Early screening may detect both early- and late-onset dyslexia

Tami Katzir, PhD, and Rotem Yinon, PhD, head and postdoctoral researcher, respectively, at the Edmond J. Safra Brain Research Center for the Study of Learning Disabilities, discuss emerging evidence that dyslexia risk can be identified far earlier—and more comprehensively—than previously understood, with important implications for pediatric practice.

Traditionally, phonological awareness has been viewed as the strongest early predictor of dyslexia, particularly for children who show reading difficulties in early elementary school. However, Katzir and Yinon emphasize that dyslexia is not a uniform condition. While phonological awareness remains a key marker for early-onset dyslexia, other skills—such as rapid automatized naming and morphological awareness—become more predictive of late-emerging dyslexia, which may not manifest until later grades.

A key innovation discussed is the ability of a brief kindergarten screening—lasting approximately 15 to 20 minutes—to capture risk for both early- and late-emerging dyslexia. This challenges the assumption that children who read adequately in early grades are no longer at risk. Instead, some children may initially appear to develop typically but struggle later as reading demands become more complex. Importantly, these risks are already detectable in kindergarten if developmentally sensitive tools are used.

Katzir and Yinon stress that such screenings are not diagnostic but serve as early warning indicators. They advocate for integrating these brief, digital, and easy-to-administer tools into routine pediatric developmental surveillance. Ideally, screening would occur regularly—potentially annually or even multiple times per year—during well-child visits, alongside assessments of vision, hearing, and motor development. This approach would allow pediatricians to monitor literacy development longitudinally and intervene before children fall significantly behind.

The integration of literacy screening into pediatric care reflects a broader “whole child” approach, recognizing that academic development is closely tied to physical, cognitive, and socioemotional health. Early identification is framed as protective, helping to prevent not only academic struggles but also secondary consequences such as anxiety, low self-esteem, and social difficulties often associated with reading disorders.

Socioeconomic status (SES) is also discussed as an important, though complex, factor. Dyslexia occurs across all SES groups, and reliance on outdated discrepancy models may overlook children—particularly those from higher SES backgrounds—who compensate early because of strong language skills and support systems but later exhibit reading difficulties. A multidimensional screening battery that includes several cognitive-linguistic measures can help ensure more equitable identification across diverse populations.

Looking ahead, an ideal screening protocol, according to Katzir and Yinon, would include multiple measures beginning in kindergarten and continuing through later grades, potentially supplemented by brief socioemotional assessments. Katzir and Yinon conclude that pediatricians are uniquely positioned to act as early gatekeepers in identifying literacy risk, advocating for a shift from a reactive “wait-to-fail” model to a proactive, preventive approach that supports children before significant academic and emotional challenges emerge.

No relevant disclosures.

Reference

Yinon R, Tal D, Shaul-Millear S, Kanat-Maymon Y, Katzir T, Karni A. Kindergarten screening for early (grade 1) and late-emerging (grade 4) dyslexia risk. JAMA Netw Open. 2026;9(3):e263036. doi:10.1001/jamanetworkopen.2026.3036