Adults with severe reading and learning difficulties: a challenge for the family physician.

BACKGROUND: An estimated 40 to 44 million adults living in the United States have severe difficulty reading, writing, spelling, and doing arithmetic. These deficiencies interfere with their receiving adequate health care. Many of these adults have reading or other learning disabilities that further compromise their ability to understand their medical conditions and to participate fully in their own care. METHODS: The literature on the cognitive and effective characteristics of adults with reading and learning disabilities was searched using the MEDLINE, PsychLIT, and ERIC databases. This literature is reviewed with an emphasis placed on how these characteristics might challenge a family physician's ability to provide optimal patient care, and what can be done to meet these challenges. Illustrative case vignettes of adults with these disabilities are described. RESULTS AND CONCLUSIONS: The cognitive and affective characteristics of this patient population make it difficult for the family physician to provide optimal medical services. Suggestions are given to make medical care more accessible and appropriate for these patients.

Inner-city adults with severe reading difficulties: a closer look.

Relatively little is known about the characteristics of inner-city adults who seek assistance from literacy programs. Increased knowledge about this population will enhance the development of more effective programs, as well as policy options. This study describes the characteristics of 280 adults, ages 16 to 63, who came to an adult literacy program that focused on severe reading difficulties. The program, located within a hospital complex in a large, urban area, attracted these individuals through an extensive multimedia outreach effort. Results suggested that the adults who sought help were generally characterized by a vast array of cognitive, academic, and social difficulties. In addition, the extent of these difficulties increased dramatically as literacy level declined. These findings suggest that comprehensive educational, social, and vocational services may be needed to help adults with severe reading difficulties cope with the diverse and severe problems they face.

Validity of a screening test for school learning problems in a pediatric clinical setting.

Children brought to pediatric outpatient clinics with the primary complaint of developmental difficulty often arrive with little or no information as to the nature of their problem. This study sought to determine if a brief screening test could facilitate the referral process by predicting the primary diagnosis subsequently given to the child based on a comprehensive interdisciplinary evaluation. Subjects for the study were 176 English-speaking children between the ages of 5 and 11 who had been evaluated at the child development center of a large urban medical school. Of the children later diagnosed as learning handicapped, 89% failed the routing test, while 78% with other primary diagnoses passed it. The results of this preliminary study suggest that a brief screening test can be used effectively to form initial hypotheses about the problems (learning vs. nonlearning) experienced by students referred to pediatric clinics for developmental difficulties. Suggestions for further research are offered.

Prognosis: the adult with a learning disability.

Deficiencies in reading and writing appear to be major and lasting handicaps for learning-disabled college students. However, gains have been made in program modifications for learning-disabled students in many higher education institutions. Many adults with learning disabilities find that their handicap makes it difficult to obtain and keep jobs. Although they perceive a need for a wide range of educational and vocational services, there are few services available at most community agencies. Service providers and educators in vocational rehabilitation and adult education and literacy programs need to know more about learning disabilities in adults and how to identify such persons and provide them with more appropriate educational instruction and job counseling and training.

The development and preliminary evaluation of a screening test to detect school learning problems.

The Einstein Assessment of School-Related Skills was developed to aid pediatricians and other professionals in the identification of children who are at risk for, or are exhibiting, school learning difficulties. This brief (7-10 minutes) screening instrument measures reading, arithmetic, auditory memory, language cognition, and visual-motor abilities of children in grades K-5. The Einstein Assessment was standardized on 1665 nonhandicapped and 116 learning-disabled children in grades K-5. The median percent of nonhandicapped children in grades 2-5 passing was 78% in the fall and 74% in the spring, compared with 18% and 14% of the learning-disabled children (numbers of diagnosed learning-disabled children in grades K-1 were too small for analysis). The median test-retest reliability coefficient was 0.94. These data provide preliminary support for the Einstein as a screening test for school learning difficulty.

Neurodevelopmental functioning of good and poor readers in urban schools.

This study investigated specific aspects of neurodevelopmental functioning in good and poor readers entering second grade and followed their neurodevelopmental course and reading progress over a three-year period. Poor readers at age seven performed significantly worse than good readers on assessment of gross and fine motor coordination and corticosensory functioning. Furthermore, the presence of soft signs at age seven was significantly predictive of reading achievement at age ten. Group differences in neurodevelopmental functioning disappeared by age ten, and the presence of soft signs at ages eight and nine no longer was predictive of reading achievement. These findings have implications for pediatricians, educators, and researchers exploring brain-behavior relationships.