Cognitive Brain Research and Innovative Community Partnerships are Helping Schoolchildren Read by Helping Teachers Teach

by Tom O’Neill

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“When you cannot read at third grade, you cannot do math at 10th grade. You cannot graduate. You cannot go to college.” — Uma Kotagal, MBBS, MSc

At birth, the human brain is wired to do some pretty instinctive things, like using fine motor skills to grasp a rattle or a parent’s finger. But as babies become toddlers and beyond, grasping the abstract concepts of reading requires a bit more finesse. 

The neural wiring must be developed and nurtured. 

“And that makes sense,” says Tom DeWitt, MD, Director of the Division of General and Community Pediatrics, “because you have to see and integrate all these visual and emotional parts. There’s decoding. All these parts of the brain interact, so you have develop those pathways.”

Today, research at Cincinnati Children’s is driving an innovative partnership with Cincinnati Public Schools (CPS) to improve children’s literacy, particularly the crucial benchmark of third-grade proficiency. 

The chart illustrates the significant rate of improvement in the percentage of targeted 3rd-graders who met national proficiency benchmarks (to 61 percent from 43 percent) in reading. In a control group, students with similar achievement levels at four non-targeted schools declined to 35 percent from 39 percent.

Our Reading and Literacy Discovery Center (RLDC) uses research to shape its evaluations and interventions for at-risk children at CPS and throughout the region. The RLDC specialists provide reports that describe each child’s performance and suggest resources and strategies that parents, teachers and tutors can use to help improve proficiency.

A child’s brain is a complicated canvas.

Reading energizes neural circuits

In a widely cited May 2015 paper in Pediatrics, lead author John Hutton, MD, and colleagues including RLDC Program Director Tzipi Horowitz-Kraus, PhD, demonstrated for the first time positive correlation between exposure to books and reading at home prior to kindergarten and differences in brain activity supporting literacy development and imagination. They have since published a series of groundbreaking, follow-up studies looking at other aspects of parent-child reading. This evidence has reinforced the view of reading as a critical aspect of brain development and health, and its integration into pediatric primary care.

Researchers at the RLDC have also provided new insights on the education front. Using regression maps, Horowitz-Kraus and colleagues illustrated positive correlation between narrative comprehension at ages 5 to 7 and subsequent scores on word-identification tests at age 11. These scientific insights are informing CPS’ approach to better educating at-risk children.

“Honestly, getting access to Cincinnati Children’s in this journey, it brought a different and wonderful perspective,” says Cheryl Broadnax, Assistant Superintendent of Early Childhood Education at CPS. “It has allowed us to speed up interventions and better analyze data points. We’re asking the deeper questions now.

“That’s been a huge part of this partnership,” she says. “It was fascinating to us, bringing all this knowledge together.” 

Teaching teachers works

The partnership began in 2016 with half-hour, twice-weekly “huddle calls” between Cincinnati Children’s improvement experts, reading experts and a designated group of elementary school teachers.

The goal was to provide teachers with access to real-time data on reading progress, along with training on novel intervention methods. The huddle approach made a rapid difference. 

In four schools participating in the pilot program, the percentage of 3rd-graders reaching or exceeding national proficiency benchmarks grew from 43 percent in the fall quarter of 2016 to 61 percent by the winter quarter. 

Conversely, in a control-group of four non-targeted schools with similar achievement levels, scores declined by four percent-age points, to 35 percent from 39 percent.  

The improvement at the targeted schools also contributed to an overall improvement for CPS in 3rd-grade reading proficiency from an “F” to a “C,” according to an Ohio report card on school performance released in September 2017. 

“The things we learned,” Broadnax says, “spread rapidly throughout the district.” 

Since starting with 15 teachers from five CPS elementary schools, the program has grown to more than 60 educators at 13 schools.

An unexpected “boost” from reading

In a May 2017 study published in the journal PLOS ONE, a team of scientists led by Hutton demonstrated that engaging with 4-year-old children while reading books together seems to “turbocharge” their language and learning brain circuits.

Using video observation and functional magnetic resonance imaging (fMRI), researchers found significantly greater brain activation in children who were more highly engaged during story listening.

The study reinforces the value of “dialogic reading,” where the child is encouraged to actively participate in the story, and eventually becomes the storyteller. A related study published in the Journal of Pediatrics in December 2017, which documented stronger brain function in children whose mothers read more interactively with them reinforced these findings. Coauthors included DeWitt,Horowitz-Kraus, Scott Holland, PhD, and Mekbib Altaye, PhD.

In research led by John Hutton, MD, scans from a functional connectivity map of brain areas connected with a seed activation cluster illustrate how those areas correlate with child-engagement scores during story listening tasks. Clusters of activation are shown at coordinates: A (top row, image four), B, third row, image three), C (bottom row, image two) and D (third row, image four). Study authors note that while an estimated 5–12 percent of reading difficulty is rooted in an organic etiology such as dyslexia, the majority is attributable to inadequate motivation and/or stimulation required to learn to read.

“The takeaway for parents is that they should engage more when reading with their child, ask questions, have them turn pages, and get more actively involved,” says Hutton, a clinical researcher in the RLDC and the Division of General and Community Pediatrics. “In turn, this helps ‘boost’ brain activation supporting critical early literacy skills such as imagery and comprehension. And it’s more fun, too!”

The studies and others conducted by the RLDC have focused on preschool-age children during a rapid span of brain growth and development who are preparing for kindergarten and beyond, emphasizing the major role of interactive reading at home. This is especially important given the disparities many children face, some arriving at kindergarten having never seen a book or with parents who are not strong readers themselves, DeWitt says. 

It takes a village … of researchers, specialists, educators and parents

Improving 3rd grade reading proficiency is one of the major priorities of the All Children Thrive Learning Network, an initiative launched by Cincinnati Children’s in conjunction with several community agencies interested in child health. 

Network participants focused on reading include teams of teachers, reading specialists, parents and agency partners including the United Way, the Success by Six Coalition, 4C’s Child Care Resource Center, Community Action Agency/Head Start, and the Strive Partnership.

“Literacy at third grade is a very important predictor of future outcomes,” says Uma Kotagal, MBBS, MSc, a senior fellow at Cincinnati Children’s and Executive Leader for Population and Community Health. “When you cannot read at third grade, you cannot do math at 10th grade. You cannot graduate. You cannot go to college. As a result, long-term health outcomes decline, and life expectancy suffers.”

While literacy can be seen as a vital measure of child health, Cincinnati Children’s sees its role as being a convener and catalyst when it comes to tackling the issue, Kotagal says. Cincinnati Children’s provides expertise in improvement science techniques, while educators, families, and community leaders play the central role in setting goals and doing the work.

With encouraging signs of progress so far, the All Children Thrive network plans to further expand the reading program with-in CPS in 2018 as well as to begin exporting lessons learned to school districts in other states.

“Community buy-in is fundamental,” says DeWitt, who leads the 3rd-grade reading task force at Cincinnati Children’s. “That’s one of the exciting things going on in the community-health area. Block by block, leaders are creating a culture where reading is as important as anything you can do for a child.”

At CPS, Broadnax calls these the ‘ah-hah’ moments of the classroom. “It just really changed our culture,” she says. “It’s powerful for teachers to have that space to be much more analytical. 

“To ask, ‘Am I giving every kid what they need?’ ” she says.

The answers to that question could help shape and nurture the “reading brains” of future researchers and doctors. Maybe even a reading specialist or two.