The literary works of Sir William Osler

A paper read at the first regular meeting of the Osler Society of McGill University, October 19, 1921.     

Academic achievement following childhood brain disease: implications for the concept of learning disabilities.

The present study examined three hypotheses regarding the consequences of early brain damage for academic achievement: First, early brain insults will have a negative impact on achievement, even in children with normal intelligence. Second, underachievement in these children will be at least partially independent of IQ (i.e., not fully accounted for by a lowering of IQ within the average range). Third, normally intelligent children with histories of brain insult will also manifest selective cognitive dysfunctions. To test these hypotheses, we compared two groups of children who had recovered from Haemophilus influenzae type b meningitis. The "complicated" group consisted of children who, as a consequence of having sustained neurologic complications during their illness, were more likely to have had brain insults. Children in the "uncomplicated" group did not have complications with their illness and were regarded as having escaped significant central nervous system (CNS) pathology. Only children with normal hearing and a prorated Full Scale IQ of at least 80 (WISC-R) were considered. Group differences on the Wide Range Achievement Test-Revised were consistent with the first two hypotheses. Although the two groups had similar Verbal IQs, the complicated group also had a lower mean Performance IQ and performed less well on perceptually demanding neuropsychological tasks. Findings suggest that learning disabilities may have selective, brain-related cognitive antecedents; but they challenge the practice of using IQ criteria for clinical diagnosis.