Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Reading difficulty in children: Normal reading development and etiology of reading difficulty

S Sutton Hamilton, MD
Section Editors
Marc C Patterson, MD, FRACP
Carolyn Bridgemohan, MD
Deputy Editor
Mary M Torchia, MD


Reading is critical to the academic, economic, and social success of children [1]. However, many children complete schooling without achieving more than basic literacy [2]. Pediatric clinicians are well positioned to identify children at risk for reading difficulties and children who have unexpected difficulties in learning to read. Early identification and timely intervention for such children improve long-term outcome.

The epidemiology, etiology, and pathogenesis of reading difficulty in children will be reviewed here. The clinical evaluation, diagnosis, and treatment are discussed separately. (See "Reading difficulty in children: Clinical features and evaluation" and "Reading difficulty in children: Interventions".)

General issues related to learning disabilities also are discussed separately. (See "Definitions of specific learning disability and laws pertaining to learning disabilities in the United States" and "Specific learning disabilities in children: Clinical features" and "Specific learning disabilities in children: Educational management".)


Literacy development is a process that begins in infancy and has a natural hierarchy of progression. Literacy develops in parallel with language, but in contrast to language, which is natural and inherent, reading is acquired and must be taught (table 1) [3]. (See "Emergent literacy including language development".)

The transition from prereading to reading skills usually begins when children enter school [4]. At this stage, children begin to associate written letters with sounds. They gradually learn to recognize all of the letters within a word and to map the letters onto the correct sound. With repeated exposure, and reading words in context, children are able to recognize certain words automatically.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Jul 03, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. McLaughlin MJ, Speirs KE, Shenassa ED. Reading disability and adult attained education and income: evidence from a 30-year longitudinal study of a population-based sample. J Learn Disabil 2014; 47:374.
  2. Murnane RJ. Improving the education of children living in poverty. Future Child 2007; 17:161.
  3. Shaywitz SE, Gruen JR, Shaywitz BA. Management of dyslexia, its rationale, and underlying neurobiology. Pediatr Clin North Am 2007; 54:609.
  4. Grizzle KL. Developmental dyslexia. Pediatr Clin North Am 2007; 54:507.
  5. Alexander AW, Slinger-Constant AM. Current status of treatments for dyslexia: critical review. J Child Neurol 2004; 19:744.
  6. National Reading Panel, National Institute of Child Health and Human Development, National Institutes of Health. Teaching children to read. Reports of the subgroups. http://www.nichd.nih.gov/health/topics/national_reading_panel.cfm (Accessed on October 16, 2012).
  7. Schatschneider C, Torgesen JK. Using our current understanding of dyslexia to support early identification and intervention. J Child Neurol 2004; 19:759.
  8. Vellutino FR, Fletcher JM, Snowling MJ, Scanlon DM. Specific reading disability (dyslexia): what have we learned in the past four decades? J Child Psychol Psychiatry 2004; 45:2.
  9. Sesma HW, Mahone EM, Levine T, et al. The contribution of executive skills to reading comprehension. Child Neuropsychol 2009; 15:232.
  10. Cutting LE, Materek A, Cole CA, et al. Effects of fluency, oral language, and executive function on reading comprehension performance. Ann Dyslexia 2009; 59:34.
  11. Fletcher JM, Lyon GR, Fuchs LS, Barnes MA. Learning Disabilities, The Guilford Press, New York 2007.
  12. American Psychiatric Association. Specific learning disorder. In: Diagnostic and Statistical Manual of Mental Disorders, 5th ed, American Psychiatric Association, Arlington, VA 2013. p.66.
  13. Catts HW, Hogan TP, Fey ME. Subgrouping poor readers on the basis of individual differences in reading-related abilities. J Learn Disabil 2003; 36:151.
  14. Harlaar N, Cutting L, Deater-Deckard K, et al. Predicting individual differences in reading comprehension: a twin study. Ann Dyslexia 2010; 60:265.
  15. Lyon GR. Learning disabilities. Future Child 1996; 6:54.
  16. Francis DJ, Shaywitz SE, Stuebing KK, et al. Developmental lag versus deficit models of reading disability: A longitudinal, individual growth curves analysis. J Educ Psychol 1996; 88:3.
  17. Shaywitz SE, Escobar MD, Shaywitz BA, et al. Evidence that dyslexia may represent the lower tail of a normal distribution of reading ability. N Engl J Med 1992; 326:145.
  18. Shapiro BK, Palmer FB, Antell SE, et al. Detection of young children in need of reading help. Evaluation of specific reading disability formulas. Clin Pediatr (Phila) 1990; 29:206.
  19. Vellutino FR, Scanlon DM, Lyon GR. Differentiating between difficult-to-remediate and readily remediated poor readers: more evidence against the IQ-achievement discrepancy definition of reading disability. J Learn Disabil 2000; 33:223.
  20. Snowling M, Bishop DV, Stothard SE. Is preschool language impairment a risk factor for dyslexia in adolescence? J Child Psychol Psychiatry 2000; 41:587.
  21. Stage SA, Abbott RD, Jenkins JR, Berninger VW. Predicting response to early reading intervention from verbal IQ, reading-related language abilities, attention ratings, and verbal IQ-word reading discrepancy: failure to validate discrepancy method. J Learn Disabil 2003; 36:24.
  22. Shaywitz SE, Shaywitz BA. Dyslexia (specific reading disability). Pediatr Rev 2003; 24:147.
  23. International Dyslexia Association. Definition of dyslexia. interdys.org/FactSheets.htm (Accessed on October 16, 2012).
  24. Lyon GR, Shaywitz SE, Shaywitz BA. A definition of dyslexia. Ann Dyslexia 2003; 53:1.
  25. Catts HW, Fey ME, Tomblin JB, Zhang X. A longitudinal investigation of reading outcomes in children with language impairments. J Speech Lang Hear Res 2002; 45:1142.
  26. Lee J, Grigg WS, Donahue PL. The Nation's Report Card: Reading 2007. nces.ed.gov/nationsreportcard/pubs/main2007/2007496.asp#pdflist (Accessed on October 16, 2012).
  27. Lerner JW. Educational interventions in learning disabilities. J Am Acad Child Adolesc Psychiatry 1989; 28:326.
  28. Démonet JF, Taylor MJ, Chaix Y. Developmental dyslexia. Lancet 2004; 363:1451.
  29. Interagency Committee on Learning Disabilities. Learning disabilities: a report to the U.S. Congress, Government Printing Offices, Washington, DC 1987.
  30. Shaywitz SE, Fletcher JM, Shaywitz BA. Issues in the definition and classification of attention deficit disorder. Top Lang Disord 1994; 14:1.
  31. Flynn JM, Rahbar MH. Prevalence of reading failure in boys compared with girls. Psychol Sch 1994; 31:66.
  32. Wadsworth SJ, DeFries JC, Stevenson J, et al. Gender ratios among reading-disabled children and their siblings as a function of parental impairment. J Child Psychol Psychiatry 1992; 33:1229.
  33. Shaywitz SE, Shaywitz BA, Fletcher JM, Escobar MD. Prevalence of reading disability in boys and girls. Results of the Connecticut Longitudinal Study. JAMA 1990; 264:998.
  34. Snowling MJ, Muter V, Carroll J. Children at family risk of dyslexia: a follow-up in early adolescence. J Child Psychol Psychiatry 2007; 48:609.
  35. Pennington BF, Lefly DL. Early reading development in children at family risk for dyslexia. Child Dev 2001; 72:816.
  36. Torppa M, Eklund K, van Bergen E, Lyytinen H. Parental literacy predicts children's literacy: a longitudinal family-risk study. Dyslexia 2011; 17:339.
  37. Bishop DV, Adams C. A prospective study of the relationship between specific language impairment, phonological disorders and reading retardation. J Child Psychol Psychiatry 1990; 31:1027.
  38. Rescorla L. Language and reading outcomes to age 9 in late-talking toddlers. J Speech Lang Hear Res 2002; 45:360.
  39. Litt J, Taylor HG, Klein N, Hack M. Learning disabilities in children with very low birthweight: prevalence, neuropsychological correlates, and educational interventions. J Learn Disabil 2005; 38:130.
  40. Stanovich KE, Siegel LS. Phenotypic performance profile of children with reading disabilities: a regression-based test of the phonological-core variable-difference model. J Educ Psych 1994; 86:24.
  41. Vellutino FR, Scanlon DM, Spearing D. Semantic and phonological coding in poor and normal readers. J Exp Child Psychol 1995; 59:76.
  42. Pennington BF. Genetics of learning disabilities. J Child Neurol 1995; 10 Suppl 1:S69.
  43. Fisher SE, Francks C, Marlow AJ, et al. Independent genome-wide scans identify a chromosome 18 quantitative-trait locus influencing dyslexia. Nat Genet 2002; 30:86.
  44. Habib M. The neurological basis of developmental dyslexia: an overview and working hypothesis. Brain 2000; 123 Pt 12:2373.
  45. Grigorenko EL, Wood FB, Meyer MS, et al. Susceptibility loci for distinct components of developmental dyslexia on chromosomes 6 and 15. Am J Hum Genet 1997; 60:27.
  46. Morris DW, Robinson L, Turic D, et al. Family-based association mapping provides evidence for a gene for reading disability on chromosome 15q. Hum Mol Genet 2000; 9:843.
  47. Temple E, Deutsch GK, Poldrack RA, et al. Neural deficits in children with dyslexia ameliorated by behavioral remediation: evidence from functional MRI. Proc Natl Acad Sci U S A 2003; 100:2860.
  48. Temple E, Poldrack RA, Protopapas A, et al. Disruption of the neural response to rapid acoustic stimuli in dyslexia: evidence from functional MRI. Proc Natl Acad Sci U S A 2000; 97:13907.
  49. Shaywitz SE, Shaywitz BA, Pugh KR, et al. Functional disruption in the organization of the brain for reading in dyslexia. Proc Natl Acad Sci U S A 1998; 95:2636.
  50. Creavin AL, Lingam R, Steer C, Williams C. Ophthalmic abnormalities and reading impairment. Pediatrics 2015; 135:1057.
  51. Shaywitz SE. Dyslexia. N Engl J Med 1998; 338:307.
  52. Center for the Improvement of Early Reading. Put Reading First: The Research Building Blocks for Teaching Children to Read, 3rd ed, 2006. http://lincs.ed.gov/publications/pdf/PRFbooklet.pdf (Accessed on October 16, 2012).
  53. Scanlon DM, Vellutino FR. Prerequisite skills, early instruction, and success in first-grade reading: Selected results from a longitudinal study. Ment Retard Dev Disabil Res Rev 1996; 2:54.
  54. Bradley L, Bryant PE. Categorizing sounds and learning to read - a causal connection. Nature 1983; 301:419.
  55. Stanovich KE, Cunningham AE, Cramer BB. Assessing phonological awareness in kindergarten children: issues of task comparability. J Exp Child Psychol 1984; 38:175.
  56. Torgesen JK, Wagner RK, Rashotte CA. Longitudinal studies of phonological processing and reading. J Learn Disabil 1994; 27:276.
  57. Catts HW, Adlof SM, Ellis Weismer S. Language deficits in poor comprehenders: a case for the simple view of reading. J Speech Lang Hear Res 2006; 49:278.
  58. Kelso K, Fletcher J, Lee P. Reading comprehension in children with specific language impairment: an examination of two subgroups. Int J Lang Commun Disord 2007; 42:39.
  59. Wise JC, Sevcik RA, Morris RD, et al. The relationship among receptive and expressive vocabulary, listening comprehension, pre-reading skills, word identification skills, and reading comprehension by children with reading disabilities. J Speech Lang Hear Res 2007; 50:1093.
  60. Nation K, Clarke P, Marshall CM, Durand M. Hidden language impairments in children: parallels between poor reading comprehension and specific language impairment? J Speech Lang Hear Res 2004; 47:199.
  61. Goldman SR. Adolescent literacy: learning and understanding content. Future Child 2012; 22:89.
  62. Hensler BS, Schatschneider C, Taylor J, Wagner RK. Behavioral genetic approach to the study of dyslexia. J Dev Behav Pediatr 2010; 31:525.
  63. Harlaar N, Spinath FM, Dale PS, Plomin R. Genetic influences on early word recognition abilities and disabilities: a study of 7-year-old twins. J Child Psychol Psychiatry 2005; 46:373.
  64. Hawke JL, Wadsworth SJ, DeFries JC. Genetic influences on reading difficulties in boys and girls: the Colorado twin study. Dyslexia 2006; 12:21.
  65. Astrom RL, Wadsworth SJ, DeFries JC. Etiology of the stability of reading difficulties: the longitudinal twin study of reading disabilities. Twin Res Hum Genet 2007; 10:434.
  66. Francks C, MacPhie IL, Monaco AP. The genetic basis of dyslexia. Lancet Neurol 2002; 1:483.
  67. Pennington BF, Gilger JW. How is dyslexia transmitted?. In: Developmental dyslexia: neural, cognitive, and genetic mechanisms, Chase CH, Rosen GD, Sherman GF (Eds), York Press, Baltimore 1996 1996. p.41.
  68. Olson RK. Dyslexia: nature and nurture. Dyslexia 2002; 8:143.
  69. Schumacher J, Hoffmann P, Schmäl C, et al. Genetics of dyslexia: the evolving landscape. J Med Genet 2007; 44:289.
  70. Smith SD, Pennington BF, Kimberling WJ, Ing PS. Familial dyslexia: use of genetic linkage data to define subtypes. J Am Acad Child Adolesc Psychiatry 1990; 29:204.
  71. Fagerheim T, Raeymaekers P, Tønnessen FE, et al. A new gene (DYX3) for dyslexia is located on chromosome 2. J Med Genet 1999; 36:664.
  72. Petryshen TL, Kaplan BJ, Hughes ML, et al. Supportive evidence for the DYX3 dyslexia susceptibility gene in Canadian families. J Med Genet 2002; 39:125.
  73. Roeske D, Ludwig KU, Neuhoff N, et al. First genome-wide association scan on neurophysiological endophenotypes points to trans-regulation effects on SLC2A3 in dyslexic children. Mol Psychiatry 2011; 16:97.
  74. Williams J, O'Donovan MC. The genetics of developmental dyslexia. Eur J Hum Genet 2006; 14:681.
  75. Schumacher J, Anthoni H, Dahdouh F, et al. Strong genetic evidence of DCDC2 as a susceptibility gene for dyslexia. Am J Hum Genet 2006; 78:52.
  76. Petryshen TL, Pauls DL. The genetics of reading disability. Curr Psychiatry Rep 2009; 11:149.
  77. Paracchini S, Thomas A, Castro S, et al. The chromosome 6p22 haplotype associated with dyslexia reduces the expression of KIAA0319, a novel gene involved in neuronal migration. Hum Mol Genet 2006; 15:1659.
  78. Eicher JD, Powers NR, Miller LL, et al. Characterization of the DYX2 locus on chromosome 6p22 with reading disability, language impairment, and IQ. Hum Genet 2014; 133:869.
  79. Gibson CJ, Gruen JR. The human lexinome: genes of language and reading. J Commun Disord 2008; 41:409.
  80. Scerri TS, Morris AP, Buckingham LL, et al. DCDC2, KIAA0319 and CMIP are associated with reading-related traits. Biol Psychiatry 2011; 70:237.
  81. Ashkenazi S, Black JM, Abrams DA, et al. Neurobiological underpinnings of math and reading learning disabilities. J Learn Disabil 2013; 46:549.
  82. Ozernov-Palchik O, Gaab N. Tackling the 'dyslexia paradox': reading brain and behavior for early markers of developmental dyslexiax. Wiley Interdiscip Rev Cogn Sci 2016; 7:156.
  83. Langer N, Peysakhovich B, Zuk J, et al. White Matter Alterations in Infants at Risk for Developmental Dyslexia. Cereb Cortex 2017; 27:1027.
  84. Molfese DL. Predicting dyslexia at 8 years of age using neonatal brain responses. Brain Lang 2000; 72:238.
  85. van Herten M, Pasman J, van Leeuwen TH, et al. Differences in AERP responses and atypical hemispheric specialization in 17-month-old children at risk of dyslexia. Brain Res 2008; 1201:100.
  86. Guttorm TK, Leppänen PH, Richardson U, Lyytinen H. Event-related potentials and consonant differentiation in newborns with familial risk for dyslexia. J Learn Disabil 2001; 34:534.
  87. Schiavone G, Linkenkaer-Hansen K, Maurits NM, et al. Preliteracy signatures of poor-reading abilities in resting-state EEG. Front Hum Neurosci 2014; 8:735.
  88. American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists. Joint statement--Learning disabilities, dyslexia, and vision. Pediatrics 2009; 124:837.
  89. Keys MP. The pediatrician's role in reading disorders. Pediatr Clin North Am 1993; 40:869.
  90. Olitsky SE, Nelson LB. Reading disorders in children. Pediatr Clin North Am 2003; 50:213.
  91. Ritchie SJ, Della Sala S, McIntosh RD. Irlen colored overlays do not alleviate reading difficulties. Pediatrics 2011; 128:e932.
  92. Cotton MM, Evans KM. A review of the use of Irlen (tinted) lenses. Aust N Z J Ophthalmol 1990; 18:307.