allergies and learning disabilities

Hammill Institute on Disabilities

Allergies and Learning DisabilitiesAuthor(s): James A. McLoughlin, Michael Nall and Joseph PetroskoSource: Learning Disability Quarterly, Vol. 8, No. 4 (Autumn, 1985), pp. 255-260Published by: Sage Publications, Inc.Stable URL: http://www.jstor.org/stable/1510588 .

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ALLERGIES AND LEARNING DISABILITIES

James A. McLoughlin, Michael Nail, and Joseph Petrosko

Abstract. Numerous connections between allergies and learning disabilities have been made in the popular press and other media directed to parents of the learning disabled. This article briefly traces the reasons for this association and critically analyzes existing research of such factors as school underachievement and learning problems, listening and hearing problems, absenteeism, and social- emotional disorders. Results of a comparison of group achievement scores, school attendance records, and medical symptoms of allergic and nonallergic students with and without learning disabilities raise serious questions about the purported relationship between allergies and learning problems.

A great deal of literature indicates that allergic children experience a variety of school problems. For example, Rapaport and Flint's (1976) analysis of case studies suggested a connection between allergies and learning disabilities. Similarly, according to Havard (1975), allergic children are rated lower in reading, auditory perception, and visual perception. In a study by Rawls, Rawls, and Harrison (1971) involving parent and teacher ratings as well as test performances, allergic children appeared less profi- cient than their nonallergic counterparts in in- tellectual, academic, emotional, and social areas. However, when their actual performance was assessed, allergic children scored no dif- ferently than their nonallergic peers in these areas. Geschwind and Behan (1982) associated left-handedness with reports of learning problems and immunological diseases (e.g., thyroid and bowel disorders).

In contrast, McLoughlin, Nall, Isaacs, Petrosko, Karibo, and Lindsey (1983) found no differences in parent reports concerning the academic achievement and behavior of allergic and nonallergic children. As a result, these authors speculated that former conclusions about low school achievement and behavior problems in allergic children were confounded by lack of control for socioeconomic status and

age. In addition, some problems may be unique to severe forms of certain allergies or may be side-effects of medications.

Hearing and listening problems are frequently associated with both learning disabilities and allergies. For example, otitis media, a middle-ear inflammation resulting from allergy-related drainage or infection, can seriously impair hearing (Northern, 1980; Siegel, 1980). Among allergic students, Szanton and Szanton (1966) found many cases of intermittent hearing loss that had been undetected on screening measures. Loose's comparative study (1984) of learning disabled students with recurrent otitis media indicated that these students experienced greater problems with allergies and verbal skills than did nondisabled children having the same medical condition.

Higher rates of school absenteeism have also

JAMES A. MC LOUGHLIN, Ph.D., is Pro- fessor, Dept. of Special Education, University of Louisville.

MICHAEL NALL, M.D., is an allergist, Louisville, KY.

JOSEPH PETROSKO, Ph.D., is Associate Pro- fessor, Department of Educational Foundations, University of Louisville.

Volume 8, Fall 1985 255



reported among allergic children (Gillman, 1981; Solomon, 1981). In addition to students with asthma (Creer, 1981), pupils suffering from other types of allergies such as chronic rhinitis tend to be absent often (McLoughlin et al., 1983). The seasonal nature of allergies may create a pattern of frequent, brief absences that disrupt work completion and opportunities for social skill development (Creer & Yoches, 1971; Douglas & Ross, 1965).

In support of Mayron's (1978) suggestion that allergies represent one of the major causes of behavior disorders in children, King (1981) estimated that as many as 70% of the students who exhibit behavior disorders have some type of allergy in their personal or family history; further, cognitive-emotional symptoms were noted after allergic exposure under double-blind conditions. Based on a review of case studies, Havard (1975) concluded that children labeled in school as hyperactive, language or learning disabled, lazy, minimally brain-damaged, or emotionally disturbed may have allergy problems.

In addition to the proposed connection between allergies and various school/learning problems, the side-effects of allergy medication on behavior are well documented. For example, Ladd, Leibold, Lindsey, and Ornby (1980) reported an array of reactions to corticosteroids, including euphoria, insomnia, and visual disturbances. These authors also listed hyperactivity, restlessness, and dizziness as resulting from theophylline. Antihistamines, the most com- monly used allergy medication, may cause seda- tion, dry mouth, and irritability (Weinberger & Hendeles, 1980). Finally, Creer (1981) found losses of as much as 20 points on intelligence test performances as a result of drug intake.

The role of food allergies in student behavior has also received considerable attention. In par- ticular, Feingold (1957b) suggested that the in- gestion of artificial food additives (colors and flavors) and naturally occurring salicylates in food results in hyperactivity and learning disabilities. Thus, the well-known Feingold Kaiser-Permanente (K-P) diet, which eliminates these ingredients, has been reported to reduce such problems based on clinical observations and anecdotal accounts (Crook, 1977; Fein- gold, 1975a). However, in recent reviews by Mattes (1983) and Kavale and Forness (1983), such supportive claims have been dismissed.

Similarly, professional panels, including the Consensus Development Conference sponsored by the National Institutes of Health (Office for Medical Applications of Research, 1982), have found little or no supporting evidence for the alleged connection between artificial food colors and flavors and hyperactivity and learning problems.

To date, most conclusions about the possible association between learning disabilities (LD) and allergies have been limited to information from such sources as parent reports, case histories, and measures of tasks unrelated to school functioning rather than school records. The present study was conducted, therefore, (a) to investigate the incidence of allergies and the relationship between allergies and a set of demographics (race, sex, grade level, and school location in the community); and (b) to analyze the relationship between allergies in both learning disabled and non-learning disabled student groups and achievement test scores and school attendance.

METHOD Procedure

Nine schools, three each of elementary, middle and high school, in three geographically separate areas of Louisville, Kentucky, served as the sites of the study. One set of schools was located in an industrial neighborhood, another in the downtown area, whereas the third group of participating schools was selected from an af- fluent suburban district. A one-page survey form was sent home with the students, and incentives were offered for classes with the highest returns. Return rates ranged from 69% in the elementary schools to 12% in the high schools, with a total return of 2,343 responses (37%).

Survey items requested that parents: (a) rate their children on a set of allergic symptoms as mild, moderate, or severe; (b) report whether they suspected allergies; (c) indicate whether allergies ran in the family; and (d) list whether their children had been diagnosed as allergic and, if so, the specific allergic reactions and the person who had made the diagnosis. Parents were also asked for permission to examine their child's school records (i.e., attendance and test scores) and medical records. For children whose parents signed the release form, attendance records and performance scores on the Com-

256 Learning Disability Quarterly



prehensive Test of Basic Skills (CTBS) were pro- vided by the school system. To validate parental opinions about their children's allergies, the physicians of 80 randomly selected children were also contacted. In 65 (81%) of the cases, the doctors confirmed parents' reports. Further, independent parent ratings for children diagnosed as allergic indicated significantly more severe symptoms of allergy (p < .01). Subjects

The characteristics of the sample were as follows: sex (46% male, 54% female); race (68% white, 32% black); grade level (37% elementary, 36% middle, 27% high school); and handicapping condition (82% nonhandicapped, 9% learning disabled, 9% other handicaps). Learning disabled indicates students receiving LD services based on school district records; other handicaps refers to students attending other special education classes (com- munication disordered, educable mentally handicapped, physically handicapped, etc.). Sub- jects constituted the following six groups: (a) not handicapped-allergic (n = 366), (b) not- handicapped-nonallergic (n = 1,060), (c) learning disabled-allergic (n = 35), (d) learning disabled-nonallergic (n = 143), (e) handicapped (non-LD)-allergic (n = 37), and (f) handicapped (non-LD)-nonallergic (n = 129).

RESULTS AND CONCLUSIONS Incidence of Allergies in Relation to Demographics

Twenty-two percentage (22%) of the sample had reportedly been diagnosed as allergic. Com- pared to their nonhandicapped counterparts, no significant differences in incidence of childhood allergies were reported for the handicapped population in general, or for specific handicapped groups such as the learning disabled. Comparisons between allergic and nonallergic children revealed significantly more males in the allergic groups (X2 = 4.12, df = 1, p < .05). Although race was not found to be a distinguishing feature, comparisons in which race and sex were considered together showed significantly more white males (X2 = 7.92, df = 3, p < .05). Significantly more allergic children were noted in certain grades (X2 = 17, df = 12, p < .01), that is, proportionally more middle-school students were found to be allergic. Finally, in terms of geographics, more

cases of diagnosed allergies (X2 = 20.26, df = 2, p < .00005) were reported for the af- fluent, suburban segment of the community than for areas associated with higher levels of air pollution. School Achievement and Attendance

Subject groups were compared on the following variables: CTBS reading, CTBS math, CTBS language, CTBS total battery, number of days absent (in school year), and total allergy symptom score (sum of 9 separate symptoms). Two-way analyses of variance were performed with handicap and allergy status as the independent variables. As indicated in Table 1, a significant main effect was found for handicap type (p < .01) on all CTBS scores (reading, math, language, and total)-the nonhandicapped group was superior to the other two groups. For all CTBS scores except reading, no significant main effect was noted due to allergies, that is, the scores of the allergic group did not differ from those of the nonallergic subjects. In reading, however, the allergic students scored higher than the nonallergic group. No significant handicap-by-allergy interaction emerged on any of the CTBS scores.

For the days-absent variable, a two-way ANOVA revealed a significant main effect due to handicap type. Thus, both LD and other handicapped students were absent more than their nonhandicapped peers (p < .01). No other effects were significant, however; that is, allergic students' attendance records were similar to those of nonallergic subjects.

Some significant, but low correlations suggested possible relationships between severity of allergy problems and both CTBS performance and school attendance. For example, children with severe allergy symptoms tended to score lower on the CTBS (r = -.17, n = 384, p < .00005) and to be absent from school more (r = -.20, n = 395, p < .00005). Among the allergy symptoms, severe wheezing was found to be most associated with lower CTBS scores (r =-.13, n = 181, p = .04); lower school attendance, in turn, appeared to be connected significantly with severe eye irritation (r = .11, n = 254, p = .05) and stomach and headaches (r = .20, n = 240, p = .001).

Among the results of the present study, the most damaging to the alleged allergy-learning disability association were the findings that (a)




Cn 0

10

Table 1

Mean CTBS Scores and Mean Number of Days Absent for Nonhandicapped, Learning Disabled, and Handicapped (Non-LD) Students

Group

Not Handicapped Learning Disabled Handicapped (Non-LD) Allergic Nonallergic Allergic Nonallergic Allergic Nonallergic

Variable n = 366 n = 1,060 n = 35 n = 143 n = 37 n = 129

CTBS

Reading 732 704 677 647 638 618 Math 701 685 681 668 634 626

Language 714 701 639 634 646 634 Total 724 711 663 656 661 653

Number of Days Absent 10.7 9.7 14.3 13.8 10.5 13.6

Note. Numbers of subjects in the six groups varied across variables because of missing data. The n's listed above are modal values.



allergic students do as well and often better than other students, at least as measured by the CTBS; and (b) being handicapped was not a significant factor. As discussed elsewhere (McLoughlin et al., 1985), past conclusions about greater school-related problems among allergic children may be a function of not con- trolling for SES and age. Also, such studies were based on measures of scholastic and behavioral competence unrepresentative of typical school situations and learning tasks or relied exclusively on parent reports. Furthermore, the allergy problem most frequently mentioned in connection with scholastic concerns, asthma, was associated with lower test performance at an in- consequential level in this study.

Also contradicting prevailing theories about the relationship between allergies and school/learning problems was the finding that allergic students were not absent from school more than their nonallergic peers. This refutes results (McLoughlin et al., 1983) based on parental reports and use of samples drawn from patients attending clinics and private allergists' offices. In the current study, subjects came from public school classrooms, perhaps reflecting greater range in severity of symptoms and parental concern than a sample regularly attending physicians' offices for treatment. However, reported cases of allergy in this study were confirmed by both physicians and independent parent ratings. Current results pertaining to absenteeism may reflect more effective treatment of children's allergies. Independent of the results related to allergies in the present sample was the higher absenteeism rate among learning disabled and other handicapped students; further study of this finding and its ramifications is needed.

The present findings that (a) allergic students functioned similarly to their nonallergic peers in terms of school attendance and group test performance, and (b) LD subjects were not reported to have been diagnosed as allergic more often or to have more severe symptoms than non-LD students make a direct relationship between allergies and learning disabilities unlikely. However, an overlap between learning disabilities and allergy may occur when allergy- related problems complicate the learning disability. For example, comprehension deficits may be intensified by otitis media resulting from allergy,

and the side-effects of allergy medication may increase the attentional disorders and hyperactivity of some LD children.

REFERENCES Creer, T. L. (1981). Behavioral problems: From the

disease(s) and treatment used. In J. Buckley & D. Cook (Chairs), School health: Regarding allergies and asthma-problems and solutions. Symposium presented at the meeting of the American Academy of Pediatrics, New Orleans.

Creer, T. L., & Yoches, C. (1971). The modification of an inappropriate behavioral pattern in asthmatic children. Journal of Chronic Diseases, 24, 507-513.

Crook, W. G. (1977, January). Letter to the editor. News and Comment, American Academy of Pediatrics.

Douglas, J. W. B., & Ross, J. M. (1965). The effects of absence on primary school performance. British Journal of Educational Psychology, 35, 28-40.

Feingold, B. F. (1975a). Hyperkinesis and learning disabilities linked to artificial food flavors and colors. American Journal of Nursing, 75, 797-803.

Feingold, B. F. (1975b). Why your child is hyperactive. New York: Random House.

Geschwind, N., & Behan, P. (1982). Left- handedness: Association with immune disease, migraine, and developmental learning disorders. Proceedings of the National Academy of Science, USA, 79, 5097-5100.

Gillman, S. A. (1981). Specific diseases: Their problems and solutions. In J. Buckley & D. Cook (Chairs), School health: Regarding allergies and asthma-problems and solutions. Symposium presented at the meeting of the American Academy of Pediatrics, New Orleans.

Havard, J. G. (1975). Relationship between allergic conditions and language and/or learning disabilities. Dissertation Abstracts International, 35, 6940.

Kavale, K. A., & Forness, S. R. (1983). Hyperactivity and diet treatment: A meta-analysis of the Feingold hypothesis. Journal of Learning Disabilities, 16, 324-330.

King, D. S. (1981). Can allergic exposure provoke psychological symptoms? Biology Psychiatry, 16, 3-19.

Ladd, F. T., Leibold, S. R., Lindsey, C. N., & Ornby, R. (1980). RX in the classroom. Instructor, 90, 58-59.

Loose, F. F. (1984). Educational implications of recurrent otitis media among children at risk for learning disabilities. Unpublished doctoral dissertation, Michigan State University.




Mattes, J. A. (1983). The Feingold diet: A current reappraisal. Journal of Learning Disabilities, 16, 319-323.

Mayron, L. (1978). Ecological factors in learning disabilities. Journal of Learning Disabilities, 11, 40-50.

McLoughlin, J. A., Nall, M., Isaacs, B., Petrosko, J., Karibo, J., & Lindsey, B. (1983). The relationship of allergies and allergy treatment to school performance and student behavior. Annals of Allergy, 51, 506-510.

McLoughlin, J. A., Nall, M., Isaacs, B., Petrosko, J., Karibo, J., & Lindsey, B. (1985). School performance of allergic students: A socioeconomic perspective. Manuscript submitted for publication.

Northern, J. L. (1980). Diagnostic tests in ear disease. In C. Bierman and D. Pearlman (Eds.), Allergic diseases of infancy, childhood and adolescence

(pp. 492-501). Philadelphia: W. B. Saunders. Office for Medical Applications of Research, National

Institutes of Health. (1982). Defined diets and childhood hyperactivity. Journal of the American Medical Association, 245, 290-292.

Rapaport, H. G., & Flint, S. H. (1976). Is there a rela-

tionship between allergy and learning disabilities? Journal of School Health, 46, 139-141.

Rawls, D. J., Rawls, J. R., & Harrison, D. W. (1971). An investigation of 6 to 11 year old children with

allergic disorders. Journal of Consulting and Clinical Psychology, 36, 260-264.

Siegel, S. C. (1980). Recurrent and chronic upper respiratory infections and chronic otitis media. In C. Bierman & D. Pearlman (Eds.), Allergic diseases of infancy, childhood and adolescence (pp. 715-724). Philadelphia: W.B. Saunders.

Solomon, N. (1981, February). Early detection and treatment offer allergy relief sooner. Courier- Journal.

Szanton, V. J., & Szanton, W. C. (1966). Hearing disturbances in allergic children. Journal of Asthma Research, 4, 25-28.

Weinberger, M., & Hendeles, L. (1980). Phar-

macologic management. In C. Bierman & D. Peariman (Eds.), Allergic diseases of infancy, childhood and adolescence (pp. 311-332). Philadelphia: W.B. Saunders.

FOOTNOTES This research was funded by the Graduate School and the School of Education of the University of Louisville. The authors appreciate the cooperation of the Jeffer- son County Public Schools, Louisville, Kentucky.

Requests for reprints should be addressed to: James A. McLoughlin, Dept. of Special Education, Universi-

ty of Louisville, Louisville, KY 40292.

The Menninger Foundation

Learning Disabilities:

The Interface Between Brain-based Dysfunctions and Adult Psychiatric Disturbances

November zz-23, 1985 Topeka, Kansas

A conference cosponsored by the Division of Continuing Education, The Menninger Foundation, and the Association for Chil- dren and Adults with Learning Disabilities

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distinguished faculty, this conference has the

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For more information, contact: Brenda Vink, Division of Continuing Education, The

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260 Learning Disability Quarterly



allergies and learning disabilities

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