Learning Disabilities: A Multifaceted Health Threat J. Floyd Williams, OD J. Floyd Williams, OD, is Chief, Vision Therapy Services, College of Optometry, University of Houston, Houston, Texas. “Hold on!” you say. “Learning disabilities are educational problems, not health problems.” While the concept of the “interdisciplinary team approach,” including health care and social counselors, has received much lip service for several years, the opening exclamatory sentence is still common. However, if we broaden our viewpoint and think of learning disabilities in the context of the total child and society, learning disabilities have many if not all of the basic characteristics of health problems. When we think of health problems we often first envision epidemics and death resulting from unhealthy conditions. The World Health Organization in 1948 characterized health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”’ With this in mind, any classroom teacher can attest to the impact of learning disabilities on a child’s social and mental well-being. The child faced with one failure after another in the classroom and on the playground often resorts to antisocial behavior to disguise failures and vent frustrations. In addition, learning disabled children develop low levels of self-esteem which further complicate remedial and guidance procedures. The prevalence of learning disabilities is difficult to assess from the literature. Various reports and studies set the incidences of learning disabilities at 9 to 209i,3q4of all school age children. The reason for the range is the result of varying definitions for learning disabilities’ and differences in test instruments and professionals utilized to assess the conditions. However, even if just 10% of our children contracted diphtheria or cholera, the local health department would declare an epidemic and help initiate coordinated community efforts to control the spread and limit the impact of the disease. The end result of most untreated, uncontrolled health threats is increased morbidity or mortality within the population. This last point of the analogy may be difficult to see but happens to be the most significant. Death is defined as a “permanent ending of life.” THE JOURNAL OF SCHOOL HEALTH

The basic end result of the “disease,” learning disability, is the academic crippling of a child, thus preventing him from taking advantage of subsequent life opportunities. Such a state of unrealized potential is equivalent to “death,” not in a physical sense, but in a mental and social sense. The afflicted individual first becomes a burden to the family, then the community, and finally a burden to society in general. To substantiate this one needs only turn to the often ignored high incidence (often as high as 90%)6*7* of juvenile delinquents who were underachievers or non-achievers, school and social dropouts. To help in the conceptualization of learning disabilities as “diseases,” Figure 1 plots the natural history of learning disabilities on a format suggested by Leave11 and Clark ( 1965). Even though Figure 1 is not all inclusive or exhaustive, the complexity and multitude of interactions which influence the prevalence of learning disabilities is apparent thus demonstrating the multifaceted nature of this health threat. As indicated in the Pre-Pathogenesis Period, there are several predisposing factors relating to learning disabilities. While the correlations are generally small, case histories reveal that many of these factors influence the critical early years of human development. These factors range from heredity through improper teaching within the educational system. One of the greatest hopes for preventing learning disabilities rests in the manipulation of environmental factors.

*

basedl

Unfortunately most of the Pre-Pathogenesis Period proceeds with little thought of future problems. The child often enters kindergarten (Early Pathogenesis Period) with faulty readiness skills, that is, without the basic skills needed to take instructions or benefit from routine educational techniques. For example, good vision and hearing are important for a child to match what he sees with what he hears to gain meaning. Inconsistencies in either system may cause confusion resulting in specific learning disabilities in reading and writing. As a result of academic failure, many children react emotionally. A child may become hyperactive 515

Fig. 1 NATURAL HISTORY OF LEARNING DlSABlLlTlES Factors contributing to the occurrence and distribution of learning disabilities functionally “dead

Individual factors 1. Age 2. Sex

3. Physical 4. Mental

5. etc.

F l i n q u e n c y and Crime 1

5. Antisoeial behavior

Environmental factors 1. Prenatal 2. Postnatal 3. Family stability 4. Socio-economic status 5. Education system 6. etc.

4. General drop in achievement due to a. inattentiveness b. poor self-esteem

CLINICAL HORIZON 3. Emotional reaction a. inappropriate behavior b. etc.

Agent Factors 1. Heavy metals 2. etc.

Interactions produce Inciting Factors

2. Specific learning problems a. cannot read b. cannot write 1. Faulty development of “readiness skills”

Re-Pathogenesis Period

exhibiting a short attention span similar to hyperactive behavior of a purely organic origin. I t is often at this point of the Natural History that the problem becomes apparent. The classroom teacher or parents cannot fully explain or fully remediate the problem and many seek professional help. The “clinical horizon” or the point at which the threat is generally recognized as a problem needing attention is relative depending on the awareness of parents and professionals involved. However, the unfortunate truth is that still too many learning disabled children are not identified until some inappropriate behavior occurs. This late in the course of events, remediation is more difficult. For this reason, the concept of early detection also emerges along with the need for interdisciplinary teams to make early diagnosis and suggestions for remedial care. The need for both, early detection and a team approach, is generally accepted. However, learning disabilities must also be universally recognized for what they truly arecripplers and debilitators of children, leaving scars for life as illustrated by points 4-7 of the Period of Pathogenesis. Granted, many children are spared this dismal sequence of events: however, many join society’s dropouts becoming criminal in nature. Dollar assessment of such societal liabilities are incalculable when we consider the enormous waste of human potential involved. 516

a. normal vision b. normal hearing c. normal sensory-motor integrations

Period of Pathogenesis

By developing models of the natural history of the condition, learning disability, avenues and strategies for remediation and prevention may be formulated. It is obvious from the complexities of interacting factors contributing to learning disabilities that a comprehensive team approach is mandatory. Further, the need for early identification of “at risk’’ children is desirable to prevent secondary mental health and social problems. Finally, the model presented here reaffirms the experience of all investigators and teachers that there is no single, never changing causative factor or treatment for the multifaceted health threats, learning disabilities.

REFERENCES 1. Wilner DM, Walkley RP, Goerke LG: Introduction to Public Health, ed 6. New York, MacMillan Publishing Co, 1973, p 65. 2. Mandell SJ: The detection of learning disorders in school, in Carter DB(ed):Interdisciplinary Approaches to Learning Disorders: A Symposium by thirteen contributors. New York, Chilton Book Co, 1970. 3. Money JE(ed): Reading Disability. Baltimore, Johns Hop kins Press, 1962. 4. Morse WC, Cutter RL, Fink AH: Public School Classes for the Emotionally Handicapped: A Research Analysis. The Council for Exceptional Children, National Education Assoc, 1964. 5. Winkley CK: Administrative procedures in guiding programs for the underachievers in reading, in Robinson HA(ed): The Underachiever in Reading. Supplementary Educational Monograph, No 92, Chicago, University of Chicago Press, 1962.

NOVEMBER 1976 VOLUME XLVl NO. 9

6. Dzik D: Vision and the juvenile delinquent. J Am Optom ASSOC31:2461-2468, 1966. 7. Dzik D: Behavioral optometric vision-A practical and comprehensive plan for juvenile delinquency control. Optom Weekly 59:23-29, 1968.

8. Tarnopol L: Delinquency and minimal brain dysfunction.

J Lm Disabil 3:200-207. 1910.

9. Leave11 HR, Clark EG: Preventive Medicine for the Doctor in His Community: An Epidemological Approach New York, McGraw Hill, 1965, p 18.

The author of this article is J. Floyd Williams, OD, chief, Vision Therapy Services, College o f Optometry, University of Houston, Houston, TX 77004.

Strong Interest in Fiber Increases Bran Cereal Consumption

Widespread interest in the fiber content of the American diet has resulted in a surge in consumption of bran cereals, the Cereal Institute has reported. Total pound sales of readyto-eat bran cereals have increased 20% during the last year. (Data from A.C. Nielsen Company). “Consumers have reacted strongly to widely publicized medical studies reporting health benefits from diets in which the amount of fiber is greater than in most American diets,” Dr. Robert B. Gravani. Ph.D., Science Director, Cereal Institute, Inc., stated. Much of the current interest in fiber results from reports by Dr. D.P. Burkitt, a British surgeon, who observed that rural Africans whose diets are high in fiber-containing foods have a low incidence of several important diseases, including appendicitis, hemorrhoids, diverticular disease and cancer of the colon. Since these same diseases are much more prevalent in the United States and other countries where diets are low in fiber, researchers theorize that lack of fiber may play a role in the development of these diseases. Fiber, present only in foods of plant origin, is not digested by the human body b u t passes through the digestive tract and is eliminated as waste. It absorbs moisture and adds bulk to food materials, and as a result body waste is eliminated more frequently. Scientists who recommend increased fiber in the American diet theorize that the greater bulk and more frequent elimination of body wastes provide important health benefits by protecting against several diseases of the large intestine. Some other scientists, however, state that extensive clinical research will be required to determine whether these theories are valid, and do not recommend large quantities of dietary fiber until more knowledge is available. While many foods of plant origin contain fiber, the amount varies from one type of food to another. Some breakfast cereals are convenient sources of fiber, with bran-types especially good. As an aid to consumers who wish to include more fiber in their diets, the percentage of fiber in breakfast cereals containing significant amounts is increasingly being shown on packages. The amount of crude fiber in the following foods is: Approximate Percentage of Crude Fiber High bran content cereals 40% bran cereals

Raisin bran cereals Wheat germ Whole wheat cereals (shredded, flaked or formed) Hot whole wheat cereals Hot oat cereals Whole wheat bread

THE JOURNAL OF SCHOOL HEALTH

1.5 3.5 2.5 2.0 1.8 1.8 1.1 1.6

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Learning disabilities: a multifaceted health threat.

Learning Disabilities: A Multifaceted Health Threat J. Floyd Williams, OD J. Floyd Williams, OD, is Chief, Vision Therapy Services, College of Optomet...
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