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H. BURTT RICHARDSON, JR. Relationship of Research to Health and Educational Services Research in the basic sciences has a long history of direct influence on developments in both health care and education. Recent decades have brought a tremendous upturn in basic scientific investigation, much of which has focused on new areas with high relevance to the learning pro- cess. Scientific discoveries of the last century have influenced these areas, as well as society itself, in two general ways. First, a number of basic scientific discoveries of elemental significance have produced pro- found changes in scientific viewpoints. Second, and more frequently, science has been called on to provide the answers to specific practical questions raised by the institutions of society. In this latter manner, both the health and the educational service systems have grown to rely increasingly on basic scientific research to solve some pressing problems. FED I A TRIG PROGRESS For a variety of reasons, the scientific bases of educational practice and medical practice have remained divorced from each other. Medicine, over 467
H. BURTT RICHARDSON, JR. at least the last half-century, has relied increasingly on physiologic, chemical, and pharmacologic research. Dramatic changes in health care have resulted from research discoveries and technical developments in both diagnosis and therapeutics. These have led to the solution of many of the most pressing problems that faced medicine fifty years ago. Over the same period, however, a broader concept of health care as a com- munity responsibility has become widely accepted. Particularly in the area of child health care, an entirely new set of responsibilities has emerged because of the solution of such massive child-health problems as infectious and diarrheal diseases. The responsibilities of the primary physician caring for children and the health-services team collaborating with him are increasingly focused on guidance and modification of early developmental processes within physical, psychologic, and social spheres during infancy and early childhood. Much observational information on developmental processes, particularly during infancy, has accumulated over the last several decades within a pediatric context, but there has re- mained considerable isolation between the application of this information and the application of information from simultaneous research in other areas of the behavioral sciences. FED A GOGIC PROGR ESS The field of education has made decisions based on the results of in- vestigations in different areas of research. Education has, of course, been strikingly influenced by basic biologic discoveries, but in large part the investigational procedures in education have involved empiric problem- solving studies and often group evaluations. There is now increasing in- terest in the educational processes of individual children and, in particu- lar, in relationships between behavioral patterns noted in the educational setting and descriptions arising from neurophysiologic and neuroana- tomic research. The perspective of educational responsibility, heretofore limited to the traditional school years, is also undergoing considerable reappraisal. As educators become increasingly concerned with the prac- tical importance of early experience and as they participate in such pro- grams as Head Start and special nursery schools, the health and educa- tional services involved form an inescapable relationship. Research within both broad areas is beginning to overlap enough that complementary, if not collaborative, services appear to be increasingly possible. 468
Relationship of Research to Health and Educational Services FUSION OF BIOLOGY AND BEHA VIOR One manner of categorizing research areas called on to elucidate the learning processes of early childhood might be to divide them into broad biologic- and behavioral-science groups, recognizing, of course, the es- sential overlapping in application to individual children or populations. The biologic approaches have included neurostructural, neurophysio- logic, and neurochemical research. Those behavioral sciences which have provided the greatest progress in medical and educational thought have included psychodynamics, perception, cognition, and learning theory. It is well to recognize that behavior is the measured endpoint or corre- late of most of these scientific studies, regardless of their theoretical basis; but the behavior described in most studies of child development has occurred in the natural environment, rather than in the controlled experimental setting. Child development has long been associated with either the biologic or the psychodynamic approach because of their com- mon connection with medicine. A better approach to developmental studies as a mode of testing any scientific hypothesis across time resides in the rapidly growing young organism. MAGNITUDE OF HEALTH-CARE DELIVER Y PROBLEM The current commitment to providing the best possible health care and educational opportunity to the entire child population carries with it an obligation to quantitate the problem, as well as to appraise the system by which the services are delivered. "Dyslexia" is a descriptive term with different definitions, all of which indicate handicaps in learning to read. Dyslexia is only one of various learning aberrations that impede class- room success. If dyslexia implies reading skills 2 years behind grade level, an estimated 15% of children are dyslexic.3 Even on the basis of a neuro- logic definition, such as that by Critchley,1 who considers dyslexia a "very real, organic problem" representing a "specialized instance of cere- bral immaturity," a prevalence of 10% is likely. The inclusion of other categories of learning disorders, of course, makes the number of children involved much higher. It is clear that the appropriate management of learning disorders of such prevalence must fall in large part to both pri- mary health-care facilities and what we might consider the primary edu- cator, the classroom teacher. 469
H. BURTT RICHARDSON, JR. Sharing of Influence If we assume that a child's learning depends on environmental variables (and available evidence leaves little doubt of that), the primary influ- ences on a child's educational success are his parents and later his class- room teacher. It is unreasonable to plan effective modification of en- vironmental stimuli for a proportion of the population as high as, say, 20% without developing the requisite manpower resources. Traditionally, parents and teachers have created learning conditions for children rela- tively independently. A parent's decisions concerning the presentation of stimuli depend on cultural norms, intuition, and guidance (particularly in the years of infancy) from health-services personnel. A teacher's de- cisions depend, in addition, on professional training and the professional expectations of the school itself. A supplementary diagnostic staff in the school frequently operates less to modify the classroom teacher's de- cisions than to make independent administrative decisions regarding class placement. Transmission of Information Since a highly relevant portion of a child's exposure to learning condi- tions is under the control of the parents, it is worth exploring points of contact through which information can be transmitted to them. General information can be transmitted, of course, through the usual communi- cation media of the culture, including the parents' formal education; but specific guidance concerning any single child, particularly one in whom a learning problem is evident during the preschool years, has generally fallen to a member of the primary health-services system. Within both pediatrics and nursing, the two professional groups delivering primary health services to the majority of American children, anticipatory guid- ance and behavioral counseling are common and well-accepted practices that are included with the provision of adequate comprehensive health care. The contact points for the acquisition and transmission of relevant information concerning the learning needs of the individual child exist, therefore, within the primary health-services system, and the personnel in that system are committed to the principle of appropriate guidance of parents. What is lacking is an informational system that might provide the communicative interface between parent, teacher, and primary health-service personnel. It would appear, then, that primary health- 470
Relationship of Research to Health and Educational Services service personnel, the classroom teacher, and the mother are in the best positions to apply most effectively the results of basic behavioral-science research. These are the only persons in the societal system who have suf- ficient contact with children to modify significantly the environmental conditions under which children learn. APPLYING NEW KNOWLEDGE TO DIAGNOSIS If our intention is to provide health and educational services to all chil- dren, we must reconsider the very nature of our diagnostic and manage- ment procedures and be willing to modify those that are out of step with scientific evidence or our stated goals. In both health and educa- tion, there is a long record of excluding children from relevant experi- ence and services on the grounds of developmental delays manifested by failure on readiness tests or other measures of general achievement. In many settings, children who score poorly on standard intelligence tests are still completely excluded from educational experiences at the lower age levels. The labels applied by many current diagnostic techniques are frequently used to separate children permanently from the success-bound educational stream. Such descriptions as "retarded," "brain-damaged," and "dyslexic" tell nothing of the mode by which a child might succeed or of the conditions under which success will be most likely. In addition, such labels are remarkably poor in communicating causative factors, a traditional (and in the case of learning disorders, frequently irrelevant) preoccupation of medicine. Labels serve only to convince the primary physicians, the classroom teacher, the parents, and, most tragically, the child that success is impossible and effort of doubtful value. How, then, can the diagnostic process be directed so that, on the one hand, it serves our stated goals and, on the other hand, it utilizes more adequately the evidence revealed by the behavioral sciences? First, it must be closely related to or even a part of the very processes that it sets out to detect. Second, it must take into account the critical importance of the specific environmental conditions that influence the behavior ob- served. Third, it must recognize the dynamic factors at play in the diag- nostic learning situation that may have more general applicability to learning at home or in school. Educators have long focused their interest on diagnosis of relevant functions, but until recently they have placed much less emphasis on the conditions of testing or the dynamics of be- 471
H. BURTT RICHARDSON, JR. havioral change manifested in the learning process. School achievement has been successfully predicted from measures that sample behavior that correlates highly with behavior demanded in school. Behavior observed in this way is closely related to the processes of primary interest, but, as alluded to above, it tends to select for failure, not for success. The diagnostic appraisal of conditions under which a sample behavior is noted or not noted has a much higher probability of offering clues to a child's future success in learning. The basic studies in perception, whether biologic or behavioral, offer much to the diagnostician whose obligation is to evaluate the significance of stimulus variables in a spe- cific child. Relevant educational material may be presented to a child through a variety of stimulus modalities, revealing a pattern of function that indicates not only at which point in an educational program the child might be expected to succeed, but also through which channels of stimulus input success will be achieved most easily. Evaluation of a child's perceptual function in distinguishing signal from noise along vari- ous input channels is equally relevant in that both stimulus quality and input modality can be easily modified in the classroom or home. A rela- tively brief examination of a child2 can sample skills in attending to auditory, visual, and tactile input of educationally relevant information and can appraise the interference of noise in the system. At the same time, one can gauge, in a standardized fashion, motor competence in the performance of specific school-required functions, such as speech intel- ligibility, handwriting, and general fine motor coordination. In addition to appraisal of the placement in a teaching program ap- propriate for a child's success, the diagnostician observing a child's be- havior has an excellent opportunity to evaluate dynamic elements of the learning process, i.e., the relationships of factors through time, as con- trasted with the static description of stimuli or observed behavior at a single point in time. Research in learning has done much to elucidate the relationship between rates of modification of behavioral responses and the occurrence of some consequences of modifications in the environ- ment. It is highly relevant to the educational process, whether in the home or in school, to be aware of these dynamics in a particular child. Thus, if learning tasks can be incorporated into the diagnostic measure, it is possible to appraise the rate of learning under standardized stimulus conditions. The social consequences of a child's responses are also suf- ficiently under the control of the examiner that a preliminary appraisal of what maintains his responses is often possible. Other dynamic factors, 472
Relationship of Research to Health and Educational Services such as the child's ability to have postponed the social recognition of his accomplishments, can be judged in a similar setting. Such observations are very relevant to the mother and teacher with whom the child inter- acts; these interactions form the basis of both socialization and educa- tional processes. In summary, the remediation of learning disorders requires early and relevant diagnosis of deficits in the processes on which successful learn- ing at home or in school depends. The number of children involved is so great that effective diagnostic procedures must be in the armamentarium of primary health-service personnel and classroom teachers. The develop- ment of adequate diagnostic measures derived from basic knowledge in perception, cognition, information-processing, and the dynamics of learning offers the best hope for collaborative efforts by the health-care and educational systems in the early childhood years. This report was supported by grant 237 from the Children's Bureau, Department of Health, Education, and Welfare. REFERENCES 1. Critchley, M. Is developmental dyslexia the expression of minor cerebral damage? Clin. Proc. Child. Hosp. D.C. 22:213-222, 1966. 2. Ozer, M. N. The neurological evaluation of school-age children. J. Learn. Disabili- ties 1:84-87, 1968. 3. Schiffman, G. Dyslexia as an educational phenomenon: its recognition and treat- ment, pp. 45-60. In J. Money, Ed. Reading Disability: Progress and Research Needs in Dyslexia. Baltimore: Johns Hopkins Press, 1962. 222 pp. 473
PANEL: Thomas T. S. Ingram, Barbara Keogh, John H. Meier, H. Bunt Richardson, Jr., Helen M. Robinson, Donald Shankweiler, and Francis A. Young, Moderator Conference Implications for Education DR. YOUNG: The value of this conference may well depend on how suc- cessfully the diverse results and hypotheses presented here are trans- lated into forms applicable to children who must learn to handle visual input. With the purpose of fostering the translation, a group of conference participants who are working in areas that directly in- volve children were asked to summarize the implications of the conference. DR. ROBINSON: For more than 30 years, I have been concerned with the problem of research in reading, the practical problem of diagnosis and correction of reading disability, and the problem of trying to help teachers understand and improve their pupils' reading. I know less today about the process of reading than I did when I began. I think that is because research in the field of reading is in its infancy. Some- times, the research designs have not been the best. We began with what we had to work withâchild behaviorâwhich was examined in the early years primarily in relation to reading itself. Many of the studies have been comparative studies to locate areas in which there were differ- ences between good and poor readers. That is the logical beginning, I believe, because it can give us leads as to where we might look for a deficit. We have been handicapped, in most instances, because we have had 474
Conference Implications for Education to look for symptoms of difficulties that distinguish good and poor readers. These symptoms are inconsistent from one group of children to another or one observer to another. As a result, we have had, and still have, differences in interpretation of the results of inconsistent studies. What we have not had, I think, is consistent study of the basis of symptoms. This conference has supported the need for good inter- disciplinary research in which those with the most knowledge in the related disciplines bring their knowledge to bear to help us explain the symptoms that we see. But we need to be very clear about these symptoms. The symptoms that have been clearly delineated by Dr. Ingram, Dr. Silver, and many others lie in the areas of visual perception, auditory perception, lan- guage, and their association in such a way that reading can take place. To the extent that we can work with the investigators who are probing behind these symptoms, I think we will be able to explain what under- lies the symptoms, rather than merely treating them. Furthermore, this conference has given me, at least, some important notions in relation to techniques of investigation. The process of reading, which seems very simple to a competent adult reader, is ex- ceedingly difficult for a child or an adult who cannot read. We need techniques to investigate the structure and function of the brain, vi- sual and auditory input systems, language, motivation for learning, and ways in which deficits impede learning. All the physical, psychologic, and instructional information must be collated. One thing we need to keep in mind is that the little knowledge we have now can lead to improved reading. I am reminded of a school sys- tem that I served as a consultant, in which the percentage of reading- disability cases was reduced over a 5-year period from some 20% to 5% by improving instructional techniques in the classrooms. We need to focus our attention on the 5%. I am fully in accord with the new aim of 100% success in learning to read. I hope I live to see it occur. I am not hopeful that it will happen right away, however. Essentially, inter- disciplinary research takes timeâtime to learn to communicate, to co- ordinate efforts, and to study children longitudinally. This meeting is an example of the tremendous effort it takes to absorb the detailed knowledge, the vocabulary, and the concepts of related fields. Whenever we aim toward research of this kind, we must have patience with each other; we must explain; we must aim to un- derstand how we complement each other in our efforts. 475
PANEL I suggest that our deliberations after this conference be directed toward further interdisciplinary research to determine the causes of reading disability. If we can determine causes, we can make systematic diagnoses and design treatments appropriate to different causes or pat- terns of causes. Until we do that, we are likely to continue to rely on clinical intuition in diagnosing and eliminating symptoms. Moreover, scientific studies should lead to prevention of reading disability or to compensatory education from the beginning of schooling. I see this conference as a beginning. Everyone here should make continued contributions to research efforts, directly or indirectly re- lated to reading. The reading researcher needs to keep abreast of the related research, to work closely with allied disciplines, and to attempt to apply new insights. Through future experimentation, a systematic approach to prevention and treatment of reading disability should be possible. DR. MEIER: The great problem at this conference is what I like to refer to as the "paralysis of analysis," wherein the esoteric characteristics of, say, dyslexia become relatively well delineated, and yet the class- room teacher is in the same situation today as she was in yesterdayâ namely, not knowing precisely what to do with a child who has failed to profit from her reading instruction. There is a network of educational laboratories that have addressed themselves to such chronic educational problems. We have tried to de- termine, first of all, the incidence of learning disabilitiesâincluded among these would be dyslexia. We have started with a stratified ran- dom sample of about 2,400 children from eight Rocky Mountain states, and the incidence of dyslexia on the basis of this pilot study is, as Dr. Richardson suggested, between 15% and 20% of the regular school population. We have developed a classroom screening instru- ment that identifies about 80 observable behavioral symptoms, which classroom teachers have been able to use with about 94% accuracy in identifying children who, on subsequent diagnostic work-up, did demonstrate some specific learning disability. The subsequent diag- nostic work-up involved 3 days of testing, including full medical and psychoeducational examinations, speech and hearing assessments, and so forth. We now are in the challenging position of attempting to go beyond the paralysis of analysis by translating the very significant work that the basic scientists are doing into both classroom practices and preschool practices. The Parent-Child Centers that Dr. Richardson 476
Conference Implications for Education mentioned, the Head Start movement, and related efforts are con- cerned with training parents, as well as teachers, to cope with and per- haps even prevent reading difficulties. I am wondering what can be done in terms of early cognitive stimu- lation of children. Are there practical ways of proliferating dendritic spines? Do learning-disabled children have difficulties, such as Dr. Lindsley intimated, in terms of selective perception of the stimuli in the environment? Do children have ways of turning their receptors off or on? If they are turning off their receptors, are they, therefore, not growing cognitively? All these questions are of interest to us who are concerned with optimal child growth and development. We are ex- perimenting with the crib as a learning environment, as Dr. Lipsitt suggested that it is. I see the observations reported at this conference coming together in a complex mosaic, which I think has great signifi- cance for the child who is failing to learn in school. I would like to present a preliminary inference that we are able to draw from our data5 âand this is a glittering generalizationânamely, that nonlearning children seem to have the greatest amount of diffi- culty in reliably sequencing visual data in space and auditory data in time. Because of this finding, we are going to launch our major efforts toward classroom techniques that will be organized in a flowchart of approaches, giving the teacher a systematic repertoire from which to draw, to apply to specific children whose deficits may appear on evaluative protocols such as those suggested by Dr. Silver (most of which we have used). In this way, the teacher can monitor the growth of the child in response to a given educational prescription and de- termine whether the child can profit from that approach or whether the next one in the hierarchy should be tried. I know this takes time and a tremendous amount of cooperation from the behavioral scientists, as well as the educational scientists (if I may call them that). I am terribly excited about the discoveries that the basic biobehavioral scientists are evidently making. One last thing I would like to ask is: What are the optimal levels of sensory stimulation for infants and children? I think that Dr. Riesen rather hastily glossed over the notion that there may be overstimula- tion. We have a social issue, here, with regard to parents and teachers who may indiscriminately impose stimuli on the organism and, in fact, do damage. I gather from the informed people here that this is another area requiring considerable investigation. 477
PANEL DR. KEOGH: This conference has demonstrated again that there are many discrepancies in what we know about basic mechanisms in reading and that we have not related some of the more technical information per- taining to it. For example, we have hardly begun to address the complexity of the reading task. Whether we are talking about learning disability, reading disability, or successful reading, there are, I hope, some com- mon elements or dimensions that can be identified, and I think that these have not been defined very clearly at this conference. I don't see the child with reading disability as a different animal. He is a youngster who has particular kinds of problems in a complex-task situation, but the components of that task are the same for him as they are for the youngster who is good in reading. Therefore, I suggest that, instead of beginning with the disability case and looking at the many correlates of that disability (which are quite unclear and clouded), it might be- hoove us to address ourselves to the reading process and attempt to define some components that cut across all levels of reading ability. There ought to be a distribution of good and bad (to use value terms) in any of these components; perhaps on that basis, we could define more carefully the problem of the child who has difficulties in reading. Most of us, first, are concerned with identification of an assumed process and, second, make the assumption that the process has some- thing to do with reading. I was interested in Dr. Silver's results, for example, with perceptual training. I want to support the position that perhaps the 50 hr that were involved might have been better spent in training in a more directly related perceptual taskâthat is, readingâ rather than in trying to train an underlying process that is presumed to have some effect on the reading task. The child who has problems in learning to read often has associ- ated, measurable visual-motor delays. My question is: Did the visual- motor delay cause the reading disorder, or did the failure to learn to read cause the visual-motor delay? That is, does the actual process of learning to read help a child to organize his own perceptual functionsâ horizontal, left-right, recognition of spatiotemporal associations, and so forth? That question has not been answered very carefully in the literature. What is the effect of learning to read on other aspects of perceptual organization? That is the kind of question that I would hope a conference like this could get to: to attempt to define the component processes of 478
Conference Implications for Education reading, and then try to relate them to disability and success. Inas- much as there are successful readers, I cannot believe that the pro- cesses that they use are very different from those used by the child with reading disability. The problem, then, is to define them critically and to see how they interact in achievers and nonachievers in reading. I would like to comment on Dr. Hochberg's presentation, because I was interested in the use of paralinguistics. He pointed out that the youngster responds to inflection, gesture, and many other things in the auditory communication system. Yet, when we present a young- ster with a reading task, we take away all those clues and present him with a page with only printed symbols on it; we remove gesture, in- flection, and interpretation, so that he must now depend on visual perception alone, without all the other things that go along with oral communication. Thus, we are presenting him with a different kind of task. DR. INGRAM: I found many of the conference papers difficult to under- stand. They were something of a challenge because of my lack of knowledge of experimental work in physiology, a great deal of which, of course, has gone on in this country in so many centers that it is al- most impossible to keep up with the relevant literature. I think that the conference has considerable value for a mere clinician in indicating what advances are taking place. Like the other speakers, I am very worried about the implications of the findings of mass surveys. If 20% or thereabout of children are unsuccessful to some degree in reading, as Eisenberg and many others have shown in this country and as has been shown in Great Britain, then this is a tremendous criticism, not of the children, but of our educational systems. Moreover, consider the figures from different types of schools. Eisenberg2 found that 1 % of the children were not doing well by a year and none by 2 years in his independent, expen- sive schools, whereas a very high proportion were doing better than expected. This may very well be due in part to social selection, but one cannot help wondering to what extent it depends on the size of the classes, the training of teachers, the early recognition of handicaps, and so on, when one compares what occurs in less favored schools. In Glasgow, there are still some children receiving part-time edu- cationâsuch is the pressure on primary-school teachers. I know of several classes in which, after 2 years, the teachers do not even know the students' names. A similar situation has been described by Cazden1 479
PANEL in this country. We have tended to concentrate, probably rightly, on the difficulties of individuals; only recently have we begun to consider the environmental difficulties to which they are exposed. Perhaps we are overestimating the problem at the higher sociologic level of the relatively small numbers of children that come to clinicians, and overlooking the larger problem among disadvantaged children. About 250 or 300 children are referred to me each year because of educational problems. About one third of these, probably, I would classify as dyslexic or as having specific spelling or reading problems. A great many of the others are children of middle-class parents who want a "respectable" diagnosis of dyslexia, rather than an "unrespect- able" diagnosis of mental retardation. I am trying to put things into focus and emphasize that we have been talking about a small minority of children. We have a very interesting control group, a natural one in Edin- burgh. A high percentage of children go to fee-paying middle-class schools, rather than state schools. These schools, by and large, al- though they have many male teachers in the primary grades, do not have any remedial-teaching system. In contrast, the state schools in Edinburgh have a highly developed remedial-teaching system, and about 8% of the children attend them at one time or another. Of the children who are referred to me because of possible learning difficul- ties, about 80% come from the middle-class fee-paying schools. That is partly because of parental drive, ambition, and anxiety about the educational attainments of their offspring, but I am sure that it is also due in part to the fact that remedial teaching at an early stage in the state schools is preventing a great deal of later disability. In fact, it is preventing the failure that results from failure. I would very much like to be at another conference where the clinicians, the experimentalists, the brain scientists, and the ophthal- mologists would be much more silent and let the talking be done by the teachers, those who organize education, and possibly some of the politicians who are so keen on education on election day and so neglectful between elections. We have to ask to what extent poor reading is environmentally determined. If a child gets off to a bad start, if he begins to fail, then there is likely to be failure upon failure, and the vicious spiral with which we are all familiar. The child fails, and he is therefore given extra training (probably of the wrong type) and becomes progressively 480
Conference Implications for Education anxious; and, of course, in a state of anxiety, no one will achieve as well as he can. Children are referred to child-guidance clinics at the age of 10 who could probably have been spared this had they received just a little more consideration at the age of 5 or 6. I am extremely concerned about the training of children in their areas of deficit. It is rather like the situation in cerebral palsy, when one ties the good hand of a child with hemiplegia to ensure the use of his bad hand. Particularly if sensation is lost in the bad hand, the child is more paralyzed than he was before. He becomes more afraid and disturbed, in addition to being basically handicapped. There is a ten- dency, in cerebral palsy, if the child does not respond to physio- therapy, to give more physiotherapy, instead of asking whether the physiotherapy is appropriate. I am afraid a great deal of remedial teaching today is based on a similar fallacy: When remedial teaching of a specific type does not appear to benefit these children, give more remedial teaching, rather than asking the rather simple question: "Is the basis for remedial teaching appropriate?" DR. SHANKWEiLER: I was struck by one characteristic of the visual sys- tem that was stressed by Dr. Sperling and Dr. Hochberg: its capacity for parallel processing. The eye can take in an enormous amount of information in only a tiny fraction of a second. If the eye is such an efficient channel, why is reading difficult for so many people? I think that Dr. Sperling has provided us with a valuable clue. The information taken in, in a single fixation, is useful to us for only a brief period, and the proportion of this information that can be used by the perceiver depends to a great extent on how quickly he can encode the informa- tion. Language is undoubtedly the most available and most ubiquitous code in human perception, and we have been shown how readily and how automatically observers encode visually perceived letter shapes, not into visual forms, but as speech (as letter names). Being able to encode optical shapes as language requires knowledge of the rules that relate shape to sounds. Dr. Chall told us that some children need more explicit drill in these things than others in order to learn how to read, and I heartily second what Dr. Keogh and Dr. Robinson have said: We need to see a great deal more work done on the reading process and its development in normal children. The great bulk of research on reading has left many questions unanswered. For example, we know that the rules that relate alphabetic symbols to language are more complex in some languages than they are in 481
PANEL others. In some languages, such as Italian, the sounds of speech (the phonemes) map rather simply onto the alphabet. In other languages, such as English, this mapping is much more complex, and one must take into account levels of language other than the sound structure in order to generate the spelling rules. It ought to follow, then, that fewer reading disabilities should occur among Italian children than among English-speaking children. That constitutes a straightforward question, but I do not think we have the answer to it. There is general agreement that many children do not read as well as they should, but 1 do not think we have made much progress in discovering why. If we really want to find out, we have to ask some specific questions about the characteristics of language and perception in children who can and cannot read. We all agree, I suppose, that a requirement for learning to read is rapid and accurate identification of the letter shapes. How many children who cannot read fail at this level? That is another straightforward question, but, again, I think that we do not know the answer. For children who can pass this test, we can then inquire whether they have learned the rules that relate letter shapes to sounds. That is a large task. It requires a detailed ex- amination of the kinds of errors that children make in reading and an attempt to relate them to aspects of the acquisition of spoken lan- guage. Dr. Ingram's work shows that we will surely find these relation- ships, but we know almost nothing about them as yet. Some of us at Haskins Laboratories and the University of Connecticut find this problem challenging. The point I want to make is that there are a number of important questions about learning to read that could be answered but that usually have not been asked in research on reading and reading dis- ability. The answers would provide the skeleton of a classification system that would permit the sorting of children who cannot read into scientifically useful categories. As long as we lack an empirically based system of classification, no rational approach to treatment is possible. DR. ROBINSON: I think we have to know, as Dr. Keogh has pointed out, whether a deficit must be corrected to some degree to promote ade- quate reading. I am concerned, for example, about those who ap- proach the teaching of reading from an auditory point of view, as though it were never necessary for the child to perceive visually. It seems strange that we can talk about teaching by using strengths and 482
Conference Implications for Education neglecting deficits, if those deficits involve absolutely essential parts of the totality of learning. I want to comment on this primarily so that none of us will leave this conference believing that he can capi- talize on the strengths and neglect essential deficits. For example, visual perception is essential because reading is a visual task. How to diagnose it and how to correct it are the major problems, and not whether it is necessary. Would you agree, Dr. Ingram? DR. INGRAM: I agree entirely with that. Obviously, some basic skills are necessary. But if a child fails, for example, in recognizing word shapes, then I would not spend my time teaching him by "look and say." I think I would encourage him to use the phonic approach, but I agree that he must first reach the stage of learning where he is able to read letters. DR. ROBINSON: Over and over again, the question has been raised about more boys than girls having reading disabilities, and we find this con- sistently. A study that I don't believe has been mentioned, but is of interest, was done by Ralph Preston6 with a colleague in Germany. It began as a comparative study of the achievement of German and American children, but one of the surprising findings was that in Germany more girls than boys had difficulty in reading. This leaves us with a question of considerable interest to explain. DR. INGRAM: In a classic study, Hallgren3 found that many more boys than girls were referred to reading clinics, but that the incidence in boys and girls of what he called "specific dyslexia," which he defined in his own terms, was approximately similar. I was reminded of this during Dr. Kagan's presentation, when he mentioned the differences in behavior in boys and girls. This is the sort of difference that leads immediately to a research project. In particular, Hallgren found, when he studied the families of the children referred to him, that the girls were also affected, but not so severely. Therefore, we are left with the simple question: "What is it that makes boys more dyslexic and makes them have more difficulties than girls?" Obviously, we are dealing with a multifactorial situation. I have mentioned environmental fac- tors already. Here is an intrinsic factor, and there must be hundreds of other factors in early upbringing that we do not know about but that determine whether a child will suffer from significant reading difficulty. DR. MEIER: Dr. Kagan, I, and others have touched on the male-teacher and male-classroom possibilities. Our experiments with kindergarten 483
PANEL and first-grade children in Greeley indicate that the all-male groups do as well as the all-female and better than the mixed groups in reading achievement. I wonder whether Dr. Robinson was getting at this when she said that in Germany the sex ratio of reading problems was re- versed, because they use male teachers for young children more than we do. Frances McGlannan4 is doing a study dealing with genetic anoma- lies in poor readers. She believes that her evidence indicates that there is a higher incidence of sex-linked genetically determined problems with poor readers. We are doing a gross chromosomal analysis, the buccal smear test, to see whether there are any indications of sex- linked anomalies in children with learning disabilities. If there are, we plan to do a total chromosomal analysis on the child. I submit that this problem is susceptible to research. The answers are elusive and complex. Dr. Sperry has indicated that boys seem to have less-stable spatial predictability, in terms of organization mediated by the right hemi- sphere, than do girls. Dr. Kagan suggests that the boys merely behaved differently and therefore responded differently. I would suggest that there is some interaction between the brain and the behavior, if you will, and a corresponding interaction between those and the teacher in the classroom. REFERENCES 1. Cazden, C. B. Three sociolinguistic views of the language and speech of lower-class childrenâwith special attention to the work of Basil Bernstein. Develop. Med. Child. Neurol. 10:600-612, 1968. 2. Eisenberg, L. The epidemiology of reading retardation and a program for preven- tive intervention, pp. 3-19. In J. Money, Ed. The Disabled Reader: Education of the Dyslexic Child. Baltimore: Johns Hopkins Press, 1966. 421 pp. 3. Hallgren, B. Specific dyslexia ("congenital word-blindness"): a clinical and genetic study. Acta Psychiat. Scand. Suppl. 65:1-287, 1950. 4. McGlannan, F. K. Familial characteristics of genetic dyslexia: preliminary report from a pilot study. J. Learning Disabilities 1:185-191, 1968. 5. Meier, J. H. Causes and characteristics of communication disorders in elementary school children. Proceedings of the 47th International Convention of the Council for Exceptional Children, Denver, Colorado, April 1969. (to be published) 6. Preston, R. C. Reading achievement of German and American children. School and Society 90:350-354, 1962. 484
Conference Implications for Education DISCUSSION DR. ROBINSON: An international study on achievement in mathematics has already been published. (Huse'n, T., Ed. International Study of Achievement in Mathe- matics: a Comparison in 12 Countries. 2 vol. New York: John Wiley & Sons, 1967. 304 and 368 pp.) I was reminded of it when the question of dyslexia in Japan came up, because it was found that arithmetic and mathematical achieve- ment of Japanese children at various age levels was ahead of that in any of the other countries studied. Having completed that study, the international group is now assessing achievement at different age levels in various other content areas and in reading. The committee is developing an achievement test that will be as fair as possible in reading and in writing for children in various countries. I think we need to look to that (it is already in progress) to make some comparisons between the kinds of achievements and disabilities that are found in countries with various language characteristics. DR. DENENBERG: I came to this conference with the belief that dyslexia was a specific human syndrome. That is definitely wrong. First, there are many correl- ative events: visuomotor coordination, spatial disturbances, perceptual problems, and pattern-recognition problems; and also there happen to be reading difficulties. The culture in which we live is such that we have focused on reading difficulties. But we have made them central rather than merely correlative. What impresses me is that all the problems except reading occur in higher mammals. I therefore sub- mit that, although we are focusing on reading disabilities, they are merely a symp- tom of a much more basic problem, which is probably not unique to humans but runs through a wide variety of higher mammals. And the way to approach the problem from a research point of view is to look at it both at a human level and at a lower-primate level. DR. RICHARDSON: I should like to add a caution to whatever is done experi- mentally in nonhuman primates. Reading is a language function, as we have spent some time discussing here. We must not lose sight of that facet in extrapolating experimental observations on nonhuman primates. The problem goes beyond the perceptual aspects. I think the visual aspects are important, but I believe we have ample evidence from research that auditory discrimination, sequencing, and lan- guage development are as important as visual perception. I referred to visual per- ception earlier only to point out that it was one of a number of factors. DR. GUNDERSON: I would like to comment on the definition and incidence of dyslexia and reading disabilities. The Interdisciplinary Committee on Reading Problems is composed of professionals representing many disciplinesâpsychology, education, sociology, linguistics, anthropology, economics, child development, and specialized fields of medicine, such as ophthalmology, pediatrics, neurology, 485
PANEL and psychiatry. One of the problems faced by the Committee was terminology. Although workers in various disciplines used the same terms, discussion revealed that the meanings of terms varied according to the discipline of the user. The Committee members were concerned with reading problems, but it was difficult to obtain a consensus on what a reading problem was or to define reading dis- ability. It was apparent that common terminology was essential for effective communication. So the group agreed to compile a glossary (Gunderson, D. V. Reading problems: glossary of terminology. Reading Research Quarterly 4:534- 547,1969) to use during the writing of the several manuscripts that will be pub- lished in a single volume by the Center for Applied Linguistics and to appear as an appendix to the volume. One of the seven Committee task forces is concerned with incidence and implications. We have found, as most of us already knew, that in the United States we have no accurate estimate of the number of children who are disabled in reading; we have only an educated guess. The primary reason for the lack of an estimate is that reading disability itself is defined in many different ways. Most workers in education would feel that an estimate of 15%-20% of children as dyslexic is rather high. DR. YOUNG: But would it be high in terms of reading disability if that is defined in terms of "years retarded"? DR. GUNDERSON: We still have to define "reading disability" and "dyslexia." Many children who are a year retarded in reading are retarded simply because of poor educational experiences and have no physical or neurologic problems. DR. BOYNTON: I have been struck by the lack of mention of an active area of research and a related point of view. Although I am not expert in it, I think this approach ought at least to be mentioned and put on the record. I refer to the use of programmed instruction or teaching machines. I know that active research is going on with such things as typewriters connected to computers that are op- erated by very young children. I submit that, although the concept of training children in how to read through the use of apparatus that requires a computer may seem way out today, this sort of approach might seem quite feasible in the near future. One of the nice things about computers is that they are precise and have infinite patience. Another good thing about computers is this: to write a program, one needs an extremely precise idea of what he wants the machine to do for him; therefore, he must sharpen his thinking about the process involved. In the pattern of the educational system that we are generally using in this country today, material is given to 30 or 40 students. Some succeed and some do not; that leads to failure on the part of those at the bottom of the group and the beginning of the downward spiral referred to earlier. I think that Professor Skinner at Harvard, who has been one of the motivating forces behind the concept of programmed learning, and many others have pointed out that, through the use of programmed instruction, an entirely different ap- proach can be taken. Rather than throwing a given quantity of material at the 486
Conference Implications for Education students and seeing whether they can handle it, we can allow each student to proceed at his own pace and arrange things, it is hoped, so that success occurs and failure is almost ruled out. DR. YOUNG: About 5 years ago, we started a group of very deprived 4-year-olds on programmed typewriters. These children are now in school and performing very well in reading. The prognosis would have been that at least one third of them would have been placed in mental-retardation classes; not one of them has been placed there. They are exceeding the control group, and even doubling their scores in several achievement tests. We intend to follow them for 12 years. Your point about the rigor involved in programming and the student's control over the pace at which the material is presented is extremely important. I would also like to say that, even if you do not have a computer or automated equipment for pre- senting data, teachers can be trained to function in a facilitative fashion, rather than in a turkey-stuffing fashionâjamming data down the unwilling throats of children. The former style of instruction is considerably more effective. Your points are germane to one of the sore spots in education. DR. ULLM ANN : I would like to refocus attention on a point that Dr. Keogh made earlier: the question of continuity versus discontinuity in the process we call reading. I am aware that, from the standpoint of science, it may be proper to consider the components of the reading process a monotonic system and yet call the dis- ability a definably different, qualitatively separate phenomenon. This seems to be so; in the children to whom Dr. Robinson has referred, reading was improved in a significantly large proportion by improving the reading instruction. I think there was a reduction in reading disability from 20% to 5%. But the 5% remain, so that one would assume that the improvement in instruction had made its con- tribution, which could continue, but that there might be something within the learner that also has to be considered, in addition to the instructional system. Similarly, there is a situation with which I have had some familiarity in the last few years: the effort by the armed forces to accept 100,000 men per year who would previously have been rejected, through improvement in instructional material and adjustment of training procedures. This is of benefit not only to the armed forces, but also to the men themselves. The person who has what we might loosely call dyslexia remains in a category separate from those who can be reached by improvements in methods for general use. Most people may have been effectively instructed, but there still seems to be a small proportion who cannot be dealt with easily within a mass approach. I do not mean that as a social policy this concern with methods of general applica- bility is unwise; but I want to highlight the fact that we still seem to have a prob- lem with residual disability. I would ask whether the concept of discontinuity must be faced if we are to reach the 100% of the children that Dr. Richardson alluded to in the further development of our educational and health system. 487
PANEL MRS. GAARDER: I would like to ask the panel members whether they can look into their crystal ball and foresee not only a speech therapist to screen children (which is done now), but a hearing therapist and a reading therapist. Perhaps after Dr. Shankweiler works out his classification of reading problems, these specialists may be able to identify children in need of special training before failure begins and to serve a very important purpose. DR. ROBINSON: That has been my goal for 20 years. Following this conference, however, I am beginning to wonder whether children should be screened before they even enter school. It seems to me that the screening process ought to come much earlier than 6 years of age, when children enter school in this country, or 5, when they enter kindergarten. At this time, I do not know what to screen or how to screen. This precision is the goal that we simply must achieve, because pre- vention is our ultimate goal. 488
