Preventing Reading Disability in Preterm and Full Term Children

Who is Eligible: Children aged 6 years and 0 months to 6 years and 11 months who are in the first grade. Children may either have been born prematurely before 32 weeks gestation or at term at 37 weeks or beyond. Children must be below average in reading skills at the time of enrollment.

Principal Investigator: Heidi Feldman, MD, PhD

Research Coordinator: Aubrey Adiao / Email: dbpresearch@stanford.edu / Phone: (650) 498-7690

OUR RESEARCH

We know how important reading has become in the modern era. By 2020, 65% of all jobs in the United States will require more training than a high school diploma. The ability to read well is an important ingredient to succeeding in post-secondary education and obtaining high-paying jobs. Reading skills vary across the population. Children who are delayed in the early stages of learning to read rarely catch up to good readers without intervention. A large body of research has identified strategies that help children learn to read at these young ages.  Often parents would like to help their children improve reading and don’t know how to do that.

Children born preterm, especially those born before 32 weeks of gestation, are at high risk of poor reading skills compared to children born at term. We have conducted NIH-funded research projects that document lower scores in reading, language, and cognitive skills in children born preterm compared to peers born at term. Surprisingly, we do not know whether reading skills in children born preterm can improve if they receive extra support in learning to read in the early grades.

Our research has also found that reading skills are related to properties of long-range white matter pathways in the brain. These pathways are important for linking brain regions that must collaborate in the reading process. The properties of the pathways are different in children born preterm and at term. The associations with reading also vary.

Now, we are embarking on a new study to test if reading skills in children born preterm can be improved through an intervention and whether that intervention changes the properties of the brain. We are enrolling children who are between ages 6 and 7, in the first grade, and either born prematurely before 32 weeks gestation or were born at term at 37 weeks or beyond. All participants must be below average in reading at the time of enrollment in the study.

All participants’ families will have access to a reading enrichment tutorial about the importance of shared reading between parents and children.  Half of the group will also be given the opportunity to use an internet-accessed, game-like program that provides instruction focused on sound-letter correspondence, phonics, and blending. We want to test whether we can see improvements in reading skills and whether the interventions change the properties of those long-range white matter pathways in the brain.

The study has high clinical and educational significance. Nearly half of very low and extremely low gestational age preterm children are eventually diagnosed with learning disorders, including reading disorders. If successful, this intervention might reduce the prevalence of reading disorders in this group. Little is known about how to prevent or treat reading disorders secondary to preterm birth. An effort to improve reading outcomes in children born preterm falls under the rubric of Precision Education, an extension of Precision Medicine, the initiative to customize biological, environmental, or behavioral interventions for conditions, such as prematurity, that cannot yet be prevented or cured.

The study will also contribute to theories about the neurobiology of learning to read. We will obtain MRI scans prior to the intervention and after intervention. We will combine different scanning techniques that help to explain how the white matter tracts of the brain change with experience. Children born preterm show distinctive features of white matter tracts in the early stages of learning to read and differing patterns of association between white matter metrics and reading at older ages. This study will establish whether learning causes similar or distinctive patterns of white matter plasticity in the two birth groups.

WHAT IS INVOLVED?

  1. Phone screening to determine your child's eligibility
  2. Testing sessions assessing reading and related skills
  3. Magnetic resonance imaging scans
  4. Reading enrichment training or computerized intervention
  5. Two additional testing sessions and two additional MRI scans

WHAT IS AN MRI SCAN AND WHAT DOES THE SCAN INVOLVE?

MRI scans use a strong magnet to take images of the brain. The scan does not expose your child to x-rays or radiation. Your child will be given earplugs to protect them from noise and may watch a movie.

WHAT ARE THE COSTS AND BENEFITS?

  • There are no costs to you or your child.
  • We will reimburse you $20 per visit for your travel costs.
  • We will compensate your child $10 at the end of each time point.
  • The reading intervention may improve your child's reading skills.