read has been shown to impede the development of vocabulary skills and content knowledge, and to have long-lasting negative consequences for all academic subjects. Alarmingly, the experience of failing at your “first job” – learning to read – can seriously erode self-esteem, and struggling readers have been found to have higher rates of anxiety and depression.

“The experience of failing at your ‘first job’ – learning to read – can seriously erode self-esteem.”

Children with untreated learning disabilities are less likely to pursue education beyond high school and more likely to enter the juvenile justice system, as well as to experience long-term socioeconomic effects, such as lower earnings.

There is currently a wide gap between the time when children are flagged and/or diagnosed with a reading impairment and the start of intensive intervention – if such resources are even available. Yet evidence shows that interventions are more effective in addressing reading failure or its precursors if implemented early, when the gap in reading proficiency between at-risk and typically developing children is still small and the secondary effects of a struggle to learn to read, such as reduced vocabulary and less content knowledge, are minimal.

Early screening is crucial – but encounters resistance

Using behavioral assessments, studies from around the world have shown that it is possible as early as preschool to identify children who are at risk of having difficulty learning to read. Furthermore, atypical brain development has been observed in prereaders who subsequently develop reading impairments, which suggests that many children enter school with a brain that is more likely to struggle with learning to read. This body of research has been instrumental in the development of early literacy milestone screening programs to identify children at a heightened risk of developing reading impairments.

“With the help of high-quality screening programs, we can identify at-risk children early on, but refrain from diagnosing them with a reading disability while they are still in preschool.”

Early screening is usually done with psychometric assessment of pre-literacy skills, which have been shown to predict long-term reading outcomes. For the English language, this includes the assessment of phonological awareness (the ability to manipulate the sounds of the language), letter-sound knowledge, rapid automatized naming skills, vocabulary, and, often forgotten, oral language comprehension skills.

The first step in preventing reading failure is therefore to assess these abilities in children prior to, or at the start of, formal reading instruction. However, this idea – which is certainly not new – still encounters resistance from educators, school administrators, and parents because of the misconceptions surrounding early screenings aimed at identifying children at risk of reading impairments.

One common misconception is that such screenings diagnose children with reading impairments as young as age four. In fact, however, their purpose is not to diagnose a reading disability in four- to six-year-olds, but to identify children at risk of developing a reading impairment.

“The prevalence of reading impairments will not change unless we take appropriate actions in response to the screening results.”

An analogy from medicine may be helpful in this context: Adults are advised to undergo screening for high cholesterol levels, which can indicate an increased risk of developing heart disease. Of course, those diagnosed with high cholesterol do not automatically receive a diagnosis of heart disease. They are, however, provided with an evidence-based “response to screening,” generally a combination of prescribed exercise, dietary changes, and/or medication. This may prevent the development of the disease, or at least lessen its severity.

The ultimate goal is to reduce the prevalence of heart disease, by encouraging individuals to take preventive action, and to improve the outcomes of those who will develop it by prompting them to implement life style changes earlier, prior to a diagnosis.

In the case of reading impairments, we need to make a similar shift from a deficit-driven to a prevention model. With the help of high-quality screening programs, we can identify at-risk children early on, but refrain from diagnosing them with a reading disability while they are still in preschool.

Policy changes are needed

However, even if we succeed in screening all children, the prevalence of reading impairments will not change unless we take appropriate actions in response to the screening results. These actions need to be systematic, structured and explicit and, most importantly, consistent with scientific evidence on reading development and should include a progress monitoring component. This preventive approach can reduce the prevalence and severity of reading impairments.

With the help of policymakers, the current deficit-driven approach or “failure” model should be replaced with a preventive “support” model. Such a model would facilitate school- and community-based early screenings (e.g. in libraries or pediatricians’ offices during well-child visits) and allow empowered, well-trained teachers to provide evidence-based responses to screening in the context of the general education system.

“With the help of policymakers, the current deficit-driven approach or ‘failure’ model should be replaced with a preventive ‘support’ model.”

Such policy changes will be effective only if they are properly implemented. This requires, for example, high-quality multilingual, culturally appropriate, bias-free, easily accessible, easy-to-administer and affordable screening tools to identify children who are at risk of struggling with reading. These tools should be evidence-based as well as demonstrably reliable and valid.

It is also important to note that inadequate reading instruction can exacerbate an at-risk child’s struggle to learn to read.  An overhaul of current teacher training programs and the adoption of reading curricula that reflect the current state of scientific knowledge are needed to ensure that teachers are adequately trained to teach reading to all children and to meet the needs of at-risk children in their classrooms.

By addressing these challenges, we can help to reduce the debilitating secondary consequences of reading impairments for children’s mental health, academic, and economic outcomes. Most importantly, we can help more children discover the joys of reading.

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