Mislabeled Child

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Brock Eide M.D. M.A. and Fernette Eide M.D.

MislabeledChild.com

Looking Beyond Behavior to Find the True Sources—and Solutions—for

Children’s Learning Challenges.

The Mislabeled Child

What is The Mislabeled Child

About?

• Learning Differences and Learning Styles: How children (and their brains) learn, and how different children learn and process information differently.

• Specific Learning Challenges: Why children struggle, and how to help them when they do.

• The many reasons for Hope and Optimism that existwhen children struggle, due to the incredible and often untapped learning resources of the brain.

When children struggle, the labels they are given oftensimply hold up a mirror to their problems:

• Trouble learning: “Learning Disability”• Trouble paying attention: “Attention Deficit”• Writing difficulties: “Disorder of written expression”• Oppositional behavior: “ODD”

The Status Quo:Too Often, Labels are

“Merely Mirrors”

True Sources Often Lie Deeper…

Failure to delve more deeply—beyond behavior—for the truesources of a child’s strugglescan result in misdiagnosis, mislabeling, and mistreatment.

As was the case for Michael…

Michael

• 11 y.o. boy from a small Midwestern town.• Very bright, but had surprising difficulty early

in school learning to read.• Easily mastered letter names and sounds, but

struggled with decoding.• In second grade, something “clicked” and silent

reading comprehension skyrocketed.• In third grade, top reading group in class, and

consistently scored in 90%ile in reading comprehension tests.

• So, where’s the problem…?

Michael

Despite strong comprehension of longer passages, Michael showed:

• Poor word-by-word decoding.• Impaired oral reading.• Difficulty reading short succinct sentences like story

problems in math or instructions on tests.• Severe difficulties with spelling.• Incredible difficulties with handwriting.• “Careless mistakes” in math.

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MichaelEven writing the alphabet was difficult:

Notice his problems forming cursive f, k, o, q.On printing, notice awkward forms like a, k, m, n, q, u; the wandering line; and g substitution for j.

When writing whole sentences, the problem got worse…

Michael

Writtencopy

Freewriting

Notice the problems with margins, spacing, spelling, consistentletter formation, and the use of conventions like capitals andperiods.

Some problems persisted even with keyboarding…

MichaelStory in the 5th Grade,

by keyboard:

“On a planet farfay awaw There was a youno man by the name of uragoner who set of for the edges of his planet in surch of the plantes bengines. His cutter had mot alwalec peen on This planet.”

Instead of reflecting his interesting, intelligent, and often humorous thoughts, Michael’s writing was much poorer in form and contentthan his speech, which made him embarrassed and self-critical…

Michael

A post-it note Michael placedmost of the it

Kick me

• By fifth grade, Michael’s ability to cope was exhausted.• He repeatedly called self stupid and dumb, and began

hitting himself on his head, saying he deserved to be punished for being so stupid.

A post-it noteMichael attachedto one of his spelling pre-testswhere he missednearly all of the items.

Michael

The school proposed a number of explanations forMichael’s difficulties:

a) Inattentive and careless,b) Not trying hard enough, or c) Unrealistic expectations: too smart to have a disability,

but not smart enough to do any better.

Their bottom line: Because Michael wasn’t actually failing, he didn’t qualify for special help. Rokenbok

VIQ 137Vocab 17Comp 17Simil 16Arith 16Infor 15Dig Sp 15

PIQ 119Obj As 14Pc Com 13Pc Arr 13BD 13Cod 11SS 11

Goal in Life: Engineer

MichaelIn Reality: Energetic, Painstaking, and REALLY SMART

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“The Beginning of WisdomIs Calling Things

By Their Right Name”:

Michael is a perfect example of why the kinds of labels we apply to children matter, and of the truth of the statement with which we open our book.

-- Ancient Chinese Proverb

Stealth Challenges: Michael

• In Michael’s case, the struggle was with what we call“stealth dyslexia.”

• Michael was a perfect example of a child with “stealth challenges”—or problems that evade the usual “radar of detection.”Michael needed help with the way his brain processed sound, visual, and sensorimotor information, and he needed to learnhow to use his many strengths to overcome his weaknesses.


Michael shows how learning challenges aren’t just issues for children formally identified as needing special services, but are often present in children who aren’t identified as having specific learning challenges, yet show:

• Underachievement relative to intelligence• Inattention or apparent carelessness• Disorganization • Overloading, anxiety, or depression• Social or behavioral difficulties

Such children are often mislabeled…

Partial Pictures

In some cases, their weaknesses may be identified but their strengths missed, resulting in labels that tell only part of their story.

Look Alikes

In other cases their behaviors may meet criteria for a commonly used diagnostic label (often from the DSM-IV), but may actually be caused by other unrecognized—and treatable—issues that affect learning and information processing.

As happened with Ethan…

Look Alikes: Ethan

• Bright, energetic 9-year-old boy.• Intense, active, emotionally and physically sensitive.• Highly self-directed in activities, difficulty with

transitions and unexpected changes.• Difficulty conforming to classroom demands. • Socially, interacted well one-on-one with older

children, but few friends among age peers.• Poor eye contact, missed social cues, overloads in

large groups.

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Look Alikes: Ethan

University Clinic diagnosed him (Sort of) with:• “Probable ADHD" • “Possible Anxiety Disorder" • “Cannot rule out Asperger's syndrome" and• “Motor Coordination Difficulties reported with

reported dysgraphia [i.e., severe handwritingproblem]."

Of Children and Checklists

• The tentative nature of these diagnoses reflects the recognition by these professionals that labels like ADHD or Asperger syndrome couldn’t capture Ethan’s full complexity.

• Behavioral checklists often miss the fact that similarbehaviors can have vastly different causes, and require vastly different solutions.

• In the MLC, we try to describe and deal with that richness and complexity, but in a way that makes it easy to understand and address.

What We Found With Ethan

• Severe handwriting impairment, source of much anxiety and misbehavior (improved with specific instruction, strengthening, and accommodations).

• Sensory-seeking (movement and touch/pressure) behaviors (improved with sensory input and movement breaks).

• Sensory-based social difficulties (improved by practice with verbal conflict resolution and social problem-solving scenarios).

Notice…

It was only by looking beyond Ethan’s behaviors to find their causes in his problems taking in,

processing, and expressing information, that we were able to match those problems with

appropriate solutions.

How to Avoid and Mishandling

Two steps to go beyond behaviors or isolated scores to truly understand a child’s learning challenges and to give that child what he or she needs.

Step 1: Create a Complete Learning Profile

Create a complete learning profile of a child’s strengths, weaknesses, interests, temperament, and learning style.

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Step 1: Create a Complete Learning Profile

In particular, systematically identify strengths and weaknesses in:

• Information Input• Pattern Processing• Output for Action• AttentionIn other words, the underlying factors that can presentas difficulties with academic and behavioral function.

Optimize education and environment by designing a detailed plan of learning, therapy, and play, that improves areas of weakness, relies more heavily on areas of strength, and provides accommodations that get around unnecessary difficulties.

Step 2: Optimize Education

In MLC we describe in detail how to make such plans to help with challenges in specific academic areas like:

• Reading and spelling;• Handwriting and Written Expression;• Math.As well as more general challenges in:• Memory and imagery;• Visual or Auditory processing;• Sensorimotor function;• Language;• Attention;• Autism;• Intellectual Giftedness.

Step 2: Optimize Education It all begins with…

Assessment

• Behaviors are useful starting points but insufficient for diagnosis.

• Similar behaviors can have very different causes.

Key Point:

Going to the Source:Aspects of Brain-Based Learning

1. Information Input 2. Pattern Processing 3. Output for Action4. Attention

Attention

Aspect 1: Information Input

• Input Problems Affect Downstream Functions and Development (Garbage In, Garbage Out)

EarsEyes

Touch / Movement

Main Routes forInformation Input

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Information Input: Micah

• 6-year-old boy, worsening self-esteem, school phobia and refusal, behavioral problems.

• In kindergarten oral language tested at 99%ile.• In first grade, trouble learning to read and write.• Sloppy work, incomplete math work, poor visual

memory, learns better one-on-one.• Increasingly anxious, aggressive, and hyperactive in

class. His teacher suspected ADHD and ODD.

Information Input: Micah

2 minute copy: “While Ben was…” Exact figure copy

Circle “bund”

• On our testing, Micah extremely intelligent and polite—until testing stressed his vision.

9 months laterGlasses + Therapy.Improved Visual Memory,Problem-solving, and Behavior.

Information Input:Micah Couldn’t See

Before Brain Can’t See

Dyslexic

Non-Dyslexic

Information Input:

Auditory – Unrecognized Ear or Brain-BasedHearing Problems (“Brain Can’t Hear”)

Touch / Movement – Sensory Processing Problemsor Mild Auditory + Visual Problems

Non-Dyslexic Dyslexic

Not HearingRhymes in Dyslexia

Brain-Based Problems of Information Input are Often Missed

Immature

“His hands were never still. He was always manipulating piecesof clay with his fingers…”

“I hated mathematics because I could not see.”

“…he was quieter and more thoughtful: while the others played games,he would stay close to his mother…”

“…neither the school nor the curriculum had appealed to him…he hadspent most of his time ‘drawing fanciful designs, telling stories, and reciting imaginary descriptions to his comrades…”

Play

Hidden Disability

Odd Habits

DifferentIn His Head

Fidgety

Flash from the Past Weak Vision, Strong Visual Imagery

Other Senses May Become Stronger

Auguste Rodin

Sculptor – Severe Myopia – Spatial Genius

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Aspect 2:Pattern Processing

• How We Recognize, Remember, and Organize Information.

- Memory Systems (File Cabinets)- Imagery Systems- Pattern Association

• Helps us understand, predict, and plan.

People Often Differ Dramatically in their Preferred Types of Memory

Pattern Processing

Dramatic Effect on Learning Efficiency Permanent Learning

Kendra, The Forgetful Learner

• Kendra was 7, beloved by teachers and students• Polite and Attentive, but very Forgetful!• Kendra’s parents told us, “She remembers some things

very well, but other things she has to learn again and again…”

Pattern Processing:

Natural Storyteller Playground Stories Birthday PartyCan’t Remember What Learns at School

• Struggle to Remember 3 Numbers in Correct Sequence

• Instruction to “Visualize”: Still Can’t.

How Did She See Them?: “Glittering numbers dancing across a stage.”

• Then: “Keep the numbers on the stage after they dance.”

Kendra now remembered 5! —Great Performance for Age.

Pattern Processing: Kendra

We Found:

Strategic Memory Imagery Personal Learner

Flash from the Past

• Poor memory

• Called his notebook his “artificial memory”

• Couldn’t take notes because he said it was toohard to listen and write at the same time

• Needed more time to ruminate over new concepts

Success or Failure Depending on How Information Presented

Enrico Fermi

• Nobel Prize winner in physics• Split the atom• Famous as a teacher – trained 4 Nobel

prize winners • Always gave lecture handouts when

teaching because he had struggled withnote-taking himself…

You can be smart and have a poor working memory

Uni-tasker Slow thinker Spatial & Conceptual Strengths

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Aspect 3: Output for Action

• Goal of learning not just understanding, but action.• Output may involve oral or written language

expression, handwriting, taking notes, acting in response to directions, or other large or fine bodily actions… potential “Explosive Child”

Output for Action: Ben

• Happy, outgoing, and well-behaved in kindergarten. • Great reader, strong speller, terrific language skills.• As first grade progressed, mood and behavior

deteriorated: angry, oppositional, work refusal, lying to parents about homework.

• Cause: Ben had severe difficulties with handwriting.

Output for Action: Ben(Dysgraphia/Handwriting Impairment)

7 y.o.: “ In 1909 he painted ‘Bread and Fruit Dish on Table.’ This was the beginning of the period known as Cubism. Cubism splits formsinto facet-like shapes.” Tearing up own work in art class

Dysfunctional Grips AccompanyMany Forms of Dysgraphia

Important: Abnormal Grip A Sign of Deeper Problem:Not Itself the Cause of Handwriting Impairments!

Writing AccommodationsDictation & Keyboarding

Therapy to StrengthenMore Time

Output for Action —Ben

Before OT

After OT

Flash from the Past

“He could never use a dictionary, couldn’t keeptrack of time, struggled with a lisp, and preferred from his adolescent years to dictate rather than to write…”

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It’s possible to be a great orator and win a Nobel Prize in Literature, but struggled with speaking and writing as a child…

Winston Churchill

Music and Visual Power of Language Talented Painter StatesmanLong Preparation Time for Speeches

Aspect 4:Attention Key Points:

Not a Single Function!Not a Single Solution!

• Spotlight : Direction, Strength, Persistence of Focus• Juggler (Working Memory) : Information at Once• Creative Corporation (Organization and Creativity)• Different Modes of Attention – Seeing, Hearing, or

Doing…• Intervention must match deficit.

Inattention Due To Visual Distractibility

• Difficulty persisting with reading or worksheets due to visualcrowding and distractibility.

• “I can do 40 problems if there are 4 on each page, but I can’t do 4 if there are 40 on a page.”

• Frequent source of “careless mistakes.”Visual CoordinationBrain-Based Visual IssuesVisual Crowding is Real!

Age

Attention and DevelopmentAuditory and Visual Attention Improve with Time

Boys Poorer Auditory Attention in Elementary SchoolBehavioral Checklists Don’t Consider Developmental or Gender Differences

• Combines Ideas, Sensations, Images• Generates Alternative Approaches• Expands Possibilities and Associations• Prefers ‘The Big Picture’

Chief Creativity Officer – Right Brain

Chief Operations Officer – Left Brain• Oriented to the ‘Bottom Line’• Focusing & Prioritizing Goals• Deals with Detailed Planning and Implementation

Rypma, Rutgers

The Executive “Corporation”Training Creativity & Operations

(Gifted Children Mislabeled with ADD) Pitfalls of Chief Operation Officers

• “Oh no, I have to think?”• Fails to Consider Alternatives• Misses the Forest for the Trees• Derivative More Than Innovative

“Valedictorians tend to be very conscientious, responsiblepeople who achieve a type of well-rounded success...but what they don’t have is that overriding passion for a singlething that is often what makes you eminent in later life...”

Karen Arnold, Ph.D.Illinois Valedictorian Study

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Pitfalls of Creativity Directors

• Disorganization• No Priority, No Plan• Unfinished Work• Poor Verbal Communication

Successful Problem Solving RequiresCooperation Between the Right & the Left

Just, Carnegie Mellon

Tower of London

Choice Possibilities

Young GiftedChildren Have

Thinner CorticesBefore the Age of 10

Then Thicker BrainCortices in the Teen

Years

Some Gifted DifferencesRooted in Brain Biology

The Higher the IQ, the More DelayedExecutive Function (Prefrontal) Maturation

Delays may be especially pronounced for children with sensory processing and motor coordination deficits.

Unevenness is More Common with Higher IQ

WISC-III VIQ / PIQ Discrepancies – 18 Points or MoreControl Sample 17.0 %Gifted Sample 54.7 %

Sweetland, Port Washington School District

Development May Differ in Different Areas:

“The servants all thought that young Isaac was foolish,and his mother did not know what to do with him…”

From Isaac Newton, The Greatest Scientist of All Time

“I used to take these maths tests which were supposed to be donein one period and it took me not just that period but the next onewhich was a play period and sometimes the one beyond that…”

Roger Penrose, Cambridge Math Professor

The Gifted-Backward Paradox

“My teachers saw me at once backward and precocious, reading books beyond my years and yet at the bottom of the Form. They were offended. They had large resources of compulsion at their disposal, but I was stubborn.” Winston Churchill My chief deficiency was arithmetic. Here my understanding was far beyond my

manipulation, which was definitely poor. My father saw quite correctly that one of my chief difficulties was that manipulative drill bored me. He decided to take me out of school and put me on algebra instead of arithmetic, with the purpose of offering a greater challenge and stimulus to my imagination.

Norbert Wiener, Nobel Laureate in Physics

The Teaching Paradox –More Learning with Greater Challenge

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Downside: DisorganizationThe Highly Active Mind

Is Often…Distracted and Disorganized“Constantly late for school, losing his books, and papers and various other things into which I need not enter– he is so regular in his irregularity in every way that I don’t know what to do.”

--Winston Churchill’s Principal

Einstein’s Office

Inattention: Creativity Officer on Steroids

"It looks like she's doing the dishes but she accidentally left it on. When she went to get her apron, the kids were getting cookies and the stool tipped over and the little boy's falling and some of the dishes were done but not all of them. and some of the water was coming out and the curtains and the window were open and some of the water got out. The girl was saying Mom!! The little boy was falling. The mom said "I'll be there in a second--get out of that cookie jar!"

7 y.o. gifted girl considered for attention problems

Who was this?

“He was often ill, prone to fits of uncontrollableweeping, and filled with a restless surging energy he could not contain. He was enrolled withoutsuccess in one school after another and oftenfound it difficult even to remain seated at his desk...”

“I wanted to run down to the beach in sun, rain,or fog and expend the pent-up physical energythat simply fermented within me. Today I wouldbe labeled hyperactive.”

Intense

HyperactiveSchool Failure

“I often wonder at the strength and courage my father had intaking me out of the traditional school situation and providingme with these extraordinary learning experiences. I am certainhe established the positive direction of my life that otherwise,given my native hyperactivity, could have been confused andcatastrophic. I trace who I am and the direction of my developmentto those years of growing up in our house on the dunes, propelledespecially by an internal spark tenderly kept alive and glowing bymy father.”

Ansel Adams

Optimism Non-traditional Schooling Personal Strengths

A Final Point on“Helping Hands” for Kids

The Truth About Accommodations…

The Right Accommodations Get Kids Into Learning,

Not Out Of It!

• Accommodations are ways toimprove function and increase achievement, not to avoid it!

• Accommodations can be enabling and therapeutic!

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"I am a Typhoon and I am on my way to Japan and gathering spead. I mite be the Typhoon that destrois the mongls and theirships on their second invashon of Japan.... My stronggest poweris wind wich can make trumendus waves that can capsise the stronggest mongl ship."

Gifted Dyslexic Boy

Before Using “Write Outloud”

Software

Author of “Mongl Invashon” after 2 years of “Write Outloud”

With Constant Feedback, Student Internalized Spelling Patterns

Take Home Message: Focus on Learning Abilities

• Behaviors are just starting points: Appropriate labeling--and intervention—requires going Beyond Behavior.

• The Brain is remarkably “Resource-Full”• Looking carefully at each child will reveal the

hidden depths of their true learning potential.

Brock Eide M.D. M.A. and Fernette Eide M.D.MislabeledChild.com


Brock Eide M.D. M.A. and Fernette Eide M.D.MislabeledChild.com

“The Mislabeled Child represents a significant step toward a rethinking of our understanding of struggling children. It…willenable us to customize education and parenting for children whose minds work differently from most!”

--Mel D. Levine, M.D., Author A Mind at a Time

“Partial Pictures”: Marshall

• Quiet 6-year-old, struggled in all subjects in school. • Built complicated Lego and Knex structures.• Drew beautifully detailed animals and insects, and

loved picture books. • At school he just looked lost. • School psychologist decided “borderline mentally

retarded.”• Family thought otherwise. They’d seen this story

before.


• Marshall’s father now a highly successful business owner with dozens of employees.

• At age 8, nearly mute, institutionalization considered. • Parents suspected hearing problems, and spent hours

barraging him with oral language. • By fourth grade: reading. By eighth grade: grade

level in all subjects. By high school: honor roll.

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• Confused unless we showed him rather than told him what we wanted him to do.

• Strong ability in spatial and mechanical reasoning.• Severe, heritable—but potentially trainable--difficulty

hearing the different sounds that make up spoken words.

We Found:

Why Mislabeling

Matters

• Labels may put a name to a child’s problems—often by simply describing or restating behaviors—yet fail to determine why those behaviors occur.

• Such inappropriate or incomplete labeling often prevents students from receiving the help they need to find success.

• Common patterns of mislabeling:* Stealth Challenges * Look-Alikes * Partial Pictures

Another Key Point…

Missed learning challenges lead to:• misdiagnosis, • mislabeling, and • mishandling.

Like Many Brain-Based Learning Challenges, Brain-Based Hearing Problems Are Subtle And Often Missed:Like the boy who told us, “It’s hard for me to spell “World”

because the “r” is silent.”

Mislabeled Child

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