Screening for Dyslexia: Not a “One-and-Done” Event By Dr. Ruth Kaminski, Acadience Learning
Reading disorders, including dyslexia, are an important issue meriting our attention. As of this writing, almost all 50 states have legislative rules and guidelines for identifying dyslexia (National Center on Improving Literacy). As someone who has spent over 30 years developing and researching assessments for the purpose of preventing reading disabilities, I believe it is time to reflect on what is known about screening and assessment and ask, “How does screening specifically for dyslexia differ from best practices in screening to prevent reading difficulties?”
To know how to use screening as a process to identify students with dyslexia, we need to understand what dyslexia is. So, let’s start there. What do we mean by the term “dyslexia”?
Educators, researchers, and policymakers generally agree that dyslexia is a learning disorder characterized by a severe and persistent difficulty with the skills involved in accurate and fluent reading and spelling, with the defining characteristic being a severe deficit in word reading. There is also general agreement that, to be diagnosed with dyslexia, children must have adequate vision and hearing acuity along with adequate cognitive skills to be able to learn to read.
According to the latest report from the National Assessment of Educational Progress (NAEP), 65% of fourth-grade students performed below the NAEP proficient reading level and 34% performed below the NAEP basic level on reading in 2019. Do all of those students have dyslexia? It is not likely.
Estimates of students with dyslexia vary widely from 5% to 35% of children who struggle with reading. The reality is that there is no single factor or group of factors that characterizes all children with dyslexia. Rather, an array of risk factors can be associated with dyslexia—including, for example, difficulties in the areas of phonological processing, alphabet knowledge, word retrieval, and oral language, as well as a family history of dyslexia. While risk factors such as these increase the probability of a student having dyslexia, they should not be perceived as proof of dyslexia. In a 2018 discussion of myths about dyslexia, Dr. Louisa Moats stated that “the only firm diagnostic criterion is that the student experiences significant difficulty reading and spelling words out of context.”
Increasingly, experts in the field of reading research point to multifactorial models of dyslexia, wherein risk factors interact with protective factors to result in an increased or decreased risk of dyslexia (Catts & Petscher, 2018; Pennington et al., 2012). In fact, there is evidence to suggest that risk for dyslexia may be reduced through early identification and intervention on essential early literacy and reading skills (e.g., Foorman & Torgesen, 2001; O’Connor, Harty, & Fulmer, 2005). Effective instruction of essential skills then becomes a critical protective factor.
What does all this mean for screening for dyslexia? Simply put, there is not a single screening test that can provide a definitive answer as to whether a child will develop dyslexia. However, screening can identify children who are at risk for reading difficulties, including dyslexia. For screening to be effective in identifying children at risk for dyslexia, it needs to: a) start early—that is, before children are readers; b) focus on essential early literacy and reading skills; c) be conducted on an ongoing basis throughout the elementary school years; and d) include an evaluation of the effectiveness of the instructional support provided.
When to start screening for dyslexia
Reading is a complex developmental process that builds on and integrates cognitive and linguistic skills, which begin to develop well before formal reading instruction begins. Thus, screening for risk for dyslexia can begin as early as kindergarten and even preschool. Children in preschool and kindergarten cannot be diagnosed with dyslexia; however, difficulties in acquiring essential early literacy skills can serve as an indicator of risk for later reading difficulties.
What skills should be assessed?
Essential early literacy and reading skills include phonological processing and phonemic awareness, phonics skills and understanding of the alphabetic principle, word reading and decoding, and accuracy and fluency reading connected text. These are essential skills because they are skills that are a) predictive of reading acquisition and reading achievement, b) can be taught, and c) result in improved reading outcomes when they are taught and learned.
It is important to note that essential early literacy and reading skills are developmental in nature; that is, earlier skills provide a foundation for later skills, which build on and integrate with earlier skills over time as students master them. For example, prior to formal reading instruction, early alphabetic knowledge—specifically fluency in naming letters—is exceptionally predictive of later reading difficulties or achievement, along with early phonological awareness skills such as rhyming or identifying initial sounds in words. Through the kindergarten and first-grade years, phonemic awareness remains predictive and alphabetic knowledge moves beyond letter-naming to basic phonics skills and an understanding of the alphabetic principle. By the end of first grade and beginning of second grade, accuracy and fluency in reading connected text becomes a strong predictor that remains throughout the school years.
In addition to essential early literacy and reading skills, assessment of additional factors or skills that are known to be risk indicators may be included in screening, such as measures of rapid automatized naming (RAN) or family history of dyslexia. That said, assessing the essential early literacy and reading skills is critical because it is these that we can address through instruction and intervention.
How frequently should students be assessed?
As the title of this article asserts, screening for dyslexia is not a “one-and-done” event. We conduct screening periodically across the school year at all grade levels for two reasons.
The first involves the developmental nature of the acquisition of essential early literacy and reading skills. During the early grades (preschool to kindergarten through first and second grades), the skills that are being assessed vary at different time points. Because these skills build on one another, It is important to ensure that all students acquire all essential early literacy and reading skills.
The second—and perhaps even more important—reason is that periodic screening throughout the school year enables us to check on students’ progress acquiring critical skills over time. Our model of ongoing assessment, including progress-monitoring, within an Outcomes-Driven Model of decision-making (Kaminski, Cummings, Powell-Smith, & Good, 2008) is consistent with prevention models of others who maintain that that the best way to identify early risk for dyslexia is to assess children’s progress in acquiring essential early literacy and reading skills with effective reading instruction (Catts & Petscher, 2021; Miciak & Fletcher, 2020). Simply put, dyslexia is a severe and persistent difficulty with learning the skills needed for accurate and fluent reading. Thus, difficulties acquiring these skills in the face of good instruction is a clear early indicator of risk for dyslexia.
Assessing the effectiveness of instructional support
A critical aspect of screening for dyslexia—one that is typically not addressed in most screening procedures—is an evaluation of the effectiveness of instructional support provided to students. Screening data that are collected periodically for all students can be summarized at various levels (e.g., instructional group, classroom, grade level) to determine the proportion of students making adequate progress.
A guideline: Intervention is considered generally effective if most of the students (~80%) receiving the intervention are making adequate progress toward achieving benchmarks or reading goals. If the instruction or intervention being provided is not working for most students, the reason for low reading skill may not be dyslexia but rather a lack of effective instruction.
To sum it all up…
The point of early screening for risk of dyslexia is not simply the identification of dyslexia; screening is not a one-and-done event, nor is it a standalone evaluation. Indeed, screening is most effective if it is part of an overall decision-making model for using assessment information in a process designed to reduce the risk of reading difficulties and improve reading outcomes for all students. Beyond simply including screening, a decision-making framework such as the Outcomes-Driven Model encompasses assessment for instructional planning, progress-monitoring, and outcome evaluation. Within such a model, the power of identifying risk early is that we can do something to mitigate that risk.
The bottom line is that to successfully screen for dyslexia, we need to do the following:
- Start early.
- Focus assessment on essential early literacy and skills.
- Provide research-based instruction and intervention.
- Conduct periodic screening of all students (and monitor the progress of students at risk more frequently).
- Use screening data at a systems level to modify instructional support and meet the needs of all students.
To learn more about Acadience® Reading K–6 and Acadience® Reading 7–8, visit https://www.voyagersopris.com/acadience/suite
Catts, H.W., & Petscher, Y. (2021). A cumulative risk and resilience model of dyslexia. Journal of Learning Disabilities, doi.org/10.1177/00222194211037062
Foorman, B.R., & Torgesen, J. (2001). Critical elements of classroom and small-group instruction promote reading success in all children. Learning Disabilities Research and Practice, 16(4), 203–212.
Kaminski, R.A., Cummings, K., Powell-Smith, K., & Good, R.H., (2008). Best practices in using dynamic indicators of basic early literacy skills for formative assessment and evaluation. In A. Thomas & J. Grimes (Eds.) Best practices in school psychology V. Bethesda, MD: National Association of School Psychologists.
Miciak, J., & Fletcher, J.M. (2020). The critical role of instructional response for identifying dyslexia and other learning disabilities. Journal of Learning Disabilities, 53(5): 343–353. doi:10.1177/0022219420906801
Moats, L. (2018, October 4). It’s dyslexia: What’s a teacher to do? https://www.voyagersopris.com/blog/edview360/2018/10/04/its-dyslexia
National Center for Education Statistics (NCES), U.S. Department of Education and the Institute of Education Sciences. (2019). The Nation’s Report Card: Reading. Retrieved from https://www.nationsreportcard.gov/reading/nation/achievement/?grade=4
O’Connor, R.E., Harty, K.R., & Fulmer, D. (2005). Tiers of intervention in kindergarten through third grade. Journal of Learning Disabilities, 38(6), 532–538.
Pennington, B.F., Santerre-Lemmon, L., Rosenberg, J., MacDonald, B., Boada, R., Friend, A., Leopold, D. R., Samuelsson, S., Byrne, B., Willcutt, E. G., & Olson, R. K. (2012). Individual prediction of dyslexia by single vs. multiple deficit models. Journal of Abnormal Psychology, 121(1), 212–224. doi: 10.1037/a0025823