Identifying Risk Factors to Prevent Difficulties
Our review of prediction studies indicates clearly that no single risk factor, on its own, is sufficiently accurate to be of practical use for predicting reading difficulties. In combination, however, measures of various kinds of risk individual, familial, and demographic can provide useful estimates of future achievement levels.
Although prediction accuracy is far from perfect, errors of prediction can be tolerated as long as children's progress is carefully monitored during kindergarten and beyond. As discussed below, how different school systems can best use the available information about risk indicators must be tailored to their particular needs, goals, and resources.
Group risk factors
- They are expected to attend schools in which achievement is chronically low
- they reside in low-income families and live in poor neighborhoods
- they have limited proficiency in spoken English
- they speak a dialect of English that differs substantially from the one used in school
Individual risk factors
- They are children of parents with histories of reading difficulty
- they have acquired less knowledge and skill pertaining to literacy during the preschool years, either through lack of appropriate home literacy experiences and/or as a result of some inherent cognitive limitations
- they lack age-appropriate skills in literacy-related cognitive-linguistic processing, especially phonological awareness, confrontational naming, sentence/story recall, and general language ability
- they have been diagnosed as having specific early language impairment
- they have a hearing impairment
- they have a primary medical diagnosis with which reading problems tend to occur as a secondary symptom
Practical use of this information
Detecting problems early, in order to avoid other problems later on, is the most practical course. The ease, cost, and reliability with which various risk factors can be measured are therefore a central concern.
Many of the group factors named above (e.g., a child is expected to attend a school in which achievement is chronically low, the child lives in a low-income family and neighborhood) are easily accessible measures. When they are present, effective preventions and early interventions can be provided throughout the age span we are addressing in this report birth through grade three.
Pediatric screening tools are effective in identifying children who have severe sensory or developmental impairments (hearing impairment, specific language impairment). When these are present, preventions and early interventions can be provided.
There is less practical utility in conducting population-wide individual screening of infants, toddlers, and preschoolers who have acquired less knowledge and skills pertaining to literacy during the preschool years, either through lack of appropriate home literacy experiences or as a result of some inherent cognitive limitations, or of those who lack age-appropriate skill in literacy-related cognitive-linguistic processing, for the purpose of identifying those who are at greatest risk for reading difficulties.
Some screening (i.e., language milestones) is already part of regular well-baby visits; in this case the information could help to define risk, especially when aggregated with other risk factors.
Kindergarten screening, in contrast, has become reasonably accurate when a combination of skills is measured (although the optimal combination is not yet identified). Ideally, screening procedures should be quick and inexpensive; they should identify all or most children who have the specific problem; and they should mistakenly detect none or few children who do not have the problem.
To achieve the goal of preventing reading difficulties, it will not be feasible or appropriate to provide the same sort of intervention to all of these groups and individuals, although some kinds of programs may be of benefit to all.