Early Literacy Research Library (ELRL) - Article

Validation of The Reading House and Association With Cortical Thickness

Hutton, J.S., Dudley, J., Huang, G., Horowitz-Kraus, T., DeWitt, T., Ittenbach, R.F., Holland, S.K. (2021) Validation of the Random House and Association with Cortical Thickness. Pediatrics, 147(3), e20201641. ,

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Publication year


core topic(s)

Early Literacy , Pediatric Primary Care

Population Characteristics

Toddler/Preschool , Urban

Exposures, Outcomes, Other

Brain/Neurocognitive , Clinic-Based Programs and Interventions , Language and Literacy Development , School Readiness and Educational Outcomes , Screening and Tools , The Reading House , Validity, Reliability, Feasibility, and Acceptability


The Reading House (TRH) is a children's book-based screener of emergent literacy skills in preschool-aged children. Vocabulary, rhyming, and rapid naming are core emergent skills, and reading abilities are associated with thicker cortex in the left hemisphere. Our objective was to expand validity of TRH relative to these skills and explore association with cortical thickness.


The Reading House (THR).

outcomes evaluated

Emergent literacy skills, cortical thickness, and THR validity.


Healthy children between 3 and 5 years old were recruited at an academic pediatric center and primary care clinics in a large Midwestern city.


Healthy preschool-aged children completed MRI including a T1-weighted anatomic scan. Before MRI, TRH and assessments of rapid naming (Comprehensive Test of Phonological Processing, Second Edition), rhyming (Pre-Reading Inventory of Phonological Awareness), vocabulary (Expressive Vocabulary Test, Second Edition), and emergent literacy (Get Ready to Read!) were administered. Analyses included Spearman-ρ correlations (r ρ) accounting for age, sex, and socioeconomic status (SES). MRI analyses involved whole-brain measures of cortical thickness relative to TRH scores, accounting for covariates.

sample size

n=70 (children completed assessments); n=52 (completed MRI)


Measures of Emergent Literacy Skills:

    • Expressive Vocabulary Test, Second Edition (EVT-2).
    • Comprehensive Test of Phonological Processing, Second Edition (CTOPP-2; rapid object naming subtest).
    • Get Ready to Read! (GRTR).
    • Pre-Reading Inventory of Phonological Awareness (PIPA; rhyming subscale).

Measure of Cortical Thickness: structural and functional MRI imaging.


Seventy children completed assessments (36-63 months old; 36 female) and 52 completed MRI (37-63 months; 29 female). TRH scores were positively correlated with Comprehensive Test of Phonological Processing, Second Edition (r ρ = 0.61), Expressive Vocabulary Test, Second Edition (r ρ = 0.54), Get Ready to Read! (r ρ = 0.87), and Pre-Reading Inventory of Phonological Awareness scores (r ρ = 0.64; all P < .001). These correlations remained statistically significant across age, sex, and SES groups. TRH scores were correlated with greater thickness in left-sided language and visual cortex (P-family-wise error <.05), which were similar for higher SES yet more bilateral and frontal for low SES, reflecting a less mature pattern (P-family-wise error <.10).


These findings expand validation evidence for TRH as a screening tool for preschool-aged children, including associations with emergent skills and cortical thickness, and suggest important differences related to SES.


Although these findings expand validation evidence for TRH, including neurobiological correlates, predictive validity has yet to be established, which requires a longitudinal design. TRH was administered by CRCs during an MRI visit and it is possible that results would not generalize to other settings. The sample was largely of higher SES (67% nonpoverty) and results might be different with greater diversity. Conservative Spearman correlations were used instead of regression models for cognitive analyses, yet these generated robust results accounting for subgroups of age, sex, and SES. Reduced sample sizes for SES subgroups in MRI analyses did not survive at FWE P < .05 yet did for FWE P < .10, and in each case, stringent correction and two-sided approach reduced the likelihood of false-positives. Differences in MRI and cognitive results related to SES may be considered a strength because these align in terms of quantifying reading readiness (ie, lower TRH scores and less efficient thickness pattern for the low-SES group), suggest adversity-informed approaches to guidance, and raise questions for further research.