Catching reading problems early

Playing the piano, to the uninitiated, is an intimidating task: learning the proper finger movements, working the pedal, reading notes, keeping time. To children with a reading disability, comprehending a simple word can be just as daunting.

“People just don’t get that reading is a complex skill,” says G. Reid Lyon, PhD, former chief of the Child Development and Behavior Branch at the National Institute of Child Health and Human Development, and a researcher in educational leadership and policy at Southern Methodist University and in cognition and neuroscience at the University of Texas at Dallas.

Learning disabilities can manifest in any number of ways, such as difficulty with mathematics or written expression. But reading disabilities are far and away the most common variety. “They compose anywhere from 80 to 90 percent of learning disabilities in general,” Lyon says.

Over the last decade, however, researchers have gotten better at spotting reading disabilities early — even as early as infancy — and designing interventions to minimize their impacts. However, with 2.5 million students still classified as learning disabled, psychologists and other experts admit they have a long way to go to put that knowledge into practice.

Baby brains

Under the Individuals With Disabilities Education Act, the federal government defines specific learning disabilities as disorders in one or more of the basic psychological processes in understanding language, which manifest as an imperfect ability to listen, speak, read, write, spell or do mathematics. By definition, children with such disabilities don’t suffer from problems such as intellectual disabilities, sensory disorders or emotional disturbance. They often have normal or above-average abilities in some academic or cognitive domains. Yet they struggle in others.

When it comes to identifying children with reading disabilities, the sooner the better. Seventy-five percent of kids who read poorly at age 9 will struggle to read for the rest of their lives, Lyon says. Traditionally, however, most interventions for reading disabilities are introduced only after a child has wrestled with reading difficulties for two or three years, says Dennis Molfese, PhD, a psychologist at the University of Nebraska in Lincoln.

“We always deal with intervention after a disability is in full bloom,” he says.

It has taken time to validate early intervention programs, and schools have been slow to adopt them. But once struggling kids fall behind, he says, they tend to stay there.

Children who get adequate help for their disabilities after struggling for a year or two still only reach reading speeds and comprehension rates that are, at best, 80 percent to 85 percent of what a normal reader achieves, he says. “Our interventions will work to a point, but [most] kids never reach a point where they’re normal readers with enjoyment of reading and success in school.”

To address that dilemma, Molfese and his wife, Victoria Molfese, PhD, a developmental psychologist specializing in early childhood education at the University of Nebraska, have developed a method to spot babies who are at risk of developing reading disabilities at birth with stunning accuracy. Back in 1985, the pair reported in Infant Behavior and Development (Vol. 8, No. 2) that they’d identified patterns in infant brain waves that correlated with differences in language skills and vocabulary size when the children reached age 3. Over the years, they’ve expanded on this work. In a study published in 2000 in Brain and Language (Vol. 72, No. 3), they reported they could predict with 80 percent accuracy which newborn infants would show significant reading problems at age 8.

“Now our accuracy is up to about 99 percent,” Dennis Molfese says.

The screening process is relatively simple, he says. He affixes electrodes to infants’ scalps and records their brain waves as they listen to different speech sounds, such as “ba” and “ga.” In most infants, there’s a marked spike in brain activity that occurs about a quarter of a second after hearing the sounds. “In babies at risk, that big peak gets delayed by about another quarter of a second. It’s very easy to see in the brain-wave records,” he says.

These infants can hear normally, but their brains are processing the speech sounds more slowly, Dennis Molfese says. When mentally decoding rapid speech sounds, a quarter of a second might as well be an eternity. “Timing in terms of brain processing is everything,” Dennis Molfese says.

If a child can’t quickly decipher the difference between a B and a G, she’ll have a lot of trouble learning to map sounds to letters, a critical skill needed to read and understand speech. “Other words are coming at you while you’re still trying to make a discrimination about what you heard in the first place,” Victoria Molfese says.

The Molfeses hope to use these findings to develop early interventions that could minimize or even prevent learning disabilities. “We know the brain has a lot more plasticity early on,” Dennis Molfese says. “Why not take advantage of that to rewire the brain?”

To that end, the pair is collaborating with researchers in Finland to develop a computer-based game that presents graphic symbols with various speech sounds. The game was originally developed for preschoolers, but the researchers hope it can be adapted for use by toddlers, Victoria Molfese says. To play, children categorize the symbols and sounds as they appear. Therapists can adjust the settings so that the difference between two sounds becomes increasingly ambiguous, helping kids gradually become more adept at distinguishing between similar sounds. Over time, she hopes, the system could fine-tune the children’s auditory processing abilities, making it easier for them to learn the skills necessary for future reading success.

Effective interventions

While intervention strategies for infants and toddlers are still being tested, approaches aimed at preschoolers and kindergarteners are beginning to be put into practice. Surprisingly, though, many teachers and psychologists still don’t have a handle on which skills are most important for beginning readers, Victoria Molfese says.

To help settle that question, she participated in the National Early Literacy Panel, convened in 2009 by the National Institute for Literacy, which is supported by the U.S. Department of Education. The panel members undertook a meta-analysis of published studies to determine which skills among kids 5 and under are most important for later success in reading, spelling and comprehension.

Their conclusion? “There’s a long list of things people have thought [were important], but a relatively short list of things that are actually predictive,” she says.

The top critical skills, she says, are writing, alphabetic knowledge, rapid naming tasks and phonological processing (the ability to break words down into their individual sounds or syllables).

Explicit testing of these skills, combined with careful monitoring their acquisition, can help pinpoint preschool- and kindergarten-age kids who simply aren’t up to speed yet, as well as kids who suffer from bona fide reading disabilities.

Because kindergarteners vary widely in their readiness to read, such screens tend toward false positives, says Jack Fletcher, PhD, a psychologist at the University of Houston who has studied learning disabilities for more than 30 years. And that’s okay. “You basically want to triage kids into groups that need to be followed because they may be at risk,” he says. As the children receive targeted practice with skills such as recognizing letters and mapping them to sounds, it quickly becomes clear which kids have true disabilities that will require more intensive intervention.

These approaches can be extremely effective, Fletcher says. “We have a lot of evidence from neuroimaging studies that shows that if kids get interventions that are effective, there’s a change in how the brain functions for reading,” he says. “Clearly, the brains of many kids are malleable.”

Making gains

Still, it’s unrealistic to think that all learning disabilities can be cured, says Lyon. “These are disabilities that occur on a continuum. You can have a severe or mild disability just like there’s severe and mild hypertension,” he says.

Children with mild impairments may overcome their disability entirely with proper intervention, he says. Even at the severe end of the spectrum, early recognition can help ensure that children receive the tools and accommodations they need to manage their disabilities.

Despite mounting evidence that early intervention programs work, though, they’ve been slow to be put into practice. “We have a very good understanding of how kids learn to read and why kids have difficulties and what we can do about that,” Lyon says. “The problem is there’s a huge gap between what we know and what we do in schools.”

Fletcher agrees. “We are still a long way from having any kind of significant implementation. The bias is still toward later identification — waiting for kids to fail,” he says.

His prescription for that problem is straightforward: “Let’s make sure we have some sort of universal screening for reading problems that’s instituted everywhere,” he says.

Dennis Molfese would prefer to see such screenings performed at birth. Most states already test newborns for hearing problems and for some genetic disorders. Adding a five-minute brain-wave test for learning disability risk would be easy and relatively inexpensive, he says.

He’s calling for “a major paradigm shift within psychology as a whole” toward prevention instead of waiting for failure by implementing empirically tested interventions sooner. There’s still a lot to learn. Other types of impairments, such as mathematic disabilities, will need to be much better understood.

After three decades of research, Victoria Molfese is hopeful — but she knows we’re not there yet. “We have at least another 30 years of research questions to go,” she says.

Kirsten Weir is a writer in Saco, Maine.