The Breakthrough Blog

A newly published article by the Department of Neurology, Division of Cognitive Neuroscience at Johns Hopkins University School of Medicine outlines another look into the role the cerebellum plays in language development and cognition. There are many researchers investigating this part of the brain that is so deeply involved in movement and a huge variety of “automated” functions. The exact logic of how the brain uses all its various systems to divide and tackle the complex cognitive tasks it performs every day is still in its infancy. However, the efficiency of cerebellar functions and how it can be enhanced through calibrated neuro-motor and vestibular training is constantly being examined as a likely method of improving brain fitness generally and as a way to overcome specific learning challenges.

The entire article is available here: Functional Topography of the Cerebellum in Verbal Working Memory, with the abstract printed below for your convenience.

Abstract :

Many of us in the LD community have children and the need to plan summer activities just like many of the families we work with. Learning Breakthrough always gets a push at the beginning of the summer by families that know they can use the flexible time that summer brings to get kids onto the equipment and working in a fun way in advance of the next school year. We also hear from parents about their LBP advances and get recommendations on the creative ways they fill their family time.

In that vein, the following article outlining “Summer Activities for ADHD Kids” is a sampling of some great ideas and general approaches for the ADHD parent that reminds us how a little bit of structure, combined with the good fun of summer, and input from our children, can make for fun days that build family connections and memories. Working with ADHD always takes more planning for those of us who work with it but it also affords us more time than usual (outside the stressful school year) to build skills, reconnect with our families and do some “brain boosting” over long summer days instead of walking straight into the feelings of “boredom” that ADHD kids readily default to.

The article Brain scans shed light on dyslexia, written By Health Day Reporter Amanda Gardner, sheds light on dyslexia causes with modern brain scanning technologies. The findings, published in the online issue of Current Biology, seem to be in line with previous research. The experiment laid the foundation for the neuro-anatomy of dyslexia versus the non-impaired reader.

Guinevere Eden, director of the Center for the Study of Learning at Georgetown University said, “A typical person has an augmented response in this part of the brain, and in dyslexics, they’re not seeing that augmentation, suggesting that there does not seem to be a system in place to show that there’s an association [between visual and sound] that’s going on.” Further work on vestibular remediation correlates remarkably well with the sensory model being described. The more sensory coordination that occurs in any reader, the more resolved the system of abstract language construction becomes. This is the heart of LBP’s design logic and why we found the article to be so relevant.

If you’re the parent of a child who’s having trouble learning or behaving in school, you quickly find yourself confronted with a series of difficult choices.

You can do nothing — and watch your child flounder while teachers register their disapproval. Or you can get help, which generally means, first, an expensive and time-consuming evaluation, then more visits with more specialists, intensive tutoring, therapies, perhaps, or, as is often the case with attention issues, drugs.

For many parents — particularly the sorts of parents who are skeptical of mainstream medicine and of the intentions of what one mother once described to me as “the learning-disability industrial complex” — this experience is an exercise in frustration and alienation.

The rest of the article describes some areas of similarity with LBP because of the program’s substantial amount of vision-related activities. The balance and vestibular issues so critical to LBP are not described, but the hurdles that parents face and the ways that treatments are presented to parents, the pressures, etc. will be very strongly identified with by those who have had to walk that road.

Read the complete article on the Times website >>

Guest Blogger

I am asked regularly about my association with certain “alternative” approaches to learning disabilities. I was recently talking about vision therapy with a New York Times reporter who was asking me about skepticism observed in the medical profession regarding the topic. I told her I believe it is important to keep an open mind when it comes to alternative treatments.  Most of these programs do not have the funds to undertake the multi-million dollar prospective studies that are needed to conclusively test these programs.  Nonetheless, many of them, like Learning Breakthrough, have merit and have helped people a great deal.

I offer Learning Breakthrough in my offices as a powerful, approachable and inexpensive treatment that complements our other therapies wonderfully.  I have found it valuable for clients with ADHD as well as dyslexia and other learning differences.  It is not purely vision therapy, but rather an “integrative therapy” that makes use of several different brain systems.  It is designed to get the brain working as an efficient, tight-knit system. Many of the clients who have completed the program have reported such improvements as a reduced or eliminated need for medication; better academic performance; increased organization skills; and heightened executive functioning. I hope you will read into the detailed background information posted on the Learning Breakthrough website to get a better feel for what I’m talking about.

• Sensory-motor Theory

• Neuroplasticity – Sensory Processing

With respect to vision therapy, I told the reporter I believe there is something to it. What the “something” is – is up for grabs, but we are learning more and more about how the vestibular system, visual system and auditory system can all be made to work better together and  improve the treatment of attention deficit, dyslexia and other learning differences.  My own son’s reading problem was helped by his doing vision and vestibular exercises based on the same methods Learning Breakthrough uses which is how I came to gain an appreciation for this particular “alternative” treatment.  This is not hocus-pocus.  The fact that medication is the best researched intervention is due to the fact that the drug companies are the only groups with enough money to fund such expensive research. I referred the reporter, and I would refer you, to the work of Dr. Mel Kaplan, an optometrist in Tarrytown, NY who is, in my estimation, a genius and a true innovator in the field.

But note, developmental optometrists are not the only professionals that understand and apply Learning Breakthrough’s ideas. Occupational therapists, physical and speech therapists, audiologists, education specialists, and physicians have all seen client improvements along the lines of those that I’ve seen.

I tell my patients that I want to use whatever works, as long as it is safe and legal. If we wait for a New England Journal of Medicine article to report on the validation of every treatment, we’ll be waiting a long time. To me, the integrative approach–making use of all the possible tools I have in the toolbox–is the best way to go.

All the best, Ned Hallowell

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MARRIED TO DISTRACTION
Announcing the publication of Dr. Hallowell’s new book, Married to Distraction: Restoring Intimacy and Strengthening Your Marriage in an Age of Interruption. See a preview now! It hits the bookstores March 16, and is available to be ordered on Amazon and other online stores now.

Two happy mothers just wrote to us and (actively) asked that we share their stories with you.  
One mom said, “I would love my son’s experience to benefit someone!”  Maybe that someone is you…

Another mom of a college student says, “Thank you for opening Michael’s world.”

If you are a Learning Breakthrough user, please be sure to send us your “success stories” also so that you can perhaps inspire others.

Dear Learning Breakthrough Staff,

For the past 5 months my son, Michael, has been actively participating in the Learning Breakthrough Program through The Hallowell Center. He performs the exercises 2-3 times a day with the DVD.  The beauty of the DVD is that it is visual and easy to follow.

Thus far the results have been remarkable. He has gone from a young adult who lived in total chaos, to one who voluntarily and easily has a clean and picked up room, a structured daily routine and a new glint in his eye!

A bright boy, barely making his way through college Michael is now talking about pursuing a career in medicine or other graduate studies. A year ago we were all at our wit’s end and very concerned for his future. Now we are optimistic that Michael will lead the happy, productive life we all envisioned for him.

Thank you for opening Michael’s world.

Best, Jen T., 
New York

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Dear Learning Breakthrough,

My son’s story is different to the stories I have read and I would love my son’s experience to benefit someone! I don’t believe there is enough advertising out there on this sort of thing. I am just sorry it took us so long before trying your product to help my son.  It is funny that parents only seem to talk openly when their child is bright and achieving at school. I remember being very private about our fears and confusion of our son’s difficulties, hence feeling very isolated although being on the parents PTA committee.

My son always had good balance, played all sports and had received a tennis scholarship at the age of 5. He knew his alphabet at 20 months and then went onto read and write extremely well at school (aged 4.5). However, he never spoke much, but his pronunciation was very good so his teachers never worried. He then seemed to get less and less happy at school by the time he was 7. It was oblivious to me that something was wrong.

He couldn’t seem to absorb information that was in text or spoken. He refused to do an end of year test at school by turning the paper over without even attempting it. By this time the school had written him off as not being very intelligent. We knew different, as we believed he had a good brain. It just didn’t add up. We were in despair as our son could not seem to absorb or retain information so I started to research and thank goodness I found Learning Breakthrough on the internet.

I immediately purchased a kit and my son loved your daily exercises as he found them great fun. It seemed so strange, we couldn’t quite believe it. He started to be able to digest and retain information. His tests improved so much!  He seemed a lot happier in himself, more upbeat. That was a real turning point for him. We then had him re-assessed by the Speech & Language therapist, who in the past confirmed that there were enormous holes in his vocabulary and upon being re-tested we found these holes have now been addressed and there are no more gaps.

The theory of using your product feels very simple to me. It exercises the brain in every way. This opens up and gets the brain chemicals moving as all  movements have been designed for that.

Regards, E. W., England

Dyslexia in children and adults is often addressed according to two models, each of which generally focus on linguistic or language-related skills. “These methods emphasize strategy and cognitive development and are not based on a brain processing relationship, which is dysfunctional in dyslexia. Consequently, these techniques have not produced consistent reading improvement.” (Goldstein, 2001) Goldstein’s assessments still ring true today. Even so, many dyslexia treatment options tout an emphasis on “teaching” those with dyslexia words in a clearer way as if other reading educational efforts have somehow failed. The problem is, of course, that dyslexia is not necessarily a letter recognition problem, it is instead a cognitive processing problem. This means that dyslexia treatments based on language skills alone often fail.

One of the most common misconceptions about reading skills and acquisition of reading ability is that reading involves only a simple recognition of letters and subsequent knowledge of how to phonologically string those letters together into words. According to this simplistic model of reading, someone with dyslexia is simply not “seeing” the letters correctly, thus there is a perceived deficit in vision or sight. Although visual cues often play a role in the formation of dyslexia treatments, sight alone is only the tip of a very large iceberg. After all, when we see a sequence of letters, it has no meaning as an object until our brain, working as an integrated network of sensory systems, assigns significance to the abstract grouping of letters. Visual processing disorders, which are NOT related to the ability to see clearly, involve difficulties understanding visual information such as movement, spatial relationships, form, or direction. Such visual processing challenges, together with Central Auditory Processing problems, are frequently found in combination and result in a formal dyslexia diagnosis or poor academic performance.

However, the process is far more complicated on a cognitive level–mere recognition of words and sounds is only the first part in a long series of events that occur quickly and unconsciously in those without dyslexia but this process is “sidetracked” as the two hemispheres of the brain react differently than they would in non-dyslexic readers. Therefore, one of the fundamental flaws of traditional dyslexia treatment is that there is a heavy focus on teaching the words themselves while overlooking the fact that the problem lies in brain’s processing of letters as opposed to some kind of simple lack of understanding of letters, words and phonology.

A great deal of contemporary research focuses on the issue of brain processing in dyslexia treatment with multiple studies examining the delay or miscommunication between the left and right hemisphere of the brain, or problems with specific areas of the brain, including “planum temporal symmetry or angular gyrus dysfunction, that result in reading impairments and do not suggest developmental hemispheric changes as a rationale for dyslexia” (Goldstein 2001). While the results of these imaging-based studies continue to change our view of the cognitive and brain processing end of dyslexia treatment, one thing is clear—simply focusing on “teaching” those with dyslexia the letters or word sounds in a more focused way is simply inadequate. If the basic brain processes that govern the abstract meaning behind words and letters are not improved, then all of the phonics and letter training in the world will likely not solve the challenges that dyslexic readers face.

Source

Goldstein, B., & Obrzut, J. (2001). Neuropsychological Treatment of Dyslexia in the Classroom Setting. Journal of Learning Disabilities, 34(3), 276.

Sensory Integration is a term that describes how we organize and fully process the information gathered from our senses. The study of sensory integration describes how the brain functions to instantly and automatically interpret where we are, what we see, what we feel, and what we hear in a meaningful framework. Efficient and accurate processing of sensory inputs is a key element of cognitive development and enables us to interpret abstract concepts. We assign meaning and extract value from contextual information of all kinds due to sensory integration and predictably, which is also how we learn what those meanings and values are, enabling the most basic cognitive concepts. Without well-functioning sensory processing abilities, the brain receives sensory signals that don’t get organized (integrated) into appropriate responses; which in turn leads to all sorts of challenges…including learning challenges.

But, why is it not possible for us to understand cognition by only evaluating one sense as it is necessary at the moment; why should they all need to work automatically and in unison at all times? To explain, let’s step out of the abstraction of developmental and neurological theory and into analogy.

Imagine, if you will, being present as a symphony prepares to play one of your favorite overtures. Your senses come alive; your vision tells you that they are getting ready to play as you see the woodwinds bring their instruments to their lips and your auditory senses tell you they have begun by the blast of sound that emerges on the first note. However, there is a problem—something is not quite right. Instead of hearing all of the instruments in full concert with one another, you can only hear the violins. The sounds of the other members of the orchestra are not allowed to reach your ears. Thus, what you are experiencing is much more like a solo than a symphony.  Without the support of the other instruments, what you hear is only the supplemental backdrop to a much grander tune.

Let’s take this analogy one step further. What if someone told you that the reason why you could only hear one instrument out of an entire symphony was because you simply couldn’t appreciate music—that you were incapable of knowing how to properly listen so that you could experience the full range of sounds? Chances are, this would bother you—you would instinctively know that the reason was not so simple or base. If this strikes you as an unfair thing to say, rest assured, it is. For those who lack full sensory integration and suffer from learning disabilities based on this deficit such as dyslexia, for instance, the problem has nothing to do with the subject matter to be learned (letters, words, sounds)—but is much more a matter of overcoming neurological barriers that keep sensory processes operating in isolation (i.e.- with poor levels of integration).

For anyone to fully hear the concert of sounds during a symphony or, for that matter, to adequately process the visual information of text into auditory, written, and other symbolic information, a well-calibrated set of sensory integration skills is necessary. If it is not present learning difficulties can occur simply because this relatively simple cognitive processing ability is lacking. However, it is possible for those with sensory integration problems to spark a new phase in their learning development. With proper training that orients sensory functions to the unchanging reference point of gravity, sensory integration and cognitive deficits can be overcome so that the full symphony can be heard in all its intended depth.

To those who have not spent time pouring over the wealth of academic studies discussing the relationship between balance and dyslexia (as well as a host of other reading and learning difficulties), it might seem strange to suggest that balance and dyslexia bear any relation. However, when we realize that balance is governed by the vestibular system—a vast network that spans across other neural and body systems—it begins to make sense that a lack of balance and calibration of the delicate but immense processes governing cognitive acts (like reading or writing) can be upset when the balance and sensory systems themselves are not performing properly.

Before getting into more details about the physiological relationship between balance and dyslexia, let’s put the issue into a simpler context via the “cake” analogy. Hypothetically, we are setting about to make a four-layer cake, which is not an easy task as it involves several elements that must be just right in order to make the whole thing come together and remain upright. The temperature of the over must be exact and even minor alterations in the amount of sugar, flour, or eggs can make the cake as hard as rock or too soft to be layered. Cognitive processes such as reading, which seem simple when you look on the surface and see the end result, require the fine-tuning of the process of making a cake. If there is one “misfiring” during the process, you’ll be left with something that is unusable; however if all elements are synched and balanced together accurately, the end result is smooth and flawless.

One of the reasons why learning disabilities like dyslexia are not uncommon is because the relationship between balance and sensory processing within the vestibular system is very complicated. The vestibular system, which is critical to balance (which in turn governs far more cognitive processes) relies on neural transmission and processes between many systems in the brain and the body. There are “interconnections with the inner-ear, superior temporal cortex, insula and the temporal-parietal junction within the cortex, and the postural and extraocular muscle systems, all of which contribute to balance and vestibular reflexes” (Solan, 2007).  In other words, with so many neural “shots” being fired in such a vast array, there is great opportunity for problems to occur—for shot to go haywire.

One expert on the vestibular system has remarked that, “each element of learning occurs as a function of the individual’s total developmental framework….Learning in the absence of suitable developmental structures may preclude assimilation” (Solan, 2007). In other words, without proper functioning of the entire system of networks that govern neural and other processes, learning cannot occur in full. Our potential is not reached due to inefficient neural processing that results in barriers that can be targeted for improvement. At some point, the gaps in this framework will manifest and the information processing event will be stunted. This is absolutely the case with dyslexia and other reading difficulties. Without suitable interaction between the vestibular system (balance) and the brain, learning and applying reading or writing skills can be nearly impossible for some people. It is only when this imbalance has been negotiated, when calibration occurs, that the framework can be made effective once more.

The expression, “our bodies are remarkably resilient” extends beyond our physical capacity to heal and recover. This can also apply to our cognitive processes and body systems. Like other major systems in the body, the vestibular system is also resilient and can be adapted to enhance the quality of life. Scientific research has confirmed that practice reforming the balance system can have a positive impact on the underlying brain processes of those who with dyslexia and other learning disabilities.

Source

Solan, H. A. (2007). Vestibular Function, Sensory Integration, and Balance Anomalies: A Brief Literature Review. Optometry & Vision Development, 38(1), 13-17.

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Publication of the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for publication in May 2013. This is an important document, you might even call it hugely important, for a number of reasons. The manual’s effects are such that its revisions can have a rippling impact for decades to come and this extends far beyond the psychiatric community of professionals that oversees its publication.

The DSM-5 is a listing of ALL psychiatric disorders in the USA and effects treatment regimens, how doctors approach diagnoses, how insurance coverage is defined, how health care is delivered, how labels are meted out for those who suffer with a covered diagnosis, and for every constituency in the medical field and many educational fields. Organizations and industries that use the DSM as a basis for their operating guidelines include the Food and Drug Administration (FDA), National Institutes of Health (NIH), insurance companies, medical companies, pharmaceutical companies, doctors, pyschiatrists, psychologists, learning pathologists, researchers, developmental specialists, clinical administrators, lawyers, judges and any group that interacts with special education and psychiatric disorders in any fashion.

Some of the headlines that are coming out of the proposed changes in this iteration of the DSM are:
•    Asperger’s Syndrome is out – everyone’s going to have an “autistic spectrum disorder” identification instead
•    Personality Disorders are out – kind of. In their place, there’s five Personality Disorder types, each of which you can have to varying degrees, and also six Personality Traits, each of which you can have to varying degrees
•    Hyperactive Sexual Desire Disorder is out, and is to be replaced with a definition of Sexual Interest and Arousal Disorder
•    Binge Eating Disorder, Hypersexuality Disorder, and Gambling Addiction are in

There are more detailed and difficult to interpret things in the DSM that have to do with diagnostic approaches, classifications, assessment standards and structural frameworks for a range of clinical definitions; and many other things that go beyond our simple observations listed here.

There are a few “DSM revision petition” sites out there and the one we are watching is at the SPD Foundation which is working to have sensory processing and sensory integration topics formally included in the DSM for the first time.

Inclusion in the DSM means a lot of things. It would serve as validation of decades of work by skilled sensory development specialists (like Frank Belgau) and open the way for Sensory Processing Disorder (SPD) to become formally recognized as a DSM-qualified disorder treatment. This would impact regulation and open the doors for countless people to have their sensory challenges treated with a level of scrutiny and resources that has not existed previously. It means pediatricians and others will have standardized criteria for making a correct diagnosis of Sensory Processing Disorder. It means treatment opportunities, funding and research priorities will be identified and propelled forward. It also means that children with Sensory Processing Disorder will be more likely to receive school accommodations and public services.  In this context, “hugely important” is probably a very fair characterization.