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Factors influencing ability to read
Volume 92 Number 3
Editorial correspondence
question at the present time. However, the question o f differences in such things as postabsorptive thermogenesis may become increasingly important in the understanding o f these differences. Griffiths' indicates that children of obese p a r e n t s - e v e n before the children are o b e s e - m a y ingest less calories and have less available for activity than children of nonobese parents. The concept of postabsorptive thermogenesis has been part of the scientific literature for many years, although it originally was described as specific dynamic action. At that time, it was thought that the increased heat loss following ingestion Of nutrient was related to the protein content of the food; it would now appear that this is a more generalizable phenomenon. A n excellent review of this subject has recently been published by Sims? Finally, Dr. Katcher comments on my conjectural statement about the relative degrees o f adiposity of male and female physicians and their concern for obesity. This statement is based only on the observation from both the Ten State Nutrition Study and the Tecumseh Study that adult males who have higher incomes tend to be more fat than adult males with lower incomes. For women, on the other hand, it would appear that the opposite is true, i.e., women with higher incomes tend to be leaner than women with lower incomes, or lower socioeconomic status? Since physicians tend to be in the higher income, higher socioeconomic status group, I conjectured that male physicians would tend to be fatter, and women physicians tend to be leaner than the average individual in the population. If one accepts the fact that obesity is related to social and psychological forces, customs, and mores, then factors that result in the male being more obese should in turn reduce his concern for this problem, whereas those forces that result in the female being less obese would increase that individual's concern for this problem. I reiterate that all of this is purely conjectural, but is open to more objective evaluation.
William B. Weil, Jr., M.D. Professor and Chairman Department of Human Development Michigan State University East Lansing, M I 48824 REFERENCES
1. 2.
3. 4.
5.
Forbes GB: Nutrition and growth, J PEDIATR 91:40, 1977. Cram SM, and Clark DC: Nutrition, growth, development, and masturation: Findings from the Ten-State Nutrition Survey of 1968o1970, Pediatrics 56:306, 1975. Garn SM, and Clark DC: Trends in fatness and the origins of obesity, Pediatric 57:443, 1976. Griffiths M and Payne R: Energy expenditure in small children of obese and non-obese parents, Nature 260:698, 1976. Sims A: Experimental obesity, dietary-induced thermogenesis, and their clinical implications, Clin Endocrinol Metabol 5:377, 1976.
Factors influencing ability to read To the Editor, I read with interest the article on reading retardation by Bell, Abrahamson, and McRae 1 i n the September issue of THE
5 17
JOURNAL.~ As the authors note, "interim results of this longitudinal study have been reported in separate papers." It is regrettable that those raw data were not included in TH~ JOURNAL article, since critical review of those papers calls into question some of the conclusions advanced by Bell and her colleagues. Using various indices of auditory, visual motor, and kinesthetic skills as predictors of poor reading performance, one inference drawn by Bell and her colleagues from their pilot group study ~ is that "the percentage o f poor readers increased in direct proportion to the number of specific anomalies shown when IQ was held constant. ''~ In fact, IQ was not held constant in that analysis. Children in the "normal IQ', group fell across 2 SD (mean • 1 SD) while the children in the "below average" group did likewise, occupying the band from - 1 SD to --3 SD. It is important to know whether within each of these groups, there is a relationship between the number of anomalies and the IQ. If such an association exists, then the usefulness of these anomalies as predictors o f poor reading performance above and beyond the predictive value of IQ itself would be diminished. A more disturbing aspect of this same pilot group study 2 is the potentially confounding influence of bilingualism. O f the 142 children entering the study, 131 remained at the end o f the first grade; of these, 35 were found to be poor readers. Interestingly, 10 of the 35 poor readers came from bilingual homes. Since bilingual children comprised 23 of the 131 study subjects, it may be seen that 44% (10/23) of the bilingual children became poor readers, while only 23% (25/108) of the nonbilingual children, became poor readers. Expressed another way, of the 131 children in the pilot group remaining at the end of grade one, 23 or 18%, were from bilingual homes,while of the 35 poor readers, 10 or 29%, came from bilingual homes. Thus, the bilingual children were disproportionately overrepresented among the group of poor readers. Bilingualism may thus be viewed either as a factor predisposing to reading retardation, or, more likely, bilingualism may represent a confounding factor in the test-taking situation. Did the children from bilingual homes show a different relationship between auditory, visual motor, and kinesthetic predictors, and other aspects of cognitive functioning? Since the children from bilingual homes constitute such a disproportionately large share of the poor readers, this would seem to be an important question to answer before drawing broad inferences of any sort from the pilot group study. Bell and her colleagues go on to assert that they found "no evidence to support the popular notion that deficits in visual perception, visual motor and/or motor skills are causal factors in reading retardation. ''1 This assertion is based on the work of their colleagues Robinson and Schwartz, ~who looked at the same pilot group of children. Using poor performance on the Hooper test, Bell's unpublished Closure test, and/or the Bender Gestalt test as their indices, 41 of the 142 pilot group children were identified at the beginning of grade one as being "high risk" for the development of reading retardation. Twenty-three children were then selected from among the 101 remaining in the pilot group, to serve as controls. At the end of grade three, nine of the 41 highrisk children, or 22%, were reading below age level, as opposed to on!y one of the 23 control children, a rate of 4%. The authors choose not to comment upon this greater than fivefold difference
5 18
Editorial correspondence
in reading retardation between the high-risk and the control groups of children. Instead, for purposes of statistical analysis the nine high-risk poor readers and the one control poor reader are combined, and compared against the remaining 32 high-risk children and 22 control children. In making this comparison, the authors failed to find any significant differences between the poor reader group and the good reader group on measurements of visual and visual motor functioning. This should come as no surprise, however, since both groups are dominated, numerically speaking, by high-risk children. The measures o f visual and visual motor functioning used by the authors do indeed pertain to risk of reading retardation, since more than five times as many high-risk children than control children did go on to become poor readers; it would be of even greater interest to learn what it was about the 32 children initially tagged as high risk that enabled them to escape the stigma of reading retardation, unlike their nine less fortunate fellows who were indeed reading below age level at the end of grade three.
James Coplan, M.D. Fellow--Developmental Pediatrics John F. Kennedy Institute Johns Hopkins University 707 N. Broadway Baltimore, MD 21205
REFERENCES
1. Bell AE, Abrahamson DS, and McRae KN: Reading retardation: A 12-year prospective study, J PEDIATR 91:363, 1977. 2. Bell AE, and Aftanas MS: Some correlates of reading retardation, Percept Mot Skills 35:659, 1972. 3. Robinson ME, and Schwartz LB: Visuo-motor skills and reading ability: A longitudinal study, Dev Med Child Neurol 15:281, I973.
R ply To the Editor: We appreciate the interest shown by Dr. Coplan in two of our papers concerned with findings on the pilot group. We agree with him that the publication of more of the data would have been preferable, but since we were trying to give an overview of the work of 12 years, this could not be done within the confines o f a single paper. The consensus of our colleagues was that pediatricians would prefer that we make the main points o f our findings known. Highly critical editors had accepted our papers for publication, and since we offered to produce any of these papers for closer scrutiny of those interested in a particular topic, we felt that we were on safe ground. In trying to be brief we may have been less than specific in some cases. We agree with Dr Coplan that the term "held constant" could be misleading if it is interpreted as identical iQ. The paper 1 points out, however, that we were disot~ssing children whose IQ fell within one of three ranges, i.e., normal, below normal, or superior. We quoted only the results for the 88 middle
The Journal of Pediatrics March 1978
IQ range children ( • SD from the mean IQ of 108) in the present paper. Complete results shown in the 1972 paper served to confirm our statements with regard to the relationship between the number of anomalies and reading skills. With regard to correlations between IQ and the number of deficiencies, we have stated that there is a significant negative relationship between the number of deficiencies and Schonell reading scores (r = -0.46). A significant correlation of IQ and reading scores is reported. Since IQ accounts for only 21% of the variance, it is plain that a number o f other factors are involved in prediction; some o f these, when numerical values could be used, are considered in these results; others such as handedness, position in family, kindergarten attendance, sex, and language spoken in the home have been discussed briefly as well? Some confirmation of our statement that the poor readers showed significantly more negative deviations on the predictor scores (including IQ in the list) was obtained when we looked at groups of children showing different levels of reading achievement (unpublished data). Five groups, A to E had mean reading scores of 26.2, 15.5, 11.5, 8.5, and 5.1, respectively. Group A's mean score was beyond a third-grade entry level, while the group E mean was equivalent to about one-half the first-grade requirement according to Schonell norms. The top group (A) had a mean of 2.3 positive (above average for the present group) and less than one (M = 0.8) negative score among the predictors. The 18 children in Group E had a mean negative deviation score of 4.5, and a mean positive deviation of only 0.2. Across the reading range from A to E, the negative deviations are shown to be inversely related to reading scores, while the positive and possibly compensatory deviations show a direct relationship, increasing as reading scores improve. Dr. Coplan has said that he is disturbed about the potentially confounding influence of bilingualism, and rightly so as we have learned through examination of the data on the expanded group when children from low and high socioeconomic areas were included in our study (1969-70). The point has been discussed in later papers? ~ The figures quoted by Dr. Coplan do seem to be statistically significant but for a number of reasons we attached little functional importance to them. In contrast to the children in an inner-city low socioeconomic area, these children lived in a middle-class suburb where English was the language commonly used in the home, in business, in school, in children's clubs, and on the playground. Language most frequently spoken in the home had been a question on our interview form. All of these children as well as their mothers used English freely; no children were recorded by the psychologists as having possibly doubtful IQ ratings due to language factors. In addition, a vocabulary score was one of our predictor variables; those children who were verbally handicapped for any reason when they entered school would have been recorded as having a negative deviation on the vocabulary subtest; these would be included in these present data. Marion E. Robinson has contributed the following analysis in answer to questions raised about findings from a study of pilot group children at the end of their third year in school: Dr. Coplan has questioned the conclusion regarding the relationship of vist~al-perceptual, visual-motor, and motor skills to reading ability. 2 He contends that the proportion of high-risk children
Editorial correspondence
question at the present time. However, the question o f differences in such things as postabsorptive thermogenesis may become increasingly important in the understanding o f these differences. Griffiths' indicates that children of obese p a r e n t s - e v e n before the children are o b e s e - m a y ingest less calories and have less available for activity than children of nonobese parents. The concept of postabsorptive thermogenesis has been part of the scientific literature for many years, although it originally was described as specific dynamic action. At that time, it was thought that the increased heat loss following ingestion Of nutrient was related to the protein content of the food; it would now appear that this is a more generalizable phenomenon. A n excellent review of this subject has recently been published by Sims? Finally, Dr. Katcher comments on my conjectural statement about the relative degrees o f adiposity of male and female physicians and their concern for obesity. This statement is based only on the observation from both the Ten State Nutrition Study and the Tecumseh Study that adult males who have higher incomes tend to be more fat than adult males with lower incomes. For women, on the other hand, it would appear that the opposite is true, i.e., women with higher incomes tend to be leaner than women with lower incomes, or lower socioeconomic status? Since physicians tend to be in the higher income, higher socioeconomic status group, I conjectured that male physicians would tend to be fatter, and women physicians tend to be leaner than the average individual in the population. If one accepts the fact that obesity is related to social and psychological forces, customs, and mores, then factors that result in the male being more obese should in turn reduce his concern for this problem, whereas those forces that result in the female being less obese would increase that individual's concern for this problem. I reiterate that all of this is purely conjectural, but is open to more objective evaluation.
William B. Weil, Jr., M.D. Professor and Chairman Department of Human Development Michigan State University East Lansing, M I 48824 REFERENCES
1. 2.
3. 4.
5.
Forbes GB: Nutrition and growth, J PEDIATR 91:40, 1977. Cram SM, and Clark DC: Nutrition, growth, development, and masturation: Findings from the Ten-State Nutrition Survey of 1968o1970, Pediatrics 56:306, 1975. Garn SM, and Clark DC: Trends in fatness and the origins of obesity, Pediatric 57:443, 1976. Griffiths M and Payne R: Energy expenditure in small children of obese and non-obese parents, Nature 260:698, 1976. Sims A: Experimental obesity, dietary-induced thermogenesis, and their clinical implications, Clin Endocrinol Metabol 5:377, 1976.
Factors influencing ability to read To the Editor, I read with interest the article on reading retardation by Bell, Abrahamson, and McRae 1 i n the September issue of THE
5 17
JOURNAL.~ As the authors note, "interim results of this longitudinal study have been reported in separate papers." It is regrettable that those raw data were not included in TH~ JOURNAL article, since critical review of those papers calls into question some of the conclusions advanced by Bell and her colleagues. Using various indices of auditory, visual motor, and kinesthetic skills as predictors of poor reading performance, one inference drawn by Bell and her colleagues from their pilot group study ~ is that "the percentage o f poor readers increased in direct proportion to the number of specific anomalies shown when IQ was held constant. ''~ In fact, IQ was not held constant in that analysis. Children in the "normal IQ', group fell across 2 SD (mean • 1 SD) while the children in the "below average" group did likewise, occupying the band from - 1 SD to --3 SD. It is important to know whether within each of these groups, there is a relationship between the number of anomalies and the IQ. If such an association exists, then the usefulness of these anomalies as predictors o f poor reading performance above and beyond the predictive value of IQ itself would be diminished. A more disturbing aspect of this same pilot group study 2 is the potentially confounding influence of bilingualism. O f the 142 children entering the study, 131 remained at the end o f the first grade; of these, 35 were found to be poor readers. Interestingly, 10 of the 35 poor readers came from bilingual homes. Since bilingual children comprised 23 of the 131 study subjects, it may be seen that 44% (10/23) of the bilingual children became poor readers, while only 23% (25/108) of the nonbilingual children, became poor readers. Expressed another way, of the 131 children in the pilot group remaining at the end of grade one, 23 or 18%, were from bilingual homes,while of the 35 poor readers, 10 or 29%, came from bilingual homes. Thus, the bilingual children were disproportionately overrepresented among the group of poor readers. Bilingualism may thus be viewed either as a factor predisposing to reading retardation, or, more likely, bilingualism may represent a confounding factor in the test-taking situation. Did the children from bilingual homes show a different relationship between auditory, visual motor, and kinesthetic predictors, and other aspects of cognitive functioning? Since the children from bilingual homes constitute such a disproportionately large share of the poor readers, this would seem to be an important question to answer before drawing broad inferences of any sort from the pilot group study. Bell and her colleagues go on to assert that they found "no evidence to support the popular notion that deficits in visual perception, visual motor and/or motor skills are causal factors in reading retardation. ''1 This assertion is based on the work of their colleagues Robinson and Schwartz, ~who looked at the same pilot group of children. Using poor performance on the Hooper test, Bell's unpublished Closure test, and/or the Bender Gestalt test as their indices, 41 of the 142 pilot group children were identified at the beginning of grade one as being "high risk" for the development of reading retardation. Twenty-three children were then selected from among the 101 remaining in the pilot group, to serve as controls. At the end of grade three, nine of the 41 highrisk children, or 22%, were reading below age level, as opposed to on!y one of the 23 control children, a rate of 4%. The authors choose not to comment upon this greater than fivefold difference
5 18
Editorial correspondence
in reading retardation between the high-risk and the control groups of children. Instead, for purposes of statistical analysis the nine high-risk poor readers and the one control poor reader are combined, and compared against the remaining 32 high-risk children and 22 control children. In making this comparison, the authors failed to find any significant differences between the poor reader group and the good reader group on measurements of visual and visual motor functioning. This should come as no surprise, however, since both groups are dominated, numerically speaking, by high-risk children. The measures o f visual and visual motor functioning used by the authors do indeed pertain to risk of reading retardation, since more than five times as many high-risk children than control children did go on to become poor readers; it would be of even greater interest to learn what it was about the 32 children initially tagged as high risk that enabled them to escape the stigma of reading retardation, unlike their nine less fortunate fellows who were indeed reading below age level at the end of grade three.
James Coplan, M.D. Fellow--Developmental Pediatrics John F. Kennedy Institute Johns Hopkins University 707 N. Broadway Baltimore, MD 21205
REFERENCES
1. Bell AE, Abrahamson DS, and McRae KN: Reading retardation: A 12-year prospective study, J PEDIATR 91:363, 1977. 2. Bell AE, and Aftanas MS: Some correlates of reading retardation, Percept Mot Skills 35:659, 1972. 3. Robinson ME, and Schwartz LB: Visuo-motor skills and reading ability: A longitudinal study, Dev Med Child Neurol 15:281, I973.
R ply To the Editor: We appreciate the interest shown by Dr. Coplan in two of our papers concerned with findings on the pilot group. We agree with him that the publication of more of the data would have been preferable, but since we were trying to give an overview of the work of 12 years, this could not be done within the confines o f a single paper. The consensus of our colleagues was that pediatricians would prefer that we make the main points o f our findings known. Highly critical editors had accepted our papers for publication, and since we offered to produce any of these papers for closer scrutiny of those interested in a particular topic, we felt that we were on safe ground. In trying to be brief we may have been less than specific in some cases. We agree with Dr Coplan that the term "held constant" could be misleading if it is interpreted as identical iQ. The paper 1 points out, however, that we were disot~ssing children whose IQ fell within one of three ranges, i.e., normal, below normal, or superior. We quoted only the results for the 88 middle
The Journal of Pediatrics March 1978
IQ range children ( • SD from the mean IQ of 108) in the present paper. Complete results shown in the 1972 paper served to confirm our statements with regard to the relationship between the number of anomalies and reading skills. With regard to correlations between IQ and the number of deficiencies, we have stated that there is a significant negative relationship between the number of deficiencies and Schonell reading scores (r = -0.46). A significant correlation of IQ and reading scores is reported. Since IQ accounts for only 21% of the variance, it is plain that a number o f other factors are involved in prediction; some o f these, when numerical values could be used, are considered in these results; others such as handedness, position in family, kindergarten attendance, sex, and language spoken in the home have been discussed briefly as well? Some confirmation of our statement that the poor readers showed significantly more negative deviations on the predictor scores (including IQ in the list) was obtained when we looked at groups of children showing different levels of reading achievement (unpublished data). Five groups, A to E had mean reading scores of 26.2, 15.5, 11.5, 8.5, and 5.1, respectively. Group A's mean score was beyond a third-grade entry level, while the group E mean was equivalent to about one-half the first-grade requirement according to Schonell norms. The top group (A) had a mean of 2.3 positive (above average for the present group) and less than one (M = 0.8) negative score among the predictors. The 18 children in Group E had a mean negative deviation score of 4.5, and a mean positive deviation of only 0.2. Across the reading range from A to E, the negative deviations are shown to be inversely related to reading scores, while the positive and possibly compensatory deviations show a direct relationship, increasing as reading scores improve. Dr. Coplan has said that he is disturbed about the potentially confounding influence of bilingualism, and rightly so as we have learned through examination of the data on the expanded group when children from low and high socioeconomic areas were included in our study (1969-70). The point has been discussed in later papers? ~ The figures quoted by Dr. Coplan do seem to be statistically significant but for a number of reasons we attached little functional importance to them. In contrast to the children in an inner-city low socioeconomic area, these children lived in a middle-class suburb where English was the language commonly used in the home, in business, in school, in children's clubs, and on the playground. Language most frequently spoken in the home had been a question on our interview form. All of these children as well as their mothers used English freely; no children were recorded by the psychologists as having possibly doubtful IQ ratings due to language factors. In addition, a vocabulary score was one of our predictor variables; those children who were verbally handicapped for any reason when they entered school would have been recorded as having a negative deviation on the vocabulary subtest; these would be included in these present data. Marion E. Robinson has contributed the following analysis in answer to questions raised about findings from a study of pilot group children at the end of their third year in school: Dr. Coplan has questioned the conclusion regarding the relationship of vist~al-perceptual, visual-motor, and motor skills to reading ability. 2 He contends that the proportion of high-risk children