Surviving Your Child’s Academic Struggles: The Value of a Neuropsychological Perspective

One of the most painful and anxiety inducing experiences parents have to endure is when their child is not making it at school. The realization that something is wrong may come about as a result of a call from the teacher or after attempting unsuccessfully to help a child with homework or understanding a concept taught that day at school.

What are parents to do?

First, it is essential to try to contain the worry that is induced by this discovery and even more important to fight the urge to be critical of your student that may result from your well-meaning, but ineffective attempt to help.

Second, it is important to avoid taking steps (i.e. immediately running out and hiring a tutor) without first having some understanding of the specific nature of your child’s problem and what kind of person or professional is the right one to address it. Many tutors are former or current teachers and while they may be competent at teaching a class, they may not have the skills to understand and address your child’s problems. Keep in mind that there is a difference between tutoring to achieve task completion (i.e. homework) and tutoring that addresses the root problem of your child’s difficulties.

What do parents, tutors, and teachers need to know?

-Academic subjects are really just names of groups of abilities that are needed to perform successfully in that subject area. For example, students with reading fluency problems may be experiencing difficulties with auditory/phonological processing, orthographic/visual  processing, long term memory, processing speed, or a combination of the above. WITHOUT KNOWING WHICH UNDERLYING ABILITIES ARE AT FAULT, INTERVENTIONS MAY BE PRESCRIBED THAT DO NOT TARGET THE DEFICITS, PROLONGING THE PAIN AND SUFFERING RESULTING FROM A LACK OF MASTERY OF THE CURRICULUM.

Identifying the root causes of a learning difficulty is best accomplished by a comprehensive neuropsychological evaluation. A competent assessment will scientifically go through the steps involved in diagnosing the presence of ability deficits and construct a tailor made intervention plan to address the problems. This includes helping tutors, teachers, and parents with specific ways to individualize instruction to maximize success.

-Identifying the root causes includes not only an analysis of your child’s ability strengths and weaknesses, but also their executive functions. Executive functions are brain processes that direct the brain to engage your child’s abilities in order to meet task demands. For example, children who procrastinate may have a very high threshold of stimulation needed to activate them.

The key here is: understand before doing. It will save time, money, and psychological pain for you and your child.

To learn more about obtaining a neuropsychological understanding of your child’s problem, click here


The Impotence Impasse: Surviving Unmotivated and Disaffected Children

One of the most difficult challenges for parents, teachers, and therapists is dealing with the unresponsiveness if unmotivated or disaffected children. Impasses develop because there is an absence of connectedness between the adults and children.  Despite our best efforts, everything we know or have learned does not effect change. In fact, being stuck often leaves us with a feeling of helplessness, hopelessness, and ineffectiveness.

What is worse is that this impasse deadens us, and it is very difficult to be spontaneously creative or think out of the box. Instead, we experience a feeling of dread when we think of our next encounter with the child or situation that is stumping us, and engage in a kind of predictable “dance” where we repeat the same logical, reasonable strategies that have failed only to feel even more defeated when they fail once again.

Here is what we need to understand about impasses and how to break them:

  • Impasses are bilateral. That is, each party is contributing to the stalemate.
  • Impasses develop as a result of deterioration in the state of the relationship we have with the other party. This worsening of relationships comes from or starts with a withdrawal of emotion or connection.
  • Fixing the connection requires that we find ways to rekindle the good feelings we have had in the past.
  • Paradoxically, the beginning of the solution to the impotence impasse is the willingness to acknowledge our feeling of powerlessness. It is only then that we can unlock its’ inherent power and utilize it as a strategic tool to lift ourselves out of the morass in which we find ourselves.

How does this work? Children who are unhappy, angry, or frustrated with the adults in their lives or with school will tend to induce in adults the very same feelings they are experiencing. They typically do this by being unresponsive (i.e. not answering when contacted, saying “I don’t know” or “I don’t care”) which usually leaves adults with feelings of powerlessness resulting from the disbelief, fear, and rage that may result.

As difficult as this may be, the first thing adults must do to break the impasse is to tolerate the induced feelings and join with the child in their feeling. It is important to remember that this does not mean sanctioning their behavior or accepting it. It simply means that you must start where the child is if you wish to promote a change. For example, an oppositional young girl who was furious about her mother dragging her into therapy, would not talk to the therapist. She even went as far as turning her back to the therapist. The therapist, resonating with the child’s rage, questioned how come her parents have not figured out that she has no intention with cooperating with their plan that she see a therapist? By posing this question, the therapist was putting into words what this girl was acting out and indirectly acknowledging how she was feeling. As a result, the girl began to talk about how her mother does not even know her and the impasse was broken.

Impasses are really resistances on the part of the child who is acting out emotions instead of talking about them. They are also counter resistances-behaviors by adults who are also acting out instead of talking about the feelings induced in them by the child. The end result is that the emotional connection is attenuated and each party just engages in a repetitive behavioral cycle that each knows will go no where.

Tolerating the intolerable feelings and not acting on them is a difficult task. However, it is absolutely necessary in order to break impasses between adults and children. The next step-giving the impasse or resistance a “twist”, is also difficult and requires some expert consultation. Changing a system requires a system. Thus, adults who are stuck in a tug-of-war with the children in their lives may need professional help to turn impasses into constructive relationships.

Executive Function: The Engine that Could

Everyone is talking about executive function or “executive function disorder” these days to try to explain difficulties their child may be having at school or in life. It is not clear, however, that this term is being understood in the same way by parents or teachers. Moreover, there is no such diagnosis. Diagnosis notwithstanding, deficits in executive function can play a significant role in a young person’s development.

Executive function has been likened to an orchestra conductor who, with a wave of the baton, tells the musicians when to play, how loud or soft to play, and when to begin and end. Another way of thinking about executive function is as a group of neuropsychological processes that serve as the engine to drive or regulate an individual’s access to his or her cognitive abilities. Without adequate “torque,” the engine does not drive the car.

An example of this is the intertwined executive functions of activation, attention, and memory. Individuals with high levels of arousal-that is, they need a great deal of stimulation to get activated-will be unable to fully direct their attention to the task at hand. Since attention is the bedrock of learning, there will likely be important information missed. Furthermore, whatever has not been attended to can’t be encoded in memory. Consequently, teachers may complain that students learn something one day, but are unable to remember it the next day. There are other executive function deficits that can explain this common complaint. For instance, some students have very slow retrieval speed. Thus, some have difficulty encoding information while others have trouble retrieving it.

Here is the point: individuals with excellent ability can have problems functioning if their executive functions are not operating efficiently as they will limit access to those abilities.

What is a parent or a teacher to do? Deficits in executive function are frustrating and often feel resistant to remediation. Very often logical and reasonable strategies fail miserably. For instance, there are a myriad number of planning and organization problems students exhibit where they are either having trouble planning how to complete a task and underestimating the time needed or regularly lose important papers or books. Applying logical solutions like organizers and timers or color coded folders work at times, but just as often do not work because they are not utilized correctly or regularly.

Since executive functions are wiring, modifying them requires a good deal of effort to enlist the cooperation of the individual student to battle with wiring issues. First, awareness must be raised because executive functions operate automatically and while disruptive, they have a certain familiarity and are often not dystonic. That is, students may not be as troubled by these issues as adults are. An example of this is telling students who have problems with time that they will earn lower grades, not get into a good college, or try to extoll the virtues of being on time may not register as these students have not developed a good time perspective.

A second step, and one often missed, is to assess a student’s objections to “buying in” to using a strategy. This is essential in order to search out unspoken resistances. Without first understanding these obstacles to successful application of a strategy, students are likely to act out their objections by not being cooperative or compliant. It is only when you understand what prevents reasonable courses of action from working that you can achieve success. Exploring these objections requires patience and a healthy dose of tolerance as the rationales may not be logical. However, this does not make them less potent as forces that can destroy your efforts. Once you unearth these objections, you can find a way to join with students so you are not viewed as an adversary, but, instead, someone who understands them. It is this understanding/joining that builds relationships and leverage. Once this is accomplished, the probability of having strategies “stick” will increase.

Response To the Right Intervention (RTRI): Marrying Neurocognitive Science to RTI

In an excellent chapter, “Linking School Neuropsychological with Response to Intervention Models,” in Best Practices in School Psychology, Della Toffalo (2010) asserts that “…educationally relevant cognitive neuropsychological assessment…can and should occur at any time (any tier) in the RTI process when an intervention team has good reason to believe that standard protocol interventions may not be adequate to address the needs of an at-risk student (p.176).”

What does this mean? When IDEA was revised to include RTI as a way to establish eligibility for special education to correct the flaws of the ability discrepancy approach, it did not go far enough. That is, students who simply fail to be successful after a RTI plan should not be automatically considered to be learning disabled. First, this view of a learning disorder fails to include the universally accepted definition of a learning disability as including a processing deficit. Moreover, it just becomes another wait-to-fail model as students may proceed through tiers of intervention without the process being informed by cognitive processing information that could help in targeting students’ deficits earlier in the intervention process.

To elaborate, it is essential that the intervention team have available all tools that can diagnose students’ learning, behavioral, or emotional difficulties at any time (any tier). Della Toffalo includes a list of disorders involving learning disabilities which RTI alone may not be successful. It just makes no sense not to use all the neuropsychological tools available to identify the source of students’ learning and performance difficulties and to have this information drive the intervention process. Otherwise, the team is in danger of shooting from the hip, a practice that may inevitably lead to the failure of the prescribed interventions.

For example, academic subjects are byproducts of cognitive processing skills. Identifying and isolating those processes that are causing students’ problems can lead to more effective interventions. Does a students’ reading problem stem from a phonological or orthographic processing deficit? Are math problems due to a problem with memorizing basic math operations or the sequential steps to solve a word problem or to conceptual difficulties? This kind of specific knowledge about students’ issues is needed to craft an individually tailored plan. This kind of information can be obtained from the administration of specific subtests from a neuropsychological battery that are targeted to the areas of concern. In addition, this can all be done prior to going through four tiers when a full battery is needed. Of course, if a comprehensive evaluation is needed, it should be considered. However, RTRI can spare students and the intervention team a lot of time, effort, and pain.

Emotional Attunement in Teaching and Therapy: Some Things Do Not Change

As the fields of education and psychotherapy continue to evolve toward an increasing reliance on “evidence based practices,” it is of equal or even greater importance not to forget that the preponderance of the professional literature points to the importance of emotional attunement in teaching or in whatever form of therapy is being practiced. In our fast paced world, it may be easy to assign a lesser value to certain relationship variables that are prerequisites for making therapy work. Having a good enough relationship with students and patients provides the leverage that moves them to engage collaboratively on the road to accomplishing their goals.

Creating a relationship that will support teaching or therapy in good times and bad begins with a recognition of the immense power of induced emotion. That is, emotions are constantly being exchanged between therapists and teachers and their patients and students often nonverbally and without being noticed unless one is primed to recognize them. Just as we unknwoleingly catch colds, we also catch emotions. Strong emotions, positive or negative, need to be experienced, tolerated, and washed clean of any toxic elements that may derail the therapeutic or educational process. In a previous paper, I cited a quote from Sheldon Kopp who referenced a biblical saying: “If you want to raise a man from mud and filth, do not think it is enough to keep standing on top and reaching down to him a helping hand. You must go all the way down yourself, down into the mud and filth. You must not hesitate to get yourself dirty.” This is not an easy task. It means using the emotions being communicated in a personal way without personalizing them. When all feelings are tolerated and can be mirrored, then patients and students feel they are with someone who is like them. As a result, they are more likely to like you, and this makes the teaching or therapy “go.” Resisting the urge to take actions to deflect emotions that feel intolerable must be resisted because this amounts to rejecting the student or patient.

It is only through this process of embracing the emotional contagion that is part and parcel of every human relationship that we can return to those with whom we are engaged in an educational or therapeutic process an emotional communication that will move students or patients progressively forward.


Summer is Almost Here: A Perfect Time for a Neuropsychological Evaluation

If your student has had a difficult year, summer is the time to consider an evaluation to understand the roots of the difficulties and to develop a plan to address them in the fall in order to have a better next year.

Why a neuropsychological evaluation?

A neuropsychological evaluation is the most comprehensive assessment available. The scope of the evaluation is much broader than psycho-educational evaluations performed at school. Moreover, the choice of a test battery and the interpretation of the findings rely on a theoretical framework that represents the best science available.

What does a neuropsychological evaluation assess?

Academic subjects are comprised of neuropsychological processes including cognitive processing abilities and executive functions. The neuropsychological evaluation assesses these brain processes with a focus on understanding which of these is the cause of the academic or behavioral problem.

What kind of help can I expect to get from a neuropsychological evaluation?

The evaluation will examine each of the processing abilities and executive functions involved in performing successfully in each academic area. Once that information is obtained, an individualized instructional plan can be created that is tailored to each student’s neuropsychological profile. This will help teachers to differentiate instruction in a way that targets specific areas of deficit.

Why should I seek an evaluation from me?

First, I conduct all evaluations personally. I do not use a technician to perform the testing. This is important because the observations and interactions that occur during the test administration are very important parts of understanding your student. I believe the testing and the interpretation should be done by the same person. In addition, the reports I write are done personally after extensive analysis of the data and are not computer generated with reams of general and impractical recommendations.

Second, I have been conducting evaluations and working with children and adolescents for over 35 years. I know child and development and I know how to create a test battery that focuses on your student’s issues. My knowledge of the linkages between processing skills and academic performance and how to make realistic, practical, and reasonable recommendations has been obtained over three decades.

Third, I have intimate knowledge of how schools work and understand what kinds of recommendations they are able to implement and those they would ignore.

Fourth, I remain available after the evaluation to help you navigate the school system and child study team. I can accompany you to school meetings and help you in advocating for your student.

The Importance of Understanding before Doing: Fixing Response to Intervention (RTI)

Anyone who reads the RTI literature will see the word “fidelity” in the context of implementing interventions. This is, of course, common sense in that any interventions need to be applied properly. However, in order to attain fidelity, the teachers (and planners) need to have an understanding of why a strategy is being recommended otherwise it is in danger of being applied in a robotic, out of context fashion without any real conviction by the teacher. Having a belief in what is being done can only be accomplished by first comprehending the purpose of the strategy, having an opportunity to ask questions about it and even share objections or reservations about it, and discussing what to do in the event it fails to deliver the expected result.

It has been my experience that teachers often have not been given a framework from which to observe, analyze, and understand student’s difficulties. They are then in the position of doing what they know and if this does not work, they reach an impasse about what to do next. Adopting the principle of understanding before doing is the first step in changing this situation and providing teachers with the supports and tools they need to feel success with their struggling students.

What do they need to understand? Academic and behavioral challenges are best understood through the lens of the framework the Cattell-Horn-Carroll cognitive processing theory provides. First, teachers need to know that academic subjects are really byproducts of neuropsychological processes like cognitive processing abilities and executive functions. Second, by understanding the linkages between cognitive processing and academic subjects, teachers can better identify the specific processing domains that are causing a student’s struggles. At the very least, they can begin to generate informed hypotheses about the root causes which can then be translated in interventions tailored to the individual student’s cognitive profile.

Providing the “toolbox” or evidenced based strategies is the easy part. Training teachers to understand students’ difficulties and to create an instructional approach that emanates from this understanding is the key to fixing RTI. That is, we need to stop shooting from the hip or applying general strategies top individual students. This is one of the reasons RTI may not work. Moreover, having a framework to understand academic and behavioral challenges allows teachers to have an idea of what to do next if a strategy fails. It is important not lose faith if this occurs because each failure yields important information about what to do next.

However, it is essential to understand before doing. Students are complex and teaching is equally complex. Being able to break down academic tasks into the prerequisite processing skills needed will provide teachers with a concrete way to identify, understand, and “fix” their students’ challenges. Without it, RTI can be an exercise of whistling in the wind.