Suggestions for Secondary Prevention of Reading Failure

Dee M. Lance, Ph.D.
Department of Speech-Language Pathology
University of Central Arkansas, Conway, AR

Brenda L. Beverly, Ph.D.
Department of Speech Pathology and Audiology
University of South Alabama, Mobile, AL

Introduction:

With the "Reading First Component" of the "No Child Left Behind Act of 2001 (US Department of Education, 2002)," our nation's focus on reading instruction and reading disabilities has increased significantly.

In the 1960's, Isabelle Liberman and her colleagues investigated the relationship between children's phonological systems and their reading ability (Brady & Shankweiler, 1991). We now call phonological skills associated with reading "phonemic awareness." Phonemic awareness is defined as an awareness that spoken language consists of a sequence of phonemes (Yopp & Yopp, 2000). Literature linking phonemic awareness and early reading skill is abundant (Adams, 1990).

Educators have been under increased pressure to help all children learn to read for many years. However, during the past decade, speech-language pathologists (SLPs) have entered this arena, debating reading instruction methods and assuming roles as reading interventionists, particularly for children with corresponding speech and language impairments. In 2001, ASHA published a position paper defining the role of the speech-language pathologist with regard to reading intervention. To assist SLPs in these pursuits, effective remediation and intervention techniques for children identified as reading disordered have been identified and employed (Lance, Beverly, Evans, & McCullough, 2003). However, the most important strategy is arguably prevention.

The American Medical Association (AMA) addressed the issue of preventive medicine as early as 1915. The polio vaccine in 1955 propelled disease prevention to new levels (ACPM, 2004). Prevention is not only a medically viable alternative, but is often the socially endorsed and preferred route, as is evident via tobacco, alcohol, drug, AIDS, pregnancy and many other prevention programs fostered across the USA.

Three Levels of Prevention:

ASHA (1999) reviewed three levels of prevention that speech-language pathologists and audiologists should address when appropriate.

Primary prevention refers to stopping pathology before it starts. Typically, primary prevention is outside the scope of practice for SLPs and audiologists. For example, medical treatment for pregnant mothers and fetuses with Rh incompatibility has significantly reduced the incidence of babies born with severe hyperbilirubinemia. Hyperbilirubinemia is a condition of severe jaundice that can result in brain injury and learning disabilities. Therefore, primary prevention of Rh incompatability can prevent associated learning disabilities.

Secondary prevention is early intervention with the intent of impeding or eliminating the progress of the disorder, thereby preventing the most severe outcomes. For instance, exposing infants and young children to books, paper and pencils (i.e., literate artifacts) to foster early knowledge of literacy can be viewed as secondary prevention. SLPs can help create optimal environments for children at risk for reading disability due to developmental delay, genetic predisposition or for those with lower socio-economic status. Another example of secondary prevention is the introduction of rhyme and sound identification to preschoolers who have, or are at risk for, speech and/or language disorders. Speech-language pathologists can play an active role in the secondary level of prevention of reading failures.

Tertiary prevention restores or maximizes function following identification of impairment. An example is targeting reading comprehension of social studies and science texts with a fourth grader who has reading disability. Tertiary prevention is the least desirable preventative strategy, in essence, a last line of defense.
All prevention levels (primary, secondary and tertiary) warrant attention and action, but speech-language pathologists can truly play a preventative role by focusing on secondary prevention of reading problems.