Reviewing Childhood Lessons – Memory and Rewards

Some Background

In third grade, I failed penmanship and arithmetic. Apparently the teacher told my mother that I had passed third grade by the skin of my teeth. Looking over my report cards reveals comments such as, “If Margaret would try she would get better grades.” In seventh grade at the DOD school in Madrid, Spain I was given the choice of moving to class D and get a “C” on my report card or stay in class C and get a “D”. Given my father’s value of high grades, I chose Class D. All of this was before 1975 when Special Education became a legislated part of the public school system. Since my perceptions of these memories indicate that I was trying, I likely would receive special education services if I were in school today.

At church, during high school I was encouraged to memorize Scriptures to improve academics. So, I began to memorize long passages of Scripture, reciting them at church and at church camps. Also, during high school, my dad offered me $1.00 per “A” I earned on my report card. By the time I was a senior, I was on the High Honor Roll with all “A’s”. My first year of college was a challenge, getting a “D” at mid-term in Psychology. However, by my senior year, I was again able to get all “A’s”. I believe I was still probably working harder for those “A’s” than other students, but I was achieving better grades. Decades later, I want to review these lessons in light of what I have learned about how we learn.

Lesson # 1: Memorizing Scriptures Develops Cognitive Skills

Yes, the old adage, “use it or lose it” applies here. When you exercise your brain it develops. Scientific Learning’s motto, “Fit Brains Work Better” reveals how this principle works.
According to the neurodevelopmental approach, “Duration, Frequency, and Intensity” present three important ideas. Short, frequent, focused review of whatever is to be learned, locks into one’s brain. Today, I tell my students to put spelling words, vocabulary words, math facts or formulas, memory verses on cards. If they go through these cards between subjects, several times a day, they will learn it. Some may need to review longer to get the desired results, but they will learn. Do all of my students follow my advice? No, I am afraid that it is a hard sell, but I am not going to quit telling them to do it. While this works with anything, when one memorizes Scripture you get an added benefit: Psalm 119:11 Thy word have I hid in mine heart, that I might not sin against thee.

 

Lesson # 2 – External Rewards Encourage Learning

As a teacher, I would always prefer that students have internal motivation to learn – “for the love of learning.” It would be great for students to be diligent in their studies in order to please God. We can continue to pray and trust God for this. It happens sometimes, but often external rewards are necessary. It may be something as simple as, “Great job!” or a high five or a sticker on a chart. Twenty-first century students would normally not be motivated by $1.00 per “A” on a report card as I was in the 60s. While a monetary reward may not be the best, it certainly works on the job for adults.

After reviewing these childhood lessons, I see that I need to remember to apply these in my life even today as I continue to learn.

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A Book Review: The World in Six Songs – How the Musical Brain Created Human Nature by Daniel J. Levitin

Dr. Daniel J. Levitin is uniquely suited to address the topic of the musical brain. His first career, record producer and professional musician, led into his becoming a research scientist. Levitin runs the Laboratory for Music Perception, Cognition, and Expertise at McGill University. Besides this book, he also has authored, This is Your Brain on Music. He classifies music into six songs: Friendship, Joy, Comfort, Knowledge, Religion and Love. Going through each of these types of songs, Levitin explains how the brain works. I found that part interesting, however, I easily tried of his couching all of this within the frame work of evolutionary fiction. If you have read other reviews I have written, you know that I learn much from individuals even though their presuppositions are evolutionary.

Levitin illustrates each of his categories with the lyrics of different songs. First, Friendship, introduces us to the first kind of song. He explains how the rhythm of songs like “Smokin’ in the boys’ room” binds a group together. Further, he tells us of a small group of hunter-gatherers in the Brazilian Amazon, the Mekranoti. These people sing for hours a day, sometimes to warn of an attack by a rival tribe. Rowing crews and other work teams have used rhythmic songs to coordinate their task. Our emotions represent neurochemical reactions in our brains.

Second, Joy represents Levitin’s second category of songs. Dr. Levitin and Rodney Crowell of the band, The Police exchanged ideas about how music began. Crowell believes that the first song was a caveman’s versions of “You Are My Sunshine.” Other “joy” songs include: “God Bless America,” Zip-A-Dee-Doo-Dah” and “Log Blues.” Our brain encourages us by providing rewards and punishments using certain neurotransmitters. Rewards include neurotransmitters like serotonin,  and norepinephrine. Punishments include cortisol, activated by stress. Music of different kinds activates these neurotransmitters.

Third, Comfort follows. When the author dropped out of college to join a rock band, he was looking for comfort. Six songs inspired him to become a musician: “Autobahn,” Beethoven’s Sixth Symphony, “Revolver,” “Through My Sails,” “The Great Gig in the Sky,” and “Night and Day.” His father gave him the book, The X Factor which explains how people become experts in their own fields. George Plimpton the author of The X Factor believes that people who eventually are successful have had more failures than those who are unsuccessful.

Fourth, Knowledge. Levitin continues by explaining that he did not earn his B.A. until he was well into his thirties. Examples of this kind includes: “The A-B-C Song,“ “Patty Cake,” and jumping rope songs (“Down by the river..” and “Cinderella, dressed in yella…”). Levitan includes many other examples. From a neurodevelopmental viewpoint, we recognize that content is learned well with music, however, the problem is that music is also needed to recall that information because it is stored in the subdominant, rather than dominant hemisphere of the brain. Retrieval requires the use of the subdominant.

Fifth, Religion, reflects another unique feature of mankind. Different religions have their own songs. Levitin mentions Chinese music for the Chinese New Year, Jewish music for their celebrations and Christian songs like, Oh Happy Day” celebrating the day Jesus “washed away my sin.” Dr. Levitin believes that all religious ceremonies almost always include at least one of these ritualistic behavior: repetitive motor actions, bowing seven times, making the sign of the cross, folding and unfolding your hands in a certain way. As a believer in Christ, I belong to a church that practices the “regulative principle of worship” meaning that God has prescribed how we are to worship Him. What we include in our worship should be what the Bible teaches is to be part of worship. Most Christian churches practice the “normative principle of worship” which believes that if God has not prohibited a practice, it is appropriate. It behooves those who follow the “regulative principle” to frequently evaluate how we worship which I would think would eliminate or greatly reduce many or all of those features that Levitin cites.

Finally, in the sixth place, Love, Levitin illustrates this category of song with Elvis’s “Love Me Tender” and “Let me Be Your Teddy Bear,” plus “Our Love Is Here to Stay,” and “Sugar, Sugar.” Our author states, “The brain learns music and language because it is configured to acquire rules about how musical and linguistic elements are combined; its computational circuits (in the prefrontal cortex) ‘know’ rules about hierarchical organization and are primed to receive musical and linguistic input during the early years of development.”p.239

Like many of the books I have reviewed, much valuable information appeared in this one as well. However, I had to wade through much more that does not fit my worldview regarding the origin of God’s creation, specifically His special creation, man.

Brain Rules by Dr. John Medina Brain Rule #4 Attention – We don’t pay attention to boring things.

Medina begins by illustrating what he later calls an Emotionally Competent Stimulus. Any emotion on the emotional spectrum will do – joy, fear, excitement, etc. According to research, this ECS can initiate attention that lasts about ten minutes. Our ability to pay attention is related to our memory. Associating details to the general idea that we already understand and remember demonstrates how it works. Further, interest plays a key role in choosing the objects of our attention. Awareness also plays an essential part. Without an awareness of something, how could we pay attention to it?

Dr. Medina relates the work of Michael Posner from about thirty years ago. As a part of Posner’s model , four of the behavioral characteristics that Medina believes have “considerable practical potential” follow:

1)      “Emotions get our attention

2)      Meaning before details,

3)      The brain cannot multitask, and

4)      The brain needs a break.” P. 79-89

While some seem to “multitask” better than others (i.e. women better than men), according to Medina, our brains deal with information sequentially, one at a time. Those who seem to do better have a better working memory than those who have difficulty “multi-tasking.” Posner’s model explains that “multi-tasking” follows these steps: 1) Shift Alert 2) Activation of Task #1; 3) Disengagement; 4) Activation of Task # 2. All of this takes time from the initial task. In a sense our brain multi-tasks by tending to our breathing and other bodily functions, but can only attend one attention-rich task at a time. P. 86-87

As a college professor, Medina organizes his 50 minute lectures into 10 minute segments, with an emotional stimulus used as a hook to gain attention for each 10 minute segment.

This concept forms the basis for the neurodevelopmental plan to have short, frequent and intense activities. Our activities are generally designed to last no more than 10 minutes. We instruct our clients to alternate activities following an activity using one system with an activity using a different system. (visual, auditory, tactile, motor etc.) By intense, we want our clients to focus on the activity they are doing. Understanding how the brain works gives us direction as to how to teach our children and how we can learn.

Brain Rules # 2 by Dr. John Medina

Dr. Medina’s Rule: The human brain evolved, too.

Young Earth Creationist’s Rule: God created the human brain to function in a marvelous way.

Psalm 139:14 “I will praise thee; for I am fearfully and wonderfully made; marvelous are thy works; and that my soul knoweth right well.”

Dr. Medina takes what he observes today and results of scientific studies of our life time and places them within his evolutionary model. Those who want to read this information within this context should read the book. For the rest of you, here is my distillation within my creationist model.

Medina outlines for us some of the unique characteristics of mankind, God’s special creation.

1)      Our ability to use symbolic reasoning. This reasoning allows us to use symbols to represent meaning. We have language which is symbolic. Since much is written down or recorded we have learned from those who came before us.

2)      Our ability to walk upright. Our body structure allows for us to walk on two feet.

3)      Our amazing brain power. In addition to the brain stem and mid-brain we have the frontal cortex. First, the brain stem “regulates breathing, heart rate, sleeping, waking.” P. 40 Next, the mid-brain is for fighting, feeding, flee and reproductive behavior. P. 40 Finally, the frontal cortex is responsible for the “executive functions” including the ability to solve problems, maintain attention, and inhibiting responses. P. 40

Regarding the function of the individual parts of the brain and how they interact, John Medina puts it well, “How this happens is mysterious. Large neural highways run overhead these two brains (brain stem and mid-brain), combining with other roads, branching suddenly into thousands of exits, bounding off into the darkness. Neurons spark to life, then suddenly blink off, then fire again. Complex circuits of electrical information crackle in coordinated, repeated patterns, then run off into the darkness, communicating their information in unknown destinations.” P. 42

4)      Our ability to predict and understand other people’s thoughts. “Symbolic reasoning is a uniquely human talent. It may have risen from our need to understand one another’s intentions and motivations, allowing us to coordinate within a group.” P. 47

Yes, there is evidence of our adapting to different climates and circumstances in our world, but these are examples of “microevolution”, not the “macroevolution” of the Darwin varieties. Since God created man and the earth as “mature” what we see today is merely thousands (6-10) of years old rather than billions. We can marvel at the work of God in mankind.

Brain Rules by John Medina, PhD – Rule #1

Dr. Medina’s Brain Rule # 1: Exercise Boosts Brain Power.

Medina tells of the astounding physical and mental strength of 90 year old Jack LaLanne. Also, he talks about the many elderly in nursing homes who have lost much physical and mental capacity. Contrasting these, Medina showcases the famous architect, Frank Lloyd Wright who in his late 80s remained alert. Researchers wonder what factors determine how we age. He explores this issue by answering six questions:

1)    Is there one factor that predicts how well you will age? Research indicates that an active lifestyle is more likely to lead to a long active life. (p. 13)

2)    Did mental function improve with exercise? Studies indicate that while an active lifestyle does not cause a well-functioning brain, there is a definite relationship. (p. 14)

3)    Can you reverse the process in a person who is already aging mentally and physically? To some extent, yes. (p. 14-15)

4)    What’s the bad news? According to the research, aerobic exercise – 30 minutes -2-3 times a week is optimal even though the exact amount is individual. (p. 15)

5)    Can exercise treat brain disorders? Risk for depression, dementia, anxiety and Alzheimer’s reduces with exercise probably it regulates the release of three neurotransmitters (serotonin, dopamine, norepinephrine) that are associated with mental health. Some studies even show that exercise can replace antidepressant medications. (p. 15-17)

6)    Are the cognitive blessings of exercise only for the elderly? While there are fewer studies on younger populations, those that have been done indicate that active children learn better. (p. 17-18)

Medina provides a detailed explanation of the digestive system and how it provides oxygen to the brain. In short, “Physical activity is cognitive candy.” (p. 22)

Studies show that taking away recess from students reduced academic progress. Adding physical education improved academic achievement. During the school day and the work day, physical activity increases productivity. “Fit employees are capable of mobilizing their God-given IQs better than sedentary employees.” (p. 27)

More information (in video clips) and extensive, notated references are available on www.brainrules.net

Disclaimer: Dr. Medina uses the evolutionary model to explain much of his brain rules. However, what he observes and the studies he talks about can still help those of us who are not evolutionists.

The Brain That Changes Itself by Norman Doidge, M.D. – The Culturally Modified Brain –Not Only Does the Brain Shape the Culture, Culture Shapes the Brain (Appendix 1)

Since all kinds of activities change the brain, as seen by brain mapping, cultured activities are no exception. “…the brain and genetics produce culture, but culture also shapes the brain. Sometimes these changes can be dramatic.” P. 288

Doidge uses the Sea Gypsies, nomadic people who live in the tropical islands in Burma, to demonstrate the culturally modified brain. These individuals learn to swim before they learn to walk and can see underwater. They are underwater hunter-gathers. Their lifestyle causes them to develop skills differently than ours do.

Scientists have tried to discover and explain why human beings, essentially alone, have developed culture. While primates have developed a very rudimentary culture, consider man. “If we considered the number of possible neural connections, we would be dealing with hyperastronomical numbers…” (Edelman, p294) concludes, “These staggering numbers explain why the human brain can be described as the most complex known object in the universe, and why it is capable of ongoing, massive microstructural change, and capable of performing so many different mental functions and behaviors, including our cultural activities.” P.294

In 2005, Michael Merzenich commented on the vulnerable brain – how the media reorganizes it:  “the Internet is just one of those things that contemporary humans can spend millions of “practice” events at, that the average human a thousand years ago had absolutely no exposure to. Our brains are massively remodeled by this exposure – but so, too, by reading, by television
, by video games, by modern electronics, by contemporary music, by contemporary tools, etc.” (p. 306)

Media has negative and positive effects on our brains. (Refer to our past blogs on Endangered Minds by Janet M Healy, PhD located on our website: http://www.centerforneurodevelopment.com)

Appendix 2 – Plasticity and the Idea of Progress

Swiss philosopher, Jean-Jaques Rousseau (1712-1778) wrote the book Emile (On Education). In this detailed book on child development “proposed that the ‘organization of the brain’ was affected by our experience, and that we needed to ‘exercise’ our senses and mental abilities the way we exercise our muscles.” ( p 313-314) He called this progress or development our “perfectability.” Later studies validated his proposals. Going too far, some called it “indefinite perfectibility of men.” (p. 316)

Yes, man is God’s special creation and has the capacity to grow and learn. With this we will say goodbye to The Brain That Changes Itself.

The Brain That Changes Itself Norman Doidge M.D. Chapter 11 –“More Than the Sum of Her Parts – A Woman Shows Us How Radically Plastic the Brain Can Be”

In Chapter 11, Dr. Doidge introduces us to Michelle Mack, a 29 year old who was born with only the right hemisphere of her brain. At birth, her doctors were not aware of this and now that they do know, they only have theories of what happened before birth. In order for Michelle to function well, her right hemisphere had to learn the function of the left hemisphere and economize its own function. At 29 she holds down a part time job and enjoys her family. There are some outwards signs of her lack of a left hemisphere: bent, twisted right hand that can be used for some things; brace on right leg; she is a lefty and her left limbs are normal. Her right visual field is limited as she has a hard time seeing things coming from her right. Blindness on her right side has helped her develop an extremely keen sense of hearing. Thus she can experience sensory overload in her hearing and touch.

During pregnancy, Michelle’s mother had some difficulties and apparently her body was trying to miscarriage. Both mom and daughter are happy it didn’t. Michelle’s parents began to notice things that indicated developmental problems – vision, motor. They noticed that she was tracking visually so she was not totally blind. Her dad noticed that she likes music and wanted to hear certain music over and over. He had her crawl to the record player to earn listening again. This helped develop her brain and function.

Michelle explained to Dr. Doidge that she would use rhyming, nonsensical words when frustrated. Concrete thinking is much easier than abstract thinking. She can play Solitaire very quickly because the decisions are very concrete. Other, more abstract decisions are more difficult for her.

Michelle demonstrated savant abilities. She could tell what day of the week a date was within the last 18 years by memory. For those dates before that time, she would have to figure it out, but still could do it quickly and accurately. Doidge told her about the work of Alexandr Luria, a Russian neuropsychologist with a memory artist who had a photographic memory. Also, he told her about “synesthetes” whose senses were “cross-wired” so that they had a color code for days of the week. Michelle said she had a scene connected with days of week.

Dr. Jordan Grafman, the chief of the Cognitive Neurosciences section of the National Institutes of Health, National Institute of Neurological Disorders and Stroke has been working with Michelle Mack. His background includes working with a woman whose brain was damaged in an assault. After five years, other doctors had given up on increasing this woman’s function. However, Grafman began an intensive program of rehab – mind and body –and the woman’s function increased. He also served our military personnel in Viet Nam. In this case as well, he saw increase in function where none was expected. He formulated a theory integrating “nondoctrinaire localization and plasticity. His research revealed four kinds of plasticity.

1)       “Map Expansion” – neurons in the center of an area focus more on a task than the ones on the outer limit. Different areas compete for those peripheral neurons. The greater the demand the more likely the use for that area.

2)       “Sensory Reassignment” – When one sense is blocked, another area takes over the function of the blocked sense. In blindness, the senses of hearing or touch develop more and are keener.

3)       “Compensatory Masquerade” – once explained as “alternative strategies” when there is more than one way to do something.

4)       “Mirror Region Takeover” – this occurs when a part of one hemisphere fails to do its job, the mirror region on the other side takes over the function as well as it can. When the damage occurs before specialization develops, function approximates “normal” more than when it is later. P. 276 This is true for Michelle, the damage was before birth, while her brain was being formed.

Michelle’s parents are making preparations for Michelle’s care after they are gone, but she is pretty happy the way she is. Doidge again introduces a person and researchers as windows into the plasticity of the brain.

A Product Review: Releasing True Potential Elizabeth Harms B.Th, CND

            Elizabeth Harms, a neurodevelopmentalist from Canada, produced a 5 ½ hour neurodevelopmental seminar, Releasing True Potential. Introducing Elizabeth, Sylvia Funk, who has since become a certified neurodevelopmentalist herself, told of her own neurodevelopmental journey with her son. Then, a young man walked up to the front of the room and gave an excellent recitation of a funny poem. Elizabeth then began her talk by describing the early years of her son’s life. She had been told of all the things her son would never be able to do and yet, the young man who had given the recitation, obviously had more function than predicted.

            Professionals often give parents the news that their child has “autism” or “cerebral palsy” or “learning disabilities.” People inform the parents of what that child will never be able to do and that they need to adjust their expectations. Elizabeth and other neurodevelopmentalists say, “NO!” that function is a direct reflection of stimulation and opportunity. When given the appropriate and specific stimulation, the brain responds by development and function.

            Harms explained the ways we receive information (sensory input – the five senses, proprioception, vestibular) and the kinds of things we should do about it when there are missing pieces. What the missing pieces are or what the underlying problem is, determines what kind of stimulation must be provided. This is what the neurodevelopmentalist evaluates to design an individualized plan for each client.

            Some areas of the visual system that must be evaluated and difficulties addressed include: acuity, convergence, central detail vision. Auditory system areas to consider include: chronic ear infection / fluid, hyper or hypo sensitive hearing, distractible, audiogram and tympanogram results. While these are the two primary channels of input, the others, tactility, taste, smell, vestibular system and proprioception can greatly impact the ability to learn.

            Auditory processing and visual processing comprise an important part of learning. Elizabeth explained how to test and train these important skills and how they affect learning. She explained the skills of conceptualization and visualization and how they fit in the whole picture of learning. Finally, she dealt with the importance of hemispheric dominance. In the dominant hemisphere resides the cognitive skills, thinking and logic and in the subdominant hemisphere rests the creativity, music and emotion. Neurological organization and optimal function depends on having a dominant hemisphere.

            Key concepts in the neurodevelopmental approach are intensity (sustained focus), frequency (how often) and duration (how long). Releasing True Potential occurs by stimulating the brain in specific ways. Watching these DVDs provide an excellent introduction to the neurodevelopmental approach and are well worth your time.

 

Releasing True Potential is available from: http://www.centerforneurodevelopment.com

 

The Brain That Changes Itself: by Norman Doidge, M.D. Chapter 10 –Rejuvenation

In this chapter, Doidge introduces us to ninety year old Dr. Stanley Karansky. After retiring at 70 years old, Karansky retrained himself to be a family doctor. He worked in a small clinic for 10 years. More recently he completed the brain exercises that Merzenich’s team developed at Posit Science. These exercises improved his driving alertness during daytime and nighttime. At the time of the writing of this chapter, Karansky was still an active ninety year old whose parents died in their 40s. Karanasky illustrates how neuroplasticity reaches in to the latter years of life.

While Ramon y Cajal tried to find the truth of neuroplasticity for older folks, he failed. His work in the early part of the 20th century helped form the foundation for this discovery. His conclusion in his masterpiece of 1913, Degeneration and Regeneration of the Nervous System was, “In adult (brain) centers the nerve paths are something fixed, ended, immutable. Everything may die, nothing may be regenerated. It is for the science of the future to change, if possible, this harsh decree.” ( p.249)

Beginning in 1965, the work of Joseph Altman and Gopal D. Das of MIT demonstrated that rat brains produced new neurons. At that time, this study did not go with the current conventional wisdom so the results were discounted. Later in the 1980s, Fernando Nottebohm, a bird specialist, examined the brains of birds and came to the same conclusion. Then, Elizabeth Gould of Prince University set out to discover that the same is true in human brains. Eriksson followed with additional proof of regeneration of neurons in human brains.

Frederick “Rusty” Gage and Gerd Kempermann of Salk Laboratories in La Jolla, California determined to find out if neurogenesis strengthens mental capacity by studying mice. Gage’s theory was that “novel environments may trigger neurogenesis.” (p. 252) This theory is consistent with the work of Michael Merzenich.

In addition to this momentous discovery, it is also know that the brain’s “pruning back” when cells die can also improve function. Research also demonstrates that lateralization diminishes during those older years.

Dr. Karansky is doing things that are important to fight off age-related memory loss and physical function by exercising the brain and body. To summarize this Doidge ends the chapter in this way: “when Pablo Casals, the cellist, was ninety-one years old, he was approached by a student who asked, ‘Master, why do you continue to practice?’ Casals replied, “Because I am making progress.’”(p. 257)

What are you doing to maintain body and brain function?

A Book Review: When the Brain Can’t Hear – Unraveling the Mystery of Auditory Processing Disorder by Teri James Bellis, Ph.D

Bellis begins the book by introducing her readers to “The Many Faces of APD” to illustrate that it looks different in people of all different ages. In this first chapter she does an excellent job of demonstrating the complexity of the disorder identified as Auditory Processing Disorder. As often is the case some remain unconvinced of its existence so Dr. Bellis addresses those concerns.

From there Bellis discusses how auditory processing relates to spelling, reading, receptive language, speech production, problem solving and socialization. Truly auditory processing affects so very much in how we relate in life and in learning. Each of these complex processes requires many sub-skills. For example, problem solving requires that one can read the problem or understand it orally, have all the essential information, understand all of the words and concepts, remember them, identify which operation to use, know the sequence of steps and perform the computation accurately.

APD can occur anytime in life, but occurring early in life greatly impacts learning as this is the time when we receive so much new information. Some of the many possible factors of APD include early neonatal intensive care, syndromes, hearing loss in family, abnormality in head, maternal infections during pregnancy, jaundice, neurological disorders, chronic ear infections and delays in hearing, speech, language or development.

Bellis goes into detail listing normal development throughout the ages and red flags when there are delays. If a young child behaves as if he cannot hear or becomes confused, APD (as well as ADHD) should be considered. Delays in developing language including articulation, syntax, semantics and pragmatics also raise flags. Individuals with APD can lose the thread of thought or tune out. When multisensory cues appear to confuse or overload an individual, there may exist a lack in interhemispheric (between the two sides of the brain) communication.

Middle and high school students with APD may have increased difficulty because of new demands of changing classes, multiple teaching rooms, more information given in lectures, puberty and peer pressure. Later, college students may have increasing difficulties due to large lecture classes and more freedom / less structure. Adults may first experience these same difficulties later in life. Men tend to experience it earlier (late 30s and early 40s) than women (post-menopausal years). Trauma to the head can occur at any time in life causing these difficulties.

Then, after the author takes the reader through the long, laborious process of

diagnosing APD she goes into the treatment of APD. Treating APD, at this time, according to Bellis is a three way process:

1) Environmental modifications.

2) Direct Therapy – training skills.

3) Compensatory strategies.

As I read this book, I recognized my clients in some of her descriptions and I tried to reconcile the

two approaches. I applaud Dr. Bellis for her work in this field with her great perceptive skills. As I thought, this is what I imagined: The phone rings and a parent describes the difficulties her child experiences. If one of Dr. Bellis’ trained staff answers the phone, the parent will get a description of the process of finding a diagnosis and treatment plan. If on the other hand the phone is answered by an individual trained in the neurodevelopmental approach, the parent will get a description of the evaluation process and the resulting individualized neurodevelopmental plan. In the first instance, a diagnosis will be the first step. In the second there will be no diagnosis, but a discovery of missing pieces of development which point to areas of the brain that need to be stimulated in order to encourage development and removal of the targeted behavior. While the parent has many questions, essentially, she wants to know one thing – “Can you help my child?” Personally, I would to see mostly direct therapy given by parents with instruction and support by the neurodevelopmental team and very little environmental modification and compensatory strategies. Certainly, the parent should understand the process and determine which approach best fits the needs of her child.