In early December PEN (Parents Education Network) hosted two speakers from the Abbey Neuropsychology Clinic, Richard D. Abbey, Ph.D., Clinical Neuropsychologist and Diana Barrett, Ph.D., Clinical Psychologist. Their focus was three complex issues: Depression, Anxiety and Learning. I was impressed with the ease that these two specialists shared the podium as they imparted their expertise. A more detailed background on both speakers can be found at the conclusion of this blog.
They began their morning talk with a focus on depression, advising us that it appears differently with children and adults. For a child, irritability is a key element. They become very edgy and display a lack of interest in something that they previously very much enjoyed, walking away from any involvement with it or others. Whereas a tip the speakers provided to indicate whether an adolescent might be in a depressed state is sleeping till noon or complaining about a tummy ache. These are safer ways for an adolescent to express depression. If there evolves a pre-occupation with poetry whose topic is life threatening, it could mean the adolescent is exploring the possibility. The challenge for a parent is discovering whether the comments are simply anxiety which interferes with a child’s functioning or whether the issue comes from a depressed state.
Often depression comes when there is a problem with learning. This causes emotional issues. Ask yourself the question: are the emotional issues out of control? Or is depression causing a learning problem? It is clear that when a child, adolescent or adult is depressed, this state interferes with other and important daily functions.
The frontal lobe of the brain is where Executive Functioning (ie: skill building) occurs. It can be one of the first segments of the brain affected by depression or anxiety. Kids who can’t keep information being taught in their mind are offering a good clue that this skill is not working well. Perhaps the school teachers are unable to track the child’s reading skills which can result in their teaching approach not matching the way the child learns. When a student hears from a teacher: “try a little harder” or, “we just told you” when they are not doing what is being asked, more than likely the child/adolescent internalizes, “I am stupid.” This can lead to depression.
There is another clue: Is the student taking a long time to accomplish a task, especially if there is sequence of tasks to accomplish with the project. This inability can lead to the student getting caught up in right and wrong. And, then they begin to say to themselves if I can’t do it perfectly I am not going to do it at all. Their anxiety becomes dominant.
These are some questions the speakers provided to begin assessing whether your child/adolescent is experiencing anxiety or depression:
1. Is anything significantly different in any domain of your child’s life?
2. Is their day to day functioning different from the norm?
3. Does the child have a problem reading aloud. Do they lose their place, skipping
words or replacing words?
4. With Executive Functioning: is there a switching of letters and numbers? Can they sort out a lot of information being taught? does their attention keep varying?
5. Are you concerned that your child may not be safe?
There are solutions/interventions to these tell tale signs: A few are listed below.
1. Professional emotional and learning assessments to diagnose what is happening with your child.
2. Cognitive Behavior Therapy. The process focuses on solving problems concerning dysfunctional emotions, behaviors and cognitions: I looked up the word “cognitive” on Wikipedia for a definition. It refers to the following skills: attention, remembering, producing and understanding language, solving problems, and making decisions. The speakers had some good news about the effectiveness of Cognitive Behavior Therapy confirming that 75% of the time there is some kind of improvement with anxiety and depression.
3. Medications: The speakers did not spend much time on this topic. They did comment that kids on medication do seem to have a working memory problem. This is a controversial issue which has been discussed at PEN many times. See former PEN and Emotion blogs within my various blogs for more information.
3. Reading interventions. The speakers cautioned parents to undertake due diligence before taking action. Some therapies only look at a part of the problem – which may or may not be appropriate for your child. For an overview the speakers recommend using the National Reading Panel. http://www.nationalreadingpanel.org.
4. Executive Functioning Coaching. The need for this skill may not present itself until college level. When it does, coaching is very important. Each person needs to learn
how to plan, how to live with goal oriented behavior.
5. Software: These speakers were promoting the use of a Pulse Pen. It records what is being said and relieves the need for the listener to take notes. They also mentioned the Intel Reader which was discussed in more detail in the previous PEN blog.
6. Cogmed: This process helps improve working memory, expand attention and executive functioning. http://www.cogmed.com/about-working-memory
7. What to do at home: Adjust expectations of your child: Set realistic goals. schedule free time along with time with you, the parent. Have a listening ear, find a way to bring up the topic you want to discuss or to hear more about from them.
8 School: School placement is very important. See previous PEN blogs on this topic.
These speakers gave me a giggle when they said: We have never spoken to a parent who didn’t think that they were right. A part of me, Ann, who is writing this blog and is not a parent, sees that part of needing to be right in myself. It takes time to undo that belief. If you, as parent are so challenged, give yourself time to learn more about the topic. Yes, I know sometimes that’s a difficult step for a parent to take. Our ego can make it difficult for us to accept there is a learning challenge. Your goal is to keep the best interests of the child to the fore. Here’s a sobering comment made by the speakers. There is evidence now that if one parent experiences depression, the risk for the child developing depression goes up. So, if you as parent experience the same issues as the child, the speakers said it helps the child if the parents also do the interventions.
The speakers urged the parents to go to gatherings, like EdRev in San Francisco, a yearly event produced by PEN which occurs at the Giant’s Baseball Park. Here parents can intermingle with hundreds of other parents and learning specialists and Depression, ansietydiscover ways to increase their knowledge base on the issues facing their child.
Remember, the brain is neuroplastic, it can and does change!
The speakers were:
Dr.Richard Abbey is a clinical neuropsychologist who specializes in assessment, diagnosis, and treatment of ADHD, learning disorders, and other neurocognitive and emotional conditions. Prior to opening the Abbey Neuropsychology Clinic in Palo Alto, Dr. Abbey was a clinical faculty member at Stanford University School of Medicine/Lucille Packard Hospital. His areas of specialty include ADHD (and non-medication based interventions for ADHD), learning disorders, pediatric brain tumors, autism, and treatment of neurocognitive deficits.
Diana Marchetti Barret, Ph.D. is a clinical psychologist who assesses and diagnoses learning disorders, developmental disorders (e.g. autism, aspergers), mood disorders, and ADHD. Dr. Barrett completed post-graduate work at the University of Utah Neuropsychiatric Institute and post doctorate training at Stanford University School of Medicine, Child and Adolescent Psychiatry. Dr. Barrett also has specialty training in Motivational Interviewing, Dialectical Behavior Therapy, non-medication treatment for ADHD, and Pivotal Response Training (PRT) for Autism Spectrum Disorders.
The speakers can be reached through: Abbey NeuroPsychological Clinic located in Palo Alto, CA. They offer ccomprehensive neuropsychological evaluations for infants, children, and adults. http://www.abbeyneuropsychologyclinic.com
The 2011/12 Parents Education Network lecture series in San Francisco began with a bang, a powerful bang. The lecturer, Dr. Leyla M. Bologlu, shared advice that made my heart sing. She underscored the importance of good, thorough evaluation for both ADHD and learning difficulties stating that the faster the parents take action the better. It is now proven that early intervention can impact neurological change. The goal is to ensure that the child has a healthy psychological life as he or she goes through the challenges of the learning process.
Some clues: A child exhibiting behavioral issues is a flag that the problem could generate from a brain-based neurological issue. (A dyslexic has different neurological pathways.) Or a child exhibiting executive functioning shortcomings as a result of the brain’s inability to manage learning activities may be experiencing ADHD.
Dr. Bologlu gave a graphic description of the brain’s development. The infant brain is relatively smooth. As the child grows and develops the complexity of bumps and squiggles on the brain increases from experience and exposure. This description had me wondering how physically crisscrossed is my brain from my dyslexia and hyperlexia. It wasn’t until I was in my forties when I learned i am dyslexic and in my sixties when I discovered that my real issue is hyperlexia meaning I had trouble in imaging words which are essential for reading and aural comprehension.
The lecture moved on to many types of specialists. At the outset is the need for parents to identify a competent evaluator who is comfortable embracing specialists in several different fields with discreet skills to address particular shortcomings. Dr. Bologlu reminded us that kids want to do well. The adult team needs to discover what is holding them back, what skill set they are missing and sets in motion the steps necessary to improve the ability of the child to learn.
The path Dr. Bologlu recommends to identify the learning challenge includes.
1. Obtaining a clear statement from the school with details of what seems to be going on/what are their concerns? If it is you, the parent, who is recognizing there is an isuue, ask for a meeting at the school to check out your hunch.
2. The next step is identifying a highly qualified educational therapist ( with a master’s degree) who knows and works with a battery of tests available and has experience with children of your child’s age. Tests include:
- Administration of cognitive tests (not an IQ test)
- Academic achievement tests
- Other screenings/tests including but not limited to: Slingerland, Levine, language development/auditory processing, phonological awareness, visual-motor integration etc.
3. Specialized testing includes:
- Speech & Language Evaluation (be sure the tester has at least an master’s level education)
- Occupational Therapy: These evaluations and treatments are specific to motor
development, sensory-motor integration and nonverbal weaknesses.
- Psycho-educational Evaluation: Be sure the consultant has a PhD in clinical psychology. The evaluations involve IQ testing, achievement tests, behavioral
questionnaires, social/emotional testing.
- Psycho-educational Evaluation. Be sure the consultant has a PhD in clinical psychology. The evaluations involve IQ testing, achievement tests, behavioral questionnaires, social/emotional testing.
- Neurpsychological Evaluation. This can include testing for intellectual skills (IQ testing), as well as congnitive functioning ability which may involve testing for skills in a) language (expressive/receptive), b) visio-spatial/visio-perceptual function c) memory, d) attentional systems, e) executive functioning, f) fine and gross motor functioning, g) sensory integration and more.
The Educational Therapist oversees the testing process. When she/he receives the assessments from other specialists, she/he draws conclusions and makes recommendations to the parents. The Educational Therapist must provide the names of the suggested treatment providers – more than one for each type of service. In addition, the Educational Therapist should make contact with all of the treatment providers recommended to outline the reason for the referral, the treatment focus and the number of sessions per week needed.
Additional appropriate support may include:
- behavior support in the classroom and at home
- sensory motor support – handwriting
- executive functioning skill support (study skills, breaking down large assignments)
- medication management. I found it interesting that Dr. Bologhu’s point of view on medication is that it may help with behavior but not with the core issue.
At the conclusion of this lecture the President and Co-Foundter of PEN, Dewey Rosetti, when thanking Dr. Bologlu for her remarks commented: If only we had had this kind of information ten years ago, what a difference it would have made! I agree and am just grateful that teh PEN lucture series exists so parents now have the information to take reasoned steps with their child’s learning challenge.
Dr. John Medina: Brain Rules for Teachers
The second lecture on Friday, January 21, 2011 that Dr, John Medina presented at PEN (http://www.parentseducationnetwork.org) was titled Brain Rules for Teachers. Dr. Medina, a developmental molecular biologist and author of the New York Times bestseller, Brain Rules, began with a familiar theme outlined in his previous lecture, Brain Rules for Parents. The brain is designed to solve problems, related to surviving, in an outdoor setting and to do so in constant motion. Secondly, the brain is incapable of multi-tasking. It takes a person twice as long and the margin for error is 50% when a person is multi-tasking. In other words, if you do well at task A, you don’t do well at task B.
Keeping these core premises in mind, Dr. Medina moved on to discuss sleep. It seems that animals, particularly gazelles, sleep in short segments to keep themselves aware of any predator about to attack. Similarly, we wake up during the night and if stressed, sleep eludes us. Stress is an arousal force if left unchecked and will keep a person awake!
Dr. Medina moved on to the topic of the brain’s need for sleep in mid-afternoon between 2 PM and 4 PM.. The brain wants a down cycle. It’s time to take a nap. Another way of expressing this idea is that the brain wants to rest 12 hours passed the midpoint of a person’s previous night’s sleep. “You may ignore this suggestion but you will not change the need,” he commented. It seems that an astronaut’s crew followed this discipline and there was a 34% improvement in the output of their work. So, Dr. Medina’s recommendation for teacher is: Do not teach between 2 PM and 4 PM.
Dr. Medina’s discussion moved to the importance of each person knowing their daily rhythm including sleep times. 20% of the population he calls Larks. They are early birds, ideally waking at 6 AM and going to bed at 9 PM. Their productive time is the morning, peaking at noon. 20% of the population he calls Owls who ideally would go to bed at 3 AM and wake at 11 AM. The rest are Hummingbirds and fall into a “regular” day pattern. A person who is a Lark cannot transform into an Owl. You can try, but your body rhythm will not change.
In summarizing sleep he said most of us are sleep deprived, a reason why school children who stay up late doing homework or other activities can seem unfocussed in school. When the students get to college and can take classes at the times when they are at the best, this behavior falls away. Dr. Medina suggested to teachers: The school of the future will have Owls teaching owls, and Larks teaching Larks. At this point teachers can’t control the sleep cycles of students but teachers can control how they teach.
In the second hour Dr. Medina described how the brain is wired. Using metaphors of Interstate Highways (trunks), city boulevards and alleys to describe the wiring. He claims trunks are the same in all people but the city boulevards and alleys are different in each person. It is in the latter where learning occurs. And, yes, we all learn differently. So teachers take note:
1. The brain is not interested in learning, it is interested in surviving. Teachers need to be able to improvise off this learning base.
2. A teaching system, or any system needs to have two approaches to learning, memorizing and improvisation. If one is taught to learn and then improvise off it, the data base of the person becomes accumulative. The knowledge edge is accumulative.
A teacher needs to develop their ability to have empathy. He suggests they give energy to learning how to penetrate inside the minds of their students. This can be taught, and Dr. Medina emphasized, kindness and safety will do more than anything else in your classroom.
In the third hour the focus turned to memory. Dr. Medina cautioned that if a speaker says that memory works in a specific way, run out of room. It is not true. There are 40 memory gadgets in the brain. At the moment we know very little about them and we know very little about how they react.
What we do know is that when a piece of information comes to the brain and the brain decides it is important it will put the information into a buffer memory. This buffer can hold seven pieces of information for thirty seconds. If it is not repeated within the thirty seconds, the brain will dump it. If the teacher or the student internally repeats it, the information goes into another buffer – working memory. Working memory has its own series of rules including that it will hold the information for only two hours. If not repeated within two hours, the brain will drop it.
So, for teachers, Dr Medina suggested transforming the 60 minute lecture into three 20 minute segments. The first being the information, the second a different activity, the third repeating the information taught during the first twenty minutes. This approach might obviate the need for homework!
If the information is repeated within two hours it is then recruited by brain for long term storage in the hippocampus located in the brain. It may take a decade to become permanent which is the reason why information within ourselves can become corrupted. At some point the hippocampus releases the information into the cortex. In this final phase, the information becomes infinitely retrievable.
This memory process is a hint for teachers. Children who learn information in grade three cannot count on the information being imprinted in the brain for ten years. Students need to be retaught what they have learned. The brain is unbelievably sensitive to repetition. Remember, the brain was not designed to be in the classroom it was designed to be in the jungle.
Dr. Medina had two final comments:
1. The hippocampus is affected by drugs. Marijuana stops the process of integration of learning.
2. The greatest predictor of the ability to learn is the emotional stability in the home!
There is more information on Dr. John Medina’s lectures for PEN. See blog Brain Rules for Parents. Dr. Medina’s website is: http://brainrules.net. His books are: Brain Rules and Brain Rules for Baby.