ADHD Nation Children, Doctors, Big Pharma, and the Making of an American Epidemic

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Alan Schwarz

ADHD Nation is as important for understanding the evolution of the diagnosis and treatment of attention disorders, the role of Big Pharma, and how attention disorders have been mismanaged as are the books NeuroTribes and In a Different Key for understanding the evolution of our understanding of autism.

Alan Schwarz is an award-winning investigative journalist whose work made public the seriousness of concussions in the NFL. Like concussions in sports, the potential side-effects of ADHD medications have been largely ignored. Big Pharma and the scientists they support have been complicit in this omission.

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ADHD medications have the potential to improve attention, motivation, and energy which is not dependent on having ADHD. When used properly, the drugs can help many people and the side-effects are minimized. But the statistics make it clear that the condition is being over-diagnosed in this country. The drugs are also being used (and misused) by many high school and college students and by others who feel that they need a boost and have never been diagnosed. The causes of their problems are not being investigated nor are other possible means of treatment. Consider the following…

In the 1930s, a drug was developed with the goal of treating asthma or nasal congestion which, serendipitously, was found to make people feel good. Smith, Kline, & French “licensed it before knowing exactly what medical condition the stuff might actually treat. Finding out was a lot easier then than it is today: Lax federal regulations did not require any proof of safety, let alone efficacy, before a drug was released for public experimentation. So SKF sent boxes of what it called ‘Benzedrine sulfate’ to any doctor willing to try the drug on patients with various ills, from asthma to postpartum depression.”

Due to known problems with amphetamines, a close cousin to amphetamines was developed to have the same effects with fewer side effects. “CIBA termed the chemical formulation of this drug ‘methylphenidate’. The company released it to the American market in 1956 as Ritalin, a treatment for narcolepsy, chronic fatigue, depression, and erratic behavior caused by senility. (Again, only in adults; the medication was untested in children.)”

Dr. Keith Connors, author of the Connors Rating Scale, is the best-known researcher in the field of ADHD. “Connors needed no questionnaire to assess the effects of Ritalin on himself. Late one afternoon, following an exhausting day in the lab, he had to attend an eight-p.m. lecture by Harry Harlow, a behavioral psychologist famous for locking young monkeys away from their mothers and studying their emotional demise. Knowing he’d never stay conscious for the whole thing, Connors found the tub of Ritalin capsules so generously donated by CIBA and took one. Within thirty minutes he snapped awake and thought to himself, ‘This is fantastic!’ He kept working until eight. He skipped dinner. He zoned in on the lecture, chatted with folks afterward, and stayed up until three in the morning. Just one dose felt so beguiling, that he never tried the stuff again for the rest of his life.”

In the early 1990s, Obetrol was an amphetamine which was prescribed for weight control but it was not a financial success. After a pediatrician discovered that it worked for some children who did not respond well to Ritalin, Obetrol was remarketed as Adderall.

“Psychiatry journals teemed with more than a thousand studies on ADHD conducted by Biederman, Barkley, and other pharma-sponsored scientists. The Food and Drug Administration relied on them when green-lighting medications as safe and effective. Their findings served as the backbone for the lectures that drug companies’ key opinion leaders delivered on world tours. The whirlwind created a self-affirming circle of science, one that quashed all dissent.”

“While almost all other developed nations immediately closed the loophole that Metadate had exploited – expressly banning direct-to-consumer advertising of controlled substances, usually through legislation – the United States sat back and let the market take over. To this day, the United States is only one of two developed nations that allow advertising of ADHD medications to the general public.”

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“Appallingly, some children have heightened anxiety interpreted not as a side effect of medication, meaning the drug should be reconsidered, but a new condition needing additional treatment…. Diagnosing young children with several overlapping psychiatric conditions became de rigueur in the 2000s, resulting in what some call a ‘medication cascade’. No doctor was more responsible for the trend than Joe Biederman up at Harvard, who evaluated dozens of drugs on behalf of his Big Pharma benefactors and almost invariably declared them safe and appropriate for children with multiple diagnoses like ADHD and bipolar disorder. Yet neither he nor anyone else tested the performance or risks of these drugs in combination – no pharmaceutical company would ever sponsor such a study, considering it too risky to their product’s reputation.”             “Adderall and methylphenidate have always been among the most addictive substances in medicine. Weird as it may sound, stimulants are dangerous by being not dangerous enough – the drugs have found a sweet spot in which their advantages are more common and immediately obvious than their more latent risks, lulling all involved into complacency.”

“Today, misuse of ADHD medications by high school students is far more widespread that most anyone realizes. About a million high school kids nationwide use Adderall, Concerta, Vyvanse, and others without a doctor’s prescription, getting them either from friends or from dealers for a few dollars a pill.”

“Dozens of studies since the 1990s have estimated that about 8 to 35 percent of undergraduates take stimulant pills illicitly to try to improve their grades; a reasonable estimate among high-pressure colleges is probably 15 to 20 percent. Most students, of course, don’t experience terrible outcomes – if they did, the dangers would already be better recognized. But many do. One 2006 study found that about one in ten adolescents and young adults who misused ADHD medications became addicted to them, with some of them becoming psychotic or suicidal.”

“A different study found that teachers suspected ADHD far more often in elementary school children whose birthdays made them one of the youngest in their grade – just a tick over six, say, when the rest of their classmates were nearing seven. Therefore, many kids were being diagnosed merely because they were born in the wrong month: ‘The youngest children in fifth and eighth grades,’ it concluded starkly, ‘are nearly twice as likely as their older classmates to regularly use stimulants prescribed to treat ADHD.”

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At the end of his working career, Dr. Keith Connors sent a letter to a colleague and closed with the following: “Beware the simple & sovereign explanation.” That is good advice to all of us.

Alan Schwarz includes in the book a mock doctor/patient interview from a certified continuing education program purported to teach physicians how to diagnose ADHD. From the start of the conversation to the writing of the Rx was six minutes. Also, it was not revealed that there was a possible conflict of interest but the following was discretely printed at the end: “Supported by an independent educational grant from Shire.”

http://www.psychologytoday.com/tests/health/adhdattention-deficit-disorder-test

There are many possible causes for ADHD behaviors other than primary “brain dysfunction”. Since there is no litmus test for ADHD like blood work or imaging, ADHD is primarily a diagnosis of exclusion. Other possible causes of ADHD should be investigated and ruled out prior to considering medication. Visual problems are one of the possible causes of these signs and symptoms but so are the accelerated curriculum, fewer recesses in school, less time playing outside, more stimulation from video games, more organized activities which reduce free time, instant communication and responses, less sleep, and more pressure. Children whose problems are not primarily due to attention, may also do better with medication, but their underlying problems are not being addressed and they may be being medicated unnecessarily. “The human brain has evolved over many thousands of years, yet only in the last hundred, a blip on that time line, have we demanded that each and every young one sit still and pay attention for seven hours a day.”

MONASTRA VIDEO

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https://www.cdc.gov/ncbddd/adhd/index.html

 

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How Adam Smith Can Change Your Life An Unexpected Guide to Human Nature and Happiness

Russ Roberts

Adam Smith is credited with being the founder of modern economics and many have heard of his book The Wealth of Nations which was published in 1776. But Smith also wrote the little-known book, The Theory of Moral Sentiments which was published in 1759. The author is an economist who had read The Wealth of Nations but had never seriously considered reading The Theory of Moral Sentiments until he was asked to interview a friend about the book. When Roberts read the book he was surprised to be captured by Smith’s thoughts. Smith’s thinking had such an influence on him that he wanted others to have the same experience without having to read the original text. Continue reading

The Knowledge Illusion Why We Never Think Alone

Steven Sloman and Philip Fernbach

It may be disappointing to understand that we know less as individuals than we realize, but continuing to be deceived by this illusion can  lead to poor decisions and unfortunate actions. “Most things are complicated, even things that seem simple.” “Complexity abounds. If everybody understood this, our society would be much less polarized. Instead of appreciating complexity, people tend to affiliate with one or another social dogma.”

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Many of us are frustrated by how much we forget – or remember incorrectly – but “remembering everything is in conflict with what the mind does best: abstraction.” Remembering everything “would make us less successful at what we evolved to do. The mind is busy trying to choose actions by picking out the most useful stuff and leaving the rest behind.”reminder

 

In conjunction with their theme of pooled intelligence, Sloman and Fernbach explain how our thinking is embodied – not just with our own bodies but also with the people and things around us. “The fact that thought is more effective when it is done in conjunction with the physical world suggests that thought is not a disembodied process that takes place on a stage inside the head. Mental activities do not simply occur in the brain. Rather, the brain is only one part of a processing system that also includes the body (including the eyes) and other aspects of the world.” “Our bodies produce feelings to make us aware and warn us.” “In other words, the mind is not in the brain. Rather, the brain is in the mind. The mind uses the brain and other things to process information.” This is not easy to grasp when we already “know” that all thinking takes place in the brain because that is what has been understood for hundreds of years. For additional information and perspective, you may want to reference the following.

A challenging question to answer is: Why have humans evolved such large brains? Large brains are very expensive. They use a lot of energy, they make childbirth dangerous for the mother and the child, and they require a prolonged period of development. What advantage is so important to outweigh these problems? The explanation may be “that large brains are specifically suited to support the skills necessary to live in a community.” “People are built to collaborate.” “The transmission of knowledge enabled by our social brains via language, cooperation, and the division of labor accumulates to create a culture. It is one of the most important ingredients in the human success story. Human capabilities are constantly increasing, but not because individuals are getting smarter. Unlike beehives, which have operated pretty much the same way for millions of years, our shared pursuits are always growing more complex and our shared intelligence more powerful.” “The smartest among us – in the sense of being most successful – may well be those who are best able to understand others.”

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The authors spend the second half of the book “exploring how many of society’s most pressing problems stem from the knowledge illusion” and how change, particularly that triggered by technology, tends to cause us to “lose touch with what really matters.” It is easier and more comfortable to discuss issues with people with whom we agree, but “one common finding is that when people with like minds discuss an issue together, they become more polarized.” This is not informed decision-making. To probe decision-making, Sloman, Fernbach, and other researches have asked people about issues about which they have strong opinions and then probe how much they understand. Striking examples relate to the Affordable Care Act, support for military intervention in the Ukraine, and about the labeling of GMO foods. The results clearly indicate that “public opinion is more extreme than people’s understanding justifies.”non-gmo-logo-400x400

“Recognizing the limits of our understanding should make us more humble, opening our minds to other people’s ideas and ways of thinking.” “Intuition gives us a simplified, course, and usually good enough analysis, and this gives us the illusion that we know a fair amount. But when we deliberate, we come to appreciate how complex things actually are and this reveals to us how little we actually know.” “A mature electorate is one that makes the effort to appreciate a leader who recognizes that the world is complex and hard to understand.” This approach applies to all important decisions, not just voting.  The authors hope that, by helping us understand the routine pitfalls of our thinking, we can improve our decision-making.

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Smart Moves:Why Learning is Not All in Your Head

    Carla Hannaford

After hearing Carla Hannaford quoted many times, I decided that it was time to read this book and I was not disappointed. I started summarizing and excerpting books years ago to share with staff, but one of the primary benefits was to slow down my reading and to allow me the time to think more deeply about the implications of the author’s words. If you follow our blog, you have come across the understanding that thinking is not all in your head. We would have little difficulty with that if we didn’t already “know” that that all learning takes place in our brains. Changing our thinking, our beliefs, and our actions is much more difficult than learning when it does not require unlearning. I hope that the following excerpts cause you to pause as they have me.

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We have missed a most fundamental and mysterious aspect of the mind: learning, thought, creativity and intelligence are not processes of the brain alone, but of the whole body. Thinking and learning are not all in our head. On the contrary, the body plays an integral part in all our intellectual processes from our earliest movements in utero right through old age. It is our body’s senses that feed the brain environmental information with which to form an understanding of the world and from which to draw when creating new possibilities.

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Neural connections can be altered and grown only if there is full attention, focused interest in what we do. In three weeks we can get ten times more proficient at anything if we are emotionally engaged with focused interest. Self-initiated movement, exploration, interaction and physical experience for the joy and challenge of it, facilitates neurogenesis (nerve growth) for a lifetime. (This has been proven over the last decade when it comes to treating amblyopia. Intensive visual tasks for 20 minutes are more effective than hours of patching without a challenging, engaging activity.)

What we know, feel, learn, and think is shaped by how we know, feel, learn, and think. How we do these things is in turn dependent on the sensory-motor systems though which all our experience of the world and of ourselves is mediated. These sensory-motor systems shape our experience, and are shaped by it. So the story of how these systems unfold is a vital key to understanding learning.

Our proprioceptive sense constantly sends feedback to the brain that readjusts the balance of our shoulder and neck muscles in order for the eyes to remain level while reading.

Touch, hearing and proprioception are important organizers of the visual aspects of learning. Vision is a very complex phenomenon, with only a small percentage (less than five percent) of the process occurring in the eyes. The other over ninety-five percent of vision takes place in the brain from the association with touch, hearing, and proprioception.

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It’s easy to forget, or ignore, how much of vision is learned. We have to train ourselves, through books, movies, and art to see three dimensions in a two-dimensional space. We could call this visual literacy.

The eyes must be actively moving for learning to occur.

Words can only be understood when they provoke some kind of image in the mind of the learner. If students cannot access the underlying images, the words are not comprehensible; there is no context or visual understanding.

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Computer scientist David Gelernter makes this point emphatically: “Emotions are not a form of thought, not an additional way to think, not a special cognitive bonus, but are fundamental to thought.” Gelernter goes on to assert that emotions are also “inextricably tied up with bodily states. The bodily state is part of the emotion, feeds it and helps define it. This means that ultimately you don’t think just with your brain; you think with your brain and body both.”

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One of the most important things a teacher can do, especially with students with disabilities, is to bond with them. CAT scans show that children process information through their emotions first, and information that is the most emotional and emotionally relevant to them, is what students will learn. On the other hand, insecurity and fear can bring learning to a screeching halt by shutting down higher brain connections.

Another unnatural challenge has to do with learning to print block letters as the first step in writing. Printing is a highly linear process that takes us away from the more continuous rhythmic flow of language, both as it is experienced in the mind and as it is expressed through the hand – as in cursive…. Part of the problem is hand development, and asking children to perform the complex process of printing, way too early. In order to print the child must first crawl for a good long time with hands forward, to develop the bones in both the hand and to gain upper arm strength…. If you look at an X-ray of hand development, you will notice that the very intricate bones of the area near the wrist – the carpals, are not fully developed until about age twenty. The more developed these bones, the easier to hold a pen or pencil to print. If the child has had a lot of sensory-motor activation of the hand, printing can be more easily taught at about ages eight to ten.

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Children who have looked at books in the home may have already acquired some foveal focus if the process was their choice and free of stress and pressure to perform, however, most children are not physically ready to read at age five as is now mandated in our schools.

Having been flooded a number of times, flood analogies come to mind. Trying to rush development is like trying to pump the water out of your basement before the level of the ground water goes down. You waste a lot of time and effort if you start too soon because the water keeps coming back in. You are eventually successful when the water (or the child) is ready. It is easy to fool yourself about the influence that you had be starting early. If we try to push children too early, we can also create failures as some children become confused and frustrated who would have done fine when they were ready and interested. Combined with this is the opportunity cost of what these children could have been doing and learning to enrich their experiential background prior to the vicarious experience that we get through reading. There is so much that can be experienced and learned in an interesting, interactive classroom. They can even go outside the classroom where most real learning takes place.

You may think that it is a contradiction for me to disparage in any way the potential to learn through reading but we learn very little when we read about things we don’t already know quite a bit about. This book is a good example. It would have glossed off me forty years ago when I knew that all learning took place in the brain. Decades of experience has enabled me to take information from this book that I could not have understood earlier in my career.

Welcome to Your Child’s Brain

Thinking Goes to School:Piaget’s Theory in Practice

Tummy Time

Visual Factors in Reading

When will identifying vision problems that affect learning become a new standard of care?

 

Head in the Game The Mental Engineering of the World’s Greatest Athletes

Brandon Sneed

Head in the Game is about the growing use of new technologies to provide feedback on what is taking place in the brain and to use feedback to train the brain and to train the integration of the mind, vision, and body to enhance sports performance. Becoming aware of how our mind is enhancing our performance, or is getting in the way, is important to improve all visual abilities, not just those related to sports. As Yogi Berra is quoted as saying, “90% of the game is half mental”. The technologies are new, but the goals haven’t changed. To be successful, the athletes need to take what they learn from the electronics and practice to make it habitual. It doesn’t matter what you do in practice or in therapy if you can’t consistently apply your new skills to your challenges. The goal is to replace a less efficient behavior with a more efficient behavior and to have the more efficient behavior become more automatic than what you were doing before. The more automatic the behavior becomes, the more resilient it will be to fatigue and stress.

Brandon Sneed’s first example is using an EEG to provide feedback. “I do best when I put myself in a mind-set of relaxed control – not straining, but working, feeling zoned in but calm, thinking only of moving forward…. Most people need at least thirty sessions to get lasting effects from EEG training. Some, even more… It is work which may be why EEG training hasn’t caught on. It’s easy to pop a pill and see when happens, but EEG training feels almost like going to the gym.” This is the same mind-set that patients need to develop when they are learning to align their eyes, to improve processing with their amblyopic eye, and to focus better and to track better. In vision therapy feedback comes from specially designed targets which may also incorporate new technologies.

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“The reason why golf is so difficult is because you’re starting the action. Your mind wants to be in control, but the golf swing has to be done on a subconscious level. It’s impossible to think about the thousands of muscles and tendons and ligaments that have to fire in a perfect sequence in a fraction of a second.” I recently blogged on How We Read. The visual components of reading are as complex as the components of swinging a golf club and are even more difficult to observe. And, while both acts are too fast and too complicated to be directed through conscious attention, you quiet your conscious mind while swinging a golf club while in reading your brain must be simultaneously combining current input with prior input from the page, along with previously stored input, while also forecasting what is coming next.

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Brandon Sneed appreciates the importance of the placebo and nocebo effects. “Then there’s this stunning example of the nocebo effect: a study at the Oxford Centre for Functional MRI of the Brain in 2011, led by professor of anaesthetic science Irene Tracey. While studying the efficacy of an opioid drug, she found that something that should be effective can be rendered useless after a subject is told it won’t work. That’s right: even though something is scientifically proven to help people – such as a pill – if people decide it’s not going to work, sometimes it won’t.” Supporting people should be an integral component of all care from medicine, to surgery, to therapy, to coaching, to teaching. This is not in lieu of effective treatment, it augments it. If someone becomes a victim and develops learned helplessness. If they become a passive patient instead of a person involved with their care. If the expectations that are placed on them are too high or too soon and they feel that they can’t, working to change that attitude must be part of their care. The teacher is more important than the curriculum. The therapist is more important than the technique. And for coaches see The Talent Code

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“To master the mind, first master the body.” The Western World separated the mind and the body at the beginning of the Enlightenment because the connections could not be proven at that time. It took hundreds of years for this accepted wisdom to be reversed. So while we are mostly training the brain, we are doing it through the body. “Keeping the mind relaxed yet focused for extended periods of time is hard and a skill almost everyone takes for granted.”

“No performance-enhancing drug or piece of technology can compare to a good night’s sleep.” Research on sleep clearly indicates that it is our brain that needs to rest and not our bodies. This is a little like turning your electronic device off and on to allow it to reset, but our brains take more time.

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I share Brandon Sneed’s amazement as it is expressed in the following excerpt. “This brings us to one to one of the most stunning thing’s I’ve learned so far. We have five senses, right? We experience those senses because of specialized cells throughout our body called sensory receptors. Everything you feel, hear, smell, taste, and see comes from those receptors sending the information they gather to your brain. Of all the sensory receptors we have, 70 percent are in our eyes alone. That’s 260 million (130 million per eye) receptors taking information in through the eyes and sending it to the brain, by way of 2.4 million nerve fibers. This adds up to our eyes sending our brain 109 gigabytes of data every second.

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“Larry Fitzgerald, the great Arizona Cardinals wide receiver, did vision training as a child with his grandfather, an optometrist. ‘Parents need to understand,’ Fitzgerald once said, ‘that you need over 17 visual skills to succeed. Seeing 20/20 is just one of those. Vision problems can have a serious impact.’ And not just in sports, he added, but also ‘on a child’s education.’”

 

The Power of Play

Sleights of Mind

How We Read

How We Read

Despite the continuing controversy over the best way to teach reading and over the best time to teach a child to read, a great deal is known and agreed upon about the hidden intricacies of accomplished reading. Reading may seem simple once it has been mastered, but it is amazingly complex. It is dependent on the interaction of many mechanisms which must be coordinated with precise timing. This coordination involves multiple areas of the brain. The evolutionary forces which selected for these mechanisms had their effects long before reading was invented. Areas of the brain which evolved for other purposes must be retrained and coordinated to make reading possible. While one of the functions of vision therapy is to help people develop visual skills whose visual problems make it difficult for them to read, most people learn to read without this intervention. I am more amazed that most people learn to read well than I am that some people have difficulty mastering reading. Complex systems such as reading and sending a rocket into space have multiple vulnerabilities. Prior suggestions that all reading problems have the same cause are as misguided as the assumption that all rocket failures are due to defective O-rings and that only one system can fail at a time.

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The visual process of reading is not as it seems. Our eyes do not move smoothly across the page. As with most of what we do, the process of efficient reading is controlled subconsciously and is not available for our conscious inspection. Our eyes make stops (fixations) and jumps (saccades) 4 times a second as we read. We do not take in visual information during saccades although our brain continues to process information. This phenomenon also happens every time we blink and whenever we look from one object to another. Although our visual input is discontinuous, our perception is continuous.

Frequent eye movements are necessary to gather information because we only see a very small area clearly at a time. (see Active Vision) Our eyes move from one area of interest to another area of interest as our brains construct the illusion that we are seeing everything clearly simultaneously. The clarity of our vision decreases sharply as objects are farther from the point of fixation. Only the central 5 degrees has clarity equivalent to 20/20. This correlates with 5 letter spaces. During each fixation which lasts 1/5 of a second, input takes place, new information is processed and combined with what has been read before, our attention shifts to where our eyes will move next, and we predict what the next word will be.

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When we think of vision, we think of our focal visual system; the primarily conscious component of our vision which enables us to see clearly, identify what we are seeing, localize it, and to see it in color. The ambient visual system, which works in parallel with the focal system, is primarily subconscious and outside of our voluntary control. It contributes to our balance, helps guide our eye movements, keeps our vision from smearing when our eyes move, and stabilizes our world even when we are moving or objects are moving around us. When this system is poorly developed or poorly integrated, people tend to be unaware that their perception of the world or of the printed page is different from that of others. Dysfunctions of this system become recognizable when the changes are sudden as is caused by head injuries, by excessive movement like spinning in circles, or by the ingestion too much alcohol.

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To process what we see efficiently, our eyes must be focused clearly and aligned precisely at each fixation, 4 times a second, and sustained over extended periods of time. If this alignment is off even hundredths of a degree, the information being sent to the brain will have increased ambiguity.

The connection between our eyes and our brain is different than the connections between the rest of our body and our brain. Each eye sends half of its information to each side of the brain. Everything seen to our left is sent to the right cerebral hemisphere by each eye and everything seen to our right is sent to the left cerebral hemisphere by each eye. Efficient readers land 1/3 of the way into a word so more attention is focused on the beginning of the word to facilitate word recognition. It is now recognized that this causes information from the beginning of a word to go to the right hemisphere first while information from the end of the word goes directly to the left hemisphere. The left hemisphere has the primary responsibility for interpreting language. It is not yet understood how this information is recombined in less than 1/5 of a second with information from the end of the word reaching the left hemisphere prior to information from the beginning of the word.

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When children start to read, they look at every letter and put the letters together to recognize the word. Not looking at the letters in the proper spatial sequence will make identifying the word more difficult. As the system becomes more efficient, words begin to be processed as single units. Accomplished readers process longer words at almost the same speed that they process shorter words which is known as the word length effect. But if the letters or words are too close together, neighboring letters and words start to interfere as would happen when fine black and white lines are too close together. School books and worksheets are often too crowded which creates more problems for some students than for others. Adults are not immune to this effect. (see Visual Crowding)

The average reading speed for high school students is 250 words per minute which is about 4 words per second or one word per fixation. A reasonable adult reading speed is 350 words per minute which means that we are reading 6 words a second or 6 words for each 4 fixations. We do not read faster by moving our eyes faster. We read faster by taking in more information with each fixation and by reducing the number of errors which are recorded by eye tracking instruments as retrograde saccades. Children start by reading orally and then progress to subvocalizing words as they read. Proficient readers stop subvocalizing most words and recognize the word and the word’s meaning without activating the speech areas of the brain. Persistent subvocalization constrains reading speed.

Over time we develop a sight vocabulary of thousands of words. Words are stored in what is known as the word-form area which develops in the same area of the brain that we use to store information about faces and names. The ability to visualize words enables the development of our sight vocabulary and is essential for successful spelling. When we recognize the shape of the face of someone that we know, a name should be associated with it. Likewise, when we recognize a shape in the form of a word that we know, a name should be associated with it.

What we read is primarily retained in visual images and accessed by recalling those images. As important as language is to our thinking, visual processing and recall develops before language. Visual thinking continues to be important although we may be less aware of when we are using visual processing that we are aware of using language.

When we think of reading and reading problems, we don’t tend to think of these low-level skills, but like many things that we do, it is difficult for our high-level skills to shine if we haven’t developed mastery and automaticity of the prerequisite low-level skills. This is as true of musicians, surgeons, athletes and artists as it is of readers. It should be mentioned that there are also low-level auditory processing skills that have a role in learning to read. As the visual system is sensitive to crowding in space, the auditory system is sensitive to crowding in time. Some people do not process streams of sounds as quickly as do others and coordinating what is seen and what is heard is important in the process of learning to read.

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All of this is not to disregard the importance of high-level processing.  Working memory is necessary to assimilate current input with what has just been read.  Comprehension is dependent on an adequate vocabulary and an information and experience base which enables the reader to relate what we are currently reading to our stored knowledge.  Strong language abilities form a rich foundation for reading.

A lot has been said about 10,000 hours being necessary to develop expertise in a complex skill. If a child has been reading daily from the time that they are able to read until they graduate from high school, they will have read over 10,000 hours. Barring complications, a child is expected to be a competent reader long before that time as long as they have been engaged in what they are reading and have not been reading only because they have been forced to read. (see The Talent Code)03282012Casa_hogar_niñas_tlahuac30

For more information see:

Reading in the Brain

Reading in the Brain, Part Two

What if Everybody Understood Child Development? Part 1

Visual word form area in visual cortex remembers words as pictures