Because they are one of the few professionals in contact with very young children, pediatricians, nurses, and other health care practitioners are in the best position to detect problems at routine checkups from infancy through preschool years. Day care and preschool settings also offer an important opportunity for early identification of the following kinds of risk:

Severe cognitive deficits

Within the normal range, IQ is moderately associated with future reading ability. But severe cognitive deficits are usually associated with very low, if any, reading achievement.

Hearing impairment

It has been well documented that children with hearing impairments are at risk of future reading difficulties. Although hard-of-hearing children tend to do better than deaf children, they are still at risk, even if they have good speaking abilities.

Early language impairment

Children acquire language at tremendously variable rates during the first four years of life. Yet some children are clearly behind by age two or three. This is an important signal. Delayed language development can be the first warning of a pervasive developmental disability, hearing impairment, or neurological problem. Any of these conditions puts a child at risk of future reading difficulties.

Often an evaluation by a speech-language professional reveals that these children have early language impairment. About 40 to 75 percent of preschoolers with such an impairment develop reading difficulties later—often along with other academic problems.

Expressive and receptive language delays

Children’s development of language during preschool years is strongly related to how well they will later learn to read. An infant’s achievement of “expressive” language milestones appears to have a particularly strong link to later reading achievement. Assessment of these milestones is part of regular well-baby visits and can be used to identify children at risk.