UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

The relationship between health history factors and academic achievement/cognitive development in Native… Nolan, Kathleen Marie 1989

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1989_A8 N64.pdf [ 4.74MB ]
Metadata
JSON: 831-1.0054376.json
JSON-LD: 831-1.0054376-ld.json
RDF/XML (Pretty): 831-1.0054376-rdf.xml
RDF/JSON: 831-1.0054376-rdf.json
Turtle: 831-1.0054376-turtle.txt
N-Triples: 831-1.0054376-rdf-ntriples.txt
Original Record: 831-1.0054376-source.json
Full Text
831-1.0054376-fulltext.txt
Citation
831-1.0054376.ris

Full Text

THE RELATIONSHIP BETWEEN HEALTH HISTORY FACTORS AND ACADEMIC ACHIEVEMENT/COGNITIVE DEVELOPMENT IN NATIVE INDIAN CHILDREN By KATHLEEN MARIE NOLAN B . S c , Dalhousie U n i v e r s i t y , 1981 B.Ed., Mount S t . V i n c e n t U n i v e r s i t y , 1983 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES ( E d u c a t i o n a l Psychology) We accept t h i s t h e s i s as conforming t o the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA October, 1989 Q Kathleen Marie Nolan, 1989 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department The University of British Columbia Vancouver, Canada DE-6 (2/88) ABSTRACT T h i s study examined the r e l a t i o n s h i p between h e a l t h h i s t o r y f a c t o r s and academic r e a d i n e s s / c o g n i t i v e a b i l i t i e s i n a sample of grade one N a t i v e Indian c h i l d r e n . S u b j e c t s ranged i n age from 5-11 t o 7-08. There were 14 male and 5 female students i n the sample. A b a t t e r y of p s y c h o e d u c a t i o n a l t e s t s was a d m i n i s t e r e d t o each c h i l d . M e d i c a l data were obtained from f i l e s at the Indian Health O f f i c e . I n d i v i d u a l h e a l t h f a c t o r s as w e l l as a composite r i s k score were used i n a n a l y s e s . C o r r e l a t i o n s were computed t o determine the r e l a t i o n s h i p between the h e a l t h f a c t o r s and the p s y c h o e d u c a t i o n a l t e s t s c o r e s . A s e r i e s of t - t e s t s was undertaken t o examine d i f f e r e n c e s i n means between the high and low h e a l t h r i s k groups. S e v e r a l s i g n i f i c a n t c o r r e l a t i o n s were found: R e s p i r a t o r y i l l n e s s e s , Dental problems and f a i l e d Denver Developmental Screening T e s t s were a s s o c i a t e d with lower s c o r e s on s e v e r a l p s y c h o e d u c a t i o n a l measures. The o v e r a l l r i s k composite was found t o be a meaningful p r e d i c t o r of r e a d i n e s s f o r t h i s sample. C h i l d r e n i n the high r i s k group scored lower on t e n of the e l e v e n t e s t s / s u b t e s t s . The d i f f e r e n c e s between the means of the high and low r i s k groups were s i g n i f i c a n t f o r the K-ABC Number R e c a l l and M e t r o p o l i t a n Readiness Language. T h i s sample d i d manifest a wide v a r i e t y of the h e a l t h a i l m e n t s found t o be endemic i n N a t i v e Indian p o p u l a t i o n s . These h e a l t h problems appeared t o be a s s o c i a t e d with t h e i r performance on the p s y c h o e d u c a t i o n a l b a t t e r y . i i TABLE OF CONTENTS ABSTRACT i i TABLE OF CONTENTS i i i LIST OF TABLES v CHAPTER I 1 INTRODUCTION 1 Statement of the Problem 6 Purpose of the Study 6 Hypothesis 7 CHAPTER I I 8 REVIEW OF THE LITERATURE 8 Ed u c a t i o n and the Native Indian 8 Na t i v e Health Status 21 Developmental and E d u c a t i o n a l Risk F a c t o r s 28 CHAPTER I I I 38 METHODOLOGY 38 P o p u l a t i o n 38 Sample 3 9 Research Design 41 Dependent V a r i a b l e s 43 Data C o l l e c t i o n 47 Hypothesis 48 Method of A n a l y s i s 48 CHAPTER IV 5 0 RESULTS 50 Summary of D e s c r i p t i v e Data 50 i i i I n f e r e n t i a l Analyses 54 Summary 66 CHAPTER V 67 DISCUSSION 67 Purpose of the Study 67 Summary of R e s u l t s 68 L i m i t a t i o n s of the Study 7 3 Recommendations 74 BIBLIOGRAPHY 76 APPENDIX 1 Frequency of Occurrence of Health F a c t o r s 87 APPENDIX 2 Consent - T e s t i n g 88 APPENDIX 3 Consent - Access t o Med i c a l F i l e s 89 i v LIST OF TABLES TABLE 1 Means and Standard D e v i a t i o n s of A b i l i t y and Achievement Test Scores 51 TABLE 2 Pearson C o r r e l a t i o n C o e f f i c i e n t s Between He a l t h F a c t o r s and T e s t Scores 55 TABLE 3 P o i n t B i s e r i a l C o r r e l a t i o n s Between He a l t h F a c t o r s and Test Scores 59 TABLE 4 T-Test - Comparisons of S u b j e c t s With or Without Health Problem f o r Test Scores 63 TABLE 5 T-Test - Comparisons of High and Low He a l t h Risk Groups 65 TABLE 6 S i g n i f i c a n t C o r r e l a t i o n s : Health and P s y c h o l o g i c a l T e s t i n g 70 v 1 CHAPTER I TNTBOnnPTTOU As a group, North American N a t i v e Indian c h i l d r e n ( h e r e a f t e r r e f e r r e d t o as N a t i v e Indian or N a t i v e ) continue t o be at g r e a t r i s k f o r academic f a i l u r e , f a l l i n g f a r t h e r behind t h e i r white peers with i n c r e a s i n g years of s c h o o l i n g (Brooks, 1978; Bryde, 1968). Academic l e v e l s of N a t i v e students are c o n s i s t e n t l y lower than n a t i o n a l norms on s t a n d a r d i z e d achievement t e s t s (More, 1984) and v e r b a l s u b t e s t s of i n t e l l i g e n c e t e s t s (McShane & P l a s , 1984; Common & F r o s t , 1988). Within t h i s group t h e r e i s a high r a t e of r e a d i n g d i s a b i l i t y with l i t e r a c y l e v e l s t e n d i n g t o be very low f o r N a t i v e s when compared t o n a t i o n a l norms (Burnaby, 1982; Lankford & R i l e y , 1986). Approximately 70 p e r c e n t of Native c h i l d r e n i n Canada do not reach grade 12 with about one t h i r d r e p e a t i n g a year by the time they enter grade 2 (Indian C o n d i t i o n s , 1980). V a r i o u s reasons have been put f o r t h f o r N a t i v e I n d i a n s ' c h r o n i c and c o n s i s t e n t academic problems. Hav i g h u r s t (1970) suggests t h a t i n s t r u c t i o n a l methods employed by t e a c h e r s of N a t i v e c h i l d r e n are not always e f f e c t i v e owing t o the d i s t i n c t needs and p e r c e p t u a l a b i l i t i e s of these c h i l d r e n . S e v e r a l r e s e a r c h e r s have e x p l o r e d the t h e o r y of a "Native l e a r n i n g s t y l e , " based on t h e i r supposed s t r e n g t h s i n v i s u a l -s p a t i a l p r o c e s s i n g r a t h e r than a u d i t o r y - s e q u e n t i a l p r o c e s s i n g . A u d i t o r y - s e q u e n t i a l i s g e n e r a l l y accepted as being more conducive t o the t y p i c a l s c h o o l environment (Kaulback, 1984; 2 Osborne, 1985; McShane & P l a s , 1984). Sabatino, Hayden and K e l l i n g (1972) r e p o r t e d t h a t Navajo c h i l d r e n r e f e r r e d f o r s p e c i a l c l a s s e s experienced s c h o o l l e a r n i n g problems predominantly due t o a l a c k of knowledge of the l i n g u i s t i c r u l e s of the E n g l i s h language. The nonstandard E n g l i s h spoken by many Na t i v e students has a l s o been a s s o c i a t e d with t h e i r l a c k of p r o g r e s s i n r e a d i n g and w r i t i n g ( B a r t h , 1979). The low v e r b a l IQ scores o b t a i n e d by N a t i v e c h i l d r e n are i n t e r p r e t e d by T e e t e r , Moore and Petersen (1982) as r e f l e c t i n g d i v e r g e n t language, c u l t u r a l and e x p e r i e n t i a l f a c t o r s r a t h e r than as a d e f i c i t i n i n t e l l e c t u a l p o t e n t i a l . Downing, O l l i l a and O l i v e r (1975) found the c h i l d r e n from the B r i t i s h Columbia Native c u l t u r e they s t u d i e d t o have l e s s e x p e r i e n c e of l i t e r a c y behavior and l e s s awareness of the a c t s of speech. They d e s c r i b e t h i s phenomenon as " c o g n i t i v e c o n f u s i o n " r e g a r d i n g r e a d i n g and w r i t i n g . T h e i r sample had l e s s knowledge of the purpose of l i t e r a c y a c t i v i t i e s and poorer t e c h n i c a l knowledge of u n i t s of speech and w r i t i n g . In a d d i t i o n t o l a c k of p r e s c h o o l e xperiences and c u l t u r a l s t i m u l u s , i r r e l e v a n t c u r r i c u l u m may a l s o be p l a c i n g these c h i l d r e n at a disadvantage i n the p r o v i n c i a l s c h o o l system (McEachern, 1981). V a r i o u s other f a c t o r s o f t e n a s s o c i a t e d with low s o c i o -economic s t a t u s , r e g a r d l e s s of c u l t u r a l a f f i l i a t i o n a l s o apply t o t h i s group, f o r example: poverty, l a c k of s t a b i l i t y w i t h i n the d i s t r i c t , as w e l l as low r a t e s of attendance. These have 3 a l s o been suggested as c o n t r i b u t i n g f a c t o r s t o t h e i r academic f a i l u r e (Vernon, 1966; Blowers, 1981; Rohner, 1965). McShane (1983) proposed a m u l t i f a c e t e d model t o e x p l a i n the unique p a t t e r n s of achievement i n these c h i l d r e n . His combined D e f i c i t - D i f f e r e n c e - D e v e l o p m e n t a l model takes i n t o account d e t r i m e n t a l environmental c o n d i t i o n s , c u l t u r a l d i s o r g a n i z a t i o n ( i . e . s h i f t i n g between the N a t i v e and dominant c u l t u r e s ) , language and emotional problems. In a d d i t i o n t o the aforementioned academic problems, N a t i v e c h i l d r e n a l s o continue t o experience a d i s p r o p o r t i o n a t e l y high i n c i d e n c e of h e a l t h problems. The types of i l l n e s s e s they are p r e d i s p o s e d t o are the same as those endemic i n other low socioeconomic groups, i . e . r e s p i r a t o r y t r a c t i n f e c t i o n s , g a s t r o i n t e s t i n a l problems, o t i t i s media (o.m.) and s k i n i n f e c t i o n s (Baker, F i n d l a y , I s b i s t e r & Peekeekoot, 1987). In s p i t e of p r o g r e s s being made they c o n t i n u e t o r e p r e s e n t a high r i s k group from disadvantaged f a m i l i e s . (Wallace, 1974; P l a x t o n , Shah, Young & Bain, 1983). Among Nat i v e groups t h e r e are more a d o l e s c e n t pregnancies, more c o m p l i c a t i o n s i n pregnancy and c h i l d b i r t h , g r e a t e r m u l t i p a r i t y , h i g h e r p e r i n a t a l , n e o n a t a l and i n f a n t deaths and more low and high b i r t h weights. They a l s o have more deaths from g a s t r o i n t e s t i n a l i n f e c t i o n s and c o n g e n i t a l anomalies. These c h i l d r e n a l s o e x h i b i t h i g h e r i n c i d e n c e of r e s p i r a t o r y i l l n e s s and severe r e c u r r e n t pulmonary d i s e a s e . (Manitoba N a t i v e Indian Mother and C h i l d , 1981). 4 D e s p i t e the marked d e c l i n e i n the i n c i d e n c e of d i p h t h e r i a the continuous presence of cases and c a r r i e r s i s a p e r s i s t e n t problem i n northern Native communities. O t i t i s media with r e s u l t a n t h e a r i n g impairment i s one of the most s e r i o u s h e a l t h problems i n t h i s p o p u l a t i o n (McShane & M i t c h e l l , 1979; Wallace, 1974) and has been f o r the past two decades, with p r e v a l e n c e e s t i m a t e s ranging from 20-70%. Much r e s e a r c h has documented the r e l a t i o n s h i p of o.m. and a c a d e m i c / l e a r n i n g problems, e s p e c i a l l y when the f l u c t u a t i n g h e a r i n g l o s s and d i s t o r t e d a u d i t o r y s i g n a l s occur d u r i n g c r i t i c a l p e r i o d s of language and a u d i t o r y p r o c e s s i n g development (McShane, 1982; Bender, Burks, Baum, Fleshman & V i e i r a , 1975). Not o n l y are N a t i v e c h i l d r e n at extreme r i s k f o r h e a r i n g problems but they a l s o appear t o be at g r e a t e r r i s k than other groups of c h i l d r e n f o r v i s i o n d i f f i c u l t i e s . Hamilton (1976) found s i x times as many Native c h i l d r e n as nonNative e n t e r i n g s c h o o l with a v i s i o n handicap. G a s t r o e n t e r i t i s has c o n s i s t e n t l y ranked as the second most p r e v a l e n t d i s e a s e f o l l o w e d by s t r e p t h r o a t , s c a r l e t f ever and i n f l u e n z a (Evers & Rand, 1983). In c h i l d r e n most of these d i s e a s e s are p r e v e n t a b l e through b e t t e r l i v i n g c o n d i t i o n s at home, more adequate housing, a s a f e r water supply system and r e g u l a r immunization (Plaxton et a l . , 1983). The high r a t e s of i n f a n t m o r t a l i t y and m o r b i d i t y a l s o suggest t h a t the N a t i v e c h i l d has a suboptimal n u t r i t i o n s t a t u s . A N u t r i t i o n Canada survey (Department of Health and Welfare, 1975) r e p o r t e d t h a t , i n g e n e r a l N a t i v e and Eskimo 5 c h i l d r e n and a d o l e s c e n t s d i s p l a y e d d e f i c i e n c i e s i n i r o n f o l a t e and v i t a m i n C. Lee, Reyburn & Carrow (1971) i n a s t u d y of two p o p u l a t i o n s of N a t i v e s i n n o r t h e r n B.C. found c a l o r i c e x c e s s w i t h r e s u l t a n t o b e s i t y r a t h e r t h a n c a l o r i c i n s u f f i c i e n c y t o be a problem. In a d d i t i o n t o t h e s e d e t r i m e n t a l h e a l t h f a c t o r s , t h e use of m e d i c a l s e r v i c e s , e s p e c i a l l y by N a t i v e p e o p l e l i v i n g o f f r e s e r v e i s o f t e n i n a d e q u a t e or i n a p p r o p r i a t e . "Developmental, v i s i o n and h e a r i n g s c r e e n i n g s a r e o f t e n not done r o u t i n e l y and t h e r e i s room f o r improvement i n p r o v i d i n g i m m u n i z a t i o n and v a c c i n a t i o n , e s p e c i a l l y among c h i l d r e n over 24 months. I n g e n e r a l p r e v e n t i v e h e a l t h c a r e i s made d i f f i c u l t because of l a c k of t r a i n e d s t a f f , h i g h t u r n o v e r and p r i o r demands of a c u t e c a r e . " ( P l a x t o n e t a l . , 1983). A c o n s i d e r a b l e gap s t i l l e x i s t s between t h e h e a l t h s t a t u s of N a t i v e p e o p l e i n Canada and t h a t of t h e g e n e r a l p o p u l a t i o n . Numerous r e s e a r c h e r s have examined t h e r e l a t i o n s h i p of e n v i r o n m e n t a l f a c t o r s such as b i r t h c o m p l i c a t i o n s and i l l n e s s e s and l a t e r development. R e s u l t s a r e i n c o n s i s t e n t a c r o s s s t u d i e s . Some have found m e d i c a l s c r e e n i n g t o be a s i g n i f i c a n t p r e d i c t o r of p s y c h o e d u c a t i o n a l d i f f i c u l t i e s , w h i l e o t h e r s r e p o r t i t t o be of m i n i m a l u s e f u l n e s s f o r p r e d i c t i o n . A f t e r an e x t e n s i v e l i t e r a t u r e s e a r c h by t h i s r e s e a r c h e r o n l y one s t u d y was found t h a t examined t h i s r e l a t i o n s h i p i n N a t i v e c h i l d r e n . T h i s was Bender e t a l . ' s (1975) s t u d y of over 600 Eskimo c h i l d r e n . T h e i r r e s u l t s i n d i c a t e d t h a t anemia i n i n f a n c y and/or t h e o c c u r r e n c e of s i g n i f i c a n t i l l n e s s e s or 6 o t i t i s media were a s s o c i a t e d w i t h lower IQ and achievement t e s t s c o r e s . S i n c e N a t i v e groups e x p e r i e n c e both h e a l t h problems and academic d i f f i c u l t i e s i n p r o p o r t i o n s which g r e a t l y exceed the n o n - N a t i v e p o p u l a t i o n i t seems t h a t an u n d e r s t a n d i n g of p o s s i b l e r e l a t i o n s h i p s between these c o n d i t i o n s may p r o v i d e a s s i s t a n c e i n d e v e l o p i n g programs at the h e a l t h s e r v i c e and s c h o o l l e v e l . A focus on e a r l y i d e n t i f i c a t i o n and i n t e r v e n t i o n f o r c h i l d r e n thought t o be a t r i s k f o r e d u c a t i o n a l d i f f i c u l t i e s would a s s i s t i n a p p r o p r i a t e l y d i r e c t i n g l i m i t e d r e s o u r c e s . The d e a r t h of r e s e a r c h i n t h i s s p e c i f i c a r e a warrant s f u r t h e r s t u d y . The r e l a t i o n s h i p s between h e a l t h problems such as o t i t i s media and p e r i n a t a l trauma and e d u c a t i o n d i f f i c u l t y have been documented. However, l i t t l e work has been done i n t h i s area f o r N a t i v e I n d i a n s . As a group they m a n i f e s t both v a r i a b l e s i n h i g h e r p r o p o r t i o n s than the m a j o r i t y c u l t u r e . E n g l i s h as a second d i a l e c t , p o v e r t y and d i f f e r e n t concept s of l e a r n i n g are a l l f a c t o r s which i n f l u e n c e a N a t i v e c h i l d ' s a d a p t a t i o n t o the p u b l i c s c h o o l sys tem. Subs tandard n u t r i t i o n and f r e q u e n t bouts of o t i t i s media and o t h e r i l l n e s s e s a s s o c i a t e d w i t h d e v e l o p m e n t a l d e l a y are a l s o h i g h l y p r e v a l e n t i n t h i s p o p u l a t i o n . P n r p n g g o f t h o . q t n H y The purpose of t h i s s tudy i s t o a s ses s the r e l a t i o n s h i p of antecedent h e a l t h h i s t o r y f a c t o r s and academic achievement 7 and r e a d i n e s s s k i l l s i n a sample of N a t i v e c h i l d r e n i n a small B.C. community. V a r i a b l e s In t h i s study the independent v a r i a b l e s w i l l be the v a r i o u s h e a l t h f a c t o r s o b tained from the medical f i l e s of each c h i l d (e.g. b i r t h weight, p e r i n a t a l trauma, o t i t i s media and so on). The dependent v a r i a b l e s are academic achievement or r e a d i n e s s as measured by the b a t t e r y of s t a n d a r d i z e d t e s t s . H y p n t h o c i c There w i l l be a s i g n i f i c a n t r e l a t i o n s h i p between h e a l t h h i s t o r y f a c t o r s and r e a d i n e s s . A l i n e a r r e l a t i o n s h i p i s expected t o e x i s t with those c h i l d r e n at h i g h e r r i s k f o r h e a l t h problems d i s p l a y i n g lower c o g n i t i v e a b i l i t i e s and r e a d i n e s s s k i l l s than c h i l d r e n with more s t a b l e h e a l t h h i s t o r i e s . 8 CHAPTER II B F V T F W O F T H P T . T T B R& T T 1 R F In t h i s review of the l i t e r a t u r e t h r e e main themes are o u t l i n e d : N a t i v e Indian education problems, the r e l a t i o n s h i p between h e a l t h r i s k f a c t o r s and developmental sequelae and N a t i v e h e a l t h s t a t u s . The s u b j e c t of N a t i ve I n d i a n s ' e d u c a t i o n problems has been wi d e l y r e s e a r c h e d over the past s e v e r a l decades. The l a c k of success N a t i v e students experience i n the p u b l i c s c h o o l system i s manifest i n high dropout r a t e s and grade r e t e n t i o n and low achievement scores (Burnaby, 1982; McShane & P l a s , 1988; More, 1984; Rohner, 1965). U n f o r t u n a t e l y low l e v e l s of e d u c a t i o n o f t e n c o e x i s t with other socioeconomic and medical problems and thus can not be s t u d i e d i n i s o l a t i o n . In s p i t e of c o n s i d e r a b l e r e s o u r c e s d i r e c t e d at improving the l i v i n g c o n d i t i o n s f o r N a t i v e s l i v i n g on and o f f r e s e r v e these i s s u e s have been an ongoing concern. The Hawthorn r e p o r t of 1966 i n d i c a t e d t h a t , at t h a t time, 94% of Canadian N a t i v e s dropped out of s c h o o l between grades one and 12. Approximately 80% repeated grade one and many again repeated grade t h r e e and i f not grade t h r e e or grade f o u r . The p r e s e n t Canadian s i t u a t i o n f i n d s the enrollment of N a t i v e c h i l d r e n at the elementary l e v e l t o be e q u i v a l e n t to n a t i o n a l elementary enrollment l e v e l s ; however, while the t o t a l secondary e d u c a t i o n enrollment has more than doubled 9 s i n c e 1965, the p r o p o r t i o n of N a t i v e c h i l d r e n e n r o l l e d has been s t e a d i l y d e c l i n i n g s i n c e a peak i n 1972-1973. T h e i r r a t e completing high s c h o o l i s l e s s than one q u a r t e r of the n a t i o n a l s c h o o l completion l e v e l s (Burnaby, 1982; Indian C o n d i t i o n s , 1980). In the Vancouver school d i s t r i c t i n 1980 over 20% of N a t i v e students repeated one grade versus about 5% of nonNatives. As w e l l they were two times more l i k e l y t o repeat a second time. The number t o graduate was one h a l f those of nonNative. On average more N a t i v e s dropped out of secondary s c h o o l than any other e t h n i c group (Hunter & Stevens, 1980). More (1984) a l s o found 41% of N a t i v e students i n B.C. t o be p l a c e d at l e a s t one year below grade l e v e l f o r c h r o n o l o g i c a l age and the dropout r a t e t o be 80%. His review of the q u a l i t y of N a t i v e e d u c a t i o n found t h a t , on every measure of achievement i n every study, N a t i v e students were s i g n i f i c a n t l y behind t h e i r nonNative peers i n achievement. About one t h i r d of the N a t i v e s were a year behind by the time they entered grade two. In many areas they were h e l d back because of language d i f f e r e n c e s or d e f i c i e n c i e s even though E n g l i s h was t h e i r f i r s t language (p.34). On s t a n d a r d i z e d t e s t s such as the Gates M a c G i n i t i e , N a t i v e c h i l d r e n were s i g n i f i c a n t l y below grade l e v e l on vocabulary and comprehension. Reading problems were e s p e c i a l l y p r e v a l e n t among those c h i l d r e n who d i d not a t t e n d k i n d e r g a r t e n . Barth (1979) documented s i m i l a r f i n d i n g s r e g a r d i n g r e a d i n g problems i n N a t i v e s t u d e n t s . 1 0 Reports and s t u d i e s on ed u c a t i o n have been commissioned by the Bands themselves as they have taken c o n t r o l from f e d e r a l and p r o v i n c i a l governments over the sc h o o l s t h e i r c h i l d r e n a t t e n d (Hamilton & Owston, 1983; More, 1984). The c o n f i r m a t i o n t h a t g e n e r a l l y N a t i v e c h i l d r e n are not succeeding i n the p r o v i n c i a l s c h o o l systems i s c o n s i s t e n t a c r o s s these s t u d i e s . "Natives s t i l l form the s i n g l e most u n d e r p r i v i l e g e d group i n B r i t i s h Columbia i n terms of ed u c a t i o n and employment (B l u n t , 1979)." V a r i o u s r e s e a r c h e r s have t r i e d t o account f o r these d i s h e a r t e n i n g s t a t i s t i c s . M a y f i e l d (1985) a t t r i b u t e d the high dropout r a t e t o l a c k of mastery of the s k i l l s needed i n formal e d u c a t i o n . Lack of knowledge of b a s i c o p e r a t i o n s i n the major c u r r i c u l a r areas, e s p e c i a l l y Language A r t s and Math was e s t a b l i s h e d i n Ki r k n e s s * (1978) sample. "Even though they appear t o have the same in n a t e p o t e n t i a l f o r l e a r n i n g t o read as any c h i l d , t h e r e e x i s t s a high r a t e of r e a d i n g f a i l u r e f o r Indian c h i l d r e n (Lankford & R i l e y , 1986)." S p i t l e r (1980) a t t r i b u t e s low scores on math achievement t e s t s t o a tendency t o r e l y on memory r a t h e r than understanding. Low Math achievement i n Native c h i l d r e n was a l s o documented by Trent and Gilman (1985 ). The concept of academic c r o s s o v e r developed by Bryde (1963) was based on the f a c t t h a t N a t i v e c h i l d r e n i n h i s study began grade four at or ahead of the g e n e r a l achievement norms. They tended t o achieve s a t i s f a c t o r i l y f o r a w h i l e , then f e l l 11 behind i n a steady d e c l i n e by the e i g h t h grade. Other r e s e a r c h e r s have r e f e r r e d t o t h i s as "cumulative d e f i c i t " ( Berry, 1968) or "age-grade d e c e l e r a t i o n i n achievement" (Rampaul, Singh & Didyk, 1984) which p l a c e s these c h i l d r e n f u r t h e r behind with i n c r e a s i n g years of s c h o o l . As much of the c u r r i c u l u m i s cumulative, b a s i c s k i l l s not l e a r n e d w e l l or not remediated e a r l y i n the ed u c a t i o n process may develop i n t o unsurmountable academic and emotional problems (Rampaul e t a l . , 1984). B e i s e r and Attneave (1982) found N a t i v e c h i l d r e n at a l l ages except 5-9 t o be at higher r i s k f o r e n t e r i n g mental h e a l t h treatment than were nonNatives. As they s t a t e d , " the d i r e c t i o n of c a u s a l i t y i s u n c l e a r , i . e . whether d e c l i n i n g academic performance i s due t o emotional problems or i f academic d e c l i n e i s i n p a r t r e s p o n s i b l e f o r i n c r e a s i n g emotional problems." Other reasons suggested as c o n t r i b u t i n g t o academic d e f i c i t s are l a c k of m o t i v a t i o n on the p a r t of the c h i l d or the p a r e n t s , c h r o n i c absenteeism (which may be a s s o c i a t e d with h i g h i n c i d e n c e of c e r t a i n h e a l t h problems), or s o c i a l problems (Lankford & R i l e y , 1986). Truancy, poor grades and a negative a t t i t u d e may be due not t o l a c k of concern on the p a r t of the parents but r a t h e r t o a lack of knowledge of and involvement i n the e d u c a t i o n system. Many asp e c t s of the c u r r i c u l u m are seen t o be i r r e l e v a n t f o r N a t i v e l e a r n e r s (Blowers, 1981; Vernon, 1966). Basal readers which are M i n i s t r y of Education approved are r e l e v a n t t o the ex p e r i e n c e s of "mainline:Canadian c h i l d r e n . " Much of the content d e a l s with c h i l d r e n l i v i n g i n urban environments where the n u c l e a r f a m i l y predominates (McEachern, 1981). Because of the d i s c r e p a n c y between t h e i r home and sch o o l i t i s assumed t h a t l i t t l e r e i n f o r c e m e n t i s giv e n a t home f o r the work of the sch o o l and v i c e v e r s a (Sealey, 1980). In r e c o g n i t i o n of t h i s , r e a d i n g s e r i e s and c u r r i c u l u m aimed at t h i s p o p u l a t i o n of students are being developed (Brooks, 1978). Current s t a f f i n g i n Native e d u c a t i o n i s c h a r a c t e r i z e d by high t u r n o v e r , inadequate t r a i n i n g f o r t r a n s c u l t u r a l education and low morale. There are few experienced or n a t i v e t e a c h e r s employed and i t i s widely accepted t h a t white t e a c h e r s have d i f f i c u l t y r e l a t i n g t o the c u l t u r a l d i f f e r e n c e s of these c h i l d r e n , e s p e c i a l l y on r e s e r v e s where white personnel are seen as t r a n s i e n t . S e v e r a l c o l l e g e s and u n i v e r s i t i e s i n Canada now o f f e r N a t i v e teacher and t r a i n i n g programmes, i n an attempt t o remedy t h i s s i t u a t i o n ( B i g a r t , 1974; Brooks, 1978). A p o s i t i v e r e l a t i o n s h i p has been found t o e x i s t between teacher e x p e c t a t i o n s r e g a r d i n g Native l e a r n e r s and academic achievement which may le a d t o a s e l f f u l f i l l i n g prophecy e f f e c t (Rampaul et a l . , 1984). Preconceived n o t i o n s and s t e r e o t y p e s h e l d by te a c h e r s may a l s o l e a d t o misconceptions; e.g. one f i n d i n g of the L i l l o o e t (Napoleon, 1988) study was t h a t although t e a c h e r s i d e n t i f i e d high r a t e s of absenteeism among Na t i v e c h i l d r e n as l i k e l y c o n t r i b u t i n g t o t h e i r lack of academic success, no s i g n i f i c a n t d i f f e r e n c e s were found i n days absent f o r Na t i v e versus white students, except f o r grade 1 3 one, when the N a t i v e c h i l d r e n were absent more. However, t h i s h igh absenteeism r a t e e a r l y i n t h e i r e d u c a t i o n may i n f a c t c o n t r i b u t e t o d e l a y e d s k i l l a c q u i s i t i o n from the onset, i n t h i s group. With Native t e a c h e r t r a i n i n g programmes and focus on c u r r i c u l u m development the s i t u a t i o n i s s l o w l y improving, though not i n p r o p o r t i o n t o the c o n s i d e r a b l e funding which has been d i r e c t e d toward Native e d u c a t i o n over the past s e v e r a l decades (Ind i a n C o n d i t i o n s , 1980). The d i s c r e p a n c y between "Native l e a r n i n g s t y l e s " and methods and m a t e r i a l s of i n s t r u c t i o n has a l s o been c i t e d as a c o n t r i b u t i n g f a c t o r t o t h e i r l a c k of achievement (Havighurst, 1970; Vernon, 1966; Brooks, 1978; Kaulback, 1984; More, 1984). The concept of the N a t i v e Indian l e a r n i n g s t y l e has g e n e r a l l y been based on the assumption t h a t N a t i v e c h i l d r e n have s i g n i f i c a n t l y g r e a t e r s p a t i a l a b i l i t i e s than v e r b a l ; the l a t t e r being more conducive t o s c h o o l achievement ( W i l l i a m s , 1986). Some r e s e a r c h e r s suggest t h a t N a t i v e p u p i l s use s p a t i a l or simultaneous a b i l i t i e s t o s o l v e t a s k s t h a t other groups might f o r example use v e r b a l or s e q u e n t i a l a b i l i t i e s t o s o l v e (Brooks, 1978; McShane & P l a s , 1988; More, 1984). The concept of an E n g l i s h language d e f i c i t or i n h e r e n t weakness i n v e r b a l s k i l l s has a l s o r e c e i v e d c o n s i d e r a b l e a t t e n t i o n by r e s e a r c h e r s . Depending on where they l i v e and the degree of i n t e g r a t i o n with the m a j o r i t y c u l t u r e , N a t i v e students come t o s c h o o l with v a r y i n g degrees of competency i n the E n g l i s h language. Approximately 60% of N a t i v e c h i l d r e n 14 e n t e r i n g s c h o o l a c r o s s Canada do l a c k f a c i l i t y i n E n g l i s h . S t a t i s t i c s from the Department of Indian and Northern a f f a i r s f o r the year 1978-79 showed t h a t 35% of N a t i v e c h i l d r e n e n t e r e d the educa t i o n system speaking N a t i v e and E n g l i s h , 23% speaking N a t i v e o n l y and 31% speaking E n g l i s h o n l y . F r e q u e n t l y those who do speak E n g l i s h show a reduced v o c a b u l a r y and e r r o r s i n grammar and syntax. When E n g l i s h i s a f i r s t language i t may be a d i s t i n c t i v e l y N a t i v e v a r i e t y t h a t i s a c o n t i n u a t i o n of the Native language t r a d i t i o n s . I t may pre s e r v e p h o n o l o g i c a l , s y n t a c t i c and semantic d i s c o u r s e p r o c e s s e s of the Na t i v e language (Ashworth, 1979; Barth, 1979; Bayles & H a r r i s , 1982; Burnaby, 1982). One O n t a r i o study (Burnaby, 1982) found t h a t "the more Nat i v e language t h e r e i s i n these peoples' background the lower t h e i r achievement and c o n v e r s e l y , the more E n g l i s h i n t h e i r background the higher t h e i r achievement." Sabatino and Hayden (1972) found s i m i l a r l i n k s between language and achievement r e p o r t i n g t h a t Navajo c h i l d r e n r e f e r r e d f o r s p e c i a l c l a s s placement experienced s c h o o l l e a r n i n g problems predominantly due t o l a c k of knowledge of the l i n g u i s t i c r u l e s of the E n g l i s h language. A f r e q u e n t l y c i t e d assumption i s t h a t the Na t i v e community does not s t r e s s o r a l language and o f t e n f u n c t i o n s without the b e n e f i t of f u l l l i t e r a c y (Downing et a l . , 1975; Hawthorn, 1966). Few of these s t u d i e s mention how they have determined t h i s d i f f e r e n t i n t e r a c t i o n s t y l e , however. Lack of v e r b a l / a u d i t o r y s t i m u l a t i o n i n e a r l y home l i f e has been 1 5 suggested as a f a c t o r making s c h o o l success p r o g r e s s i v e l y more d i f f i c u l t f o r N a t i v e c h i l d r e n with age (Mickelson & Galloway, 1969). I n t e r f e r e n c e from the student's n a t i v e language has been an obvious problem i n E n g l i s h language a c q u i s i t i o n . I n t e r f e r e n c e from nonNative E n g l i s h l e a r n e d from parents who are the f i r s t g e n e r a t i o n t o be monolingual i n t h a t language, l a c k of vocabulary and e x p e r i e n t i a l background and the o f t e n h i g h l y a r t i f i c i a l usage of E n g l i s h i n the classroom may be regarded as a d d i t i o n a l problems (Barth, 1979; Burnaby, 1982). Downing e t a l . (1975) found k i n d e r g a r t e n p u p i l s from two B.C. N a t i v e bands i n which t h e r e were no t r a d i t i o n s of w r i t t e n language t o be " i n a s t a t e of c o g n i t i v e c o n f u s i o n r e g a r d i n g the f u n c t i o n s and t a s k processes of the s k i l l s of l i t e r a c y . " They were l e s s a b l e t o r e c o g n i z e the a c t s of r e a d i n g and w r i t i n g , the l e t t e r s and t h e i r names. As w e l l , they were immature i n t h e i r concepts of the communicative f u n c t i o n of r e a d i n g and w r i t i n g compared t o nonNative c h i l d r e n from the same geographic a r e a . T h e i r study d i d not c o n t r o l f o r socioeconomic s t a t u s , however,with the Native homes poorer e c o n o m i c a l l y , with fewer r e a d i n g m a t e r i a l s . In L i l l o o e t the N a t i v e students i n grades one and t h r e e were s i g n i f i c a n t l y below the norms on the PPVT-R, with the net e f f e c t being t h a t they s t a r t o f f s c h o o l at a disadvantage, unprepared f o r " s c h o o l r e l a t e d v o c a b ulary" (Napoleon, 1988). I n s t e a d of f i n d i n g improvements with age, Ashworth (1979) found t h a t the q u a l i t y of N a t i v e c h i l d r e n ' s d e s c r i p t i v e 1 6 language d e c l i n e d as they got o l d e r . Language development seemed t o slow down as they moved from grade one t o grade t h r e e . They were a l s o l e s s p r o f i c i e n t i n the language used i n s c h o o l , i n terms of d e s c r i b i n g , e x p l a i n i n g , q u a l i f y i n g , e t c . than were nonNative urban c h i l d r e n . Attempts t o measure Na t i v e students' achievement and a p t i t u d e are complicated by r e a d i n g , w r i t i n g , language and attendance problems. T h i s leads t o g e n e r a l problems i n c o n d u c t i n g c o n t r o l l e d q u a n t i t a t i v e r e s e a r c h with t h i s p o p u l a t i o n . Although the number of s t u d i e s concerned with Native performance on IQ t e s t s i s s m a l l the r e s u l t s are g e n e r a l l y c o n s i s t e n t i n demonstrating t h a t the language s k i l l s of Native c h i l d r e n c o n t r i b u t e t o a c h a r a c t e r i s t i c WISC-R p a t t e r n , t h a t i s , s i g n i f i c a n t l y lower v e r b a l than performance s c a l e s (McShane & P l a s , 1984; Common & F r o s t , 1988). C u l t u r a l and s o c i a l b i a s e s u s u a l l y r e s u l t i n lower f u l l s c a l e IQ scores than the norms. Ch r i s J o h n , Towson, Pace & P e t e r s (1989) suggest t h a t when t h e i r recommended procedures f o r c r o s s c u l t u r a l assessment are p r a c t i c e d t h e r e i s no " I n d i a n / n o n l n d i a n " d i s t i n c t i o n . Some of the procedures they employed may v i o l a t e s t a n d a r d i z e d a d m i n i s t r a t i o n g u i d e l i n e s . For example, they do not s p e c i f y the amount of t r a i n i n g g i v e n t o t h e i r N a t i v e examiners nor the extent of " t e s t i n g the l i m i t s " which i s a l l o w a b l e . T e e t e r et a l . (1982) examined a group of Navajo c h i l d r e n r e f e r r e d f o r a v a r i e t y of s p e c i a l e d u c a t i o n s e r v i c e s ; the only 17 study l o c a t e d which i n c l u d e d a handicapped N a t i v e sample. They found t h a t t h e i r students, r e g a r d l e s s of s p e c i f i c l e a r n i n g d e f i c i t s scored lower than the s t a n d a r d i z a t i o n group on v e r b a l s u b t e s t s of the WISC-R. Consequently they i n t e r p r e t e d the low v e r b a l s c o r e s as r e f l e c t i n g d i v e r g e n t c u l t u r a l , language and e x p e r i e n t i a l f a c t o r s r a t h e r than as a d e f i c i t i n i n t e l l e c t u a l p o t e n t i a l . McShane (1984) i n a review of l i t e r a t u r e on WISC-R t e s t i n g with N a t i v e c h i l d r e n came t o the c o n c l u s i o n t h a t an 8-19 p o i n t d i s c r e p a n c y i n favour of the Performance s c a l e c o u l d be c o n s i d e r e d t y p i c a l f o r Native c h i l d r e n . T h i s v e r b a l performance d i s c r e p a n c y has a l s o been documented i n s e v e r a l other s t u d i e s . T h i s p a t t e r n has been ob t a i n e d by r e s e a r c h e r s i n d i f f e r e n t p a r t s of Canada u s i n g N a t i v e s from d i f f e r e n t l i n g u i s t i c and indigenous peoples' groups. Without t a k i n g i n t o account socioeconomic f a c t o r s , c u l t u r a l o p p o r t u n i t i e s , type of s c h o o l i n g , e t c . i t i s d i f f i c u l t t o make statements r e g a r d i n g the u n d e r l y i n g causes of lower v e r b a l s k i l l s however these r e s u l t s have been c o n s i s t e n t l y found; t h e r e f o r e they must be c o n s i d e r e d c h a r a c t e r i s t i c of the performance of Na t i v e Indians on s t a n d a r d i z e d i n t e l l i g e n c e t e s t s (Common & F r o s t , 1988 p. 22 ) . Sternberg (1984) proposed t h a t t h e r e are probably no d i f f e r e n c e s a c r o s s c u l t u r e s i n in n a t e c o g n i t i v e processes and s t r a t e g i e s , r a t h e r i t i s the r e l a t i v e importance of v a r i o u s a s p e c t s of c o g n i t i v e f u n c t i o n i n g which vary from c u l t u r e t o 18 c u l t u r e . S e v e r a l r e s e a r c h e r s suggest t h a t N a t i v e groups tend t o use nonverbal communication between parents and c h i l d r e n , c o n c l u d i n g t h a t performance type s k i l l s w i l l l i k e l y be f o s t e r e d more than v e r b a l (Common & F r o s t , 1988; Kaulback, 1984; Pepper & Henry, 1986). T e s t s developed and normed on the white p o p u l a t i o n w i l l r e f l e c t those s k i l l s and c a p a b i l i t i e s which are adapt i v e t o the white c u l t u r e and r e a l l i f e s i t u a t i o n . They w i l l not n e c e s s a r i l y be those which are adaptable and r e l e v a n t t o the Nat i v e way of l i f e (Common & F r o s t 1988). Rohner (1965) however, suggests t h a t although such scores are a b i a s e d measure of " i n t e l l e c t u a l c a p a c i t y " they may p r o v i d e a rough p r e d i c t o r of academic achievement i n the dominant s c h o o l system, which i t s e l f i s c u l t u r a l l y b i a s e d , t o the disadvantage of the N a t i v e student. More and O l d r i d g e (1980) suggest t h a t N a t i v e c h i l d r e n were o v e r r e p r e s e n t e d i n c l a s s e s f o r the me n t a l l y r e t a r d e d i n B.C.and a l s o propose t h a t t h i s i s p a r t l y due t o t o c u l t u r a l b i a s e s of c u r r e n t IQ t e s t s used t o make t h e i r placements. For example, another study i n the L i l l o o e t D i s t r i c t , N a t i v e students made up 40% of the enr o l l m e n t , however they made up 70% of the enrollment i n " s p e c i a l programmes" (Napoleon, 1988). S i m i l a r f i n d i n g s were a l s o found i n the Okanagon N i c o l a study (More, 1984) and a B.C. c e n t r a l i n t e r i o r s c h o o l d i s t r i c t (Barth,1979). Other sequalae of academic f a i l u r e such as emotional problems have been documented. " C h i l d r e n a t t e n d i n g a 19 c h a r a c t e r i s t i c a l l y high v e r b a l s c h o o l may f i n d themselves i n a c u l t u r a l l y i n c o h e r e n t s i t u a t i o n with an e f f e c t approximating c u l t u r e shock" (Pepper & Henry, 1986). Much of the l i t e r a t u r e r e f e r s t o t h i s c o n f l i c t between the white c u l t u r e of the s c h o o l system and the Native c u l t u r e of the home ( B i g a r t , 1974; Rohner, 1965). Socioeconomic data a l s o f i n d N a t i v e Indians t o be o v e r r e p r e s e n t e d i n the percentage e a r n i n g incomes below the p o v e r t y l i n e . The r e l a t i o n s h i p between low SES and IQ scores and academic achievement has been an accepted phenomenon f o r some time. T h e r e f o r e the f i n d i n g s of More & O l d r i d g e (1980), t h a t i s , higher p r o p o r t i o n s of N a t i v e s i n s p e c i a l e d u c a t i o n , may be expected, as they r e p r e s e n t a disadvantaged group e c o n o m i c a l l y and a c a d e m i c a l l y . Low socioeconomic s t a t u s a l s o appears t o be a c o n t r i b u t i n g f a c t o r t o the h e a l t h problems which N a t i v e c h i l d r e n manifest w e l l i n excess of the n a t i o n a l norms. Although the d i r e c t i o n of c a u s a l i t y again i s u n c e r t a i n , i t appears t h a t the e d u c a t i o n a l s i t u a t i o n of N a t i v e students i s t o be expected g i v e n the disadvantaged p o s i t i o n they m a i n t a i n i n our s o c i e t y . Much of the l i t e r a t u r e i n t h i s chapter i n c l u d e s assumptions and g e n e r a l i z a t i o n s r e g a r d i n g N a t i v e l e a r n e r s which are accepted as f a c t . However, e a r l i e r r e s e a r c h which forms the b a s i s f o r these assumptions was o f t e n m e t h o d o l o g i c a l l y flawed. The overwhelming m a j o r i t y of r e s e a r c h employed e i t h e r survey, o b s e r v a t i o n a l or h i s t o r i c a l methods, as w e l l t h e r e are r e l a t i v e l y few primary sources. ChrisJohn et a l . (1989) r e f e r t o many of the viewpoints c u r r e n t i n Native e d u c a t i o n t h e o r y as being " l a t e n t l y r a c i s t . " Statements have been p u b l i s h e d such as, "the m o t i v a t i o n i s e x c e l l e n t i n the e a r l y y ears among Indians ... by 12 or so they f a l l o f f i n keenness and tend t o become i n t r o v e r t e d and s u s p i c i o u s (Vernon, 1966). Few comparative s t u d i e s c o n t r o l l e d f o r SES or language p r o f i c i e n c y . Concepts such as v e r b a l i n t e r a c t i o n i n the homes was r a r e l y q u a n t i f i e d . Assessment measures were o f t e n i n a p p r o p r i a t e f o r t h i s group or inadequate f o r the purposes of the study. Brandt (1984) i n her c r i t i q u e s p e c i f i e s e v e r a l other l i m i t a t i o n s which apply t o much of the l i t e r a t u r e , e.g. t r e a t i n g a l l N a t i v e s as a homogeneous group r e g a r d l e s s of degree of a s s i m i l a t i o n i n t o the m a j o r i t y c u l t u r e , and not t a k i n g i n t o account handicapped as w e l l as normal p o p u l a t i o n s . In s p i t e of these l i m i t a t i o n s , c o l l e c t i v e l y these s t u d i e s do j u s t i f y the premise t h a t Native c h i l d r e n are at r i s k f o r e d u c a t i o n a l f a i l u r e . One group of f a c t o r s which may be r e l a t e d t o t h e i r underachievement i s the h e a l t h problems which Na t i v e s manifest w e l l i n excess of n a t i o n a l norms. Na t i v e c h i l d r e n form a high r i s k group with r e g a r d t o q u a l i t y of p r e n a t a l care, n u t r i t i o n and g e n e r a l h e a l t h s t a t u s Higher i n c i d e n c e of many d i s e a s e s which have been a s s o c i a t e d with developmental outcome are endemic i n t h i s p o p u l a t i o n . Th next s e c t i o n d e a l s with the medical r e s e a r c h which has documented the c u r r e n t s t a t e of the h e a l t h of the Native Indian c h i l d . 21 W a r i v p H e a l t h S + a H - „ g E x t e n s i v e r e s e a r c h has been conducted on the h e a l t h s t a t u s of Na t i v e Indian c h i l d r e n . T h i s r e s e a r c h has been impeded by l a c k of norms f o r v i t a l s t a t i s t i c s , such as weight and h e i g h t , f o r Na t i v e people who are e t h n i c a l l y , c u l t u r a l l y and p h y s i c a l l y d i s t i n c t and whose l i f e s t y l e more o f t e n resembles t h a t of t h i r d world c o u n t r i e s r a t h e r than t h a t of the m a j o r i t y c u l t u r e . (Indian and I n u i t H e a l t h Committee 1987). N a t i v e s c o n t i n u e t o f a l l s i g n i f i c a n t l y below n a t i o n a l standards f o r v a r i o u s aspects of h e a l t h c a r e , d e s p i t e improvements i n t h e i r l i v i n g c o n d i t i o n s . Types of i l l n e s s e s among Na t i v e c h i l d r e n are the same as those among lower socioeconomic groups: r e s p i r a t o r y t r a c t i n f e c t i o n s , g a s t r o i n t e s t i n a l problems, s k i n i n f e c t i o n and trauma (Baker et a l . , 1987; Evers & Rand, 1983). Admissions t o h o s p i t a l are s i g n i f i c a n t l y more frequent than those of the average white c h i l d (Houston, W e i l e r & Harbick, 1979; Shawana & T a y l o r , 1988; Manitoba N a t i v e Indian Mother and C h i l d , 1981). L i f e expectancy, a r e f l e c t i o n of h e a l t h standards, i s s t i l l 10 years l e s s than t h a t of the r e s t of the Canadian p o p u l a t i o n (Shah & Farkas, 1985). The freguency of p a r a s i t i c d i s e a s e s , mental d i s o r d e r s , c o m p l i c a t i o n s of pregnancy, s k i n d i s e a s e , d i a b e t e s and p o i s o n i n g i s higher i n Native people than among nonNatives both i n r u r a l and urban areas. T h i s appears t o i n d i c a t e t h a t these problems are not r e s t r i c t e d t o those l i v i n g i n i s o l a t e d communities. Many of the h e a l t h problems seen on r e s e r v e s are 22 a c t u a l l y exacerbated by the s t r e s s of a d a p t a t i o n t o the urban h e a l t h c a r e system which o f t e n d i f f e r s d r a m a t i c a l l y from community based h e a l t h care s e r v i c e s on r e s e r v e s (Shah & Farkas, 1985). The N a t i v e p o p u l a t i o n has been i n c r e a s i n g f a s t e r than the g e n e r a l p o p u l a t i o n . As a r e s u l t of h i g h e r f e r t i l i t y r a t e s and lower l i f e expectancy the N a t i v e p o p u l a t i o n i s younger and more dependent than the n a t i o n a l p o p u l a t i o n . Though a l c o h o l and drug abuse are r e c o g n i z e d as major h e a l t h problems i n N a t i v e communities, l i t t l e a t t e n t i o n has been g i v e n t o problems r e l a t e d t o i t such as c h i l d abuse and f e t a l a l c o h o l syndrome. A r e c e n t study s a n c t i o n e d by the band of a B.C. N a t i v e community found the p r e v a l e n c e of f e t a l a l c o h o l syndrome t o be 190 out of 1000 c h i l d r e n up t o 18 y e a r s . Two t h i r d s of these c h i l d r e n were m e n t a l l y handicapped and i t was the l e a d i n g cause of r e t a r d a t i o n i n the community (Robinson, Conry & Conry, 1987). McShane and P l a s (1984) a l s o emphasize the importance of FAS as a p o s s i b l e c o n t r i b u t o r t o the l e a r n i n g d i f f i c u l t i e s experienced by many Na t i v e c h i l d r e n . May, Hymbaugh and Aase, (1983) draw a t t e n t i o n t o F e t a l A l c o h o l E f f e c t s which, though l e s s e a s i l y r e c o g n i z e d appear t o have n e g a t i v e consequences on development as w e l l . E a r l y a l c o h o l consumption by the N a t i v e c h i l d h i m s e l f i s a l s o thought to have d e t r i m e n t a l e f f e c t s on i n t e l l e c t u a l f u n c t i o n i n g (McShane & P l a s , 1984). High i n f a n t and youth m o r t a l i t y accounts f o r a lower N a t i v e l i f e expectancy, a g e n e r a l i n d i c a t i o n of h e a l t h s t a t u s (Shawana & T a y l o r , 1988). Low b i r t h weight, i n a d e q u a t e l y u t i l i z e d a n t e n a t a l care s e r v i c e s , a c c i d e n t s , substandard p e d i a t r i c care and f a i l u r e t o diagnose p o t e n t i a l l y t r e a t a b l e c o n d i t i o n s have been found t o be common causes of p e r i n a t a l death. (Evers & Rand, 1983). P e r i n a t a l deaths i n a study on Manitoba r e s e r v e s were s i g n i f i c a n t l y higher than those of the p r o v i n c i a l p o p u l a t i o n ' s , with i n f a n t m o r t a l i t y approximately 100% h i g h e r and p e r i n a t a l about 60% h i g h e r . These mothers and i n f a n t s c o n t i n u e t o show as a high r i s k group i n s p i t e of improved q u a l i t y and access t o h e a l t h s e r v i c e s (Manitoba N a t i v e Indian Mother and C h i l d , 1981). Normal labour as a percentage of t o t a l b i r t h s appears t o be s t e a d i l y d e c l i n i n g and the Caesarean s e c t i o n r a t e f o r the P a c i f i c Coast r e g i o n n e a r l y doubled s i n c e 1974. (Medical S e r v i c e s Report, 1980). G e n e r a l l y t h e r e are more ad o l e s c e n t pregnancies, g r e a t e r m u l t i p a r i t y and more low and high b i r t h w e i g h t s ( M a y f i e l d , 1985; Manitoba N a t i v e Mother and C h i l d , 1981). Higher than average b i r t h w e i g h t s have been a t t r i b u t e d t o v a r i o u s f a c t o r s , e.g. e t h n i c v a r i a t i o n s and food p a t t e r n s , maternal age, p a r i t y s t a t u r e , weight before pregnancy and weight g a i n d u r i n g pregnancy (Munroe, Shah, Badgley & Bain, 1984). A N u t r i t i o n Canada survey (Department of Health and Welfare, 1975) showed t h a t 60% of Native women between 20 and 40 years of age were at moderate r i s k f o r o b e s i t y , which g r e a t l y i n c r e a s e s the r i s k of g e s t a t i o n a l d i a b e t e s (Indian and I n u i t study, 1987). S t u d i e s i n the U.S. have a l s o shown the weight of N a t i v e c h i l d r e n t o be c o n s i s t e n t l y g r e a t e r than the U.S. standard f o r age i n d i c a t i n g t h a t o b e s i t y i s a more s e r i o u s problem f o r them than f o r the r e s t of the U.S. p o p u l a t i o n . Though c a l o r i c i n s u f f i c i e n c y does not seem t o be a problem s e v e r a l s t u d i e s have found d e f i c i e n c i e s i n i r o n f o l a t e and v i t a m i n C. Anemia, a common problem i n N a t i v e c h i l d r e n has been a t t r i b u t e d t o a l a c k of animal p r o t e i n i n the d i e t , which again i s r e l a t e d t o low SES ( B i r b e c k et a l . , 1971, Evers, Orchard & McCracken, 1985). Another m a n i f e s t a t i o n of a p o o r l y balanced d i e t i s the l a r g e i n c r e a s e i n d e n t a l c a r i e s (Desai & Lee, 1971). Inadequate p r o f e s s i o n a l care and u n s a t i s f a c t o r y o r a l hygiene are a l s o seen as c o n t r i b u t i n g t o t h i s i n c r e a s e (Mayhall, 1975). A l a r g e p r o p o r t i o n of p o s t n e o n a t a l m o r t a l i t y i n N a t i v e p o p u l a t i o n s i s a t t r i b u t e d t o r e s p i r a t o r y a i l m e n t s and i n f e c t i o u s and p a r a s i t i c d i s e a s e s . These o f t e n r e f l e c t poor housing, l a c k of sewage d i s p o s a l and p o t a b l e water as w e l l as l e s s access t o medical f a c i l i t i e s ( C a r l i l e , Olson, Gorman, McCracken, VanderWagen & Connor, 1972; Indian Health S e r v i c e s , 1978). N a t i v e c h i l d r e n , p a r t i c u l a r l y those who are overweight, have a l s o been found t o have a g r e a t e r tendency f o r repeated episodes of b r o n c h i t i s , pneumonia and other r e s p i r a t o r y i n f e c t i o n s (Upadhyaay & G e r r a r d , 1969). The r a t e of 75 i l l n e s s e s per 100 c h i l d r e n per year documented by Evers & Rand (1985) f a r exceeded the r a t i o f o r nonNative c h i l d r e n used as c o n t r o l s i n t h e i r study i n s e m i - r u r a l southern O n t a r i o . Severe r e c u r r e n t pulmonary d i s e a s e a s s o c i a t e d with d i a r r h e a as w e l l as o t i t i s media have been l i n k e d t o b o t t l e f e e d i n g and d a i r y 25 p r o d u c t s . Recent r e s e a r c h has a l s o documented a high i n c i d e n c e of l a c t o s e i n t o l e r a n c e among Na t i v e people ( L e i c h t e r & Lee, 1971). Houston et a l . (1979) suggest t h a t the high frequency with which chest i n f e c t i o n s were a s s o c i a t e d with d i a r r h e a may i n d i c a t e a higher s u s c e p t i b i l i t y of both the r e s p i r a t o r y and g a s t r o i n t e s t i n a l systems t o i n f e c t i o n or t o a common p r e c i p i t a t i n g cause, such as milk a l l e r g y . Although the i n c i d e n c e of rheumatic f e v e r has been d e c l i n i n g worldwide, a study i n Manitoba found the i n c i d e n c e and s e v e r i t y t o be unacceptably high among N a t i v e c h i l d r e n . The r e s e a r c h e r s suggest t h a t t h i s i s due t o s o c i a l and c u l t u r a l f a c t o r s such as p o v e r t y and overcrowding r a t h e r than a g e n e t i c p r e d i s p o s i t i o n ( L o n g s t a f f e , P o s t l , Kao, N i c o l l e & Ferguson, 1982). D i p h t h e r i a i n f e c t i o n a l s o c o n t i n u e s t o p e r s i s t as a p u b l i c h e a l t h problem i n t h i s p o p u l a t i o n , even though the m a j o r i t y of cases and c a r r i e r s have been found to be w e l l immunized. The g r e a t m a j o r i t y of i s o l a t i o n s were from the d i s c h a r g e a s s o c i a t e d with o t i t i s media. Young (1984) maintains t h a t u n l e s s o t i t i s media i s c o n t r o l l e d e r a d i c a t i o n of d i p h t h e r i a i n f e c t i o n i s u n l i k e l y t o be achieved. While many c h i l d r e n experience episodes of acute o t i t i s media, c h r o n i c o t i t i s media with r e s u l t a n t h e a r i n g impairment has long been the most s e r i o u s h e a l t h problem f o r Native c h i l d r e n ( I n d i a n Health Trends, 1978; McShane & M i t c h e l l , 1979). Prevalence estimates range from 20-70%. Incidence f o r the g e n e r a l p o p u l a t i o n i s approximately 5%, with those f o r the poor i n c r e a s i n g t o 20%; thus N a t i v e c h i l d r e n have much i n excess of what would be e x p l a i n e d by t h e i r low socioeconomic s t a t u s (McShane, 1982; McShane & P l a s , 1984; Tempest, 1987). The high i n c i d e n c e of r e s p i r a t o r y i n f e c t i o n s among Nat i v e s i s f r e q u e n t l y c i t e d as a p r e d i s p o s i n g f a c t o r (Kaplan, Fleshman, Bender, Baum & C l a r k , 1973) although some s t u d i e s c l a i m t h a t the r e v e r s e r e l a t i o n s h i p i s t r u e . Manning (1975) suggests t h a t the r a p i d change i n n u t r i t i o n a l s t a t u s i s a p o s s i b l e c a u s a t i v e f a c t o r which best f i t s the epidemiology of d i s e a s e . He f u r t h e r s t a t e s t h a t the high amounts of d e n t a l c a r i e s i n c h i l d r e n with o.m. supports the r e l a t i o n s h i p between suboptimal n u t r i t i o n and o.m. V i r a l i n f e c t i o n s , a l l e r g i e s , poor h e a l t h care as w e l l as e u s t a c h i a n d y s f u n c t i o n may a l s o p l a y a r o l e ; i n s h o r t i t s a c t u a l cause and means of p r e v e n t i o n are unknown. G a s t r o e n t e r i t i s has c o n s i s t e n t l y ranked as the second most p r e v a l e n t d i s e a s e i n Native people, f o l l o w e d by s t r e p t h r o a t , s c a r l e t f e v e r and i n f l u e n z a ( I n d i a n H e a l t h S e r v i c e s , 1978). Na t i v e c h i l d r e n a l s o appear t o be at r i s k f o r v i s i o n problems. In a d d i t i o n t o myopia, astigmatism appears t o be endemic i n t h i s group. Hamilton (1976) found s i x times as many Nat i v e c h i l d r e n as nonNative e n t e r i n g s c h o o l with a v i s i o n handicap and the m a j o r i t y of the N a t i v e c h i l d r e n not t o be wearing t h e i r p r e s c r i b e d g l a s s e s . The degree of anomaly was o f t e n g r e a t e r and f o r most not d e t e c t e d b e f o r e f o u r t h grade. Tempest (1987) as w e l l found 24% of Navajo f i f t h graders to have S n e l l e n r e a d i n g s of 20/50 or worse i n a t l e a s t one eye. 27 Many f a c t o r s seem t o be c o n t r i b u t i n g t o the c o n t i n u i n g e x i s t e n c e of o.m. and other l a r g e l y p r e v e n t a b l e d i s e a s e s . Poor l i v i n g c o n d i t i o n s f o s t e r and exacerbate N a t i v e m o r b i d i t y and m o r t a l i t y r a t e s (Shawana & T a y l o r , 1988). N a t i v e parents are o f t e n unaware of the s i g n s and symptoms of these i l l n e s s e s . Lack of knowledge i n the h e a l t h p r o f e s s i o n s about the u n i q u e l y high p r e v a l e n c e of these d i s e a s e s i n Native c h i l d r e n and the need f o r s p e c i a l a t t e n t i o n , such as s c r e e n i n g , p r e v a i l (McShane, 1982). The use of medical s e r v i c e s by N a t i v e people, e s p e c i a l l y those l i v i n g o f f r e s e r v e i s o f t e n inadequate or i n a p p r o p r i a t e . D i f f i c u l t y i n m a i n t a i n i n g longterm h e a l t h s e r v i c e s s t a f f , p a r t i c u l a r l y i n remote areas, i s not conducive t o e s t a b l i s h i n g c o n t i n u i t y of s e r v i c e and p o s i t i v e r a p p o r t with p a t i e n t s ( J u l i e n , Baxter, Crago, I l e c k i & T h e r i a n , 1987). As w e l l , developmental, v i s i o n and h e a r i n g s c r e e n i n g are o f t e n not done r o u t i n e l y or i f done use i n a p p r o p r i a t e measures f o r the s u b j e c t s . (Burke, Sayers, Baumgart & Wray, 1985; Evers & Rand, 1983). There i s room f o r improvement i n p r o v i d i n g immunization and v a c c i n a t i o n , e s p e c i a l l y among c h i l d r e n over 24 months. A l l of these above mentioned f a c t o r s combine to make p r e v e n t i v e h e a l t h care f o r N a t i v e groups d i f f i c u l t ( P l a x t o n e t a l . , 1983). The next s e c t i o n d e a l s with the r e l a t i o n s h i p between v a r i o u s h e a l t h f a c t o r s and p s y c h o e d u c a t i o n a l outcome. Most of the r e s e a r c h i n t h i s area d e a l s with samples of c h i l d r e n from the dominant c u l t u r e . 28 n^wol npmpnta 1 anri F H n r a t i n n a l Risk F f l r f n r s T h e r e i s no d e a r t h o f e x p e r i m e n t a l e v i d e n c e r e l a t i n g t h e e n v i r o n m e n t a l c o n d i t i o n s w i t h i n w h i c h a c h i l d i s b o r n , g r o w s an d d e v e l o p s , t o l a t e r e d u c a t i o n a l h a n d i c a p ( E v a n s , 1 9 7 6 ) . O v e r a c e n t u r y ago L i t t l e n o t i c e d an u n u s u a l l y h i g h o c c u r r e n c e o f l a b o u r c o m p l i c a t i o n s i n t h e h i s t o r i e s o f c h i l d r e n w i t h L i t t l e ' s D i s e a s e , l a t e r t o be c a l l e d c e r e b r a l p a l s y (Page,_ 1986, p . 1 2 5 2 ) . S t u d i e s w h i c h h a v e f o c u s e d on t h e r e l a t i o n s h i p o f a s i n g l e o b s t e t r i c n e o n a t a l r i s k f a c t o r t o l a t e r d i s a b i l i t y h a v e n o t b e e n s u c c e s s f u l i n p r e d i c t i n g l a t e r a b n o r m a l i t y . S h o r t t e r m f o l l o w - u p s t u d i e s o f t e n m i s s e d l a t e r o u t c o m e s s u c h a s l e a r n i n g d i s a b i l i t i e s , a t t e n t i o n s p a n d i s o r d e r s a n d a b n o r m a l v i s u a l m o t o r i n t e g r a t i o n a t s c h o o l a g e . As w e l l , m i l d e r p r o b l e m s n o t e d i n i n f a n c y a r e n o t n e c e s s a r i l y p r e d i c t i v e o f e n d u r i n g d i s a b i l i t i e s a nd c o n v e r s e l y n o r m a l d e v e l o p m e n t d o e s n o t g u a r a n t e e n o r m a l i n t e l l e c t u a l a b i l i t i e s l a t e r i n c h i l d h o o d ( H u n t a t a l . , 1 9 8 2 ) ; t h u s t h e n e e d f o r l o n g i t u d i n a l s t u d i e s . I n t e r v i e w and o p e n - e n d e d q u e s t i o n n a i r e f o r m a t i n some r e s e a r c h o f t e n l a c k s t h e s t r u c t u r e n e c e s s a r y f o r r e s e a r c h p u r p o s e s and may r e l y t o o h e a v i l y on m o t h e r s ' a n d o t h e r s ' m e m o r i e s o f d e v e l o p m e n t a l / m e d i c a l e v e n t s w h i c h may h a v e t a k e n p l a c e s e v e r a l y e a r s p r i o r t o d a t a c o l l e c t i o n ( G r a y , Dean & R a t t a n , 1 9 8 7 ) . M e d i c a l s c r e e n i n g h a s p r o v i d e d some i m p o r t a n t e v i d e n c e a b o u t t h e r i s k s a s s o c i a t e d w i t h p e r i n a t a l m o r t a l i t y . Though d i f f i c u l t t o s e p a r a t e f r o m e a c h o t h e r some f a c t o r s h a v e been 29 g e n e r a l l y accepted as being i n d i c a t i v e of i n c r e a s e d r i s k . Examples of these are: a very young or o l d e r (over 35) mother, g r a v i d a , s p e c i f i c a l l y the f i r s t and beyond a f o u r t h pregnancy, maternal m a l n u t r i t i o n or substance abuse and Apgar scores l e s s than or equal t o s i x at one minute (Aubry & Pennington, 1973). C e r t a i n c o n d i t i o n s such as high l e v e l s of p h e n y l a l a n i n e , or PKU and sensory d i s o r d e r s have obvious i m p l i c a t i o n s f o r e d u c a t i o n a l development, o t h e r s such as low b i r t h weight, p e r i n a t a l trauma, e t c . a r e l e s s c l e a r . "While medical s c r e e n i n g may be e f f i c i e n t f o r c e r t a i n profound handicaps i t s u s e f u l n e s s as a p r e d i c t o r of m i l d e r p s y c h o e d u c a t i o n a l d i f f i c u l t y i s deb a t a b l e " (Lindsay & Wedell, 1982). Numerous s t u d i e s have examined a high r i s k group with a view t o d e t e r m i n i n g developmental outcome, however, few of these s i m i l a r l y examined a matched c o n t r o l group. Johnson, Cox and McKim's (1987) r e t r o s p e c t i v e study of 143 low b i r t h weight i n f a n t s found 10% t o have severe neurodevelopmental a b n o r m a l i t i e s and 11 % t o have minor problems such as s e i z u r e s , developmental d e l a y and behavior d i s o r d e r s . Though low b i r t h w e i g h t may not y i e l d many severe handicaps, Hunt, Tooley and Harvin (1982) i n a l o n g i t u d i n a l follow-up of 102 low b i r t h w e i g h t i n f a n t s found t h a t many of these c h i l d r e n l a t e r were shown t o be at r i s k f o r l e a r n i n g d i s a b i l i t i e s as the demands of s c h o o l became more complex. The most common problems were i n the areas of language comprehension and v i s u a l - m o t o r i n t e g r a t i o n . T h e i r i n c i d e n c e f i g u r e s of 37% were almost twice t h a t of the h i g h e s t e s t i m a t e s f o r l e a r n i n g 30 problems i n the g e n e r a l p o p u l a t i o n . N e i t h e r of the above s t u d i e s examined a matched c o n t r o l group. One of the l a r g e s t s c a l e l o n g i t u d i n a l s t u d i e s was The B r i t i s h P e r i n a t a l M o r t a l i t y Study and the f o l l o w up N a t i o n a l C h i l d Development Study (Davie, B u t l e r & G o l d s t e i n , 1972). Researchers began with a group of 16,000 expectant mothers and concluded t h a t c e r t a i n h e a l t h f a c t o r s were of value i n the p r e d i c t i o n of severe p h y s i c a l / m e n t a l handicap and e d u c a t i o n a l backwardness. Among those were low f o r g e s t a t i o n b i r t h w e i g h t pre or p o s t m a t u r i t y and s o c i a l c l a s s . P f e i f f e r , Heffernan & P f e i f f e r (1985) found medical v a r i a b l e s , g e s t a t i o n a l age and b i r t h weight, t o account f o r g r e a t e r than 50% of the v a r i a n c e i n McCarthy General C o g n i t i v e s c o r e s at age t h r e e y e a r s . T h e i r sample of 100 p r e s c h o o l e r s having high r i s k n e o n a t a l h i s t o r i e s s c o r e d about one standard d e v i a t i o n lower than the low r i s k c o n t r o l group. Cadman, Walter, Chambers, Ferguson, Szatmari, Johnson and McNamee (1988) a l s o found h e a l t h , developmental and b e h a v i o r a l h i s t o r i e s t o p r e d i c t l a t e r s c h o o l problems and suggest t h a t h e a l t h p r o f e s s i o n a l s may p l a y a u s e f u l r o l e i n s c r e e n i n g f o r f u t u r e s c h o o l problems. In a r e t r o s p e c t i v e study of 50 l e a r n i n g d i s a b l e d c h i l d r e n C o l l e t t i (1979) examined h e a l t h h i s t o r y v a r i a b l e s such as len g t h of pregnancy, p a r i t y , blood i n c o m p a t i b i l i t y , i n f e c t i o n s , l e n g t h of labour, c o m p l i c a t i o n s , b i r t h type and b i r t h weight. When compared t o n a t i o n a l norms, s i g n i f i c a n t l y fewer l e a r n i n g d i s a b l e d c h i l d r e n were c a t e g o r i z e d as w e l l and h e a l t h y at b i r t h , with longer 3 1 second stage labour, more induced b i r t h s , c o m p l i c a t i o n s of labour and s i g n i f i c a n t l y lower Apgar scores i n t h i s group. C o l l i g a n (1984) however, i n a l a r g e sample p r o s p e c t i v e study, n = 386, found o n l y marginal support f o r the concept of a continuum of r e p r o d u c t i v e c a s u a l t y . That i s , p e r i n a t a l s t r e s s , as measured from combined o b s t e t r i c , d e l i v e r y and puerperium data, was not a s i g n i f i c a n t f a c t o r i n p r e d i c t i n g r e s u l t s of l a t e r p s y c h o l o g i c a l t e s t s . S o c i a l s t a t u s and concomitant environmental c o n d i t i o n s a l s o appeared t o be s i g n i f i c a n t f a c t o r s i n s e v e r a l m u l t i f a c t o r i a l s t u d i e s which took them i n t o account. Li e v a n s (1974) found almost a l l of h i s s u b j e c t s with p e r i n a t a l s t r e s s ( i . e . n e o n a t a l c e r e b r a l e f f e c t s without n e u r o l o g i c a l s e q u e l a e ) , from "normal homes" (not d e f i n e d i n the study) t o d i s p l a y v a r i o u s anomalies i n c o g n i t i v e and a f f e c t i v e f u n c t i o n i n g , l e a d i n g t o l e a r n i n g problems i n t h r e e s p e c i f i c a reas: inadequacy of a t t e n t i o n , inadequacy of motor c o n t r o l and inadequacy of emotional i n h i b i t i o n s . F i f t y - f o u r p e r c e n t of t h i s sample were one or more years behind i n school i n the primary grades. A major r e t r o s p e c t i v e study of over 13,000 b i r t h s suggested t h a t p e r i n a t a l f a c t o r s such as breech d e l i v e r y and asphyxia at b i r t h were not r e l a t e d t o l a t e r developmental s t a t u s . B i r t h weight and s o c i a l f a c t o r s appeared t o be b e t t e r p r e d i c t o r s ( N e l l i g a n , K o l v i n & G a r s i d e , 1976). Badian (1988) i n a nine year follow-up study found the main c h a r a c t e r i s t i c s d i f f e r e n t i a t i n g poor readers from good were c o m p l i c a t i o n s d u r i n g pregnancy and labour, b i r t h order, speech d e l a y and SES. Sameroff and Chandler (1975) found t h a t s o c i a l s t a t u s reduced or a m p l i f i e d i n i t i a l i n t e l l e c t u a l d e f i c i t s a s s o c i a t e d with n e u r o l o g i c a l i n s u l t . D e f i c i t s tended t o decrease i n the middle c l a s s p o p u l a t i o n and i n c r e a s e i n the lower c l a s s . SES had a st r o n g mediating e f f e c t on c o g n i t i v e outcome of low b i r t h weight c h i l d r e n . General c o g n i t i v e a b i l i t i e s and language a b i l i t i e s were p r o p o r t i o n a l t o maternal ed u c a t i o n and c h i l d c a r e . Gross p e r c e p t u a l and motor a b i l i t i e s were p r o p o r t i o n a l t o p e r i n a t a l c o m p l i c a t i o n s . S i e g a l (1982) i n r e c o g n i t i o n of the e f f e c t s of m u l t i p l e v a r i a b l e s , developed a r i s k index based on r e p r o d u c t i v e and demographic f a c t o r s t o p r e d i c t developmental d e l a y . The index i n c l u d e d such items as g r a v i d i t y , b i r t h w e i g h t and Apgar s c o r e s . A s t a n d a r d i z e d r a t i n g of SES and a Home Observation Measure were a l s o used. The combination of environmental f a c t o r s i n a d d i t i o n t o b i o l o g i c a l f a c t o r s y i e l d e d c o r r e l a t i o n s r a n g i n g from .38 t o .63, with subsequent c o g n i t i v e and language development f o r the high r i s k group. The combination system of p e r i n a t a l , r e p r o d u c t i v e and environmental v a r i a b l e s allowed f o r the d e t e c t i o n of i n f a n t s at r i s k f o r developmental problems. In g e n e r a l , although the r e l a t i o n s h i p between h e a l t h r i s k f a c t o r s and v a r i o u s developmental outcomes has been s t u d i e d e x t e n s i v e l y , the r e s u l t s are u n c l e a r . Robert's (1969) study i n Wales came t o the c o n c l u s i o n t h a t many c o m p l i c a t i o n s of b i r t h and pregnancy may c o - e x i s t and t h a t because of the many interdependent v a r i a b l e s , t o study the i n f l u e n c e of one 33 c o m p l i c a t i o n on i n f a n t development would be f u t i l e . The o v e r a l l p a t t e r n does seem t o p o i n t t o i n c r e a s e d problems i n the p o p u l a t i o n at r i s k f o r h e a l t h problems, however s e v e r a l other v a r i a b l e s such as SES seem t o c o n t r i b u t e s t r o n g l y as w e l l , thereby making p r e d i c t i o n more d i f f i c u l t . Research i s f u r t h e r c o m p l i c a t e d by the f a c t t h a t "the sequelae of neonatal c o m p l i c a t i o n s r a r e l y occur i n an a l l or none f a s h i o n but i n s t e a d develop along a continuum of d i s a b i l i t y n e c e s s i t a t i n g the use of somewhat a r b i t r a r y endpoints of n o r m a l i t y ... t h e r e f o r e i t i s not always p o s s i b l e t o get a f i r m d e f i n i t i o n of dependent and independent v a r i a b l e s and t o keep others c o n s t a n t (Page, 1986, p.1253)." Few r e s e a r c h e r s have examined t h i s r e l a t i o n s h i p i n c u l t u r a l l y d i s t i n c t and/or m i n o r i t y groups, which adds yet another v a r i a b l e t o the a n a l y s e s . Werner and Smith (1979) looked at longterm i n t e r a c t i o n e f f e c t s of p e r i n a t a l s t r e s s and the q u a l i t y of f a m i l y environments f o r a m u l t i r a c i a l cohort i n Hawaii. T h e i r p r o s p e c t i v e study f o l l o w e d 660 s u b j e c t s from preterm t o age 18 y e a r s . By age 10 d i f f e r e n c e s between c h i l d r e n exposed t o v a r i o u s degrees of p e r i n a t a l s t r e s s and those born without p e r i n a t a l s t r e s s were l e s s pronounced than at age two. In f ollow-up s t u d i e s they found s i g n i f i c a n t i n t e r a c t i o n e f f e c t s between c h a r a c t e r i s t i c s of the f a m i l y environment and p e r i n a t a l s t r e s s which produced the l a r g e s t d e f i c i t s f o r the most disadvantaged c h i l d r e n . The impact of the c a r e t a k i n g environment appeared more powerful than the r e s i d u a l e f f e c t s of p e r i n a t a l c o m p l i c a t i o n s f o r most of the c h i l d r e n . A comparison of the developmental s t a t u s of preterm and high r i s k i n f a n t s i n a Southeast A s i a n c u l t u r e was c a r r i e d out by W i l l i a m s , W i l l i a m s and D i a l (1986). They found p e r i n a t a l events c o r r e l a t e d with developmental d e l a y s (p < .001) as measured by the Denver Developmental Screening T e s t s t a n d a r d i z e d on the l o c a l p o p u l a t i o n . T h e i r p r e l i m i n a r y evidence i n d i c a t e d t h a t a combination of p r o f e s s i o n a l i n t e r v e n t i o n and p a r e n t i n g s k i l l t r a i n i n g proved e f f e c t i v e i n improving outcomes. Some r e s e a r c h e r s have examined the r e l a t i o n s h i p between s p e c i f i c d i s o r d e r s such as o t i t i s media, and e d u c a t i o n a l problems and language d e l a y i n Na t i v e p o p u l a t i o n s . M i l d c o n d u c t i v e h e a r i n g l o s s has been l i n k e d t o impaired language development, s e r i o u s e d u c a t i o n a l d i f f i c u l t y , l e a r n i n g d i s a b i l i t i e s and s p e c i f i c p r o c e s s i n g problems. (McShane, 1982 McShane & M i t c h e l l , 1979; J u l i e n et . a l . , 1987; Tempest, 1987) S c a l d w e l l and Frame (1985) i n a study i n a F e d e r a l Native s c h o o l found over 50% of O n t a r i o N a t i v e c h i l d r e n r e f e r r e d f o r d i f f i c u l t i e s i n word r e c o g n i t i o n and s p e l l i n g t o have a h i s t o r y of c h r o n i c middle ear i n f e c t i o n and r e s p i r a t o r y a i l m e n t s . A long term study by Kaplan et a l . (1973) on a sample of 500 I n u i t c h i l d r e n found t h a t those with the greate number of episodes of o.m. d u r i n g t h e i r f i r s t two years of l i f e s c o r e d lower on v e r b a l s c a l e s of the WISC-R than those with fewer e p i s o d e s . Furthermore the achievement gap tended t widen with age. Bender et a l . (1975) i n a r e l a t e d study of 35 over 600 I n u i t c h i l d r e n suggest t h a t n u t r i t i o n a l anemia i n i n f a n c y without o v e r t m a n i f e s t a t i o n s of m a l n u t r i t i o n was r e l a t e d t o poorer i n t e l l e c t u a l f u n c t i o n i n g i n c h i l d h o o d . They a l s o found the occurrence of s i g n i f i c a n t i l l n e s s e s before age two, such as pneumonia and m e n i n g i t i s , t o be a s s o c i a t e d with lower IQ and achievement t e s t s c o r e s . O t i t i s media, before age two, independent of any a s s o c i a t i o n with s i g n i f i c a n t i l l n e s s e s or anemia, was a l s o a s s o c i a t e d with impairments of i n t e l l e c t u a l development at s c h o o l age. The r e d u c t i o n i n v e r b a l s k i l l s was c o n s i d e r e d s i g n i f i c a n t , e s p e c i a l l y i n t h e i r combined m o r b i d i t y group, i . e . those c h i l d r e n with two or t h r e e of anemia, o t i t i s media and s i g n i f i c a n t i l l n e s s . Those f a c t o r s which d i d not appear t o be s i g n i f i c a n t were p r e m a t u r i t y , p r o t e i n c a l o r i c m a l n u t r i t i o n and SES. A p r o f i l e of Navajo Indian students on r e s e r v e found those students who had fewer i l l n e s s e s t h a t r e q u i r e d h o s p i t a l i z a t i o n t o have s i g n i f i c a n t l y higher achievement than t h e i r peers with more frequent i l l n e s s e s . A l s o s i g n i f i c a n t l y c o r r e l a t e d with achievement was the d i f f e r e n c e between high and low a c h i e v e -ment and income, as w e l l as o t i t i s media (Tempest, 1987). O v e r a l l , "while p r e d i c t i o n may be p o s s i b l e when i n f l u e n c e s o p e r a t i n g on the c h i l d are c o n t r o l l e d , p r e d i c t i o n f o r the m a j o r i t y whose d e f i c i e n c i e s are balanced a g a i n s t t h e i r r e s o u r c e s i s d i f f i c u l t " (Lindsay & Wedell, 1982 p.215). P e r i n a t a l f a c t o r s tend t o be i n t e r r e l a t e d and have a c o n t r i b u t o r y r a t h e r than c a u s a l e f f e c t . Depending on t h e i r r e s o u r c e s c h i l d r e n compensate over time f o r t h e i r d e f i c i e n c i e s 36 (Hunt et a l . , 1982). In the case of the Na t i v e Indian c h i l d , q u i t e o f t e n h e a l t h c o m p l i c a t i o n s are i n combination with or caused by d e p r i v a t i o n i n terms of h e a l t h c a r e , n u t r i t i o n , economic means and g e n e r a l c u l t u r a l f a c t o r s at odds with the m a j o r i t y c u l t u r e . Regardless of the cause these c h i l d r e n do e x h i b i t an i n o r d i n a t e frequency of h e a l t h problems as w e l l as e d u c a t i o n a l d i f f i c u l t i e s . E a r l y d e t e c t i o n of these h e a l t h problems, which appear t o be r e l a t e d t o c o g n i t i v e development, should minimize subsequent d i s t o r t i o n s of development and a v o i d secondary problems which obscure the d i a g n o s i s and co m p l i c a t e treatment. T h i s need has been i d e n t i f i e d by v a r i o u s r e s e a r c h e r s (Cadman et a l . , 1988; Parkyn, 1985; Badian, 1988.) as w e l l as the Canadian Standing Senate Committee. (1982). T h e i r r e p o r t on the C h i l d at Risk r e f e r s t o the need f o r a system of i d e n t i f i c a t i o n and follow-up of c h i l d r e n at r i s k f o r developmental d e l a y and f a i l u r e t o t h r i v e . E s p e c i a l l y r e l e v a n t t o e a r l y d i a g n o s i s , a c c o r d i n g t o Rogers (1981) are g e n e t i c and pregnancy h i s t o r y , neonatal assessments and n e u r o l o g i c a l examinations, developmental h i s t o r i e s and p e r i o d i c developmental assessments i n i n f a n c y and c h i l d h o o d . Most of the l i t e r a t u r e on N a t i v e academic problems has focused on s o c i o c u l t u r a l f a c t o r s such as language, l a c k of s t i m u l a t i o n i n the home, c o g n i t i v e p rocesses and l e a r n i n g s t y l e s . Apart from the e f f e c t s of o t i t i s media on language development and r e l a t e d f u n c t i o n s , l i t t l e r e s e a r c h has d e a l t with the e f f e c t s of other v a r i a b l e s c o n t a i n e d i n the h e a l t h 37 h i s t o r i e s , which may be p l a c i n g these c h i l d r e n at r i s k f o r l e a r n i n g problems. Given the myriad of i l l n e s s e s and h e a l t h c o m p l i c a t i o n s p r e v a l e n t from the p r e n a t a l p e r i o d onward i t seems t h a t the sequelae of some of these f a c t o r s are worth f u r t h e r study. An examination i n the Native context would e l i m i n a t e confounding f a c t o r s i n h e r e n t i n p r e v i o u s r e s e a r c h which d i d not i n c l u d e s o c i o c u l t u r a l f a c t o r s i n i t s a n a l y s e s . T h i s chapter has o u t l i n e d many of the problems Native students encounter i n the p u b l i c s c h o o l system, such as low achievement l e v e l s , low s e l f esteem and high r a t e s of grade r e t e n t i o n . Research has a l s o shown these c h i l d r e n t o be at r i s k with r e g a r d t o h e a l t h . Although r e s u l t s are not c o n c l u s i v e , another avenue of r e s e a r c h has examined the r e l a t i o n s h i p between h e a l t h s t a t u s and developmental outcome. E a r l y i d e n t i f i c a t i o n of Native c h i l d r e n with a h i s t o r y of h e a l t h f a c t o r s which prove r e l e v a n t t o academic achievement would p r o v i d e educators with a means of a s s i g n i n g p r i o r i t y f o r support s e r v i c e s t o t h i s subset of c h i l d r e n who, i n essence are behind b e f o r e they begin. The problem i n t h i s study t h e r e f o r e , i s t o determine i f t h e r e i s a r e l a t i o n s h i p between h e a l t h f a c t o r s and academic r e a d i n e s s / c o g n i t i v e development i n a sample of Native Indian c h i l d r e n . CHAPTER I I I 38 The f o l l o w i n g t o p i c s are d e s c r i b e d i n t h i s c h a p t e r : The t a r g e t p o p u l a t i o n , sample c h a r a c t e r i s t i c s , d e s i g n of the study, instruments used, procedures f o l l o w e d , the s t a t i s t i c a l h y p o t h e s i s and f i n a l l y , the method of a n a l y s i s . T h i s study was conducted i n c o n j u n c t i o n with a l a r g e r r e s e a r c h p r o j e c t i n i t i a t e d by s i x of the L i l l o ' o e t area Indian bands, based on community concerns r e g a r d i n g the q u a l i t y of e d u c a t i o n t h e i r c h i l d r e n were r e c e i v i n g . The t h e s i s study was p r e s e n t e d t o the bands f o r t h e i r a p p r o v a l , which they p r o v i d e d , as w e l l as guidance and support. P n p n l a t i n n The t a r g e t p o p u l a t i o n was grade one N a t i v e c h i l d r e n i n the B.C. s c h o o l system. I t can not be assumed t h a t a l l Native groups have had s i m i l a r c u l t u r a l or environmental e x p e r i e n c e s , t h e r e f o r e t h i s study was r e s t r i c t e d t o c h i l d r e n of one t r i b a l group. The p o p u l a t i o n used f o r the study was from the L i l l o o e t n a t i o n , which i s p a r t of the I n t e r i o r S a l i s h l i n g u i s t i c group. The p o p u l a t i o n of the L i l l o o e t area bands numbers approximately 1900 people. The r e s e r v e ' s boundaries f a l l w i t h i n a 35 m i l e r a d i u s of the town of L i l l o o e t , 160 m i l e s n o r t h e a s t of Vancouver. The h i s t o r y of t h i s t r i b e with regard t o e d u c a t i o n i s s i m i l a r t o t h a t of the m a j o r i t y of B.C. N a t i v e groups. Day s c h o o l s were f i r s t s e t up on r e s e r v e i n the 1950's. In the e a r l y 1960's an agreement between the f e d e r a l Department of Indian A f f a i r s and the P r o v i n c i a l Government allowed Native students t o be i n t e g r a t e d i n t o the p u b l i c s c h o o l s i n town. The c u r r e n t N a t i v e e n r o l l m e n t makes up 43% of the t o t a l s c h o o l e n r o l l m e n t (Napoleon, 1989). The N a t i v e community has expressed concern with t h e i r c h i l d r e n s ' a s s i m i l a t i o n i n t o the p u b l i c s c h o o l system. The N a t i v e language and c u l t u r e are f a d i n g and few c o n c e s s i o n s are made i n the s c h o o l s f o r p r o p a g a t i n g these important a s p e c t s of t h e i r way of l i f e . The main i n d u s t r i e s i n the area are l o g g i n g , r a n c h i n g and f i s h i n g . However, the people from t h i s t r i b e s u f f e r from high r a t e s of unemployment as w e l l as r e l a t e d s c h o o l dropout and substance a d d i c t i o n (Napoleon, 1989). S a m p l p The sample used i n t h i s study c o n s i s t e d of 23 grade one and t r a n s i t i o n - o n e N a t i v e students i n the two elementary s c h o o l s i n the L i l l o o e t a r e a. The t r a n s i t i o n - o n e (T-1) programme i s designed f o r students who, a f t e r the k i n d e r g a r t e n year s t i l l do not have the s k i l l s necessary f o r grade one. S i x of the students i n the sample were e n r o l l e d i n T-1. Those students c o n s i d e r e d t o be c u l t u r a l l y N a t i v e were i d e n t i f i e d by the E d u c a t i o n C o n s u l t a n t f o r the s i x l o c a l I n dian bands, and community r e p r e s e n t a t i v e s on the Band's e d u c a t i o n committee. The sample t h e r e f o r e i n c l u d e d s t a t u s on and o f f r e s e r v e , as w e l l as those whose mothers had l o s t t h e i r s t a t u s through marriage. Most of the c h i l d r e n l i v e d on the t h r e e l o c a l r e s e r v e s . The sample was r e l a t i v e l y homogeneous with regard to socioeconomic s t a t u s , with most of the c h i l d r e n coming from homes a t the low end of the socioeconomic s c a l e . The predominant language spoken i n t h e i r homes was E n g l i s h . Students i n the grade one and t r a n s i t i o n one c l a s s e s were s e l e c t e d , as the focus of the study was s c h o o l r e a d i n e s s . E i g h t y p e r c e n t of the students i n the T-1 c l a s s were Nat i v e , i n c o n t r a s t t o 29 and 21 percent i n the two r e g u l a r grade one c l a s s e s . The p a r e n t s of a l l the N a t i v e c h i l d r e n were sent l e t t e r s r e q u e s t i n g consent f o r p s y c h o e d u c a t i o n a l t e s t i n g as p a r t of the l a r g e r study (see Appendix 2 ) . A l l N a t i v e students i n grade one and T1 whose parents consented were t e s t e d , f o r a t o t a l of 23 of a p o s s i b l e 28. Two students were absent on the day of t e s t i n g . Those four whose consents were not r e t u r n e d were from both c l a s s e s and appeared t o be homogeneous with the r e s t of the sample i n terms of age, SES, days absent, e t c . A d d i t i o n a l l e t t e r s were sent r e q u e s t i n g access t o medical f i l e s of the grade one students who had been t e s t e d (Appendix 3). The N a t i v e Health workers e x p l a i n e d i n f u r t h e r d e t a i l the purpose of the study i n d i v i d u a l l y t o a l l of the pa r e n t s or gu a r d i a n s . One parent d i d not r e t u r n the consent form and t h r e e c h i l d r e n had v i r t u a l l y no data a v a i l a b l e on f i l e as t h e i r f a m i l i e s were t r a n s i e n t . As a r e s u l t , complete h e a l t h f i l e s from the Indian Health O f f i c e , and t e s t i n g r e s u l t s were a v a i l a b l e f o r 19 s u b j e c t s , f i v e female and f o u r t e e n male. The s u b j e c t s ranged i n age from 5-11 t o 7-08, with the mean age being s i x years s i x months. The d e s i g n was c o r r e l a t i o n a l i n nature and i n v o l v e d two f a c t o r s : h e a l t h problems, c o n s i s t i n g of 30 v a r i a b l e s and p s y c h o e d u c a t i o n a l measures, c o n s i s t i n g of 11 v a r i a b l e s . Independent V a r i a b l e s The independent v a r i a b l e s , i . e . h e a l t h h i s t o r y f a c t o r s , were o b t a i n e d from e x i s t i n g h e a l t h r e c o r d s maintained by the l o c a l I n dian Health S e r v i c e o f f i c e . The sample was f a i r l y s t a b l e , with l i t t l e movement from the area. D e t a i l e d r e c o r d s have been kept f o r the past 8-10 y e a r s ; however, some s u b j e c t s showed a prolonged time p e r i o d between v i s i t s , when the f a m i l i e s moved away from the r e s e r v e . In most i n s t a n c e s t h i s move was i n t o town, thereby u t i l i z i n g P u b l i c H e a l t h , where the r e c o r d keeping system was l e s s s y s t e m a t i c . As s t a t e d i n the p r e v i o u s chapter Native c h i l d r e n m a nifest c e r t a i n c o n d i t i o n s i n excess of the m a j o r i t y c u l t u r e and a t times i n excess of what would be expected g i v e n t h e i r low socioeconomic s t a t u s . Many of these have been l i n k e d i n the l i t e r a t u r e with developmental and e d u c a t i o n a l d e l a y or d i s a b i l i t y . Based on t h i s the f o l l o w i n g s p e c i f i c v a r i a b l e s were examined: B i r t h w e i g h t (grams) G e s t a t i o n a l age (weeks) Apgar s c o r e s (a r a t i n g of 1-10 p o i n t s of the g e n e r a l c o n d i t i o n of the neonate, a s s i g n e d by p h y s i c i a n at 5 and 10 minutes a f t e r b i r t h ) Mother's age (years) Denver Developmental Screening Test/DDST s c o r e s ; a s c r e e n i n g of i n f a n t and p r e s c h o o l e r s ' o v e r a l l development, a d m i n i s t e r e d i n t h i s study by the p u b l i c h e a l t h nurse (0=pass, 1 = f a i l ) Gravida (rank order of pregnancy). The remaining v a r i a b l e s were recorded on the s u b j e c t s ' medical f i l e s , however l i t t l e i n f o r m a t i o n was p r o v i d e d i n terms of frequency or s e v e r i t y of occurrence, e t c . Because of t h i s l i m i t a t i o n these were dichotomized and r e p o r t e d as being p r e s e n t (0) or n o t ( 1 ) : P r e n a t a l c a re P e r i n a t a l c o m p l i c a t i o n s O b e s i t y G a s t r o i n t e s t i n a l problems Frequent f e v e r s " c o l d s R e s p i r a t o r y i n f e c t i o n s Pertussis-whooping cough O t i t i s media Hearing l o s s V i s i o n problems A l c o h o l i s m i n f a m i l y Poor d e n t a l care Dental surgery r e q u i r e d Impetigo-skin d i s e a s e caused by staph or s t r e p b a c t e r i a N e g l e c t Poor n u t r i t i o n Composite h e a l t h r i s k score (a continuous score, from 0-6) In a p r e l i m i n a r y p i l o t survey the above v a r i a b l e s were noted with high frequency on the f i l e s sampled. Many of the h e a l t h problems have been found t o be s i g n i f i c a n t l y more p r e v a l e n t i n N a t i v e groups. The dependent v a r i a b l e s , p s y c h o e d u c a t i o n a l t e s t s , were t measure academic r e a d i n e s s i n the sample. The concept of r e a d i n e s s encompasses a broad range of s k i l l a r e a s . For the purposes of t h i s study, academic r e a d i n e s s r e f e r s t o the student's a b i l i t y t o cope with p a r t i c u l a r i n t e l l e c t u a l l y demanding s i t u a t i o n s , and i s a f u n c t i o n of g e n e r a l i n t e l l e c t u a l development. An i n d i v i d u a l c h i l d ' s s t a t e of r e a d i n e s s i s r e f l e c t i v e of h i s g e n e t i c i n h e r i t a n c e , i n c i d e n t a e x p e r i e n c e , i n t e l l e c t u a l s t i m u l a t i o n and e d u c a t i o n a l background (Anderson & Faust, 1973). Researchers have i d e n t i f i e d the f o l l o w i n g s k i l l areas as being r e l a t e d t o r e a d i n e s s f o r academic achievement, p a r t i c u l a r l y r e a d i n g : Verbal/Language V i s u a l - M o t o r A u d i t o r y Sensorimotor ( Z i n t z & Magg, 1986) These s k i l l s develop as a h i e r a r c h y and i t i s important t h a t c h i l d r e n develop them t o p r o g r e s s t o the requirements of the primary c u r r i c u l u m . The f o l l o w i n g measures were used t o determine o v e r a l l academic r e a d i n e s s : M e t r o p o l i t a n Readiness T e s t s , L e v e l I I , Form P Developmental T e s t of V i s u a l - M o t o r I n t e g r a t i o n Peabody P i c t u r e Vocabulary T e s t - R e v i s e d Kaufman Assessment B a t t e r y f o r C h i l d r e n M e t r o p o l i t a n Readiness T e s t s , L e v e l I I , Form P - 1976 e d i t i o n The M e t r o p o l i t a n i s a group-administered t e s t designed t o measure p r e - r e a d i n g s k i l l s emphasized i n b e g i n n i n g grade one i n s t r u c t i o n a l programmes. I t was s t a n d a r d i z e d i n two f u l l -s c a l e n a t i o n a l t e s t i n g programmes. S p e c i a l normative data were a l s o o b t a i n e d f o r l a r g e - c i t y s c h o o l d i s t r i c t s with a p u p i l e n r o l l m e n t of 100,000 or more. T h i r t y - t w o thousand c h i l d r e n p a r t i c i p a t e d i n the r e s e a r c h programmes. The sample was randomly s t r a t i f i e d based on sex, s c h o o l system enro l l m e n t , SES and geographic r e g i o n . The t e s t i s made up of s u b t e s t s designed t o measure the s k i l l s presumed t o be needed i n b e g i n n i n g r e a d i n g and mathematics. These are Beginning Consonants, Sound-Letter Correspondence, V i s u a l Matching, F i n d i n g P a t t e r n s , School Language, L i s t e n i n g , Q u a n t i t a t i v e Concepts and Q u a n t i t a t i v e O p e r a t i o n s . S t a n i n e s and p e r c e n t i l e ranks are generated i n four s k i l l a reas: A u d i t o r y , V i s u a l , Language and Q u a n t i t a t i v e . A PreReading composite summarizes performance on the A u d i t o r y , V i s u a l and Language are a s . The M e t r o p o l i t a n was found t o be the best s i n g l e p r e d i c t o r (r = .76) from among the Lee C l a r k Reading T e s t , the C a l i f o r n i a T e s t of Mental M a t u r i t y , PPVT-R and the Bender V i s u a l G e s t a l t T e s t , of f i r s t , as w e l l as second grade achievement i n a sample of low SES r u r a l c h i l d r e n ( L e s s l e r & B r i d g e s , 1973). P e r c e n t i l e s f o r the o v e r a l l composites were converted t o z s c o r e s , based on the t e s t ' s norms, i n t h i s study f o r data a n a l y s i s . A d m i n i s t r a t i o n took p l a c e i n l a t e October and e a r l y November u s i n g grade norms f o r the F a l l of grade one. Developmental T e s t of V i s u a l Motor I n t e g r a t i o n (VMI) The VMI c o n s i s t s of a sequence of 24 forms, ordered from simple t o complex, t o be c o p i e d by the c h i l d . I t i s designed f o r p r e s c h o o l and e a r l y grade c h i l d r e n . The 1984 e d i t i o n used i n t h i s study was normed on 3090 c h i l d r e n . The authors r e p o r t r e l i a b i l i t y c o r r e l a t i o n s f o r two or more s c o r e r s r anging from .58 t o .99. T e s t r e t e s t r e l i a b i l i t y has been r e p o r t e d from .63 t o .92. The c o n c u r r e n t v a l i d i t y with r e a d i n e s s t e s t s averages about .50, t e n d i n g t o be higher i n the primary grades. The VMI was found t o be p a r t i c u l a r l y s e n s i t i v e i n i d e n t i f y i n g "high r i s k " boys i n k i n d e r g a r t e n who subsequently had r e a d i n g d i f f i c u l t y . The p r e d i c t i v e v a l i d i t y appears t o d e c l i n e i n the hig h e r grades (Satz & F r i e l , 1974). Beery (1982) i n t e r p r e t s t h i s as being because they compensated f o r t h e i r v i s u a l motor weaknesses with v e r b a l language s k i l l s . Numerous s t u d i e s r e p o r t s i g n i f i c a n t r e l a t i o n s h i p s between v i s u a l - m o t o r c o o r d i n a t i o n t a s k s and academic achievement, p a r t i c u l a r l y b e f o r e grade t h r e e (Book, 1974; Solan, 1987; Tempest, 1987). 46 Peabody P i c t u r e Vocabulary T e s t - R e v i s e d (PPVT-R) The PPVT-R, an i n d i v i d u a l l y a d m i n i s t e r e d t e s t , measures r e c e p t i v e v o cabulary f o r standard "American E n g l i s h " . I t was s t a n d a r d i z e d on 4200 i n d i v i d u a l s , 200 i n each age group. The sample was s t r a t i f i e d based on sex, geographic r e g i o n , SES and e t h n i c background. S p l i t h a l f r e l i a b i l i t y on form L ranges from .67 t o .88. Immediate r e t e s t ranges from .73 t o .91 and d e l a y e d from .53 t o .90. The PPVT-R has been used s u c c e s s f u l l y (r = .62) i n the p r e d i c t i o n of achievement of c u l t u r a l l y d e p r i v e d and N a t i v e c h i l d r e n i n combination with other measures ( P l a n t & Southern, 1968; Tempest, 1987). Kaufman Assessment B a t t e r y f o r C h i l d r e n (K-ABC) The K-ABC i s an i n d i v i d u a l l y a d m i n i s t e r e d measure of mental p r o c e s s i n g f o r c h i l d r e n from 2 years 5 months t o 12 years 5 months. I t was normed on 2000 c h i l d r e n a c r o s s the U n i t e d S t a t e s . The sample was s t r a t i f i e d by sex, age, geographic r e g i o n , SES, e t h n i c group, community s i t e and e d u c a t i o n a l placement. The s u b t e s t s are d i v i d e d i n t o s e q u e n t i a l p r o c e s s i n g - s o l v i n g problems where the emphasis i s on the s e r i a l or temporal of s t i m u l i , and simultaneous p r o c e s s i n g - u s i n g a g e s t a l t l i k e or h o l i s t i c approach t o i n t e g r a t e many s t i m u l i t o s o l v e problems. Four of the s u b t e s t s were used i n t h i s study: Number R e c a l l and Hand Movements which f a l l i n t o the s e q u e n t i a l c a t e g o r y ; and G e s t a l t C l o s u r e and S p a t i a l Memory, which f a l l i n t o the simultaneous category. These f o u r s u b t e s t s were found t o be the best i n d i c a t o r s of 47 the two p r o c e s s i n g modes i n a p r e v i o u s study of N a t i v e c h i l d r e n of the same l i n g u i s t i c group (More, 1984). Both simultaneous and s e q u e n t i a l p r o c e s s i n g have been shown t o be necessary t o achievement ( K i r b y & Das, 1977). However d i f f e r e n t c u l t u r a l groups may have d i f f e r e n t i a l p r o f i c i e n c y i n , or a p r e f e r e n c e f o r , modes of i n f o r m a t i o n p r o c e s s i n g and t h i s may be g e n e t i c a l l y determined (Cummins & Das, 1977). I f t h e r e i s not a u n i q u e l y " I n d i a n " l e a r n i n g s t y l e , t h e r e at l e a s t appear t o be c o n s i s t e n t p a t t e r n s among N a t i v e students which d i f f e r e n t i a t e them from non I n d i a n . Research a l s o suggests t h a t the K-ABC may be a "more s e n s i t i v e " measure than some other widely used instruments when t e s t i n g c o g n i t i o n i n m i n o r i t y c h i l d r e n , t h a t i s they tend t o score h i g h e r on the K-ABC than on the WISC-R or PPVT-R (Bing & Bing, 1985, N a g l i e r i , 1984). D a t - a P o l 1 P ^ r i r m The d a t a were c o l l e c t e d between November, 1986 and May, 1986. The r e s e a r c h e r compiled a l l of the h e a l t h h i s t o r y i n f o r m a t i o n with the a s s i s t a n c e of the s t a f f at the Indian H e a l t h S e r v i c e . Examination of these data r e v e a l e d c o n s i d e r a b l e h e t e r o g e n e i t y w i t h i n the group with regard t o the h e a l t h f a c t o r s . S e v e r a l f a c t o r s were manifested by o n l y one or two s u b j e c t s , e.g. j a u n d i c e and o b e s i t y . T h i s y i e l d e d a v a r i e d assortment of h e a l t h problems f o r each c h i l d with no c l e a r p a t t e r n or continuum emerging. Because of t h i s and because of the s m a l l sample s i z e , an a d d i t i o n a l o v e r a l l h e a l t h composite score r a n g i n g from a low of 0 t o a high of 6 was c a l c u l a t e d f o r each s u b j e c t . I t was d e v i s e d by an experienced p e d i a t r i c i a n r e s e a r c h e r at the U n i v e r s i t y of B r i t i s h Columbia, based on the t o t a l h e a l t h h i s t o r y i n f o r m a t i o n a v a i l a b l e f o r each s u b j e c t . A l l i n d i v i d u a l t e s t s were a d m i n i s t e r e d and scored by the (Caucasian) r e s e a r c h e r a c c o r d i n g t o s t a n d a r d i z e d procedures o u t l i n e d i n each a d m i n i s t r a t i o n manual. These were a d m i n i s t e r e d i n the same order t o each c h i l d i n one s i t t i n g . A tea c h e r ( O r i e n t a l ) e x p e r i e n c e d i n the a d m i n i s t r a t i o n of the M e t r o p o l i t a n T e s t s gave these t o groups of students over a two day p e r i o d . She a l s o scored a l l p r o t o c o l s . A l l t e s t i n g was done i n E n g l i s h , i n the stu d e n t s ' own s c h o o l s . One student was absent at the time of the M e t r o p o l i t a n t e s t i n g , and data was m i s s i n g f o r t h a t student. H y p n f h o c i c The h y p o t h e s i s f o r t h i s study i s t h a t t h e r e i s a p o s i t i v e c o r r e l a t i o n between h e a l t h problems and p s y c h o e d u c a t i o n a l sequelae. Those c h i l d r e n having the most h e a l t h problems are expected t o score lower on the t e s t s of r e a d i n e s s and achievement. M p t h n H n f A n a l y g j g An a p p r o p r i a t e a n a l y s i s would be m u l t i v a r i a t e , such as H o t e l l i n g ' s T, but due t o s m a l l sample s i z e t h a t a n a l y s i s was not f e a s i b l e . A s e r i e s of u n i v a r i a t e t - t e s t s f o r c o r r e l a t e d means had t o be undertaken t o examine the a s s o c i a t i o n between p s y c h o e d u c a t i o n a l t e s t s c o r e s and each h e a l t h f a c t o r , as w e l l 49 as between t e s t s c o r e s and o v e r a l l h e a l t h r i s k groups (low vs high r i s k ) . A median s p l i t on the g e n e r a l r i s k index was performed f o r t h i s purpose, d i v i d i n g the s u b j e c t s i n t o two groups, lower r i s k s c o r i n g 0-3, n = 9 and h i g h e r r i s k s c o r i n g 4-6, n = 10. Pearson's product moment c o r r e l a t i o n s were a l s o computed between the s c o r e s on the t e s t b a t t e r y and the continuous h e a l t h v a r i a b l e s . P o i n t b i s e r i a l c o r r e l a t i o n s were computed t o assess the a s s o c i a t i o n between dichotomous h e a l t h v a r i a b l e s and continuous t e s t s c o r e s . The next chapter d e a l s with the r e s u l t s of the data a n a l y s i s . CHAPTER IV PEgfTT.T'g T h i s chapter r e p o r t s the r e s u l t s of the data a n a l y s e s and the s i g n i f i c a n t r e l a t i o n s h i p s which r e s u l t e d . The f i r s t s e c t i o n p r e s e n t s a d e s c r i p t i v e summary and the second s e c t i o n summarizes the r e s u l t s of the i n f e r e n t i a l a n a l y s e s . The h y p o t h e s i s i s t h a t t h e r e w i l l be a n e g a t i v e a s s o c i a t i o n between presence and degree of h e a l t h r i s k f a c t o r s (the independent v a r i a b l e s ) and c o g n i t i v e / developmental t e s t r e s u l t s (the dependent v a r i a b l e s ) . A continuum of h e a l t h problems was expected t o e x i s t , with those s t u d e n t s m a n i f e s t i n g the g r e a t e r degrees of o v e r a l l h e a l t h problems a t t a i n i n g lower s c o r e s on the c o g n i t i v e / d e v e l o p m e n t a l t e s t s than s u b j e c t s with fewer h e a l t h problems. Summary n f n p g r r i p t i v o f la t* Sample C h a r a c t e r i s t i c s : As s t a t e d i n the Methodology, data a n a l y s i s was performed on the t e s t r e s u l t s and medical i n f o r m a t i o n o b t a i n e d on a t o t a l of 19 s u b j e c t s . Demographic data i n d i c a t e d t h a t 35% were female and 65% male. The average age was s i x years s i x months. S i x t y - f i v e p e r c e n t of the s u b j e c t s were e n r o l l e d i n r e g u l a r grade one, 35% i n t r a n s i t i o n one. Ps y c h o e d u c a t i o n a l Test Data: The mean s c o r e s and standard d e v i a t i o n s were c a l c u l a t e d f o r the sample on the p s y c h o e d u c a t i o n a l t e s t b a t t e r y . The r e s u l t s are summarized i n Table 1. 51 Table 1 Means and Standard Deviations of Ability and Achievement Test Scores Dependent Variable Mean (n=19) S.D. PPVT-R Std. Scores 73.13 10.91 Beery Std. Scores 7.78 2.19 K A B C : Simultaneous Processing Gestalt Closure Std. Scores Spatial Memory Std. Scores 11.48 8.65 2.83 3.20 K A B C : Sequential Processing Hand Movement Std. Scores Number Recall Std. Scores 8.39 8.69 1.56 2.72 Metropolitan Composite Auditory Stanines Visual Stanines Language Stanines 5.38 5.19 4.43 1.80 1.43 1.07 Pre-Reading Composite Z Scores -0.03 0.71 Quantitative Z Scores -1.16 0.18 The group mean on the PPVT-R f a l l s w i t h i n the moderately low range, which i s c o n s i s t e n t with the r e s u l t s of other s t u d i e s on language s k i l l s of N a t i v e s t u d e n t s . These c h i l d r e n ranged from extremely low t o average on t h i s measure of r e c e p t i v e v o c a b u l a r y . The VMI i s at the low end of the average range i n d i c a t i n g average v i s u a l / m o t o r s k i l l s . The mean = 10 and standard d e v i a t i o n = 3 f o r the s t a n d a r d i z a t i o n sample. Standard scores ranged from 5 t o 12 i n t h i s study's sample. That i s , some c h i l d r e n were very weak i n t h e i r v i s u a l - m o t o r s k i l l s , and the h i g h e s t s c o r i n g c h i l d r e n were s t i l l w i t h i n the average range. A l l of the K-ABC s u b t e s t s c o r e s were w i t h i n average l e v e l s . Subtest score ranges were as f o l l o w s , Hand Movements 6-12, G e s t a l t C l o s u r e 6-16, Number R e c a l l 5-14 and S p a t i a l Memory 4-15. No c l e a r p a t t e r n emerged with r e g a r d t o simultaneous versus s e q u e n t i a l p r o c e s s i n g s t r e n g t h s or weaknesses, t h a t i s , both s e q u e n t i a l s u b t e s t s were w i t h i n the average range as were the two simultaneous s u b t e s t s . T h i s i s c o n s i s t e n t with the f i n d i n g s of More (1984) on a sample of seven year o l d s from the same l i n g u i s t i c group. G e s t a l t C l o s u r e , with a group mean score of 11.48, at the higher end of the average range, does stand out as being somewhat higher then the other s u b t e s t s , which had mean sc o r e s at the lower end of the average range. Thus, as a group t h i s sample scored s l i g h t l y h i g h e r on the G e s t a l t C l o s u r e , a simultaneous s u b t e s t . I f a N a t i v e l e a r n i n g s t y l e , as proposed by some r e s e a r c h e r s such as Kaulback ( 1 984 ), More ( 1 984,) and o t h e r s , 53 was manifested by t h i s sample, both of the simultaneous s u b t e s t s would be expected t o be s i g n i f i c a n t l y h i g h e r than the s e q u e n t i a l s u b t e s t s . S i n c e a l l of the s u b t e s t s were a c t u a l l y w i t h i n the average range, i t i s not meaningful t o c o n s i d e r e i t h e r area as being a s i g n i f i c a n t s t r e n g t h or weakness. The M e t r o p o l i t a n s u b s c a l e s , A u d i t o r y , V i s u a l and Language are r e p o r t e d as s t a n i n e s , the s c o r e s p r o v i d e d i n the norms t a b l e s from the manual. Both A u d i t o r y and V i s u a l were average and Language low average. Again, t h i s i s c o n s i s t e n t with More 1s ( 1 984 ) f i n d i n g s t h a t N a t i v e c h i l d r e n tend t o score lower on language measures than white c h i l d r e n used as c o n t r o l s . The PreReading and Q u a n t i t a t i v e composites are r e p o r t e d as z s c o r e s , c a l c u l a t e d by the r e s e a r c h e r f o r the data a n a l y s i s . The P r e r e a d i n g s c o r e s f e l l w i t h i n the average range and the Q u a n t i t a t i v e i n the below average range. The range of s c o r e s on the P r e r e a d i n g composite was q u i t e l a r g e with s u b j e c t s s c o r i n g from the 3rd t o the 82nd p e r c e n t i l e . That i s , t h e r e was a l a r g e v a r i a b i l i t y i n the l e v e l of the P r e r e a d i n g s k i l l s a c q u i r e d by t h i s group, with some s c o r i n g w e l l above average and o t h e r s being n o t a b l y weak. The group was more uniform with r e s p e c t t o Q u a n t i t a t i v e s c o r e s which ranged from the 7th t o 18th p e r c e n t i l e . Low Math achievement has been documented among Native c h i l d r e n from other c u l t u r a l groups as w e l l (Trent & Gilman, 1985; S p i t l e r , 1980). As a group these c h i l d r e n appear t o have a c q u i r e d low average t o average r e a d i n e s s s k i l l s f o r t h e i r age and grade 54 placements i n a l l areas except Q u a n t i t a t i v e , which was below average. The f r e q u e n c i e s of h e a l t h problems found on each s u b j e c t ' s medical f i l e are t a b u l a t e d i n Appendix 1 . There was a low i n c i d e n c e of c e r t a i n d i s o r d e r s , some of which were manifested by o n l y one c h i l d , f o r example, j a u n d i c e and Rh i n c o m p a t i b i l i t y . T h i s l i m i t e d the extent of the i n f e r e n t i a l a n a l y s i s . T n f o r p n f i a l A n a l y c o c Based on the h y p o t h e s i s , a ne g a t i v e c o r r e l a t i o n was expected t o e x i s t between h e a l t h v a r i a b l e s and t e s t r e s u l t s . That i s , those students e x h i b i t i n g the g r e a t e r frequency and degree of h e a l t h problems were expected t o score lower on the a p t i t u d e and achievement t e s t s than t h e i r h e a l t h i e r peers. Pearson's product moment c o r r e l a t i o n s were c a l c u l a t e d between the continuous h e a l t h v a r i a b l e s , such as b i r t h weight, and the continuous t e s t s c o r e s . P o i n t b i s e r i a l s were c a l c u l a t e d f o r the dichotomous h e a l t h v a r i a b l e s , such as presence of p e r i n a t a l c o m p l i c a t i o n s , and the c o g n i t i v e t e s t s c o r e s . Using the SPSS" programme, each of the 30 h e a l t h v a r i a b l e s was c o r r e l a t e d with the 11 t e s t r e s u l t s . These were c a l c u l a t e d t o determine the magnitude and d i r e c t i o n of the r e l a t i o n s h i p between each of the independent and dependent v a r i a b l e s . Table 2 shows the value s of the c o r r e l a t i o n s between the s i x continuous h e a l t h v a r i a b l e s and the p s y c h o e d u c a t i o n a l t e s t s c o r e s . S i g n i f i c a n t f i n d i n g s are b o l d f a c e d . Due t o the small 55 Table 2 Pearson Correlation Coefficients1 Among Health Factors and Psychoeducational Test Scores Test Scores Health Factors Birth Weight Gestational Age Apgar 1 min Apgar 5 min Mother's Age Gravida PPVT-R Std. Scores 39 33 22 00 05 05 Beery Std. Scores 23 08 07 33 01 03 K A B C Subtests (Std. Scores) Hand Movements -37 -02 39 64 -14 -41 Gestalt Closure 13 03 06 -39 11 24 Number Recall 06 13 27 00 -57 -63 Spatial Memory 10 -19 -27 -66 -11 -17 Metropoli tan Composites (Stanines) Auditory -35 -13 06 -49 -19 -05 Visual 10 29 -21 -96 15 31 Language -15 31 36 00 07 02 Pre-Reading Z Scores -21 02 -04 -64 -01 17 Quantitative Z Scores -01 15 24 -55 09 09 Correlation coefficients are shown at two significant figures and decimals omitted with boldface coefficients significant at .10 level. 56 sample s i z e the p r o b a b i l i t y value of .10 was e s t a b l i s h e d t o i n c r e a s e the l i k e l i h o o d of d e t e c t i n g p a t t e r n s or t r e n d s of p r a c t i c a l s i g n i f i c a n c e and i n an attempt t o c o n t a i n the p r o b a b i l i t y of a Type I I e r r o r . S i g n i f i c a n t c o r r e l a t i o n s were between .32 and .71. Those c o r r e l a t i o n s which a t t a i n e d s i g n i f i c a n c e (p < .10) are as f o l l o w s : B i r t h weight was p o s i t i v e l y c o r r e l a t e d with h i g h e r standard s c o r e s on the PPVT-R and n e g a t i v e l y c o r r e l a t e d with the Hand Movements s u b t e s t . Only two c h i l d r e n i n the sample had b i r t h w e i g h t s which would be c o n s i d e r e d t o p l a c e them at r i s k (<2500 g. or >4000 g. i n Blackburn, 1986) and the average b i r t h w e i g h t was 3211 grams. As b i r t h w e i g h t i n c r e a s e d the c h i l d was more l i k e l y t o score h i g h e r on the measure of r e c e p t i v e v o c a b u l a r y . T h i s i s c o n s i s t e n t with the f i n d i n g s of Johnson et a l . (1987) and Hunt et a l . (1982), t h a t low b i r t h w e i g h t i s r e l a t e d t o v a r i o u s types of developmental d e l a y and l e a r n i n g problems, most commonly, language comprehension and v i s u a l -motor i n t e g r a t i o n . There does not appear t o be a reason f o r the n e g a t i v e c o r r e l a t i o n between b i r t h w e i g h t and Hand Movements, a s e q u e n t i a l v i s u a l memory s u b t e s t . G e s t a t i o n a l Age was r e l a t e d t o r e c e p t i v e language development. That i s , c h i l d r e n born t o f u l l term g e s t a t i o n showed hig h e r PPVT-R scores than those who were premature. P r e m a t u r i t y , along with other high r i s k v a r i a b l e s has been documented as i n c r e a s i n g a c h i l d ' s p o t e n t i a l f o r l a t e r developmental d e l a y (Blackburn, 1986). Table 2 a l s o shows t h a t as Apgar scores (taken at 1 minute) i n c r e a s e d , c h i l d r e n s 1 scores on Hand Movements and M e t r o p o l i t a n Language i n c r e a s e d . S i m i l a r l y , as Apgar scores taken at 5 minutes i n c r e a s e d again Hand Movements i n c r e a s e d . C o n v e r s e l y , S p a t i a l Memory, P r e r e a d i n g and Q u a n t i t a t i v e scores decreased. I t i s important t o r e a l i z e t h a t a second Apgar i s o f t e n o n l y a d m i n i s t e r e d i f a low s c o r e , i n d i c a t i n g an i n f a n t at r i s k , i s o b t a i n e d on the f i r s t a d m i n i s t r a t i o n . In the p r e s e n t sample o n l y 8 c h i l d r e n were a d m i n i s t e r e d second Apgar r a t i n g s as opposed t o 19 who r e c e i v e d scores f o r the one minute a d m i n i s t r a t i o n ; Thus, those few who had second scores c o n s t i t u t e a h i g h e r r i s k group and would be expected t o o b t a i n lower s c o r e s on the t e s t b a t t e r y . A l s o a l l of the second a d m i n i s t r a t i o n s were scored 9 or 10, which i n d i c a t e s adequate o v e r a l l s t a t u s at t h a t time. C o l l e t t i (1979) found lower Apgar sc o r e s i n combination with other v a r i a b l e s , such as labour c o m p l i c a t i o n s , longer second stage labour, e t c . t o be s i g n i f i c a n t l y (p < .05) h i g h e r i n a sample of l e a r n i n g d i s a b l e d c h i l d r e n compared t o a group of c o n t r o l s . The mean age of the mothers of the c h i l d r e n i n t h i s sample was 21 y e a r s , with a range from 16 t o 38 y e a r s . Maternal age <16 and >35 i s g e n e r a l l y accepted as being high r i s k f o r pregnancy (Blackburn, 1986). As mother's age i n c r e a s e d the c h i l d r e n s ' s c o r e s on Number R e c a l l s i g n i f i c a n t l y d ecreased. I t i s p o s s i b l e t h a t t h i s i s because o n l y one of the sample was a c t u a l l y at high r i s k on t h i s v a r i a b l e . As a 58 r e s u l t , i t i s not a c l i n i c a l l y s i g n i f i c a n t d i s c r i m i n a t o r of r i s k i n t h i s group. C h i l d r e n s ' s c o r e s on Hand Movements and Number R e c a l l decreased s i g n i f i c a n t l y (p < .04 and p < .002 r e s p e c t i v e l y ) as the number of p r e v i o u s pregnancies, or Gravida i n c r e a s e d . T h i s again i s c o n s i s t e n t with the l i t e r a t u r e i n d i c a t i n g t h a t g r a v i d a g r e a t e r than 4 i s high r i s k (Aubry & Pennington, 1973; Blackburn, 1986). I t a l s o seems l i k e l y t h a t mothers with s e v e r a l other c h i l d r e n a t home w i l l have l e s s time t o devote to each i n terms of language development and o t h e r forms of i n t e l l e c t u a l s t i m u l a t i o n . Table 3 shows the p o i n t b i s e r i a l c o r r e l a t i o n s between the d i s c r e t e h e a l t h f a c t o r s and the p s y c h o e d u c a t i o n a l t e s t s c o r e s . While c h i l d r e n born by Caesarean s e c t i o n tended t o score lower on Number R e c a l l , t h e r e were onl y two such cases i n t h i s sample. The s i x c h i l d r e n e x h i b i t i n g p e r i n a t a l c o m p l i c a t i o n s tended t o score h i g h e r on S p a t i a l Memory, A u d i t o r y and P r e r e a d i n g , which c o n t r a d i c t s most r e s e a r c h i n d i c a t i n g t h a t such c h i l d r e n are at r i s k f o r developmental d e l a y i n v a r i o u s areas of c o g n i t i v e f u n c t i o n i n g . However, again i t i s d i f f i c u l t t o make i n t e r p r e t a t i o n s based on a sample of s i x . The Denver Developmental Screening T e s t ( f i r s t a d m i n i s t r a t i o n ) showed s e v e r a l s i g n i f i c a n t r e l a t i o n s h i p s with p s y c h o e d u c a t i o n a l t e s t s c o r e s , p a r t i c u l a r l y the PPVT-R, G e s t a l t C l o s u r e , M e t r o p o l i t a n Language and P r e r e a d i n g s k i l l s . Higher s c o r e s on the second a d m i n i s t r a t i o n of the DDST were Table 3 Point Biser ial C o r r e l a t i o n s ' A m o n g Health Factors and Psychoeducat iona l Tes t S c o r e s Health Factors2 Test C A R C A E PER D S 1 D S 2 O B S OTI HEA DEN SUR FEV COL R E S IMP SHI G A S IMEG DIE A L C J A U RH VIS IRO P E T H E M | RISK P P V T - R 10 10 0 4 58 4 7 - 1 9 - 2 3 - 1 2 - 1 9 - 1 3 2 3 0 3 -40 - 0 4 - 2 0 17 0 2 - 2 2 1 1 12 2 5 - 1 0 - 1 1 - 0 9 -48 | -33 Beery 0 6 - 1 3 - 1 7 - 0 7 71 0 4 2 0 13 - 2 1 - 0 3 1 5 2 6 - 0 6 33 - 2 1 0 1 - 1 2 - 3 0 0 6 - 1 7 - 0 7 - 1 1 2 1 - 2 8 - 2 8 | 0 0 KABC Subtests | Hand M o v e m e n t s 3 3 13 - 1 5 - 1 9 17 -32 - 0 6 2 6 -37 -39 33 - 0 1 -39 - 1 3 -39 -41 -40 - 2 1 - 1 9 1 3 - 2 2 - 1 1 0 6 1 3 1 3 j - 2 7 Gestalt C l o s u r e 0 0 - 0 3 1 1 38 0 7 - 2 0 0 8 32 - 1 0 - 3 7 42 32 - 0 1 0 7 0 0 17 0 9 - 1 9 1 4 32 32 2 1 0 9 0 6 -36 j 2 0 Number Recal l 2 2 -35 0 7 0 8 12 -41 -32 - 1 4 - 1 4 - 0 6 - 0 8 2 0 - 2 7 1 8 -33 -47 - 0 5 - 1 8 - 2 4 2 6 - 2 2 - 0 4 17 - 1 3 - 1 3 j -49 Spatial M e m o r y 1 3 - 0 9 40 0 9 2 9 17 - 1 8 1 1 2 1 -40 - 2 1 - 0 7 - 2 4 - 0 8 - 0 3 0 5 - 1 8 - 0 6 -33 2 2 - 0 6 36 2 1 - 0 7 1 4 | 0 3 Metro Comps | Aud i to ry 3 7 - 0 5 44 3 4 4 3 -46 - 0 3 39 -45 - 2 6 2 5 0 0 -44 1 4 - 2 0 0 0 0 8 - 2 5 1 5 48 1 6 10 - 1 2 — 1 6 | - 0 7 Visual - 2 8 - 3 1 2 6 19 - 0 7 13 - 0 5 2 5 -32 0 0 0 0 - 0 9 0 0 71 1 1 0 0 33 0 0 40 1 7 0 0 1 4 -38 — 0 0 | - 1 2 Language - 0 8 - 2 4 - 0 8 43 0 0 - 2 9 -36 0 8 - 2 6 - 2 9 - 0 2 0 1 -43 34 0 5 0 5 55 1 1 36 47 - 0 6 - 1 0 - 2 8 — - 0 6 j -39 P r e - R e a d i n g Z 1 8 - 1 8 3 9 40 4 0 - 2 6 - 1 0 37 -40 - 1 6 19 - 0 8 -39 3 3 - 1 1 0 4 2 3 - 1 4 3 0 40 1 3 0 9 - 2 2 — 11 j - 1 0 Quantitative Z 0 8 - 1 6 2 4 0 5 - 0 8 - 1 8 10 0 9 -58 - 2 5 17 0 6 - 0 3 56 - 1 5 - 1 2 - 0 5 2 2 2 8 0 5 17 - 1 9 -37 — 17 j 0 4 C o r r e l a t i o n c o e f f i c i e n t s are s h o w n at t w o signif icant f igures and dec imals o m i t t e d . C o e f f i c i e n t s appearing in b o l d f a c e are s igni f icant at . 1 0 leve l , n varies f o r each health fac to r . ^ABBREVIAT IONS; C A R ; Prenatal Care OTI; Otit is R E S ; Upper Respi ratory A L C ; A l c o h o l H E M ; Hemang C A E ; Caesarean H E A ; Hearing L o s s IMP: Impetigo J A U ; Jaundice RISK; Risk C o m p o s i t e PER; Perinatal Compl i ca t ions D E N ; Dental SHI; Shigel la R H ; Rh D S 1 ; D D S T 1 S U R ; Surgery G A S ; Gastro Intestinal V I S ; V i s i o n D S 2 : D D S T 2 F E V ; Fevers N E G : Neg lec t IRO; L o w Iron O B S ; Obesi ty C O L ; C o l d s DIE; Diet P E T ; Per tuss i s s t r o n g l y r e l a t e d ( r = .71, p = .02) t o h i g h e r scores on the VMI. A d m i n i s t r a t i o n times f o r the DDST v a r i e d g r e a t l y f o r these c h i l d r e n . F i r s t a d m i n i s t r a t i o n s ranged from 3-14 months, and second, i f g i v e n at a l l , from 10-36 months. I t can a l s o be seen from Table 3 t h a t c h i l d r e n e x p e r i e n c i n g o t i t i s media scored lower on Number R e c a l l , an a u d i t o r y s e q u e n t i a l s u b t e s t , and Language. Research on the e f f e c t s of o t i t i s media has c o n s i s t e n t l y found lowered language and a u d i t o r y type s k i l l s , p a r t i c u l a r l y i n those c h i l d r e n who e x p e r i e n c e the i l l n e s s b e f o r e age two (Bender et a l . , 1975; J u l i e n et a l . , 1987). Those documented as e x p e r i e n c i n g h e a r i n g l o s s a c t u a l l y scored h i g h e r on G e s t a l t C l o s u r e , A u d i t o r y and P r e r e a d i n g , a r e s u l t c l e a r l y at odds with the h y p o t h e s i s . F u r t h e r from Table 3, c h i l d r e n having more d e n t a l problems scor e d lower on Hand Movements, A u d i t o r y and V i s u a l s u b t e s t s of the M e t r o p o l i t a n and lower on the P r e r e a d i n g and Q u a n t i t a t i v e a r e a s . C h i l d r e n with more c o l d s scored higher on G e s t a l t C l o s u r e . R e s p i r a t o r y i n f e c t i o n s appeared t o be a good p r e d i c t o r of developmental s t a t u s , with those c h i l d r e n having r e s p i r a t o r y i n f e c t i o n s s c o r i n g lower on s e v e r a l measures, s p e c i f i c a l l y the PPVT-R, Hand Movements, A u d i t o r y , Language and P r e r e a d i n g . The i n c i d e n c e of impetigo was s i g n i f i c a n t l y r e l a t e d (p < .05) t o h i g h e r V i s u a l and Q u a n t i t a t i v e s k i l l s , i n d i c a t i n g tha t h i s c o n t a g i o u s s k i n d i s e a s e i s n o t a s s o c i a t e d w i t h l o w e r p e r f o r m a n c e on a c a d e m i c r e a d i n e s s t y p e s k i l l s . G e n e r a l g a s t r o i n t e s t i n a l p r o b l e m s and s h i g e l l a , a s p e c i f i c i n t e s t i n a l i n f e c t i o n f o u n d i n 4 members o f t h i s s a m p l e , w e r e b o t h r e l a t e d t o l o w e r s c o r e s on Hand Movements an d Number R e c a l l . G e n e r a l i z e d n e g l e c t was a l s o r e l a t e d t o l o w e r s c o r e s on Hand Movements. W h i l e p a r e n t a l i n v o l v e m e n t w i t h a l c o h o l was r e l a t e d t o some s u b t e s t s , t h e r e c o r d i n g o f t h i s v a r i a b l e on t h e h e a l t h c h a r t s was c o n s i d e r e d t o be t o o i n c o n s i s t e n t and s u b j e c t i v e t o w a r r a n t i n t e r p r e t a t i o n o f t h i s r e s u l t . F o r e x a m p l e f i l e n o t e s w e r e o f t e n a n e c d o t a l o r b a s e d on t h i r d p a r t y i n f o r m a t i o n . S i g n i f i c a n t c o r r e l a t i o n s a s s o c i a t e d w i t h j a u n d i c e , o b e s i t y , Rh i n c o m p a t i b i l i t y , v i s i o n p r o b l e m s , l o w i r o n , p e r t u s s i s a n d hemangioma a r e t o be i n t e r p r e t e d w i t h c a u t i o n a o n l y one o r t w o c h i l d r e n m a n i f e s t e d e a c h o f t h e s e v a r i a b l e s ( r e f e r t o A p p e n d i x 1 f o r s p e c i f i c f r e q u e n c i e s ) . The l o w i n c i d e n c e o f t h e s e d i s o r d e r s i n t h i s s a m p l e r e s u l t e d i n a l o p s i d e d m a r g i n a l s p l i t , t h e r e b y r e d u c i n g t h e v a l i d i t y o f t h e P o i n t b i s e r i a l c a l c u l a t i o n . T h e s e v a r i a b l e s w e r e , h o w e v e r , u s e f u l i n t h e i r c o n t r i b u t i o n t o t h e o v e r a l l r i s k s c o r e c a l c u l a t e d f o r e a c h c h i l d . T h e y w i l l n o t be d i s c u s s e d f u r t h e r a s f a r a s t h e i r i n d i v i d u a l c o r r e l a t i o n s w i t h t h e t e s t s c o r e s a r e c o n c e r n e d . As a means o f g r o u p i n g t h e s e s p e c i f i c h e a l t h f a c t o r s i n t a more m e a n i n g f u l v a r i a b l e , t h e o v e r a l l r i s k c o m p o s i t e s c o r e 62 was c a l c u l a t e d . I t was shown t o be r e l a t e d t o lower Receptive Vocabulary, lower Number R e c a l l and lower Language s k i l l s . In summary, as seen from T a b l e s 2 and 3, h e a l t h v a r i a b l e s were found t o be s i g n i f i c a n t l y r e l a t e d t o s c o r e s on s e v e r a l of the measures of c o g n i t i v e and academic development, i n the d i r e c t i o n s t a t e d i n the h y p o t h e s i s ; t h a t i s , i n c r e a s e d h e a l t h problems were a s s o c i a t e d with lower scores on the p s y c h o e d u c a t i o n a l t e s t s . Those h e a l t h v a r i a b l e s which y i e l d e d the g r e a t e s t number of s i g n i f i c a n t c o r r e l a t i o n s i n the expected d i r e c t i o n were f u r t h e r a n alyzed u s i n g t - t e s t s . Table 4 i l l u s t r a t e s the magnitude of mean d i f f e r e n c e s on the c o g n i t i v e t e s t s c o r e s between those s u b j e c t s m a n i f e s t i n g the p a r t i c u l a r h e a l t h problem, versus those without. Examination of Table 4 shows t h a t c h i l d r e n i n t h i s group who e x p e r i e n c e d r e s p i r a t o r y i l l n e s s d i f f e r e d s i g n i f i c a n t l y from those without t h i s i l l n e s s , p a r t i c u l a r l y on the v a r i a b l e s r e l a t e d t o language development. They were more l i k e l y t o s c o r e lower on r e c e p t i v e vocabulary, a u d i t o r y and g e n e r a l language s k i l l s , as w e l l as on Hand Movements and P r e r e a d i n g . N a t i v e c h i l d r e n have been found t o d i s p l a y o t i t i s media c o n c u r r e n t l y with upper r e s p i r a t o r y i n f e c t i o n s , c a u s i n g r e s e a r c h e r s t o propose t h a t the two d i s e a s e s are i n t e r r e l a t e d (Kaplan et a l . , 1973; Manning, 1975). D i r e c t r e s e a r c h has l i n k e d o t i t i s media with language d e l a y ( J u l i e n e t a l . , 1987, McShane, 1982). 63 Table 4 T-Test Comparisons of Subjects With Versus Without Health Problem for Test Scores Upper Respiratory Illness Dependent Variable Group 1 Mean S.D. t value P 2 PPVT-R Std. Scores No Yes 72.64 64.40 9.28 6.77 1.81 0.04 K A B C Subtest Hand Movements Std. Scores No Yes 8.57 7.40 1.34 1.14 1.73 0.05 Metropolitan Composites Auditory Stanines No Yes 5.38 3.75 1.44 1.71 1.90 0.04 Language Stanines No Yes 4.46 3.50 0.78 1.29 1.86 0.04 Pre-Reading Z Scores No Yes -0.02 -0.65 0.54 1.03 1.66 0.06 Dental Problems Dependent Variable Group 3 Mean S.D. t value P K A B C Subtest Hand Movements Std. Scores No Yes 8.78 7.80 1.39 1.23 .1.62 0.06 Metropolitan Composites Auditory Stanines No Yes 5.75 4.33 1.75 1.22 1.95 0.03 Visual Stanines No Yes 5.50 4.55 1.69 1.24 1.33 0.10 Pre-Reading Z Scores No Yes 0.12 -0.42 0.86 0.42 1.67 0.06 Quantitative Z Scores No Yes -1.05 -1.27 0.13 0.18 2.79 0.01 63a Table 4 continued Denver Screening Test: 1st Administration Dependent Variable Group * Mean S.D. t value P PPVT-R Std. Scores Fail Pass 61.00 73.84 1.73 8.06 -2.68 0.01 K A B C Subtest Gestalt Closure Std. Scores Fail Pass 9.33 12.08 2.89 2.72 -1.56 0.07 Metropolitan Composites Language Stanines Fail Pass 3.33 4.36 1.53 0.81 -1.64 0.06 Pre-Reading Z Scores Fail Pass -0.68 0.01 1.31 0.51 -1.52 0.08 1 N o group: n=14 Yes group: n = 5 2 One tailed t-tests with level of significance set at p<.10 3 N o group: n=9 Yes group: n=10 'Fa i l group: n=3 Pass group: n=12 Those c h i l d r e n i n the group having d e n t a l problems showed a s l i g h t l y d i f f e r e n t p a t t e r n . T h i s group tended t o be lower i n Hand Movements and P r e r e a d i n g , as w e l l as V i s u a l and A u d i t o r y They d i f f e r e d most s i g n i f i c a n t l y i n the area of Q u a n t i t a t i v e s k i l l s (p < .01) where they s c o r e d c o n s i s t e n t l y lower. Researchers have found poor d e n t a l care t o be an i n d i c a t o r of suboptimal n u t r i t i o n and a l s o t o be a s s o c i a t e d with o t i t i s media and other upper r e s p i r a t o r y a i l m e n t s ; a l l of which have been found t o be a s s o c i a t e d with lowered c o g n i t i v e / developmental s t a t u s (Manning, 1975; Mayhall, 1975). The Denver Developmental Screening T e s t ( f i r s t a d m i n i s t r a t i o n ) a l s o y i e l d e d some s i g n i f i c a n t r e s u l t s . C h i l d r e n who f a i l e d on t h i s a d m i n i s t r a t i o n s c o r e d lower on Rec e p t i v e v o c a b u l a r y , Language and P r e r e a d i n g s k i l l s , as w e l l as on G e s t a l t C l o s u r e . As d e s c r i b e d i n Chapter I I I a composite r i s k score was compiled f o r each c h i l d i n the sample. A median s p l i t procedure y i e l d e d h i g h r i s k (4-6) and low r i s k (0-3) groups. The d i f f e r e n c e s between the means of the t e s t b a t t e r y scores f o r the low and high r i s k groups were t e s t e d f o r s i g n i f i c a n c e u s i n g t - t e s t s . The r e s u l t s are summarized i n Table 5. In a l l cases, except G e s t a l t C l o s u r e , the low r i s k group o b t a i n e d higher mean s c o r e s than the high r i s k group, t h a t i s , c h i l d r e with fewer h e a l t h problems scored higher on the psycho-e d u c a t i o n a l t e s t b a t t e r y . S i g n i f i c a n t l y lower s c o r e s were ob t a i n e d by the high r i s k group on the K-ABC Number R e c a l l (p = .01) and the M e t r o p o l i t a n Language (p = .02). S e v e r a l other 65 Table 5 T-Test Comparisons of High and Low Health Risk Groups for Test Scores Dependent Variable Risk Group 1 Mean S.D. t value P 2 PPVT-R Std. Scores Low High 72.78 68.40 8.44 9.95 1.03 0.16 Beery Std. Scores Low High 7.67 7.60 2.34 2.32 0.06 0.47 KABC Subtests (Std. Scores) Hand Movements Low High 8.44 •8.10 1.67 1.10 0.54 0.30 Gestalt Closure Low High 11.22 11.30 2.11 3.50 -0.06 0.48 Number Recall Low High 9.67 7.10 2.65 1.66 2.56 0.01 Spatial Memory Low High 9.11 8.80 4.20 2.74 0.19 0.42 Metropolitan Composites (Stanines) Auditory Low High 5.50 4.56 1.60 1.59 1.22 0.12 Visual Low High 5.37 4.67 1.51 1.50 0.97 0.17 Language Low High 4.75 3.78 0.71 0.97 2.33 0.02 Pre-Reading Z Scores Low High 0.06 -0.37 0.62 0.74 1.29 0.11 Quantitative Z Scores Low High -1.15 -1.18 0.21 0.06 0.29 0.39 'Low risk group: n = 9 High risk group: n=10 2 One tailed t-tests with level of significance set at pS.10 66 measures a l s o approached s i g n i f i c a n c e ; among these were the PPVT-R, A u d i t o r y and PreReading composite. Performance on these t e s t s and, p o s s i b l y the u n d e r l y i n g a b i l i t i e s which they p u r p o r t t o measure, may t h e r e f o r e be more more s u s c e p t i b l e t o the e f f e c t s of e a r l y h e a l t h problems. S u m m a r y The r e s u l t s suggest t h a t o v e r a l l h e a l t h problems ex p e r i e n c e d e a r l y i n a c h i l d ' s development may have d e t r i m e n t a l e f f e c t s l a t e r i n the attainment of c e r t a i n r e a d i n e s s s k i l l s as w e l l as some c o g n i t i v e a b i l i t i e s . In a d d i t i o n t o o v e r a l l h e a l t h problems, as i n d i c a t e d by the h e a l t h composite s c o r e , some v a r i a b l e s appeared t o be c o n s i s t e n t l y a s s o c i a t e d with lowered t e s t s c o r e s , these were: R e s p i r a t o r y d i s e a s e , Dental problems and f a i l e d DDST (1st a d m i n i s t r a t i o n ) . These f i n d i n g s and t h e i r i m p l i c a t i o n s are d i s c u s s e d more f u l l y i n Chapter V. CHAPTER V 67 n T f i P M g g T n w T h i s chapter i n c l u d e s a restatement of the purpose of the study, as w e l l as a summary of the r e s u l t s . L i m i t a t i o n s i n v o l v e d i n g e n e r a l i z i n g these r e s u l t s t o the Na t i v e s c h o o l p o p u l a t i o n and recommendations f o r f u r t h e r r e s e a r c h i n the f i e l d s of h e a l t h and educa t i o n are a l s o p r e s e n t e d . P n v p o c o n f t h o S - t - n H y D e s p i t e e f f o r t s on the p a r t of government and Na t i v e groups themselves, many asp e c t s of d a i l y l i f e f o r Canada's Na t i v e peoples are below a c c e p t a b l e standards f o r the western world. Among these are the h e a l t h problems which continue t o be endemic i n t h i s group and the high dropout and f a i l u r e r a t e s of N a t i v e students i n the s c h o o l system. Research i n the f i e l d s of e d u c a t i o n and medicine has tended t o focus on these i s s u e s i n d e p e n d e n t l y . The c o n t r i b u t i n g e f f e c t s and p o s s i b l e i n t e r a c t i o n s of s e v e r a l c o n d i t i o n s on developmental outcome of Na t i v e c h i l d r e n have been suggested by r e s e a r c h e r s as a l t e r n a t i v e s t o p r e v i o u s l y h e l d s t e r e o t y p e s and assumptions. Recommendations have been made f o r f u r t h e r study i n t h i s area (McShane & P l a s , 1988; W i l l i a m s , 1986). The purpose of the pr e s e n t study t h e r e f o r e , was t o ex p l o r e the r e l a t i o n s h i p between h e a l t h problems and c o g n i t i v e development/academic r e a d i n e s s i n a sample of grade one Native c h i l d r e n . T h i r t y h e a l t h v a r i a b l e s c i t e d i n the l i t e r a t u r e as being r e l e v a n t i n the p r e d i c t i o n of developmental outcome were 68 o b t a i n e d from s u b j e c t s ' medical f i l e s . A b a t t e r y of psycho-e d u c a t i o n a l t e s t s found t o be a s s o c i a t e d with p r e d i c t i o n of academic a p t i t u d e was a d m i n i s t e r e d t o the 19 c h i l d r e n i n the sample. S u m m a r y n f R o g n l t g Examination of the d e s c r i p t i v e data r e v e a l e d t h a t many of the p a r a s i t i c and i n f e c t i o u s d i s e a s e s which are a s s o c i a t e d with suboptimal l i v i n g c o n d i t i o n s , f o r example impetigo and s h i g e l l a , o c c u r r e d with some frequency i n t h i s sample. T h i s f i n d i n g i s c o n s i s t e n t with those of s e v e r a l r e s e a r c h e r s who found t h a t N a t i v e c h i l d r e n as a group manifest many h e a l t h problems i n g r e a t e r frequency and s e v e r i t y than white c h i l d r e n (Shawana & T a y l o r , 1988; Shah & Farkas, 1982). Mean sc o r e s on a l l of the t e s t s i n the b a t t e r y a d m i n i s t e r e d were w i t h i n the moderately low t o average range, with the e x c e p t i o n of the M e t r o p o l i t a n Q u a n t i t a t i v e , which was below average. The mean score on the VMI, a t the low end of the average range i s a c t u a l l y lower than would be expected i n t h i s sample. Most r e s e a r c h tends t o f i n d N a t i v e c h i l d r e n having s t r o n g average s k i l l s i n t h i s area, a r e l a t i v e s t r e n g t h i n c o n t r a s t t o t h e i r lower v e r b a l a b i l i t i e s (Kaulback, 1984; Blowers, 1981). The average s c o r e s o b t a i n e d on the other measures are c o n s i s t e n t with the r e s e a r c h of Bryde (1963) and o t h e r s ( B e r r y , 1968, Rampaul e t a l . , 1984) who found t h a t N a t i v e c h i l d r e n a c t u a l l y began s c h o o l on an e q u i v a l e n t l e v e l with t h e i r white c o u n t e r p a r t s , with achievement problems i n t e n s i f y i n g i n l a t e r grades. T h i s i s i n c o n f l i c t with the m a j o r i t y of r e s e a r c h e r s , f o r example, Downing et a l . (1975) who found N a t i v e students l a c k i n g i n r e a d i n g r e a d i n e s s s k i l l s i n k i n d e r g a r t e n . M i c k e l s o n and Galloway (1969) a l s o r e f e r r e d t o an i n i t i a l l a c k of preparedness f o r academic success f o r N a t i v e s , and suggested t h a t a c o n t r i b u t i n g f a c t o r was l a c k of v e r b a l / a u d i t o r y s t i m u l a t i o n i n e a r l y home l i f e . The r e s u l t s of the Pearson and P o i n t B i s e r i a l c o r r e l a t i o n s i n d i c a t e d s e v e r a l s i g n i f i c a n t n e g a t i v e c o r r e l a t i o n s between the h e a l t h v a r i a b l e s and sco r e s on the v a r i o u s p s y c h o e d u c a t i o n a l t e s t s . S i g n i f i c a n t c o r r e l a t i o n s ranged from .32 t o .96 (Tables 2, 3, and 6). Due t o the small sample s i z e and v a r i a b i l i t y i n the h e a l t h h i s t o r i e s , t h e r e were on l y one or two cases of s e v e r a l of the i l l n e s s e s . Because of the r e s u l t i n g imbalance i n the marginal s p l i t s f o r the P o i n t B i s e r i a l s such cases must be i n t e r p r e t e d with c a u t i o n . Those h e a l t h v a r i a b l e s which were p r e s e n t i n s u f f i c i e n t numbers and y i e l d e d s i g n i f i c a n t (p < .10) c o r r e l a t i o n s were as f o l l o w s : Denver Developmental Screening T e s t ( f i r s t a d m i n i s t r a t i o n ) was a s s o c i a t e d with lower PPVT-R, G e s t a l t C l o s u r e , Language and P r e r e a d i n g composite. Although the DDST was found i n the medical f i l e s and was a d m i n i s t e r e d by the p u b l i c h e a l t h nurse i t can be argued t h a t , i n f a c t , i t i s more a measure of c o g n i t i v e development than a h e a l t h f a c t o r , t h e r e f o r e the p o s i t i v e r e l a t i o n s h i p between i t and the other academic-type t e s t s i s t o be expected. Cautions have been r a i s e d by r e s e a r c h e r s with r e g a r d t o the Denver's use with TABLE 6 SIGNIFICANT CORRELATIONS BETWEEN HEALTH FACTORS AND PSYCHOEDUCATIONAL TEST SCORES (P < 0.10) Dependent Variables Independent variables PPVT-R VMI K-ABC Hand Move. Gestalt Closure Number Recall Spatial Memory Metro. Auditory Visual Language Pre-Reading Quant. BirthWeight 0.39 -0.37 Gestation 0.33 Perinatal Comp 0.4 0.44 0.39 Mother's Age -0.57 Gravida -0.41 -0.63 Apgar 1 min 0.39 0.36 Apgar 5 min 0.64 -0.66 -0.96 -0.64 -0.55 DDST 1 0.58 . 0.38 V 0.43 0.4 DDST 2 0.71 Otitis Media -0.32 -0.36 Hearing Loss 0.32 0.39 0.37 Dental Probs -0.37 -0.45 -0.32 -0.39 -0.58 Dental Surgery -0.39 -0.39 Fevers 0.33 0.42 Colds 0.32 Resp. Illness -0.4 -0.39 -0.44 -0.43 -0.39 Impetigo 0.33 0.71 0.56 Shigella -0.39 -0.33 GI Problems -0.41 -0.47 General Neglect -0.4 0.33 0.55 Risk Composite -0.33 -0.49 -0.39 71 N a t i v e c h i l d r e n , however as the use of E n g l i s h i s not a p p r o p r i a t e i n some N a t i v e communities ( t h i s i s l i k e l y not a f a c t o r i n the p r e s e n t study) and many of the items are scored as "no o p p o r t u n i t y " , p a r t i c u l a r l y i n i s o l a t e d areas (Burke, Sayers & Wray, 1981). Those same f a c t o r s which are seen t o b i a s the DDST f o r N a t i v e students are a l s o f a c t o r s which hamper the N a t i v e c h i l d i n the p r o v i n c i a l s c h o o l system, which r a r e l y accommodates f o r t h e i r d i f f e r e n t backgrounds and s k i l l a c q u i s i t i o n . Because of t h i s , the DDST may i n f a c t be a good p r e d i c t o r of academic a p t i t u d e , as i t was i n t h i s study. Dental Problems were a s s o c i a t e d with lower s c o r e s on Hand Movements, A u d i t o r y , V i s u a l , PreReading composite and Q u a n t i t a t i v e . Although t h e r e i s no apparent reason why d e n t a l problems themselves would a f f e c t these t e s t s , poor d e n t a l s t a t u s has been a s s o c i a t e d i n the l i t e r a t u r e with a v a r i e t y of other h e a l t h f a c t o r s , such as o t i t i s media and suboptimal n u t r i t i o n and t h e r e f o r e i t appears t o be one i n d i c a t o r of o v e r a l l h e a l t h s t a t u s . The high i n c i d e n c e of d e n t a l problems i n N a t i v e groups has been a t t r i b u t e d t o a s h i f t t o the high sugar and carbohydrate North American d i e t , as w e l l as l a c k of u t i l i z a t i o n or a v a i l a b i l i t y of adequate d e n t a l care (Manning, 1975, M a y h a l l , 1975). The encouraging aspect of t h i s f i n d i n g i s t h a t these problems, and presumably t h e i r sequelae, are l a r g e l y p r e v e n t a b l e . F i n a l l y , r e s p i r a t o r y i l l n e s s e s were r e l a t e d t o lower s c o r e s on the PPVT-R, Hand Movements, A u d i t o r y , Language and PreReading. Three of these four t e s t s have a major language 72 component. Lowered performance i n t h i s s p e c i f i c area would be expected based on the l i t e r a t u r e l i n k i n g r e s p i r a t o r y i l l n e s s with the i n f l a m e d e u s t a c h i a n tubes and f l u c t u a t i n g h e a r i n g l o s s a s s o c i a t e d with o t i t i s media ( J u l i e n et a l . , 1987; Kaplan et a l . , 1973; McShane & M i t c h e l l , 1979; S c a l d w e l l & Frame, 1985). The s e v e r i t y and frequency of r e s p i r a t o r y d i s e a s e i n N a t i v e c h i l d r e n i s o f t e n s i g n i f i c a n t l y g r e a t e r than t h a t documented i n white c h i l d r e n and r e s u l t s i n h i g h e r r a t e s of h o s p i t a l i z a t i o n f o r them (Houston e t a l . , 1979). T h i s i n c r e a s e i n l e n g t h of i l l n e s s as w e l l as h o s p i t a l s t a y i s l i k e l y r e s p o n s i b l e f o r frequent absences from s c h o o l and reduced o p p o r t u n i t y f o r c o g n i t i v e development. S i g n i f i c a n t c o r r e l a t i o n s were a l s o noted on s e v e r a l other h e a l t h v a r i a b l e s , s p e c i f i c a l l y o t i t i s media, g a s t r o i n t e s t i n a l i l l n e s s and s h i g e l l a , though with few fewer p s y c h o e d u c a t i o n a l measures. I t i s p o s s i b l e t h a t more f i n d i n g s of s i g n i f i c a n c e would be o b t a i n e d with more d e t a i l e d h e a l t h h i s t o r y i n f o r m a t i o n . For example, the frequency of o c c u r r e n c e s of o t i t i s media has been found t o a f f e c t developmental outcome, with g r e a t e r than four occurrences being a s s o c i a t e d with lower v e r b a l s k i l l s than l e s s than four (McShane, 1982). The same l i k e l y a p p l i e s t o s e v e r a l of the h e a l t h v a r i a b l e s which were dic h o t o m i z e d i n t h i s study. The method of r e c o r d i n g h e a l t h h i s t o r y i n f o r m a t i o n employed by the Indian H e a l t h O f f i c e prevented such depth of data c o l l e c t i o n . The assignment of the h e a l t h r i s k composite score p e r m i t t e d a more g l o b a l examination of the d a t a . A p a t t e r n was 73 found t o e x i s t , i n d i c a t i n g more f a v o r a b l e outcome f o r the low h e a l t h r i s k group on each of the p s y c h o e d u c a t i o n a l t e s t s a d m i n i s t e r e d . The mean d i f f e r e n c e s were s i g n i f i c a n t (p < .05) with Number R e c a l l and Language. These r e s u l t s suggest t h a t f o r t h i s sample s e v e r a l s i g n i f i c a n t c o r r e l a t i o n s e x i s t e d i n the d i r e c t i o n s t a t e d i n the r e s e a r c h h y p o t h e s i s . Such f i n d i n g s support the views of s e v e r a l r e s e a r c h e r s (McShane, 1983; Bender e t a l . , 1975; Tempest, 1987) who proposed a combination r a t h e r than s i n g l e v a r i a b l e e f f e c t on developmental outcome. In summary, t h i s sample d i d manifest a wide v a r i e t y of h e a l t h problems, t h e i r mean scores on the p s y c h o e d u c a t i o n a l t e s t s were somewhat lower than the norms, though not s i g n i f i c a n t l y so, and t h e r e d i d appear t o be a r e l a t i o n s h i p between t h e i r h e a l t h problems and performance on the t e s t b a t t e r y . T . i m i r a H n n c o f rho S f n r f y The f i n d i n g s of the p r e s e n t study must be i n t e r p r e t e d i n view of s e v e r a l l i m i t a t i o n s t o i t s g e n e r a l i z a b i l i t y . The s m a l l sample s i z e was a major l i m i t a t i o n narrowing the scope of the data a n a l y s i s . T h i s , i n combination with the degree of v a r i a b i l i t y w i t h i n the s u b j e c t s ' h e a l t h h i s t o r i e s made group e f f e c t s d i f f i c u l t t o determine. I t had been assumed t h a t a continuum would e x i s t with some s u b j e c t s m a n i f e s t i n g s e v e r a l of the h e a l t h problems and other s u b j e c t s m a n i f e s t i n g r e l a t i v e l y few. In f a c t most of the s u b j e c t s had an assortment 74 of d i s o r d e r s , y i e l d i n g a f a i r l y heterogeneous sample, with each c h i l d d i s p l a y i n g v a r i e d h e a l t h concerns. The second major l i m i t a t i o n was the c o l l e c t i o n of data f o r the independent v a r i a b l e s . The medical f i l e s f o r s e v e r a l of the s u b j e c t s were incomplete or y i e l d e d minimal i n f o r m a t i o n . For example, o t i t i s media would be l i s t e d as a s i n g l e e n t r y with few d e t a i l s on the s e v e r i t y of the episode, i f treatment was r e q u i r e d , or the frequency of o c c u r r e n c e s . Very sparse i n f o r m a t i o n was a v a i l a b l e on those s u b j e c t s who had a v a i l e d of P r o v i n c i a l P u b l i c Health r a t h e r than the Indian Health O f f i c e . As w e l l , t h e onus was on the mother t o arrange p r e n a t a l v i s i t s and t o b r i n g her c h i l d i n f o r r e g u l a r checkups, where the DDST s c r e e n i n g s , e t c . , o c c u r r e d . T h i s may have r e s u l t e d i n some b i a s i n the group which had t h a t i n f o r m a t i o n a v a i l a b l e . R e s u l t s of the L i l l o o e t E d u c a t i o n Study (Napoleon, 1988) showed t h a t f o r the grade one group o n l y (which formed t h i s study's sample), N a t i v e c h i l d r e n were absent more f r e q u e n t l y than whites. T h i s l e a d s one t o q u e s t i o n why they were absent, perhaps because they experienced more h e a l t h problems. I f so, i s i t the missed i n s t r u c t i o n a l time or i l l n e s s which i s c a u s i n g t h e i r academic d i f f i c u l t i e s ? The d i r e c t i o n of c a u s a l i t y i s d i f f i c u l t t o determine. R o r n m r n o n i i a t i r i n g The r e s u l t s of t h i s study r a i s e a number of i s s u e s which appear worthy of f u t u r e r e s e a r c h . The p a t t e r n of lower t e s t s c o r e s i n the high r i s k group suggests t h a t a study examining t h i s r e l a t i o n s h i p i n a l a r g e r sample may a r r i v e at more c o n s i s t e n t s i g n i f i c a n t r e s u l t s . As Parkyn (1985), S i e g a l (1982) and o t h e r s have suggested, the use of s o c i a l as w e l l as p h y s i c a l f a c t o r s i s l i k e l y a more e f f e c t i v e means of a c c o u n t i n g f o r v a r i a b l e s r e l a t e d t o developmental outcome, than examining s i n g l e f a c t o r s . A f f e c t i v e measures should a l s o be i n c o r p o r a t e d as N a t i v e c h i l d r e n tend t o be at r i s k f o r emotional problems, as w e l l as low s e l f esteem with r e g a r d t o academic p u r s u i t s ( B e i s e r & Attneave, 1982, Rampaul e t a l . , 1984). Such a study c o u l d employ m u l t i v a r i a t e a n a l y s i s t o compare the i n f l u e n c e s of h e a l t h , emotional s t a t u s and SES on c o g n i t i v e development. A l o n g i t u d i n a l method which e n t a i l e d keeping d e t a i l e d accounts of the r e l e v a n t medical s t a t u s of s u b j e c t s i n combination with an assessment of c u r r e n t h e a l t h s t a t u s , u s i n g v a r i o u s p h y s i c a l examinations, s t r e n g t h measures and so f o r t h , would l i k e l y overcome some of the problems a s s o c i a t e d with r e t r o s p e c t i v e medical data c o l l e c t i o n . A d m i n i s t r a t i o n of p s y c h o e d u c a t i o n a l t e s t s e a r l y and l a t e r i n the academic stages would c o n t r o l f o r the p o s s i b l e m i t i g a t i n g e f f e c t s of time on p r e s c h o o l h e a l t h problems, as w e l l as "academic c r o s s o v e r " , "cumulative d e f i c i t " and other e f f e c t s which confound r e s e a r c h on achievement i n t h i s p o p u l a t i o n . 76 BIBLIOGRAPHY A n d e r s o n , R. & F a u s t , G. W. ( 1 9 7 3 ) . B H n ^ a t i n n a l p c y f h n l o g y • Thp s r i p n r p n f i t i g t m r t i n n a n H l o a r n i n g . New Y o r k : Dodd, Mead a n d Co. A s h w o r t h , M. ( 1 9 8 0 ) . L a n g u a g e d e v e l o p m e n t a n d t h e c h i l d r e n o f A h o u s a t , B r i t i s h C o l u m b i a . I n H.G. Cannon ( E d . ) , Thp A h n n c a t o H n r - a t - j o n c r n H y . V a n c o u v e r : U n i v e r s i t y o f B r i t i s h C o l u m b i a . A u b r y , R., & P e n n i n g t o n , J . C . ( 1 9 7 3 ) . I d e n t i f i c a t i o n a n d e v a l u a t i o n o f h i g h - r i s k p r e g n a n c y : The p e r i n a t a l c o n c e p t , r i i n i r a l O h s f p t r i P S a n i l fiynprnlngy, -L£( 1 ), 3-27 . B a d i a n , N.A. ( 1 9 8 8 ) . The p r e d i c t i o n o f g o o d a n d p o o r r e a d i n g b e f o r e k i n d e r g a r t e n e n t r y : A n i n e - y e a r f o l l o w - u p . .Ton-rna 1 o f T e a m i n g n i g a h i l i t i a g , 2_L( 2 ) , 98-1 03. B a k e r , F.W., F i n d l a y , S., I s b i s t e r , L., & P e e k e e k o o t , B. ( 1 9 8 7 ) . N a t i v e h e a l t h c a r e : An a l t e r n a t i v e a p p r o a c h . C a n a d i a n Mprii r a 1 A g c o r - i a t i o n . T o n r n a l , _L3L£, 6 9 5 - 6 9 6 . B a r t h , J . L . ( 1 9 7 9 ) . N o n s t a n d a r d E n g l i s h a n d N a t i v e I n d i a n s t u d e n t s : When i s a d i f f e r e n c e a d i s a b i l i t y ? B-J2- .Tom-na 1 o f P p o r - i a l F H n o a r i o n _3_( 4 ) , 3 5 7 - 3 6 3 . B a y l e s , K.A., & H a r r i s , G. ( 1 9 8 2 ) . E v a l u a t i n g s p e e c h -l a n g u a g e s k i l l s i n P a p a g o I n d i a n c h i l d r e n . . T o n r n a l o f A m e r i o a n T n H i a n F H n r - a r i o n , 2J-( 2 ) , 10-18. B e e r y , K.E. ( 1 982 ) . P o v i c o H a H m i n i c r r a r i o n c r - n r i n g a n H t P a r h i n g manual f o r r h o n o v e l o p m o n r a 1 T o c f o f V i a n a l M o t o r - T n t a g r a t i o n . T o r o n t o : M o d e r n C u r r i c u l u m P r e s s . B e i s e r , M., & A t t n e a v e , C.L. ( 1 9 8 2 ) . M e n t a l d i s o r d e r s among A m e r i c a n I n d i a n s a n d A l a s k a n N a t i v e c h i l d r e n : R a t e s and r i s k p e r i o d s f o r e n t e r i n g t r e a t m e n t . A m o r i o a n .Tom-na i o f P s y r - h i a i r y , 1 39, 193-1 98. B e n d e r , T.R., B u r k s , J.M., Baum, C , F l e s h m a n , K., & V i e i r a , T. ( 1 9 7 5 ) . I n t e l l e c t u a l d e v e l o p m e n t o f c h i l d r e n who w e re a n e m i c o r i l l i n i n f a n c y . I n J . C . H a y w o r t h ( E d . ) , N n r r i r i o n o f T n H i a n a n H F c V i m o P h i l H r o n - P o p o r r o f t h g g f l r n n H f a n a H i a n P o g c r n n f o r o r r - o on p a o H i a r r i <- r a c o a r r h ( p p . 1 6 3 - 1 7 0 ) . M o n t r e a l : R o s s L a b o r a t o r i e s . B e r r y , B. ( 1 9 6 8 ) . T h e o H n r - a + i o n o f t h e A m o r i o a n T n r l i a n . W a s h i n g t o n : D e p a r t m e n t o f H e a l t h , E d u c a t i o n a n d W e l f a r e . B i g a r t , R.( 1 974 ). W a r r i o r s i n t h e b l a c k b o a r d j u n g l e . TJaa K l p m p t i t a r y S o h o o l . T o n r n a l , JA, 4 1 0 - 4 2 1 . 77 Bang, S.B., & B i n g , J.R. ( 1 9 8 5 ) . C o m p a r i s o n o f t h e K-ABC and PPVT-R w i t h Head S t a r t c h i l d r e n . P s y c h o l o g y i n t h e Srhnnlq, 21, 2 4 5 - 2 4 9 . B i r b e c k , J . A . , L e e , M., M y e r s , G., & B r a x t o n , M. A. ( 1 9 7 1 ) . N u t r i t i o n a l s t a t u s o f B r i t i s h C o l u m b i a I n d i a n s : I I a n t h r o p o m e t r i c m e a s u r e m e n t s , p h y s i c a l a n d d e n t a l e x a m i n a t i o n s a t A h o u s a t a n d Anaham. I n M. L e e , B.M. A l f r e d , J.A. B i r b e c k , I.D. D e s a i & G.S. M y e r s ( E d s . ) , r J n t r i r i o n a 1 c t a t i i g o f P , r i f i c ; h P o l n m h i a T n H i a n p o p n 1 a t i o n e a h o n c a t a n H & n a h a m r o g p r v o c . R e p o r t . D i v i s i o n o f Human N u t r i t i o n S c h o o l o f Home E c o n o m i c s ( p p . 2 3 - 3 3 ) . V a n c o u v e r : U n i v e r s i t y o f B r i t i s h C o l u m b i a . B l a c k b u r n , S. ( 1 9 8 6 ) . i s s a g s i n p n t n f r i c > - P a r i n a t a l , f a m i l y a n r l g r v i r n n i t i f l n r a l p o r g p o i - j - i v o g . New Y o r k : H a w o r t h P r e s s I n c . B l o w e r s , E.A. ( 1 9 8 1 ) . The e c o n o m i c a l l y d i s a d v a n t a g e d a n d o r g e o g r a p h i c a l l y i s o l a t e d I n d i a n p u p i l : an i d e n t i f i c a t i o n p r o b l e m ? Canadian Journal o f W a t i v o R H n r a f i n n , £ . ( 4 ) , 1 3 -1 8 . B l u n t , A. ( 1 9 7 9 ) . E d u c a t i o n a l l e v e l s o f a d u l t s t a t u s I n d i a n s i n B r i t i s h C o l u m b i a , PACT? H o v g i a t t a r , 3 ( 4 ) . B o l o z , S.A. & V a r r a t i , J . ( 1 9 8 3 ) . A p o l o g i z e o r a n a l y z e : m e a s u r i n g a c a d e m i c a c h i e v e m e n t i n t h e r e s e r v a t i o n s c h o o l . J n i i r n a 1 Q i A m e r i c a n T n H i a n F H i n - a t i n n , 2L3_ ( 1 ) , 2 3 - 2 7 . Book, R.M. ( 1 9 7 4 ) . P r e d i c t i n g r e a d i n g f a i l u r e : A s c r e e n i n g b a t t e r y f o r k i n d e r g a r t e n c h i l d r e n . . T n n m a i o f T , e a r n i n g - n i s a h i 1 i t i p s , 2 ( 1 ) , 5 2 - 5 5 . B r a n d t , E. ( 1 9 8 4 ) . The c o g n i t i v e f u n c t i o n i n g o f A m e r i c a n I n d i a n c h i l d r e n : A c r i t i q u e o f McShane a n d P l a s . ^ r h n n l Pqyrhnlngy R P V J P W , J_l( 1 ) , 7 4 - 8 2 . B r o o k s , I.R. ( 1 9 7 8 ) . T e a c h i n g N a t i v e c h i l d r e n : L e s s o n s f r o m C o g n i t i v e p s y c h o l o g y . T h o . T o n r n a l o f B H i i f a H n n a l T h o n g h r , 1_2( 1 ) , 5 6 - 6 7 . B r y d e , J.F. ( 1 9 6 3 ) . A n o w a p p r o a c h t o T n H i a n a r l i i f a H n n . V e r m i l l i o n : U n i v e r s i t y o f S o u t h D a k o t a . B u r k e , S.O., S a y e r s , L.A. & Wray, J . ( 1 9 8 1 ) . T h e v a i i H i t y o f t h e nnST w i t h n o r t h e r n O n t a r i o M a H v o o h i l H r e n . T o r o n t o : O n t a r i o M i n i s t r y o f H e a l t h . B u r k e , S.O, S a y e r s , A., B a u m g a r t , A., & Wray, J . ( 1 9 8 5 ) . P i t f a l l s i n c r o s s - c u l t u r a l u s e o f t h e D e n v e r D e v e l o p m e n t a l S c r e e n i n g T e s t : C r e e I n d i a n c h i l d r e n . C a n a d i a n . T o n r n a l D f P n h l i r H o a l f h , 2 £ , 3 0 3 - 3 0 7 . 78 Burnaby, B. (1982). Language i n e d u c a t i o n among Canadian N a t i v e p e o p l e s . In L a n g u a g e a n H T . i f o r a r y S e r i e s . Toronto: OISE P r e s s . Cadman, D., Walter, S., Chambers, L., Ferguson, R., Szatmari, P., Johnson, N., & McNamee, J . (1988). P r e d i c t i n g problems i n s c h o o l performance from p r e s c h o o l h e a l t h , developmental and b e h a v i o u r a l assessments. P a n a r i i a n M o n i c a 1 A g g n r i a t i n r T m i r n a l , 133., 31-36. C a r l i l e , W.K., Olson, H., Gorman, J . , McCracken, C , VanderWagen, R., & Connor, H.(1972). Contemporary n u t r i t i o n a l s t a t u s of North American I n d i a n c h i l d r e n . In W.Moor, M . S i l v e r b e r g & M.S. Read ( E d s . ) , N n t r i t i nn, g r o w t h a n H H o w e 1 o p m e n t n f N o r t h A m e r i c a n T n H i a n c h i l d r e n (pp. 47-63 ). Washington, D.C: Department of Health and Welfare. C h r i s j o h n , R.D., Towson, S.M., Pace, D., & P e t e r s , M. (1989). The WISC-R i n a N a t i v e a p p l i c a t i o n : I n t e r n a l and e x t e r n a l a n a l y s i s , t o appear i n J . Berry et a l . ( E d s . ) , P r o o e e H i n g s o f t h e f i r s t r e g i o n a l N o r t h A m o r i p a n c o n f e r e n c e o f t h e T n t c r n a t i n n a l A s s o o i a t j nn f n r f.rnSS-P n I t n r a l P s y c h o l o g y . C o l l e t t i , L. (1979). R e l a t i o n s h i p between pregnancy and b i r t h c o m p l i c a t i o n s and the l a t e r development of l e a r n i n g d i s a b i l i t i e s . T o n r n a 1 o f T , e a r n i n g ni g a h i 1 i f i o g J .12.(10), 25-29. C o l l i g a n , R.C. (1974). Psychometric d e f i c i t s r e l a t e d t o p e r i n a t a l Stress. T o n r n a 1 o f T . e a r n i n g n i s a H i 1 i t i e s f 2 ( 3 ) , 36-42. Common, R.W. & F r o s t , L.G. (1988). The i m p l i c a t i o n s of the mismeasurement of N a t i v e s t u d e n t s ' i n t e l l i g e n c e through the use of s t a n d a r d i z e d i n t e l l i g e n c e t e s t s . P a n a H i a n . T o n r n a l o f N a t i v e F H n o a t i o n , _L5.( 1 ) , 19-29. Cummins, J . , & Das, J.P. (1977). C o g n i t i v e p r o c e s s i n g and r e a d i n g d i f i c u l t i e s : A framework f o r r e s e a r c h . A 1 h p r t a . T o n r n a 1 o f P V i n o a t i o n a l R e s e a r c h , 22., 245-246. Davie, R., B u t l e r , N.R., & G o l d s t e i n , H. (1972). Frnm R i r t h t n c; O W lan - London: L i v i n g s t o n e . Department of H e a l t h and Welfare. (1975). N n t r i t i n n P a n a d a : T h e T n H i a n s u r v e y r e p o r t . Ottawa: The Bureau Of N u t r i t i o n a l S c i e n c e s . Desai I.D., & Lee, M. (1971). N u t r i t i o n a l s t a t u s of B r i t i s h Columbia Indians I I I . B i o c h e m i c a l s t u d i e s at Ahousat and Anaham r e s e r v e s . In M.Lee, B.M. A l f r e d , J.A. B i r b e c k , I.D. Desai & G.S. Myers ( E d s . ) , N u t r i t i o n a l s t a t u s nf 79 R r i t i c h r o l n m h i a T n H i a n p n p n l a t i n n c . A h o n c a t a n H A n a h a m i ? p g p r v < a s - Report D i v i s i o n of Human N u t r i t i o n , School of Home Economics (pp.34-43). Vancouver: U n i v e r s i t y of B r i t i s h Columbia. Downing, J . , O l l i l a , L., & O l i v e r , P. (1975). C u l t u r a l d i f f e r e n c e s i n c h i l d r e n ' s concepts of r e a d i n g and W r i t i n g . R r i t i s h . T o n r n a l o f F H n o a t i o n a 1 P s y r - h o 1 o g y , AS., 312-316. Dunn, L., & Dunn, L.M. (1981). P o a n o H y P i r - t n r o V o c a b u l a r y T P g t - p . p v i c o H . M a n u a l , c i r c l e P i n e s , MN: American Guidance S e r v i c e . Evans, R. (1976). The p r e d i c t i o n of e d u c a t i o n a l handicap. F H n o a t i o n a l R o c o a r c h J J_3.( 1 ) , 57-67. Ever s , S., Orchard, J . , & McCracken, E. (1985). Lower r e s p i r a t o r y d i s e a s e i n Indian and non-Indian i n f a n t s . P a n a r i i a n J o u r n a l nf P n h l i r H p a l f h , IS., 195-198. Evers, S. & Rand, C.G. (1983). M o r b i d i t y i n Canadian Indian and non-Indian c h i l d r e n i n the second year. C a n a i i i an T o n r n a l o f P i i h . H r - H o a H - h J JA, 191-194. Gray, J . , Dean, R.S., & Rattan, G. (1987). Assessment of p e r i n a t a l r i s k f a c t o r s . P s y c h o l o g y i n t h o S t h e n i c , 2A, 15-21 . Hamilton, J . E . (1976). V i s i o n anomalies of Indian s c h o o l c h i l d r e n : the Lame Deer study. A m e r i c a n n p t n m p t r i o A s s o c i a t i o n . T n n r n a l , Al( 4 ) , 479-487. Hamilton, W.D. & Owston, R.D. (1 983 ). T h o r h a p o i TP.1 and p H u r a r i n n e v a l u a t i o n r e p o r t . F r e d e r i c t o n , New Brunswick: U n i v e r s i t y of New Brunswick. H a v i g h u r s t , R . J . (1970 ) . T h o n a t i o n a l c t n r l y n f A m o r i r - a n T n H i a n o H n o a t i o n • T h o o r l n r a H n n o f T n H i a n c h i l H r o n a n H y o n t h . Summary Report and Recommendations. Hawthorn, H.B. (Ed.) (1966, 1968). A e n r v a y o f c o n t e m p o r a r y T n H i a n s o f P a n a H a . ? v o l s . Ottawa: Indian A f f a i r s Branch. Queen's P r i n t e r . H ealth and Welfare Canada. ( 1 Q f t n ) . M P H J c a l R o r v i r o c a n n u a l r o p o r t - P a c i f i c P o g i o n . Ottawa. Houston, C.S., W e i l e r , R.L., & Harbick, B.F.(1979). S e v e r i t y of lung d i s e a s e i n Indian c h i l d r e n . C a n a d i a n M p r l i r a l A s s o c i a t i o n T o n r n a l , J_2H, 1116-1121. 80 Hunt, J.V., Tooley, W.H., & H a r v i n , D. (1982). L e a r n i n g d i s a b i l i t i e s i n c h i l d r e n with b i r t h w e i g h t s <1500 grams. S g m i n a r g i n P p r i n a t n l o g y , £(4 ), 280-286. Hunter, S. & Stevens, R. (1980). A rlptnngraphi r study nf Native T n r l i a n g + n r l o n + c i n V a n r n n v p r g r - h o o l g (Research Report No. 80-04). Vancouver: Vancouver School Board. T n r i i a n r n n r i i t i o n g - A finrvoy. ( 1 980 ). Ottawa: Department of I n d i a n and Northern A f f a i r s . I n d ian H e a l t h S e r v i c e s . ( 1 978 ) — T n i i i a n h p a l t h , trpnrlp. and g o T - v i r o c , R o c k v i l l e , Maryland: U.S. Department of Health, Welfare and E d u c a t i o n Indian and I n u i t H e a l t h Committee, Canadian P a e d i a t r i c S o c i e t y . (1987). Growth c h a r t s f o r Indian and I n u i t C h i l d r e n . P a n a r l i a n M o r l i o a l A g g o c i a t i o n . T n n r n a l , J_2£, 118-119. Johnson, M.A. Cox, M., & McKim, E. (1987). Outcomes of i n f a n t s of very low b i r t h weight: A g e o g r a p h i c a l l y based study. P a n a r l i a n M o r i i o a 1 A g g n r i a t i o n . T o n r n a l , 136, 1 1 57-1 1 65. J u l i e n , G., Baxter, J.D., Crago, M., I l e c k i , H.J., & T h e r i a n , F. (1987). C h r o n i c o t i t i s media and h e a r i n g d e f i c i t among Na t i v e c h i l d r e n of K u u j j u a r a a p i k (Northern Quebec): A p i l o t p r o j e c t . P a n a r l i a n . T o n r n a l nf Pllhl i C H p a l f h , 22., 57-60. Kaplan, G.J., Fleshman, J.K., Bender, T.R., Baum, C , & C l a r k , P.S. (1973). Longterm e f f e c t s of o t i t i s media: A ten year c o h o r t study of Alaskan Eskimo c h i l d r e n . Pprli a t r i r-g, JL2, 577-585. Kaufman, A.S. & Kaufman, N.L. (1983). Kaufman Asspssmpnt R a + t e r y f o r P h i l r l r g n ? T n t a r p r a H v s M a n u a l - C i r c l e P i n e s , Minn.: American Guidance S e r v i c e s . Kaulback, B. (1984). S t y l e s of l e a r n i n g among N a t i v e c h i l d r e n : A review Of the r e s e a r c h . C a n a d i a n T o n r n a l nf N a t i V P F H n o a t i o n J J_l( 3 ) , 27-37. K i r b y , J.R. & Das, J.P. (1977). Reading achievement, IQ and s i m u l t a n e o u s - s u c c e s s i v e p r o c e s s i n g . Jnnrna 1—o_E. F r l n r - a t i o n a l P g y o h o 1 o g y , £3.(5), 564-570. KirkneSS, V . J . ( 1 978 ). F H n r ' a t i n n o f T n r l i a n g i n f t a r i ^ r a 1—anrl p r o w i n o i a i c o h o o i g i n M a n i t o H a . E v a l u a t i o n Report. Ottawa: Department of I n d i a n A f f a i r s and Northern Development. 81 L a n k f o r d , R. & R i l e y , J.D. ( 1 9 8 6 ) . N a t i v e A m e r i c a n r e a d i n g d i s a b i l i t y . J n i i r n a 1 n f A m e r i c a n T n H i a n F H n o a t i o n , 25.(3), 1 - 1 0 . L e e , M. ( 1 9 7 5 ) . N u t r i t i o n o f I n d i a n a n d E s k i m o c h i l d r e n . I n J.C.HayWOrth ( E d . ) , N u t r i t i o n o f T n H i a n a n H R s V i m o c h i I H r o n . R o p n r t n f t h e c o r n n H f a n a H i a n P o s s r n n f c r o n r o n n p a o H i a t r i o r e s e a r c h ( p p . 5 6 - 6 1 ) . M o n t r e a l , P.Q.: ROSS L a b o r a t o r i e s . L e e , M., R e y b u r n , R. , Se C a r r o w , A. ( 1 9 7 1 ) . N u t r i t i o n a l s t a t u s o f B r i t i s h C o l u m b i a I n d i a n s : D i e t a r y s t u d i e s a t A h o u s a t a n d Anaham r e s e r v e s . I n M. L e e , B.M. A l f r e d , J . A. B i r b e c k , I.D. D e s a i & G.S. M y e r s ( E d s . ) , N n t r i t i n n a 1 s t a t u s n f B r i t i s h P n l n m h i a T n H i a n p o p u l a t i o n s . AhOllSat a n H A n a h a m r e s e r v e s . R e p o r t . D i v i s i o n o f Human N u t r i t i o n , S c h o o l o f Home E c o n o m i c s ( p p . 1 0 - 2 1 ) . V a n c o u v e r : U n i v e r s i t y o f B r i t i s h C o l u m b i a . L e i c h t e r , J . & L e e , M. ( 1 9 7 1 ) . L a c t o s e i n t o l e r a n c e i n C a n a d i a n w e s t c o a s t I n d i a n s . I n M. L e e , B.M. A l f r e d , J . A. B i r b e c k , I.D. D e s a i & G.S. M y e r s ( E d s . ) , N u t r i t i o n a l s t a t u s n f R r i t i s h P n l i i m h i a T n H i a n p o p u l a t i o n s . A h n n s a t a n H A n a h a m r p s p r v p s . R e p o r t . D i v i s i o n o f Human N u t r i t i o n , S c h o o l o f Home E c o n o m i c s ( p p . 4 5 - 4 9 ) . V a n c o u v e r : U n i v e r s i t y o f B r i t i s h C o l u m b i a . L e s s l e r , K. & B r i d g e s , J . S. ( 1 9 7 3 ) . The p r e d i c t i o n o f l e a r n i n g p r o b l e m s i n a r u r a l s e t t i n g : Can we i m p r o v e on r e a d i n e s s t e s t s ? . T o n r n a l o f T . e a r n i n g n i s a n i 1 i t i o s , £.(2), 3 6 - 4 0 . L i e v a n s , P. ( 1 9 7 4 ) . The o r g a n i c p s y c h o s y n d r o m e o f e a r l y c h i l d h o o d a n d i t s e f f e c t s on l e a r n i n g . . T o n r n a 1 o_f_ L p a r n i ng n i s a H i 1 i t i o s , 2 ( 1 0 ) , 3 6 - 4 1 . L i n d s a y , G.A. & W e d e l l , K. ( 1 9 8 2 ) . The e a r l y i d e n t i f i c a t i o n o f e d u c a t i o n a l l y " a t r i s k " c h i l d r e n r e v i s i t e d . T o n r n a i o_f_ L e a r n i n g D i s a H i 1 i t i o s , J_5.( 4 ) , 2 1 2 - 2 1 7 . L o n g s t a f f e , S., P o s t l , B., Kao, H., N i c o l l e , L., & F e r g u s o n , C A . ( 1 9 8 2 ) . R h e u m a t i c f e v e r i n N a t i v e c h i l d r e n i n M a n i t o b a . f a n a H i a n M o H i o a l A s s o c i a t i o n T o n r n a l f 1 ?, 7 , 4 9 7 -4 9 8 . M a c L e a n , H. ( 1 9 7 3 ) . A r e v i e w o f T n H i a n o H u c a t i o n i n N o r t h A m o r i o a . T o r o n t o : O n t a r i o T e a c h e r s F e d e r a t i o n . T h e M a n i t o H a N a t i v e T n H i a n M o t h o r a n H P h i 1 H • A n i s o u s s i o n P a p p r nn a h i g h r i s k p o p u l a t i o n ( A u g u s t , 1 9 8 1 ) . W i n n i p e g : Community T a s k F o r c e on M a t e r n a l a n d C h i l d H e a l t h . M a n n i n g , P . J . ( 1 9 7 5 ) . The n u t r i t i o n a l b a s i s o f o t i t i s m e d i a . I n J . C H a y w a r d ( E d . ) , N u t r i t i o n o f T n H i a n a n H F s l f i m o 82 Chi Ifirprt • P<=-pnrt n f t h o c o r n n r i P a n a H i a n P n g g r o n f p r o n r o n n P o H i a t n > R p g o a r r h (151-153). Montreal: Ross L a b o r a t o r i e s . May, P.A., Hymbaugh, K.J. & Aase, J.M. (1983). The epidemiology of f e t a l a l c o h o l syndrome among Americans of the SOUthwest. S n r - i a l R-ir.1r.rjy, 3J1, 374-387. M a y f i e l d , M.I.(1985). Parents, c h i l d r e n and r e a d i n g : H e l p i n g Canadian N a t i v e Indian p a r e n t s of p r e s c h o o l e r s . Thp P o a H i n g T o a r - h o r - , 3-9(3 ), 301-305. Mayha l l , J.T. (1975). Dental c a r i e s and n u t r i t i o n . In J.C. Hayworth ( Ed.), U n t - r i l - i n n r>f T n H i a n a n H F g V i t n n r-h i 1 H r o n • v o p r i r - f n f t h o g p c n n H P a n a H i a n R n g g r n n f o r o n r o n n p o H i a + r i r - r o c a a r r h ( p p . 155-161). Mo n t r e a l : R O S S L a b o r a t o r i e s . McEachern, W.R. (1981). C u l t u r a l l y r e l e v a n t r e a d i n g m a t e r i a l : A d d r e s s i n g a need. P o a H i n g T m p r n v e m a n l - f L8-, 96-1 00. McShane, D. (1982). O t i t i s media and American I n d i a n s : p r e v a l e n c e , e t i o l o g y , p s y c h o e d u c a t i o n a l consequences, p r e v e n t i o n and i n t e r v e n t i o n . In Mow r i i r o p t i n n g i n p r e v a n r i n n a m o n g A m a r i r - a n T n H i a n g a n H A l a g V a W a t i v a r-ommnn i f i a g . P o r t l a n d : Oregon Health S c i e n c e s U n i v e r s i t y . McShane, D. (1983). E x p l a i n i n g achievement p a t t e r n s of American Indian c h i l d r e n : A t r a n s c u l t u r a l and developmental model. P ^ a h n H y . T n n r n a l n f Vrfur'ai- i n n , £J.( 1 ) , 35-47. McShane, D. & M i t c h e l l , J . (1979). Middle ear d i s e a s e , h e a r i n g l o s s and e d u c a t i o n a l problems of American Indian C h i l d r e n . Jnnma 1 n f A m e r i c a n T n H i a n R H n r a H n n , J_9.( 1 ) . McShane, D. & P l a s , J . (1984). The c o g n i t i v e f u n c t i o n i n g of American Indian c h i l d r e n : Moving from the WISC t o the WISC-R. C i n h n n l P c y r - h n l n g y R a v i ow J_1(1), 61-73. McShane, D. & P l a s , J . (1988). The r e l a t i o n s h i p of i n t e l l e c t u a l and p s y c h o l i n g u i s t i c a b i l i t i e s t o the achievement g a i n s of American Indian c h i l d r e n . r a n a H i a n J o u r n a l nf N a t i v e E d u r a t i n n , .15.(3), 66-79. Mi c k e l s o n , N. & Galloway W. (1969). Cumulative language d e f i c i t among Indian c h i l d r e n . F . v r a p t i n n a l r h i l H r - o n , 2 £ ( 3 ) , 187-190. More, A. J . ( 1984). T h o O V a n a g n n N i n n l a q u a l i t y n f a r i n r a t i n n g j - n H y . P e n t i c t o n : Okanagon Indian L e a r n i n g I n s t i t u t e . 8 3 M o r e , A . J . & O l d r i d g e , B. ( 1 9 8 0 ) . An a p p r o a c h t o n o n -d i s c r i m i n a t o r y a s s e s s m e n t o f N a t i v e I n d i a n c h i l d r e n . B.P. J o u r n a l n f S p e c i a l F r l n r a t i n n , K l ) , 5 1 - 5 9 . M u n r o e , M., Shah C P . , B a d g l e y , R., & B a i n H . W . ( 1 9 8 4 ) . B i r t h w e i g h t , l e n g t h , h e a d c i r c u m f e r e n c e a n d b i l i r u b i n l e v e l s i n I n d i a n n e w b o r n s i n t h e S i o u x L o o k o u t Z o n e , n o r t h w e s t e r n O n t a r i o . P a n a H i a n M o H i n a l A g g n n i a t i n n J o u r n a l , 1 3 1 , 4 5 3 - 4 5 6 . N a g l i e r i , J.A. ( 1 9 8 4 ) . C o n c u r r e n t a n d p r e d i c t i v e v a l i d i t y o f t h e Kaufman A s s e s s m e n t B a t t e r y f o r C h i l d r e n w i t h a N a v a j o S a m p l e . -Ton m a l n f S n h n n l P g y n h n 1 n g y f J _ L f 3 7 3 - 3 8 0 . N a p o l e o n , M. ( E d . ) . ( 1 9 8 8 ) . T.i l i n n e t a r e a o r l n r - a t i n n g t n H y . L i l l o o e t , B.C.: L i l l o o e t I n d i a n E d u c a t i o n R e s e a r c h B o a r d . N e l i g a n , G. , K o l v i n , S., & G a r s i d e , R. ( 1 9 7 6 ) . R n r - n r n n e n n n f n r h n r n t n n gma11_ L o n d o n : S p a s t i c s I n t e r n a t i o n a l M e d i c a l P u b l i c a t i o n s / H e i n e m a n n . N u r s s , J . & McGaUVran, M.E. ( 1 9 7 6 ) . T h o M o t r n p n l i t a n P o a H i n o g g T p c t - g - l o v a l T T ; r o a n h o r c m a n u a l - T n t o r p r o t a t i n n a n H n e e nf f p s t r p s n l f s . H a r c o u r t B r a c e J o v a n o v i c h , I n c . O s b o r n e , B. ( 1 9 8 5 ) . R e s e a r c h i n t o N a t i v e N o r t h A m e r i c a n s ' Cogni t ion: 1 9 7 3 - 1 9 8 2 . . T o n r n a l n f A m o r i r - a n T n H i a n F H n r - a t i n n , 2 4 . ( 3 ) , 9 - 2 3 . P a g e , K.A. ( 1 9 8 6 ) . P r e d i c t o r s o f out c o m e o f l o w b i r t h w e i g h t i n f a n t s : A r e v i e w o f t h e l i t e r a t u r e a n d m e t h o d o l o g i c a l i s s u e s . P h y g i r - a l T h e r a p y , £ £ ( 8 ) , 1 2 5 2 - 1 2 5 4 . P a r k y n , H.J. ( 1 9 8 5 ) . I d e n t i f i c a t i o n o f a t - r i s k i n f a n t s a n d p r e s c h o o l c h i l d r e n . I n W . K . F r a n k e n b u r g , R. N.Emde, & J . W . S u l l i v a n ( E d s . ) , T T a r l y i H o n r i f - i r a t i n n n f n h i l H r e n a t r i g k - A_n i n t e r n a t i o n a l p e r g p o n t i vo ( p p . 2 0 3 - 2 0 9 ) . New Y o r k : P l e n u m P r e s s . P e p p e r , F . C & H e n r y , S.L. ( 1 9 8 6 ) . S o c i a l a n d c u l t u r a l e f f e c t s on I n d i a n l e a r n i n g s t y l e : C l a s s r o o m i m p l i c a t i o n s . P a n a H i a n . T o n r n a l n f M a r i v o F H n r - a t i o n f J_3.( 1 ) , 5 4 - 6 1 . P f e i f f e r , S., I . , H e f f e r n a n , L., & P f e i f f e r , J . S . ( 1 9 8 5 ) . The p r e d i c t i o n o f p o s s i b l e l e a r n i n g d i s a b i l i t i e s i n h i g h r i s k i n f a n t s . T n t e r n a t i n n a 1 . T n n r n a 1 n f P l i n i r a l M e n r n p g y r - h n l n g y , . 2 ( 1 ) , 4 9 P l a n t , W.T. & S o u t h e r n , M.L. ( 1 9 6 8 ) . F i r s t g r a d e r e a d i n g a c h i e v e m e n t p r e d i c t e d f r o m WPPSI a n d o t h e r s c o r e s o b t a i n e d 1 8 months e a r l i e r . P m n o e H i n g g n f t h e 7 f i t h annua 1 r - o n w o n t i n n , A m e r i c a n P g y n h o 1 o g i r-a 1 A g e n r i a t i n n . P l a x t o n , K., Shah, C P . , Kue Young, T., & Bain, H. (1983). P r e v e n t i v e h e a l t h care of Indian p r e s c h o o l e r s in the Sioux Lookout Zone, northwestern O n t a r i o . r * n a H i a n Medi Cr\ 1 ^ ^ r i a t i o n . T o n r n a 1 , 123., 965-968. Rampaul, W.E., Singh, M., & Didyk, J . (1984). The r e l a t i o n s h i p between academic achievement and tea c h e r e x p e c t a t i o n s of N a t i v e c h i l d r e n i n a no r t h e r n community s c h o o l . TFPIT, P a n a H a . T o n r n a 1 , 2.( 1), 27-40. Roberts, C.J. (1969). Incidence of and r e l a t i o n between the common c o m p l i c a t i o n s of pregnancy and d e l i v e r y . P.r i t i s h .Tniirnrl 1 o f P r p v o n r i v a a n H S o c i a l M o r l i i - i n o , 23., 128-131. Robinson, G.C, Conry, J.L., & Conry, R.C. (1987). C l i n i c a l p r o f i l e and pr e v a l e n c e of f e t a l a l c o h o l syndrome i n an i s o l a t e d community i n B r i t i s h Columbia. r a n a H - i a n M o H i c a l A s s o c i a t i o n . T o n r n a l . 122, 203-207. Rogers, M.G. (1971). The e a r l y r e c o g n i t i o n of handicapping d i s o r d e r s i n Childhood, n o v a l n p m c n t a l M o H i r i n o a n H P h i I H N e u r o l o g y , J _ l , 88-101. Rohner, R.P. (1965). F a c t o r s i n f l u e n c i n g the academic performance of Kwakiutl c h i l d r e n i n Canada, P o m p a r a t i w e F H n o a t i o n R e v i e w , ± ,331-340. Sabatino, D.A., Hayden, D.L., & K e l l i n g , K. (1972). P e r c e p t u a l , language and academic achievement of E n g l i s h , Spanish and Navajo speaking c h i l d r e n r e f e r r e d f o r s p e c i a l C l a s s e s . Jnnrna 1 r . f S c h o o l P c y r h n l o g y , J_Q, 39-46. Sameroff, A .J. & Chandler, H.J. (1975). Reproductive r i s k and the continuum of c a r e t a k i n g c a s u a l t y . In F.D. Horowitz, J . S c a r r , & G. S i e g a l ( E d s . ) , R e v i e w o f r - h i I H H o v o l o p m o n t (vn"! . 4_L. Chicago: U n i v e r s i t y P r e s s . S a t z , P. & F r i e l , J . (1974). Some p r e d i c t i v e antecedents of s p e c i f i c r e a d i n g d i s a b i l i t y : A p r e l i m i n a r y f o l l o w up. Jnnrna 1 o f T . e a r n i n g n i s a h i 1 i t i o s , _7_, 48-55. S c a l d w e l l , W.A. & Frame, J.E. (1985). Prevalence of o t i t i s media i n Cree and Ojibway s c h o o l - c h i l d r e n i n s i x O n t a r i o communities. - T o n r n a l o f A m e r i c a n T n H i a n F H n o a t i o n , 25.( 1 ) , 1 -5 . Sealey, B.D. (1980). T h e e H n c a f i o n o f N a t i v e p o p p i e s i n M a n i t o h a Winnipeg: U n i v e r s i t y of Manitoba. Shah, C. & Farkas, C S . (1985). The h e a l t h of Indians i n Canadian c i t i e s : a c h a l l e n g e t o the h e a l t h care system. Canadian MPdiral A s s o c i a t i o n . T o n r n a l , 122., 859-863. Shawana, P. & T a y l o r , R. ( 1 9 8 8 ) I n d i a n h e a l t h c a r e : S o c i o l o g i c a l p e r s p e c t i v e s i n l a w . P a n a H i a n T n n m a i of. Nat i VP E d n p a r i n n . 1 5 ( 3 ), 3 9 - 6 5 . S i e g a l , L. ( 1 9 8 2 ) . R e p r o d u c t i v e , p e r i n a t a l a n d e n v i r o n m e n t a l f a c t o r s a s p r e d i c t o r s o f t h e c o g n i t i v e a n d l a n g u a g e d e v e l o p m e n t o f p r e t e r m a n d f u l l - t e r m i n f a n t s . ° h i I H n p y p l n p m p n t , 53., 9 6 3 - 9 7 3 . S o l a n , H.A. ( 1 9 8 7 ) . A c o m p a r i s o n o f t h e i n f l u e n c e s o f v e r b a l -s u c c e s s i v e a n d s p a t i a l - s i m u l t a n e o u s f a c t o r s on a c h i e v i n g r e a d e r s i n f o u r t h a n d f i f t h g r a d e : A m u l t i v a r i a t e c o r r e l a t i o n a l s t u d y . J o u r n a l nf L p a r n i n g P i s a h i 1 i t i p . s , 211(4 ), 2 3 7 - 2 4 2 . S p i t l e r , G. ( 1 9 8 0 ) . M a t h a c h i e v e m e n t : S t u d i e s a t A h o u s a t , B.C I n H.G. Cannon ( E d . ) , T h o A h n n c a t B r l n r a t i n n S t n H y . V a n c o u v e r : U n i v e r s i t y o f B r i t i s h C o l u m b i a . S t a n d i n g S e n a t e C o m m i t t e e on H e a l t h , W e l f a r e a n d S c i e n c e . ( 1 9 8 0 ) . P h i l H a t R i c V . H u l l , Quebec: C a n a d i a n G o v e r n m e n t P u b l i s h i n g C e n t r e . S t e r n b e r g , R . J . ( 1 9 8 4 ) . A c o n t e x t u a l i s t v i e w o f t h e n a t u r e o f i n t e l l i g e n c e . T n t o r n a t i n n a l . T n n r n a l n f P c y r h n 1 o g y , J_a, 3 0 7 - 3 3 4 . T e e t e r , A., M o o r e , C.L., & P e t e r s e n , J . ( 1 9 8 2 ) . WISC-R v e r b a l a n d p e r f o r m a n c e a b i l i t i e s o f N a t i v e A m e r i c a n s t u d e n t s r e f e r r e d f o r s c h o o l l e a r n i n g p r o b l e m s . P s y r - h n l n g y i n t h o Sphnnls, 1 2 , 3 9 - 4 4 . T e m p e s t , P h y l l i s ( 1 9 8 7 ) . The p h y s i c a l , e n v i r o n m e n t a l a n d i n t e l l e c t u a l p r o f i l e o f t h e f i f t h g r a d e N a v a j o . J n n r n a 1 n f A m o r i r - a n T n H i a n F H n r - a t i n n t 2£L, 2 9 - 4 0 . T r e n t , J . H . & G i l m a n , R . A . ( 1 9 8 5 ) . M a t h a c h i e v e m e n t o f N a t i v e A m e r i c a n s i n N e v a d a . T n n r n a l n f A m e r i c a n T n H i a n E r i i i p a t i n n , 2 A ( 1 ) , 3 9 - 4 5 . U p a d h y a y , Y.B. & G e r r a r d , J . W . ( 1 9 6 9 ) . R e c u r r e n t p n e u m o n i a i n I n d i a n c h i l d r e n . A n n a l s n f A I l o r - g y , 2 2 , 2 1 8 - 2 2 4 . V e r n o n , P.E. ( 1 9 6 6 ) . E d u c a t i o n a l a n d i n t e l l e c t u a l d e v e l o p m e n t among C a n a d i a n I n d i a n s a n d E s k i m o s . r?.r\\ir-ar i n n a 1 R p y j PW, i a , 7 9 - 1 9 4 . W a l l a c e , H. M. ( 1 9 7 4 ) . The h e a l t h o f A m e r i c a n I n d i a n c h i l d r e n I n M. L e e ( E d . ) , n i a g n n s i g a n H t r o a t m o n t n f p r a u a l o n t fiJRPa .SPS i n Nnrth A m o r i r - a n T n H i a n p n p n 1 a t i n n s • p a p e r s ( p p . 1 8 2 - 1 9 2 ) . New Y o r k : MSS I n f o r m a t i o n C o r p . W e r n e r , E.E. & S m i t h , R.S. ( 1 9 7 9 ) . An e p i d e m i o l o g i c p e r s p e c t i v e on some a n t e c e d e n t s a n d c o n s e q u e n c e s o f 86 c h i l d h o o d mental h e a l t h problems and l e a r n i n g d i s a b i l i t i e s . - T n n r r a l n f r h o A m o r - i r - a n A r a r l o m y n f P h i l H P s y p h i a t r y , _L8.( 1 ), 292-306. W i l l i a m s , D.G. ( 1 986). S i mil 1 t a n o n n c a n H c o g n o n t i a l p r n i - p s s i n g T - o a H i n g a n H n o n r n l n g i r-a 1 m a t m - a t i n n n f M a r i w T n r l i a n P h i i H r o n f T c i m e h i a n ) D o c t o r a l D i s s e r t a t i o n . The U n i v e r s i t y of B r i t i s h Columbia. W i l l i a m s , P.D., W i l l i a m s , A.R., & D i a l , M.N. (1986). C h i l d r e n a t r i s k : p e r i n a t a l events, developmental d e l a y s and the e f f e c t s of a developmental s t i m u l a t i o n program. T n t p - r n a t i n n a 1 . T n n r n a 1 nf N l i r s i n g S t l l p M P S , 23.( 1 ) , 21-38. Young, T.K. (1984). Endemicity of d i p h t h e r i a i n an Indian p o p u l a t i o n i n northwestern O n t a r i o . C a n a H i a n T o n r n a l of, P n h U r Hpalth, 25., 310-313. Z i n t z , M. & Maggart, Z. ( 1 986). f o r r o r t i v o r - o a H i n g . Dubuque, IA: Wm. C. Brown P u b l i s h e r s . Appendix 1  Health History Variables — Occurrence Health Health Variables 1 Subject BWT GES NAT CAE COM JAU MAG GRA APG DSC OBS OTI FLU EYE DEN SUR FEV COL RES IRO IMP SHI PER DIA HAE NEG NUT ALC 1 3 5 3 0 36 , 0 0 0 19 1 9 P 0 0 0 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 2 6 6 4 9 40 1 0 0 0 18 1 9,10 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 3 3 8 1 5 40 1 1 0 0 9,10 F 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 4 2 8 9 0 1 0 0 0 16 1 8,10 P 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 5 2 7 9 0 3 8 0 0 0 17 2 8,10 P,F 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 1 1 1 6 3 0 6 8 1 0 1 0 8,9 P 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 7 3 7 7 0 4 0 0 0 0 38 5 8 P 1 0 0 0 1 1 0 0 0 0 0 1 0 1 0 1 1 1 8 3 9 2 0 40 1 0 1 0 23 3 4,9 F.P 1 1 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 9 2 2 0 0 35 0 0 0 20 2 8,10 P 0 1 1 0 1 1 0 0 0 1 0 0 0 0 0 1 0 1 10 3 4 3 0 40 1 0 0 0 16 1 8 P 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1 1 2 9 1 0 40 1 0 0 0 18 1 8 F P 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 1 12 3 8 1 8 4 0 1 0 0 0 27 5 8 P 0 1 1 0 0 0 0 1 1 0 1 0 0 0 0 1 0 1 13 3 4 6 0 4 0 1 0 0 0 23 4 P,F 0 0 0 0 1 0 0 0 1 0 0 1 1 1 0 0 0 0 14 3 3 4 0 3 8 1 1 0 0 20 2 8 P 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 15 3 1 0 0 40 1 0 0 0 18 3 7 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 1 16 2 6 9 0 3 8 1 0 0 0 31 3 9 P 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 17 3 2 5 0 37 1 0 0 1 21 3 8 P 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 1 18 1520 34 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 19 4 1 7 0 4 0 1 0 1 0 17 2 7,9 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 20 2 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ABBREVIATIONS: BWT; Birth W t (grams) MAG; Mother's Age FLU; Flucuating Loss RES; Upper Respiratory HEM; Haemangioma GES; Gestation (weeks) GRA; Gravida EYE; Vision Prob IRO; Low Iron NEG; Neglect NAT; Prenatal Care APG; Apgar 1,5 min DEN; Dental Poor IMP; Impetigo NUT; Poor Nutrition CAE; Caesarean DSC; Denver Score SUR; Requiring Surgery SHI; Shigella ALC; Alcoholism in Family COM; Complications OBS: Obesity FEV; Frequent Fevers PER; Pertussis J A U ; Jaundice OTI; Otitis Media COL; Colds DIA; Chronic Diarrhea 88 Parent Consent Form School D i s t r i c t #29 ( L i l l o o e t ) and the s i x Indian bands i n the L i l l o o e t area are p a r t i c i p a t i n g i n a study o f student achievement and ap t i t u d e s i n cooperation w i t h the U n i v e r s i t y o f B r i t i s h Columbia. Your c h i l d ; has been s e l e c t e d randomly, t o take p a r t i n the study i f you are w i l l i n g . 1. His/her p a r t i c i p a t i o n w i l l i n v o l v e about 1 1/2 hours of t e s t i n g over one t o three t e s t i n g s e s s i o n s . The t e s t s are a s e r i e s of achievement and a p t i t u d e t e s t s . 2. A l l t e s t i n g w i l l be done by f u l l y q u a l i f i e d psychometrists. 3. A l l t e s t r e s u l t s w i l l be kept i n s t r i c t e s t confidence. 4. P a r t i c i p a t i o n i n t h i s p r o j e c t i s v o l u n t a r y and may be terminated a t any time by the student, parents or guardian, or teacher. 5. The r e s u l t s of the study w i l l help the schools understand the achievement and ap t i t u d e s of c h i l d r e n i n the scho o l d i s t r i c t , as w e l l as provide the teacher of your son or daughter w i t h very h e l p f u l i n f o r m a t i o n that would not normally be a v a i l a b l e . 6. For f u r t h e r i n f o r m a t i o n please contact your school p r i n c i p a l . Please s i g n one l i n e below I AGREE t o my c h i l d t a k i n g p a r t i n the study. Parent or Guardian I DO NOT AGREE t o my c h i l d t a k i n g p a r t i n the study. . Parent or Guardian Date 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0054376/manifest

Comment

Related Items