Kindergarten cognitive deficits linked to dyslexia risk

Researchers have identified a link between distinct patterns of cognitive-linguistic deficits in kindergarten and a greater risk of early- and late-emerging dyslexia, publishing their findings in JAMA Network Open.¹

Literacy has been identified as a core domain of child development and health, making pediatric primary care an opportunity to identify early dyslexia risk. While dyslexia is linked to mental health consequences and reduced educational attainment, timely intervention can improve outcomes.²

“However, the predictive validity of optimal prereading screening measures remains unestablished, representing a critical evidence gap that must be addressed before pediatric implementation,” wrote investigators.¹

Cognitive assessments

The cohort study was conducted to assess the link between cognitive-linguistic skills in kindergarten and both early-emerging (grade 1) and late-emerging (grade 4) dyslexia risk. Participants were selected from a larger Israeli study evaluating reading, writing, arithmetic, cognitive, and linguistic development in Hebrew-speaking children.

Between May and June 2019, kindergarten students underwent assessments of risk measures for dyslexia. This was followed by reading ability assessments when these children were in mid–grade 1 between January and March 2020, and when they were in mid– to late–grade 4 between February and June 2023.

Dyslexia was identified by the 10th percentile cutoff for kindergarten predictors and subsequent word-reading fluency (WRF) outcomes. This was defined as 1.5 standard deviations below the mean and is used to diagnose dyslexia in Diagnostic and Statistical Manual of Mental Disorders criteria for academic skill deficits.

Evaluating cognitive-linguistic domains

Cognitive-linguistic domains assessed included phonological awareness, rapid automatized naming, letter knowledge, and morphological awareness. Investigators measured composite scores across these domains to determine kindergarten risk by averaging raw scores from 2 to 3 tasks.

Children completed 2 timed WRF tasks in grades 1 and 4 to determine their dyslexia risk. These included the Dutch One-Minute Test in grade 1 and the Hebrew version of the Test of Word Reading Efficiency in grade 4. There were 515 Hebrew-speaking children aged a mean 5.9 years at kindergarten assessment included in the final analysis, 55.3% of whom were girls.

Linking kindergarten skills to fluency

Among these patients, a significant association was reported between kindergarten cognitive-linguistic skills and WRF in grades 1 and 4. These associations included a strong link for phonological awareness with grade 1 WRF (r = 0.47) and a weaker link with grade 4 WRF (r = 0.22). For letter knowledge, these correlations were r = 0.43 and r = 0.41, respectively.

Negative correlations were reported between rapid automatized naming and both grade 1 (r = −0.33) and grade 4 (r = −0.34) WRF. This indicates a link between faster naming and increased fluency. Additionally, a correlation of r = 0.29 was reported between morphological awareness and both grade 1 and grade 4 WRF.

Grade 1 WRF deficit risk was significantly increased by letter knowledge and phonological awareness, with ORs of 4.75 and 4.17, respectively. However, no links were reported for rapid automatized naming and morphological awareness. Grade 1 WRF was also significantly associated with later dyslexia risk at grade 4, with an OR of 4.98.

Understanding early- and late-emerging risks

Kindergarten deficits in letter knowledge also remained significantly linked to dyslexia risk in grade 4, and links were also reported for morphological awareness and rapid automatized naming. ORs for these associations were 3.57, 2.56, and 2.39, respectively.

Overall, these results highlighted links between cognitive-linguistic measures in kindergarten and early- and late-emerging dyslexia. Investigators concluded this data highlight the need for surveillance frameworks to be informed by developmentally sensitive screening approaches.

“Pediatricians, as primary health care practitioners, are well positioned to support early identification and intervention, shifting dyslexia care from reactive to preventive and reducing long-term educational and psychosocial consequences,” wrote investigators.

References

1. 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
2. Gaab N, Petscher Y. Screening for early literacy milestones and reading disabilities. Perspect Lang Lit. 2022;48(1):11-18.