How much reading?

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306 TEACHING INTERVIEWING

come increasingly aware of their own responses

and their own responsibilities. There are

individu-als or isolated programs devoted to supporting the

student health professional in the hope that with

this support his anxiety will be less likely to

inter-fere with

his

learning or force him to retreat from

the psychosocial aspects of patient care. What is

needed now is more widespread recognition and

more systematic Inquiry concerning these

com-plex

issues

so that

we can

subsequently

incorpo-rate our findings into the selection process as well

as into the education of student health

profession-als. It can be anticipated that in this way, in the

future, the scope of interest and competence of

the health professional will be expanded and his

therapeutic potential can

be more

fully

realized.

BARBARA

M.

KORSCH,

M.D.

Childrens Hospital of Los Angeles

4650 Sunset Boulevard

Los Angeles, California O27

REFERENCES

1. HeIfer, R. E., Black, M. A., and Teitelbaum, H.: A corn-parison of pediatric interviewing skills using real and

simulated mothers. Pediatrics, 55:397, 1975. 2. Stephens, L. L.: Critical issues in the process of

pro-fessionalization, unpublished manuscript, 1974. 3. Kimball, C.: Medical education as a humanizing

proc-ess. J. Med. Educ., 48:71, 1973.

4. Reader, C., and Goss, M.: Comprehensive Medical Care and Teaching. Ithaca, New York: Cornell Uni-versity Press, 1967.

5. Gregg, A.: For Future Doctors. Chicago: University of Chicago Press, 1957.

6. Senn, M. J. E., and Stricker, F. L.: An Appraisal of Un-dergraduate Medical Education in the United States with Reference to the Teaching of Medical Psychol-ogy. New Haven, Connecticut: Yale University Child Study Center, 1950.

7. Knight, J. A.: Medical Student, Doctor in the Making. New York: Appleton-Century-Crofts, 1973. 8. Engel, C. L., Green, W. L., Jr., Reichsman, F., Schmale,

A., and Ashenburg, N. : A graduate and undergrad-uate teaching program on the psychological aspects of medicine. J. Med. Educ., 32:859, 1957.

9. Romano, J.: Basic orientation and education of the medical student. JAMA, 143:409, 1950.

10. Lief, H. I., and Fox, R. C.: Training for “detached con-cern” in medical students. In, Lief, H. K., Lief, V. F., and Lief, N. R. (eds.): The Psychological Basis of Medical Practice. New York: Harper & Row, 1963, chap. 2.

11. Becker, H. S., Geer, B., Hughes, E. C., and Strauss, A. L.: Boys in White: Student Culture in Medical School. Chicago: University of Chicago Press, 1961. 12. Merton, R. K., Reader, G. G., and Kendall, P. L.: The Student Physician. Cambridge, Massachusetts: Har-yard University Press, 1957.

13. Hammond, K. R., and Kern, F., Jr.: Teaching Compre-hensive Medical Care: A Study of a Change in Medi-cal Education. Cambridge, Massachusetts: Harvard University Press, 1959.

14. Davis, M.: Attitudinal and behavioral aspects of the doctor-patient relationship as expressed by medical students and their mentors. J. Med. Educ., 43:337,

1968.

15. Rosenberg, P.: Students’ perceptions and concerns dur-ing their first year in medical school. J. Med. Educ., 46:211, 1971.

16. Keniston, K.: The medical student. Yale J. Biol. Med., 39:346, 1967.

How

much

reading?

Many therapies have been recommended for

remediation of learning disabilities. Elsewhere in

this issue of Pediatrics, Silver’ presents a timely

review of current methods of remediation with

comments on their effectiveness which provides a

valuable reference source for the physician

deal-ing with learning-disabled children. A learning

disability is an unexpected school failure in a

cir-cumscribed area of performance. The child must

have relatively normal intelligence and

willing-ness to learn. A cognitive deficit is presumed. If

the child’s problem involves reading, a selective

reading disability exists. Selective disabilities

occur in other areas such as arithmetic, art, and

physical education, although these disabilities are

seldom brought to clinical attention. Educational

and social pressures are concentrated on reading,

and written texts are the major sources of

infor-mation for learning in most schools. Since we have

elected to place the emphasis upon reading, it

be-comes important to examine this skill critically.

The reading process is an extremely complex

neural function. It is not surprising, therefore,

that many persons of otherwise normal

intelli-gence have problems of some degree in reading.

Reading should not be confused with intelligence

nor does reading always involve learning.

The neurologic abnormalities occurring in

asso-ciation with a circumscribed reading disability

are of questionable significance. The neurological

examination does not specifically test the parts of

the brain dealing with reading.2 Mixed cerebral

at Viet Nam:AAP Sponsored on September 8, 2020 www.aappublications.org/news

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COMMENTARIES 307

dominance occurs in good readers as well as poor

readers.3 Abnormalities of the eye and of eye

movement are extremely rare as causes of reading

disability The electroencephalogram is of no

clearcut usefulness’

Scores for reading abilities fall roughly on the

normal distribution or Gaussian curve. In a

hypo-thetical “average school,” 50% of the students

will read at or below grade level. Considerable

ef-fort has been expended in attempting to cut off

the low end of the reading ability distribution

curve. The curve can theoretically be shifted to

the right, but it will still have a low end.

Individu-al variation in reading skill exists over a wide

range. What becomes a disability is an artifact of

where the line is drawn. There is no clearcut

sep-aration between what is “normal” and what is

“abnormal.”6 Jf, for example, abnormal reading

were defined as reading skills at a level lower than

two standard deviations below the mean for age.

or grade, much confusion would be eliminated

and there would be fewer children with reading

disabilities.

Unfortunately, the natural history of reading

disability remains relatively unknown. For most

children whose reading skills are below other

cog-nitive abilities, the reading disability probably

represents simply a developmental delay, and the

problem will ultimately be at least partially

out-grown regardless of remediation.’ Except in the

case of diffuse brain damage, it is extremely

un-common for the child with reading difficulty to be

a total non-reader as an adult.

America is not a nation of bibliophiles.7 Many

adults go through their lives without having read

anything written by Rousseau, Charles Darwin, or

Robert Frost. Some adults, with satisfactory

read-ing skills, by choice indulge in minimal reading

activities and can be considered literate

non-read-ers. In many occupations, academic competence

may not be the critical factor determining

suc-cess.

We have entered an era with many alternatives

to reading as a means of communication.

Televi-sion and movies, radio and recordings, public and

private gatherings, all provide avenues for the

dis-semination of facts and opinions. Television

coy-erage of the Vietnam conflict had a profound

im-pact on public opinion, and the recordings of Bob

Dylan, Pete Seeger, and Joan Baez were potent

factors in the social and peace movements of the

1960’s.8 The recent problems surrounding the

Watergate investigation demonstrate the

impor-tance of television and tape recording in our

con-temporary society. We must now learn to deal

critically with non-literary forms.’

Though parents may complain that their

chil-dren with unremediated reading difficulties are

not achieving their maximum potential, the fact is

that few adults perform at maximum potential,

and those who attempt to do so are subject to

ad-justment disorders, anxiety, and psychosomatic

illness. Excessive pressure for achievement may

provoke similar difficulties in children.

School systems have made heavy investments in

remedial reading programs and the reading skills

of the children in these programs have usually

im-proved. However, the long-term retention of skills

is no greater for treated groups than for

con-trols.’#{176}” Though reading teachers may sincerely

feel they help their students to some extent, most

would readily admit they rarely change poor

readers into good readers. More research is

need-ed to determine what influence the teaching of

reading skills to poor readers has on their ultimate

capability and enthusiasm for reading.

Early identification of reading disabilities,

prior to first grade, may run the risk of ignoring

variation in the physiological readiness to acquire

reading skills. Would it not be reasonable to delay

the teaching of reading for the child who has

diffi-culty early in

his

educational experience?

Label-ing children as poor readers and predicting poor

performance subjects these children to all the

risks of the self-fulfilling prophecy.”3

Our present problems in teaching reading skills

could be minimized if several simple measures

were employed: (1) The relative importance of

reading could be deemphasized and the child

of-fered options to use whatever channels the child

finds most comfortable for learning. The child

who wants to read should be supported and

en-couraged, but the child who prefers to use

audio-visual materials should also be supported and

en-couraged. If the lecture is a satisfactory teaching

method for universities, and the oral exam is

ac-ceptable for testing graduate students, why

can-not these techniques be used in elementary

schools? This would permit learning to occur

be-fore reading capacity matured. (2) For some

chil-dren reading as a skill could be introduced later in

the school curriculum. (3) A more soundly based

statistical definition of “abnormal” should be

uti-lized in assessing students and planning teaching

programs. We must move away from the attitude

that if you cannot read it, you cannot learn it.

While there is no doubt that a good reader is

better off than a poor reader both in and out of

school, being a poor reader need not prevent