Charles Ungerleider, Professor Emeritus, The University of British Columbia
[permission to reproduce granted if authorship is acknowledged]
When I began kindergarten more than 70 years ago, children were screened annually for impediments to their vision. I recall lining up with my classmates while each student was expected to toe a line and designate with our fingers what symbols were visible to us on the Snellen chart. We would point three fingers at the ceiling to indicate what looked like a W, to the right to indicate an E, or to the left to indicate a symbol that looked like an ꓱ facing the wrong way. Vision screening was universal and conducted annually. As we mastered the alphabet, the symbols on the chart were replaced by letters.
The test was administered by the nurse who worked in the school and to whom we would be sent if we were injured or ill (or feigned a stomach-ache to be able to go home and watch the World Series). The nurse would attend to our wounds, make us comfortable, or arrange for us to be picked up by a caregiver… or returned to class if she detected our deception. She also ensured that our immunizations were current and, during the polio epidemic, helped administer the vaccine.
Over time, school nurses diminished in number. Instead of a fulltime nurse in schools, nurses became itinerant, serving several schools in a week. In many – perhaps most - places, there are no longer school nurses. Some of the functions performed by the school nurse became the responsibility of school administrative assistants. Administrative assistants collect proof of immunization, care for minor wounds, arrange for caregivers to pick up children who are ill, and less subtly detect test avoidance.
According to data from the 2016 census, approximately 13.5% of Canadian children exhibited at least one activity limitation. They had difficulty seeing (2.6%); hearing (0.9%); learning, remembering, or concentrating (7.9%); with mobility, flexibility, or dexterity (0.9%); or manifested emotional, psychological, mental health problems (4.0%); or long-term health problems (4.0%).
Some children had multiple activity limitations. Three quarters (75.8%) of children for whom mobility, flexibility, or dexterity was difficult and 70.7% of children with emotional, psychological, or mental health conditions had multiple limitations. Fewer (40.7%) of the children who had difficulty seeing and about half (52.1%) of children who had difficulty learning, remembering, or concentrating had multiple limitations.
It is true that many children with activity limitations will have them detected outside of school. Some children with limitations will not.
Our recognition of limitations has evolved from ones that are primarily physical to ones that include factors or obstacles in the social and educational environment that should be overcome to ensure the full benefit of schooling. The work underway in many places to eliminate racism and discrimination in the school environment is one example. Anti-bullying strategies are another.
Universal, annual, health screening is gone, but the need for screening remains because access to a regular family physician in Canada is declining. The decline is greatest among families most in need.
Identifying
and eliminating or mitigating activity limitations are important to ensure that
students benefit from their school experience. So, too, is screening children
each year for potential reading limitations - arguably the greatest obstacle to
school success. Addressing limitations early in a child’s school career should
reduce the burden that the limitations impose upon the child, parents,
teachers, and school system.