Category Archives: Neuropedagogy

See this case study published online at the International Brain Injury Neurotrauma newsletter for June 2015!

A CASE STUDY ON THE RELATIONSHIP BETWEEN SENSORY PROCESSING SKILLS AND ACADEMIC ACHIEVEMENT WITH A 14 YEAR OLD WITH ACQUIRED BRAIN INJURY AND ELECTROGRAPHIC STATUS EPILEPTICUS IN SLEEP (ESES)

Authors: Dechantal C. V. Montano, OTR/L, Sara T. Naegele, MS Ed,  Ronald C. Savage, Ed.D.

Introduction

Children with acquired brain injuries face an array of cognitive, behavioral, and sensory-motor problems.   In particular, many of these children have problems with sensory processing, which, in turn, interfere with their neuro-development. Sensory processing (sometimes called “sensory integration” or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Sensory Processing Disorder (SPD) is a condition that exists when sensory signals do not get organized into appropriate responses. Dr. A. Jean Ayres (Ayres, 2005), an occupational therapist and developmental psychologist, pioneered work in sensory integration dysfunction in the 1960s. She proposed that in order to function the brain needed to receive and interpret sensory information correctly using a seven-sense sensory system, which includes the tactile, visual, auditory, gustatory, olfactory, vestibular and proprioception systems. She likened sensory dysfunction to a neurological “traffic jam” because problems occur when sensory input is not processed or misrouted in the brain. “SPD is not one specific disorder…but rather an umbrella term to cover a variety of neurological disabilities,” explains Carol Kranowitz (Kranowtiz, 2005), an educator and expert in sensory processing and integration. Children with SPD, especially children with acquired brain injuries, will find it difficult to process and act upon information received through their senses, which creates challenges in performing countless everyday tasks. Learning difficulties, motor clumsiness, behavioral problems, anxiety, depression, school failure, and other impacts may result if the disorder is not treated effectively.

SPD is not presently recognized as a distinct and separate group of disorders in The Diagnostic and Statistical Manual V but is recognized as occurring in individuals with other neurological disorders. Most research to date involving SPD has involved individuals with Attention Deficit and Hyperactivity Disorder (ADHD) and Autism Spectrum Disorders (ASD). Few isolated studies on how Sensory Processing Disorder manifests as an image of brain dysfunction have been conducted. This could be in part because its existence as a separate and distinct neurological disability is still quite controversial. According to a recent policy statement put forth by the American Academy of Pediatrics, “the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive,” (2015). However, Owen et al. (2013) in a landmark study showed that children who met criteria only for sensory processing disorder have anatomical differences in their brain structure than children who do not present with sensory processing difficulties. Owen and her colleagues at The University of California San Francisco found that children affected specifically with Sensory Processing Disorder (SPD) have abnormal white matter microstructure. This is the first time that a biological basis for the disease, which sets it apart from other neuro-developmental disorders has been found. According to the researchers, one of the reasons SPD has been overlooked until now is that it often occurs in children who also have ADHD or autism. This study also shows that SPD may in fact be a distinct disorder that affects individuals with and without other neurological disabilities. Therefore, more research into this disorder as well as treatment for this disorder needs to be further explored in other populations.

As mentioned above, the common pediatric conditions of study with Sensory Processing Disorder are Autism and ADHD; therefore, the uniqueness of this study is that it focuses on SPD in a population other than those previously studied. The subject is a 14-year-old female who has had early biological insults to the developing brain via infantile stroke and the condition Electrical Status Epilepticus of Sleep (ESES). This is a rare form of epilepsy that produces subclinical (unseen) seizures during sleep. This type of epilepsy is characterized by the presence of generalized 1-3 Hz spike-wave discharges occupying 85% or more of the EEG of non-REM sleep. Overall, she presents with a neuro-developmental disorder due to an acquired brain injury (ABI) occurring both in utero and continuously due to the ESES. Ungerleider (1995) states “recent functional brain imaging studies in humans indicate that learning and memory involve many of the same regions of the cortex that process sensory information and control motor output.” This study shows that there is a potential for a positive correlation between SPD, learning and memory.      Furthermore, findings from a study by Tarapore et al (2013) support the hypothesis since “disruption of the long-range communication between brain regions, as measured by reductions in functional connectivity, would be found in patients [with TBI] compared with matched controls.” The results from this study and Owen et al show that both individuals with traumatic brain injury (TBI) and SPD have reduced connectivity between brain regions. Therefore, SPD could be a prevalent issue either dependent or independent of the brain injury for individuals with ABI; subsequently, the intervention for SPD could be effective for individuals with ABI.

Given the lack of research in the area of SPD for acquired brain injury populations coupled with the researchers’ combined therapeutic and educational experiences an interest was taken into studying the relationship between increased sensory processing skills and academic achievement for a 14-year-old female with infantile stroke and Electrical Status Epilepticus of Sleep (ESES) among other neurological disorders. The objective of this study was to determine the relationship between an increase in sensory processing alertness/engagement and academic achievement for a subject with neuro-developmental disorders specifically ESES. Since there was evidence that Sensory Processing Disorder was indeed a neuro-developmental brain disorder, and manifested in a neurologically similar way as ABI, it was hypothesized that the similarities between the deficit manifestations could respond to an external intervention previously used for individuals with SPD and ultimately improve cognition and learning. As previously stated very few studies have been conducted to investigate this theory; however, Polatajko et al (1991) found that a sensory integrative intervention was as effective as perceptual-motor training,  “when administered for 1 hour, once a week, for 6 months…in improving academic and motor performance in children with learning disabilities associated with SI dysfunction.”

Subject Background
The subject was internationally adopted at seven months old. Her hospital records contained insufficient documentation of parental pre-adoption history; however, according to medical records, her weight was reported to be 700 grams, and she had APGAR scores of 3, 5, and 5. Her hospital birth records noted the amniotic fluid smelled fetid.  It was later that an analysis of an MRI of her brain indicated interruption in blood flow to the brain. This occurred at approximately the 23rd week of gestation.  Based upon a CT scan taken at 9 months, doctors estimated she had lost approximately 30 percent of brain matter. Subject’s current head circumference is 43.3 cm, which is considered to be in the first percentile for a 20-month-old girl and indicates microcephaly.Her motor and cognitive developmental milestones were all delayed or never occurred.  In regards to her gross motor development, her records indicated that she began standing alone while holding onto a stable object at 3.5 years; she began to walk independently on a flat surface at 4.5 years, and was able to navigate stairs with assistance at 6.5 years. In regards to her cognitive development with a focus on communication, her records indicated, she was interested and attracted to sound at 7 months, she spoke her first word at 3 years, she spoke unintelligible words and phrases at 9 years, and began speaking in some intelligible short simple sentences in combination with a high-tech communication device at 13 years.

When initial researchers’ interventions with the subject began, formal education had stopped for an entire academic year. The subject was instead receiving traditional out-patient therapies (OT, PT, and speech), and Augmentative and Alternative Communication (AAC) Training for her Dynavox device for approximately 20 hours each week.

Methodology
Researchers gathered baseline academic achievement through scores indicated on her Individualized Education Plan (IEP) from September 2013. The scores were taken from an independent psycho-education evaluation. Additionally, modified testing using the Brigance Inventory of Early Development III (2013) was completed in order to corroborate results specified in her IEP. Tests included: color identification, identifies uppercase letters, identifies basic personal information, rote counting, reads words from common signs, word recognition grade placement test (modified). Subject responded to questions utilizing her AAC device and verbal responses to closed questioning. Additionally, researchers collected baseline sensory systems data. Both cognitive and sensory intervention was delivered in school and home with participation of medical, educational and technical staff.

Research clinicians used an experimenter designed 7-sense diet and tracking sheet to measure outcomes from the Experimenter Sensory Diet, based on the sensory diet theory from research conducted on subjects with sensory defensiveness by Occupational Therapist Patricia Wilbarger in 1991. “A sensory diet is a form of a home program intervention plan that incorporates organizing sensory input, or utilizes already existing sensory input, into everyday life in order to assist the person to maintain a regulated behavioral state, such as the calm, alert state required during certain school activities (Wilbarger, 1991). Multiple sensory diet strategies may be implemented at regular intervals throughout the day. In particular, these strategies may be performed prior to times that may be considered challenging, in order to prepare or set up the body to maintain an organized state throughout the activity, or they may also be used during activities in order to assist the client to maintain an organized state throughout the activity (Williams & Shellenberger, 1994). In this study, the diet tracking sheets were designed by the research clinicians to measure the observable sensory strategies via Levels of Engagement (LoE) and Levels of Alertness (LoA) on a 5-point scale, and were recorded by a trained technician on specific diet adjustments dependent upon the various phases of the research.

Direct Instruction coupled with aspects of strategy-instruction was utilized during individual/small group instruction. Glang et al (1991) found that after 12 hours of direct instruction, “both Subject made substantial academic progress in their targeted instructional areas.” Direct Instruction is a teacher-directed method of instruction in which cognitive skills are broken down into very basic components and explicitly taught. “Specific techniques include: breaking down the instructions and tasks into small steps, teaching modeling of skill or task, administering feedback repeatedly…allowing independent practice and individually paced instruction. “ In addition, aspects of Strategy Instruction such as “verbal modeling, questioning, reminders to use strategies or procedures,” (Sohlberg, M, et al, 2005) were utilized. Direct Instruction was utilized because it is one of the only researched methods of instruction shown to be effective in teaching Subjects with Acquired Brain Injury.  Glang et al (2008) concluded in a literature review that “Two instructional approaches—Direct Instruction and cognitive strategy intervention—have significant evidence supporting their use with many populations of children, with and without disabilities, and address many of the common needs and learning characteristics of Subjects with TBI, thus showing particular promise for these Subjects.”

Review of Process
Modified 7- sense (visual, tactile, auditory, vestibular, proprioceptive, olfactory, and gustatory) sensory diets were assigned in three phases: The Introductory Phase, The Second Phase (Extremity-Specific Phase), and The Third Phase (Subject Initiation Phase). In the first 4 months, diets were implemented up to 6 times a day on the subject (Head, Upper and Lower Extremities). During the next 8 months, diets were scaled back and implemented to 3 times a day.

During all of the phases, a modified 7-sense tracking sheet was aligned to the specific extremity and the protocol order with (Levels of Alertness) LoA and Levels of Engagement (LoE). Likert Scales for LoA and LoE were developed by the researchers and attached to the protocol.  LoA were measured as: 1 (deep sleep); 2 (sleepy/intentional eye closure), 3 (calm/neutral/awake); 4 (wide-awake); and 5 (hyper-active). LoE were measured as: 1 (unengaged); 2 (engaged 25%); 3 (engaged 50%); 4 (engaged 75%); 5 (engaged 100%). In addition, pictures accompanied each Likert demarcation for added clarity of the descriptions.

In the Introductory Phase, a Proximo-distal, hierarchical arrangement of the sensory protocol was performed on both upper and lower extremities at one session.  The hierarchical arrangement included, in order: modified milking massage (15 repetitions on every extremity), modified Wilbarger brushing (unidirectional, from proximal to distal, 15 repetitions on every extremity with moderate pressure), localized extremity joint vibration with battery-operated 4 prong Homemedics handheld massager (Proximal to distal: UE shoulder, elbow, wrist; LE hip, knee, ankle, 15 counts per joint), modified auditory integration program (50% volume on source, Sound Health Series mix, Sennheiser Closed 202 headphones). Each sensory diet lasted between 15 to 30 minutes in total length.  Each part of the diets was labeled and defined to the subject by provider prior, during and after the diet was completed. This lasted for the first 3 months.

The Second Phase was a division of the Introductory Phase into extremity-specific sessions. One 15- 30-minute session would be dedicated to the Upper Extremity protocol; another 15-30 minute session would be dedicated to the Lower Extremity protocol. Both types would use the modified Auditory Integration Therapy respectively. Diets lasted between 15 to 30 minutes in total length, and these were repeated up to three (3) times a day respectively. Diets were labeled and defined by provider prior, during and after the diet was completed. This was initiated immediately after the Introductory Phase, the next 3 months.

The Third Phase required Subject determination and use of communication strategies embedded in her AAC device. The provider would inquire what body extremity (UE/LE or R/L), and what specific diet was preferred. Diets lasted between 15 to 30 minutes in total length, and these were repeated up to five (5) times a day respectively.  Diets were labeled and defined by Subject choice prior, during and after the diet was completed. This came immediately after the Second Phase, the last 3 months.

Direct Instruction coupled with aspects of strategy-instruction was utilized during individual/small group instruction. The aspects of strategy-instruction included verbal modeling, questioning, and verbal reminders to use support strategies. When subject mastered content with at least 80% accuracy over five consecutive sessions, new topics were introduced. Previous skills were consistently revisited during the first five minutes of lessons as well as incorporated into lessons when applicable to the new skill being taught. Subject’s academic program took place five days a week and consisted of two-three formal 30-minute individual or small group  (2-3 Subjects) periods, and two formal 30-minute whole group (6 Subjects) periods over the course of 480 minutes per day for 12 months.

Post-Test academic achievement and sensory processing was taken one year after baseline. Post-Test academic achievement was taken again via an independent psycho-educational testing and modified Brigance testing which was completed in October 2014. Brigance testing included: knows personal information, Identifies parts of the body, word recognition grade placement test, counts by rote, reading comprehension grade placement, recognizes quantity, understands qualitative concepts, identifies common signs, reads words from common signs, recognizes quantity, adds numbers, subtracts numbers, multiplies numbers, divides numbers. Subject responded to both assessments utilizing a combination of AAC device, open and close verbal questioning and a touch screen device.  A case study by Kirsch, et al (2004) concluded, “ATC interventions can facilitate functional performance and contribute to learning of specific adaptive skills. Wireless, interactive, Web-based interventions appear particularly suited to tasks in the home and community, permitting remote intervention and monitoring of task status.”

Results
At baseline, the subject presented with aversion to the diet protocol (0% for both levels of engagement and alertness). The subject required maximal technical assistance for 2 months (October-November 2013) prior to responding positively to the diet protocol; the protocol was narrowed from a 7 sense to a 5 sense during this time period to accommodate the subject’s sensory processing needs as recorded by the technician on the LoA and LoE tracking sheets. From December 2013 to January 2014, a segmented protocol was introduced, also known as phase-two, to isolate sense stimulation with the head and extremity stimulation. From February 2014-May 2014, the subject continued with phase 2 and the technician recorded trends of responses.

It was also noted at baseline that the subject tested at a pre-kindergarten level for word recognition and kindergarten level for computation. Results corroborated with the independent psycho-education evaluation.

Evidence from assessments demonstrated a positive correlation between increased and consistent levels of alertness and engagement during improvements in segmented diets and academic achievement.

Post-Testing Sensory Diet Tracking results in May-June 2014 showed the subject to be alert at level 3 (calm/neutral/awake) for 86.7% and at level 2 (sleepy, intentional eye-closure) for 13.3% of the recorded sessions. The tracking sheets also showed the subject to be engaged at level 4 (engaged for 75% of the activity) for 68.3%, at level 3 (engaged for 50% of the activity) for 26.7% and at a level 2(engaged for 25% of the activity) for 5% of the recorded sessions. This is in comparison to the results from baseline upon introduction of the protocol for which the subject responded aversively and therefore was reported to be at 0%.

In addition, post-testing cognitive results via the modified Brigance testing had subject at a 3rd grade level on word recognition and computation (addition, subtraction, multiplication and division), in comparison to subject’s baseline testing which was respectively at a Pre-Kindergarten and Kindergarten level.

Conclusion
Based on the results, this case study shows a positive correlation between increased sensory processing alertness/engagement and increased academic achievement when sensory diets are administered. It is showing a significant change in percentage of optimal alertness and engagement for this 14-year old with neuro-developmental disorder specifically ESES Subject who displayed an 87% LoA (wide awake) and 68% LoE (engaged 75%) in the sensory diet protocol with an improvement in performance in modified Brigance testing from a Pre-K work recognition to 3rd grade, and K Comp to 3rd grade. This reveals a 4 and 3-grade level jump, respectively, over the course of one year. This case study validates the hypothesis that increased sensory processing alertness/engagement plays a part in increasing academic achievement in an adolescent female with neuro-developmental disorder specifically ESES.

This study utilized a single-subject design, which strengthens the internal validity of the study; however decreases the external validity of the study as it is not generalizable to other individuals within this population as it only pertains to the change evidenced with this particular subject. Furthermore, it needs to be noted that additional traditional therapies, including physical therapy, occupational therapy, speech and language therapy including augmentative and alternative communication therapy as well as modified conductive education, a program designed for children with motor dysfunction, which integrates education and rehabilitation into one program with the goal of achieving ortho-function–the capacity of individuals to respond to biological and social demands (Darrah, 2003)–were performed throughout the Subject’s day, which decreases the internal validity of the study as these interventions were not controlled for and may have played a role in her overall increase in academic achievement.

However, the results of this study indicate that a comorbidity of SPD and subsequent interventions for SPD need to be further explored for individuals with ABI as a way to increase sensory processing and academic achievement. Further work on the efficacy of sensory processing skills needs to be studied within a clinical based setting to determine if the benefits are generalizable to other children within this population as well other populations. Future studies should control for factors including but not limited to therapeutic interventions and duration of interventions on a daily basis.

Finally, according to a recent policy statement put forth by the American Academy of Pediatrics, “the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive,” (2015). Therefore, more clinical based research regarding SPD as a distinct diagnosis and as a co-morbidity with the ABI population needs to be conducted in clinical based settings in order to address the controversy and limitations surrounding diagnosis and interventions for SPD either as a distinct or co-morbid diagnosis. This case study and the few that proceeded serve as first step in a relatively unexplored field that stands to yield significant benefits for both individuals with and without ABI.

References
Ayres, A. Jean. (2005). Sensory integration and the child. Torrance, CA: Western Psychological
Services.

Brigance, Albert H. (2013). The inventory of early development III. North Billerica, MA:
Curriculum Associates, LLC.

Darrah, Johanna et al. (2003). Effects of conductive education intervention for children with a
diagnosis of cerebral palsy: an AACPDM evidence report.

Glang, Ann et al. “Using Direct Instruction with Brain Injured Subjects.” Direct Instruction News.
Fall 1991: 23-28.

Glang, Ann et al. (2008). Validated instructional practices: applications to Subjects with    traumatic brain injury. The Journal of Head Trauma Rehabilitation, 23(4), 243-251.

Kinnealey, M., Oliver, B., & Wilbarger, P. (1995). A phenomenological study of sensory defensiveness in adults. American Journal of Occupational Therapy49(5), 444-451.

Kirsch, Ned, L. et al. (2004). Web-based assistive technology interventions for cognitive

impairments after traumatic brain injury: a selective review and two case studies. Rehabilitation Psychology, 49(3), 200-211.  

Kranowitz, Carol S. (2005). The out-of-sync- child: recognizing and coping with sensory processing disorder. New York, NY: Penguin Group.

Owen, Julie, P. et al. (2013). Abnormal white matter microstructure in children with sensory
processing disorders. NeuroImage: Clinical, 2, 844-853.

Polatajko, Helene, J. et al. (1991). The effect of a sensory integration program on academic achievement, motor performance, and self-esteem in children identified as learning disabled: results of a clinical trial. The Occupational Therapy Journal of Research, 11(3), 155-176.

Shellenberger, S., & Williams, M. (2002). How does your engine run?. The Alert Program for self-regulation. In A. Bundy, S. Lane, E. Murray (Eds.), Sensory integration: Theory and practice, 342-345.  

Sohlberg, McKay, M. et al. (2005). Instructional techniques in cognitive rehabilitation: a  preliminary report. Seminars in Speech and Language, 26(5).  268-279.

Tarapore, Phiroz E. et.al, (2013). Resting state magnetoencephalography functional connectivity   in traumatic brain injury. Journal of Neurosurgery. 118(6), 1306-1316.

Ungerleider, Leslie, G. 1995. Functional brain imaging studies of cortical mechanisms for memory. Science, 270(5237), 769-775.

Wilbarger, J., & Wilbarger, P. (2002). Clinical application of the sensory diet. Sensory integration: Theory and practice. 2nd ed. Philadelphia: FA Davis Company, 339-341.

Journal of Head Trauma Rehabilitation Abstract May/June 2015 Publication!

Journal of Head Trauma Rehabilitation
doi: 10.1097/HTR.0000000000000150
Original Articles: Abstracts

North American Brain Injury Societys 12th Annual Conference on Brain Injury

Silver, Jonathan MD; Ziejewski, Mariusz PhD

XLargeThumb.00001199-201505000-00000.CV

0018 A Case Study on the Relationship Between Sensory Processing Skills and Academic Achievement in a 14 year old Female With Electrical Status Epilepticus During Sleep (ESES)

Category: Neurorehabilitation- Case report/Clinical Research

Author’s preference: Oral

Dechantal Montano, Sara Naegele

ESNP Educational Consulting, Brooklyn, NY, USA

Introduction/Rationale

This case study shows a relationship between increased sensory processing skills and academic achievement for a 14-year-old female with infantile stroke and electrical status epilepticus of sleep (ESES) among other disorders. The objective of this study was to determine the relationship between an increase in sensory processing alertness/engagement and academic achievement for a student with ESES.

Method/Approach

An independent psychoeducational evaluation, modified Brigance Testing, and 7-sense diet tracking were used to gather baseline data. Diet measured levels of engagement (LoE) and alertness (LoA) on a 5 point scale. Modified 7- sense sensory diets were implemented up to 6 times a day in the first 4 months lasting for 15-30 minutes, and up to 3 times a day for the last 8 months. The academic program was two to three formal 30-minute individual, or small group, periods, and two formal 30-minute whole group periods for 12 months. A direct instruction model was used. Post-test academic and sensory processing achievement was measured one year after baseline was determined.

Results/Effects

At baseline, the student presented with sn aversion to the diet protocol (0% for both LoE and LoA). The student tested at the pre-kindergarten level for word recognition and computation and kindergarten level for rote counting. For post-testing the student had to be alert 86.7% at level 3 (calm, neutral/neutral/awake) and 13.3% at level 2 (sleepy, intentional eye-closure) and engaged 68.3% at level 4 (engaged for 75% of the activity), 26.7% at level 3 (engaged for 50% of the activity) and 5% at a level 2 (engaged for 25% of the activity). Modified Brigance-Testing had her at 3rd grade on word recognition and computation (addition, subtraction, multiplication and division).

Conclusions/Limitations

This case study shows positive correlation between increased sensory processing alertness/engagement and academic achievement when sensory diets are administered. Increased sensory processing alertness/engagement plays a part in increasing academic achievement in children with ESES. Please note that additional therapies were performed throughout the student’s day and may have played a role in her overall increase in academic achievement. Further work on the efficacy of sensory processing skills needs to be studied within a clinical based setting to determine if the benefits are generalized to other children within this population, as well as to other populations.

Attention (is to Thinking) and Sustenance

Stop. Listen to a song, podcast or have a conversation with a friend—for 30 seconds. That is about the length of time a child with severe attention issues is able to focus on any given piece of information coming from one sensory source at any given moment. Regardless of whether the time felt long or short, children today are required to not only pay attention, but pay_attentioncomprehend and take notes on the important information being delivered through a primarily one-dimensional sensory source for at least 5 minutes, but many times 20 or 30 minutes at a time.

Sustained attention is the ability to direct ones attention to a specified source without losing focus despite potential distractors. Children and adults greatly struggle with sustained attention today; the environment no longer demands it and, in many instances reinforces, the opposite. From the 10-second news clips, to the demands on attention from multiple sources ranging from text messages, to email, to the never-ending checklist of tasks needing to be completed. The length one is expected to pay attention has significantly decreased in the digital age of instantaneous communication and access to information. However this change has not only affected the world of adults and adult occupations. It has infested itself down to the youngest of children. Dr. Straub discusses what Dr. Dimitri Christakis found in a Baby Einstein episode “A Day on the Farm”, seven scene changes occurred in a 20 second period of time compared to no scene changes in a clip of Mister Roger’s Neighborhood. Taken one step-further, Mister Roger’s Neighborhood was the only show that had no impact on children’s attention span later in school when compared to children who watched no TV. Dr. Straub theorizes this is because the show was designed to increase attention span by requiring the sole focus to be on one person. Other television series, including Baby Einstein and Sesame Street had a negative impact on attention spans in school-aged children. The theory behind this is known as the overstimulation hypothesis, which states, “That is, prolonged exposure to rapid image changes during a child’s critical period of brain development preconditions their mind to expect high levels of stimulation, which leads to inattention in later life.” While pediatricians and child development experts dissuade children from being exposed to television, computers, etc., these changing demands on attention can be found in other modalities. Toys that light up, blink, play songs, talk, move all at the push of various buttons are not effectively aiding children in improving his/her sensory processing, but rather decreasing his/her ability to focus on any given stimulus sources for more than 30 seconds. This short snippet of required attention is reinforced throughout a child’s early development.

Then school happens. Children are suddenly required to pay attention for 5-15 minutes with major distractors—wiggly bodies, children and adults talking, chairs being pulled out and pushed in, etc. If these same children have been exposed to children’s so called educational programs, smartphones, electronic toys, they have essentially been set-up to fail. Their muscle for sustained attention has not be developed and it has little if anything to do with ADHD; the pace of learning is simply too slow. Their brains have been wired to expect and therefore perform in a near opposite way for the first 5 years of their life; therefore, like most new tasks, one needs to practice in order to become successful. Children today, need practice at sustaining their attention. Oftentimes these students with weakened sustained attention are automatically labeled and sometimes mislabeled as having Attention-Deficit-Hyperactivity Disorder (ADHD); however according to Dr. C. Thomas Gualtieri, et al “ADHD is not simply a disorder of sustained attention. Indeed, impairment in sustained attention is common to a certain extent to all children with psychiatric disorders. Neuropsychological studies of ADHD children and adults reveal subtle but clear impairments in ???????????????????????????????????????several complex functional systems: Selective attention memory; reaction time and information processing speed; motor speed and visuomotor ability; and executive control functions, like set-shifting, inhibitory control, and working memory.” Therefore, since one can have sustained attention weakness without having ADHD; it is essential for educators to be well-versed in understanding executive function skills as well as the vast array of researched and identified disorders that emerge during childhood. Quick fixes such as medication may not always be the best answer, especially if the cause is has been wrongly concluded.

Before wrongly labeling every attention-deficient student, steps to strengthen the sustained attention muscle are critical. One way to effectively do this is to incorporate state changes intentionally throughout the lessons in order to allow students to set-shift before becoming disengaged with the material because the content is being presented without a scene change and/or utilizing only one sense. State changes for all intensive purposes provide that ‘scene change’ the brain has become programmed to expect. Attention spans for elementary aged students range anywhere from 4 to 6 minutes; mini lessons are targeted at 5 minutes; however can easily go up to 15 or more. These numbers are based on what is average or typical; therefore there will be students whose sustained attention can barely make it to 3 minutes. Steve Roninette defines state changes as, “continually switching the sensory focus from visual to auditory to body kinesthetic and back again. This keeps students’ attention and gives them the opportunity to learn more as they tap into all their senses.” State changes come in a variety of forms and can become integrated into the lesson to enhance a particular point. They can be kinesthetic in nature and unrelated to any lesson, in which case it’s best to use them between lessons. Examples include: Brain Gym Activities, simple yoga poses, wiggle or dance breaks. Dr. Gerard Evanski explains the scientific reason behind the necessity and effectiveness of state changes, “The human brain does not store energy. The brain needs a constant blood supply, which brings it oxygen and nutrients. Dr. David Sousa has said that blood tends to pool in “our feet and our seat” when we sit for too long. Many of my state changes for students are designed to also energize them, and get their blood full of oxygen and flowing to the brain.” While kinesthetic state changes may be the most energizing, they are not the only option. State changes can also be verbal or auditory and related to the content, and therefore should be incorporated into the lesson right before students typically tune out. Examples include: turn and talks, think, pair, share, or any form of verbal/auditory recap of the lesson content. State changes can also be more passive and simply change the way information is being presented to students. For example, showing a video to reinforce the topic that was just presented.

In addition to state changes, increasing sustained attention through sustaining attention is another way. Meditation or attending to guided imagery exercises offer a non-academic way to increase sustained attention while also decreasing the cortisol release and overall levels of stress. A study conducted by Dr. Stephani Sutherland at University of Southern California, found that mindfulness training and continued practice improved sustained attention when compared to no interventchildrenion or the practice of physical relaxation, whereas there was no difference between the two groups when measuring changes in concentration and inhibition of distraction. This shows that simple and easy to use interventions can be utilized in the classroom to target and increase student’s sustained attention.

Overall, the demands placed on people in the twenty-first century significantly inhibit our ability to pay attention for long periods of time; however, the very system that educates our children and many occupations in which those same children enter demand just the opposite—an ability to focus for a duration of time and internalize information despite distractors. Until one or the other changes. It is crucial to build in opportunities to help strengthen weakened or never developed abilities to attend. Most children simply cannot come to school ready-made with a skill that is not only not expected of them or naturally reinforced in their environment, but the exact opposite skill is being applied on a daily basis. If training and teaching does not occur for children during their school-day, like many other shifts in the field of education, this will be one more that sets up children for failure instead of success.

Children (Both Big and Small) Learn What They Live

Children Learn What They Live


By Dorothy Law Nolte, Ph.D.

If children live with criticism, they learn to condemn.

If children live with hostility, they learn to fight.

If children live with fear, they learn to be apprehensive.

If children live with pity, they learn to feel sorry for themselves.

Many children spend more waking time in the presence of their teachers, than their parents and caregivers.  Therefore, it may be a safe assumption that children growing up in the twenty-first century are learning what they live based on their school experience–their teachers–just as much (maybe some cases more) as they are from their caregivers.  While teachers have been taught about behavior management, best practices and given scripts for curriculums, not many are required to take college courses on developing executive functioning skills or more specifically character. Yet, they may be responsible for a large part of character development for the students they teach on daily basis.

In recent years, this is become quite obvious as there has been the push for character education to return to school curriculums and the creation of character report cards that grade children on the development of their character. This is a useful tool if character is being taught, modeled and monitored throughout the semester.

If children live with ridicule, they learn to feel shy.

If children live with jealousy, they learn to feel envy.

If children live with shame, they learn to feel guilty.

If children live with encouragement, they learn confidence.

While the intent of these two movements are originating from different sources; they are sending a similar message: children today are not naturally developing and/or aware of their character. The former was in response to the increase in bullying and ostracization of students; the latter was the rude realization that while schools were producing high school graduates capable of earning a high school diploma and acceptance into college; these same students were not only struggling once they reached college, but were dropping out.

Enter Dr. Angela Lee Duckworth. Her research uncovered that grit and self-control are better predictors for academic achievement than IQ, socio-economic status (family income) among other factors. Her research states that “Grit is the tendency to sustain interest in and effort toward very long-term goals (Duckworth et al., 2007). Self-control is the voluntary regulation of behavioral, emotional, and attentional impulses in the presence of momentarily gratifying temptations or diversions (Duckworth & Seligman, 2005; Duckworth & Steinberg, in press). Her definitions for grit and self-control mirror two concepts found in executive function skills: goal-directed persistence and response inhibition. However, regardless of what they are called, the fact remains that these skills appear essential to success; yet adolescents today do not possess these traits upon graduation from high school and pay for it dearly. So some critical questions remain: Can anyone possess these characteristics or skills? How does one acquire them? Who is ultimately responsible for “teaching” them?

If children live with tolerance, they learn patience.

If children live with praise, they learn appreciation.

If children live with acceptance, they learn to love.

If children live with approval, they learn to like themselves.

If viewed from an executive functioning perspective, the answer to the fist two questions is relatively straightforward. Yes, anyone can possess them; some people appear to demonstrate more natural strengths or abilities in particular skills than others, but strategies to strengthen or accommodate areas of weakness exist and yield successful outcomes. The last question is more difficult to answer.

If viewed from a character perspective, researchers and the U.S. Education System answer the first two questions in a similar fashion. Anyone is capable of possessing these characteristics. They are acquired through direct instruction, modeling, and life experience. They also offered a straightforward answer to the third question: it is the responsibility of both schools and parents to teach character.

What happens then, if teachers themselves have never been taught or simply demonstrate a weakness in the character traits they are expected to teach and model? Or what happens if parents and teachers view these skills through different lenses?

If children live with recognition, they learn it is good to have a goal.

If children live with sharing, they learn generosity.

If children live with honesty, they learn truthfulness.

If children live with fairness, they learn justice.

Mostly likely, that is happening right now. Character traits like grit and self-control may or may not be taught in schools and in homes. If they are taught, perhaps they are taught differently which leads to children experiencing mixed-messages and putting a hybrid of the two into practice. This may work for some, but for others it leads to dropping or failing out of high school or college. The origins of character education are synonymous with an academic education. Character education changed in the 1960s and 1970s when the focus shifted to the process of making moral decisions versus the content of morality. It has now reemerged in the past decade most likely as a result of the publicized findings on college success rates of KIPP Academy students and theories as to why it was so low.

Yet, the re-introduction of the curriculum does not mean the mastery of skills by those expected to teach it. If teachers haven’t been taught, are never asked to self-reflect and evaluate their own areas of strength and weakness the result inevitably is they don’t know what they don’t know. So, how can they teach it?

The oversimplified truth is they can, just not effectively. It has been shown that children not only learn what they live, they live what they learn. Teachers are children all grown up; they too now live what they learned. And they can only be expected to teach what they have been taught. Maybe it is time to share the focus on how we teach our children with how we teach our teachers.

If children live with kindness and consideration, they learn respect.

If children live with security, they learn to have faith in themselves and in those about them.

If children live with friendliness, they learn the world is a nice place in which to live.

The Balancing Act Homework and Extracurricular Lives in School-Aged Children

For every generation of parents who have school age children, there is a theme that binds parents from the past to present: either there is too much homework, or too many extracurricular activities. Modern life has sped up the pace incredibly, especially in metropolitan cities around the world, making the demands after the school day on the family become even more stressful.

And it isn’t actually an unusual complaint or observation from a parent. The perception that homework has increased in recent years is supported by the results of a research study from the University of Michigan in 2000. The Institute for Social Research at the University of Michigan found that time spent on home study by 6- to 8-year-old children more than doubled between 1981 and 1997 (Hofferth & Sandberg, 2000). Their results found a 146% increase between 1981 and 1997 in the time that six- to eight-year-old children (generally in grades K-3) spent on home study. In 1981, time diaries that were used to record homework times indicated that primary-grade children spent an average of 52 minutes studying per week; this figure increased to 128 minutes per week in 1997 (Hofferth & Sandberg, 2000). The proportional increase seemed very large because the baseline measurement—time spent on study in 1981—was very small. Moreover, the ISR study found no substantial increase in home study time over the same period for nine to twelve-year-old children (generally third to sixth graders). Their average weekly home study time was 3:22 in 1981 and 3:41 in 1997— a difference that was not large enough to achieve statistical significance.(Hofferth & Sandberg, 2000)

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In 2003, The Journal of Educational Evaluation and Policy Analysis published a study by Brian P. Gill and Steven L. Schlossman entitled,  “A Nation at Rest: The American Way of Homework.” The researchers found that the great majority of American children at all grade levels then spent less than one hour studying on a typical day—an amount that has not changed substantially in at least 20 years. High school students in the late 1940s and early 1950s studied no more than their counterparts did in the 1970s, 1980s, and 1990s.

Gill and Schlossman have also concluded that changes in educational opinion on homework over the last half century prior to 2003 have had little effect on student behavior, with only two notable exceptions: a temporary increase in homework time in the decade following Sputnik, and a new willingness in the two decades before the 2000’s to assign small amounts to primary-grade students. Does this signify then that homework is dictated by current events and/or standings of students when ranked side by side their peers from other countries?

As a standard, homework recommendations from the National Education Association conclude that, “The National PTA recommendations fall in line with general guidelines suggested by researcher Harris Cooper: 10-20 minutes per night in the first grade, and an additional 10 minutes per grade level thereafter (e.g., 20 minutes for second grade, 120 minutes for twelfth). High school students may sometimes do more, depending on what classes they take.”

They also cite that homework usually falls into one of three categories: practice, preparation, or extension; the purpose usually varies by grade. Individualized assignments that tap into students’ existing skills or interests can be motivating. At the elementary school level, homework can help students develop study skills and habits and can keep families informed about their child’s learning. At the secondary school level, student homework is associated with greater academic achievement. (Review of Educational Research, 2006).

The Review of Educational Research published a comprehensive survey of all the studies on homework and achievement performed between 1987 and 2003. A strong connection was found between the two particularly in high school. In elementary grades, homework helps youngsters establish healthy study habits and keeps parents connected to what their children are doing at school. Homework in high school also lead to higher scholastic success. However, more recently in 2014, a Stanford researcher found that too much homework can negatively affect kids, especially their lives away from school, where family, friends and activities matter. The researchers used survey data to examine perceptions about homework, student well-being and behavioral engagement in a sample of 4,317 students from 10 high-performing high schools in upper-middle-class California communities. Students in these schools average about 3.1 hours of homework each night.

Denise Pope, a senior lecturer at the Stanford Graduate School of Education co-authored a study published in the Journal of Experimental Education with Mollie Galloway and Jerusha Conner, found that too much homework is associated with:

• Greater stress: 56 percent of the students considered homework a primary source of stress. Forty-three percent viewed tests as a primary stressor, while 33 percent put the pressure to get good grades in that category. Less than 1 percent of the students said homework was not a stressor.

• Reductions in health: In their open-ended answers, many students said their homework load led to sleep deprivation and other health problems. 

• Less time for friends, family and extracurricular pursuits: Both the survey data and student responses indicated that spending too much time on homework meant that students were “not meeting their developmental needs or cultivating other critical life skills,” according to the researchers. Students were more likely to drop activities, not see friends or family, and not pursue hobbies they enjoy.

In places where students attend high-performing schools, too much homework can reduce their time to foster skills in the area of personal responsibility, the researchers concluded. “Young people are spending more time alone,” they wrote, “which means less time for family and fewer opportunities to engage in their communities.”

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On the flipside, there are students who value time to engage in their interests and communities via extracurricular activities on top of homework. Participation in activities such as sports, clubs, private lessons, and religious activities enrich students’ lives by supporting social skills.  Several studies emphasize the benefits of extracurricular activities and homework, while others focus on the negative consequences of each. Overscheduled children may not have as much time to complete homework assignments, leading to a decline in academic achievement. According to the critics too much involvement in extracurricular activities takes away from time that could be spent studying or completing homework.  On the other hand there were many students who also felt forced or obligated to choose homework over developing other talents or skills.

A bit of history on the extracurricular path into student lives. Extracurricular activities began in the United States in the 19th century. At first they were just an additional part to the normal academic schedule for the year and usually had some practical or vocational interest that was included into the activities. The first extracurricular activities that were well known in schools started at Harvard and Yale University. They were literacy clubs that consisted of different debate clubs and Greek systems such as fraternities and sororities.

Students in American schools were the first to initiate athletic clubs which soon became popular while literacy clubs began to decline. Around the time of World War I, schools started adding clubs such as journalism, and newspaper. (Casinger, J. 2011) Now these clubs have become popular and many public high schools and grade schools have clubs for all interests. In the year 2010, about 1 in 4 students participated in academic clubs. (Miller, Zittleman, 2010).

To determine the relationship between extracurricular involvement and homework performance,  a research study was conducted by Rachel Johnson and Ryana Moulden entitled, “A Correlational Study of Extracurricular Involvement and Homework Performance of Third Grade Students.”  Data was collected in two third grade classes for the four-week study in two elementary schools. For the first two weeks, math homework scores were recorded, and the second two weeks, language arts homework scores were recorded. No significant correlation was found between the number of hours spent in extracurricular activities and math homework performance, however the results revealed a significant negative relationship between the number of hours spent in extracurricular activities and language arts homework performance.

In his article, “Extracurricular Activities,”  Fred C. Lunenburg states, “Extracurricular activities serve the same goals and functions as the required and elective courses in the curriculum. However, they provide experiences that are not included in formal courses of study. They allow students to apply the knowledge that they have learned in other classes and acquire concepts of democratic life.”(2010)  The positive effects that extracurricular activities have on students’ education are behavior, better grades, school completion, positive aspects to become successful adults, and a social aspect. Higher grades and positive attitudes towards school are secondary effects that extracurricular activities have on students. Self esteem can be a predictor of academic performance. Students who don’t like school won’t do as well as the students who do like school because they are not motivated to succeed. The students who don’t like school usually feel as though they are not succeeding or that they can succeed.

A study done by the United States Department of Education revealed that, “Students who participate in extracurricular activities are three times more likely to have a grade point average of a 3.0 or higher. This is higher than students who did not participate in extracurricular activities. This is regardless of their previous background or achievement.” Students that participate in extracurricular activities also showed positive changes in students self confidence, teacher perception, and greater confidence, and then developed positive school related adult attachments. Extracurricular activities increases a students connection to school, raises their self esteem, and positive social natures.

These are some of the results of The Harris Poll of 2,241 adults (of whom 457 have school-aged children) surveyed online between June 11 and 17, 2014. With parents of K-12 students reporting their children spend an average of 38.4 hours per week on scheduled activities during the school year (including school time, extra-curricular school activities and other scheduled commitments), while maintaining an average of 19.1 hours of free time, this finds America’s school-aged children with a roughly 2:1 ratio of scheduled to free/leisure time.  Perhaps not surprisingly, parents whose children have 15 or more hours per week of combined extracurricular and other “scheduled” time are much more likely than those whose children have under 15 hours to report feeling pressured to put their child in activities that other children are doing (21% <15 hours, 36% 15+ hours). They are then also more likely to worry their child is “over-programmed” (18% and 35%, respectively).

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At the end of the day, it is a balance between time and aptitude between homework and extracurricular activities, as both are a part of character and brain development for students. In the Harris Poll where some adults see a crowded calendar, others see the opportunity for new experiences, and nearly two-thirds of Americans (65%) wish they had the opportunity to have as many varied experiences as children do today. This sentiment is significantly stronger among those with school-aged children (73%) than among those without (62%).

Please Share This Resource With Parents

Thank you to the parents of East Harlem Scholars Academy in New York, NY for coming to a seminar today on campus.  This brochure was provided to them by one of ESNP’s therapy partners to the parents as a quick reference to help their children at home. If you would want to use this free resource, or want to use the information in the brochure, just contact us via email or through this site.

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Special Education: Redesigned and Redefined

BFyjIO4CMAAXatbWhen a bright eyed and idealistic teacher walks into the classroom, she does not have any pre-conceived notions that the mission statement of the school will be vaguely if at all reflected in the daily battle called teaching. The act of teaching is a juggernaut of sorts: between the principals, the administrators, the board members, and/or the politics — that it may feel like a fluke if the teacher maintains sight of the student, or if the student can honestly say that the teacher is, well, teaching.

Now, add a dash of one, or maybe three of the 13 special education classifications in the mix of students in a classroom of 28 to 30 students. This teacher may or may not have any background knowledge on educational disabilities, best practices for children classified with these disabilities; however it is a safe assumption that within this classroom of students, those who are not or cannot conform will stand out. And by the year’s end, the previously idealistic teacher may be anything but. Additionally, she may have fallen into damaging stereotypical thinking and labeling because she was never given the opportunity or education to think differently.

Most education professionals are aware of the studies that reveal teachers’ negative bias toward students labeled as having a learning disability. These studies have concluded that teacher’s rate behaviors more negatively, put less effort into educating these students and recommend them less for gifted education, even when given evidence of giftedness. Unfortunately, the why behind this occurrence is relatively easy to answer. Despite the progress at the federal level for children with disabilities since the 1970s, the stereotypes associated with the Special Ed label remains engrained in the general public as well as general ed mindset. Gaining access to a free and appropriate public education has done only that. The doors have been opened and the children welcomed in. Yet, the question begs to be asked: “are these students being taught?” Perhaps it is not the students we should be labeling as disabled or unable to learn, but rather the schools and the education system as a whole.

L30009e5et’s take a snapshot of the current system: schools invest thousands of dollars in curriculums that align to the common core standards, which tout an increase reading and math proficiency. Yet these curriculums are changed yearly because student scores do not increase at the expected rate. Some schools banned use of textbooks and teachers, who have been supposedly taught how to teach are also now expected to create curriculums or piece together a decade worth of rejected curriculums oftentimes for either multiple grades or multiple subjects. And within this disorganized system, children who struggle to learn within a traditional classroom, for reasons neuropsychologists are still trying to determine, are expected to adapt and learn in the same way, at the same rate with the same retention as their typically developing peers. Administrators and teachers alike, are allowed to overlook this since their academic background never afforded them an opportunity to learn nor required it of them. Yet the perfectly typical students with atypical brains become the ones punished for this oversight. Not only do teachers have decreased expectations, which leads to decreased effort; being labeled as special ed is shown to have a negative impact on self-esteem.

Taylor et. al found that students with generic special education labels had significantly lower self esteem compared to children with specific labels such as dyslexia. Furthermore, there was no difference in self-esteem between those identified and labeled as dyslexic to those without a special education and/or disability label. The authors concluded that children with a general label “offers very little in the way of an explanation for the child’s academic difficulties and because targeted interventions are not as available for those with a less specific label” This shows that it is the lack of transparency, discussion, effective interventions given to children with non-specific learning disabilities that play a major role in decreased self-esteem. Additionally, it was noted that there was stigma from peers more often associated with classroom labels of resource room and special class than the label of a generic or specific disability.  These conclusions indicate that environment, misconception, lack of discussion, transparency, and inclusion building measures within a community are to blame for decreased self-esteem, ridicule and teasing among students with disabilities, not the disability itself.

This reinforces the notion that schools and the education system are disabled and disabling those students who learn differently. Ideally, teachers and students alike would be equipped and well versed in what ilabeling-kidst means to have a disability, the strengths and weaknesses associated with that disability and strategies in which that student can overcome barriers within academic institutions in order to find success. However, this is next to impossible when teachers are not required to learn more than simple terminology associated with educational disabilities such as IEP, learning disability, and maybe related services. In 2013, 13% of school-aged students in public school were classified as having a learning disability. That means 4 students in a class of 30 will have an IEP and receive special education services of some sort. However, there are typically students who have not been identified or whose parents do not want them classified and receiving services specifically because of the stigma associated with it; therefore, it is safe to assume that approximately 1out of every 5 within a class of 30 students will have some form of a a disability. Yet, the teacher in the general education classroom is not required to have any prior knowledge about the disability, how to teach effectively to students with that given disability or even what supports that child might need; those responsible fall to the special education teacher of the Special Education Support Services Teacher who is typically with the student for about 5 hours a week. The additional 25 -30 hours, the student is left to his or her own devices in how to mange.

In no other profession, would a business that provided an qualified employee on average 13 – 17% of the time be considered “appropriate” to meeting the needs of the business or consumers. Yet, under the current law, for students with disabilities placed in inclusion classrooms, this is considered just that. Perhaps it is time to stop dis-abelling students and start enabling our education system by educating educators to actually teach to the brains, the bodies and the minds of the learners in their classrooms. This would of course require general education teachers to take courses about educational classifications, differentiation, and special education law, but all teachers to demonstrate proficient knowledge in the developing brain, body and mind including neuroanatomy, neuropsychology and cognitive psychology to name just a few. It is time to enable not only students, but teachers and administrators, by un-labeling teachers as general or special education and in turn removing the stigmatizing labels from students. No education should just be general; in order for all students to achieve their true potential, all education should be special and built on a scientific and wholistic foundation of knowledge. 

So until the time schools either have an alleviated pressure to pack classrooms to the maximum capacity, and/or the testing rigor is substituted with individual performance aptitude (similar to portfolio based measurements), the sting of bias and the risk of a child’s learning falling through the juggernaut remains at large.

Metacognition is to Mindfulness (Not Everyone Can Always Teach…)

Big buzz words, both of them in the title of this article. One featuring a significant process of the Pre-Frontal Cortex, and the other, affectation of awareness from the entire brain, based upon the driving of the Pre-Frontal Cortex. However, let’s simplify the language of Metacognition and veer away from the “thinking about thinking” cliché (albeit that is what that is, the repetitive use of the definition is overused).

Meta (after, or beyond) cognition (conscious mental activities : the activities of thinking, understanding, learning, and remembering) is that ten second delay before the thinking is decided upon as the last answer or decision. It is the pulling yourself out of your own awareness to look at the process that is involved in your own thinking: from the first suggestion of an idea to the last decided action. Metacognition then is the conscious mental activity that is after or beyond the activities of thinking, understanding, learning and remembering.

The Metacognition Phase
The Metacognition Phase

It’s what we commonly refer to as THINKING ON YOUR FEET. When you rely on the automatic responses of behavior that you tuck in the memory bank for the ‘rainy days’ and successfully combine these responses without reference to a specific technique or to a pattern, you have successfully practiced the art of metacognition. Most of us use the metacognitive process in its basest sense that its application is usually muted.

Labels, both rigid and tailored to testing have been directing the voice of education. Plotting one’s education based on the ability to test versus improving the quality of the inquiring mind has recently been winning the battle of what standards should look like and what ‘schooling’ should seem to be in the eyes of a successful community, and in the grander picture, what the world expects of a citizen belonging to a particular first-world geographical location. Teaching to the BRAIN inside the human being has been scoffed in skepticism and propaganda by purists of testing protocol, and worse, by those who insist that the BRAIN is a static piece of software that can only evolve in, well, the dog-eat-dog thriving situations to effectively learn (forgetting that the BODY is attached to it, inconveniently).

And yet, there are those who do acknowledge that there is a BRAIN that echoes its decisions on the shadow called a MIND (which apparently is highly controversial for those who have either no imagination, philosophical inclinations, or even quantum physical understanding of cause and effect). The MIND is not simply an artistic, metaphorical description of romantics or serialists.

The In-Between Phase: Anticipation From Metacognition to Mindfulness
The In-Between Phase: Anticipation From Metacognition to Mindfulness

Mind (the part of a person that thinks, reasons, feels, and remembers) fulness (the eventual quality or state of being full). Mindfulness then is inherently a state of consciousness. Although awareness and attention to present events and experiences are given features of the human organism, these qualities can vary considerably, from heightened states of clarity and sensitivity to low levels, as in habitual, automatic, mindless, or blunted thought or action (Wallace, 1999).  Therefore, Mindfulness is the eventual quality, state or part of a person that thinks, reasons, feels and remembers that is full.

Conscious activities of thinking lead to filling up the state of a person that thinks, feels, reasons and remembers. Conscious and purposeful filling, which is aimed at harnessing powers of understanding from genetic, evolutionary biological cognitive methods, now contrast with teaching-to-test. Conscious and meaningful activities where learning is matched with the learner’s natural aptitude while harnessing multiple abilities of learning.

Teaching with the Meta-Mind process is the ideal, not necessarily realistic. The Teacher, broken as Teach (to cause or help a person to learn how to do something by giving lessons and showing how it is done) -er (person or thing belonging to or associated with something) fulfills this process with such subconsciousness if you ask him or her the process of the real teaching, they would have to pause and trace the Meta of how they begin. And when there are words to describe this magical process (taking away the paperwork load and the political requirements), the Teacher’s Metacognition  begins with an idea, a seed, a stage either theatrical, comical, empirical or thoughtful. The Teacher  is actively immersed in the conscious mental activity that is after or beyond the activities of thinking, understanding, learning and remembering.  The preparation for every scenario entails an almost see something-say something proactiveness; student temperament will never be the same in spite of the occurrence in the exact classroom, having the exact community of students, and/or support through the same rules and regulations. Only homeostasis remains similar as learning experiences are emotionally, memory-dependent.

The students come, the dance begins of giving and taking…sometimes with upstarts and hiccups; however, with the arsenal from the Teacher’s Meta phase, the learning is curved to where it momentarily docks. After the last word on the subject, the wards attach the knowledge to a memory base, perhaps a mnemonic one for future reference. And the Teacher? He or She goes into the Mind phase: Mindfulness of students sharing, discovering, uncovering and maybe not fully comprehending what just had happened in the minutes before with the topic at hand. The Teacher in this phase enters into that eventual quality, state or part of a person that thinks, reasons, feels and remembers that is full.

The Mindfulness Phase: Is  it the Silhouette or is it the Canvass?
The Mindfulness Phase: Is it the Silhouette or is it the Canvas?

How then can the teacher be unreasonably requested to match the learning of a subject that is not only too cognitively complex for the developing brain of the current roster he or she is given, but also when there is a predetermination of the worded script, the presentation of the activity or knowledge base, and/or finely trimmed boundaries they are unable to be flexible with? How is that called common core really a commonality? The Meta-Mind cycle is interrupted, the learning process is artificial, and citizens are not created, rather parrots with haphazard training preparation for the competitively overflowing sea of professional niches. The Teacher ceases to have a democratic role in the abilities and skills he or she thought was hired to use in the classroom; amazingly, all that’s needed to do this newly reinvented job are professionals with paper pedigree to continually beat down their passion or dedication…unless the latter is just a bad dream someone decided to share with us.

Please allow the teachers to teach again. Respect the Meta-Mind Process of Learning.

The Article as seen in Brainblogger.com: The Fundamentals of Neuropedagogy

Thanks to our friends at Brainblogger, here you can read the complete article. Happy reading!

Introduction

Over the past decade, we have learned that for every student who is simple to understand or figure out, there are one or two who are a conundrum. Over this same decade we as separate and collaborative professionals have also discovered that the answer to these students’ needs being met is two-fold: 1. Education looks only at symptomology not etiology 2. Education fails to integrate disciplines effectively. Special education needs to stop being about labels and start being about the whole child.

Enter the practice of Execu-Sensory and Neuropedagogy. When we look at the child as a whole: brain, body and mind, we begin to understand that more than what teachers are taught in school is at play. Take child development, for example, this class may or may not be required to earn a Masters in Educations, especially if the focus is middle childhood rather than early or elementary.  Yet, the brain is not done growing, literally, until the age of 19 or 20 and the prefrontal cortex continues to develop until the age of 25. Not to mention, the developmental surge that takes places during adolescence is akin to the one which occurs during early childhood. How then are teachers prepared to teach the ever evolving whole child if they lack the basic knowledge of brain development.  The simple answer is they most likely cannot. The brain is a vastly complex system of electrical wiring and firing that is critical to understanding, given the goal is not only to teach, but teach effectively.

However for the purposes of this blogpost, we shall focus the discussion on the fundamentals of Neuropedagogy in practice with some aspects of Execu-Sensory components.

Structure of Neuropedagogy

Neuropedagogy in its most basic state begins with the executive function skills and the developing Pre-Frontal cortex. However when we attempt discussion with other educators, the typical response is,  “Executive what in the where? Neuro?”

Understandable response, seeing as this predominantly European concept is commonly referred in the United States as Educational Neuroscience or Neuroeducation--or perhaps more commonly not discussed among educators at all. It was introduced during an educational summit in 2009 at Johns Hopkins University simultaneously with a “Learning and the Brain” wherein organizers and educators alike agreed there needed to be an interdisciplinary field that combines neuroscience, psychology and education to create improved teaching methods and curricula. It was bringing into focus new links between arts education and general learning, how learning physically alters the brain, and what goes wrong in students with learning disabilities.

Neuropedagogy however went further than Neuroeducation. The European definition of Neuropedagogy is when science and education meet and whose scientific aims are to learn how to stimulate new zones of the brain and create connections. It is targeted at stimulating the brains of all types of learners, not only those with students who have learning disabilities. Dr. Judy Willis a practicing neurologist made a conscious transition to the classroom as an educator feels that there needs be research about the brain’s neuroplasticity and the opportunities we have as educators to help students literally change their brains — and intelligence. To become a teacher without understanding the implications of brain-changing neuroplasticity is a great loss to teachers and their future students.

Based on the experience and the research we have done on current classroom structures in New York City, we have found that the most effective use of Neuropedagogy was in three sections: Brain Element Neuropedagogy, Body Element Neuropedagogy, and Mind Element Neuropedagogy. The hierarchy of training is dependent on the prior knowledge of brain function, thus beginning the discussion with the brain was the most functional and useful approach. The body then and it’s organic processes were the next step in the training and understanding connections between innervation and control, and lastly the mind which not all fields of classroom instruction fully develop or are able to reach without the clear understanding of how the brain and the body encompass the physics of the mind.

To say the least, one would need basic brain to facilitate the body and change the mind.

The Brain Element Neuropedagogy

The most obvious reason to share information is for learning, and learning can only be achieved if there is sufficient brain function. In our practice, we lay the foundation for understanding the Central Nervous System (CNS) neurotransmission, the utilization of approximate brain mapping of the cerebral hemispheres, and raise awareness of the unmistakable impact of the digital society on the organic brain.

By organizing the hierarchy of understanding based on the processes involved from brain neurotransmission in each section of the cerebrum at any given time, we shed more light into the powerful effects of neuroplasticity, the endless ability for the brain to change itself. There are four that have been identified for learning: Acetylcholine (ACH), Serotonin, GABA, and Dopamine. Ultimately these are the communicators responsible in delivering the information to all the lobes, including the Pre-Frontal Cortex. The PFC is not currently recognized as a lobe; however, the role that it plays in learning and behavior have been measured via Executive Function Skills.

Many definitions for executive function skills exist and they all essentially make the same point. The National Center for Learning Disabilities defines executive function skills as,” mental skills that help the brain organize and act on information… [it is the ability to use] information and experiences from the past to solve current problems.” These skills are critical to understand because when they are weak or delayed in developing, they can mask themselves as an educational disability which may lay the groundwork for an Individualized Education Plan (IEP) as determined by a mutlidisciplinary team.  For example, let’s say a child is referred for an evaluation for special education services because he is showing consistent negative behavior, such as being unable to focus for more than a few minutes at a time, constantly calling out, and failing to complete homework, all of which lead to decreased academic gains.  The child will most likely be mis-classified as having ADHD or a learning disability, which ultimately leads to inefficient or worse ineffective solutions. If the interventionists applied an interdisciplinary Neuropedagogical Approach, a different and more effective outcome may have played out.

Now, let’s add a layer of dynamic complexity to Neuropedagogy. Neuroscience has looked at the brains, personalities, strengths and weaknesses of people born after 1986 and compared them with brains, personalities, strengths and weaknesses of people born before 1986. The studies show a significant difference between the two. The over-arching difference: access to the digital world.  The first group is digital natives; the second digital immigrants. Digital natives have brains that have weakened pathways for interaction, decreased activity in anterior cingulate gyrus and medial orbital frontal cortex, increased isolation, aggression, passivity, loneliness, etc, increase in cortisol due to excessive brain fatigue, decreased hippocampal size. Digital immigrants, the ones who have the capacity to hand down life experiences effectively via examples and who can communicate thoughts personally are ones who are usually comfortable with familiar technology and shy away from change in that department. They have been found to have faster PFC circuitry as they have had abilities to strengthen neuronal circuits with numerous life experiences, including delaying gratification.

WIth all of the Brain Element Neuropedagogy, one can proceed to appreciate understanding the Body and it’s unique processes.

The Body Element Neuropedagogy

In our modern society, people are perceived initially from the way they present themselves. Usually what is displayed from the external body is what immediately connects one person to the next. The body’s senses take in the physical and external world, neuronally process the input and in the cortex it’s given meaning.

From a learner’s perspective, the body is both intake and output. As interdisciplinary brain-based practitioners, we shed light into the Sensory Processing Systems, the limitless potential of a person’s Multiple Intelligences and Emotional Quotient (EQ), culminating on the influence of what we have managed to call the 3 External E’s (Ergonomics, Economics, and Environment).  The body by itself is a complete sensory organ, however it has been proven by evidence-based practice that the seven (7) senses are the checkpoints of the body: sight, sound, smell, touch, taste, movement and position in space. Research in this area was pioneered by Dr. A. Jean Ayres and current practitioners include Dr. Lucy Jane Miller and Carol Kranowitz all of who have contributed to the education and learning landscape. One simply cannot function by brain alone!

Multiple Intelligences Theory was pioneered by Howard Gardner, a developmental neuropsychologist,who played the violin well, wondered if a tool, aside from the Intelligence Quotient (IQ test), could be developed to measure additional attributes to determine a person’s complete intelligence. Another factor we considered was Daniel Goleman’s Emotional Quotient (EQ) as this too plays an important factor externally; even as the limbic system is brain centric in it’s processing of emotions, the manifestation on the outside is clearly body centric.

Education in the twentieth and now twenty first century tends to teach to two types of learners: visual and auditory. Yet, research has shown that multiple types of learners exist, not just two. Teaching methodologies need to start designing lessons, activities and classrooms not only for the typically forgotten or ever present kinesthetic learners, but for the quiet introvert and the shy extrovert and multiple combinations of them.

Simple modifications such as state changes, strategically planned brain gym breaks or yoga ball chairs have shown to improve the executive functioning skills of sustained attention and task persistence. Additionally, when inserting brief yet planned breaks of any type, students are given an opportunity to work on set-shifiting a skill in high demand in the modern digital-world.  Modifications for the introvert include quiet spaces in the classroom or projects with an option to work alone.  The shy extrovert, may benefit from group projects with assigned jobs. However, this type of differentiated instruction is believed to be fitting only to the special education population. The rest of these students, rather than adopting a label that may or may not fit, they are instructed to adapt their bodies to fit because that is what the ‘real world’ will expect of them. Meanwhile, that potential intelligence lays mostly dormant because teachers are not teaching to them, and were probably never taught how. Neuropedagogy recognizes the learning process that processes from a brain and proceeds into the body offers perspective and solutions to teaching with the body in mind.

The Mind Element Neuropedagogy

Of all of the Elements that we train, it is the Mind Element that is the most challenging to explore.The brain and the mind are used interchangeably in the realm of education; however, scientists have discovered that although they do seem to be influential of the other, the brain and mind affect each other in very different but significant ways. The psyche in psychology practice have also been associated with the mind, and pop culture usually uses the word mind loosely as choice or state of one’s mental being.

In referencing the brain, it  is the material organic matter that has the physical manifestation of the neuronal processes while the mind is where consciousness and active thinking occur. However a thought may occur from consciousness which may alter the neuronal process that was intended to happen and vice versa. The mind discussion includes: theory of mind, the belief-desire reasoning in learners, and neuroplasticity in the habit loop, Behavior Modification and Habit Routine change that can have both positive and negative effects.

Neuropedagogy of the mind starts with the premise that the mind of a child is complex. The Belief-Desire Reasoning from H.M. Wellman’s The Child’s Theory of Mind Mechanism shows just that.  Thinking, perception, sensations, beliefs, cognitive emotions, physiology, basic emotions are all interconnected and simultaneously interacting to produce desires, intentions, actions and inevitably reactions. Actions are merely the tip of the iceberg to the ongoings of a child’s, and ultimately a learner’s mind. Educators who understand and teach with Executive Function Skills such as Metacognition, Emotional Control and Response Inhibition in mind, essentially have x-ray vision, which provides them the insight to ask the questions that will reveal the iceberg. Intention is marked by a WHOLE person, a product of perception, inception and conclusions.

Conclusion: The Neuropedagogy Synthesis

ESNP's Unique Neuropedagogy Synthesis
ESNP’s Unique Neuropedagogy Synthesis

When science and education meet it is called Neuropedagogy, whose scientific aims are to learn how to stimulate new zones of the brain and create connections. The information that is presented here may appear overwhelming and less comprehensive in practice however it the changing the lens and perspective that allow best practices to occur, to remind those involved in direct service that people are not formulaic in their learning.

The Neuropedagogy synthesis demonstrates just that. One of our current partnerships, The Teaching Firms of America Professional Charter School in Brooklyn, New York applies these principles by tying choice and action to their basis in the brain, Theory of Mind, and most importantly, the brain has the ability to change.  They empower their scholars to be thinkers and owners of their actions and choices by giving them knowledge from the world of neuroscience.  Finally, the utilize the principles of Neuropedagogy to guide and inform their instruction, interactions and interventions. It is a common occurrence to hear students say, “I can change my brain.” From initial classroom set-up to end of day classroom clean up, they created and continue an atmosphere of curiosity and intellect, which always seems to start and end with the brain.

Education, Meet Neuro

Careers in Education span from being a one to one teaching assistant, which may or may not require education beyond high school, to holding a doctorate in education with the hopes of changing policy, running a school or teaching future teachers at prestigious universities. The paths to becoming an educator therefore, are as multi-faceted–ranging from the vocational training as a one to one teaching assistant to trial by fire  in teacher-certification or principal training programs. Arts_Education_KoreaLogoMany who enter the field, hold the ideals of wanting to change the world and to contribute to the education of the future generation; however, many of those same inviduals leave the field after a long and albeit arduous career,  with little to no passion for the profession they entered or beliefs they had about changing the world.

Why the phenomenon? Our colleagues have narrowed it down to the lack of support overall, both in background preparation and in workplace coaching. No one from either area really says flat out to a teacher-to-be, guess what, your classroom is a mini neighborhood, and you are expected to be town policeman, mayor, judge and parent. Maybe it is time to add therapist and neurologist to this list; skills possessed by these individuals may actually benefit an educator’s craft.

Currently, the majority of the programs that prepare our teachers discuss education theory, history and pedagogy. Many programs have teachers spend an entire semester creating a unit plan of about 5 lessons, when in reality many teachers need to create multiple lessons for multiple grades or multiple subjects in any given day. In addition, they teach to learners ranging from gifted and talented to those struggling to learn–classified, diagnosed or otherwise.

If schools of education added a fraction of the courses required to graduate with a degree in a related therapeutic service, psychologist and neurologist, perhaps it would not only change the approach taken to teaching, but also preserve the mentality educators have at the beginning of the field when they finally leave the field. An even greater outcome is teachers would change the world, at least the world for the children who they had the privilege of teaching. This is the potential of neuropedagogy. Neuropedagogy Synthesis

Neuropedagogy blends psychology, neuropsychology, neuroscience, school psychology, educational neuroscience and pedagogy into one, which results in a more complete understanding of the whole child in regards how children learn, how the brain functions and the role emotions play in both. Essentially, neuropedagogy explores the brain, body and mind of a child and takes all into account when teaching in a classroom.  However, the first step in teaching from a neuropedagogical point of view is to understand the anatomical brain, the power of neuroplasticity, and what is happening in brains of struggling learners.

Some schools have begun teacher training programs that explore this very notion, Harvard offers a Master’s Degree in Mind, Brain and Education. Courses include: cognitive neuroscience, statistics, educational neuroscience, atypical neurodevelopment, applying cognitive science to learning among other more typical education courses. The Teacher’s College at The University of Columbia offers a Master of Science degree in Neuroscience and Education and the courses are similar to those offered at Harvard. Finally The School of Education at John Hopkins offers a Mind , Brain and Teaching Certificate. The School of Education at John Hopkins has started an entire neuro-education initiative, which aims to inform teaching practices about the the research from neurosciences and how it can positively impact teaching practices. Most likely more programs are out there and gaining steam; however, these programs are all optional specializations in schools of education, not required. Educators or other professionals enrolling in these programs most likely have an understanding and background in the role neuroscience plays in teaching.

It is not enough. This is a fundamental disconnect, which poses  to lead to irreparable damage not only for the United States’s educational system as a whole, but for the ability of students to learn and learn to their optimal potential. Little understanding exists on the long-term effects of technology on developing minds, especially given the rate at which children are exposed to it in the 21st Century. Some doctors like Dr. Gary Small have begun studying the impacts. He has found less than positive outcomes on the development of essential executive functioning skills, which require a developed pre-frontal cortex and access to that cortex in order to employ them. Excessive exposure to technology threatens that entire process. Yet, teachers are expected to teach and children are expected to learn. How?

Teachers (and children for that matter) need to understand the brain and how that brain develops a mind and how both affect the body because all impact how a child learns, thinks, behaves and reacts. Take the Child’s Belief-Desire Reasoning developed by Dr. Henry Wellman, from The University of Michigan.  This complex thought process occurs instantaneously, and provides a glimpse as to why understanding the brain, body and mind is essential to successful teaching.  Child's Belief-Desire Reasoning

Common Core (for better or worse) changed the standards for our children; yet the change occurred before equipping educators with the ability to meet those changes armed with the required knowledge.  An education program would not be approved if they failed to teach lesson planning, educational theory, and areas of specialization–whether early childhood or advanced calculus. Neither should they be approved if they don’t teach teachers about the anatomy of the brain, how it functions, and how children learn.

The challenge therefore is to stop separating education from the very field it uses most. Education, meet Neuro.

Learning to Test or Testing to Learn?

The focus on reforming education in the twenty-first century has lead to a near obsession with standardization. We have standardized  curriculums, tests, grading, participation, essentially the entire learning process. Yet with this  shift to standardization, we have failed to meet the basic standard of a school, which is a place children come to learn. Pacing calendars, pre-packaged curriculums with differentiated tracks, cookie cutter bubble tests are teaching our children to be ready for a test, one that will rank not only their individual performance against a national standard, but the school’s performance as well. However, this test ultimately seems to prove only one thing, how well a student can take a test.

standardized-test-6

Unfortunately the test heavy focus of education reformation has annihilated a tried and true strategy for learning: testing. Teachers give summative tests at the end of the unit; they provide a study guide a few days before the test, tell students to study and perhaps hold a study session in class. However, according to How We Learn by Benedict Carey, that is not how we learn best if the goal is for information to be retained. We best learn and retain information when we systematically review learned information based on time to test and when we study by testing our knowledge of the information.

Dr. Melody Wisheart and Dr. Harold Pashler found this study interval to be most optimal for retention:

 

Time to Test

This table provides guidelines for either students or teachers to review material in order to increase retention at time of test. Using this information, teachers and students can intentionally plan study sessions to increase student’s retention of the material. Teachers can  revisit material learned at the beginning of the unit at the first interval and continue to add new material to subsequent study sessions until time of the test. By building in time to review material, teachers are teaching students how to study and providing them opportunities to review material in an effective way. This method is to increase retention of information and works best for facts, definitions, dates,mathematical equations etc.

Testing not studying is the answer to learning. Teachers often design pre-tests to determine what students know and what upcoming lessons need to focus on. However, pre-tests serve an even greater objective: they start the learning process of the material being test, evenwilson-train-the-brain-istock if the student guesses on every single question.  Dr. Robert Bjork found that after a simple experiment with his introductory psychology class that students performed 10% better on questions related to pre-test questions when taking the final exam than on questions with no similar equivalent on the pre-test. Students have the possibility of improving test scores by an entire grade with the addition of a pre-test. Furthermore, testing as a study strategy decreases the illusion of fluency, which tends to occur when students read notes or the text book multiple times as a way to study. Dr. Henry Roediger  theorizes that it forces the brain to do something more challenging that visually or auditorally process information; this additional effort increases the strength at which it is stored and later the ability at which is can be retrieved. Essentially, testing acts as a novel opportunity to learn and store the information; therefore, it becomes stored in a new way in the brain, connecting to other related facts thus strengthen storage and recall.

Testing needs to be re-branded in our classrooms. It can occur through a variety of ways (i.e. conversations with peers, family, other teachers, games, projects, and traditional paper/pencil tests), but  the focus needs to be taken off the final score and placed on the value of knowledge gained, whether that reveals the student knows all of the information in the unit, or she needs to spend more time ‘testing’ her knowledge, to she recalled all of what she knew before and more.

If we start testing to learn, the learning to test will naturally follow.

learn

Text Used in this post: How We Learn: the surprising truth about when, where and why it happens. Benedict Carey. Random House, 2014.