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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.


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