A FAT City Moment: Auditory Processing and Wait Time

Many of us know smart kids who believe that they are stupid. Dumb. Losers.
Some of them are the kind of kids that you just know have more than two brain cells to rub together, but the grades, the schoolwork, and the homework just doesn't reflect what we know is there. For those who have always done well in school, it is hard to imagine what might be going on with these kids, and they get 'teacher's lounge' diagnoses.

You know what they are: lazy, oppositional, a problem child, gorked, and, of course, BAD PARENTING.

It's hard to look at perfectly normal looking kid who is not succeeding and imagine that the problem may be organic rather than moral. It's harder for someone to put themselves in the shoes of such a 'normal' child than it would be for, say someone in a wheelchair. You know, somebody who looks the part, so to speak, when it comes to having a disability.
And sometimes, it's even difficult for us--the parents--who know full well what the problems are to walk a mile in our LD or AS or AD/HD kiddo's shoes.

I had one of those experiences today.
I do not normally think of myself as having a learning disability. After all, I am an academic, I learn fast and do well on tests. But I do have problems with word finding and auditory processing. It is not usually a problem--if I have time to think.

Today it was a problem.
I had a mouse brain anatomy test.
For tests on our human brains, we would go into the lab,and using real brains that we had dissected, we have gone from station to station and looked at where the pin was located in a brain, and named the structure. No problem. If I was stuck, I just went back to the station later. We could spend some time looking at the structure and thinking about it, and if I was having word finding problems, I could think until the word came to me.

Today, the test was different. We never dissected a mouse brain. We used pictures of sections to study. We were not given the names of the structures on the pictures, we had to go on the internet and find the list of structures. But I think I could have compensated for that. What killed my A in the class was the format of the test.

We gathered in the classroom. We were handed a sheet with numbers and blanks. A slide was flashed up on the whiteboard and the professor used a laser pointer to point to the structure in question. She's say something like: "What is this tract here?" Then, after about 15 seconds, it was on to the next slide.

Since I am slow at handwriting, I often could not even write down the whole name of the structure before we went on to the next one.
And when I could not immediately retrieve the word, I was, as we used to say, SOL.
I knew that structure she was pointing to, and that one, too! But the words were not coming fast enough to me. Soon I was getting the lines that I had skipped mixed up, and then I couldn't hear anything at all.
Then she had us exchange papers to grade them.
Boy, did I feel stupid.

Now fortunately, at my age, I understand that one grade in one class is not the most important thing in the universe. In fact, it is not even that important in my life, one of several billion human lives on a small planet a third of the way out in the arm of a rather commonplace galaxy.
And I have a lot of evidence that I am, despite my performance today, a reasonably intelligent person.

But imagine having such experiences day after day.
Imagine having them and being told that grades are the most important thing your life right now. Imagine being told that your scores on high-stakes tests show that you are stupid.
I can imagine beginning to believe that the ubiquitous "they" who says all of these things are right. I can imagine that such kids would easily come to believe every teacher's lounge label that is put on them.

Every now and then, we all need to have experiences to remind us of what some kids go through every day of their school lives.
Smart kids. But they are kids who, with whatever other IDEA label they might carry, have problems with auditory processing and working memory.

For these kids, a couple of very easy interventions would make a world of difference. One is to structure tests so that the auditory working memory component does not mask their knowledge. In other words, avoid oral tests.
The other is really simple and yet universally ignored.

Wait time. If you ask a question or do a quick verbal check to see if students "got it" during a lesson, wait a long time--at least a minute, and sometimes more depending on the complexity of the problem, and do not let anyone answer in that time.

I knew that the first structure was the nucleus accumbens, and in a less stressful, less auditorily focused situation--one in which the wait time was long enough, I would have gotten it. I just needed time.
But as the test went on and I became more and more stressed, I began to get more and more questions wrong. I could retrieve fewer and fewer words.
What was being tested was not my knowledge of mouse brain anatomy.
What was being tested was whether or not I have a learning disabiltiy.

For me, it is not a big deal. I have plenty of academic success to buffer the blow. I am at a point where I can shrug my shoulders and move on, because I know that I know the mouse brain anatomy.

But for a child who experiences these failures over and over again, and who is told that grades will determine his whole future, this experience can be devastating.

It is important for me to walk a mile in the LD shoes now and then.
In fact, it is important for all teachers to do so.
This is why going to a FAT City workshop can be helpful. Richard LaVoie, the one who facilitates them, simulates what it is like to have a learning disability. He is so good that he actually gets grown men and women to throw papers and books on the floor and have temper tantrums. And then they get it.

They say: "This is what my students are going through."

My FAT City moment today reminded me of why I took N. out of school altogether.
And it reminded me that I, too, need to continue to walk a mile in his shoes. Because I get impatient with his auditory processing probems sometimes, too.
Sometimes I cannot help but compare him to the other kids I read about on the homeschool blogs.

And today I got a healthy reminder that he knows a lot. But he shows me what he knows differently.
The point is that he knows it, not how he shows it.

NOTE: I edited this blog because I spelled FAT City as FATT City. So much for my spelling ability! Richard LaVoie's video about his FAT City workshops is entitled: F.A.T. City: How Hard Can This Be? F.A.T. stands for 'frustration, anxiety, and tension.' I just wanted to add 'tired' to the mix.

Animal Tracks

Nearly Wordless Wednesday

This rodent was out in the sunrise, checking out the results of the snowstorm.





















This rabbit was out before the dawn, and came across our driveway.
















This rabbit had a bad morning, but the Coyote got some breakfast.

The deer were out before the morning light, too!

Three deer had crossed the trail, but I could only get the tracks of one in my camera lens. The group of three has been around since summer. These appear to be the tracks of the yearling.







All the pictures were taken with my Sony Cybershot, Zeiss 15X zoom lens, at various zoom magnifications, on Saturday morning, November 24.

It's Not Another Shot in the Ritalin Wars

A few weeks ago a neuroimaging study was published in the Proceedings of the National Academy of Sciences. Normally, many such studies are published in various journals in science and medicine without a whole lot of fanfare. But this one had a magic phrase in the title. The phrase was one that gets ideologues everywhere very excited. The title of the study is:

Attention deficit/hyperactivity disorder is characterized by a delay in cortical maturation

The magic phrase? Attention Deficit/Hyperactivity Disorder.
In the weeks since the study was published, the press and blog worlds have been having a great deal of fun making the conclusions into another shot in the ideological "Ritalin Wars."
Some writers have claimed that AD/HD does not exist. Others have used it to claim that AD/HD is an artifact of poor diet, bad parenting, and/or curriculum reform in the public schools. Some have actually come to the conclusion that the title might suggest, that AD/HD is definitively a form of developmental delay. As we shall see, though, despite the way you might read the title, that is not the conclusion of the study.

Being a scientist myself, I decided that I would not weigh in on the conclusions until I had the chance to actually read the study. Today, as I procrastinate on a research paper I am writing, seemed like the ideal time to do so. So I went to the NY Times article from a few weeks ago and got the journal title for the article, as well as the name of the first author. Then I connected to my university library system -the joys of technology are without number!--and in five minutes I had used the e-journal finder to navigate to Highwire Press and download a pdf file copy of the study.

You can try this at home, but you may have to pay a fee to download the study. Most journals are made available to students and researchers via institutional subscriptions to publishers and databases. The article was published earlier this month in the PNAS. It is in the current issue.
The citation is:
Shaw, P. et. al. (2007). Attention deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Sciences, 104 (49) 19649 - 19654.

It is a very good study. The methodology was good, the number of subjects was impressive--446 human subjects--and the conclusions made matched the data that was published. This study overall is an excellent advance in tracking brain anatomy differences between subjects that carry the diagnosis of AD/HD and those that do not.

In the abstract the researchers say:
There is controversy over the nature of the disturbance in brain development that underpins attention-deficit/hyperactivity disorder (ADHD). In particular, it is unclear whether the disorder results from a delay in brain maturation or whether it represents a complete deviation from the template of typical development.
They are telling us the purpose of the study: to get evidence that might solve the controversy in the field. But pay attention to the wording. The controversy is not whether or not the disorder results from a delay in brain maturation, but whether or not it "represents a complete deviation from the template of typical development." The question they is whether or not AD/HD can result partly from a delay in brain maturation.

The authors repeat this in different words in the introductory paragraph:
Since its earliest descriptions, there has been debate as to whether the disorder is a consequence partly of delay in brain maturation or as a complete deviation from the template of typical development.

As I have said above, the data from their work does support their hypothesis that AD/HD is "a consequence partly of delay in brain maturation." That means they have done a good study. But one study does not an etiology make. It is important for the non-scientist to get it that one does not prove or disprove a hypothesis from one study, even one so well constructed as this one. Good scientists know this, and in the discussion section of any well-written scientific report, they will report caveats and weaknesses and any possible confounding variables. This is so that, when future studies are done, they (or others) can try to fill in the gaps for the study. That's usually done by fiddling with the methodology.

This study was a well-written study by good scientists and they do point out weaknesses that might be fixed in future work. In the very beginning they point out that many studies using physiological data (this study uses anatomical data)--that is how the brain is actually working--support their hypothesis, but there are also many other studies that find "a quantitatively distinct neurophysiology, with unique architecture of the (EEG) and some highly anomylous findings in functional imaging studies, more in keeping with ADHD as a deviation from typical development." This is interesting. When I first heard of the study and heard that it was done using anatomical imaging, I wondered about what functional imaging would show. If I want, I can check it out.

Geek Alert! A question I now have is this: fMRI studies require the use of fluorescent dyes or other ways of getting the signal above ground. These are not usually done on children (for obvious reasons). So I wonder if these confounding studies are targeting an adult population with ADHD? If so, it could be that we are dealing with two very different populations. After all, adults with ADHD would be the children who did not grow out of it.

Another issue: The study was done using anatomical imaging and not functional imaging. The researchers used very good techniques to get at the maturational rate of various parts of the brain, but ultimately they were still measuing gray matter (neuron cell bodies) cortical thickness. Two questions: Are there differences between the two populations in the percentage of gray matter v. white matter (glia and myelenation)? And what about physiological differences? Do the brains work differently? I saw an fMRI study just this morning that showed differences in activation in the pre-frontal cortex (Brodman 9) for adults with ADHD (little to no activation) and typical adults.

In other words, anatomy is not the whole story here.
And to be fair, it was not the authors who claimed that it was.
That would be the press and pundits and ideologues. In other words, those who either did not bother to read the study carefully or those who have an axe to grind when it comes to issues about AD/HD.

So what did we find out from this study? We found out that part of the difference between kids with a diagnosis of ADHD and those without, is in the rate of brain maturation. Kids with AD/HD diagnoses (it was a mixed group of kids with primarily hyperactive, primarily inattentive and combined types) have brains in which the cortices mature more slowly, delayed by approximately 3 years, with a very significant p value. And we found out that in these kids, the brain development trajectory was the same for kids with and without ADHD.

But the researchers also analyzed the data for specific brain areas. And these tests showed that the trajectory of the brain development for all cortical areas was not identical. The kids with ADHD tended to have faster motor area maturation than those without. And they had slower executive function (frontal lobes!) maturation.
What does James Webb say of gifted kids? Farrari motor and dune buggy driver! It looks like the same developmental pattern is true for kids with ADHD.

This is very useful information. It is particularly useful for people who treat kids with ADHD as well as for people who teach them. It is very helpful in planning interventions to help these kids learn academically and function socially to know that their executive function maturity may be more than three years behind the average kid. As a teacher, as a researcher, and as a parent, I find this information to be extremely helpful and very interesting.

But it is not another shot in the Ritalin wars.

The authors did not say that ADHD does not exist. In fact, in their first paragraph, they define it as a neurological disorder. They describe the delayed maturation of the cortices of the brain as a "characterizing" ADHD. It is, then, a characteristic that could be used to differentiate people who have ADHD and people with other psychiatric diagnoses.

They did not say that children with ADHD should not be treated with stimulants like Ritalin. In fact, one possible confounding variable they mention is that 80% of the clinical population in the study (clinical = those with ADHD diagnoses) were being treated with stimulant medication. They do say that stimulant medication can be an effective short-acting treatment.

Finally, by calling the maturational delay a characteristic, the authors imply that there is another, more ultimate cause. They discuss this further in the last part of the discussion. The differences cannot be attibuted to intelligence or sociocultural factors because these were controlled in the design of the study. There is definite evidence that the differences are partly due to genetics because brain growth and development is controlled by molecules called neurotrophins and "polymorphisms within the brain-derived neurotrophic factor and
nerve growth-factor 3 genes have already been tentatively linked with ADHD."
A polymorphism is a difference in DNA base sequences from one individual to another.

A claim that genetics is involved in causing a neurological disorder does not mean that environment does not play a role. It is likely that something as complicated as differences in brain development is controlled by quite a few genes, that is, it is polygenic. It is also likely that some of those genes effect a number of different systems, that is, they are pleiotrophic. And of course, environment does affect gene expression--that is what proteins the genes make and when they are activated.

So that's it, folks. It is a very good study. It was done well, and as in most well-done scientific studies, it raises more questions for future work.

And the findings do not provide fuel for the ideologues among us.

It's That Time Again...

It's come down to the last two weeks of the semester for me and for MLC.

She had a paper due today and one due Wednesday.

I have a paper due on Thursday. It's the one about the neurogenic hypothesis for depression. It was interesting. It was exciting. Until about 1 PM today, when I realized that I still have about 5 pages to write and I am absolutely sick of the subject! I will be glad--glad!--when I hear that the hypothesis isn't so hot after all!

I have reached that point where I find myself dreaming about French Polynesia in the middle of a sentence about how SSRI's up regulate adult neurogenesis in the granular layer of the hippocampus. Soon I will be asking myself the existential questions:

Where do we come from?

What are we?

Where are we going?

And I know that I will truly have had enough when begin I answer them in neuroscientific jargon (with apologies to Paul Gauguin):

Where do we come from? Our memory for location appears to be formed in the posterior portions of the hippocampus.

What are we? Neurons that fire together wire together.

Where are we going? A genetic predisposition for depression can be triggered by environmental influences such as stress.

But my questions will continue with the one that plagues all graduate students as the final weeks of the semester loom large before them:

What was I thinking, anyway?

But no, I refuse to even try to answer that one!

French Polynesia is looking better and better. Sun. Sand. Palm trees...

...and no environmental stress.

I wonder if I have enough frequent flyer miles?

Hmmm. I'll check that out, as soon as I finish discussing the problems with the neurogenic hypothesis.

After the Snow, A Winter Wonderland

This morning the dawn broke over a sparkling winter wonderland created by the combination of snow and freezing fog from the Thanksgiving snowstorm.

At dawn the temperature was 15.6 degrees F.








The storm was lifting up it's skirts and heading to the northeast, leaving the Sandias coated with a delicate white frosting.

We knew it would soon be gone, so we got bundled up to take the dogs for a Shabbat walk.

We had planned only a short walk because it was cold, but even thought the temperature was in the teens there was no wind and the sun was intense and warm on our faces as we headed up the new road into the high meadow.

As the clouds retreated, the sky took on that intense blue of winter in snow at high altitudes.

Despite the cold, the dogs were frisky and happy to be outside after the storm.

The animals had already been out and about their business like shoppers venturing out to fill the larder after a big snow.

Here, in the woods, we found rabbit tracks venturing out of the brush and into a small glade.

We also saw coyote tracks, deer tracks, and the tracks of field mice. At one place in the meadow we saw the tracks of a coyote overcome those of a field mouse. The field mouse had become the coyote's breakfast tidbit.









The grasses and trees were coated with horfrost from the freezing fog, with snow frosting lightly over the frost.
As the sun rose up over the mountain, the whole meadow and woods became blue, white, and gold with diamond points of light so intense that we could not look directly at them.











The houses of Rancho Verde Road look like pueblos agains the shadows and snow of South Mountain.

Winter is still new and wonderous now and this snow will not last. As I write, it is dripping and sliding off the metal roof, melting away in the solar heat of midday.


But the ground will be colder and frozen and the next time it snows, all of it will remain as more falls.

We are thankful this Thanksgiving weekend for the snow which brought much needed moisture to our mountains. And we are ever mindful of the beauty of our mountains that unfolds differently with the coming of each new evening and every new morning.

White Friday

For some people, today is black Friday--the day of shopping madness that begins the Madison Avenue version of the Christmas season.

For us, it's white Friday.


It actually started last night.

We had finished our Albuquerque Turkey with all the trimmings, and had eaten pumpkin pie with "real whipped cream," as N. calls it. You know, the kind you whip up with a mixer.
We had had our after-dinner cup of tea, washed the dishes and put the crystal away.

N. kept going to the window to see if had started yet.


We settled into our living room--usable once again, now that the floor is done--when we heard the sleet against the skylights.

Doesn't the living room look nice? We got the rug on sale at the hardware store. N. helped pick it out. I wanted a softer, more expensive one, but as N. pointed out: "Mom, we have two dogs, two cats and me!" So I bought a can of spray-on scotch guard and the more practical, inexpensive rug.

But I digress! As I was saying,
the long-predicted storm had finally come!
But we were snuggled on the couches--me and N. on one, the dogs on the other, and Bruce in his recliner, to watch It's a Wonderful Life, as is our custom every Thanksgiving after dinner. I did snap a picture of two when we took the dogs out of the first snow with accumulation of the season. As we walked the dogs in the falling snow last night, Bruce and N. gave us a rousing chorus of Over the River and Through the Woods. We are easily pleased!

This morning we woke up to a nice, snowy White Friday. We had about an inch of snow on the ground at 7 AM, when MLC called from Dallas. Bruce was actually thinking of driving into to town because the "Chinese store" had a six hour sale on various tools. But the snowplow did not come, and I am opposed to shopping on this day anyway, so we took a good walk with the dogs instead.

I love it when Mother Nature conspires to help me remain steadfast in my resolve not to go shopping the day after Thanksgiving!

It has been snowing off and on all day, with bouts of lowering clouds and freezing fog. The temperature in Tijeras is 30 degrees, with wind, and here in Sedillo it is 27. A good day to refrain from driving.

It is a wonderful day to enjoy the beauty of our mountains, rejoice in the first measurable precipitation since October 19th, and stay home and snuggle.

We had laid up a good supply of hot chocolate, spiced cider, and of course we have leftovers from our Thanksgiving Dinner.

I am enjoying White Friday more than I would have enjoyed Black Friday.

It is a nice way to have downtime before the frenzy that marks the end of the university semester begins! And Hannukah comes early this year, too!

The Albuquerque Turkey

In honor of our yearly pilgrimage to the shrine of the bird, we bring you the famous Albuquerque Turkey song.

Sung to the tune of "Oh, My Darling Clementine--sort of.

Albuquerque had a turkey,

it was feathered, it was fine.

And it wobbled as it gobbled,

and it's absolutely mine.

It's the best pet you can get yet,

better than a dog or cat!

It's my Albuquerque Turkey

and I'm awefully proud of that!

Now my Albuquerque Turkey is

sleeping snuggled in his bed,

And for our Thanksgiving dinner

we'll have egg foo-yung instead.

But seriously, folks, our Albuquerque Turkey is browning nicely in the oven.

After a nice walk in the woods, we are just getting ready to get the trimmings heated up so we can sit down for our Thanksgiving dinner.

Here's a wish that you are having a wonderful day with family and friends near and far!