Download - Mislabeled Child
1
Brock Eide M.D. M.A. and Fernette Eide M.D.
MislabeledChild.com
Looking Beyond Behavior to Find the True Sources—and Solutions—for
Children’s Learning Challenges.
The Mislabeled Child
What is The Mislabeled Child
About?
• Learning Differences and Learning Styles: How children (and their brains) learn, and how different children learn and process information differently.
• Specific Learning Challenges: Why children struggle, and how to help them when they do.
• The many reasons for Hope and Optimism that existwhen children struggle, due to the incredible and often untapped learning resources of the brain.
When children struggle, the labels they are given oftensimply hold up a mirror to their problems:
• Trouble learning: “Learning Disability”• Trouble paying attention: “Attention Deficit”• Writing difficulties: “Disorder of written expression”• Oppositional behavior: “ODD”
The Status Quo:Too Often, Labels are
“Merely Mirrors”
True Sources Often Lie Deeper…
Failure to delve more deeply—beyond behavior—for the truesources of a child’s strugglescan result in misdiagnosis, mislabeling, and mistreatment.
As was the case for Michael…
Michael
• 11 y.o. boy from a small Midwestern town.• Very bright, but had surprising difficulty early
in school learning to read.• Easily mastered letter names and sounds, but
struggled with decoding.• In second grade, something “clicked” and silent
reading comprehension skyrocketed.• In third grade, top reading group in class, and
consistently scored in 90%ile in reading comprehension tests.
• So, where’s the problem…?
Michael
Despite strong comprehension of longer passages, Michael showed:
• Poor word-by-word decoding.• Impaired oral reading.• Difficulty reading short succinct sentences like story
problems in math or instructions on tests.• Severe difficulties with spelling.• Incredible difficulties with handwriting.• “Careless mistakes” in math.
2
MichaelEven writing the alphabet was difficult:
Notice his problems forming cursive f, k, o, q.On printing, notice awkward forms like a, k, m, n, q, u; the wandering line; and g substitution for j.
When writing whole sentences, the problem got worse…
Michael
Writtencopy
Freewriting
Notice the problems with margins, spacing, spelling, consistentletter formation, and the use of conventions like capitals andperiods.
Some problems persisted even with keyboarding…
MichaelStory in the 5th Grade,
by keyboard:
“On a planet farfay awaw There was a youno man by the name of uragoner who set of for the edges of his planet in surch of the plantes bengines. His cutter had mot alwalec peen on This planet.”
Instead of reflecting his interesting, intelligent, and often humorous thoughts, Michael’s writing was much poorer in form and contentthan his speech, which made him embarrassed and self-critical…
Michael
A post-it note Michael placedmost of the it
Kick me
• By fifth grade, Michael’s ability to cope was exhausted.• He repeatedly called self stupid and dumb, and began
hitting himself on his head, saying he deserved to be punished for being so stupid.
A post-it noteMichael attachedto one of his spelling pre-testswhere he missednearly all of the items.
Michael
The school proposed a number of explanations forMichael’s difficulties:
a) Inattentive and careless,b) Not trying hard enough, or c) Unrealistic expectations: too smart to have a disability,
but not smart enough to do any better.
Their bottom line: Because Michael wasn’t actually failing, he didn’t qualify for special help. Rokenbok
VIQ 137Vocab 17Comp 17Simil 16Arith 16Infor 15Dig Sp 15
PIQ 119Obj As 14Pc Com 13Pc Arr 13BD 13Cod 11SS 11
Goal in Life: Engineer
MichaelIn Reality: Energetic, Painstaking, and REALLY SMART
3
“The Beginning of WisdomIs Calling Things
By Their Right Name”:
Michael is a perfect example of why the kinds of labels we apply to children matter, and of the truth of the statement with which we open our book.
-- Ancient Chinese Proverb
Stealth Challenges: Michael
• In Michael’s case, the struggle was with what we call“stealth dyslexia.”
• Michael was a perfect example of a child with “stealth challenges”—or problems that evade the usual “radar of detection.”Michael needed help with the way his brain processed sound, visual, and sensorimotor information, and he needed to learnhow to use his many strengths to overcome his weaknesses.
The Mislabeled Child
Michael shows how learning challenges aren’t just issues for children formally identified as needing special services, but are often present in children who aren’t identified as having specific learning challenges, yet show:
• Underachievement relative to intelligence• Inattention or apparent carelessness• Disorganization • Overloading, anxiety, or depression• Social or behavioral difficulties
Such children are often mislabeled…
Partial Pictures
In some cases, their weaknesses may be identified but their strengths missed, resulting in labels that tell only part of their story.
Look Alikes
In other cases their behaviors may meet criteria for a commonly used diagnostic label (often from the DSM-IV), but may actually be caused by other unrecognized—and treatable—issues that affect learning and information processing.
As happened with Ethan…
Look Alikes: Ethan
• Bright, energetic 9-year-old boy.• Intense, active, emotionally and physically sensitive.• Highly self-directed in activities, difficulty with
transitions and unexpected changes.• Difficulty conforming to classroom demands. • Socially, interacted well one-on-one with older
children, but few friends among age peers.• Poor eye contact, missed social cues, overloads in
large groups.
4
Look Alikes: Ethan
University Clinic diagnosed him (Sort of) with:• “Probable ADHD" • “Possible Anxiety Disorder" • “Cannot rule out Asperger's syndrome" and• “Motor Coordination Difficulties reported with
reported dysgraphia [i.e., severe handwritingproblem]."
Of Children and Checklists
• The tentative nature of these diagnoses reflects the recognition by these professionals that labels like ADHD or Asperger syndrome couldn’t capture Ethan’s full complexity.
• Behavioral checklists often miss the fact that similarbehaviors can have vastly different causes, and require vastly different solutions.
• In the MLC, we try to describe and deal with that richness and complexity, but in a way that makes it easy to understand and address.
What We Found With Ethan
• Severe handwriting impairment, source of much anxiety and misbehavior (improved with specific instruction, strengthening, and accommodations).
• Sensory-seeking (movement and touch/pressure) behaviors (improved with sensory input and movement breaks).
• Sensory-based social difficulties (improved by practice with verbal conflict resolution and social problem-solving scenarios).
Notice…
It was only by looking beyond Ethan’s behaviors to find their causes in his problems taking in,
processing, and expressing information, that we were able to match those problems with
appropriate solutions.
How to Avoid and Mishandling
Two steps to go beyond behaviors or isolated scores to truly understand a child’s learning challenges and to give that child what he or she needs.
Step 1: Create a Complete Learning Profile
Create a complete learning profile of a child’s strengths, weaknesses, interests, temperament, and learning style.
5
Step 1: Create a Complete Learning Profile
In particular, systematically identify strengths and weaknesses in:
• Information Input• Pattern Processing• Output for Action• AttentionIn other words, the underlying factors that can presentas difficulties with academic and behavioral function.
Optimize education and environment by designing a detailed plan of learning, therapy, and play, that improves areas of weakness, relies more heavily on areas of strength, and provides accommodations that get around unnecessary difficulties.
Step 2: Optimize Education
In MLC we describe in detail how to make such plans to help with challenges in specific academic areas like:
• Reading and spelling;• Handwriting and Written Expression;• Math.As well as more general challenges in:• Memory and imagery;• Visual or Auditory processing;• Sensorimotor function;• Language;• Attention;• Autism;• Intellectual Giftedness.
Step 2: Optimize Education It all begins with…
Assessment
• Behaviors are useful starting points but insufficient for diagnosis.
• Similar behaviors can have very different causes.
Key Point:
Going to the Source:Aspects of Brain-Based Learning
1. Information Input 2. Pattern Processing 3. Output for Action4. Attention
Attention
Aspect 1: Information Input
• Input Problems Affect Downstream Functions and Development (Garbage In, Garbage Out)
EarsEyes
Touch / Movement
Main Routes forInformation Input
6
Information Input: Micah
• 6-year-old boy, worsening self-esteem, school phobia and refusal, behavioral problems.
• In kindergarten oral language tested at 99%ile.• In first grade, trouble learning to read and write.• Sloppy work, incomplete math work, poor visual
memory, learns better one-on-one.• Increasingly anxious, aggressive, and hyperactive in
class. His teacher suspected ADHD and ODD.
Information Input: Micah
2 minute copy: “While Ben was…” Exact figure copy
Circle “bund”
• On our testing, Micah extremely intelligent and polite—until testing stressed his vision.
9 months laterGlasses + Therapy.Improved Visual Memory,Problem-solving, and Behavior.
Information Input:Micah Couldn’t See
Before Brain Can’t See
Dyslexic
Non-Dyslexic
Information Input:
Auditory – Unrecognized Ear or Brain-BasedHearing Problems (“Brain Can’t Hear”)
Touch / Movement – Sensory Processing Problemsor Mild Auditory + Visual Problems
Non-Dyslexic Dyslexic
Not HearingRhymes in Dyslexia
Brain-Based Problems of Information Input are Often Missed
Immature
“His hands were never still. He was always manipulating piecesof clay with his fingers…”
“I hated mathematics because I could not see.”
“…he was quieter and more thoughtful: while the others played games,he would stay close to his mother…”
“…neither the school nor the curriculum had appealed to him…he hadspent most of his time ‘drawing fanciful designs, telling stories, and reciting imaginary descriptions to his comrades…”
Play
Hidden Disability
Odd Habits
DifferentIn His Head
Fidgety
Flash from the Past Weak Vision, Strong Visual Imagery
Other Senses May Become Stronger
Auguste Rodin
Sculptor – Severe Myopia – Spatial Genius
7
Aspect 2:Pattern Processing
• How We Recognize, Remember, and Organize Information.
- Memory Systems (File Cabinets)- Imagery Systems- Pattern Association
• Helps us understand, predict, and plan.
People Often Differ Dramatically in their Preferred Types of Memory
Pattern Processing
Dramatic Effect on Learning Efficiency Permanent Learning
Kendra, The Forgetful Learner
• Kendra was 7, beloved by teachers and students• Polite and Attentive, but very Forgetful!• Kendra’s parents told us, “She remembers some things
very well, but other things she has to learn again and again…”
Pattern Processing:
Natural Storyteller Playground Stories Birthday PartyCan’t Remember What Learns at School
• Struggle to Remember 3 Numbers in Correct Sequence
• Instruction to “Visualize”: Still Can’t.
How Did She See Them?: “Glittering numbers dancing across a stage.”
• Then: “Keep the numbers on the stage after they dance.”
Kendra now remembered 5! —Great Performance for Age.
Pattern Processing: Kendra
We Found:
Strategic Memory Imagery Personal Learner
Flash from the Past
• Poor memory
• Called his notebook his “artificial memory”
• Couldn’t take notes because he said it was toohard to listen and write at the same time
• Needed more time to ruminate over new concepts
Success or Failure Depending on How Information Presented
Enrico Fermi
• Nobel Prize winner in physics• Split the atom• Famous as a teacher – trained 4 Nobel
prize winners • Always gave lecture handouts when
teaching because he had struggled withnote-taking himself…
You can be smart and have a poor working memory
Uni-tasker Slow thinker Spatial & Conceptual Strengths
8
Aspect 3: Output for Action
• Goal of learning not just understanding, but action.• Output may involve oral or written language
expression, handwriting, taking notes, acting in response to directions, or other large or fine bodily actions… potential “Explosive Child”
Output for Action: Ben
• Happy, outgoing, and well-behaved in kindergarten. • Great reader, strong speller, terrific language skills.• As first grade progressed, mood and behavior
deteriorated: angry, oppositional, work refusal, lying to parents about homework.
• Cause: Ben had severe difficulties with handwriting.
Output for Action: Ben(Dysgraphia/Handwriting Impairment)
7 y.o.: “ In 1909 he painted ‘Bread and Fruit Dish on Table.’ This was the beginning of the period known as Cubism. Cubism splits formsinto facet-like shapes.” Tearing up own work in art class
Dysfunctional Grips AccompanyMany Forms of Dysgraphia
Important: Abnormal Grip A Sign of Deeper Problem:Not Itself the Cause of Handwriting Impairments!
Writing AccommodationsDictation & Keyboarding
Therapy to StrengthenMore Time
Output for Action —Ben
Before OT
After OT
Flash from the Past
“He could never use a dictionary, couldn’t keeptrack of time, struggled with a lisp, and preferred from his adolescent years to dictate rather than to write…”
9
It’s possible to be a great orator and win a Nobel Prize in Literature, but struggled with speaking and writing as a child…
Winston Churchill
Music and Visual Power of Language Talented Painter StatesmanLong Preparation Time for Speeches
Aspect 4:Attention Key Points:
Not a Single Function!Not a Single Solution!
• Spotlight : Direction, Strength, Persistence of Focus• Juggler (Working Memory) : Information at Once• Creative Corporation (Organization and Creativity)• Different Modes of Attention – Seeing, Hearing, or
Doing…• Intervention must match deficit.
Inattention Due To Visual Distractibility
• Difficulty persisting with reading or worksheets due to visualcrowding and distractibility.
• “I can do 40 problems if there are 4 on each page, but I can’t do 4 if there are 40 on a page.”
• Frequent source of “careless mistakes.”Visual CoordinationBrain-Based Visual IssuesVisual Crowding is Real!
Age
Attention and DevelopmentAuditory and Visual Attention Improve with Time
Boys Poorer Auditory Attention in Elementary SchoolBehavioral Checklists Don’t Consider Developmental or Gender Differences
• Combines Ideas, Sensations, Images• Generates Alternative Approaches• Expands Possibilities and Associations• Prefers ‘The Big Picture’
Chief Creativity Officer – Right Brain
Chief Operations Officer – Left Brain• Oriented to the ‘Bottom Line’• Focusing & Prioritizing Goals• Deals with Detailed Planning and Implementation
Rypma, Rutgers
The Executive “Corporation”Training Creativity & Operations
(Gifted Children Mislabeled with ADD) Pitfalls of Chief Operation Officers
• “Oh no, I have to think?”• Fails to Consider Alternatives• Misses the Forest for the Trees• Derivative More Than Innovative
“Valedictorians tend to be very conscientious, responsiblepeople who achieve a type of well-rounded success...but what they don’t have is that overriding passion for a singlething that is often what makes you eminent in later life...”
Karen Arnold, Ph.D.Illinois Valedictorian Study
10
Pitfalls of Creativity Directors
• Disorganization• No Priority, No Plan• Unfinished Work• Poor Verbal Communication
Successful Problem Solving RequiresCooperation Between the Right & the Left
Just, Carnegie Mellon
Tower of London
Choice Possibilities
Young GiftedChildren Have
Thinner CorticesBefore the Age of 10
Then Thicker BrainCortices in the Teen
Years
Some Gifted DifferencesRooted in Brain Biology
The Higher the IQ, the More DelayedExecutive Function (Prefrontal) Maturation
Delays may be especially pronounced for children with sensory processing and motor coordination deficits.
Unevenness is More Common with Higher IQ
WISC-III VIQ / PIQ Discrepancies – 18 Points or MoreControl Sample 17.0 %Gifted Sample 54.7 %
Sweetland, Port Washington School District
Development May Differ in Different Areas:
“The servants all thought that young Isaac was foolish,and his mother did not know what to do with him…”
From Isaac Newton, The Greatest Scientist of All Time
“I used to take these maths tests which were supposed to be donein one period and it took me not just that period but the next onewhich was a play period and sometimes the one beyond that…”
Roger Penrose, Cambridge Math Professor
The Gifted-Backward Paradox
“My teachers saw me at once backward and precocious, reading books beyond my years and yet at the bottom of the Form. They were offended. They had large resources of compulsion at their disposal, but I was stubborn.” Winston Churchill My chief deficiency was arithmetic. Here my understanding was far beyond my
manipulation, which was definitely poor. My father saw quite correctly that one of my chief difficulties was that manipulative drill bored me. He decided to take me out of school and put me on algebra instead of arithmetic, with the purpose of offering a greater challenge and stimulus to my imagination.
Norbert Wiener, Nobel Laureate in Physics
The Teaching Paradox –More Learning with Greater Challenge
11
Downside: DisorganizationThe Highly Active Mind
Is Often…Distracted and Disorganized“Constantly late for school, losing his books, and papers and various other things into which I need not enter– he is so regular in his irregularity in every way that I don’t know what to do.”
--Winston Churchill’s Principal
Einstein’s Office
Inattention: Creativity Officer on Steroids
"It looks like she's doing the dishes but she accidentally left it on. When she went to get her apron, the kids were getting cookies and the stool tipped over and the little boy's falling and some of the dishes were done but not all of them. and some of the water was coming out and the curtains and the window were open and some of the water got out. The girl was saying Mom!! The little boy was falling. The mom said "I'll be there in a second--get out of that cookie jar!"
7 y.o. gifted girl considered for attention problems
Who was this?
“He was often ill, prone to fits of uncontrollableweeping, and filled with a restless surging energy he could not contain. He was enrolled withoutsuccess in one school after another and oftenfound it difficult even to remain seated at his desk...”
“I wanted to run down to the beach in sun, rain,or fog and expend the pent-up physical energythat simply fermented within me. Today I wouldbe labeled hyperactive.”
Intense
HyperactiveSchool Failure
“I often wonder at the strength and courage my father had intaking me out of the traditional school situation and providingme with these extraordinary learning experiences. I am certainhe established the positive direction of my life that otherwise,given my native hyperactivity, could have been confused andcatastrophic. I trace who I am and the direction of my developmentto those years of growing up in our house on the dunes, propelledespecially by an internal spark tenderly kept alive and glowing bymy father.”
Ansel Adams
Optimism Non-traditional Schooling Personal Strengths
A Final Point on“Helping Hands” for Kids
The Truth About Accommodations…
The Right Accommodations Get Kids Into Learning,
Not Out Of It!
• Accommodations are ways toimprove function and increase achievement, not to avoid it!
• Accommodations can be enabling and therapeutic!
12
"I am a Typhoon and I am on my way to Japan and gathering spead. I mite be the Typhoon that destrois the mongls and theirships on their second invashon of Japan.... My stronggest poweris wind wich can make trumendus waves that can capsise the stronggest mongl ship."
Gifted Dyslexic Boy
Before Using “Write Outloud”
Software
Author of “Mongl Invashon” after 2 years of “Write Outloud”
With Constant Feedback, Student Internalized Spelling Patterns
Take Home Message: Focus on Learning Abilities
• Behaviors are just starting points: Appropriate labeling--and intervention—requires going Beyond Behavior.
• The Brain is remarkably “Resource-Full”• Looking carefully at each child will reveal the
hidden depths of their true learning potential.
Brock Eide M.D. M.A. and Fernette Eide M.D.MislabeledChild.com
The Mislabeled Child
Brock Eide M.D. M.A. and Fernette Eide M.D.MislabeledChild.com
“The Mislabeled Child represents a significant step toward a rethinking of our understanding of struggling children. It…willenable us to customize education and parenting for children whose minds work differently from most!”
--Mel D. Levine, M.D., Author A Mind at a Time
“Partial Pictures”: Marshall
• Quiet 6-year-old, struggled in all subjects in school. • Built complicated Lego and Knex structures.• Drew beautifully detailed animals and insects, and
loved picture books. • At school he just looked lost. • School psychologist decided “borderline mentally
retarded.”• Family thought otherwise. They’d seen this story
before.
“Partial Pictures”: Marshall
• Marshall’s father now a highly successful business owner with dozens of employees.
• At age 8, nearly mute, institutionalization considered. • Parents suspected hearing problems, and spent hours
barraging him with oral language. • By fourth grade: reading. By eighth grade: grade
level in all subjects. By high school: honor roll.
13
“Partial Pictures”: Marshall
• Confused unless we showed him rather than told him what we wanted him to do.
• Strong ability in spatial and mechanical reasoning.• Severe, heritable—but potentially trainable--difficulty
hearing the different sounds that make up spoken words.
We Found:
Why Mislabeling
Matters
• Labels may put a name to a child’s problems—often by simply describing or restating behaviors—yet fail to determine why those behaviors occur.
• Such inappropriate or incomplete labeling often prevents students from receiving the help they need to find success.
• Common patterns of mislabeling:* Stealth Challenges * Look-Alikes * Partial Pictures
Another Key Point…
Missed learning challenges lead to:• misdiagnosis, • mislabeling, and • mishandling.
Like Many Brain-Based Learning Challenges, Brain-Based Hearing Problems Are Subtle And Often Missed:Like the boy who told us, “It’s hard for me to spell “World”
because the “r” is silent.”