Reading problems and vision

Reading problems and vision

In our schools across the country, we find thousands of learners who just can’t manage reading.  In the lower grades, children struggle to learn to read, and in the higher grades, they cannot read to learn.  In all other respects, they seem to be normal and just as intelligent as their reading classmates.

This is so sad. We know that these children start school with an eagerness to learn. Then they are confronted with reading and in spite of trying really hard, cannot do it. They fail and fail again. The primary path to learning is through reading, so this first experience of school, of the world of learning and education, has become a disaster.

In spite of the high number of children with reading problems, not all teachers or their schools are aware of the visual problems that may underlie the difficulties. Integrated Learning Therapy (ILT) practitioners are confronted on a daily basis with families who report that their child’s eyesight has been tested and found to be normal. But they still can’t read.

The truth is that vision for reading requires far more than is tested in a standard eye examination. This aims at identifying refractive errors (near or far-sightedness, astigmatism) or an eye turning in (strabismus). These problems are caused by irregular eyeball shapes which prevent the image focused by the lens from falling accurately onto the retina.

Reading requires more than accurate focusing – it also needs good binocular vision. This is the process requiring several sets of nerves and muscles which make it possible for the two eyes to work together so that an image falls on the centre of each retina, then fuses into one and finally has the lens focus the image.  Binocular vision is what enables us to see in three dimensions, to estimate distance and basically is crucial for almost everything we do with our eyes.   Reading especially requires good binocular vision so that the eyes can fixate effortlessly on a visual target; images appear clearly as one; the eyes are able to track along letters, words and sentences or shift from one target to another.  A child with poor binocular vision may show other problems as well.  She may appear clumsy, have trouble stacking blocks or pouring water into a cup – all because she cannot judge space accurately.

All of this means that a child may not be visually ‘ready’ by the time they begin school. The question of why puzzles us, and we have no definitive answer. The changing nature of children’s games may be questioned. Instead of games of the past that challenged visual-motor coordination have been replaced by electronic and battery-operated toys, leading to a lack of practice of the visual system.  TV occupies a significant percentage of children’s leisure time without providing practice for the visual system.

If reading is a problem, then the child’s vision needs closer investigation.  This should be carried out by a Developmental or Behavioural Optometrist, who is a professional with additional training in Binocular Vision and can help a child with Visual Therapy to improve binocularity.

Unfortunately, there are few such specialists in our country so if you are not in an area where you have access to a Developmental Optometrist, you can see if you have an Integrated Learning Therapist (ILT) close to your school or community.  ILT practitioners are trained to screen for binocular issues and have the tools to very successfully help children whose reading problems are causing them so much stress.

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Heavy metals and the brain

Heavy metals and the brain

Neurodevelopment starts in the early prenatal stage that begins with rapid growth of spreading brain cells, forming synapses especially during the last trimester. Further synaptic growth during the first 2 years of life is particularly critical to ongoing functioning and development.

Myelination begins in the second half of pregnancy and continues until the mid-twenties, with different systems myelinating at different times. As we have learned, the brain’s centre of reasoning and problem solving is among the last to mature, during young adulthood.

The first areas of the brain to mature are those with the most basic functions, such as processing the senses and movement. Areas involved in spatial orientation and language (parietal lobes) follow.  Areas with more advanced functions – integrating information from the senses, reasoning and other ‘executive’ functions – mature last.

Tremendous rate of growth in areas of vision and sensation occur in the early school years.  During the middle school years (Grades 5-8) areas responsible for language development show rapid growth.

Because infancy and childhood are characterized by the development of different systems, children have unique susceptibilities not seen in adults – and critical time windows for these susceptibilities.  The critical times include preconception, gestation and the postnatal period.

It might be hard to imagine that it was only a few decades back that the discovery was made that the foetus is vulnerable to exposures. You’ll remember the terrible wake-up call that came from the use of thalidomide by pregnant women. This was a tragic lesson of the ability of chemicals to traverse the placenta and damage the foetus.

Now we know that during gestation, the foetus may be susceptible to various chemicals, ionizing radiation, alcohol, methylmercury and lead. During the postnatal period, infants are susceptible to second-hand tobacco smoke and lead, amongst other offenders.

Let’s have a brief look at some of these heavy metal offenders.

Lead 

Preventing lead exposure continues to be a major challenge in many countries, especially developing countries. Poverty, a large informal sector, limited public health challenges and low levels of awareness of lead hazards and weak capacity to enforce legislation contribute to the intensity of the challenge.  Despite progress in this area, a wide range of sources of lead exist in South Africa and certain settings and groups continue to be at high risk of lead exposure.  Exposure comes from paint, mining, lead melting in subsistence fishing communities (making of sinkers) and food production.

When lead poisoning begins in the womb, it can affect the most critical system, being the central nervous system of the foetus. The effects of lead exposure can be seen in various areas.  Firstly, high levels cause loss of intellectual capacity and changes in behaviour.  It has been identified as adversely affecting speech and language, attention, cognitive flexibility and visual-motor integration.  These may come about because of low lead concentrations that don’t necessarily produce physical signs.  High levels of lead exposure results in disruption of semantic language function in young adulthood.

Mercury

Children who are exposed to mercury (often by mothers who consume a high fish diet contaminated with mercury) may develop reduced IQ, learning and behaviour problems.  Mercury is known to have neurotoxic properties and is identified as a significant risk factor for neurodevelopmental behavioural disorders in children.

Acceptance of this now recognised fact has been slow in coming and only recently have dentists acknowledge that teeth fillings containing mercury are a risk factor.

Tobacco

There is now strong evidence that prenatal tobacco exposure is linked with the development of attention difficulties associated with ‘ADHD’. Such exposure can be due to mothers who smoke or who were exposed to second-hand smoke in the home.

We know that there are other heavy metals and environmental offenders that can be contributing to a child’s learning and behaviour challenges. This serves as a reminder that we have to be aware of the many aspects that can impact on neurodevelopment. Don’t overlook anything and if you suspect heavy metals, have a hair analysis done at one of the pathological laboratories

 

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What early school performance tells us

What early school performance tells us

 

It seems that your child’s performance at the beginning and end of the Foundation Phase (that is, the end of Grades 0 and 3) of school can be a reliable predictor of future academic success.  The reason for this is logical. Higher academic skills depend on fluent reading, writing and mastery of numeracy, which is why the ‘three R’s’ have been emphasised through the ages.  Truly, the early years of school create a firm foundation for what is to come.

Many countries realise this, which is why schools are, for example, trying to introduce reading skills into the Grade 0 curriculum.  Is this good or bad? Some children will be able to gain reading skills at this early age but there is a good chance that a percentage of young learners will struggle with the pressure of early academic demands.

This will lead to some children being held back because they are considered to be immature. Repeating the grade is believed to give them time to ‘catch up’ and mature further.  Very often, however, the child will be a year older but still immature in certain significant ways.

The maturity needed for academic tasks concerns the central nervous system – with the brain being a crucial part of this.  The development and maturity of the brain and its functions depends on the internal wiring of nerve connections that allow us to function in ways recognised as human skills.  This includes speaking, listening, perceiving, moving, and balancing as well as learning to get along with others, read, spell and calculate.

If this network of brain cells has not developed optimally by the time a child enters school, it can impact negatively on that child’s ability to cope with classroom demands.  The process of brain development is widely referred to as ‘neurodevelopment’.

We are well aware of the importance of early childhood and the need children have for stimulating the brain. This comes through the senses so that the brain is activated to grow, insulate and make connections between cells.  Active engagement with and exploration of the world with adult intervention is an important component of brain growth, but there are also many circumstances that can impact negatively on brain development. These cause delays in the brain ‘wiring’ that will result in the child’s lack of learning readiness.

Included in, but by no means limited to, the list of possible negative circumstances that children face in our modern society include our technological age, our internal and external chemical environments, nutrition, factors during pregnancy and birth, and many others.  For example, the fear of SIDS (Sudden Infant Death Syndrome) led to parents being urged to encourage babies to sleep on their backs.  This led to babies becoming less inclined to want to be on their stomachs, consequently spending less ‘tummy time’ in infancy.  The spin-off from this is that some infants fail to mature certain neck reflexes that cause problems in later years.  The greater majority of hyperactive children are found to have immature reflex patterns that create physical discomfort when trying to remain still.   There are many other similar examples of ‘what can go wrong’.

A year repeated in a grade might help to some extent, but what is needed is careful assessment of what is lacking in the child’s neurodevelopment and then using the information to give the brain a second chance to develop optimally.  We are not dealing here with a child’s chronological age.  Another year of growth does not guarantee better brain networking.

A neurodevelopmental approach helps tremendously in enhancing and mastering abilities that ultimately provide the learning readiness that is needed to succeed in school.

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The CEO centre of the brain

The CEO centre of the brain

Our children are young, so we expect them to be irresponsible, to need our advice and supervision. We don’t expect them to be able to independently plan to meet their goals, do their homework, safely cross the road or to take on complex tasks while still very young.  Why not? What is it about childhood that prevents them from these responsible behaviours?

It’s all about brain development, of course.  Tasks that require wise decision making, organising, planning, managing time, thinking before you act and avoiding impulsivity are part of the functions of the front part of the brain – called the prefrontal cortex.  This happens to be the very last part of the brain to develop completely – at around age 25 years.  This is why adolescence can be a difficult and dangerous age.  Young people have so much knowledge, skills and ability yet don’t have the brain development needed to always supervise their own actions in a wise, responsible way.  We call the functions performed by this part of the brain Executive Functions.  The prefrontal cortex is literally the boss of the brain.

Most children gradually develop this brain area but some may be slower in some areas than others.  They may struggle with completing tasks, remembering what homework has been set, being able to focus their attention and stay on task, recalling important detail, and controlling strong emotions.  All of us tend to develop unevenly – with some aspects streaking ahead but others lagging behind.  This is normal and not necessarily a sign of a serious problem.  It is also normal for such a child to need support while waiting for a very natural progression of brain development.

There are ways to help.  Leaving such children alone may prevent them from reaching their potential and labelling slower development negatively may impair the very development they need.  Supporting them in positive ways can help them over obstacles.

A useful website to visit for clear explanation of executive functions, help that works and ways that could worsen the situation is written by Seth Perler.  The website (Google Seth Perler.com) is available and contains a wealth of information about Executive Functioning and helping to coach children through challenges.  You might find the information valuable.

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Learning difficulties and Learning disorders

Learning difficulties and Learning disorders

In this article, some answers are given to some of the most often asked questions that parents pose about learning disabilities and difficulties[1].

  1. What is a learning difficulty?

Typically a learning difficulty or problem is defined as a difficulty acquiring academic skills such as reading or maths.  Some children show very subtle problems which are hardly noticeable. Other problems are very severe and make it virtually impossible for the child to progress in a certain academic area.

Learning problems can be rooted in emotional factors, such as fears, a highly stressful environment, family troubles and so on. It can be based on a mismatch between the child and her environment – for example, a school that is too unstructured for her her.  It could be biological – and due to irregularities in brain development and functioning.  If fairly severe, the term commonly used is ‘learning disability’. If not, ‘learning difficulty’ would be appropriate.  Either way, it would be unwise to ignore it and hope it will go away.  Better to have a comprehensive evaluation to try and determine the root causes underlying the learning problem. A learning disability, on the other hand, cannot be due to emotional problems.

  1. What is a learning disability?

A learning disability is usually understood to be a learning problem that is severe enough to impact negatively on a child’s academic progress and that can be attributed to some or other inefficient brain functions.  It is NOT the result of lower intelligence, severe emotional disturbance or a physical challenge such as sight or hearing impairment.  Some learners are incorrectly labelled as ‘slow’ learners, suggesting below average intelligence when, in fact, they are suffering from an unrecognised learning disability.

Some intellectually gifted children who are coping at school but failing to realise their very high potential may also have a learning disability.

  1. Can a learning disability be outgrown?

It is more likely that a child with a learning disability may learn how to compensate for her difficulties.  This isn’t necessarily a bad thing because it can help to build resilience and strength that can help enormously throughout life. In fact, many of us have ways of compensating for areas of weakness.  An example of a compensatory technique is reading through study content in preparation for a class if you cannot follow spoken language easily, or reading content out loud  (or making an audio recording of it to play back) if you can understand and remember better through auditory channels.

  1. Can a learning disability be caused by an emotional problem?

No. The root of learning disabilities lie in irregular functioning of certain brain areas. A child may, of course, show accompanying emotional problems which are caused by the distress of her learning disability.  In this case, the emotional problems may be helped by therapy.  It is rare for a child with a learning disability to not show low self-esteem and a sense of being a failure.  Years of struggling result in confusion about one’s self identity, anger, despair and frustration.

Trouble at home, parental discord and so on are never the primary, underlying cause of a learning disability.  Neither is poor parenting, abusive parenting or inattentive parenting. These factors can exacerbate the effect the disability has on the child and how well she can cope with it, but they don’t cause disabilities.

  1. Can medication ‘cure’ a learning disability?

No known medication addresses the root cause of a learning disability.

  1. Can disabilities be inherited?

This is a difficult question. Some research suggests that some learning disabilities may be inherited and that others are not.  Often those in the field of neurodevelopment find that a weakness in a certain brain area or other important brain system might be inherited. This might result in a learning disability but the child may have a different experience to the family member which results in her not showing any lack of ability at all.  ILT practitioners have had the experience of seeing parents experienced surprising improvement in certain areas if they participate in their child’s therapeutic programme.  This is because the underlying brain area has benefitted and becomes more efficient.

  1. When should I consider placing my child in a remedial or special needs school?

The fact that a child has a learning disability doesn’t necessarily mean that she has to leave mainstream schooling.  If the prognosis is good, it might be better to seek out the support of the current school while the child undergoes a programme to help.  It is sometimes not easy to return from remedial or special needs environments to mainstream education so a child who can cope might benefit more by staying put.  However, school personnel and other professionals need to be in agreement with this and together you can decide on the best course of action if it is warranted.

Most children with learning disabilities can be helped and ILT has a very good track record when it comes to turning dis-ability in ability.  However, we can never guarantee 100% success – we are regularly humbled by children who present with very puzzling problems.  In spite of saying that, a child with a learning disability will not flourish over the long run without proper assessment and treatment.  Don’t delay in getting your child the help she needs.

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[1][1] With thanks and acknowledgement to Barbara Novick and Maureen Arnold who wrote the book ‘Why is my child having trouble at school?’

Helping children with Learning Difficulties (LD)

Helping children with Learning Difficulties (LD)

Over the last few years there seems to have been an enormous leap in explanations for Learning Disabilities (LD).  There is talk of genetic predisposition, processing times (e.g. slow auditory processing), brain imaging techniques and findings, quantified EEGs, brain biofeedback, sound therapy, light therapy, and many others. Each new avenue quickly gains a following of professionals offering help.

In the midst of all this, one might wonder if the ‘old-fashioned’ belief in movement programmes is outdated.  With all the computerized programmes, new therapies and drugs that speed up processing times being more and more widespread, can we motivate the belief in the power of movement programmes?  Why does Integrated Learning Therapy (ILT) still achieve such good results, even though the approach does not rely on technology or sophisticated equipment?

The answer lies in the simple truth that LD is not just a cognitive (intellectual) deficit.  A really close look at children identified has having LD will show that they also have significantly high deficits in several motor (movement) areas.  This was supported by research in England, which suggested that very refined, accurate tests of balance might be a quick way of screening for LD[1].

Integrated Learning Therapy (ILT) finds that movement training is wonderfully beneficial.  It refines and speeds up kinesthetic (feeling of movement) processing as well as auditory processing, visual processing and the integration of all three to produce balanced, calmer individuals who become more proficient in reading, spelling, maths and writing.

ILT sees that the learning problem is in the brain of children who have difficulties – not because of lack of intelligence.  The brain ‘wiring’ is faulty or incomplete, leading to neurological disorganization.  Look at the behaviour of a child with LD.  They reflect the disorganized neural networks in their brains with their disorganized ways of trying to learn and cope with the demands of home and school.  They are struggling with information that is not getting through from skin, body, ears and eyes to the brain, or they are processing the information too slowly, or it may be scrambled along the way.  Some children may be hearing only part of a word or sentence and, to make matters worse, what they do hear may be processed slowly and is confusing.  They don’t hear full instructions from teachers and parents.  Others can’t use their eyes to learn because vision might not be supporting them – even though optometrists declare their sight to be normal.

To add insult to injury, their two brain hemispheres may not be working together.  You can see signs of this in school-aged children: they don’t automatically know their left from their right, they can’t do more than one thing at a time, handwriting and producing written work is tedious and really hard because they struggle to organize themselves or their work.  Not surprisingly, they become frustrated with the daily effort and may have meltdowns.  Simply put, LD children are usually working much, much harder than their more ‘learning ready’ classmates.

The good news

The good news is that we can speed up the rate at which information reaches the brain and is correctly processed.  Brain networks can be reinforced to be more stable – and we do this with the knowledge that the brain is plastic and in a constant state of change throughout our lifespans.

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[1] Angela Fawcett, in Pheloung, B. Help your class to learn. Manly: Australia.