Neurodiversity

Neurodiversity
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Neurodiversity

The neurologically different are a new addition to social subcategory of class, gender and race differences. Like biodiversity it simply means that we are all different, so the neurodiverse are contrasted to the neurotypical. However it is more correct to say we are all on a continuum. Nevertheless, there are categories of diversity outlined in the Diagnostic and Statistical Manual (DSM – V) which is used to classify a psychological or mental health condition. Among these categories are brain based differences in learning, designated as Dyslexia, Dyspraxia (or Developmental Coordination Difficulty), Dysgraphia, Dyscalculia, Attention Deficit Disorder and Autistic Spectrum Disorder.

Additionally once a person has been designated in one of the neurodiverse categories they are protected under The Education Act (Special Needs section) and the Education authorities have a duty placed on them to make sure the child has special help to overcome their disability, or at least accommodate it. Employers too, are bound by The Equal Opportunities Act to supply accommodations that make it possible for a neurodiverse worker to fulfil their duties. This is not always a burden, as any Neurodiverse people have special talents and there are times when a “disability” can be a useful skill.

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Case Studies

Percentage of the population with:

100 %
ADHD
100 %
Autistic
100 %
Dyslexia
100 %
Dyspraxia

Attention Deficit

The classical model of Attention Deficit Disorder involves three major themes; inattention, impulsivity and hyperactivity. A child can exhibit one or all of these trends to be diagnosed with this specific learning disability.

In fact girls tend more often to exhibit inattention only, appearing dreamy and spaced out while boys are more often diagnosed with the Attention Deficit/Hyperactivity Defict.

(Brown ADD scales, The Psychological Corporation)
At home problems are trying to get the child to do routine tasks, homework and the child procrastinates, protests at being overwhelmed by what are really quite manageable tasks and is easily irritated, frustrated and very impatient. And yet cannot finish things they have started. They will daydream, appear not to be listening and will tend to misunderstand directions and instructions. As they grow, getting up in the morning can be a problem and the child often appears sleepy during the day. A tendency to obsessions and perfectionism can develop.

From being a coliky, crying baby the typical AD/HD child usually progresses through a hyperactive toddlerhood and often the nursery will bring up concerns of lack of concentration, and possibly impulsivity. The emotionally secure child learns to soothe themselves after a stressful episode, but a chemically deficient child remains miserable, and will cry or scream to exhaustion. When this is at an extreme level the child grows up unable to read the emotions of others and so stumbles into conflicts that emotionally literate children can avoid. These AD/HD children may not learn to empathise with others problems and fail to develop good relationships.

There is a cascade of neurochemistry shown to be lower than normal in children who have poor attention spans and a consequent hyperactivity. The major chemistry deficit is Dopamine, which structures working memory, attention and also is our feel good factor, that gives us the buzz after completing a goal. That being the case low Dopamine levels tend to go with low self-esteem and lack of motivation. True AD/HD which is genetically determined is thought to be due to a dysfunction in one of the Dopamine receptors and there is a corresponding decrease in the brainwaves of alertness and an increase in the brain-waves that are correlated with drowsiness. Thus the child is trying to learn while their brain is still half-asleep and attention cannot be activated or sustained.

To learn effectively the child must attend to the information. Unless the attention span is long enough to consign what is learnt to long term memory, information is forgotten and new skills come slowly. This further affects concentration and also affects motivation, so that the child is vulnerable to the stresses of life, especially criticism from others which further decreases motivation. That being the case there is little expectation of competence. A perfectionist and rather rigid attitude can develop since fear failing then becomes a dominant motivation. When a task presents challenges it is easier to abandon it rather than persevere. In the classroom it is difficult to concentrate on routine learning with the effect that only activities of strong interest can motivate the child to keep on task. Sometimes particular interests (or avoidances) will be developed to the exclusion of almost all else. The stresses and mood of the day will affect performance so that the quality of schoolwork is inconsistent.

Other family members may have related problems such as alcoholism, addiction, tourettes syndrome, social phobias, allergies and other learning difficulties such as Dyslexia and Autism. In fact Dyslexia co-exists with AD/HD in about 30% of cases.

(Blum K. The Reward Deficiency Theory, Scientific American 1992)

However, prolonged stress, long term abuse and troubled, insecure relationships can alter neurochemical systems even in children who are not genetically vulnerable. When the stress hormones flood the emotions constantly it damages both emotional and immune systems. The child becomes hypervigilant, constantly on the lookout for insults and can misperceive threat and may therefore often gets into fights. They will have a short attention span which looks very much like AD/HD.

The working memory weakness in AD/HD means that it is difficult for the child to remember lists, instructions, polysyllabic words, long sentences and even abstract words and concepts. Added to which much parental communication is necessarily short No/Stop it/Give it back/Don’t do that! etc. rather than complex philosophical discussions, so conversational skills are often less good than in non-AD/HD children.

At school the child will be distractible, tend to give up easily, never trying again. They will have difficulty remaining seated, tending towards impulsive grabbing, interrupting and intruding on others. There will often be an inability to wait for his/her turn and the AD/HD child will start off on work before listening to the instructions. They will be better at concrete subjects than abstract ones and although they may talk incessantly will still be a loner. Social skills are lacking.

As the AD/HD child grows older the impulsivity, difficulty in suppressing responses, the lack of foresight and uneven motivation that is seen as normal for a child can become stubbornness, obstinacy and negativism. Such a decline is often accompanied by mood swings, a low frustration point, temper outburst, maybe bullying and low self-esteem. If this difficult adolescence period coincides with criticism and punishment the adolescent is likely to develop these characteristics as part of their personality and go on to some form of delinquency by 17 years of age. Even if this doesn’t happen they may have a driving, tense mode of life, changing job frequently and the childhood unfinished hobbies become adult unfinished projects. This personality is especially vulnerable to addictive drugs and dangerous activities.

On the other hand with self-awareness/management strategies and a job that offers variety the distractibility can become a high energy level, with the AD/HD adult zipping around, motivating others, thinking laterally and painting creative visions of the future. Included in the right job would be a secretary following along, taking care of the details.

The assessment of Attention Deficit is a combination of the genetic, childhood and medical History with teacher and parental ratings of current behaviour. Age-oppropriate attention Span is measured by one or other of the standard computerized attention tests. An I.Q. test is usually done since there is often a suggestive discrepancy between the reasoning scales And the scales measuring distractibility and speed of processing.

Strategies include reinforcement for lengthening attention span and desirable behavior, self-awareness/monitoring and thinking strategies, activity regulation, social skills groups, neurofeedback, nutritional intervention, identification of food and substances the child may be allergic to, and/or medication.

Chris seemed a bright, interested child to his parents so they were dismayed to hear at the Parents and Teachers meeting that he was always out of his seat, distractible, chatting to the other children, often disrupting them, usually the first to call out when the teacher asked a question even if he wasn’t always right, but worst the teacher said, she just can’t get any written work out of him. He sits and squirms, gets up to sharpen a pencil (or any of the hundreds of excuses he has for not getting on with his work). The last exercise it took him an hour to write his name and two words beginning a sentence. She said she has never seen more than a minimalist account of anything – even things he knows a lot about and can discuss eloquently. Chris’s mother was amazed to hear that he had difficulty in sitting still and concentrating because at home he could concentrate on his play station games for HOURS, to the point of not hearing when he is called for dinner. However, she recognized that it was almost impossible to get him to do homework. They have huge tantrums unless she sits down and virtually does it for him. We diagnosed Chris with Attention Deficit Disorder and asked the School to break down his work into smaller “bites” so that he could see the completion goal. This meant he did not “turn off” at such an impossible goal. He sat in front of the class and was provided with a “privacy board” that he could put on his desk when working, to shield him from distractions. Once Chris felt his teachers (well most of them) were trying to help him rather than criticize him all the time he found it easier to maintain attention and his work improved. We also suggested that he use a lap-top in class which helped to overcome the writing problem and for his homework his parents bought him a speech driven writing programme (Nuance) so the tantrums over homework also, if not ceased, at least reduced. As his work and self-esteem improved his blurting out wrong answers reduced and impulsivity could be seen as spontaneity. Probably the best thing about the assessment said his parents was Chris’s understanding of himself. He was able to see that his tantrums weren’t productive and only alienated his teachers and upset his mother. He used to get satisfaction from upsetting everyone but now it was a whole different ball game. It was a great feeling to be part of a sort of team, all working to the same goal.

Margaret was almost the opposite to Chis. Where he was cheeky she was polite, where he was noisy she was quiet, his boastfulness was her modesty, his impulsiveness was her passivity. While Chris had loads of friends that changed frequently, Margaret had 2 or 3 special friends right from the beginning of school. His “sportiness” was in contrast to Margaret’s “couch-potatoness”.
But they had the same problem. Neither could produce any written work of age appropriate standard. Margaret didn’t get to us until she was 12 and failed her SATS. Everyone was surprised.
A polite, hardworking pupil had been the theme of all her reports, but still a few “could do better if she tried” type comments. The trouble was that Margaret didn’t try. She just daydreamed the day away, usually with a pencil in hand so it looked as if she was working. She had a couple of good friends who knew she found writing hard and who would let her copy their work but this didn’t work for tests and exams. The teachers assumed that anxiety had got the better of her and she would do better next time. Of course she never did, but by that time teachers had changed and only her parents could see the pattern of avoidance that her anxiety couldn’t explain.
Chris and Margaret had the same diagnosis; Attention Deficit Disorder! But he had the subtype of impulsiveness and she the subtype of inattentive. The Diagnostic and Statistical Manual classifies them differently too. Chris was ADHD of the predominantly hyperactive/impulsive presentation
(314.01) while Margaret qualified for the ADD of the predominantly inattentive presentation (314.00)
Once Margaret and her parents understood that, things changed. She was introduced to relaxation techniques and her parents encouraged her interest in animals. They have helped her develop a Journal of the Natural World in which she writes and illustrates beautifully the insects and animals she watches. Writing is not a problem now that she has some knowledge. Her parents have bought some lovely illustrated books of the Biological World and watch with pleasure how Margaret can almost “hyper-focus” when she is following through the life cycle of these creatures. Another David Attenborough they joke to themselves. Maybe a Beatrix Potter and for sure she will do well in Biology. The school is now aware of her tendency to day dream and have put some strategies in place so even other subjects are improving. She has been moved to the front of the class and the teacher finds opportunities to ask her to move around, such as handing out books. This makes Margaret feel more part of the class and less like drifting away into dreamland. But best, Margaret now has her goal – to be an Animal Behaviour expert of some sort, maybe even a Vetinary, and she knows what she has to do to get there.

Then there is Sebastian, a polite child according to his reports who sits in the back of any group, rarely contributing to class discussion and if asked a question directly will usually have to ask the teacher to repeat it. He has a little group of friends, and plays normally but mostly in non-active games like chess and cards. He is so SLOW at everything – getting dressed for PE, getting to the right place in games, answering questions, getting started on projects or even just packing up to go home. At the parents meeting, teacher said “I can be sure he is the last to leave any classroom, still gathering up his belongings when others have long vanished.” Sometimes she notices that he seems to drift off at his desk and wondered if he is getting enough sleep. She mentioned this to his mother one parents evening but mother said although she battles to get him to turn the light out at a reasonable time (he reads in bed) she also has to battle to get him up in the morning, which is why he is often late for school, but does get a normal amount of sleep. Weekends he can sleep till noon if not disturbed! He is also very musical and can play several instruments (parents are musicians) and they are hoping for a scholarship later to a music college. His parents are concerned though at his reluctance to practise and in fact when he was picked to play solo for the school concert last year he kept putting off practising the piece so much that his parents refused to let him go out to play games until he did and also took his telescope away. He likes watching the night sky and knows a lot about star systems and planets. Whereupon Sebastian put down his violin and refused to ever play it again. This has gone on for a year now so they are careful not to set off his stubborn side. He seems to try hard, but like Chris, can spend an unreasonably long time just writing his name. In an effort to help him when there was a school inspection, the teacher once let him dictate his story about Alpha Centuri to them and were amazed at his knowledge and imagination. In fact it could have been the basis of a science-fiction story but like the violin sonata, that was the first and last time they ever saw any good work. Seb was another dreamer, like Margaret. But he had a stubbornness and in contrast to Margaret wanted to feel in control. His refusal to fit in with adult demands was the male equivalent to Margaret’s “drifting off”. He also had a musical gift on which he could hyper focus when it was his own self making the demands. With Neurofeedback we were able to rebalance his brainwaves. His sleep patterns improved and with it his level of energy. The school accepted his difficulties in writing and continued to provide a scribe for tests, since he was just as slow at learning to type. He eventually made the grade for Music College and we are sure will be able to develop his talents without the hindrance of his weaknesses.
Although girls with attention difficulties express their problems differently to boys they share this amazing imagination which is usually overlooked in school and even sometimes dismissed at home because their academic results are so dismal. But find the key, their interest or talent and all sorts of abilities are unlocked.

In general for all students with short attention spans, information is best assimilated in “attention-size” bits of information which will be shorter than the average student/worker, this allows a brain based “goal completion” to be kept in mind. Usually this means the individual will take longer, but certainly not as long as sitting staring, overwhelmed with a piece of work and not being able to start. This may mean establishing a base line attention graph of activities over the day and plotting these on a graph. For children this can be displayed with a reward system geared to extending attention a little every week but even adults could do this for themselves.
Getting starting and continuing the task can be helped with schedules and timers – some are unobtrusive – like pocket timers that give a vibration that can’t be heard and certainly take the place of a tap on the shoulder!
Of course the student should sit near source of information and where it is quiet, less activity (front row or near a good “role model”) who listens, takes notes etc.
Teachers and Managers should take care to involve the student/worker in necessary tasks and in a positive, open ended way, thus avoiding instructions/commands which may not be paid attention to – “Should we do x”/ “Would it be a good idea to..” , “How could we….”, “Why don’t we…?”
Clear concise instruction with verbal feedback to check understanding would help.
At school a reduced or alternative forms of written assignments can lighten the load – projects heavily illustrated by photos, drawing or entirely presented by power points or videos.
In giving instructions, back them up with written or visual reminders
In note taking arrange hand-outs, peer assistance or show the student how to use technology to record information, photograph the board with digital technology etc.
Be aware that drifting off in repetitive, tedious tasks is inevitable and that breaks to refocus are necessary. In school this can be pre-arranged with a “time-out” card that allows the student to hold up the card (unobtrusively) when unable to concentrate and being allowed (with a silent cue from the teacher) to leave the room to undertake a rejuvenating activity such as running on the spot or anything that gets the child out of breath (oxygen stimulates the attention networks) for a minute or so. This must be associated with a guarantee from the child to return within 2/3 minutes otherwise this privilege will be withdrawn.
Additionally asking the student to run errands, hand out papers/books etc can achieve the same refocus. Movement stimulates Dopamine the presumed neurochemical deficiency. Allow and encourage the inattentive student to stand while working and similarly for impulsive adults
A learning diary. The student should take down at least some key words in each class and meet with the special needs or support teacher regularly (optimally every day, but at least weekly) This teacher should have access to the Curriculum and know where the student should be in his/her studying plan. This teacher should then discuss the key words, help the student fill in any gaps in their knowledge and help rewrite the keywords into a coherent theme, which the student can rewrite in class and eventually build up to adequate note taking, essay writing and examination techniques.
Each exposure will increase memory of that information. Homework can be written into this journal for parents to check and sign off.
Older students can use a “cognitive monitoring” system, whereby they have a schedule on their desk which is divided into 5, 10 or 15 minute blocks – the student uses a timer that vibrates in synchrony (a non-audible buzzer, many watches do this) with the time slots and the student notes down whether he was paying attention or not, thus becoming more aware of attention lapses and therefore more motivated to use strategies to avoid them. Gradually the time interval should be able to be increased. Research suggests that such self-monitoring and frequent reminders to pay attention, does improve this ability.
For adults a learning diary based on books such as the Steven Saffren book “Mastering your Adult ADD” helps the individual to set goals and plan ways of maintaining them. There are several other systems for organisation and time-planning for adults, such as the book and programme by Susan Young.
For the impulsive child it is almost impossible to stop doing a planned action or thought – this is brain based and often children are sorry they have done or said something they shouldn’t but it is true when they say “I couldn’t help it”.
So parents and teachers need to choose their battles to maintain a balanced household. This means ignoring minor, inappropriate behaviour or at least not giving it undue attention. On the other hand positive attention and praise for just sitting quietly, acting politely or helpfully goes a long way. Impulsive children are more used to negative communication such as “No”, “Stop”, “Don’t do that”,
“You never know how to behave/study/organise” – or whatever the problem is. This adds to the impulsive child’s sense of inadequacy. When things are really out of hand “Time-out” means the child is required to go to a place or room where he is isolated from others – younger children can be physically removed, older children may need some sort of sanction but disapproval is made clear and all activity stops for the child for a period, until they have cooled down.
Try to seat the impulsive student near a good role model and praise this model for positive or exemplary behaviour, i.e. when they put their hand up to answer instead of calling out or waiting for someone to finish their remark before “butting in”.
Set up a “behaviour contract” in self-monitoring of behaviour (pushing in, blurting out unthought comments, talking over others). A reward system for reduction/cessation of name calling/answering before hands-up can be operated by teachers or other impulsive behaviours
Allow and encourage the impulsive inattentive student to stand while working and similarly for impulsive adults. Allow them to use stress balls or other means of continual movement that doesn’t distract others. Stress and “squeezy” toys and kick balls under the desk for example.
Help the student develop an automatic checking system – this is rarely done by the impulsive student who just wants to get work “over and done with”. So praise the student for checking, proofreading – especially if they found a mistake… see this as a whole new skill!
Where possible work through alternative consequences – “if you had/hadn’t done that what would have happened? Work through more positive outcomes… the idea being to try to instil thinking before acting.
Organization is generally weak in impulsive students so they may need the provision of files or headed dividers, written timetables stuck to desks, labelled hooks/shelves for coats and sports gear.
Check them regularly and praise for neatness (or at least some semblance of organisation)
Best to give assignments one at a time – so not to overwhelm the ADHD or ADD child with a perceived impossibility – they have a very short time scale and imagine anything they find difficult will take TOO LONG!
In general writing will be the student’s most difficult attribute – so either refer them to the special needs dept. for extra handwriting and written expression skills or require less writing in projects, possibly with alternative means of displaying information. All ADHD, ADD and Dyslexic students should be taught keyboard skills. 


Given the figures of 30% of children who have ADHD or ADD will also have reading problems, be aware they may need Dyslexia help and also shorten the amount of required reading and allow information technology such as scanners that read books and documents aloud. This can be done in the classroom with headphones.


Often, especially in impulsive ADHD, emotions and mood will be volatile so this needs reassurance, calmness, positive comments, help with social interaction, awareness of signs of anxiety or frustration building up which can be alleviated by reduction of work, breathing exercises, yoga, and biofeedback – or at its worst anger management strategies. Make the child aware that these are available and encourage them to ask for help in calming down.


All these teaching techniques are a build up to getting the student to self-monitoring of their own behaviour.

Executive function as an ADHD endophenotype

In an ever-changing world, a vital skill for survival is the preparation of possible actions, the monitoring of a selected action and the termination of an inappropriate action. Therefore, preparation, selection, monitoring and inhibition are all core aspects of executive function; they are also some of the key deficits in attention deficit hyperactivity disorder (ADHD).

Maturational lag in ADHD or maturation deficit?

Behavioural maturation correlates with brainbased development. Maturation is not a linear story, there is an ebb and flow that has to be precisely timed for normal development – too fast can be just as damaging as too slow. In fact, a slower development of the prefrontal cortex can result in a cortical thickness that has been associated with a higher intelligence quotient (IQ) and ‘late bloomers’,1 while a rapid development of the brain is associated with autism. Progressive increases in the thickness of pyramidal cells and synaptic density, peak and ebb over childhood.3 Brain weight and head circumference increase and plateau at various ages.

Neurofeedback and ADHD

Neurofeedback (NF) is based on brain imaging studies, quantitative electroencephalography (qEEG), positron emission tomography and single photon emission computed tomography (SPECT), which all show cortical brainwave slowing in the majority of attention deficit hyperactivity disorder (ADHD) patients, as well as too much or too little coherence across functional areas of the brain. Evoked potentials too, reveal subtypes of ADHD, which are known as endophenotypes and will influence the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–V), due to be published in 2011. An endophenotype is both a psychiatric concept and a biological marker forming a link between the genotype and the phenotype.7 Diverse behavioural symptoms of a complex disease, such as ADHD, are grouped into a set of up or down regulated genes that from a cluster – eventually a neural network. For example, impulsivity; the correlation between gene expression and behavioural measures of impulsivity, such as the delay-discounting task and other behavioural measures, suggest an interaction between genes expressing mesolimbic dopamine activiation and impulsivity.

Books for Children on attention, reading age 10 to 12 years, but well illustrated and could be read to them:

  • “The Girls Guide to ADHD” by Beth Walker woodbine press
  • “Train Your brain for Success: a teenagers guide to executive functions” by Randy Kulman speciality press
  • “The Survival Guide for Kids with ADD” by John Taylor, Free Spirit pb.
  • “Learning to slow down and pay attention” Kathleen Nadeau & Ellen Dixon
  • “Putting on the Brakes” by Patrica Quinn and Judith Stern

For Adolescents:

  • “Ready for Take-off: Preparing Your Teen with ADHD for College” by Theresa E. Laurie Maitland, Patricia O. Quinn
  • “The ADHD Student Guidebook: 10 simple strategies to help you get organized and work efficiently” by Guido Saltarelli
  • “ADD at college” Sylvia Moody

Books on Adult ADD as well as good advice in a readable manner are:

  • “Mastering your adult ADD” Steven Saffren
  • “From Fidget to Focus: Outwitting your boredom” by Rotz and Wright – highly recommended.
  • “Out of the Fog” by Kevin Murphy
  • “Adult ADD and cognitive behavioural strategies” Susan Young
  • “Healing ADD” by Daniel Amen
  • “The ADD Nutrition solution” by Marcia Zimmerman – nutrition seen to be the key
  • “ADD: the 20 hour solution” by Mark Steinberg & S. Othmer – about neurofeedback
  • “The Disorganised Mind. Coaching your ADD Brain” by Nancy Ratey
  • “ADD-friendly ways to Organize your Life” Judtih Kolberg and Kathleen Nadeau
  • “Making the Grade with A+DD, A student’s guide to Succeeding in College with
  • “Attention Deficit Disorder” by Stephanie Moulton-Sarkis
  • “Driven to Distraction” and “Delivered from Distraction” both by Edward Hallowell
    And both highly recommended. Dr Hallowell suffers from Attention Deficits himself but nevertheless pursued a medical through Harvard University successfully. His website has useful strategies.

Some other useful websites are:

  • www.chadd.org – excellent information not only about AD/HD and related symptoms but also related problems, such as depression, obsessional behaviour, autism and tourettes syndrome
  • www.add.org – more adult orientated information on AD/AD
  • www.nimh.nih.gov/publicat/adhd.htm – masses of detailed information
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Autistic Spectrum

In the last version of the Diagnostic and Statistical Manual (DSM V) the separate conditions of Autism and Asperger’s syndrome were put together as one: Autistic Spectrum Disorder. 

To most parents, teachers and practitioners this seemed perverse since the non-verbal child who will never be able to attend a main stream school would now have the same diagnosis as the clever child whose unawareness of social conventions made him/her seem like a “little professor”. Asperger’s Syndrome was initially recognised as a developmental disorder, and was included in the diagnostic criteria of DSM IV, an internationally recognised list of mental and learning difficulties. It was defined as the mildest and highest functioning end of the spectrum of Autistic Disorder. Despite the abolishing of Asperger’s Syndrome as a separate category, the books written on Asperger’s Syndrome remain just as relevant, despite any difference in diagnosis. One of the best, “Asperger’s Syndrome” by Tony Attwood (JKPb.) lists the symptoms as:

• Qualitative impairment of social interaction
• Restricted, repetitive, and stereotyped patterns of behaviour, activities and interests
• Social impairment with extreme subjectivity
• Limited interests and preoccupations
• Repetitive routines and rituals
• Speech and language peculiarities
• Non-verbal communication problems
• Motor clumsiness

There is a genetic vulnerability to the anxiety that underlies the impairment of social skills and the obsessiveness that can propel the “little professor” to academic, if not social success. Parents of the affected child will often have echoes of the near obsessive attention to detail that allows them to succeed, especially in careers involving, science, maths, computing and I.T., even though they are not autistic themselves. The journey to Autism in their children has had many theories, from abnormal eye movements and neurochemistry that truncates neural connections to inadequate methylation and vulnerability to toxic build-up of pollution and damaging chemicals such as mercury, pesticides, organophosphates that the autistic system cannot deal with normally. This would include the “leaky gut” idea that also suggests that diet can help.

Whatever the cause there are many scientific breakthroughs that only that dogged concentration on detail have allowed. Mendel for example, who with his continual planting and crossbreeding of green, yellow, wrinkly, smooth, short and tall pea plants, discovered the laws of inheritance, now known as genes. Not to mention Newton with his discovery of the laws of motion that still form the basis of today’s physics. These men and many other great scientists are recorded to have had the classic signs of Autism.

But to get a child with this background onto a successful path involves a great deal of effort and understanding on the part of parents and teachers. Both have to understand the sensory overload an Asperger’s child experiences. (From this point the information refers to a child who fulfils the old definition – i.e. normal I.Q., age-appropriate literacy and numeracy but as noted above, weighed down with anxiety, disliking change, fearful of social interaction and tendency to obsessional interests) But even children with Asperger’s syndrome differ a great deal in these traits, from the simply slightly anxious and awkward introvert to the total obsessive energy of the child only happy when they are pursuing their particular interest shut away in their bedroom for hours on end.

Awkwardness is easy. It seems odd to some that people who cannot communicate with others (after all we are a social species) have survived and even increased, some surveys quote up to 1 in 100 people diagnosed with Autism. However, Ty Tashiro in his book on awkwardness makes the point that these are the people who don’t waste time partying and are better at devising algorithms or developing cyber security protocols. Obsessiveness seems to breed sharp focus and a localised processing that acts as an attentional spotlight as well as an admirable persistence, probably due to the underlying neurochemistry. Tashiro’s studies found that University students doing well in computer science and Maths were the socially less fluent. They will probably not be diagnosed with Asperger’s syndrome, just thought a bit socially inept.

Social blindness is harder. Many Asperger’s syndrome people are unaware of social cues (turn-taking in conversation, politeness etc.) and the unwritten rules of social interaction. Their anxiety makes them avoid eye contact that non-Asperger people use to understand the feelings and motivations of others. Their disinterest in others and their feelings comes across as egocentric. Their dislike of sensory overload – loud noises, bright lights, and large busy crowds are an assault on their nervous systems and seem odd to the more socially adventurous. Other symptoms such as extreme or obsessional thinking and behaviour and lack of “common-sense” seem eccentric to their peers as does the bias towards their emphasis on self rather than the give and take characteristic of normal social interaction

For school this means the necessity to understand the anxiety that lies behind the child’s reluctance to interact socially, especially in groups. Typically the Asperger’s diagnosed child is unable to generalise easily and adapt to new and variable situations and learning and note-taking and written work is never consistent with the child’s understanding. Teachers will be concerned over how difficult the Asperger’s pupil finds it to maintain attention on information and conversation in which they are not interested. Organisational ability is weak because it involves an overall progressing and integration of details. There are some general principles in managing such children at school.

• Classroom routines should be kept as consistent, structured and predictable, though they must be clear and explicit teaching should try to connect to the particular interests of the child, i.e. bring in examples of their pet interest when teaching general subjects.
• Use visual material, schedules, charts, lists, pictures
• Keep teaching as concrete as possible, avoiding figurative speech, idioms and simplify abstract concepts and language, they may need some help with meta-cognition – generalising knowledge and generating concepts
• Try to find a mature child who might “look out” for the Asperger’s diagnosed child in social groups
• Designate a named teacher to whom the child can go for help when they feel overwhelmed by social interaction
• Keep classes and groups they are going to join as small as possible or least in a less crowded part of the classroom.

At home and in general the Asperger diagnosed child needs to become more aware of the non-verbal aspects of social interaction. It is this that allows perception of others motivations, which is the basis of empathy and co-operation. An over emphasis on words at the expense of body-language and emotional tone of speech leads to a literality, which is perceived as lack of social sensitivity.

It is important to maintain exemplar conversations at home, with co-operative turn taking observed, continuance of the topic, elaborated conversational “repair” mechanisms observed, scrupulous attention to another’s topic and so on. “Mood Management” by Carol Langelier, Sage publications, is a cognitive-behavioural skills-building programme (book) for adolescents which older students could benefit. They must then be able to apply these psychological concepts to others and realise that others act in an orderly predictable way and that their own actions can affect that. For teachers “Social Standards at School” by Judi & Tom Kinney, pbld by Attainment Company gives self-monitoring skills checklists for inclusion in IEP’s.

Games involving the detection of emotional states from facial expression, body language and tone of voice will help. See the LDA catalogue (0800 783 8648) for “Social Sequences”, “Photo Emotions” games and “Photo adjectives” – that will encourage a more expressive, less literal language. A more complex programme for adolescents “Mind Reading; the interactive guide to emotions” a programme on a set of DVD’s from Jessica Kingsley Pblrs.

Home based ideas are to point out occasions when people demonstrate emotion or emotional conflicts i.e. a person who really wants to say no, agreeing. Parents can ask the child to comment on people the family come into contact with after they have demonstrated some emotion. Discussing the symbolic associations of colour and how they might represent emotional state widens emotional perception. For teachers and parents ”Nurturing Emotional Literacy” by Peter Sharp and “Non-verbal Reasoning” by Alan Blackmore also published by Jessica Kingsley gives good ideas and exercises for developing and becoming aware of emotions. If possible a valuable exercise would be videotaping the child in social interaction and showing this to them, pointing out how others perceive this and how it can be changed. Role-plays of potentially frightening situations (asking another child to stop etc.) at home can alleviate anxiety; the more a frightening situation is discussed, practised and alternatives generated the less fearfully anticipated it will be. If this doesn’t happen the child can develop an armour against his anxiety by assuming they are always right and will avoid conflict by not discussing the situation. The other possible downside is the vulnerability to internet addiction. Many parents feel that long hours on gaming changes the Asperger child’s personality and behaviour and leads them to become manipulative and deceptive. In fact, Video game addiction is becoming recognised as an impulse control disorder, or an Internet Addiction Disorder, similar to other psychological addictions and affecting over 1% of the population. Treatment ranges from total removal to limitation of time spent on the games at the same time as a replacement of some interest to the child to help make up the void, See http://kidsfitnessfirst.org/?study=internet-addiction-or-excessive-internet-use for some help.

Most children with mild Asperger’s syndrome manage life quite successfully, especially if they are able to be educated to a normal level, which involves the above special arrangements. The major deficit in Asperger’s syndrome is not understanding social rules (which are unwritten) and these then have to be taught, just as other children need to be taught literacy. A normally intelligent child is quite able to learn these even though they may not have an intuitive understanding of them. Thus there will always be an element of over-rationalisation to their emotional interactions, since they will be acting on learnt cortical knowledge rather than feeling “heart” knowledge.

Learning to put together cause and affect means the Asperger-diagnosed child or adult can learn and understand the higher order social concepts – that co-operation benefits all, that people have feelings that dictate their actions, etc. even if they don’t accept this emotionally. Learning to understand the perspective of others is taught by modelling and role play in social groups. Then the child can “join up” their disparate (at the moment) knowledge and come to a better understanding of social interaction. The area of most concern for young children is the necessity for more and more appropriate social interaction as they move through education. This is the area most out of their control. In later life they will be able to control the level and degree of social interaction they can tolerate. But as they move up through senior school and Higher Education these pupils will be at their period of highest vulnerability, more social interaction will be forced on them which may be frightening to them. Thus preparation is essential – familiarizing the pupil with the syllabus, other students and teachers and so on.

The National Autistic Society puts out much useful information and the OAASIS group has a free mailing group for assistance, support and information. Schafer@ sprynet.com will put you on a free website detailing all the latest world-wide research in Autism and Asperger’s syndrome.

Many parents find nutritional supplements helpful, and this is addressed in the Nutrition section of this website.

Colin was a quiet, introverted pupil but his reports note how resistant to change he is, and very literal. He became upset when people made fun of his “collection” in his desk and rigid with anger if anyone tried to touch it. This collection was pencils of every known lead quality. He knows all their weights and each had to be lined up in order of lead hardness or HB number. He won’t have other children sit next to him case they upset his collection. This seems partly reasonable as he is an exceptional draughtsman and is years ahead in D & T. and Art. So the teacher tolerated his insistence on having a spare desk either side of him that no one else is allowed to sit at, for the present although she was concerned that he didn’t do enough written work, sometimes turning in a few words set out in bullet points when they were expecting a story of at least 200 words. He doesn’t seem to get asked to parties, to play etc. and cuts a lonely figure in the playground, usually drawing the school building, but always the same.

When Colin came to us he had a monotone voice and shrank behind his mother, repeating no, no, no it a high pitched whine and wouldn’t look at us. The precipitating incident getting him to us was his biting of a child after the child said “no” to Colin’s asking “will you be my friend” and then did it again the next two days despite the telling off he got. His parents tried to explain that Colin was in a state of shock. Being in school where he knew no-one had pushed him into a level of stress with this uncharacteristic response.

His mother said he had never been comfortable when new people came into his orbit. although at home he is a sweet and compliant child and gets on with his two older sisters to tend to “baby “ him a bit. She suspects some provocation of the part of the other child. But he did the biting in the cloakroom, even lay in wait the teachers said – so they believed he must have planned it. He hadn’t shown any previous aggression – more anxiety and fear. But his teacher is more concerned that Colin seems unable to produce any expressive writing despite his excellent drawing.

After a school visit to the zoo the class was asked to write an essay about it choosing their favourite animal to describe. Colin simply wrote a list of all the animals there and then went on to write more animals that weren’t even at the zoo. He probably would still be listing out animals now if the teacher hadn’t have stopped him. He was nonplussed when asked to write a story about their lives but he eventually brought back on Monday day another list, which mother said took him all weekend! Against each animal was it’s life-span, habitat, preferred food, native habitat and other statistics.

Colin’s lesson to learn was how to get on with others. We suggested a social skills group. Socialization requires pointing out reciprocal interaction of other children, highlighting examples of give and take, kindness, empathy, politeness etc. Learning to put together cause and affect helps the child understand that co-operation benefits all, that people have feelings that dictate their actions, etc. Learning to understand the perspective of others is taught by modelling and role play in social groups, which Colin took advantage of.

Now his anxiety is reduced he has become more sociable.

We suggested he set up a drawing club once a week after school overseen by a supportive teacher. This worked so well that they have been invited to produce a banner for the Education Show that the Council is sponsoring.

Colin doesn’t need to bite anyone any more, he is a happy fulfilled child, negotiating the terms , sharing out the rewards fairly between all the Art Club participants and yes, he too now dictates his essays into a speech driven word processor. He will be allowed to use it for his exams.

Academic Book List:

Many books and articles by Simon Baron-Cohen of Cambridge Autism Research

 

Parents and teachers:

  • “The Complete Guide to Asperger’s Syndrome” – Tony Attwood JKPress
  • “Parenting a child with Asperger’s Syndrome: 200 tips and strategies” by Brenda Boyd
  • “Asperger’s Syndrome – what teachers need to know” by Matt Winter
  • “The Oasis Guide to Asperger’s syndrome; advice, support, insight and inspiration” by Patriciza Boyd, Barbara Kirby and Simon Baron-Cohen
  • “Asperger’s syndrome; your child, a parents huide”by Michael Powers and Janet Poland
  • “Create a reward plan for your child with Asperger’s syndrome” by John Smith et al.
  • “Asperger’s syndrome: practical strategies for the classroom; a teachers guide” by Leicester City Council and Education dept
  • “Asperger’s syndrome; a practical guide for teachers; resources and materials” by Val Cumine et al
  • “Social Skills training for children and adolescents with Asperger’s syndrome and social communication difficulties” by Jed E Baker
  • “Social Skills training for children and adolescents with Asperger’s syndrome; a step by step guide” (JKP resource material) by Kim Kiker Painter

All of these are available from amazon.co.uk or Jessica Kingsley Press.co.uk

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Dyslexia

Children acquire language by listening to those around them talking. In the first year of life they are building an ever-increasing store of speech sounds. This store is phonological memory — the units of sounds that make up words. If these sounds are stored in phonological memory in a faulty manner, the child’s perception of speech will be compromised, as will reading and spelling. Research by Paula Tallal shows that Dyslexic (and language impaired) children are unable to perceive fast sounds. These are the stop consonants that change to the vowel frequency before 40 milliseconds. Consonants such as b, t, k, d not perceived by the slow sensory processing system of the average Dyslexic and consequently auditory nerves are not stimulated into action in the same way. Many speech sound distinctions are lost.

Tallal, P. and  Piercy, M. (1973) Defects of non-verbal auditory perception in children with developmental aphasia.  Nature, 241:468-469.

Nagarajan S et. al. “Cortical auditory processing in poor readers” Proceedings National Academy of Sciences, vol. 96, no. 11, (1999)
This abnormal auditory processing is due to smaller neuronal fields in the left medial geniculate nuclei (MGN) according a post-mortem study of Dyslexics (Galaburda A et al, 1994, “Evidence for Aberrant Auditory Anatomy in Developmental Dyslexia” in Proceedings of the National Academy of Sciences, Vol. 91), and backed up by brain imaging studies showing the “knock-on” effect of auditory inefficiencies are weak phonological processing in Broca’s area (left frontal gyrus) which is often the target of stroke damage, which suggests this area is responsible for speech articulation. When speech is lost due to damage here it is called aphasia.

Other research suggests a timing circuit throughout the brain that simultaneously identifies letters (in the visual cortex) while the phonological analysis is progressing. After this meaning is mediated by the superior temporal gyrus and parts of the middle temporal and supramarginal gyri.

Shaywitz S. “Dyslexia” Scientific American, Nov 1996.

Tallal P. “The science of literacy: From the laboratory to the classroom” Proc Natl Acad Sci U S A. 2000 Mar 14; 97(6): 2402–2404.

Some Dyslexics show a pattern of under activation in the visual regions with a corresponding over activation in the phonological regions, when measured by qEEG (quantitative eeg, a measure of brain activation). There seem therefore to be both sub-types and developmental stages of Dyslexia. The consistency of the brain based under and over activation in certain areas suggests a genetic causation and this is backed up by studies of families where Dyslexia affects generation after generation.

But early middle ear infections too, can cause a child to perceive speech sounds unevenly so that some are heard before others and the whole auditory system can be mistimed, and sounds misequenced. Thus there is a delay (in milliseconds) in the perception of speech sounds, which others notice as a time lag between their speaking and the child’s response. This affects the rate at which phonemes are matched to the syllable to recognize a word, the “inner voice” can’t keep up with the eyes and reading is inefficient.

Another environmental cause is premature birth This also is highly correlated with difficulties in the acquisition of literacy since the auditory nerve active in the last trimester, is not activated and primed as much as it would be if the baby was full term, especially if the baby is put into an incubator which cuts off sound. This has effects on the perception of speech sounds. Another environmental cause can be early exposure to the sounds of a second language before the child is secure about the sounds of the first language. While most children manage this quite successfully and go on to become bi-lingual, if there is any inefficiency in auditory perception it can inhibit the acquisition of literacy.
And our Eyes must synchronize

Slowness in processing affects all the senses in Specific Learning Difficulties. Perception refers to the interpretation the brain makes of information from the senses. If the senses can’t convey a rapid feedback due to lack of neurons devoted to the function then information is mistimed and misequenced.

In fact most Dyslexic children have been taken to have their hearing and eyes checked early on, only to be told by the optician and audiometric Ian that there is nothing wrong with their eyes or ears. This is sometimes bad news for them — their parents or teachers may make a negative judgment — laziness or stupidity or any number of reasons for their failure in learning to read. The accounts children give of blurring print, losing lines in reading text or music, headaches on reading, not being able to see the blackboard, copy fast enough or listen to the teacher are all hard for a parent to interpret after being told there is nothing wrong at the physical level. But these complaints are common and are due to inadequate processing of visual, auditory and kinesthetic information.

In fact up to 25/30% of children may have light sensitivity and colour based visual perceptual problems. The current opinion is that at least some of the observed problems (glare off the page, moving and blurring of text, sore, watery eyes on reading, losing lines, needing to reread constantly to get the sense,) are due to an analogous deficit (to the auditory problems) in the visual pathways. The lateral Geniculate nucleus has been identified as smaller in cellular content in Dyslexics than in normal readers by Margaret Livingstone at Harvard University “Physiological and anatomical evidence for a magnocellular defect in developmental Dyslexia” 1991, Proc. Natl.Acad. Sci. Vol: 88. pp. 7943-7947

Most visual information moving from the retina via the lateral geniculate nucleus of the thalamus travels through one of 3 visual pathways. One of these, the magnocellular is thought to carry visual information about space — such as movement, depth and the relationships between them. The magnocellular is thickly myelinated (for rapid transmission) and ends up in the parietal cortex. The other important visual pathway, the parvocellular, the “what” pathway, which ends in the temporal cortex, must synchronize for efficient reading, so the theory is that when the magnocellular is not able to keep up with the parvocellular, visual tracking and fixation is unstable when the eyes sweep across a page. Visual information carried through the magnocellular in Dyslexic brains, has been shown by brain imaging studies (Eden, G. in Nature, 1995) to be poor in identifying movement in comparison to normal readers. By the time the information gets to the visual cortex the signal is quite faint in Dyslexics compared to normal readers. Thus the magno can’t control eye movements or guide them to the object to be looked at. Some researchers believe this means the magno or “What” pathway acts as an attentional spotlight. (Vidyasagar T. (1999) “Impaired Visual Search in Dyslexia related to the role of the Magnocellular pathway in attention” Neuroreport; 10) Studies showed that Dyslexic children are poorer at a visual search task than normal readers and the more distracters there were in the background the worse they did because reading places great demands on the attentional spotlight, far more than a complex visual scene. In other words a slow visual processing analogous to the slow auditory processing mentioned above. This has led some researchers to propose an auditory magnocellular system, analogous to the visual

For some children the interaction of these problems causes a light sensitivity with headaches, pattern glare off white pages (copying their work on pastel colours helps) — this is known as scotopic sensitivity, first identified by Helen Irlen — see her help for parents book “Reading by the colours”. Her solution is to screen the child or adult using coloured lenses until the right portion of the spectrum is inhibited or enhanced. This detected by reading rate, clarity of depth perception and subjective feeling of comfort.

Behavioral optometrists give vision exercises to help strengthen the convergence and accommodation.

Other techniques are monocular occlusion (covering the left eye with opaque lenses while reading)

Sub-types of Dyslexia

Reading requires both;

Phonological (sound based) analysis

Levels of phonological awareness

  1. Syllables c/a/t
  2. onset and rime tr / ip
  3. analogy zip/nip — beak/bean

(need good auditory sequencing and sound discrimination)

Orthographic (visual code) analysis

  1. requires orientation
  2. visual sequencing
  3. visual tracking

details of shape — horizontals, verticals, dots etc.

Letter to sound mapping is all locked into a precise, hierachchial sequence of neural events. This must be carried out in milliseconds or comprehension collapses.

A grammatical analysis is also going on. The subject and object of a sentence must be identified before the brain starts to analyze the meaning of the sentence, so if there is any slowness in the phonological or orthographic analysis then the brain never gets to the meaning level, or only imperfectly so.
Phonological sensitivity

In western writing we break each syllable down into individual phonemic segments represented by alphabetic symbols. (Cat = c/a/t/) Phonemes are a human invention, unlike syllables they are not generated by neurologically distinct programmes, i.e. they are physiologically arbitrary

Phonological skill correlates with the ability to switch attention from a word’s meaning to an analysis of its acoustic properties.

Normal readers can track changes in the pitch of a sound and can segment words into their constituent phonemes to match them to symbol. Insensitivity to temporal auditory changes correlates with poor phonological awareness which affects reading of irregular words, non-words, homophones, delay in sensitivity to rhythm of speech — kissing fish, kissing fish (meaning is added to by prosody, for initial parsing analysis)

Therefore the best test of phonological awareness is can they read non-words. These have the same sound structure as the English language but the child has never seen them before so cannot rely on visual memory.

 

Orthographic skill

Orthographic skill correlates with ability to use and identify familiar letter sequences with minimal phonological information — letter order, frequency, spatial position, (spelling)

Orthographic sensitivity is independent of phonological sensitivity and can contribute to poor reading even when phonological skills are normal. (Good motion detectors are less likely to mistake anagrams for real words (xepi for pepsi) Even in non-dyslexic children these sensory abilities correlate with reading and spelling.

The best test of orthographic skill is homophones – can they distinguish reign from rain, sale from sail etc.When auditory and visual sensitivity are analyzed together they can explain 93% of variance in reading.

Both types of discriminatory sensitivity, orthographic and phonological, have 40/50% heritability.

Evidence is based on studies reported in;

“Dynamic sensitivity and children’s word decoding skills” Talcott, J, Witton. C. et al. 2000 PNAS, 97, 6, 2952 — 57
The sensitivity of the magnocellular component of visual processing can be assessed psychophysically by using stimuli that selectively stimulate it. Flickering lights, low intensity, low contrast, coarse (low spatial frequency) gratings and moving targets stimulate the magno selectively. But less so in Dyslexics .. Motion sensitivity is tested by a random dot “kinematogram”, a square of moving dots, and Dyslexics need to see 30% more dots move before they perceive movement, in relation to normal readers.

Similarly sensitivity to amplitude modulation (perception of change of auditory frequency) measured at 2Hz FM sensitivity is the best predictor of phonological Dyslexia, this reflects the phonemic range in language.

“Impaired Neuronal Timing in Developmental Dyslexia – The Magnocellular Hypotheis” Stein J. et. al. (1999) Dyslexia 5: 59-77

Charlie was one of those pleasant children, always calm, philosophical, rolls with the punches and genuinely a pleasure to be with. He interacted well with others and did a wonderful model of a dragon for the school play and a butterfly that hung over the stage. Despite his creativity his teachers though his reports were a catalogue of despair over his academic work, especially in English, but also Maths. Last year’s teacher used to keep him in at playtime to redo his spelling lists and writing full of careless mistakes and his Father went into school to make sure this doesn’t happen this year. Charlie had not mentioned this to his parents for a whole year because he thought they might be cross too. But the day they found out he was scheduled for an emergency assessment with us. Father himself had had a rough time at school and was kept in for making mistakes in his spelling and writing. He asked the teacher to teach him, not punish him and showed her the stories that Charlie had written at home about dragons all illustrated with complex mystical figures. The teacher found it hard to decipher Charlies’s stories but once she did she realised that there were some good ideas even if they were practically illegible because of the poor spelling, grammar and punctuation – not to mention the erratic letter formation. So the assessment changed Charlie’s life too. His teachers could see how high his I.Q. was but also that he had poor phonological awareness, just like his father. Dyslexia has a high heritability rate, so there will often be a parent, grandparent or Uncle who also is Dyslexic. It didn’t help that Charlie had had constant ear infections as a baby. This is the biologically sensitive time for the child to register the speech sounds of the language on which is based the phonological code that is drawn on in learning to read. A history of early ear infections is very common in Dyslexics.

The remedy was a phonics-based programme, taught in a multi-sensory manner by a Dyslexia trained, or at least knowledgeable teacher. Reading requires a simultaneous analysis of the whole word (sight word) with a phonological (part word) decoding. Phonological awareness is the ability to break words down into their constituent phonemes, or speech sounds, of which there are 44 in the English language and from which all words can be decoded. Clearly this is critical to reading and sight word recognition cannot be efficiently developed without phonological awareness. There are thousands of words in the language that would need to be committed to memory by sight/whole word, which is an impossible task for even an excellent visual memory. Therefore a phonological analysis must be used simultaneously with visual/whole word memory alone which Charlie was not able to do. Multi-sensory means using all the senses to bridge poor verbal and phonological memory, usually visual but also motor memory by tracing out letters in sand and later words in writing. Getting the child to move around letters chalked on the ground can work for younger children. For those with also weak visual and motor memory linking letters and words to odour can help (Orange for O sounds etc.)

There are many commercial programmes such as “Alpha to Omega”, “The Hickey Programme”, “The Dyslexia Institute Programme”, “Units of Sound”, “Toe to Toe”, “Lexica”, among others, but given Charlie’s excellent visual memory we suggested that a more visually based, colourful programme w as used, such as “Letterland”. All these programmes are carefully structured and go through all the letter and word families of the language in a cumulative and hierarchical way using touch, image, colour, sound and any other sense that can be usefully invoked to strengthen memory. There are also computer based programmes, set in games format, such as “Nessy Learning” a dyslexia remedial literacy program downloadable to a PC or ipad and which could go from school to home for frequent practise. It took Charlie less than a year having his Dyslexia lessons once a week to reach an age appropriate level in reading and once he knew the sounds of letters and syllables he could spell and write. He still had a shaky letter formation despite being taught writing so he too was allowed to use a computer for his work. He has sent us a story that convinces up that he will be a writer one day. Imagine that, a Dyslexic writer… watch this space.

“Dyslexia: A parents” Guide. By Gavin Reed
“Theory and Good Practise in Dyslexia” by Angela Fawcett – Whurr Press.“Board Games for comprehension of reading.
“6 Comprehension board games” from Smart

www.bda.org for masses of resources

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Dyspraxia

Dyspraxia which is now known officially as Development Coordination Disorder is defined in the Diagnostic and Statistical Manual Ed: V as “below expected performance in daily activities that require motor coordination, often manifested by marked delays in achieving motor milestones (walking, crawling, sitting), poor performance in sports, clumsiness, dropping things and poor handwriting. A necessary criteria is that the level of motor competence (the planning and execution of movements) observed must be discrepant from intellectual ability and age appropriateness.

 

More colloquially this used to be called the Clumsy Child syndrome. The clumsy child annoys everyone. They are seen as careless or even split the beans (metaphorically) on purpose. Motor skill difficulty increases under stress so the accidents often happen during a tense situation which makes it seem more deliberate.

Actually there is another type of Dyspraxia – verbal, where the motor movements necessary to make speech sounds are out of sync so the speed, rhythm and volume of speech is compromised in some way. There is often a history of speech disorder in the family. Eating normally can be an issue.

Then when only fine motor skills are affected the more appropriate label is Dysgraphia (difficulty in writing). It is difficult for Dysgraphics to make continuous movements well enough to form letters. They fail to see or can’t make strokes above the line well enough to differentiate between h and n and so on. Tracing letters out in sand, felt or plasticine helps them internalise the graphic form. Or put more simply develop the muscle-hand-eye feedback that a normal writer has. Often the Dysgraphic has no perception of margin so the words they can write might start several lines or inches down the page. They cannot do tasks that require both verbal and visuo/spatial skills together, such as handwriting, recording, some games including board games, reading from scripts while talking etc., although by adulthood enough practise can mean normal development.

In the classroom the Dyspraxic/DCD and Dysgraphic child will mostly read well but will not be able to produce their usually excellent classroom discussion in writing, at least not to the same level. They have trouble in organising their thoughts into written expression and that will include spelling and grammar ( despite normal phonological and reading capacity). It extends to number formation as well as letter formation and problems in aligning columns so sometimes they are calculating one column then accidentall add in a figure from column two, which throws out the whole calculation.

The Dyspraxic/DCD child will be the one that falls off their chair just as the main point in the story is reached, accidentally drop their pencil box on the floor or miss the baton in the relay race. Visuo/motor memory will usually be weak so they forget where things are, what they looked at .Bull in a teashop is the usual refrain. Dyspraxic/DCD children are disorientated in respect of their environment, never where they should be, untidy personally and a trail of crumbs and bits of food from the table to where they went next. The young Dyspraxic child will tend to get dressed in the sequence so end up with overclothes on before some item of underclothing.

Because of the discrepancy between their good verbal skills and weak visuo/motor skills they also can take words as gospel and fail to notice the non-verbal aspects of language such as facial expression, body language/posture and tone of voice that qualifies the words. “But he said…x.” one often hearr the child protesting. To which the answer is usually, “Yes, but didn’t you notice HOW he said it. You could tell he didn’t really want to agree, or that he was keen – or any one of the ways humans use to clothe the real message. So of course they are often surprised at what they perceive as untrustworthiness. And rarely understand the full emotion and motivation of those around them.

Occasionally the Dyspraxic/DCD girl will go over the top and become too friendly, thus misjudging other’s personal space and becoming too reliant on those who help them. They have the same level of emotional naivety but probably because of society’s scripting choose to be everyone’s best friend on a sort of “fake it till you make it” basis.

When this link between movement and learning is inefficient it makes imaging things difficult. Like having to see things and then move them physically to see what the new décor would be like. Wheras skill here makes a good interior designer who can conjure up alterative scenarios for clients – or theatre stage managers who with bits of plastic, cloth, paint, wood and light can suggest changing seasons or centuries even.  Or choreographers of dance and ballet

The delay in taking in visuo/motor information relative to verbal might only be in fractions of a second, but that’s all you need to miss the ball or the upstroke of a letter in writing. Think back to if you’ve ever been on anti-histamines or had jet lag, everything seems a bit faster than you can cope with at the moment, although you CAN do it, it requires effort. Of course the gap between “thinking” and “doing” affects planning or any motor action so these children have trouble in organising themselves, such as getting changed for PE, getting books out of the cupboard, where to start on a written project or deciding on the correct behaviour for a particular situation. So sometimes they are figures of fun in the playground and never chosen to be a partner in games and sports.

In writing posture is important, sitting at a sloping desk helps them sit up a little straighter and breathe in a better rhythm. They will have a weak grasp of the pencil and compensate for that by holding the pencil very tightly so often their knuckles show white. There is often a decreased awareness of touch in their fingers. Using fibre tipped pends that don’t need much pressure helps and special pencils with hand grips. But using a key board can overcome these problems even if learning to type is an uphill job.

David seemed a great pupil to his teachers at first, his reports were enthusiastic about him, always with his hand up and always the right answer. Eager to please and so knowledgeable about subjects they almost couldn’t keep him quiet. But, actually, that was the trouble – the questions, questions, Questions… getting more and more irrelevant. He has to know EVERYTHING about a subject before he can start a project and then often misinterprets what he is supposed to be doing. On the last day when each pupil had to stand up and deliver a 5 minute oral account of their project David started out well with factual information about where cocoa came from and historical facts about it’s use by wealthy people and then wandered off into drug use in general and he was extremely upset when the teacher pointed out that he had already had 8 minutes. He wouldn’t give his conclusion until he had finished his middle points and so he got marked down. This resulted in an inappropriate mini-tantrum, which did him no good in the class popularity stakes. In fact the teachers noticed that he never gets picked for anyone’s partner in games and PE as well as class projects. The last time there was a paired information getting exercise it ended with David overwhelming the other child with facts and refusing to let him contribute because he didn’t think the other child’s information was correct or relevant. Watching him in the playground, mother says he seems un-coordinated, beyond the usual difficulty of the tall child. Teachers commented on his clumsiness in the classroom, always managing to knock over chairs or drop pencil cases even though he is always extremely sorry and surprised it happened. He is often involved in heated discussions with other children about some perceived unfairness (to himself) or violation of the rules of the game. His most constant refrain seems to be “it’s not FAIR”. But his last report stresses his writing – it goes on and on sometimes on a tangent with no organisation or plan, it is poorly spaced sometimes with whole lines totally missed or written over so that sentences can seemed joined together when they are not. It just goes on and on almost opposite to Chris’s effort (or rather, non- effort). This was the point at which David came to us some years ago and his testing revealed a very high verbal reasoning ability but weak visuo-motor skills. This is the major criteria for Developmental Coordination Disorder which used to be known as Dyspraxia. The discrepancy between verbal and visuo/motor skills affects both gross and fine motor skills. But his poor motor skills meant he had just as much difficulty in learning to type. Eventually he was allowed to use different formats to present his work, heavily illustrated projects, photographs, power points and other multimedia at which he was good and occasionally a verbal explanation of his knowledge, a sort of mini-lecture (at which he excelled) but which took up the teacher’s time in listening and marking it.
This neurodevelopmental difference makes a great talker but a much less able “doer”. Plans are talked about but never realised, or if so, much later than should have been the case. The hand can’t keep up with thoughts so writing suffers. But David is now at University running the local radio. At 18 he is a poplar D.J. and will do his Media degree using a computer and is long past the days the days of being turned down as sports or project partner.

Remediation is usually done with an Occupational therapist or a sensory integration specialist who use a series of balance and motor exercises. Or a neuraldevelopmental delay therapist who seeks to release the retained reflexes that inhibit normal motor development.

When it is only fine motor skills that are affected the more appropriate description is Dysgraphia. In general, a child with dysgraphia may have trouble with the following:
• Forming letters, numbers, and words
• Spelling words correctly
• Organizing thoughts and ideas into written expression
Dysgraphia means difficulty in writing, so describes a child who has a much easier time expressing ideas verbally than in writing.

Books on writing

  • “Why Johnny Can’t Write” by Lumsden and Whimby (LEA Press)
  • “Putting Pen to Paper” by Melvyn Ramsden – Southgate Press
  • “Improve Your Writing Skills” by Roy Johnson – Clifton Press
  • “Expressive Writing” by Gerard Engleman – SRA Press
  • “Writing Assessment and Instruction for Students with Learning Disabilities” 2nd Edition by Nancy Mather, Barbara J. Wendling, Rhia Roberts.

Books on DCD (developmental coordination disorder) formerly known as Dyspraxia

  • “Developmental Coordination Disorder in Children” by David Sugden and Mary Chambers
  • “Developmental Dyspraxia” by Madeleine Portwood
  • “Dyspraxia; by Kathy Kirby – David Fulton Press.
  • “Dyspraxia 5 – 11 A Practical Guide” by Christine Macintyre – David Fulton
  • “If only we’d known; motor difficulties in early childhood “– Margaret Sasse

(this are about stimulating proper motor development from birth, which in the area of smaller houses, excessive use of playpens, flats that don’t have gardens, Schools that have sold of their playing fields, roads too dangerous to let children bicycle round) 

  • “Smart Moves: why learning is not all in the head” by Carla Hannaford
    Also
  • “The Dominance Factor: how knowing your dominant eye, ear brain and Foot can improve your learning” – same author
  • “Attention, Balance and Coordination: the ABC of Learning Success” by Sally Goddard Blythe (About releasing retained reflexes)

  • “Not all in the Head” by Carla Hannaford

     

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Auditory Processing Disorder

Auditory Processing Disorder refers to the interpretation by the brain of information from the senses. When this perception is slow, mistimed or misequenced the child cannot develop sufficiently fast registration of auditory and information for accurate and sustained listening and often reading.

The will misinterpret some words, particularly ones that have fast (high frequency) speech sounds, find it difficult to listen to lengthy verbal information such as lectures, or people who are fast speakers or who have accents. Others often notice a gap between their speaking and the response as if they hadn’t heard first time round. In fact those with weak auditory perception will often be asking for repetition, inviting the response “Why don’t you listen”. Trouble is they ARE, they are using all their mental energy to perceive the speech stream and often feel embarrassed to keep asking for repetition. Thus they can get the wrong end of the stick when instructions are too fast or complex. The cause can be genetic (to do with constrictions in the ear canal but is certainly associated with ear inflammations at the biologically sensitive time (before 3 years old) when the child is registering the sounds of the language. On this they build the phonological code necessary for reading so there is often a knock-on effect. Grommets are the usual treatment but by that time the auditory membrane has missed much development. Adults who have auditory processing problems avoid social occasions where there are too many people because they can’t link the sound to the location and often don’t know who in the group is speaking unless they are watching the faces. Actually many APD sufferers, even young children get to lip read without even knowing they are doing so, so it is a valuable skill to develop their lip reading capacity with lessons.

We use the Scan test of Auditory processing to evaluate this difficulty. The child, adolescent or adult (there are 3 versions) are required to listen and repeat words under four different conditions;

• some part of the words missing various frequencies as they would be likely to be if a child is sitting at the back of a classroom, or listening to a teacher who speaks rapidly, or who has an accent or who speaks while turning to the board to write. Difficulty here means the child must be working very hard to understand and listen in the classroom.

• Against background noise as words would be in a playground or busy classroom or a noisy social occasion. If a child cannot discriminate these words to an age appropriate level he or she should be seated near the source of information, usually near the teacher and away from extraneous noises. Light ear plugs can help when this is not possible.

• When competing words must be identified, which is an indication of auditory developmental or maturity level and of ear advantage. Often the poor auditory processor will inadvertently join two words together inappropriately, for example hire in one ear with fear in the other, can be perceived as one word – fire. The implication is that the second word so interferes with auditory attention sufficiently enough to make it impossible to to process either word. When the auditory system is not fast enough to perceive accurately two competing words in separate ears teachers must be prepared to articulate clearly, pause between concepts and make sure the pupil is looking at them.

• When competing sentences must be identified. An efficient auditory system should be able to ignore information from one ear in order to register information in the other but a weak auditory processor will mix the sentences up so that they don’t make sense.

When this test produces below age appropriate results we know that the individual must be using a good deal of mental energy to register information and instructions given verbally or more likely just gives up, which means not concentrating. It is difficult to maintain sustained attention when only part of the auditory speech field is perceived. This fatigue in auditory processing – is NOT a hearing problem, but an auditory speech perception problem. Listening accurately requires mental energy and the below average processor cannot maintain auditory attention for lengthy periods or when background distractions interferes with adequate interpretation of verbal information, instructions, listening, and conversation. It is both tiring and frustrating to register only part of the auditory field and this can be responsible for lack of concentration as the child habituates to “zoning out” and of course this affects new learning. Articulating clearly, pausing in between concepts to allow the child to register the first piece of information before coping with the next will help their apparent slowness in processing concepts in class. Sitting in the front where he or she can see the teacher’s face will allow him/her to use visual recognition (facial expression and lip movements of the teacher) to aid their understanding.

Programmes such as “The Listening Skills Programme” are available and there are several sound therapy systems from Tomatis, Samonas and Johannssen – www.johannssensoundtherapy.co.uk. Auditory discrimination Apps also exist – from Don Johnson “Earobics” to programmes sold by www.speechmark.co.uk It is also possible to have an audio link from the teacher to the pupil that enhances auditory perception, see “Phonak”.

Central Auditory Processing Disorder (the same as Auditory Processing Disorder) is recognised by the American Speech –Lanuage-Hearing Association as “deficits in the processing of audible signals not attributed to impaired peripheral sensitivity or intellectual impairment”. It results in limitations in the ongoing transmission, analysis, organization, transformation, elaboration, storage, retrieval and use of information contained in auditory signals. Lasky & Katz (1983) describe central auditory processing as the manipulation and utilization of sound signals by the central nervous system – thus central auditory processing dysfunction (Boone 1987) is defined as “difficulty in processing auditory stimuli which doesn’t reach the brain with adequate processing of the perceived stimuli. Deficits may be mild to severe but will certainly affect the ability to listen to continuous speech, especially if fast paced, heavily accented or if there is any background noise. It is also affects the ability to recall auditory sequences in various forms, words, numbers and sequences as well as the ability to note phonemic differences in words. This is the basis reading (decoding words) and spelling (recoding words). Much research (Tallal, 91, Galaburda, 98, Witton 98 and Stein 2008 among others) show that discrimination between stop consonants such as T and P is more challenging than – for example, l or m. Difficulty here is present at birth and is the basis of Dyslexia. Thus this is a developmental difficulty and also age-related (Trace, 1993) with progressive asymetricalisation of the brain resulting in lessened interhemispheric communication, thus less ability to process auditory information. Hearing aids are of minimal benefit here although recent research on cochlea implantation has shown benefits. Therapy for children ranges from auditory discrimination tasks either with a speech and language therapist or computer based programmes such as “The Listening Skills Programme” with a trained specialist. In severe cases a microlink can be put into the classroom to facilitate the child’s reception of the teachers voice.

An addition to the American therapeutic market is “FastForward” which enhances auditory discrimination by artificially elongating rapid sounds (those that go from consonant to vowel in less than 40 milliseconds, thus exceeding the capacity of an impaired auditory system). Sounds that are not well-perceived cannot of course be linked to their symbol – the sight of the letter, syllable or phoneme. Thus the knock-on effect is difficulty in reading since there is not a reliable association between phoneme and grapheme the child can learn. Thus developmental Dyslexia is a usual consequence of Central Auditory Processing Disorder. The research into the brain based problems in auditory processing is detailed on the FastForward website www.scientific learning.com Thus this programme, although used in American schools is based on the neurological deficits of the child and can be classed as a medical intervention as well as an educational one. We don’t have such easily available knowledge or treatment in the UK, although Phonak, developed and supplied in the U.S. has recently set up a distributer in the U.K.

Sound therapy and listening skills programmes available here are described by Dorine Davis in “Sound Bodies through Sound Therapy” who explains what sound therapy is and how it stimulates the voice-ear-brain connection, gives thorough explanations of the leading sound therapies used today — Berard AIT (Auditory Integration Training), Tomatis®, The Fast ForWord ™ Series, The Listening Program™, Interactive Metronome®, Samonas™, Earobics™, and BioAcoustics™

 

Auditory Processing Disorder Checklist
Although Auditory Processing Disorder originates in the brain, neurological dysfunction is not observable. APD tends to manifest as poor listening skills or an inability to process auditory information and is often acompanied by motor problems.
It is important that parents do not disregard the indicators of APD – the earlier the condition is identified, the more likely that intervention will have a positive effect.

Does your child frequently demonstrate any of the following problems with expressive language?
• Doesn’t speak fluently or articulate clearly
• Has poor vocabulary, sentence structure and grammar usage
• Displays illogical flow of stories or ideas
• Uses vague words such as ‘thing’, ‘stuff’, ‘whatever’
• Problems with receptive language?
• Needs to hear instructions/directions more than once
• Appears overwhelmed when there is a lot of auditory activity
• Misinterprets verbal messages
• Confuses similar words or sounds
• Seems distracted or unable to sustain attention when receiving verbal messages

Problems with other language tasks?
• Cannot associate sounds with their written symbols
• Tends to spell words phonetically (eg. spelling ‘fire’ as ‘fier’)
• Reads slowly and has poor reading comprehension

Problems with auditory sensitivity?
• Finds neutral sounds unpleasant or painful
• Puts volume of music or television unusually high or unusually low

Demonstrate any of the following physical coordination problems?
• Poor fine motor skills (using scissors, writing neatly, holding a pencil, etc)
• Poor gross motor skills (catching a ball, skipping, swimming, etc)
• Inability to perform many simple physical activities that others of the same age are able to do
• Falls over and loses balance easily or handles objects clumsily

Demonstrate any of these additional problems?
• Has poor personal organisation (operating within time limits, approaching tasks in a logical order, etc)
• Becomes frustrated, overwhelmed or irritated more easily than most children
• Experiences difficulty with concepts that involve time, direction or sequence

“Hearing equals Behaviour” by Guy Berard
“When the Brain can’t Hear” by Terri B Michael
“Auditory Perception” by Patricia Gilmore

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Oppositional Defiant Disorder

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Articles

Dyslexia and Creativity

The emerging field of Neuroaesthetics describes the brain’s propensity to recognise shape, form, colour, illumination and movement and how it is built on by great artists to produce art that gives us a similar pleasure – or a peak-shift in the brain. This is a biologically based frissant of pleasure, mediated by the chemistry of reward, Dopamine.

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The Concept of Attachment and it’s relation to Education

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The four styles of learning difficulties; Asperger’s, ADHD, Dyslexic and  Dyspraxic or Developmental Coordination Difficulty (DCD) have different abilities and needs.

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Percentage of the population with:

Attention Deficit
11%
Autistic Spectrum
1%
Dyslexia
10%
Dyspraxia
6%

Bev’s big finish text here… soon!

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