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  • Author
    Anthony Gobran
  • Co-author

    Anthony Gobran, Vincent Liu, Alison Bailey Ed.D, Ed.M, and Sai Iyer, MD

  • Title

    Screening for Early Literacy Delays in Preschool Children

  • Abstract

    Screening for Early Literacy Delays in Preschool Children



    Children develop early literacy skills in the preschool age that are predictive of their later reading abilities. (2) Screening for early literacy delays in the preschool years allows for early intervention, prior to school entry.  Such screenings are being done in select preschools but are not universally accessible to all preschool-aged children. All children do visit their primary care physician prior to school entry. Therefore, the 4-year-old Well Child Care(WCC) visit presents the ideal opportunity for universal literacy screening.


    In previous studies, the principal investigator developed two screening measures for this purpose:

    1. Early Literacy Screener (ELS): This is a 5-item parent questionnaire for 4 and 5-year-old children designed to predict the risk of later reading failure.(4)
    2. Early Literacy Skills Assessment Tool (ELSAT): This is a 10-item picture book-based clinician-administered assessment for 4-year-old children that predicts risk of later reading failure.(5)




    The aim of this study is to validate the ELS and ELSAT against standard reference measures of language and early literacy (Peabody Picture Vocabulary Test [PPVT], Get Ready to Read-Revised [GRTR-R], and Comprehensive Test of Phonological Processing-2 [CTOPP-2]) and home literacy environment (Stim-Q Preschool) in multiple community-based preschool sites.




    Since this is a validation study, our goal is to recruit 4-year-old children and their parents as efficiently as possible before testing the tools in a clinical setting. We plan to recruit 150 four-year-old children and their parents. For this 8-week portion of the project, we recruited 17 children from 3 UCLA-associated preschools: University Village, the Fernald Child Development Center, and the Kreiger Early Child Care Center. In the future, children and their families will be recruited from the LA Unified School District (LAUSD), as well as from partnerships with Head Start preschools.


    Power analysis:

    Based on our previous studies, with an expected failure rate of 35%, a sample size of 150 will provide a margin of error less than 15% for sensitivity and specificity for ELS such that the 95% confidence interval (CI) will be (0.80, 0.94) and (0.35, 0.63) respectively.

    For the ELSAT, with an expected failure rate of 40%, a sample size of 150 will provide a margin of error less than 11% for sensitivity and specificity of ELSAT such that the 95% CI will be (0.84, 0.96) and (0.60, 0.82) respectively.


    The study was approved by the Instituitional Review Board at UCLA. Additional approvals were sought from the leadership of the participating preschools.


    Written, informed consent was obtained from participating families. Parents who consented were asked to fill out an initial questionnaire that asks about patient and family characteristics, demographic information, and previous diagnosis of developmental delay or neuro-disability in their child. Parents will be compensated for their time with a $20 gift card. 


    Children were assessed using the ELSAT and the following reference measures:

      1. Peabody Picture Vocabulary Test (PPVT)
      2. Get Ready to Read- Revised (GRTR-R)
      3. Comprehensive test of phonological processing 2 (CTOPP2)


    Results of each child’s performance in the reference measures will be shared with their parents along with information about resources for those who score below the average range on any one of the reference measures.



    The children were tested individually in an isolated area away from distractions in their preschools. The ELSAT and the CTOPP2 were administered to all children by a single examiner. A second trained research assistant administered PPVT and a third trained research assistant administered the GRTR-R . No direct feedback or praise will be provided to the children during the testing, except for reminders to stay on task, as needed. The testing was completed in a single sitting and children were given a sticker when they completed the testing.


    Inclusion Criteria: 

    Only 4-year-old children from families that speak English as their primary language will be eligible since the test measures are only available in English.


    Exclusion Criteria: 

    Children with a prior diagnosis, per parent report, of a known developmental disability that precludes their active participation in the assessments will be excluded.  


    Statistical Analyses:

    For this portion of the study, correlations of ELSAT with PPVT, GRTR-R and CTOPP-2 were computed. We will also examine the correlation of the ELS vis-à-vis the reference measures. When the data collection is complete, we will generate Receiver Operating Characteristic (ROC) curves and corresponding sensitivities and specificities and area under the curve (AUC) will be calculated for different cut-off scores, for the ELS and ELSAT separately. 


    Future studies:

    After successful completion of this project, our next steps will be to study the feasibility and validity of these tools in clinical practice and conduct a randomized controlled trial of literacy screening versus usual care in primary care pediatric settings. We also plan a longitudinal follow-up of children assessed with the ELS and ELSAT and determine the predictive validity of these measures.




    The results presented below represent our initial pilot data from 17 children. The mean age of the study sample was 55.8 months (S.D.5.9). There were 9 girls (53%)  in the sample.

    The mean scores in the ELS and all reference measures are shown in Table 1. The correlations between the ELSAT and reference measures are shown in Table 2.







    Mean (S.D)

    ELSAT (Max score 10)

    7.5 (2.9)

    PPVT (Standard score)

    128.4 (13.2)

    GRTR-R (Standard Score)

    104.1 (11.3)

    CTOPP-2 (Composite Score)

    114 (9.1)



    Table 2

    Pearson’s Correlation










    Our preliminary results from this sample is similar to our previous findings,with the ELSAT showing strong correlation with the GRTR-R and the PPVT and modest correlation with the CTOPP-2. Given that our current sample is from a higher socio-economic group, it will be important to see how the ELSAT performs in children from middle and lower income groups. 



    The 10-item ELSAT shows promise as a brief, practical screening tool for early literacy delays in preschool children.







    Early Literacy Skills AssessmentTool


    Show me the name of the book.


    Which line do I read last?


    What is this letter?









    Letter sound association

    What sound does this letter make (point to H)?


    What sound does this letter make (point to S)?



    What word rhymes with ‘stout’? 



    Word segmentation

    Say the word ‘downstairs’ without saying ‘down




    1. Ahearn, Katie. Reach Out and Read. “Where Great Stories Begin: Congress Recognizes the Importance of Pediatric Early Literacy Programs.” 10 Dec 2015. Web. 11 Mar 2018.
    2. Whitehurst GJ LC. Child development and emergent literacy. Child Dev. 1998;69:848-72.
    3. Bailet LL, Repper KK, Piasta SB, Murphy SP. Emergent literacy intervention for prekindergarteners at risk for reading failure. Journal of learning disabilities. 2009;42(4):336-55. doi: 10.1177/0022219409335218. PubMed PMID: 19398614.
    4. Iyer SN, Sawyer MI, Germany M, Super DM, Needlman RD. Development of a 5-item parent questionnaire to screen preschool children for reading problems. Clin Pediatr (Phila). 2014;53(6):571-8. doi: 10.1177/0009922814521285. PubMed PMID: 24480812.
    5. Iyer SN DD, Tibbs M, Hattrup K, Malcarne V, Akshoomoff N, Berger S, Gahagan S, Needlman RD. Screening for delayed early literacy skills in preschool children. 2017.


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