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Article History

Received: 21 November 2025

Revised: 15 April 2026

Accepted: 23 April 2026

First Online: 14 May 2026

Competing interests

: John Hutton conceived, wrote, and edited The Number Farm , the children’s book and screening tool featured in this study. Dr. Hutton is the founder of Blue Manatee Press, the publisher of The Number Farm , though he receives no salary for this role. The Number Farm is intended to be distributed at low-cost as a screening tool to clinics, preschools, and non-profit organizations. Royalties, if any, are reinvested into the development of other books. The other authors have no financial relationships to disclose.

: This study was approved by the sponsoring institution’s Institutional Review Board. Prior to screening, written informed consent was obtained from the child’s parent.