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Even though quite accurate estimates can be made on the basis of known risk factors, it is still difficult to predict precisely which young children will have difficulty learning to read. We therefore propose that prevention efforts must reach all children. To wait to initiate treatment until the child has been diagnosed with a specific disability is too late. However, we can begin treatment of conditions associated with reading problems, for example, hearing impairments.

Ensuring success in reading requires different levels of effort for different segments of the population. The prevention and intervention efforts described in this report can be thought of in terms of three levels (Caplan and Grunebaum, 1967, cited in Simeonsson, 1994; Pianta, 1990; and Needlman, 1997).  Primary prevention is concerned with reducing the number of new cases (incidence) of an identified condition or problem in the population, such as ensuring that all children attend schools in which instruction is coherent and competent.

Secondary prevention is concerned with reducing the number of existing cases (prevalence) of an identified condition or problem in the population. Secondary prevention likewise involves the promotion of compensatory skills and behaviors. Children who are growing up in poverty, for example, may need excellent, enriched preschool environments or schools that address their particular learning needs with highly effective and focused instruction. The extra effort is focused on children at higher risk of developing reading difficulties but before any serious, long-term deficit has emerged.

Tertiary prevention is concerned with reducing the complications associated with identified problem, or conditions. Programs, strategies, and interventions at this level have an explicit remedial or rehabilitative focus. If children demonstrate inadequate progress under secondary prevention conditions, they may need instruction that is specially designed and supplemental—special education, tutoring from a reading specialist—to their current instruction.



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