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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Body by Darwin

Jeremy Taylor

This book presents the growing evidence that we cannot continue to make progress in health care unless we consider the influences of our evolutionary past. Jeremy Taylor addresses seven areas:

  • Our immune system;
  • Issues regarding fertilization, pregnancy, and childbirth;
  • The effects of upright posture;
  • The development of the eye and macular degeneration;
  • The challenges of cancer;
  • Coronary artery disease; and
  • Dementia.

Each chapter stands on its own. I have chosen excerpts from his discussion of our immune system because these disorders affect such a large (and growing) number of our patients. “It is impossible to get to the root of the very peculiar human immune system and design really effective cures for allergies and autoimmune diseases without a fresh understanding of how the immune system evolved and for what reasons.” p. 7

“The world of our ancestors was a much dirtier place than it is now. Evolution took the expedient route, since microorganisms in prehistory could not be eradicated, of allowing humans to live with them rather than continually fight them. The great collateral cost of self-inflicted damage to our tissues caused by permanently raging immune systems was avoided by handing over the regulation of our immune systems to the microbes inside us, so that we ended up tolerating them. Evolution could not foresee a world where public hygiene, antibiotics, and chemicals that kill 99.9 percent of all household germs has so depleted this microbial population inside all of us that our immune systems no longer mature properly or are properly regulated, giving rise to dramatic increases in allergy and autoimmunity.” p. 8

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The author reviews volumes of research and shares a number of anecdotes including one about a boy with autism whose behavior was so uncontrollable that he had to be institutionalized. Soon after institutionalization, he had a complete reversal in behavior which was caused by chigger bites. To perpetuate his recovery, his immune system is now being treated with infusions of pig whipworms, without which his behavior regresses. This case supports the “hygiene hypothesis which links the bacteria, fungi, and helminths (parasitic worms) in our guts, on our skin, and in our airways and vaginas, with a host of autoimmune and allergic diseases. There is mounting evidence that the composition of all these organisms, living on and inside us – collectively known as our microbiota – can offer protection against a formidable list of autoimmune diseases, including the inflammatory bowel diseases Crohn’s disease and ulcerative colitis, type 1 diabetes, rheumatoid arthritis, multiple sclerosis, and, as we have seen, mental health.” p. 17

“Of all the autoimmune diseases, type 1 (or early-onset) diabetes is rapidly becoming the main scourge of life in the modern, hygienic Western world. Karelia is a large northern European landmass that used to belong to Finland but was partly ceded to Russia during World War II. As a result, the country has been partitioned. Although Russian and Finnish Karelians have the same genetic makeup, including the same susceptibilities to diabetes, the differences in their socioeconomic status and health could not be more stark. One of steepest standard-of-living gradients in the world exists at the border between Russian and Finnish Karelia, with the latter having eight times the gross national product of the former. Yet the incidence of type 1 diabetes, and a host of other autoimmune diseases, is far higher on the Finnish side. Finnish Karelians have six times the incidence of diabetes, five times the incidence of celiac disease, six times more thyroid autoimmunity, and much higher allergy levels than Russian Karelians.” p. 21

“The baby is born with a gut that is almost completely sterile and must be populated immediately with bacteria. If it is breast-fed, it starts to receive one of the most extraordinary products in the natural world. Human breast milk contains a complex array of fats and sugars – fast food – but it also contains immunoglobulin A, an antibody that protects the lining of the human gut and prevents pathogens from attacking and perforating it. It has also been estimated that a breast-fed infant receives over 100 million immune cells every day, including macrophages, neutrophils, and lymphocytes, together with a host of cytokines, chemokines, and colony-sustaining factors – molecules that signal between cells of the immune system and promote their growth. Over seven hundred species of bacteria have been found in human breast milk. It also contains oligosaccharides which the baby is totally incapable of digesting. It is present to feed the bacteria from the breast milk which are colonizing in the baby’s gut”. p. 24

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“Within a week or so after birth, the infant gut, originally sterile, has become colonized by up to 90 trillion microbes. The number of microbes in our guts eventually exceeds the total number of cells in our bodies by a factor of ten. Scientists now refer to the existence of a meta-genome to represent the combined genomes of human and microbiota, a superorganism in which we humans are the junior partner and without which we could no longer exist.” p. 27

“Our resident gut microbiota – the mass of over two thousand bacterial species identified as frequent, long-term inhabitants inside us – is extremely complex. Our relationship with them is so close and intertwined that many of the metabolic signatures that can be identified in human blood, sweat, and urine actually come from our commensal bacteria, not us.” P. 34

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“The gut has been called the ‘second brain’ and has its own dedicated nervous system embedded throughout the gut wall. It is becoming increasingly clear that our gut molecules can communicate directly with our brains, and they are implicated in brain development, brain chemistry, behavior, and mental illness.” pp. 36 – 37

This is support for the importance of children getting outside to play in areas that have a variety of foliage comes from a different perspective – as long as we check carefully for tics.

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The Power of Play

Let Them Eat Dirt

Gut: The Inside Story of Our Body’s Most Underrated Organ

Grain Brain

 

A for Effort

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There is an article in the June 18, 2017 edition of the New York Times Magazine which reports research that children who were in an exercise program for one hour a day after school improved on academic testing and had less visceral fat*. In the second phase of the study, the control group will have the same program as the research group.

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While I laud the research and the results, the whole situation causes me to sit back and shake my head. In the whole history of the United States, would anyone have even thought of this study until the last 25 years? The study also states that most children in our country do not have an hour of activity a day. This is a huge change compared to the childhoods of most of their parents and grandparents.

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The exercise in this program was active play such as playing tag. While the article focused on the change in visceral fat, it also stated that the exercise group performed better on tests of attention, processing information, and controlling their impulsivity. What else is involved with playing a game like tag other than running? Attention? Planning? Cooperation to distract the person who is it? Not being impulsive? Having fun as a group?

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Are children’s choice of out of school activities significantly influencing their current lives and their futures? Are the changes in recreational activities and the accelerated curriculum contributing to some of the problems that children are having such as attention disorders, hyperactivity, undeveloped sensory integration, immature visual motor skills, and visual problems?                                                           I strongly believe that they are.

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The Power of Play

Let Them Eat Dirt

Balanced and Barefoot

The Pressure to Learn to Read Early

*Visceral fat is body fat that is stored within the abdominal cavity and is therefore stored around a number of important internal organs such as the liver, pancreas and intestines. … Storing higher amounts of visceral fat is associated with increased risks of a number of health problems including type 2 diabetes.

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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

Becoming a Nation of Readers

The Report of the Commission on Reading

This report was compiled from research on reading instruction and outcomes. The Commission on Reading was formed from representatives of three federal education agencies and the report was published in 1985. While we keep up with current research and new information, it is important not to forget select older volumes which contain information whose value has been proven over time. The following are some of the pearls from this publication.

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The reading teacher’s repertoire must draw upon the deepening knowledge of child development. I frequently see children who are referred for “problems” which are within the norms of development for their age but do not match the expectations of the curriculum. If their parents were doing this at their age, it would have been considered to be normal.

Mastery tests must not treat reading as a set of discrete skills when research has indicated that a closely integrated set of processes supports fluent reading. As adults it is easy to not recognize that the early stages of reading and writing require significant multitasking. Even after the discrete skills have become automatic in isolation, including a number of visual skills, rehearsal will still be necessary to develop their automatic integration.

Reading is a holistic act. A text is not so much a vessel containing information as it is a source of partial information that enables the reader to use already-processed knowledge to determine the intended meaning. (This calls into question the use of “cold reading” to assess reading ability.)

Five generalizations flow from the research of the past decade on the nature of reading:

 

    1. Skilled reading is constructive. Comprehension is highly dependent on prior knowledge and the ability to read with sufficient mastery to be free to simultaneously consider stored knowledge.
    2. Skilled reading must be fluent to free attention for the analysis of meaning.
    3. Skilled readers are strategic. They read for a purpose.  Becoming a skilled reader requires learning to sustain attention and learning that written material can be interesting and informative.
    4. Reading requires motivation. It will take most children years to learn to read well.
    5. Reading is a continuously developing skill.

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The single most important activity for building the knowledge required for eventual success in reading is reading aloud to children.

Such old-fashioned materials as chalkboards and paper and pencils can make a difference in children’s learning to read. When children who learned to read before going to school were compared to similar children who couldn’t read, the early readers were found to have greater access to chalkboards and paper and pencils and to do more writing.

Children’s proficiency in letter naming when they start school is an excellent predictor of their first- and second-grade reading achievement.

Familiar words are especially useful for teaching children letter names and letter-sound relationships, because children can learn to recognize familiar words prior to learning all the letters.

Phonics instruction should aim to teach only the most important and regular of letter-to-sound relationships, because this is the sort of instruction that will most directly lay bare the alphabetic principle. Once the basic relationships have been taught, the best way to get children to refine and extend their knowledge of letter-sound correspondences is through repeated opportunities to read. Child_reading_at_Brookline_Booksmith.jpg

Blending may seem simple to an adult who already knows how to read, but in fact it is a difficult step for many children. Until a child gets over this hurdle, learning the sounds of individual letters and groups of letters will have diminished value.

Teaching phonics is a benefit to most children who are learning to read, but the relationships between the sounds and the print are not as clear as it appears to adults who already know how to read. Implicit phonics depends on “phonemic segmentation”. This is the ability to identify separate speech sounds in spoken words. There is evidence that many young children cannot extract an individual sound from hearing it within a word. (This is also very hard for adults. We have the illusion that we can do this due to our word knowledge. How many times do we misunderstand what someone says because they did not say what we expected them to say? “Phonemic segmentation” must also be coupled with “visual segmentation” which is dependent on language arts knowledge and figure-ground skills within a crowded letters of a word.) Implicit phonics may actually presuppose what it is supposed to teach. Also see Marilyn Jager Adams in Beginning to Read.

A problem with explicit phonics is that both teachers and children have a difficult time saying pure speech sounds in isolation. All that phonics can be expected to do is help children approximate pronunciations. These must be “tried out” to determine whether recognizable words have been produced which make sense in the context. Oral reading errors provide a window into what is going on inside children’s heads as they read. Research suggests that first graders taught through an explicit phonics approach make more nonsense errors than other children.

A clear finding from research of the past decade is that young readers and poor readers of every age do not consistently see relationships between what they are reading and what they already know.

There are qualitative differences in the experience of children in high and low reading groups that would be expected to place children in low groups at a disadvantage. Children in low groups do relatively more reading aloud and relatively less silent reading. They more often read words without a meaningful context on lists or flash cards, and less often read words in stories.

An indisputable conclusion of research is that the quality of teaching makes a considerable difference in children’s learning. Studies indicate that about 15 percent of the variation among children in reading achievement at the end of the school year is attributable to factors that relate to the skill and effectiveness of the teacher. In contrast, the largest study ever done comparing approaches to beginning reading found that about 3 percent of the variation in reading achievement at the end of first grade was attributable to the overall approach of the program. Thus, the prudent assumption for educational policy is that, while there may be some “material-proof” teachers, there are no “teacher-proof materials.

How We Read

Reading Instruction in Kindergarten

Visual Factors in Reading

The Hidden Link Between Vision and Learning

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?