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By Kim R. Fitzer and James B. Hale

Image of a brain.

Is Reading Natural?

Reading is not a natural part of human development. Children do not automatically learn how to read and need to be taught to read. Statistics Canada (2009) reported that of all children with disabilities (ages 5 to 14), more than half (59.8%) have learning disabilities (LDs).

Most of these children have a disability in reading (89.6%) (Gabel, Gibson, Gruen, LoTurco, 2010; Semrud-Clikeman, Fine, & Harder, 2005). This may be due to the importance of reading in all academic areas, as studies suggest math and writing LDs are also very common (Shaywitz, 2007; Willis, 2008).

Word Attack Skills, Reading Decoding, and Reading Competency

Defining Terms

  • Phonological Awareness: skill at identifying and manipulating sounds.
  • Phonemic Awareness: understanding that words are made of sounds (44 English phonemes) that can be used to create new words.
  • Grapheme Awareness: understanding that symbols in reading (letters) correspond to sounds.

Early exposure to sounds and letters is critical, even before school begins (Richards, 2009; Tallal, 2012). Children must learn four things:

  1. Awareness that speech is composed of the smallest meaningful units of sounds (phonemes);
  2. Awareness that letters (graphemes) and word parts (morphemes) are visual language symbols;
  3. Recognition that written letters represent the sounds (alphabetic principle);
  4. Understanding that phonemes and morphemes can be manipulated (Segmenting and Blending).

A Common Problem Seen in Early Reading and Word Reading LDs

Children can memorize words by sight instead of developing word attack or reading decoding skills. This is a common problem in children who have reading LDs (Fiorello, Hale, & Snyder, 2006).

This memorizing strategy allows children to guess at most words in the early grades from the initial letter or whole word configuration (shape of word) and still achieve average scores on most reading tests. What they often struggled with is pseudoword reading tasks (e.g., read the words belped, fralt, nockess). Although these children may not be identified with a reading LD, because of their average scores in early grades, later in elementary school they may have significant reading problems (Berninger et al., 2000; Hale et al., 2008).

Why would that lead to reading problems later in school?

In kindergarten, children are exposed to words that are easily memorized, because there aren’t that many of them. However, as the lexicon expands dramatically through elementary school - with approximately 2000 to 3000 new words learned each year (Biemeller, 2003) – this visual memorizing strategy becomes less effective.

These same children cannot memorize enough words over time, and so their word reading and reading comprehension decline with age (Shaywitz, 2003). A child has to decode harder words not visually recognized to link the words to lexical-semantic word memory and their definitions (Biemeller, 2003).

What should parents and teachers do?

It is important to build word attack skills and good understanding of phoneme-grapheme correspondence throughout the early grades (Ramus et al, 2003; Shaywitz et al., 1999). Parents and teachers should watch for children who often guess at words or skip words they don’t know. These children will often read much quicker during silent reading (because of the guessing/skipping strategy) and try to avoid oral reading.  Comprehension too may be better during silent reading because they are able to “fill in the gaps” when they miss a word, and still understand what they read.

The Neuropsychology of Word Reading

There are many brain areas involved in reading competency, even at the basic word reading level (Feifer & Della Toffalo, 2007; Hale & Fiorello, 2004; Shaywtiz, 2005), so problems in one or more of these areas of the brain could lead to reading disabilities.

In a landmark study, Pugh et al. found a functional disconnect between the phonemic and graphemic systems in the inferior parietal lobe, which is likely the most common cause of word reading disability (Fiorello et al., 2006).

Click here to access the handout Brain Areas and Reading Skills.

Reading Fluency/Speed and Reading Comprehension

Reading comprehension requires reading quickly (reading fluency),keeping track of what words are in the sentences (working memory), vocabulary meaning and text conventions (semantics/grammar), and understanding what is read (receptive language) (Berninger & Richards, 2002; Cutting, Materek, Cole, Levine, & Mahone, 2009).

Children must learn six things:

  1. Automatic recognition of words as “pictures” in the brain (sight word recognition);
  2. Quickly retrieving words in visual long-term memory for rapid naming (retrieval/fluency);
  3. Linking read words with word meanings (vocabulary) in long-term memory (lexical/semantic knowledge);
  4. Keeping track of words and meanings for sentences and passages (verbal working memory);
  5. Knowledge of sentence structure and punctuation (grammar);
  6. Linking read words, word meanings, and grammar for understanding (receptive language).

Common Problems Seen in Children with Reading Comprehension LDs

Most proficient readers read words by sight, and some children may be good at word decoding/attack, but they don’t transfer those words to long-term visual memory (Hale & Fioello, 2004). Without automatic sight word recognition, too much effort is spent on decoding and comprehension is impaired (Ehri, 2005; Wolf, Miller, & Donnelly, 2000).

Why would poor sight word recognition lead to reading comprehension problems?

Problems with long-term visual memory can lead to poor sight word recognition. Without a good sight word vocabulary, reading speed is reduced, and working memory is consumed with reading decoding/attack. This does not allow for working memory to keep track of the words read, and comprehension is subsequently impaired (Elliott et al., 2010; Torgesen, Wagner, Rashotte, Burgess, & Hecht, 1997).

This seems in direct contrast with the earlier comments about not allowing children to use a sight word approach only for reading. This is because reading is hierarchical. A child first learns to decode words, then transfer the decoded words to long-term visual memory so the words can be rapidly named, and thus comprehension can develop as word reading competency increases (see Fiorello et al., 2006).

What should teachers do?

It is important to build vocabulary first and foremost, and then decoded words can be translated into reading sight words efficiently. With sight word recognition and reading speed, the demands on working memory are less, and so working memory can be used for reading comprehension to occur.

Watch for children who always try to “sound out” (decode) words, and/or have slow reading speed (Willis, 2008; Wolf, 2007).

The Neuropsychology of Reading Fluency/Speed and Comprehension

There are many brain areas involved in reading comprehension, even if basic word reading and reading speed are adequate (Berninger & Richards, 2002; Feifer & Della Toffalo, 2007; Hale & Fiorello, 2004; Shaywtiz, 2005). Reading comprehension and oral language comprehension are highly related, so any child with receptive or expressive language problems may also have a problem with reading comprehension (Feifer & Della Toffalo, 2007; Roth, Speece, & Cooper, 2002).

Click here to access the handout Brain Areas and Comprehension Skills.

Putting it Together: A Model of Word Reading and Comprehension

There are “fast” and “slow” routes for reading in the brain. In the beginning stages, one learns to decode words using the connection between sound and symbol in the brain’s dorsal stream. But the fastest way to read a word is by sight, which is important for reading fluency and comprehension. Without reading fluency, word reading takes all of one’s working memory, and comprehension is impaired.

So the reader’s goal is to transfer an unknown word from the dorsal stream (word attack) to the ventral stream (automatic sight word reading) (Feifer, Nader, Flanagan, Fitzer, Hicks, 2014). Competency in both decoding and sight word recognition are needed however, with the former proceeding the latter during reading skill development.

Should we teach children to memorize words instead of decoding them?

The answer is NO. It is important to NOT let children try to learn words by sight only (e.g., guessing at words based on initial letter or total word configuration).


Because as the lexicon expands with increasing age there are too many words to try to memorize, so decoding of harder words is necessary for words we don’t automatically recognize by sight, and then we can access them via the slower dorsal stream (Hale & Fiorello, 2004).

What do specific problems with reading look like? What are the implications for intervention?

The following table highlights some of the problems students experience during reading. No one pattern is “clear cut” because reading competencies are interrelated, and there may be more than one of the following problems in the same child, especially if a reading LD is present. However, understanding these patterns is a good first step toward developing effective interventions for children with reading disabilities (Crews & D’Amato, 2010; Feifer & DeFina, 2000; Fletcher & Vaughan, 2009).


Phonetic Coding and Sound/Symbol Association Word Recognition Visual Procssing/Rapid Automatic Naming Reading Comprehension
Difficulty learning  visual letters Difficulty recognizing words and letters in print, may see lip movement when reading May have difficulty with visual discrimination or recognition of letters; makes phonemic equivalent errors Comprehension not impaired for oral language or sentences presented orally, but impaired for written sentences
Difficulty learning sounds for letters Over-relies on sight word approach. Guesses at words by initial letter or whole word configuration Good visual memory may lead to adequate reading performance in early grades (not later grades, where decoding is needed) Comprehension directly related to words misread; as number of inaccurate guesses increases, comprehension declines
Difficulty with sound (phoneme) – symbol (grapheme) association Slow and laborious reading, with many misread words; reads with little expression, but lip movement seen during silent reading Letter reversals, b for d, p for q; m for w, Letter and number inversions; poor memorization of words and linking meaning to read words Comprehension errors frequent as majority of working memory is taxed by decoding, oral comprehension may be adequate
Difficulty breaking apart words or combining parts of words Slow and laborious reading, with many misread words; some sight word reading may be used Re-reads words and skips lines while reading; complains that eyes hurt or rubs eyes; loses place while reading Confuses word order (syntax); Frequent errors in comprehension due to working memory being taxed or poor word relationships
Reasonable phonetic misspellings “akshun” for action Rarely uses punctuation when reading, sounds out all words, even sight words, such as “righut” for the word right Sequencing and tracking  errors, will say “on” for no or “saw” for was;  Complains of eyes hurting or sore when reading, and words or letters move (“jump”) on the page Slow laborious reading interferes with fluency, working memory, and comprehension; often re-reads a passage numerous times before understanding it
Good sound-symbol association for decoding words Recognizes a majority of words taught May not have problems with visual processes, but could have sequential processing problem Working memory problem leads to poor text meaning or connected text understanding; so poor comprehension of sentences and passages despite good word reading

 Most children may experience one or more of these problems during their reading skill development, therefore, it is important to note if the pattern is consistent over time, and resistant to intervention (Crews & D’Amato, 2010; Feifer & Della Toffalo, 2007).

In addition, it is important to recognize that good readers and children with reading LDs differ in their brain function and error patterns, so a good error analysis is critical for developing effective interventions for affected children (Feifer et al, 2014; Cao, Bitan, Chou, Buma, & Booth, 2006; Simos et al., 2005, 2007).

Teaching Reading: Linking Assessment and Intervention

There are a number of valuable resources for teaching children with reading problems and reading LDs. The following evidence-based intervention strategies were developed based on a number of important resources, including Berninger & Wolf (2009), Feifer & Della Toffalo (2007), Fry, 2010; Mercer, Mercer, & Pullen (2008), and Shawitz (2005). Several of these intervention strategies recognize the National Reading Panel (2000) findings that effective reading instruction addresses alphabetics, fluency, and comprehenison. 


Click here to access the handout Interventions for Sound/Symbol Association and Phonetic Coding (K-2).

Click here to access the handout Interventions for Sound/Symbol Association and Phonetic Coding (3+).


Click here to access the handout Interventions for Word Recognition/Automaticity (K-2).

Click here to access the handout Interventions for Word Recognition/Automaticity (3+).


Click here to access the handout Interventions for Reading Fluency (K-2).

Click here to access the handout Interventions for Reading Fluency (3+).


Click here to access the handout Interventions for Reading Comprehension (K-2).

Click here to access the handout Interventions for Reading Comprehension (3+).

Related Resources on the LD@school Website

Click here to access the article WIST Program: A strategy to improve orthographic memory in students with reading disabilities.

Click here to access the article Improving Reading Fluency: Which Interventions are the Most Effective?.

Click here to access the article Integrating Vocabulary Instruction with Reading Comprehension Strategies.

Click here to access the article Direct Instruction of Reading for Elementary-aged Students.

Click here to access the article Effective Vocabulary Strategies for Students with Learning Disabilities.

Additional Resources

Click here to access the resource Phonemic Awareness: Developing Sound Sense.


Biemiller, A. (2003). Vocabulary: Needed if more children are to read well.Reading Psychology24(3-4), 323-335.

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Berninger, V. W. & Richards, T. L. (2002). Brain Literacy for Educators and Psychologists. USA: Academic Press.

Berninger, V. W., & Wolf, B. J. (2009). Teaching students with dyslexia and dysgraphia. New York: Paul H. Brooks Publishing.

Cao, F., Bitan, T., Chou, T. L., Buman, D. D., & Booth, J. R. (2006). Deficient orthographic and phonological representations in children with dyslexia revealed by brain activational patterns. .Journal of Child Psychology and Psychiatry, 47, 1041-1050.

Crews, K. J., & D’Amato, R. C. (2010). Subtyping children’s reading disabilities using a comprehensive neuropsychological measure. Journal of Neuroscience, 119(10), 1615-1639.

Cutting, L. E., Materek, A., Cole, C. A., Levine, T. M., & Mahone, E. M. (2009). Effects of fluency, oral language, and executive function on reading comprehension performance. Annals of Dyslexia, 59(1): 34–54.

Ehri, L. C. (2005). Learning to read words: Theory, findings, and issues. Scientific Studies of Reading, 9(2), 167-188.

Elliott, C. D., Hale, J. B., Fiorello, C. A., Dorvil, C., & Moldovan, J. (2010). Differential Ability Scales–II prediction of reading performance: Global scores are not enough. Psychology in the Schools47(7), 698-720.

Feifer, S. G., & DeFina, P. D. (2000). The neuropsychology of reading disorders: Diagnosis and intervention.Middletown, MD: School Neuropsych Press.

Feifer, S. G., Nader, R. G., Flanagan, D. P., Fitzer, K. R., & Hicks, K. (2014). Identifying Specific

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Fiorello, C. A., Hale, J. B., & Snyder, L. E. (2006). Cognitive hypothesis testing and response to intervention for children with reading problems. Psychology in the Schools43(8), 835-853.

Fletcher, J. M., & Vaughn, S. (2009). Response to intervention: Preventing and remediating academic difficulties. Child Development Perspectives, 3, 30–37.

Fry, E. (2010). How to teach reading (4th ed.). Huntington Beach, CA: Shell Educational.

Gabel, L. A., Gibson, C. J., Gruen, J. R., LoTurco, J. J. (2010). Progress towards a cellular neurobiology of reading disability. Neurobiology of Disease, 38, 173-180.

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Hale, J. B., & Fiorello, C. A. (2004). School neuropsychology: A practioner’s handbook.  New York: Guilford.

Mercer, C. D., Mercer, A. R., & Pullen, P. C. (2010). Teaching students with learning problems (8th ed.). New York: Pearson.

National Reading Panel (2000). Teaching children to read: An evidence-based assessment of the scientific literature on reading and its implications for reading instruction. Washington, DC: US Government.

Pugh, K. R., Mencl, W. E., Shaywitz, B. A., Shaywitz, S. E., Fulbright, R. K., Constable, R. T., ... & Gore, J. C. (2000). The angular gyrus in developmental dyslexia: task-specific differences in functional connectivity within posterior cortex. Psychological science11(1), 51-56.

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Richards, T. L., Aylward, E. H., Berninger, V. W., Field, K. M., Grimme, A. C., Richards, A. L., & Nagy, W. (2006). Individual fMRI activation in orthographic mapping and morpheme mapping after orthographic or morphological spelling treatment in child dyslexics. Journal of Neurolinguistics 19, 56-86.

Roth, F. P., Speece, D. L., & Cooper, D. H. (2002). A longitudinal analysis of the connection between oral language and early reading. The Journal of Educational Research95(5), 259-272.

Semrud-Clikeman, M., Fine, J., & Harder, L. (2005). The school neuropsychology of learning  disabilities. R.K. D’Amato E. Fletcher-Janzen, & C. R. Reynolds (Eds.). Handbook of School Neuropsychology. New York, NY: John Wiley & Sons.

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Simos, P. G., Fletcher, J. M., Sarkari, S., Billingsley-Marshall, R., Denton, C. A., & Papanicolaou, A. C. (2007). Intensive instruction affects brain magnetic activity associated with oral word reading in children with persistent reading disabilities. Journal of Learning Disabilities, 7 (1), 37-48.

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