Year: 2026
Type: article
Study design: Observational Study
Abstract: Importance: Pediatric primary care offers a unique opportunity for early dyslexia screening, yet validated prereading measures capturing the full spectrum of developmental risk are absent from standard assessments, representing a critical gap in preventive care. Establishing predictive validity of these measures is essential before clinical implementation. Objective: To examine whether and to what extent deficits in 4 cognitive-linguistic domains in kindergarten estimate risk for both early-emerging (grade 1) and late-emerging (grade 4) dyslexia. Design, Setting, and Participants: This prospective longitudinal cohort study was conducted at 128 kindergartens and 60 public elementary schools representing diverse socioeconomic backgrounds in northern Israel from May 2019 to June 2023. Hebrew-speaking children who demonstrated age-appropriate nonverbal abilities (as assessed with the Raven Progressive Matrices) were included. Exposures: Exposures included 4 cognitive-linguistic measures, (1) phonological awareness, (2) rapid automatized naming, (3) letter knowledge, and (4) morphological awareness, assessed in kindergarten (May to June 2019). Main Outcomes and Measures: The primary outcome was dyslexia risk in grades 1 (January to March 2020) and 4 (February to June 2023), defined as word-reading fluency at or below the 10th percentile. Cognitive-linguistic and word-reading fluency composite scores were computed by averaging raw scores from 2 to 3 tasks. Logistic regression was used to estimate associations of cognitive-linguistic measures with dyslexia risk, which were expressed as odds ratios (ORs) with 95% CIs. Results: Among 515 Hebrew-speaking children (285 girls [55.3%]; mean [SD] age, 5.9 [0.4] years), kindergarten deficits in letter knowledge (OR, 4.75; 95% CI, 2.04-11.04; P < .001) and phonological awareness (OR, 4.17; 95% CI, 2.05-8.47; P < .001) were associated with a 4- to 5-fold increased risk of dyslexia in grade 1. Deficits in letter knowledge (OR, 3.57; 95% CI, 1.53-8.31; P = .003), morphological awareness (OR, 2.56; 95% CI, 1.09-5.97; P = .03), and rapid automatized naming (OR, 2.39; 95% CI, 1.05-5.43; P = .04) were associated with a 2.4- to 3.6-fold increased risk of dyslexia in grade 4, independently of grade 1 risk (OR, 4.98; 95% CI, 2.22-11.13; P < .001). Conclusions and Relevance: In this cohort study of 515 children followed from kindergarten through grades 1 and 4, distinct patterns of cognitive-linguistic deficits in kindergarten were associated with 2- to 5-fold increased risk for early- and late-emerging dyslexia. These findings provide a foundational evidence base to support the integration of developmentally sensitive screening into pediatric surveillance frameworks, facilitating early identification and a shift from reactive to preventive care, including for children at risk of late-emerging dyslexia.
Source: JAMA Network Open
Institutions: University of Haifa, Reichman University
Language: English
Subfield: Developmental and Educational Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,000
Funder: University of Haifa
OpenAlex ID: W7140187491