Prevention is usually described as primary, secondary, or tertiary, depending on when and why preventive action is taken. The prevention of learning disabilities may involve all three types.
Primary prevention means keeping the disability from occurring in the first place. Primary prevention in learning disabilities might involve reducing the chances of brain injury, improving teachers' skills in instruction and behavior management, or teaching parents child-rearing skills. For primary prevention to work, the strategy must be aimed at reducing or eliminating the cause(s) of learning disabilities or protecting against causal factors.
For example, it was too late to do primary prevention of the difficulties noticed in kindergarten by Jamal's teacher. After problems emerge, it is too late for primary prevention.
We caution that even if primary prevention is implemented—including good instruction—learning disabilities will occur. Primary prevention may reduce the number of children who have learning disabilities or lessen the severity of the disabilities, but it will not eliminate learning disabilities (the same statement can be made regarding primary prevention of any type of disability; see Kauffman, 1999, 2003). Thus, primary prevention is important in keeping the prevalence of learning disabilities as low as possible. However, it is a mistake to assume that it will reduce the prevalence to zero.
Secondary prevention means correcting the disability after it occurs, or at least keeping it from getting worse. Remedial instruction is a secondary preventive strategy. In fact, most of the interventions for learning disabilities involve secondary prevention, because the child's learning problems have been noticed and the aim is to correct the problems or prevent them from getting worse. If a special education teacher works not only with students already identified as having learning disabilities but also with others who are struggling academically but have not yet been identified, the teacher may be practicing secondary prevention, both with labeled students and those not labeled as having learning disabilities.
Jamal's kindergarten teacher could have done secondary prevention for the problems she detected. She would not have had to label him as having learning disabilities, but she would have had to label him or his problems as something needing intervention—noting, perhaps, "child in need of special instruction" (CINOSI) or something similar. It is impossible to practice secondary prevention without a word (label) designating the need for special attention or instruction (Kauffman, 1999, 2003,2004). Although math disabilities are currently Shannon's major problem, she was first identified as having a learning disability in reading. However, she was not identified with this disability in reading until she was about 7½ years old. Any preventive action taken at that time had to be secondary or tertiary simply because she already had serious problems in reading.
Tertiary prevention means keeping the effects of the problem or disability from spreading to other areas of functioning. When remedial interventions are initiated long after a learning disability has developed, the primary goal may be tertiary prevention. For example, if a student has had learning disabilities in reading that have existed since the early grades and these have not been corrected, tertiary prevention at the high school level may involve teaching the student skills that will prevent failure in finding and holding a job.
If Jamal's teachers in the primary grades address his problems effectively so that additional problems of academic failure or misbehavior do not develop, then they are practicing tertiary prevention. To the extent that teachers can provide services to avoid future problems for Shannon, they are practicing tertiary prevention.
Of course, it is possible to practice secondary and tertiary prevention at the same time and in essentially the same way. Secondary prevention addresses existing problems. Tertiary prevention addresses complications or the development of additional problems. The Case Connections box above illustrates how Shannon's science teacher implemented a combination of secondary and tertiary prevention. This teacher knew of Shannon's problem with new concepts and also knew that failure to address it would lead to problems of low self-esteem and anxiety.
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