New Book Helps Identify Risks of Reading Difficulties | Nutrition Fit



Summary: A new book helps researchers screen for potential reading difficulties in young children.

Source: Cincinnati Children’s Hospital

A study published in the journal Pediatrics expands validation evidence for a new screening tool that directly engages preschool-age children during clinic visits to assess their early literacy skills. The tool, which is the first of its kind, has the potential to identify reading difficulties as early as possible, target interventions and empower families to help their child at home, according to researchers at Cincinnati Children’s Hospital Medical Center.

The Reading House (TRH) is an assessment for ages 3-5 based on a specially designed children’s book, which was developed by John Hutton, MD, and his team at Cincinnati Children’s. Screening takes five minutes and gauges performance levels for ages 3-4 and 4-5. It addresses a significant gap in ways to efficiently and directly screen early literacy skills. The tool, which is intended to be fun for the child, could be used in primary care or preschool settings. Early screening is particularly important for children from disadvantaged backgrounds.

“While developmental screening is a mainstay of pediatric practice, there is no established standard to assess reading readiness and identify children at-risk early,” said Hutton, director of the Reading & Literacy Discovery Center at Cincinnati Children’s. “As a result, many children arrive at kindergarten unprepared to learn to read, especially from minority and economically impoverished backgrounds – estimated at over 50% of children from impoverished backgrounds in the U.S. and over 25% overall.”

The screener measures core skills typically emerging in the preschool age range, including vocabulary, rhyming, alphabet knowledge and print concepts (how books work). All are skills predictive of reading success and often implicated in reading difficulties, according to Hutton.

After screening, the family is given the book to take home and read together, helping address the important question: “What should I do to help my child?” Possibilities include enrollment in preschool as well as building nurturing home-reading routines.

The study involved 70 healthy children–34 boys and 36 girls–between 3 and 5 years old from various socioeconomic status backgrounds. The children completed standardized assessments of important literacy skills: composite, vocabulary, rhyming and rapid automatized naming (how quickly they can access linguistic information about objects, letters or words).

Fifty-two of these children also successfully completed magnetic resonance imaging (MRI), including measurement of cortical thickness, or the gray matter surface of their brains. Thicker cortex, particularly in left-sided areas supporting language and reading, has been associated with higher skills that are predictive of reading outcomes.

This shows a page from the book
The Reading House (TRH) is an assessment for ages 3-5 based on a specially designed children’s book, which was developed by John Hutton, MD, and his team at Cincinnati Children’s. Credit: Cincinnati Children’s

These findings are the first of their kind, building on a series of “firsts” involving relationships between reading and brain development in preschool-age children published by the research team from Cincinnati Children’s.

“We found significantly thicker gray matter cortex in the left-sided areas of the brain in children with higher TRH scores, which align with cortical thickness patterns found in older children and adults with higher reading skills,” Hutton said. “This is an important neurobiological correlate of screened skills at this formative age, when the brain is growing rapidly.”

Higher scores on TRH were also strongly related to higher vocabulary, rhyming and rapid naming scores, adding to validation evidence for the TRH measure.

An additional finding involved substantial differences in cortical thickness patterns for children in poverty versus those not in poverty related to higher TRH scores.

“We found a less mature or ‘strain’ pattern and thinner cortex overall in the subsample of children from impoverished backgrounds, which is a potential biomarker of lower readiness and early adversity often found in such children,” Hutton said. “By screening early during pediatric clinic visits, especially in practices serving disadvantaged families, we can hopefully target effective interventions that help children better prepare for kindergarten and improve reading outcomes — literally ‘shaping their brains to read.’ “

Funding: The study was funded by a Procter Scholar Award from the Cincinnati Children’s Research Foundation. Potential conflicts of interest: Dr. John Hutton conceived and wrote the children’s book featured in this study.

Dr. Hutton is the founder of blue manatee press, the publisher/distributor of The Reading House, though receives no salary or other compensation for this role.

The Reading House is not intended for sale in retail, library or other direct-to-consumer channels. Its intended use is as a screening tool, distributed at low-cost to clinical practices, preschools and organizations.

Royalties, if any, are determined via intellectual property policies at Cincinnati Children’s Research Foundation. The other authors have no financial relationships relevant to this article to disclose.

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About this literacy research news

Source: Cincinnati Children’s Hospital
Contact: Shannon Kettler – Cincinnati Children’s Hospital
Image: The image is credited to Cincinnati Children’s

Original Research: Closed access.
Validation of The Reading House and Association With Cortical Thickness” by John S. Hutton, Jonathan Dudley, Guixia Huang, Tzipi Horowitz-Kraus, Thomas DeWitt, Richard F. Ittenbach and Scott K. Holland. Pediatrics


Validation of The Reading House and Association With Cortical Thickness

BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics recommends literacy and school readiness promotion during well visits. The Reading House (TRH) is a children’s book–based screener of emergent literacy skills in preschool-aged children. Vocabulary, rhyming, and rapid naming are core emergent skills, and reading abilities are associated with thicker cortex in the left hemisphere. Our objective was to expand validity of TRH relative to these skills and explore association with cortical thickness.

METHODS: Healthy preschool-aged children completed MRI including a T1-weighted anatomic scan. Before MRI, TRH and assessments of rapid naming (Comprehensive Test of Phonological Processing, Second Edition), rhyming (Pre-Reading Inventory of Phonological Awareness), vocabulary (Expressive Vocabulary Test, Second Edition), and emergent literacy (Get Ready to Read!) were administered. Analyses included Spearman-ρ correlations (rρ)accounting for age, sex, and socioeconomic status (SES). MRI analyses involved whole-brain measures of cortical thickness relative to TRH scores, accounting for covariates.

RESULTS: Seventy children completed assessments (36–63 months old; 36 female) and 52 completed MRI (37–63 months; 29 female). TRH scores were positively correlated with Comprehensive Test of Phonological Processing, Second Edition (rρ = 0.61), Expressive Vocabulary Test, Second Edition (rρ = 0.54), Get Ready to Read! (rρ = 0.87), and Pre-Reading Inventory of Phonological Awareness scores (rρ = 0.64; all P < .001). These correlations remained statistically significant across age, sex, and SES groups. TRH scores were correlated with greater thickness in left-sided language and visual cortex (P–family-wise error <.05), which were similar for higher SES yet more bilateral and frontal for low SES, reflecting a less mature pattern (P–family-wise error <.10).

CONCLUSIONS: These findings expand validation evidence for TRH as a screening tool for preschool-aged children, including associations with emergent skills and cortical thickness, and suggest important differences related to SES.


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