Child-Based Risk Factors

Diverse group of 3 kindergarten students

Individual children may come to school with conditions that make them more likely to experience trouble learning to read. Find out more about these conditions, such as cognitive, hearing, or language problems.

Physical and clinical conditions

Some primary organic conditions are associated with the development of learning problems as secondary symptoms. That is, the child's reading and more general learning problems are thought to result from cognitive or sensory limitations that follow from the primary diagnosis. These primary conditions include:

  • Severe cognitive deficiencies
  • Hearing impairment
  • Chronic otitis media
  • (Specific) early language impairment
  • Attention deficit/hyperactivity disorder

Cognitive deficiencies

Children with severe cognitive deficiencies usually develop very low, if any, reading achievement. Other factors that are associated with developmental delays in cognitive abilities include severe nutritional deficiency, very low birth weight, fetal alcohol syndrome, lead poisoning, and severe psychopathological conditions that emerge in early childhood.

Hearing impairment

Hearing impairment or deafness is another condition well documented to be associated with reading difficulty (Conrad, 1979; Karchmer et al., 1978; Waters and Doehring, 1990).

Chronic ear infections (chronic otitis media) often lead to intermittent hearing loss during the early years. Concern has thus been raised regarding the effects of this on language development and, later, on reading. For chronic otitis media and reading difficulties, results are mixed. Wallace and Hooper (1997) reviewed 18 studies examining chronic otitis media and reading and noted a modest association between the two for language-based skills such as reading.

Early language impairment

Although there is tremendous variability in the rate with which children acquire language during their first four years of life, some children are so clearly behind by age 3 that it arouses concern on the part of their parents, neighbors, preschool teachers, pediatricians, or others.

In many such cases, delayed language development is the first indication of a broader primary condition, such as a general developmental disability, autism, hearing impairment, or neurological condition, which is likely to be associated with reading difficulty.

In other cases, however, an evaluation by a speech-language professional results in a diagnosis of "(specific) early language impairment"(ELI) and usually the initiation of a course of therapy designed to stimulate language growth in one or more domains.

There have been more than a dozen follow-up studies of the later academic achievements of children who were clinically identified as having specific early language impairment. In this work, the sampling criteria, the initial skill levels of the children, and the measures of outcome status have not always been well specified and are rarely comparable from study to study; nevertheless, several general trends are evident.

First, between 40 and 75 percent of preschoolers with early language impairment develop reading difficulties later, often in conjunction with broader academic achievement problems (Aram and Hall, 1989; Bashir and Scavuzzo, 1992).

Second, the risk for reading problems appears to be lowest among those whose early language weaknesses were relatively mild or were confined to a narrow domain (especially to speech production alone). Nevertheless, some children with only mild-to-moderate language delays, who appear to overcome their spoken-language difficulties by the end of the preschool period, remain at greater risk than other youngsters for the development of a reading difficulty (e.g., Scarborough and Dobrich, 1990; Stark et al., 1984; Stothard et al., in press).

Third, regardless of a child's general cognitive abilities or therapeutic history, in general the risk for reading problems is greatest when a child's language impairment is severe in any area, broad in scope, or persistent over the preschool years (e.g., Stark et al., 1984; Bishop and Adams, 1990).

Attention deficits

Although good evidence indicates that attention deficit/hyperactivity disorder and reading disability are distinct disorders, they frequently co-occur. Longitudinal follow-up indicates that, from the beginning of formal schooling, reading disability is relatively common in children with inattention problems (31 percent in first grade), becoming even more frequent as the child matures (over 50 percent in ninth grade — S.E. Shaywitz et al., 1994; B.A. Shaywitz et al., 1995a).

Other conditions

A visual impairment is not in itself a predictor of reading difficulty. If not correctable, it makes the reading of printed text impossible, so the visually impaired child must instead learn to read Braille manually.

Because Braille notation for English text is alphabetic, and because discovering the alphabetic principle is often the biggest obstacle to children in learning to read, many of the same risk factors that have been identified for sighted children also presumably apply. Unless these or some other Braille-specific processing difficulties (such as poor manual discrimination) are present, there is probably no higher risk for reading difficulties among blind children than among sighted children, provided that early and adequate instruction in reading Braille is provided.


Click the "References" link above to hide these references.

Aram, D.M., and N.E. Hall. (1989). Longitudinal follow-up of children with preschool communication disorders: Treatment implications. School Psychology Review 18(4):487-501.

Bashir, A.S., and A. Scavuzzo. (1992). Children with language disorders: Natural history and academic success. Journal of Learning Disabilities 25(1):53-65.

Bishop, D.V.M., and C. Adams. (1990). A prospective study of the relationship between specific language impairment, phonological disorders and reading retardation. Journal of Child Psychology and Psychiatry 31:1027-1050.

Conrad, R. (1979). The Deaf School Child. London: Harper and Row.

Karchmer, M.A., et al. (1978). Early Manual Communication, Parental Hearing Status, and the Academic Achievement of Deaf Students. Paper presented at the American Education Research Association Annual Meeting, March 1978, Toronto, Ontario, Canada.

Scarborough, H.S., and W. Dobrich. (1990). Development of children with early language delays. Journal of Speech and Hearing Research 33:70-83.

Shaywitz, B.A., J.M. Fletcher, and S.E. Shaywitz. (1995a). Defining and classifying learning disabilities and attention-deficit/hyperactivity disorder. Journal of Child Neurology 10(Supplement 1):S50-S57.

Shaywitz, S.E., J.M. Fletcher, and B.A. Shaywitz. (1994). Issues in the definition and classification of attention deficit disorder. Topics in Language Disorders 14(4):1-25.

Stark, R., L. Bernstein, R. Condino, M. Bender, P. Tallal, and H. Catts. (1984). Four year follow-up study of language-impaired children. Annals of Dyslexia 34:49-68.

Stothard, S.E., M.J. Snowling, D.V.M. Bishop, B.B. Chipchase, and C.A. Kaplan. (In Press). Language impaired pre-schoolers: A follow-up into adolescence. Journal of Speech and Hearing Research.

Wallace, I.F., and S.R. Hooper. (1997). Otitis media and its impact on cognitive, academic, and behavioral outcomes: A review and interpretation of the findings. In Otitis Media in Young Children, J.E. Roberts, I.F. Wallace, and F.W. Henderson, eds. Baltimore: Brookes Publishing Co.

Waters, G.S., and D.G. Doehring. (1990). The nature and role of phonological information in reading acquisition: Insights from congenitally deaf children who communicate orally. In Reading and Its Development: Component Skills Approaches, T. Carr and B.A. Levy, eds. San Diego: Academic Press.

Excerpted from: Snow, C. E., Burns, S. M., & Griffin, P. Editors. (1998). Preventing Reading Difficulties in Young Children, Chapter 4: Predictors of Success and Failure in Reading.. National Research Council, National Academy of Sciences. Courtesy of National Academy Press. Reprinted with permission.


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