Chapter 1
EDUCATION AS A FORM OF CARE
It is needlessly tragic when children grow up disappointing themselves
and the adults who care about them. They do so because they perform
so inadequately in school. These children come to question their
own worthiness, as they gaze about and compare themselves to others.
Often they harbor profound concerns about their minds, believing
that somehow they are defective as thinkers. We are actually describing
the sad plight of children with learning disorders. Their brains
have difficulty performing certain highly age-specific roles that
are needed to keep pace with the demands imposed in school. Learning
disorders are complex conditions that take many different forms.
In view of their complexity, it is not surprising that these
children are frequently misunderstood. They are apt to confuse
their parents and their teachers. They confuse themselves as well.
This book is intended to reduce that confusion, to enable all
concerned to develop a better understanding of the reasons for
an individual child's exasperating struggles to keep pace.
So much is at stake. Children who experience
too much failure too early in life are exquisitely vulnerable
to a wide range of complications. When these students are poorly
understood, when their specific problems go unrecognized and untreated,
they are especially prone to behavioral and emotional difficulties
that are frequently more severe than the learning problems that
generated them. It is not unusual for these students to lose motivation,
to become painfully (and often secretly) anxious about themselves,
to become non-compliant, to commit antisocial acts (including
substance abuse and delinquent activity), and to lose ambition.
A Model
This book presents a model, a way of thinking about many of the
common forms of learning disorders, their recognition, their implications,
and their treatment. It is a model based on clinical, educational,
and research experience. It is a model that favors description
over labeling and that takes into account the great heterogeneity
of forms of learning disorder. The model also places a heavy emphasis
on the identification and utilization of innate strengths among
these children. Also, the model is developmental and highly descriptive.
It relies heavily upon the close observation and precise description
of how children are functioning. Such observation and description
is performed by clinicians, teachers, parents, and, notably, the
children themselves.
In order to begin to understand this conceptual
model, some basic ideas and terms need to be introduced. The first
is the notion of an observable phenomenon, namely, a particular
problem with learning or performing in school that is clearly
visible as one observes a child over time and/or during some form
of testing. For example, one might observe the phenomenon of a
child having trouble entering new material in memory while studying
for tests. In this book, we will be examining 34 common observable
phenomena. Not surprisingly, there can be many different reasons
why a child might exhibit a particular observable phenomenon.
Very often the phenomenon is a manifestation of one or more neurodevelopmental
dysfunctions. These neurodevelopmental dysfunctions represent
gaps, delays, or variations in the way a particular child's brain
is developing. In reality, neurodevelopmental dysfunctions may
stem from a lack of appropriately dense nerve connections in specific
regions of the brain. Or they may be the result of unusual patterns
of blood circulation in the brain, chemical/metabolic abnormalities,
or uneven brain growth. In most cases, we simply do not know (or
need to know) the exact mechanisms responsible for a child's neurodevelopmental
dysfunctions. We are certain, however, that the dysfunctions themselves
have the potential to interfere with learning, with productive
work output, and with behavior in school.
To further refine the role of neurodevelopmental
dysfunctions, it is necessary first to acknowledge the importance
of neurodevelopmental functions. Any learning task that
a child is asked to complete in school demands the collaboration
or participation of multiple neurodevelopmental functions. Thus,
if a young child is asked to write her name, she must make use
of several neurodevelopmental functions that mobilize and regulate
the muscles in her fingers. She must also deploy several forms
of memory to recall the letter formations and the correct spelling
of her name. In addition, she needs to focus her attention on
the task, use self-monitoring abilities to ensure she makes no
careless errors, and apply spatial awareness to inscribe her name
in the right place on the page. If one or more of these requisite
neurodevelopmental functions fails to operate properly, the child
may have trouble writing her name legiobly and accurately. So
it is that every academic endeavor represents a collaboration
between multiple neurodevelopmental functions. This joint effort
must be exquisitely integrated and synchronized. That is to say,
the necessary functions have to operate at just the right moment
and at precisely the appropriate rate for the task to be completed
effectively and without excessive effort. Once we have a good
understanding of the constituent neurodevelopmental functions
required to complete a task, we can then begin to understand better
a child who has difficulty with that particular task. We can explore
which of the called for neurodevelopmental functions
represents a neurodevelopmental dysfunction that is thwarting
the successful accomplishment of the activity.
As the term implies, neurodevelopmental
functions and dysfunctions are highly developmental.
That is, children's functional abilities evolve and usually strengthen
over time. However, the expectations imposed upon children also
are changing during the course of the school years. They are changing
in both content and complexity, As a result, at any point in a
child's educational career, imposed expectations may exceed current
capacities.
Different neurodevelopmental functions
become critical for school success at different stages during
a child's education. For example, the functions needed to acquire
reading skills in the early grades include a keen awareness of
language sounds and an ability to manipulate these sounds within
words and to match the sounds with visual symbols. The neurodevelopmental
functions required to be a proficient reader in tenth grade are
quite different. They include the ability to recall prior knowledge
quickly while reading, to interpret with highly abstract and technical
language while reading, and to hold in mind the content of the
beginning of a chapter while at the same time comprehending the
material near the end of it. So it is that very different demands
on the brain exist for a tenth grader from those that confront
a first or second grade student. It is not surprising then that
a child may be much more successful at one particular age than
he or she is at another time during education. A learning disorder
thus may have its onset at any age. Similarly, at a particular
grade level, a student's strengths can become educationally relevant
for the first time, so that success may arrive late!
In understanding the nature of a child's
learning disorder it is essential to understand not just that child's
dysfunctions but also the role of neurodevelopmental strengths.
In fact, most children can compensate for neurodevelopmental dysfunctions
by making good use of their neurodevelopmental strengths. There
are many tasks or activities that can be accomplished in more
than one way. So a child may have difficulty appreciating language
sounds. Ordinarily this dysfunction could interfere with the ability
to spell accurately. However, it might be the case that the student
possesses a highly developed visual memory and is therefore able
to picture the words so well that his weakness of language sound
appreciation does not impair spelling. So often an understanding
of a child's neurodevelopmental strengths can be invaluable in
trying to help her make use of her strengths as a way of overcoming
the effects of dysfunctions.
A dysfunction becomes a handicap
when it interferes with a necessary component of performance in
school. It is possible to harbor a form of neurodevelopmental
dysfunction that is not a handicap. For example, a person may
have trouble with the motor coordination of his cheek muscles.
That motor dysfunction may make it very hard for him to whistle,
but a whistling deficit is hardly a handicap in our culture! In
fact, we all have neurodevelopmental dysfunctions, most of which
do not cause great difficulty in our lives. It is unlikely that
anyone could read this book without recognizing himself or herself
in some of the descriptions of observable phenomena. After all,
there are no perfect brains! It is only when our neurodevelopmental
dysfunctions are sufficiently severe, when they occur in "clusters,"
when they obstruct critical areas of performance, and/or when
they are hard to bypass with compensatory strengths that they
become problematic. Such is the case facing the students who are
the major focus of Educational Care.
Sometimes it is difficult to decide whether
a particular child's brain is "disabled" or whether
it is "highly specialized". Unquestionably, some (perhaps
most) minds seem to function very well in specific contexts or
when confronted with certain demands but not so well under other
circumstances. The adult world desperately needs a wide range
of "kinds of minds". It is only during childhood that
a young person is expected to be reasonably adept at everything.
That expectation may discriminate against children who have uneven
abilities. Furthermore, it may sometimes cause variation to be
confused with deviation! So it is that some of the children who
harbor neurodevelopmental dysfunctions may ultimately perform
very well in life but only when they are permitted to "practice
their specialties", to pursue the areas of their function
that best serve them. In the adult world, such specialization
is not only easy, but is also highly desirable and adaptive. During
childhood, specialization and/or the freedom to make use of a
unique learning style may not be viable options.
The Concept of Educational Care
Sometimes education is perceived merely as a process in which
skills and knowledge are conveyed or imparted to learners. There
may be little regard for the individual needs of the learner.
There may be an assumption that what is good for one student is
good for all students. In this book we will suggest a very different
approach. We will put forth the notion that education is a system
of care as well. It is common to talk about health care
delivery, a service through which medical professionals tend
to the specific needs of patients. These needs vary considerably
from individual to individual. Not all medical conditions require
the same medicine or the same level of health care. Education
too must be a form of care. Like other forms of care, it needs
to be individualized and it needs to be a caring kind of care.
As we have described, children arrive at school each morning with
a vast array of profiles of neurodevelopmental strength and weakness
and, therefore. with diverse educational care needs. While we
cannot (and should not) individualize all learning for all students,
in so far as this is feasible it is imperative for those who are
innocent victims of their dysfunctions. When the system is completely
rigid, there are many children who will fail to receive acceptable
educational care. Those children who harbor handicapping neurodevelopmental
dysfunctions are especially needy. Society will pay a high price
if they are deprived of the educational care that they need. As
with health care, there should be good prevention (of complications),
accuracy of diagnosis, and responsible management.
In view of the wide diversity of forms
of neurodevelopmental dysfunction, no universal panacea will ever
exist. Individualization must be the rule. On the other hand,
we certainly do not wish to isolate these children, to cause them
to feel defective, or to remove them from the "mainstream"
of education. Fortunately, it is possible to recognize and meet
individual needs without such segregation and stigmatization.
It is the intention of this book to portray some of the ways in
which such optimal educational care can be provided.
Collaboration Between Home and
School
A major supposition in this book is that a child with a learning
disorder cannot receive the best educational care at school unless
there is close collaboration with the adults at home. Throughout
this book, therefore, we will stress collaborative management.
After each observable phenomenon is described and its possible
neurodevelopmental underpinnings explored, we will offer specific
suggestions relating to the kinds of care the child should receive
in school and the forms of care she or he ought to receive at
home. In this model of shared responsibility, there is a strong
emphasis on consistency. Parents and schools need to use the same
terminology, share the same understanding of the child and with the
child, work from the same conceptual models of strength and dysfunction,
and communicate with the student in a similar manner so as to
minimize that student's confusion about himself. If a teacher
is basing her actions and her communication with the student on
one particular explanation of the child's difficulty, while the
parents are using a totally different frame of reference, that
student is likely to become increasingly anxious and disoriented.
The result may be a noticeable loss of motivation and a deep sense
of hopeless defectiveness on the part of the child.
The Plan of The Book
Chapters 2 through 7 of Educational Care describe critical areas
in which neurodevelopmental dysfunction may deter learning and
performance in school. Within each chapter common observable phenomena
are described. There are descriptions of the kinds of neurodevelopmental
dysfunctions that may underlie these phenomena. Suggestions are
made for the home and school management of the observable phenomena.
These suggestions are not intended to be "recipes" nor
are they presuming to represent "the whole cure" for
a child. Instead, they comprise a sampling of kinds of management
techniques that are likely to be helpful. It is expected that
parents and teachers will augment and customize the list as they
provide educational care to a child.
In Chapters 2 - 7, there are sections
on "demystification" which is a process through which
adults talk to children about the nature of their learning disorders
and strengths. Suggested approaches to demystification relate
to each of the areas covered in the book. More general guidelines
on demystification are presented in Chapter 8.
Chapter 8 consists of an overview of the
processes of assessment and management. Included is a presentation
of the forms of evaluation needed by children with learning disorders.
There is also a broad overview of the systems and strategies that
can be used for their management.
Finally, Chapter 9 offers an examination
of the implications of educational care. There is some discussion
of the policy implications for schools, for communities, and for
our broad conceptualization of childhood and the needs of developing
children.
It is hoped that this book will influence
the way in which adults think about struggling children. These
pages will have fulfilled their mission if and when conscientious
parents, teachers, school administrators, and policy makers can
come to perceive education as primarily a form of care - and a
way of caring.
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