Learning Disabilities: Implications for Health Education Phil Heit, EdD Timothy E. Heron, EdD

INTRODUCTION Health educators generally agree that the goal of health education is to help individuals learn how to achieve a reasonable level of health as well as to motivate them to follow practices which contribute to a state of health and well-being. To reinforce this idea, former President Richard Nixon stated “. . . it is in the interest of our entire country to educate and encourage each of our citizens to develop sensible health practices.” To meet the goal of promoting well-being, health professionals emphasize prevention - that is, early identification of potential health problems is stressed so as to minimize the chances of these problems requiring treatment. Thus, school health educators concerned about illicit drug use, cigarette smoking, and other forms of unhealthy behaviors seek to prevent the adoption of these practices. In the classroom, health educators use many teaching techniques in order to provide accurate information, clarify values and attitudes, promote responsible decision making, and influence health behavior. To be successful, we must first assess the specific needs of our students, and second, we must clearly identify the tasks most appropriate to meet these needs. Health educators must be able to identify accurately the underlying causes of unhealthy behavior. The literature is replete with the need to build a positive selfconcept as a prerequisite for promoting “high level wellness,” a phrase so aptly coined by Halbert Dunn. Yet, if health educators fail to correctly identify the factors predisposing toward particular health practices, our ability to promote positive self-concept as well as its result - positive health behavior - is thwarted. 174

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The following example is an experience of one of the authors which illustrates the need for health educators to examine possible motivating forces of negative adaptations. During the course of a conversation, Linda mentioned that she had been readmitted recently to college on academic probation. She had been dismissed after her sophomore year due to poor grades. This appeared to be unusual since she conversed intelligently, appeared physically and emotionally healthy and did not seem troubled. As we spoke, she indicated that her grades in high school were borderline pass. Teachers often told her and her parents that she was not bright, even though she studied a great deal. Linda did not fare well on examinations. However, she was supported continuously by her parents. There were points in Linda’s life when she had a desire to drop out of high school. She also seriously considered using drugs. Fortunately, she did not choose that route. One day Linda and her home economics professor were reviewing an examination that was poorly written. Professor Smith noticed that Linda’s exam paper contained statements, the sequence of which were illogical when compared to the class lecture. At this point, Linda was referred to a reading specialist who diagnosed a learning disability.

This situation has a great deal of significance to the health educator. Although health texts and professional journals in our field make note of the many causes of poor health practices, none has emphasized the relationship between learning disabilities and health behavior. A review of the indices of the major health education publications - teacher preparation texts and health books for survey courses - failed to yield one reference which alluded to learning disabilities. Yet, as the example illustrates, learning disabilities can be a causative agent toward the adoption of unhealthy practices. To be effective as a positive change agent, it is important for the health educator to underMARCH 1979

stand what a learning disability is so they can work with the many disciplines involved in diagnosis and remediation.

DEFINING LEARNING DISABILITY Dr. Samuel Kirk used the term learning disabilities to define a population of children having certain physiological, neurological, and/or behavioral characteristics which interfered with their ability to learn academic material. Some of the children who Kirk attempted to describe had difficulties with letter identification, reading comprehension, and arithmetic. Other children had difficulty in motor or perceptual areas and may have been unsuccessful with even simple copying tasks. The learning disabled populations, therefore, represented a heterogeneous classification of children. The definition of learning disabilities has undergone many revisions; 34 and while a final definition awaits further empirical study and documentation, many authors agree - according to Wallace and McLoughlin - on the following common characteristics of the learning disabled population: 1. At least average intelligence, 2. marked discrepancy between academic potential and academic achievement, 3. do not suffer primarily from sensory insult (blindness, deafness), and 4. exhibit difficulty in basic psychological processes involved in written or spoken language. Given the varying definitions of learning disabilities and the fact that specific learning disabilities are often unique to individual children, it is difficult to estimate the total population of children affected by this problem. According to the National Advisory Committee on Handicapped Children, one to three percent of children in the United States suffer from some learning problem. 6 More liberal estimates place the incidence at approximately 15% .g-9 IDENTIFICATION Children are identified as having specific learning disabilities by a number of methods. Often the child’s parents are the first to notice that their son or daughter “does not seem to be developing like other children.” They may notice that the child is extremely hyperactive, easily distracted, or that he frequently has difficulty in social encounters. Unfortunately, many parents of preschool children do not know where to turn to obtain assistance. Reliance on the family physician or pediatrician for treatment may or may not allay the fears of parents. When the child reaches school age, teachers may observe that he or she has difficulty following directions, attending to auditory or visual stimuli, or MARCH 1979

succeeding in academic subject areas (eg, reading, writing, arithmetic, et cetera). The teacher may also observe an uneven pattern of school performance. That is, the student will perform at grade level in reading, math, and social studies, yet be two or more years behind grade level in spelling. Ideally, children are diagnosed “learning disabled” by school personnel only after a complete set of formal and informal assessments have been administered and the child has been observed in the classroom for a period of time. Once a child has completed the assessment battery, a team conference is conducted to determine the most appropriate educational placement and intervention for the child. According to Wallace and McLoughlin, the primary purpose of diagnosis is to identify the learning style of the child and to gather educationally relevant information. The authors believe that it is more important to ask questions about the differential effects of teaching methods and materials for individual students than it is to attempt to identify etiological factors which may or may not be related to the general population of learning disabled children. Other authors feel that identification of etiology is very important. Finally, it should be noted that Public Law 94-142 specifies that parents be an integral component of the academic planning for their child. Additionally, the law requires that the child is to be educated with his normal peers to the maximum extent possible. That is, if the assessment data indicate that the child is performing at a level commensurate with his grade-agemates, he/she is to be integrated into the regular classroom. For those subjects or areas for which the child is below the expected performance level, supportive services are to be provided to him. SUPPORTIVE SERVICES AND REFERRAL SYSTEMS While the health educator’s repertoire of school and community health-related resources may be adequate, his knowledge of support services for children with learning disabilities perhaps is not. Yet studies indicate the majority of referrals to learning disabilities specialists are made by classroom teachers. lo The referrals typically indicate that the child is engaging in too much activity, too little activity, or that his behavior is inappropriate. Learning problems can be academically related; in fact, reading problems account for the overwhelming majority of referrals. Assuming that the problem cannot be handled by the classroom teacher alone, the following services are normally provided. It should be noted that the services listed below are arranged in a least restrictive sequence. That is, as the services the child receives move toward a self-contained placement, the likelihood of interacting with “normal” children is reduced. THE JOURNAL OF SCHOOL HEALTH

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Regular Classroom Placement with Consultation. Consultants can provide indirect service to the teacher. That is, subsequent to conducting informal assessments and/or observations, the consultants can recommend a course of action to be followed in the classroom. Consultants can assist with planning individualized lessons or evaluating the effectiveness of a teaching approach. Regular Classroom Plus Tutoring. Some school districts employ tutors to provide direct remedial assistance for learning disabled children. Tutors usually serve LD children on a 1:l or small group basis. In the past, tutoring services have been provided primarily at the elementary level. Fortunately, the trend is changing; and more and more tutors are being provided at the secondary level for learning disabled children. Regular Classroom Plus Resource Room. The benefit to be derived from a dual placement in a regular classroom plus resource room is that the child is able to remain with his classmates for a portion of the day while simultaneously receiving remedial assistance in specific academic areas from a diagnostic-prescriptive resource room teacher. Selfcontained Classroom. In the past, the selfcontained classroom had been the primary placement alternative for many learning disabled children. The advantages of a self-contained placement are low teacher-student ratio, homogeneous grouping of students and, in some cases, the availability of an aide. The disadvantages include a more restrictive environment and “labeling,” the effects of which can be detrimental to the child. The learning problems of many children are not readily observable. Some problems only surface under certain stimuli, while other learning problems are more pervasive. The skilled teacher of learning disordered children who has a firm grasp of the principles of learning and reinforcement and who has an awareness of educational alternatives will be providing a competent service to learning disabled children.

CONCLUSION If the health educator is to play a significant role in the prevention of health-related problems, it is important that we consider the many precipitating factors which can lead to these conditions. Based upon

the case study at the beginning of this article, a learning disability which is not diagnosed can be an important factor in a student’s unhealthy lifestyle selection. Being knowledgeable about a learning disability will assist the health educator in his role. Could we have made an impact on the lives of some students who selected unhealthy behaviors if we had more knowledge about the real problem? The implications of learning disabilities to health educators are many. The health educator should not overlook the relationship between the academic, emotional and social problems of a learning disability.

REFERENCES 1 . Larry R: Report of the President’s Committee on Health Education. U.S. Government Printing Office, 1973. 2. Dunn HL: High Level Wellness. Washington, DC, Mount Vernon Publishing Company, 1961. 3. Kirk SA: Educating Exceptional Children. Boston, Houghton Mifflin, 1962. 4. Johnson D, Mykelbust H: Learning Disabilities: Educational Principles and Practices. New York, Grune and Stratton, 1967. 5. Kass C, Mykelbust H: Learning disabiliti6: an educational definition. J Learn Disabil2:377-379, 1969. 6 . National Advisory Committee on Handicapped Children: Special Education for Handicapped Children. Annual Report. US Department of Health, Education and Welfare, January 3 1 . 1968. 7 . Wallace G , McLoughlin JA: Learning Disabilifies: Concepts and Characteristics. Columbus, OH, Charles E. Merrill Publishing Co., 1975. 8. Meir JH: Prevalence and characteristics of learning disabilities found in second grade children. J Learn Disabil4:6-21, 1971. 9. National Advisory Committee on Dyslexia and Related Reading Disorders:Reading Disorders in the United States. US Department of Health, Education and Welfare, 1%9. 10. Stephens TM: Teaching Skills to Children with Learning and Behavior Disorders. Columbus, OH, Charles E. Merrill Publishing Co.. 1977.

Phil Heit, EdD, Assistant Professor, Sctpool of Health, Physical Education and Recreation, The Ohio State University, 1760 Neil Avenue, Columbus, Ohio 43210 (Corresponding author). Timothy E. Heron, EdD, Assistant Professor, Faculty for Exceptional Children, The Ohio State University, 1945 N . High Street, Columbus, Ohio 43210.

Research in Maternal Child Health and ImplicationsforClinical Practice

April 6-7,1*9 Selected nursing researchers will lecture in this seminar sponsored by the College of Nursing, University of Arizona at Tucson. The program is designed to update nurses on current research being conducted in the area of maternal child health. The fee is $40. For more information, write: Mary Jane Welty, Associate Dean for Continuing Education, College of Nursing, University of Arizona, Tucson, AZ 85721. 176

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Learning disabilities: implications for health education.

Learning Disabilities: Implications for Health Education Phil Heit, EdD Timothy E. Heron, EdD INTRODUCTION Health educators generally agree that the...
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