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

Reading difficulty in children: Interventions

S Sutton Hamilton, MD
Section Editors
Carolyn Bridgemohan, MD
Marc C Patterson, MD, FRACP
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.

Interventions for children with reading difficulty in children will be discussed here. Normal reading development and the epidemiology, etiology, clinical features, and evaluation of reading difficulty are discussed separately. (See "Reading difficulty in children: Normal reading development and etiology of reading difficulty" and "Reading difficulty in children: Clinical features and evaluation".)

General issues related to educational interventions for children with learning disability and the evolution of laws related to special education in the United States also are discussed separately. (See "Specific learning disabilities in children: Educational management" and "Definitions of specific learning disability and laws pertaining to learning disabilities in the United States".)


A variety of terms are used to describe reading problems. Different terms may be used in different settings and by different groups (eg, educators, healthcare providers). Definitions for the terms that are used in this topic review are provided below. A detailed discussion of terminology is provided separately. (See "Reading difficulty in children: Normal reading development and etiology of reading difficulty", section on 'Terminology and conceptual framework'.)

Reading difficulty — "Reading difficulty" is defined from a normative perspective (ie, how a child performs in reading compared with peers or educational expectations) [3]. Reading difficulty has a number of causes, one of which is reading disability.

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: Nov 2017. | This topic last updated: Nov 16, 2016.
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. Fletcher JM, Lyon GR, Fuchs LS, Barnes MA. Learning Disabilities, Guilford Press, New York 2007.
  4. American Psychiatric Association. Specific learning disorder. In: Diagnostic and Statistical Manual of Mental Disorders, 5th ed, American Psychiatric Association, Arlington, VA 2013. p.66.
  5. 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.
  6. Shaywitz SE, Shaywitz BA. Dyslexia (specific reading disability). Pediatr Rev 2003; 24:147.
  7. International Dyslexia Association. Definition of dyslexia. interdys.org/FactSheets.htm (Accessed on October 04, 2011).
  8. Lyon GR, Shaywitz SE, Shaywitz BA. A definition of dyslexia. Ann Dyslexia 2003; 53:1.
  9. Shaywitz SE, Gruen JR, Shaywitz BA. Management of dyslexia, its rationale, and underlying neurobiology. Pediatr Clin North Am 2007; 54:609.
  10. Foorman BR, Breier JI, Fletcher JM. Interventions aimed at improving reading success: an evidence-based approach. Dev Neuropsychol 2003; 24:613.
  11. National Reading Panel, National Institute of Child Health and Human Development, National Institutes of Health. Teaching children to read. Reports of the subgroups www.nationalreadingpanel.org/Publications/subgroups.htm (Accessed on October 04, 2011).
  12. Alexander AW, Slinger-Constant AM. Current status of treatments for dyslexia: critical review. J Child Neurol 2004; 19:744.
  13. Olitsky SE, Nelson LB. Reading disorders in children. Pediatr Clin North Am 2003; 50:213.
  14. National Early Literacy Panel. Developing Early Literacy: Report of the National Early Literacy Panel. National Institute for Literacy, Jessep, MD 2008. www.nifl.gov/earlychildhood/NELP/NELPreport.html (Accessed on October 04, 2011).
  15. Ohgi S, Loo KK, Mizuike C. Frontal brain activation in young children during picture book reading with their mothers. Acta Paediatr 2010; 99:225.
  16. Zuckerman B, Augustyn M. Books and reading: evidence-based standard of care whose time has come. Acad Pediatr 2011; 11:11.
  17. Council on Early Childhood, High PC, Klass P. Literacy promotion: an essential component of primary care pediatric practice. Pediatrics 2014; 134:404.
  18. Yeager Pelatti C, Pentimonti JM, Justice LM. Methodological review of the quality of reach out and read: does it "work"? Clin Pediatr (Phila) 2014; 53:343.
  19. Mendelsohn AL, Mogilner LN, Dreyer BP, et al. The impact of a clinic-based literacy intervention on language development in inner-city preschool children. Pediatrics 2001; 107:130.
  20. High PC, LaGasse L, Becker S, et al. Literacy promotion in primary care pediatrics: can we make a difference? Pediatrics 2000; 105:927.
  21. Theriot JA, Franco SM, Sisson BA, et al. The impact of early literacy guidance on language skills of 3-year-olds. Clin Pediatr (Phila) 2003; 42:165.
  22. Duursma E, Augustyn M, Zuckerman B. Reading aloud to children: the evidence. Arch Dis Child 2008; 93:554.
  23. Needlman R, Toker KH, Dreyer BP, et al. Effectiveness of a primary care intervention to support reading aloud: a multicenter evaluation. Ambul Pediatr 2005; 5:209.
  24. Weitzman CC, Roy L, Walls T, Tomlin R. More evidence for reach out and read: a home-based study. Pediatrics 2004; 113:1248.
  25. Rikin S, Glatt K, Simpson P, et al. Factors Associated With Increased Reading Frequency in Children Exposed to Reach Out and Read. Acad Pediatr 2015; 15:651.
  26. Torgesen JK, Morgan S, Davis C. The effects of two types of phonological awareness training on word learning in kindergarten children. J Educ Psychol 1992; 84:364.
  27. Ball EW, Blachman BA. Does phoneme awareness training in kindergarten make a difference in early word recognitition and developmental spelling? Read Res Q 1991; 26:49.
  28. Wise BW, Olson RK. Computer-based phonological awareness and reading instruction. Ann Dyslexia 1995; 45:99.
  29. Foorman BR, Francis DJ, Beeler T, et al. Early interventions for children with reading problems: study designs and preliminary findings. Learn Disabil 1997; 8:63.
  30. Lyon GR. Toward a definition of dyslexia. Ann Dyslexia 1995; 45:3.
  31. Oakland T, Black JL, Stanford G, et al. An evaluation of the dyslexia training program: a multisensory method for promoting reading in students with reading disabilities. J Learn Disabil 1998; 31:140.
  32. Schatschneider C, Torgesen JK. Using our current understanding of dyslexia to support early identification and intervention. J Child Neurol 2004; 19:759.
  33. Cohen J. Statistical power for behavioral sciences, 2nd ed, Lawrence Erlbaum, Mahwah, NJ 1988.
  34. Suggate SP. A Meta-Analysis of the Long-Term Effects of Phonemic Awareness, Phonics, Fluency, and Reading Comprehension Interventions. J Learn Disabil 2016; 49:77.
  35. Galuschka K, Ise E, Krick K, Schulte-Körne G. Effectiveness of treatment approaches for children and adolescents with reading disabilities: a meta-analysis of randomized controlled trials. PLoS One 2014; 9:e89900.
  36. McArthur G, Eve PM, Jones K, et al. Phonics training for English-speaking poor readers. Cochrane Database Syst Rev 2012; 12:CD009115.
  37. Pinnell GS, Pikulski JJ, Wixson KK, et al. Listening to children read aloud, US Department of Education Office of Educational Research and Improvement, Washington, DC 1995.
  38. Pikulski JJ, Chard DJ. Fluency: Bridge between decoding and reading comprehension. The Reading Teacher 2005; 58:510.
  39. Shaywitz SE, Morris R, Shaywitz BA. The education of dyslexic children from childhood to young adulthood. Annu Rev Psychol 2008; 59:451.
  41. Assisting students struggling with reading: Response to intervention (RtI) and multi-tier intervention in the primary grades. US Department of Education NCEE 2009-4045. National Center for Educational Evaluation and Regional Assistance. http://ies.ed.gov/ncee/wwc/pdf/practice_guides/rti_reading_pg_021809.pdf (Accessed on October 04, 2011).
  42. Multisensory structured Language programs: Content and principles of instruction (1995). www.ldonline.org/article/6332 (Accessed on October 04, 2011).
  43. Shaywitz S. Overcoming dyslexia: A new and complete science-based program for reading problems at any level, Alfred A. Knopf, New York 2003.
  44. Cogo-Moreira H, Andriolo RB, Yazigi L, et al. Music education for improving reading skills in children and adolescents with dyslexia. Cochrane Database Syst Rev 2012; :CD009133.
  45. Rawstron JA, Burley CD, Elder MJ. A systematic review of the applicability and efficacy of eye exercises. J Pediatr Ophthalmol Strabismus 2005; 42:82.
  46. Bull L. Sunflower therapy for children with specific learning difficulties (dyslexia): a randomised, controlled trial. Complement Ther Clin Pract 2007; 13:15.
  47. 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.
  48. Handler SM, Fierson WM, Section on Ophthalmology, et al. Learning disabilities, dyslexia, and vision. Pediatrics 2011; 127:e818.
  49. Ritchie SJ, Della Sala S, McIntosh RD. Irlen colored overlays do not alleviate reading difficulties. Pediatrics 2011; 128:e932.
  50. Tan ML, Ho JJ, Teh KH. Polyunsaturated fatty acids (PUFAs) for children with specific learning disorders. Cochrane Database Syst Rev 2012; 12:CD009398.
  51. Cotton MM, Evans KM. A review of the use of Irlen (tinted) lenses. Aust N Z J Ophthalmol 1990; 18:307.
  52. Albon E, Adi Y, Hyde C. The effectiveness and cost-effectiveness of coloured filters for reading disability: a systematic review. West Midlands Health Technology Assessment Collaboration, Birmingham 2008. www.birmingham.ac.uk/Documents/college-mds/haps/projects/WMHTAC/REPreports/2008/ColouredfiltersforreadingdisabilityFINALVERSION.pdf (Accessed on August 28, 2014).
  53. Vellutino FR, Scanlon DM, Small S, Fanuele DP. Response to intervention as a vehicle for distinguishing between children with and without reading disabilities: Evidence for the role of kindergarten and first-grade interventions. J Learn Disabil 2006; 39:157.
  54. Coyne MD, Kame'enui EJ, Simmons DC, Harn BA. Beginning reading intervention as inoculation or insulin: first-grade reading performance of strong responders to kindergarten intervention. J Learn Disabil 2004; 37:90.
  55. Shaywitz SE, Fletcher JM, Holahan JM, et al. Persistence of dyslexia: the Connecticut Longitudinal Study at adolescence. Pediatrics 1999; 104:1351.
  56. Scarborough HS. Continuity between childhood dyslexia and adult reading. Br J Psychol 1984; 75 ( Pt 3):329.
  57. Felton RH, Naylor CE, Wood FB. Neuropsychological profile of adult dyslexics. Brain Lang 1990; 39:485.
  58. Bruck M. Persistence of dyslexics' phonological awareness deficits. Dev Psychol 1992; 28:874.
  59. Vellutino F, Scanlon D, Jaccard J. Toward distinguishing between cognitive and experiential deficits as primary sources of difficulty in learning to read: A two year follow-up of difficult to remediate and readily remediated poor reade. In: Preventing and Remediating Reading Difficulties: Bringing Science to Scale, Foorman BR (Ed), York Press, Timonium, MD 2003. p.73.
  60. Torgesen JK, Alexander AW, Wagner RK, et al. Intensive remedial instruction for children with severe reading disabilities: immediate and long-term outcomes from two instructional approaches. J Learn Disabil 2001; 34:33.
  61. Bruck M. Word recognition skills of adults with childhood diagnoses of dyslexia. Dev psychol 1990; 26:439.
  62. Hatcher J, Snowling MJ, Griffiths YM. Cognitive assessment of dyslexic students in higher education. Br J Educ Psychol 2002; 72:119.
  63. Grizzle KL. Developmental dyslexia. Pediatr Clin North Am 2007; 54:507.
  64. Francis DJ, Shaywitz SE, Stuebing KK, et al. Developmental lag versus deficit models of reading disabilty: A longitudinal, individual growth curves analysis. J Educ Psychol 1996; 88:3.
  65. Ferrer E, Shaywitz BA, Holahan JM, et al. Achievement Gap in Reading Is Present as Early as First Grade and Persists through Adolescence. J Pediatr 2015; 167:1121.
  66. Denton C, Mathes P. Intervention for struggling readers. In: Preventing and Remediating Reading Difficulties: Bringing Science to Scale, Foorman BR (Ed), York Press, Timonium, MD 2003. p.229.
  67. Arnold EM, Goldston DB, Walsh AK, et al. Severity of emotional and behavioral problems among poor and typical readers. J Abnorm Child Psychol 2005; 33:205.
  68. Goldston DB, Walsh A, Mayfield Arnold E, et al. Reading problems, psychiatric disorders, and functional impairment from mid- to late adolescence. J Am Acad Child Adolesc Psychiatry 2007; 46:25.
  69. Carroll JM, Maughan B, Goodman R, Meltzer H. Literacy difficulties and psychiatric disorders: evidence for comorbidity. J Child Psychol Psychiatry 2005; 46:524.
  70. National Center on Secondary Education and Transition. Dropout and graduation. www.ncset.org/topics/dropout/default.asp?topic=36 (Accessed on May 06, 2014).
  71. Trzesniewski KH, Moffitt TE, Caspi A, et al. Revisiting the association between reading achievement and antisocial behavior: new evidence of an environmental explanation from a twin study. Child Dev 2006; 77:72.