Rethinking Education: Sharing School Reform Ideas and Education Reform Insights – an American Education Group Blog

As a developmental pediatrician, I have spent many years researching and diagnosing learning disorders. During my time as director of the Division of Child Development at the University of South Florida’s College of Medicine, in the 1980s and 1990s, I conducted research on Brain Electrical Activity Mapping (BEAM) and published a number of papers around the topic. Our research was driven by the belief that detecting and diagnosing learning disorders through brain activity would be much more accurate and successful than the current method of relying upon observable behavior.

Unfortunately, although we were able to identify key areas of brain abnormality, and even developed diagnostic tests to evaluate the data, I began to question the clinical diagnostic utility of BEAM. In fact, the topic remains under much debate due to the overlap and inconsistency of findings over the years.

I was interested to come across the TEDTalk from Aditi Shankardass, A Second Opinion on Learning Disorders. Her team is utilizing EEG technology in an attempt to more accurately diagnose learning disorders. She speaks specifically about the ability of this technology to detect seizures in a child that was previously thought to have autism. However, neurologists have been able to use traditional EEG for this purpose for over 90 years and there is little evidence that BEAM enhances our diagnostic ability in any significant way. Multiple studies have shown that seizures masking as autism is a very rare occurrence.

Significant differences have been detected between children with ADHD and children without, and between children with LD and children without;  however, the findings are not consistent and there is considerable overlap. For instance, if you look at the BEAM maps of ADHD children compared to children without ADHD, the primary differences will be in the frontal lobe. But when you look at the BEAM maps of schizophrenic adults compared to non-schizophrenic adults, they too show abnormalities in the frontal lobe. While these studies have clearly shown that there is a neurological basis to these disorders, they are not very helpful in making a diagnosis;  if a child has a BEAM map showing frontal lobe dysfunction, do they have ADHD or schizophrenia? Or are they part of the 5-10% of the population who will show frontal lobe problems without any clinical symptoms (in other words, a false positive)?

Parents, schools, teachers, and children would all benefit from the development of a technology that would accurately and definitively diagnose learning disorders. As Ms. Shankardass rightly points out, these are neurological disorders and thus it makes sense to attempt the diagnosis with neurological techniques. However, I very much doubt that these expensive and time-consuming tests really add any diagnostic utility over a combination of detailed history-taking, close observation of the child in the classroom, and current psycho-educational testing.

The Common Core State Standards being adopted in states across the country will raise assessment expectations for all students – special education students included. As we see in the District Administration article, Common Core’s Implications for Special Ed Students, assessments for the new standards will apply to all special education students without severe cognitive disabilities.

Check out the full article on the District Administration’s website.

In other special ed news, it appears that “education litigation is on the rise, with special education leading the way, according to an analysis from Lehigh University professor Perry A. Zirkel, an expert in special education law,” as reported on in Education Week’s Special Education Court Decisions on the Rise.

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For children with ADHD or a learning disability, there are numerous programs to help them learn while in elementary school, despite their difficulty with focus and organization. Public schools assemble an Individualized Education Plan (IEP) or a 504 plan. These plans help define what additional services, teaching strategies, and accommodations can be made available to the child. Many private schools offer a learning specialist to help children with ADHD improve their writing, organizational, and time management skills. In many larger cities, there are even specialized private schools which will work in an even more strategic and intensive way with kids with ADHD. The Lexis Preparatory Schools in Tampa, Florida (Tampa Day School); Scottsdale, Arizona; and Las Vegas, Nevada are great examples.

But what happens when children with ADHD and learning differences become adolescents and young adults, ready to go off to college? All parents worry when children reach this stage. Will they manage their time appropriately? How will they manage money? Will they be able to get up and get to class on time? Will they turn in that paper or study in advance for a test, without constant reminders from their parents?

As we see in The New York Times article, Learning With Disabilities, some colleges are addressing these concerns in unique ways. Landmark College in Putney, Vermont is a two-year school which works exclusively with adolescents and young adults with ADHD, to prepare them for admission to a full four-year college. Beacon College in Leesburg, Florida provides a similar program. These programs are not cheap (up to $48,000 per year), but if they can learn the study and organizational skills necessary for better time management, then children and young adults with ADHD and learning differences can and will succeed in a regular four-year program.

Using sophisticated imaging procedures related to functional MRI, researchers at Stanford University were able to predict with 90% accuracy which teenagers with dyslexia would improve in their reading scores two and a half years later. While the children were engaged in a reading task that required phonological awareness, they received two different types of brain scans. No intervention was implemented, but their reading ability was then re-examined 2 ½ years later.  None of the psycho-educational testing that was performed initially could predict which children would improve in their reading ability. However, the brain scans were able to predict which children showed spontaneous improvement. The researchers focused on the right superior longitudinal fasciculus, an area in the right frontal part of the brain that has previously been hypothesized to be important in the processing of phonological dues.

This is a critically important finding and may become very useful in the future as an objective tool for diagnosis and predicting prognosis. While this research has no current clinical implications beyond the laboratory, it is intriguing because further research might predict which reading technique would be more appropriate for different children.

Having said this, I cannot help but make an observation. This study was able to distinguish between children who improved without specific intervention. The scientific implication of this finding might be that certain children would not need any specific intervention, because they would improve anyway. I have difficulty envisioning the use of this finding in this particular way. This finding might be reassuring to me as a parent, but I would be hard-pressed to then conclude that my child does not need any intervention at all. What if my child is in the 10% that they incorrectly identified and then 2 ½ years later we find he has not made the expected gains in reading? On the other hand, one could argue that for those children that are going to improve without intervention, it might be harmful to identify them as “different,” and thus intervention could actually do more harm than good. Nevertheless, I am sure that we are going to see much more research in this area, and eventually we should see some clinical application. Until then, I still believe that early identification and intervention is of critical importance.

Read the full article on the research findings at Science Daily, Neuroimaging Helps to Predict Which Dyslexics Will Learn to Read, or read the authors’ abstract, Neural Systems Predicting Long-Term Outcome in Dyslexia.

Autism is characterized by a lack of flexibility in thought processes that leads to communication difficulties, behavioral problems, and obsessive- and compulsive-like behaviors. However, obtaining a proper diagnosis has always been a major problem. The symptoms are not evident until 18 to 24 months of age, and diagnosis before 2 ½ years is difficult. Diagnosis usually relies upon the parent’s description of the child’s behavior and sometimes on direct observation. There exists no blood test, X-ray test, or any other objective medical test upon which to rely for the diagnosis.

However, a research group at Boston’s McLean Hospital, affiliated with Harvard University, is attempting to change that with a study published last week in the journal Autism Research. Using MRI scans, they found consistent abnormalities in the temporal lobe of the brain by measuring white matter microstructure. These measurements were able to correctly identify 94% of the children with autism and correctly identify 90% of the children without autism, resulting in an overall accuracy of 92%.

This test cannot yet be used in a clinical setting. This study was done with a relatively small group of children (30 children with autism and 30 matched children without autism) and will need to be replicated in a larger sample. Furthermore, while MRI scans exist throughout the country, the sophisticated measurements used by these researchers are not necessarily available to all operators of MRI equipiment. MRI differences in autistic children have been identified often over the last 10 years, although not with the accuracy of this study. So while very intriguing, further research will be needed before this technique can be used in “prime time.”

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A recent Supreme Court decision has expanded the population of children with disabilities who are eligible for reimbursement from their local school district for a private school education (Forest Grove School District v. T.A.).

Children with disabilities must be provided a “Free and Appropriate Public Education” that prepares them for further education, employment, and independent living, as guaranteed by the Individuals with Disabilities Education Act (IDEA) passed by the United States Congress in 2004.  This means that if a child with disabilities cannot receive an appropriate education in the public school system, then the school district must either develop and provide that program, or pay for the child to attend a private school which can provide that education.  However, it was always assumed that in order to receive this funding the child must have had an evaluation by the school district who must then have recommended the specialized classroom approach through an Individualized Education Plan (IEP).

This is no longer the assumption. As reported in the SCOTUSblog (the Supreme Court of the United States blog), in a 6–3 decision in June 2009, the US Supreme Court “held that parents of disabled children can seek reimbursement for private education expenses regardless of whether their child had previously received special-education services from a public school.”

Following the tragic deaths of four teens and pre-teens, the bullying problem in our nation’s schools is resurfacing as a major issue. It is certainly not unique to our schools; bullying can be found in countries around the world. We also know that bullying has happened as long as there have been children; you can’t meet anyone who doesn’t know someone who has experienced it. It is hard to say if the problem is actually getting worse or if we just hear more about it now. Regardless though, the question remains, why does it happen and what can be done about it?

In a guest commentary on DenverPost.com today, Working Together to End Bullying in Schools, the executive director of One Colorado, Brad Clark, looked at anti-lesbian, gay, bisexual, and transgender (LGBT) bullying. He quoted a statistic from the 2009 study conducted by the Gay, Lesbian, and Straight Education Network (GLSEN), that “nearly 90 percent of LGBT students experienced harassment at school”, and that “30 percent of LGBT students missed at least one day of school in the past month because of safety concerns”. Certainly this data points to a lack of tolerance amongst children which is especially damaging, as we’ve seen recently, in the turbulent years of adolescence, when image and social acceptance is so critical.

There is such a huge range of “reasons” that children might be bullied for – race, gender, learning difficulties, intelligence – and sometimes it’s for no “reason” at all. It’s such cruel behavior and can have a lifelong psychological impact on the child experiencing the bullying behavior.

So who is doing the bullying? How can other children be so mean? In a page on Bullying in Schools from Bully Online, the UK National Workplace Bullying Advice Line, we can see that there are a variety of extreme reasons for bullying such as neglect or abuse, but the very first reason listed is simply frustration:

Frustration – a child is impaired in some way and is frustrated and resentful because the source of their difficulty has not been identified – problems can include deafness, dyslexia, autism, allergy, being left-handed, undiagnosed PTSD or some unidentified learning difficulty – nevertheless the child is expected to perform at the level required by the school and no attempt is made to identify the source of the frustration.

Now that sounds familiar. We know that there are so many children who are not succeeding in our mainstream, traditional school environments. These children will certainly deal with their frustration in different ways, but it’s likely that many of them are bullying. It must stem from helplessness – how else can they have their voices heard?

This is yet another reason we need to change our education system. If every child could learn the way he or she needs to; could form real relationships with teachers who would know if the child was learning or needed something different; and could experience success at school, it’s likely we could head off some of the problems caused by this frustration. Bullying probably wouldn’t just go away, but just think how much better it could be?

Our hearts go out to all of the children who experience this type of harassment at school and feel helpless to change their situation, and to the families of the children who couldn’t take it anymore. Something must change, and more than just introducing anti-bullying laws. It starts with remembering that each child is an individual, and then educating all children that way.

For more information on bullying, and how to help stop it, you can visit Stop Bullying Now. The Ellen DeGeneres Show also recently released an anti-bullying statement. And finally, we are very proud of our one-to-one school in Los Angeles for holding an all-school meeting to talk about bullying.

Regardless of your personal opinions on medicating children, the fact is that medical interventions abound for diagnoses such as ADHD/ADD, anxiety, depression, and many more.

As a teacher, educated in academics and student learning, how do you deal with the topic of student medication? What do you do when a student comes into class and says “I can’t study today; I didn’t take my meds.”?

English teacher Nancy Schnog, a 20-year veteran in the field, was confronted with this very issue and didn’t know how to react. She decided to research the topic over summer, so that she would be better prepared next time the situation arose. She came up with some interesting findings, which many teachers could find useful.

Read her full story in The Washington Post: An English teacher learns how to deal with medicated students.

At the conclusion of ADHD Awareness Week, it seems appropriate to talk more about the different educational requirements of children with ADD/ADHD. In this article by Thomas E. Brown, Ph.D., taken from his book Attention Deficit Disorder: The Unfocused Mind in Children and Adults (Yale University Press, 2005), we learn that there are six cognitive executive functions: activation, focus, effort, emotion, memory, and action. Together they comprise that most complex function of the mind: attention. Many of the “symptoms” of ADHD seem to actually be an impairment of one or more executive functions of the brain.

Dr. Brown states that:

Most persons diagnosed with ADHD report significant chronic difficulties in at least some aspect of each of these six clusters. Impairments in these clusters of cognitive functions tend to show up together; they appear clinically to be related.

Executive function impairment chart shown in the article "Executive: Describing Six Aspects of a Complex Syndrome", by Thomas E. Brown, Ph.D.

Armed with the understanding of cognitive executive functions, and how they can break down, we can easily see how a traditional school environment would not be able to hold the attention of children with ADHD. Furthermore, it is unlikely that children with ADHD would be able to successfully learn and achieve in this environment, which does not generally provide assistance and support in overcoming difficulties with these cognitive processes. Clearly other solutions are needed for these children, ones that help them understand why their brain works a little differently, and gives them tools to succeed.

Written by Sallie Borrink.

Tamara Fisher, a gifted and talented specialist, describes her job in this way:

(I)t’s my goal (among others) to help them understand, accept, and learn how to manage the advantages and disadvantages that can come with their high intelligence and high creativity. We have conversations about effective ways to respond to (or not respond to) teasing, we discuss friendship issues and strategies for finding and making quality (vs. quantity) friends, we talk about what giftedness is (a learning difference) and what it is not (specialness), we celebrate challenge and the hard work it takes to learn when challenged, and we foster an attitude that it’s okay to be who you are… our world needs all sorts. Generally speaking, these conversations, over time, do help them to understand, accept, and manage the advantages and disadvantages that come with their giftedness.

Fisher recently shared her students’ perspectives on the downsides of being gifted. She then later asked them what they appreciated about being gifted. Here is a sampling of their responses as to the upside of being gifted:

“Having a great ability at something gives me the joy of immersing myself in working on that area.” Michelle, 7th grade

“Being gifted is great when the school meets me where I’m at academically. I love being challenged in my advanced classes.” Wendy, 7th grade

“I just learn differently, and I’m okay with that.” Cural, 5th grade

“I think I have found a lot of less-known things interesting, causing me to have a very diverse set of life experiences. Because of that, I have a very different thought process than most people.” Scribblenaut, 12th grade

“I sometimes enjoy feeling smarter than the others and I feel like all that I have worked for in the past has paid off. And I’m thankful that there is a class where I can (humbly) exercise my abilities and be surrounded by others who have the same talents, a class where I won’t feel different from other kids.” Olive, 9th grade

“I like that I can ‘see through’ the motives of the so-called cool crowd.” Puff the Magic Dragon, 5th grade

Helping students who learn differently to embrace and even enjoy their differences is a large part of helping them become successful students and, eventually, successful adults. Celebrating their strengths and individuality on a regular basis will contribute greatly to their own acceptance of their unique approach to life.

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