[...A FEW BRICKS SHY, Cont'd ]

TYRANNIES

               His COVD paper had a very long title, but the essence of what I learned then and have found dogging my heels on the Yellow Brick Road ever since, was contained in the title’s first five words:  “The Tyranny of the Premise”.  The essence of this is that we are all tyrannized by what we are taught.  What we are taught and told is so. The tenets of our belief are laid by our mentors, our Very Important People in our lives: parents, teachers, ministers, professors. Few students have the insight or the lion-like courage to break beyond what they are taught—even when the facts they are taught are belied by their observations in the patient before them—facts that could not possibly fit  the model, the premises that they have been taught and digested.

               My symposium paper was a unifying hypothesis that speculated upon a mechanism that created nearsightedness, farsightedness and astigmatism as a by-product of visual distress.  The pivotal “switch” that made it one or the other (nearsightedness or farsightedness) or a mix (astigmatism), was the effects of stress on the personality of the individual. Dr. Forrest was writing a book on stress and its impact upon vision.  My presentation confirmed his own theory. Later, we exchanged papers and he included a reference to my paper in his book “Vision and Stress”.

               I bring up this point to illustrate the storm I found myself struggling with then and to this day (and will, probably, for the rest of my life):  people legalistically cling to what they know.  Everybody is logical in what they know and do -- it's just that they begin with different presupmtions and are reluctant to change them.  JR had almost gotten lost in the shuffle because of that attitude.

               Even when you or I present evidence of the accuracy of our new ideas, critics tend to withdraw to the safety and comfort of their own ideas and data.  “Your data isn’t as good as my data!”, they seem to say, dismissing any consideration of new concepts.

               It’s just human nature, I guess.

               The most dramatic discovery that I’ve uncovered in the learning model that I use is the importance of bilateral integration, but that really wasn’t new, even when I described it in a chapter that I wrote for a monograph on the integration of vision with the other senses. Like so many “new” concepts, we are always building on the foundations, the shoulders, of those who have preceded us.  Few new ideas arise magically, mysteriously.  The seeds of innovation are already planted, we who innovate merely prune and replant, and hybridize the old ideas, distilling the best of what was there long since.

               In my case, I built on to Rosner’s foundation, who was building on Strauss and Kephart, who in turn, most likely, built on Orton’s work. Educational and psychology giants like Piaget, Montessori, Edward Seguin, and all the way back to the great Swiss educational reformer, Johann Pestalozzi in the late 1700’s, built upon the others’ foundations.

               Rosner’s research revealed that the learning skills that were criterion-referenced into academics boiled down to two essential perceptual skills: Visual Analysis and Auditory Analysis.  His discovery may have been almost too simplistic:  frustration seemed to be looming in the background, when he said,

“Are there other critical variables – perceptual skills – that relate, in a different way, to classroom achievement?  Probably.  Those already identified and described in this paper do not seem to be sufficiently extensive nor adequately complex to account for as much of the variance in classroom achievement as we would like.  In retrospect, they may even seem trifling, compared to the time and effort devoted to the task by the staff of this Project and the many other LRDC Research Associates who have contributed valuable guidance.  Thus far, however, no other important variables have been defined.  Perhaps, as Simon [ed. note: a fellow researcher]…states:

‘A man, viewed as a behaving system, is quite simple.  The apparent complexity of his behavior over time is largely a reflection of the environment in which he finds himself.’”

The Development and Validation of an Individualized Perceptual Skills Curriculum: Rosner, Jerome

                                                            LRDC, University of Pittsburgh, 1972/7

                                                            (Emphasis added)

               Rosner was closer to Oz than he many have fully realized.  The quote he cited in the excerpt above may say more than enough: “A man, viewed as a behaving system, is quite simple.”  My experiences as I learned from him and others bears out this observation: though the mental and physiological processes are almost mystically complex, their day-in, day-out development appears to be almost ridiculously simple.

               For thirty years, all that has been clinically necessary in the greatest majority of the kids and adults was to address the visual and auditory analytical skills, the motor skills, and remove the visual functioning barriers.  Remedying these four areas has proved enough to solve the difficulties in 80% or more of the population that I’ve seen.

               Gross motor movement is the foundation for fine motor movement. Efficient fine motor movement refines oculo-motor performance, which further refines fine motor skills.  these don’t happen one at a time, there is a synkinetic harmony—a simultaneous teamwork of each with the other, with Vision as the grand wizard in its own right, directing the further refinement of itself and the perceptual-motor skills that build cognition, even Mind itself….

Simply. Splendidly.  Naturally.  And rapidly.  But it was resisted. Was it, is it, too simple an answer?

ROOTS OF LEARNING

Jane Healy, in her book “Endangered Minds: Why Our Children Don’t Think and What We Can Do About It”, brings out the point several times that neurobiologists have a message for educators:  the brain does change and that change is driven by experience.  The human brain has evolved in an environment where active experiences and manufacturing skills were the norm for development and survival.  We now live in a video and cyber age where far too often, observation is the new norm.  Mothers whose responsibility, primitively, was to teach language and social concepts are absent more often now, through no choice of their own.  Fathers whose historical role has been to teach manufacturing skills and related concepts are more often absent from the family, either due to family breakdown or to the drive of work and materialism.  Not always, of course, but often enough, especially in first-world countries where learning problems are more rampant than in second- and third-world countries.  Does our modern civilization rob certain children of the experiences that would assure more proper neurodevelopment?  I believe that the question is rhetorical.

I found myself besieged by storms of criticism and cynicism.  Pediatricians, school psychologists (but oddly enough, not clinical psychologists), ophthalmologists, educators (but again, oddly enough, not classroom teachers, mostly just administrators and many school psychologists) – all echoed the tyranny of their taught premises: perceptual and visual therapy was worthless; all the V.T. optometrists were after was money; kids just need to be taught. They seemed unable to comprehend that many children lack learning skills. 

Those learning skills can be learned.

It was so frustrating.  I hated the foot-dragging.  I wanted to say to them all, “Don’t believe what I am saying, believe what I am doing!”

I was dealing with kids called dyslexic, ADD, ADHD, learning disabled, depressed, oppositional/defiant, pervasively developmentally delayed, delinquent, globally delayed, anxiety disordered, and half-a-dozen other more minor diagnoses.  We had success with them all, some dramatic, others merely satisfying.  The only children we had little success with were the angry children: children who were passively simmering over slights, real and those merely perceived.  Some were angry at their teachers, many more with their fathers, and one memorable one with his mother.

When we helped these children and young adults develop new vision, new perceptual styles, they found success, self-confidence and hope.  Their lives changed. I was helping them to change their lives.

Just like Dr. Manas had said in our visual training classes:

“There is no professional who has more power to change a person’s life than his optometrist doing his job properly.”

If only they could see beyond Kansas, see the world of Oz down at the end of the Yellow Brick Road.

It takes a storm to move a person, sometimes….

Chapter Three

LOOKING AT JR

(The Tin Man, a Scarecrow and the Lion)

When I tested JR, using the standardized perceptual tests of The Learning Clinic protocol, we found a pre-teen boy with first-grader’s skills. How could this child ever fully profit from the classroom experience? The checklist of symptoms that his mother had handed me looked like a war zone of check marks. He had visual difficulties, movement difficulties, auditory perceptual difficulties, visual perceptual problems, and he could barely blend information from one sensory channel to that from another.

Like the Tin Man in Oz, JR needed a Brain, it seemed. And when I looked at the video of JR’s first experience with the wraparound assessment center, it was apparent that the boy I was now seeing who had  brought such willy-nilly and angry emotions in with him now had a heart bigger than any Oz-ian (is that a word?) Scarecrow. His mother was the Lion, for she had fought courageous battles for the boy to get him to this point.

I had a ton of reports to catch up on before I could begin to understand this boy who I was now committed to try to help. As I pored over them, I saw a pattern of progress that by rights shouldn’t have been there—a behavioral pediatrician had tested him over a period of three years as part of the medical assessment needed to keep JR in his private school in California and her results showed something that Diane said no one had mentioned before—JR had improved one year for each year he had been schooled at the center. True, he was three years behind, but the data showed that he wasn’t falling any further behind, that he was growing one year mentally for each chronological year. I checked with several of my friendly experts and they confirmed that autistic children don’t generally change year for year. Hmmm.

JR had a number of reasons to have neurological problems.  His delivery was difficult and though he was fine at five minutes after birth, initially he was a “blue baby”, indicating some degree of oxygen deprivation had occurred and it had to be administered to him.  As a toddler, he had fallen down a flight of steps and suffered a head injury; he was prone to high fevers. He also had chronic ear problems over the next months and years, requiring surgery to implant tubes.

Any of these can cause later developmental problems, but JR had shown sucking difficulty and a hyper-tactile response from shortly after birth, being overly sensitive to touch.  He also had some seizure activity, they thought.  The neural implications of these are not clear-cut, but they suggest a brain insult of some degree, according to various sources.

“Poor kid”, I thought, as I reviewed the many reports from the various specialist who had seen him over the years.  The little guy has been through a real war, and happily to say, from the looks of things, he was winning.

The reports from California were encouraging.  The autistic program at the private school he attended had indeed kept him from falling behind, but he wasn’t getting ahead.  The agency who evaluated him here in Pittsburgh and was to provide him with 40 hours a week of one-to-one wraparound services did a remarkable job of assessing him over the four years he’d been with them to the point when I saw JR.

However, there was a tolerant air in the one report where a Pittsburgh developmental pediatrician discussed the subject of the Doman techniques that Diane, Walt and JR learned to do at the Institutes for the Achievement of Human Potential—and had embraced wholeheartedly.  He cautioned about alternative methods (yeah, boy, had I ever heard those same kind of complaints about Visual Therapy!)—and requested that scientific reports be supplied to him.  Hopefully, he’ll be able to read these pages and perhaps find out for what might be the first time that 10 weeks later, the psychologist at Pressley Ridge was nothing short of amazed in her report of how much change had occurred in JR in the 3 months since she had last seen him.  She mentioned the treatment techniques JR had been doing from the Doman Center without comment, she didn’t connect them with any progress since the time of her last evaluation.  She said:

“JR has markedly and dramatically decreased tantrums and aggressive behaviors as well as self-stimulating behaviors.  On the other hand, academic knowledge has skyrocketed …”  and, “Each time I have seen JR, following the first evaluation, I have noted remarkable progress and today was no exception.  If anything, the pace of  JR’s progress has accelerated.”  And, lastly, “JR is making remarkable progress. Within the last year, there has been incredible growth on his part which could not have been predicted in September 1996.  JR’s autistic-like symptoms are markedly diminished.” [Emphasis added.]

Whoa!

Don’t misunderstand.  I’m not giving any blanket endorsement of the techniques of the IAHP.  I’ve seen disheartening failures here in the Pittsburgh area.  But the rate of change had accelerated in the same period that the cross-crawling, patterning, and masking techniques had been undertaken.  Coincidence?  We can’t know for sure, but something about the process appears to have worked, though precisely what we can’t know.  Objective evaluation of their methods would be of real value right about here.

The current attitudes of medical disdain about the IAHP won’t lead us to any great enlightenment.

My testing revealed a disheartening aspect of JR’s development.  Even though his social and academic skills had changed and he was now able to deal much better with pragmatic speech, there was virtually no difference in his mental age as tested by my perceptual battery (see Table I).  How can that be?

Moreover, JR was off all his heavy-duty drugs and was now sleeping through the nights, and that, without diapers.  This shouldn’t be happening, I think others would say.  I just took it all in for consideration. True, there were no reports of studies correlating the tests of perception that I was doing with the Leiter and Expressive 1-Word tests, the two primary tests that were used, but I’m not attempting to say that. What I am saying simply is that Table I shows that at about age 8½, JR was tested in California as having the intellectual skills of a 5½ to 6½ year-old, and that four years later, we measured his perceptual skills as being that of a 5½ to 6½ year-old.

How can he be reading at a second-grade level with such poor perceptual skills?

Indeed.

You need to know a bit about people with brain damage. Those individuals very often test much poorer than their skills would suggest. That is to say, they are able to do much more than testing would suggest. We have to be careful to not over-rely on test results when the child’s behaviors suggest that the tests are minimal evaluations, not totally accurate ones.

Over the years, I had seen others change dramatically in spite of dire predictions—and yes, even when they were my own sour expectations—and I was not about to say no to JR, if he and his family were willing to consider a trial of therapy, with continuation of the therapy to be predicated on whatever or however much progress was possible.

We had our work cut out for us.  In spite of encouraging comments in the prior reports of JR’s motor skills progress, JR at 12½ could not balance on both feet, could only hop on his right foot, and had other major motor inabilities such as only being able to do one sit-up.  He had recently learned to skip and was able to do that only after much coaxing.  This is important to understand, for kinesiologists over the years have shown that there are moderate to strong correlations of motor skills to academic performance although they are not cause and effect correlations.

His auditory perceptual skills were at the kindergarten and first-grade levels, as were his visual-perceptual skills.  His ability to exchange experiences from one sensory channel to another was either non-existent or merely unable to be tested.  Thus, he couldn’t relate sounds to pictures very well, if at all, and indeed, most of his reading was by sight recognition of the word forms.

Yoy!

We reallyhad our work cut out for us.

Chapter Four

WORKING WITH JR

(Repairing the Yellow Brick Road)

               This was a mutual learning experience for Diane and me.  She taught me how to manage JR with the skills she’d learned from the wraparound teachers, and she was an avid student of the techniques that I was teaching her about perceptual-motor skills training.

               What delighted us both was how the work I had JR doing was such a natural extension of where they had left off in the IAHP training. We often laughed in the delight of discovery as JR succeeded with our ministrations, and as we modified the techniques.  We worked on the five main areas that had evolved into the Learning Clinic protocol:

1)    Visual Skills – based in my functional vision training with Dr. Leo Manas.

2)      Motor Skills - based in Rosner’s Perceptual Skills Curriculum (PSC) and adapted physical education strategies.

3)     Visual-Motor Skills – derived from the PSC and traditional developmental activities.

4)    Auditory-Motor Skills – based in the PSC and Computer Orthoptic activities developed by Dr. Sidney Groffman.

5)    Integrative Skills – developed from the PSC and Groffman materials, supplemented with traditional methods.

               The Learning Clinic protocol is based upon Rosner’s discoveries and techniques in his research at the Learning Research and Development Center at the University of Pittsburgh, but especially upon the concrete-to-abstract hierarchy of development that he postulated and worked into the PSC. Several other factors were drawn upon as well.  A providential telephone conversation I had with adapted physical education specialist Dr. Jean Pyfer of the University of Texas Women’s School at Denton, Texas, reinforced the need for gross motor and “trunk” motor skills. She shared with me that fine motor skills don’t naturally come in until trunk skills are in place. 

A later conversation with Dr. Bill Ludlam of the Pacific University College of Optometry got me doing as much convergence and divergence range visual therapy as I could with the appropriate kids.  He had done a small experiment with several training patients, and found that he was able to either develop or increase alpha-wave blocking neurally with increases in convergence skills. 

This is probably very significant since it is known that kids with attentional problems more often have trouble blocking alpha waves.  Alpha waves are important for stress reduction and reducing blood pressure, but they are resting waves, produced mostly with the eyes closed.  They should be blocked with the eyes open.  A high percentage of ADD/ADHD kids can’t do that!  Because of this, some researchers have proposed that Ritalin works by stimulating the kids so that they don’t have to stimulate themselves with hyperactivity.  Time will tell us either their ideas are correct or just how correct they are.

Intellectual Measures

JR

1993-2001

Key: “R.S.” = Raw Score

During the three years at Villa Esperanza, there was about one year’s change each year.

In the four years in between, with 2 years being spent using IAHP techniques, there appears to be no essential intellectual changes

(though the top two and the bottom five tests are NOT equivalent). Many social changes did occur during that period, however.

In  the six months records at The Learning Clinic, there has been at least 16 months’ and as much as three years’ change.

(Some of the scores were notably higher in interim test sessions: i.e., the AAT and the Rutgers A.)