learning-connections.org.uk

The Treatment of Neurologically Impaired Children using Patterning

2007-02-27T11:43:00.000Z

The Treatment of Neurologically Impaired Children Using Patterning
Movement Therapy
The submission by the AAP, that, "treatment programmes that offer patterning remain unfounded" needs to be considered thus; the basis of today’s physical therapy movement programmes, is built entirely on the premise, that movement by a therapist, of any part of the human anatomy, on a regular daily basis is in effect "patterning". This movement therapy, practised daily by fully trained, qualified, physiotherapy, and occupational therapists, to rehabilitate stroke victims is accepted worldwide in private, and state medical regimes. The team originally put together by Fay was done so to rehabilitate stroke victims and recipients of traumatic brain injury through accidents.
In effect the AAP critique undermines today’s physio and occupational therapy practitioners those practitioners that the AAP refers to in their web site. www.medicalhomeinfo.org/health/Downloads/EIBrochureF.pdf. to which autistic children should be referred to for therapy as the basis for Early Intervention

The original critique of the AAP in 1968 which led Neman et al, in their paper "Experimental Evaluation of Sensorimotor Patterning used with Mentally Retarded Children", published in American Journal of Mental Deficiency 1974, Vol.79, No.4, 372-384, to quote "The rapid rise to prominence of the Doman-Delacato regimes, the zeal of their followers, and the stories appearing in the popular press telling of remarkable ‘cures’ all served to bring the wrath of the ‘establishment’ to bear upon the Institutes for the Achievement of Human Potential and its methods", was only published 15 years after the establishment of the organisation.

The basis of a movement therapy programme, Sensory Integration Therapy for Neurological Rehabilitation being used in school environments dedicated to the education of special needs children has been established within the Westminster Governments’ Department for Education and Skills.
In their document "Planning, teaching and assessing the curriculum for pupils with learning difficulties", accessible via www.nc.uk.net/ld/index.html they offer the following guidance;
Physical education; Opportunities at Key Stage 1
Much of the programme of study at Key Stage 1 is relevant to pupils with learning difficulties. With modification, it can provide stimulating and challenging learning opportunities. All pupils can contribute in group work with others at their own level of ability.
The document suggests pupils explore basic body movements and actions using different parts of their bodies. To acquire and develope skills, suggesting, crawling, sliding, rolling, moving backwards and forwards. To select and apply skills, tactics and compositional ideas, be helped to follow and respond to simple instructions for example stop and start.
At Key stage 2, the document suggests listening and responding to action words, for example, walking, marching on the spot. Suggesting, as part of games activities, ball games, catching, throwing, on the floor foot skills of passing, dribbling. Throwing and catching bean bags, all as part of hand eye coordination programme, to develop binocular vision.
The Welsh Assembly Government, in their recently published guidance document "Routes for learning", Crown copyright 2006, reference AC/GM/0612, April 2006, affirms that, "This guidance document, written to support the use of the Routes for Learning materials, offers an overview of the main theories and background information, underpinning the effective teaching and assessment of learners with profound, and Multiple Learning Difficulties". In the Additional Guidance section, the document suggests that therapies, including movement therapy, and occupational therapy to address sensory impairment, could be included in the curriculum design. The rationale for this is explained in the premise that inhibiting factors in the student’s ability to learn is irrefutably connected to sensory impairments exhibited by students with learning delay. The document outlines the reasons for the sensory impairments linked to retained inhibitive reflexes. Addressing these inhibitive reflexes being the key to improved learning ability.
It is essential to recognise that the physical exercise components of the DfES document, and movement therapy in the Welsh Document are the core elements of Delacato Therapy, evolved from the ideas of neurologist Dr Temple Fay and propounded in his paper The Origin of Human Movement, presented to the Fourth Annual Institute in Psychiatry and Neurology April 1954 and published in Amer. J. Psychiatry 111:644-652,1955.
In the published work "Using a developmental movement programme to enhance academic skills in grade 1 learners" Fredericks, Kokot, Krog, Teacher Education, University of South Africa, Pretoria, Republic of South Africa, describe the outcomes of a rigorous experimental programme to associate the benefits of physical exercise movement to cognitive learning and academic skills and investigate the efficacy of a movement programme on the academic skills of early learners
In their opinion " The results of the pre-testing and post-testing indicate that the learners of the experimental group showed a significant improvement in spatial development as well as in reading and mathematical skills, compared to the learners in the control group, free-play group and educational toys group".
In support of the rationale behind their experimental programme, the authors cite Summerford, C. (2001). What is the impact of exercise on brain function for academic learning? Teaching Elementary Physical Education, 12(3): 6-8." that physical education is often seen as a frill, and has been discontinued in many South African schools, which might be a misguided kind of thinking "
The authors, drawing on the works of Kephart, (1975). The slow learner in the classroom. Columbus, OH: Merrill, Ayres, (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services. Delacato, (1959). The treatment and prevention of reading problems. Springfield, IL: Charles C. Thomas. . (1974). The ultimate stranger, the autistic child. Novato, CA: Academic Therapy, and the recent works, brain research of Pica, (1998). Movement and the brain: moving and learning in early childhood. Teaching Elementary Physical Education, 9(6): 18-19, De Jager, (2001). Breingim. Kaapstad: Human & Rousseau, and others suggest, "in effect, that the body, as a sensory-motor response system, causes the brain to learn and thus to organise itself ".
The premise that movement (physical education programmes) is the sole mechanism for effective remedial action has to be viewed with caution. Feigley, (1990), Should schools eliminate mandating physical education classes? School Administrator, 47(2): 15, 17, 20.proposes that physical education programmes need to more than mere physical fitness regimes. Likewise according Fredericks et al, Corrie and Barratt-Pugh, (1997). Perceptual-motor programs do not facilitate development: why not play? Australian Journal of Early Childhood, 22(1): 30-36, report on studies showing that certain perceptual motor training was not an effective intervention technique for academic cognitive or perceptual-motor variables. The results show little effect in any developmental domain, even on children's gross motor skills. Furthermore, the programmes made little difference to the reading, arithmetic, language or spelling of children with learning difficulties or of normally developing children. However, even though it may initially seem that Corrie and Barratt-Pugh) do not accept the theory that movement leads to learning, they do state that it is not the importance of perceptual-motor development that is disputed, but the way of supporting and facilitating that development that is critical.
According to the authors Fredericks et, al a sensori-motor movement programme should be aimed at the root cause of learning difficulties. On the basis that vestibular, proprioceptive, tactile visual and or auditory systems are dysfunctional, the child will fail in its attempts at academic work. Kokot,S.J. (2003a). Diagnosing and treating learning disabilities in gifted children: a neurodevelopmental perspective. Gifted Education International 17(1): 42-54. The complete document can be viewed at www.ilt.co.za/aricles3.hml.
In May 2006 the American Academy of Pediatrics republished its Policy statement originally published in its journal Pediatrics Vol. 104 no.5 November 1999, pp.1149-1151, http://aappolicy.aappublications.org/cgi/content/full/pediatrics; 104/5/1149.
This in turn was a reiteration of the original statement of 1968 and 1982. The May 2006 statement affirms that "Current information does not support the claims of proponents that this treatment is efficacious, and its use continues to be unwarranted". However nowhere in the References appendage is cited any peer reviewed, journal published work after 1999 which refers to the above mentioned subject matter, to which the article refers, either in support of the argument of the subject matter, or against the subject matter.
Another failure of the AAP, which, is considered to be necessary in balanced scientific commentary, is to ensure that the content of the argumentative discourse at the time of publication contains references to the latest published information from authors of the discussion material pertaining to the subject matter.
To this point, the omission of references to published works of Delacato in 1970, and 1974, "A new start for the child with reading problems" and "The ultimate stranger the autistic child" is to be questioned, as patterning, as defined by the AAP is not referred to in either book.
If the uncommitted reader is to draw a judgement from the argument by the presenters then the reader has to have been given the opportunity to consider a balanced view of the critique.
The reader would then have discovered that the so-called Doman –Delacato therapy was first proposed by Dr Temple Fay MD a neurosurgeon working in Philadelphia, who incidentally, was responsible for the introduction of brain cooling protocol prior to neurosurgery, whose original operational cooling equipment was exhibited at the Smithsonian.
Fay’s paper "The origin of Human Movement" was published in Amer.J. Psychiatry 111: 644-652, 1955.

Further more the uninformed reader would have discovered that Delacato and Robert Doman had left the Institutes by 1973 creating the centre for neurological rehabilitation, and later, Delacato alone continued his work to develop a new therapy which relied less heavily on the "patterning" concept first laid down by Fay.
The submission by the authors for a need for several persons to perform exercises to the head and extremities for several hours a day, no longer applies to today’s Delacato Therapy, except on individuals with no movement ability, and then only for very short periods.
The omission of these pertinent points by the AAP, is a serious misjudgment by the AAP to construct a valid balanced argument, necessary to have credence in the cause of scientific discourse, which makes their published critique appear to be more of personal issue, rather than a scientific one. This can be argued due to the fact that other individuals were working on the same principles around the same period as the Doman’s and Delacato, Kephart (1975), Cratty (1972,1973) and only the Doman-Delacato work is primarily referred to in text and References.
In 1970, Carl Delacato (17) proposed a new revolutionary concept together with a new curative therapy, outlined in his book, " A New Start for the Child with Reading Problems".
In his book Delacato describes his work as being hard in as much as it presented a new approach to reading problems; reading problems were the result of lack of development of the nervous system, especially in the development of complete one-sidedness.
Delacato notes that the previous book relating reading to brain function was written in 1923 by Dr Samuel Orton, and now he was to resurrect and add fuel to that old fire in educational circles.
Dr Orton, a clinician and prominent dyslexia researcher, hypothesised that normally developing readers suppress the visual images reported by the right hemisphere of the brain because these images could potentially interfere with input from the left.
Using functional magnetic resonance imaging to study brain activity in children, researchers led by Dr Guinevere Eden (18) at Georgetown University Medical Center confirmed part of an eighty year old theory on the neurobiological basis of reading disability, and shed new light on brain regions that change as children become accomplished readers. Advanced technology allowed the researchers to discover that children do in fact turn off the right side of their visual parts of the brain, as they become accomplished readers. This confirms an aspect of Ortons’ work - borne out of observations of individuals with reading disability - is correct.
To put this theory into its simplest terms, systems of reading and language difficulty, show up where there is conflict between one side of the brain and the other to gain language dominance.
In the human brain the language area is usually located in either, the left, or right side of the brain. Likewise, man is usually left- handed or right- handed.
Normally, dominance in the brain begins as soon as baby learns to speak, total dominance achieved around 7 to 8 years of age. Theoretically, a missing of any stage of development between crawling, creeping, walking, seeing, talking and writing creates problems in reading.
In November 2003 researchers led by Dr Mark Wallace (19), report that Dyslexia may stem from how the brain processes sight and sound together rather than simply a problem decoding the written word. They go on to suggest "For the first time, there is evidence that dyslexia is a multi- sensory disorder. It is not solely a problem with visual processing or with language"," our study suggests that it is actually a problem combining visual information with auditory information. "Early reading involves matching what you see with what you hear. The sights and sounds of words are inappropriately matched. So, while the average person very quickly matches the written word "dog" with the sound "dog", a child with dyslexia may have much more difficulty".
Turning again to the text of the body of the critique, there is a precis of the theory of neurological organisation underpinning patterning. "According to this theory" the authors consider that, "the majority of cases of mental retardation, learning problems, and behaviour disorders are caused by brain damage or improper neurologic organisation. Current information does not support these contentions".
On this issue alone has the AAP ignored or completely missed the plethora of peer reviewed, journal published, investigative research papers, suggesting, by brain scanning autistic subjects, with the latest high definition MRI, CAT, and PET scanners, and identifying lesions in various parts of the autism forming brain.
The submission by the AAP, that "treatment programmes that offer patterning remain unfounded" needs to be considered thus; the basis of today’s physical therapy movement programmes, is built entirely on the premise that movement by a therapist, of any part of the human anatomy, on a regular daily basis is in effect "patterning". This movement therapy, practised daily by fully trained, qualified, physiotherapy, and occupational therapists, to rehabilitate stroke victims is accepted worldwide in private, and state medical regimes. The team originally put together by Fay was done so to rehabilitate stroke victims and recipients of traumatic brain injury through accidents.
In effect the AAP critique undermines today’s physio and occupational therapy practitioners those practitioners that the AAP refers to in their web site. www.medicalhomeinfo.org/health/Downloads/EIBrochureF.pdf. to which autistic children should be referred to for therapy as the basis for Early Intervention

Reading and the Autistic child

2006-12-05T11:08:00.000Z

Reading and the Autistic Child

The basis of a movement therapy programme, Sensory Integration Therapy for Neurological Rehabilitation being used in school environments dedicated to the education of special needs children has been established within the Westminster Governments’ Department for Education and Skills. (1)
In their document "Planning, teaching and assessing the curriculum for pupils with learning difficulties", accessible via www.nc.uk.net/ld/index.html they offer the following guidance;
Physical education; Opportunities at Key Stage 1
Much of the programme of study at Key Stage 1 is relevant to pupils with learning difficulties. With modification, it can provide stimulating and challenging learning opportunities. All pupils can contribute in group work with others at their own level of ability.
The document suggests pupils explore basic body movements and actions using different parts of their bodies. To acquire and develope skills, suggesting, crawling, sliding, rolling, moving backwards and forwards. To select and apply skills, tactics and compositional ideas, be helped to follow and respond to simple instructions for example stop and start.
At Key stage 2, the document suggests listening and responding to action words, for example, walking, marching on the spot. Suggesting, as part of games activities, ball games, catching, throwing, on the floor foot skills of passing, dribbling. Throwing and catching bean bags, all as part of hand eye coordination programme, to develop binocular vision.
The Welsh Assembly Government, in their recently published guidance document (2)"Routes for learning", affirms that, "This guidance document, written to support the use of the Routes for Learning materials, offers an overview of the main theories and background information, underpinning the effective teaching and assessment of learners with profound, and Multiple Learning Difficulties". In the Additional Guidance section, the document suggests that therapies, including movement therapy, and occupational therapy to address sensory impairment, could be included in the curriculum design. The rationale for this is explained in the premise that inhibiting factors in the student’s ability to learn is irrefutably connected to sensory impairments exhibited by students with learning delay. The document outlines the reasons for the sensory impairments linked to retained inhibitive reflexes. Addressing these inhibitive reflexes being the key to improved learning ability.
It is essential to recognise that the physical exercise components of the DfES document, and movement therapy in the Welsh Document are the core elements of Delacato Therapy, evolved from the ideas of neurologist Dr Temple Fay (3).
In the published work (4)"Using a developmental movement programme to enhance academic skills in grade 1 learners" Fredericks, Kokot, Krog, describe a rigorous experimental programme to associate the benefits of physical exercise movement to cognitive learning and academic skills and investigate the efficacy of a movement programme on the academic skills of early learners
In their opinion " The results of the pre-testing and post-testing indicate that the learners of the experimental group showed a significant improvement in spatial development as well as in reading and mathematical skills, compared to the learners in the control group, free-play group and educational toys group".
In support of the rationale behind their experimental programme, the authors cite Summerford, (5) , that physical education is often seen as a frill, and has been discontinued in many South African schools, which might be a misguided kind of thinking
The authors, drawing on the works of Kephart (6), Ayres (7), Delacato (8,9), and the recent works, brain research of Pica (10), De Jager (11), suggest, "in effect, that the body, as a sensory-motor response system, causes the brain to learn and thus to organise itself.
The premise that movement (physical education programmes) is the sole mechanism for effective remedial action has to be viewed with caution. Feigley (12), (1990), proposes that physical education programmes need to more than mere physical fitness regimes. Likewise according to Corrie and Barratt-Pugh, (13), report on studies showing that certain perceptual motor training was not an effective intervention technique for academic cognitive or perceptual-motor variables. The results show little effect in any developmental domain, even on children's gross motor skills. Furthermore, the programmes made little difference to the reading, arithmetic, language or spelling of children with learning difficulties or of normally developing children. However, even though it may initially seem that Corrie and Barratt-Pugh do not accept the theory that movement leads to learning, they do state that it is not the importance of perceptual-motor development that is disputed, but the way of supporting and facilitating that development that is critical.
According to the authors Fredericks et, al a sensori-motor movement programme should be aimed at the root cause of learning difficulties. On the basis that vestibular, proprioceptive, tactile visual and or auditory systems are dysfunctional, the child will fail in its attempts at academic work. Kokot, S.J. (14)
For decades, it has been well established that one child in five has serious reading difficulties. Many systems of special teaching have been tried.
In his paper "Ontogeny of Reading Problems"(15) presented to Claremont Reading Conference in 1963, Dr Carl Delacato, Ed.D reasoned that "the process by which one attains the ability to read – the ability to learn to express oneself starts at birth. If the child is not afforded the opportunity to develop total neurological organisation, the child cannot become totally "human", and as a result cannot communicate at the level at which the child might have been able to, had neurological organisation been completed."
The 1963 paper, and his book in 1970, both stem from original research. (16)
In this paper the principles of Sensory Integration Therapy are proposed.
In 1970, Carl Delacato (17) proposed a new revolutionary concept together with a new curative therapy, outlined in his book, " A New Start for the Child with Reading Problems".
In his book Delacato describes his work as being hard in as much as it presented a new approach to reading problems; reading problems were the result of lack of development of the nervous system, especially in the development of complete one-sidedness.
Delacato notes that the previous book relating reading to brain function was written in 1923 by Dr Samuel Orton, and now he was to resurrect and add fuel to that old fire in educational circles.
Dr Orton, a clinician and prominent dyslexia researcher, hypothesised that normally developing readers suppress the visual images reported by the right hemisphere of the brain because these images could potentially interfere with input from the left.
Using functional magnetic resonance imaging to study brain activity in children, researchers led by Dr Guinevere Eden (18) at Georgetown University Medical Center confirmed part of an eighty year old theory on the neurobiological basis of reading disability, and shed new light on brain regions that change as children become accomplished readers. Advanced technology allowed the researchers to discover that children do in fact turn off the right side of their visual parts of the brain, as they become accomplished readers. This confirms an aspect of Ortons’ work - borne out of observations of individuals with reading disability - is correct.
To put this theory into its simplest terms, systems of reading and language difficulty, show up where there is conflict between one side of the brain and the other to gain language dominance.
In the human brain the language area is usually located in either, the left, or right side of the brain. Likewise, man is usually left- handed or right- handed.
Normally, dominance in the brain begins as soon as baby learns to speak, total dominance achieved around 7 to 8 years of age. Theoretically, a missing of any stage of development between crawling, creeping, walking, seeing, talking and writing creates problems in reading.
In November 2003 researchers led by Dr Mark Wallace (19), report that Dyslexia may stem from how the brain processes sight and sound together rather than simply a problem decoding the written word. They go on to suggest "For the first time, there is evidence that dyslexia is a multi- sensory disorder. It is not solely a problem with visual processing or with language"," our study suggests that it is actually a problem combining visual information with auditory information. "Early reading involves matching what you see with what you hear. The sights and sounds of words are inappropriately matched. So, while the average person very quickly matches the written word "dog" with the sound "dog", a child with dyslexia may have much more difficulty".
Man is unique in the fact that the species is the only life form that has developed a written form of communication, which developed from his ability to communicate orally in the form of speech. Having established this premise it has to be cautioned that the ability to read and write is not dependent on the ability of the individual to use coherent speech. This is true of many autistic children with little or no vocabulary being taught to read and write and autistic children with coherent language not being able to read and write. One thing however is certain that that both cohorts of children are capable of being taught reading and writing by developing the conditions that enable written language to be both taught and learnt.
A spoken and written language is the result of having sideness and uniqueness of a brain, which contains an upper portion divided into two halves, the cortex. The uniquely human characteristic of sideness developed in man has one half of the cortex becoming the dominant, language-controlling hemisphere, and the other becoming sub-dominant.
The ability of a child born without the encumbrance of a traumatic birth process and incident free pregnancy, to develop a written language is a precise process, any part of that process being missed or not totally developed compromises the process and inhibits the end result of written language and the ability to read written language.
To understand the reasons why the compromised process inhibits reading and writing is firstly to understand the precise developmental processes, which lead to reading and writing, and only then, can we understand why children, born with a traumatic birth procedure after a problem pregnancy, are unable to read and write. Only by this understanding can intervention be applied to correct these inadequacies.
In his paper "Ontogeny of Reading Problems" presented to Claremont Reading Conference in 1963, Dr Carl Delacato, ED. D reasoned that the process by which one attains the ability to learn to read - the ability to learn to express oneself starts at birth .If the child is not afforded the opportunity to develop total neurological organization, the child cannot become totally " human ", and as a result cannot communicate at the level at which the child might have been able to, had neurological organization been completed.
Based on the rationale of neurological reorganization, prevention of communication dysfunction and, as well, the development of meaningful communication is very possible. It must be based, however, on the premise that there are significant development stages of neurological organization which cannot be bypassed, and as the child reaches each stage chronologically, it must be given every opportunity to master the functional neurological activities at that level before moving on to the next. With such a logical approach to child development, we could become able to deal with the problems that face us today, by seeing that every child is given the opportunity to develop wholly and completely in terms of functional neurological organization.
Prior to the presentation of this paper at the Claremont reading Conference, Carl Delacato had spent over 10 years developing the theories on which his paper was based; studying cultures around the world and working with and studying children and adolescents with varying degrees of communication and development delay problems. This research led to his premise that all the affected individuals studied, had either an incomplete neurological development, or had received, or been subjected to an event which interrupted the natural sequence of development leading to complete neurological development. His two books published in the period up to 1963 outline his rationale and treatment regime, which leads to neurological completion and thus to the individual to achieving meaningful communication.
The remainder of the presentation goes on to outline the rationale of his premise, by presenting the etiology of brain injury, which leads to the development of sensory problems, and the retention of inhibitive reflexes, which hinder the natural development sequence, and create lost opportunities, such as, failing to crawl on hands and knees, before walking.
I have discussed elsewhere "Making Sense of the Senses"(19,20) the subject of sensory dysfunction of the autistic child as well as the subject of retained inhibitive reflexes, (acquaintance with the work of Sally Goddard on the reflexes is recommended).
Delacato goes on to say "Let us look at the significant stages of development to see how the lack of opportunity for complete neurological organization at each successive stage of neurological development relates to the ontogeny of a reading problem. For our purposes, let look at the successive stages receptively in terms of audition, vision and expressively in terms of movement.
As the child who has had a non-traumatic birth arrives at 3 to 20 weeks of age we find that his mobility consists of creeping on his stomach in a homolateral pattern. That is, the child moves forward with the arm and leg on the same side of the body extended and the arm and leg on the opposite side of the body flexed. His head turns toward the flexed side and as he moves, this body position is reversed. The mobility is aimed in a two-dimensional world toward seeking vital and basically crude comfort. If we view the child at this age from a visual point of view, we note that this body position places eyes in such a position that the child is binocular in visual performance. That is, as the right arm and leg come up, the right eye looks at the right hand, the left eye does not. It remains somewhat strabismic. As the position is reversed, the left eye looks at the left hand and the right eye has no part in the visual process. At this stage the child operates visually binocularly, using only one eye at a time just as one side of the body at a time in the homolateral pattern.
The same is true in audition. At this stage the child cannot place sound in space simply because auditorially the child receives the stimulus from one ear or the other. This total performance lies performance lies in terms of neurological organization at the level of the Pons. This is basically a one-sided level of function. Mobility is homolateral, or one side used for propulsion at a time, vision is binocular, and audition is binaural.
When the child moves on to the level of the mid – brain at the age of 7-9 months, we find a whole new area of function arising. The child, in terms of mobility, adds the third dimension to movement. The child now crawls on hands and knees and the stomach is no longer in contact with the floor. Significantly, as the child moves now, the opposite appendages are used for propulsion. In other words as the child moves, the right hand and left knee are used at one time and then the left hand and right knee are used for propulsion. The child has become a cross- patterned organism. The child no longer one-sided, but now is distinctly two -sided. The child has become a bilateral human being.
In vision, at this stage, the child begins to use eyes in concert. The child no longer uses one eye at a time in a monocular fashion. Instead, the child uses the two eyes in concert and here is the beginning of binocularity. Those children who present to us later in the developmental picture a lack of good binocularity are children who have not been given adequate opportunity to develop binocularity at this stage of development, which is the responsibility of the mid-brain. Such children, who are not given adequate opportunities for creeping, later develop problems for which binocularity is a variable.
In audition the same phenomenon takes place at the level of mid-brain. During the 7 to 9 month development levels the child learns to place a sound in space. The child becomes binaural, that is, tends to use two ears in concert. The stimuli are mediated and the child can place a sound in space.
We have all seen these children to whom we could not teach phonetics, no matter how hard we tried. In our investigations we find that those children are lacking in this very basic binaural skill, which is a function of mid-brain and not of the cortex, as we had assumed in the past. Children who are not afforded the opportunities for development at the level of mid-brain in the area of vision, mobility and audition at the ages of 7 to 9 months are beginning to develop significant problems in communication. If they lack binocularity, binaural function and mid-brain overall responsiveness we have started them on their way toward a disability in language.
As children reach one year of age they become cortical creatures and they move from bilateral activity, binocular and binaural, to a new level of function, that is stereo or depth within their receptive and expressive mobilities. Children from the age of one on begin to develop stereopsis in vision. This must be superimposed upon strong binocularity. They begin to develop stereophonic abilities in hearing which must be superimposed upon strong binaural activities. They begin to develop true cross –patterned walking which must be superimposed upon the more elemental mid-brain cross-pattern crawling. Indeed at this time in the other areas of receptiveness they have developed from the level of the Pons, at which they were able to receptively discriminate between very painful and very strong stimuli along to the point at the level of the cortex wherein they have developed complete stereagnosis receptively.
In a few short years from birth the child has moved from being one-sided to being two-sided and now must move on to the final human level, that of developing or superimposing upon this developmental continuum cortical hemispheric dominance. Here is where man is unique in neurological terms. Man is the only creature who has developed one hemisphere, which is dominant over the other hemisphere. As a result man is the only creature who has a symbolic language.
As a child begins to make early choices of sidedness, the culture must give opportunities to reinforce this sidedness so that the child develops complete unilaterality, which results in one-sidedness, the child can begin the process of becoming completely human in terms of his receptive and expressive abilities.
This sequential continuum, called neurological organization, ends at about the age of six, or about the age when generally we begin the formal teaching of reading. To recap, the whole process of development of readiness to read begins at birth. It goes on to the level of Pons, which functions in an alternating one-sidedness, to the level of the mid-brain which is two-sidedness, to the level of the cortex, which encompasses stereo functions, to the level of the development of complete cortical hemispheric dominance. This continuum forms the basis of human perceptual abilities.
Perception is a fundamental process. We learn to see in varying stages and in varying ways; we learn to move in varying stages and varying ways; we learn to hear in varying stages and varying ways; we learn to feel in varying stages and varying ways. There are no shortcuts to these developmental processes in any of the sensory modalities, sequentially, logically and according to the development of the human nervous system. Only by going through the process as nature intended it to be can we form good perceptual abilities.
Superimposed upon the development of perceptual abilities are the apperception’s which we build from our experiences which, in turn, result in conceptualization and the ultimate in reading, which is human conceptual comprehension. The ability to learn to read and the ability to learn to express oneself starts from birth on. If one is not afforded the opportunity to develop this total neurological organization, they cannot become totally human, and as a result, cannot communicate at the level at which they might have been able to, had the neurological organization been complete.
To diagnose our language problems, therefore, we must start at the age at which we first see the child, but we must look back developmentally to the original area of the dysfunction. As a result, it may be that in terms of the diagnosis, some of our children are not well developed at the level of the Pons, some at the level of the mid- brain, some at the level of the cortex and some at the level at cortical hemispheric dominance. If we are to diagnose validly and reliably, we must go through each succeeding stage to assess the mastery of function at each stage.
Treatment must also follow this sequence. In treatment we must go back to the original point of departure from development norms and we must re-create for that brain level and that chronological level, those functions so that the child can go through the proper developmental stages and begin to move on to the establishment of complete neurological organization .In, we must start at the lowest level at which there appears to be a lack of neurological organization and we must give the child the opportunity to master the activities and functions of that level and of each succeeding level until we have mastered complete cortical hemispheric dominance.
Here is now outlined a beginner’s guide to the causes, recognition of, and description of how to overcome the child’s difficulty.
There is an increased risk of mild diffuse brain injury, leading to reading difficulty and learning delay, from, difficult pregnancy, difficult birth procedures, including emergency and elective Caesarian section delivery, and early post natal period up to 6 months.
The child who misses a stage of development i.e. crawling and creeping increases the risk of reading problems and learning delay.
In the event that the parent believes that such an event, like viral or bacterial infections, risk of miscarriage during pregnancy, premature birth, a birth procedure longer than 12 hours or less than 2 hours, has occurred, should be aware of increased risk to the normal development of the child. A Caesarean Section birth, increases risk as this is invariably less than 2 hours.
The next critical stage is at approximately 5 months when the child should start to creep on hands
and knees. In the event that the child wants to start to walk without creeping, the parent should ignore this wish, and encourage the child to creeps on hands and knees for at least 4 months. After which, walking erect is then allowed.
Should you now recognise that you have a problem with your child, then the following rehabilitation can be practised.
For children over the age of 2-3 years and up to the age of 5 years, the following exercises can be carried out.
Each exercise to be carried at least twice a day, for a duration of 2 minutes each exercise, for a minimum of 4 months until you believe your child has improved to your satisfaction
Creeping on hands and knees for at least 4 months.
Rolling the child on a well-carpeted floor or alternatively on the bed up and down. You do the rolling, do not allow the child to do it itself.
Slow controlled spinning in a revolving chair, alternatively rotating 3 times to right and 3 times to left. You spin the child, remember that children spinning and rolling themselves are self-stimulation, you spinning the child is therapy.
Catching and throwing balls, rolling balls, catching after one bounce, catching balloons, chasing bubbles, kicking balls.

Record the preference of which hand the child uses to pick up objects and holds a pencil. If the predominance is right hand, then you will create the brain dominance on the left side of the brain, left-hand preference creates right hand side dominance of the brain.
For the child older than 5 years of age the encouragement of the use of hand, eye, foot, and hearing on one side of the body only, is necessary to create the condition for effective reading and writing.
When you have determined which hand your child prefers to use you can then reinforce this preference to fix the handedness and make your child all one-sided, and achieve hemispherical dominance.
This you can do by ensuring he always uses his preferred hand to write, pick up objects, throw and catch balls.
Next ensure that when he starts to walk from a standing or sitting position, he starts to walk always using his leg which is on the same side as his preferred hand. With ball games roll the ball to the foot you want your child to kick back to you with.
A good exercise for footedness is to stand the child at the bottom of the stairs and have the child place the preferred foot on the first step and then return to normal standing position. Repeat the exercise until this becomes a natural instinct.
To ensure he only uses the correct eye we can use the effect of red/red or red/green filters when the child is writing or reading.
When writing with a red/orange pen/crayon/pencil the words disappear when viewed through a red lens.
Putting a green filter on a page of a book, the words disappear when viewed through red lenses.
To enable the child to use the correct eye, we cover the other eye with a red lens.
The child uses the red lens for 2 minutes twice a day for reading and writing exercises. These exercises continue until you the parent are satisfied that your child has successfully mastered reading and writing.
To complete the handedness and create one- sided dominance in the brain, hearing needs to be addressed. Spend two, five – minute periods each day talking or reading to your child. While sitting on the right side, ask your child to cover the left ear while listening to you. If left- handed, sit on the left side and cover the right ear during listening.
When your child is all one-sided, using eye, ear, hand and foot, on one side of the body only, neurological organisation is complete.
References
1. Department for Education and Skills. "Planning, teaching and assessing the curriculum for pupils with learning difficulties", accessible via www.nc.uk.net/ld/index.html
2."Routes for learning", Crown copyright 2006, reference AC/GM/0612, April 2006,
3.The Origin of Human Movement, presented to the Fourth Annual Institute in Psychiatry and Neurology April 1954 and published in Amer. J. Psychiatry 111:644-652,1955.
4."Using a developmental movement programme to enhance academic skills in grade 1 learners" Fredericks, Kokot, Krog, Teacher Education, University of South Africa, Pretoria, Republic of South Africa. www.ilt.co.za/articles3.html.
5.Summerford, (4) C. (2001). What is the impact of exercise on brain function for academic learning? Teaching Elementary Physical Education, 12(3): 6-8."
6. Kephart (6) (1975), The slow learner in the classroom. Columbus, OH: Merrill,
7 Ayres, (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services.
8. Delacato (1959). The treatment and prevention of reading problems. Springfield, IL: Charles C. Thomas.
9.Delacato (1974). The ultimate stranger, the autistic child. Novato, CA: Academic Therapy.
10.Pica (1998). Movement and the brain: moving and learning in early childhood. Teaching Elementary Physical Education, 9(6): 18-19,
11.De Jager, (2001). Breingim. Kaapstad.
12. Feigley (1990), Should schools eliminate mandating physical education classes? School Administrator, 47(2): 15, 17, 20.
13. Corrie, Barratt-Pugh, (1997). Perceptual-motor programs do not facilitate development: why not play? Australian Journal of Early Childhood, 22(1): 30-36.
14. Kokot,S.J.(2003a). Diagnosing and treating learning disabilities in gifted children: a neurodevelopmental perspective. Gifted Education International 17(1): 42-54.
15.Delacato,Carl Ed.D Ontogeny of Reading Problems, Claremont Reading Conference 1963.
16. Delacato, Doman, Doman "Behaviour, Learning and Mobility, cause and effect of Rehabilitation". Institute of Physical Medical and Rehabilitation, New York in 1953,
17. Carl Delacato" A New Start for the Child with Reading Problems". 1992 Morton Books
18. Dr Guinevere Eden, Georgetown University Medical Center, May 18th on line publication of the journal Nature Neuroscience. www.sciencedaily.com/releases/2003/05/030519083450.htm accessed 19/11/06
19. Dr Mark Wallace Wake Forest University Baptist Medical Centre at the annual meeting of Society for Neuroscience in New Orleans, November 2003 www.sciencedaily.com/releases/2003/11/031110054404.htm accessed 19/11/06
20."Making Sense of the Senses"www.learning-connections.org.uk
21 Retained Inhibitive Reflexes, www.learning-connections.co.uk/2005/12/inhibition-of-primitive-reflexes-to_02.html.
Robin Burn
The Autism Centre
November 2006

Making Sense of the Senses

2006-11-15T09:22:00.000Z

Making Sense of the Senses
"If we do not try to express any psychological or behavioral theory
in terms of neurons, we are unlikely to get to the bottom of the problem."
G.M.EDELMAN
Most autistic children are highly sensitive to changes in the volume of noise. The louder the noise, the harder it gets for the child to tolerate, until the child bursts into tears.
This is caused by a faulty mechanism by which sound is input at the level of the hearing cortex. The first layer of the hearing system in the cerebral cortex consists of neurons that are sensitive to variations in noise levels. The same neurons also distinguish one tone of voice from another: calm or angry. An anatomical or chemical injury to this layer can cause serious disturbances making it difficult to adapt to high frequency sounds.
Human beings can hear sounds between 16 and 16,000 Hz. Clearly as the sound approaches one or other of these extremes it becomes more difficult to listen to the sound, which is either extremely dull or very acute. Brain injured children, including autistic children, have a very low tolerance for high frequency sounds, particularly if the noise is also loud.
Autistic children do not tolerate high frequency sounds but love low sounds, like whispering.
A very quiet and unruffled environment can put a stop to a whole range of strange behavior, such as hiding under the table, staying under water for long periods, sleeping with a blanket over the head, fingers in the ears, making a continuous even sound, staying in the corner of the room. Many autistic children like the corners of rooms because they feel protected against sounds.
The cheek color of autistic children changes very often. Sometimes in the course of a single day they can go from a healthy red to pale gray, particularly around the eyes. This is a symptom of great suffering.
The color changes when the noise level becomes intolerable, but this level is very low for autistic children, since they are hypersensitive to sounds. When the noise level is intolerable the child begins to behave in one of the ways described earlier (hiding under the table, fingers in the ears, etc.). If the level of intolerability is very high the child uses a different mechanism that is even more effective: he becomes pale and cuts himself off from the rest of the world. Even very loud noises no longer penetrate. Call him and nothing happens. It is as though he has suddenly gone deaf. The only way to get the child to come back into the world is to whisper something in his ear. The sound is very low, so there is no need for the nervous system to maintain a high level of defense. A low sound allows the child to lower his defenses and enables him to let sounds back in.
If the child is the source of the sound, or knows that the sound will come, the nervous system gets itself ready and copes with the noise, but if the noise comes suddenly and unexpectedly the child cannot cope and, as it were, shuts down.
A child screaming also makes perfect sense. Often autistic children react in this way to show their suffering or try to use their own voice, an instrument with which they are familiar.
Switching on the TV or staring at the washing machine as it turns and tumbles are familiar traits of behavior in autistic children with an impaired sound pathway. They use this sound, which they themselves provoke, to focus on and drown out all other noises.
For many years very little hope was held out for autistic children in terms of speech ability. But nowadays we know much more about the neurological basis of speech abilities.
Antonio and Hanna Damasio have carried out very interesting studies in this area. They and their team have investigated three different neural structures related to speech. The first structure consists of a large number of neurons in both the right and left hemispheres; these neurons process sensorial inputs. The second structure consists of a numerically smaller number of neurons located mainly in the left hemisphere; these neurons are used for the recognition of phonemes, the combination of phonemes and an understanding of syntax. The neurons of the third structure are also in the left hemisphere; these mediate between the other two. For example, if you want to say a color, the neurons of the third structure place the neurons of the other two structures in communication. The first structure contains the visual sensation of the color and the second the phonemes to pronounce the word. In other words, the memory must contain the correct phonemes and the correct sensory experience. If someone does not have the visual apparatus to perceive colors, forms or movements correctly, the concept of color, form and motion will be lacking, and hence the words relating to these things will also be lacking.
Defective perception becomes defective language and unfortunately autistic children are seriously affected by defects in sight, hearing, touch, taste and smell.
If we just think back to the example of a child hyper auditory, it is not difficult to understand the problems the child has in acquiring the proper use of language.
We know that the first layer of the hearing cortex controls the volume of sounds. The second layer is used to distinguish a series of sounds, their pitch and rhythm.
The second layer enables us to understand speech. Every spoken word has two elements: volume and rhythm. The first layer of the cortex receives the sound of the word and distinguishes the volume; the second captures the rhythm. The result is that the word can be memorized and learned. The pathway is obligatory from the first to the second layer. The first layer filters sounds, especially volume, that reach the second layer and hence influences its structure. If the first layer does not carry out its filtering function properly, the second layer slows its activity and is unable to distinguish the rhythm of words and hence to distinguish and understand spoken words.
Autistic children are often unable to control the volume of the sounds they hear, although there are many different forms of this disability. In some cases the difficulty is so severe that no sounds reach the second layer; the child is "acting deaf." In such cases the second layer is deprived of information and proper linguistic abilities are impossible. If the sensitivity to differences in volume is less pronounced, sounds do reach the second layer and hence the child is able to make certain distinctions between words. Speech is by no means perfect but the child is often able to repeat some words or to make sounds that are similar to words. If the dysfunction is quite small, the second layer is able to carry out its functions properly and in this case the autistic child acquires superior language abilities compared to the norm. If impairment of a sensory pathway is only slight, the child develops special mechanisms to offset the disturbance, and may be able, for example, to learn an entire telephone book by heart, finish a complicated jigsaw puzzle in a few minutes or reproduce a drawing at sight, and so on. Sometimes these abilities reach extraordinary heights but the other disabilities of the child are generally so severe that the child is not independent.
Children are able to juggle objects, defy gravity. But what was most astonishing is the fact that they seemed to pay no attention whatsoever to what he was doing during these moments. Their eyes are elsewhere. Children spend hours in this way, sometimes throwing things across the room or from the balcony, or leaving them neatly arranged at the edge of the table.
It is amazing the deceptive nature of the behavior of autistic children. That way of looking askance at things was not a sign of lack of interest, but the only way children could actually see things. By looking out of the corner of their eyes they perceived the object. The juggling act was actually a way of focusing on it, seeing it better.
For many autistic children the only way they can see is to move their heads sideways and look out of the corner of the eye.
The visual apparatus of human beings is quite complex: essentially it involves breaking elements down into separate entities and then recomposing the picture as it was. Of course we are not aware that this is what we do. Every time we look at an object, a person, the scenery, a group of people, neurons analyze color, form, depth and motion. The neurons that recognize color are all located in one area of the brain, and so on, for other functions.
There are five such vision areas in the brain that for simplicity’s sake we can call V1, V2, V3, V4 and V5.
The first area, V1, is also known as the layered or primary area. This area receives the images falling on the retina. These images are then passed to V2, which links up to the other areas making up the area of associative vision, or the pre-layered cortex.
Area V3 receives information from V1 and V2 concerning form. Areas V4 and V5 also receive information from V1 and V2, but V4 concerns form and color. While V5 concerns depth and movement.
Once V3, V4 and V5 have done their jobs, the message is sent back to V1 and V2 along pathways that integrate the information, so the image is recomposed.
It is as if the elements of a picture were poured into a funnel. Everything goes through the neck of the funnel and mixes together: color, form, depth and movement.
In order to see the world normally these areas must be perfectly balanced; any imbalance can cause distorted vision.
Serious damage in the V1 and V2 areas causes total blindness while damage in the pre-layered area (V3, V4 and V5) causes difficulties in perceiving form.
One of the world’s leading experts on vision in human beings, Semir Zeki, has noticed that people with brain injury in the pre-layered area, who therefore have difficulty identifying forms, tend to rotate their heads in order to create movement, or prefer objects which move such as objects seen on television.
Typical behavior of autistic children is to tilt the head in order to look at things out of the corner of the eye. Another is to frenetically rock or rotate an object, or to watch television programs featuring things in rapid motion, such as the list of characters, actors and crew at the end of a film. They also like to see the same scene of a cartoon over and over again, or watch quiz shows like "The Price is Right" or "Wheel of Fortune."
A lot of evidence concerning autistic children points to injury of the pre-layered cortex. This is not necessarily wrong, but there is also evidence of other types of disturbance such as the inability to distinguish between similar images, or to see small things on an object’s surface or to remember a visual experience such as scenery or the route along a road.
It is therefore more correct to say that autistic children process visual inputs differently. This different perception may be associated with injury in the occipital lobe (the area related to vision) and may involve one or more areas of vision.
A slight but widespread injury at an early age may not have serious immediate consequences but certainly alters the neurological organization of the central nervous system. To make things simpler we could say that the brain of a newborn child is like a building site where the engineer is running things. An injury is like a construction event that won’t change the scaffolding but causes all of the engineer’s orders to be carried out slightly wrong, with consequences that may make the building unsteady or unusable. It is as if the engineer were speaking a slightly different language from the builders following his orders. The inputs are skewed, making the building out of shape. The neurons—the builders in our metaphor—simply carry out orders as best they can, building things the way they seem to have been told. The result in autistic children is a series of neurological maps that don’t correspond with the real world, giving rise to antisocial and unusual behavior.
In the case of vision, only V1 has an efficient neurological organization at birth. This means that the baby uses this area immediately in order to see. But it also means that this area is the most exposed to injury during pregnancy.
In addition, the primary visual cortex is just like the engineer on the building site: all other areas of vision are organized by V1 despite the fact that the messages go through V2. If the orders coming from V1 are in this rather odd language the rest of the visual apparatus is built wrong.
Lack of perception of color could be caused by injury to the specific area dealing with color perception (V4) or to the primary visual cortex (V1) failing to give the right messages to V4. If the only defect in vision were the perception of color, it would probably be correct to assume the injury has occurred in V4. But autistic children generally have many defects of vision, so it is far more likely that V1 has been injured and the entire language of the engineer is off-cue. Usually V4 is unlikely to be injured since autistic children generally receive injury during pregnancy or in the first few months of life, and V4 practically does not exist at this time.
So the hypothesis is that autistic children receive injury to V1 before or just after birth. Now we need to explain how this determines their behavior.
Let us recap what we know about the primary visual cortex: first, it works from birth. Second, it receives all visual inputs. Third, it communicates with all other areas. Fourth, serious injury causes total blindness.
Now we can go backward over these points. Autistic children are very rarely blind Usually their injury is not severe. The layered visual cortex (V1) sends information to all other areas, determining the way in which these areas develop. In order to do this, the neurons in V1 must be able to recognize each visual input and understand where to send it. The nerve cells in V1 that recognize a stimulus are contained in the layer. Nerve cells responding to movement are found in sub-layer IV c a , the cells recognizing forms in sub-layer IV c b and other cells responding to color and spatial orientation in layers II and III.
The presence of nerve cells responding to all types of visual stimulus in, V1 means, this area of the brain is independent. In other words, with this area alone we can perceive forms, colors and movement. But this does not make for proper vision. We would find it difficult to focus on nearby objects, would see few differences in color and would only be able to see the outline of an object by moving it. We would see like a newborn child who only has the V1 area of the brain available for seeing. But in the case of a newborn child, vision improves as the functions of the pre-layered cortex come into play.
The pre-layered cortex receives its orders from V1, which is organized in layers, each one responding to a particular stimulus and each transmitting input to other areas. The nerve cells in these areas activate a series of synapses that excite and inhibit, forming a kind of circuitry.
One of the circuits called the magnocellular circuit, transports information concerning depth and movement. Another called the parvicellular circuit, transports information concerning form and color.
The magnocellular circuit starts with some rather large ganglial cells (hence the name) connected to cells on the retina that recognize movement. The signal is then projected onto the V1 sub-layer IV Cc a , where spiny star-shaped nerve cells respond to the stimulus, activating an exciter synapse. The message processed by these cells is then transmitted via V2 to V5 where specialist neurons further analyze the message.
The parvicellular circuit starts with some rather small ganglial cells (hence the name) connected to cells on the retina that recognize form and color. The signal related to form is projected to the sub-layer of V1, IV c b , and to some cells in layers II and III where the remaining cells respond only to color. The messages processed by these sub-layers are sent to V3 and V4 respectively.
The cells contained in sub-layer IVC b are exciters, but those in layers II and III excite a group of cells contained in layer VI of V1—smooth star-shaped nerve cells—which inhibit and modulate the effect of exciter cells. Two observations can be made at this point. The first is that the pathway carrying messages about movement and the pathway carrying a message about color and form are completely separate. The second observation concerns the nature of some cells in V1: they are generally exciter cells but are regulated by inhibitor cells. The message that is finally sent back to V1 is the result of the balance between these two types of cells.
If the pathways are separate, one may be injured without affecting the other. For example the parvicellular circuit may be damaged but the magnocellular circuit may be intact.
This is probably what occurs in autistic children.
The magnocellular circuit is the first to develop; the receptors or rods at the edge of the retina develop and detect movement. The ganglial cells creating the magnocellular circuit start from there. Autistic children seem to be able to detect movement perfectly well, almost too well. So it is unlikely that this circuit has been damaged. It is more probable that the processing of the image in the parvicellular circuit is affected.
The balance between inhibitor and exciter cells is very delicate. A slight injury to the visual cortex can have serious consequences. For example, if these cells are not perfectly balanced, the information processed in sub-layer IV c b and in layers II and III concerning the form and outline of objects, affects perception. The alteration is transmitted to V3, which then works on faulty input. It may be that V3 receives excessively detailed information about parts of an object, without providing the outline, so that the child is bombarded with information about single parts of objects without perceiving them as wholes. Autistic children with this vision defect recognize people not from their faces but by the shape of their ears or their shoes. They are also able to notice tiny changes in two almost identical figures and to reproduce images effortlessly. They can do jigsaw puzzles at a very astonishing speed and notice a tiny crumb on the floor.
Conversely, the effect of imbalance between inhibitor and exciter cells in the parvicellular circuit, may also send too little information to V3, so shapes are indefinite. Autistic children of this sort need to use special strategies to distinguish shapes.
It is well known that to distinguish the outline of an object motion is helpful. Autistic children are masters of this. Similarly, a child may place things along the edge of a table in order to make the edge clearer or touch things with the tips of the fingers. Another method is to create strong color contrasts. The way children played with saliva in front of the window was a way of creating light contrasts. With hands shade is created that fell over the eyes; the saliva had a prismatic effect, separating colors.
The way children continuously move their hands is a torment for parents. Even if they kept hands relatively still, they continue playing with things around him—a pen, a piece of paper, a leaf, to rock in front of their eyes.

Autistic children have problems perceiving depth. Every time they come close to a carpet they seem to raise their feet as though they were about to climb onto a step A lack of depth perception, i.e. the inability to see how far away things are, creates enormous difficulties. It is like walking in mid-air, without having any idea of how far away the floor or the wall is. It makes stairs difficult to climb and the ceiling appearing to fall. Children with this difficulty often trip over colors and designs.
One of the consequences of this problem is that in large open spaces autistic children often scream in order to receive an echo and calculate the distance to the walls. Or they throw things to see when they impact with the wall.
Our sense of depth is a complex process that requires the combination of information from both eyes. The information is sent from V1 to V5 but it would be mistaken to think that V5 is the area where the information is definitively processed. Depth information has nothing to do with objects in motion. On the contrary, it often requires the use of a distant, stationary object. An injury to the primary visual area means that all information coming from this area may be erroneous, particularly if the sensory input comes from a stationary object. Therefore the correct sense of depth is one of the most common difficulties.
Mothers try to hug her child and the child moves away as if irritated. Over the years many psychologists have investigated this problem and have come up with a number of theories, none of them satisfactory. These theories are usually based on a conflicted relationship between mother and child and have never had any scientific basis. For years, mistaken diagnoses were made on the basis of these theories and treatments often damaged the child and parents more than the illness itself.
This was happening to children and families at the same time that the world’s libraries were filling up with books dedicated to the physiology of the nervous system and the processes of responding to sensory stimuli. It would have been sufficient to read practically any one of them to come to a different conclusion. For any human being the sense of touch is intimately associated with survival. Hence the neurological organization governing the sensory pathway for touch is particularly sophisticated.
This neurological organization helps us to distinguish between light touches and harder contacts, and to feel heat. This is made possible by an inhibitory system for tactile sensations, that filter some out. It is like turning on a radio and looking for a particular station. When you first switch the radio on you cannot distinguish between all the messages arriving; it’s just noise. By turning the tuning knob one message emerges stronger than the others and then entirely replaces the previous noise. This is how the neurological organization of tactile inputs works, by choosing one sensation and removing others. Every day we are bombarded with tactile sensation—the touch of clothes against the skin, the feel of a wristwatch, and so on. All of these signals would lead to total confusion if we were not able to "tune in" to one sensation or another. The inhibitory system is exactly this form of tuning in to one signal. We use it to gain tactile information about the world around us.
Tactile information travels along pathways—nerve fibers—that go from the extremities to the center and vice versa. The nerve fibers that carry information about light touches do not carry information about heat or harder contacts; these are carried by other nerve fibers. It is like a three-lane highway where the traffic moves in parallel to the same destination.
In order to enable us to distinguish between one type of tactile sensation and another, groups of receptors on the skin carry out different activities. Some receptors are excited only by very light touches, others only by heat and still others only by deeper contacts.
When we are affected by heat, our heat receptors pick up the information but other receptors are not stimulated since they cannot read this type of input. In other words each type of receptor only picks up signals of a certain type, and is unaffected by other types of signals. We can see that the receptors are specialists, making the tactile sensory pathway extremely efficient.
When the light-touch receptor picks up information it transmits the stimulus along the correct pathway, heat receptors along the heat pathway and so on. The three types of nerve fiber carry only one type of information.
Draw a circle on the palm of your hand then try to stimulate the center of the circle with a paintbrush. In this way you are stimulating only the sensors of light touch. All the other receptors in the circle have been inactive because they cannot read the stimulus. If you then take a pin and prick the center of the circle, the receptors of harsh sensation come into play and the sensors of light touch remain inactive. If you then touch the palm of your hand with an ice cube the receptors of heat will be excited but no others.
The three pathways transmit only one type of information to the cortex, which does not accept the signal as it is, but tends to modify it. The basic function of the cerebral cortex is to receive all inputs from the outside world and to put them together into one message. To do this it inhibits certain inputs, as in the example above.
Inhibition of tactile messages takes place in the bulb and thalamus where exciter and inhibitor neurons are distributed—as in the case of all sensory pathways—with exciter neurons at the center and the inhibitor neurons at the extremities of these brain areas. The part of the input that reaches the center is transmitted to the next nucleus. The part that hits the edge is inhibited. The closer to the edge the impulse is received, the stronger the inhibition. The next nucleus receives only the portion of the input that hits the center. The pathway hands on the message from nucleus to nucleus in this way until the input finally reaches the cerebral cortex.
All sensorial pathways—sight, sound, touch, taste and smell—have inhibitors. In the case of touch there are three types of inhibitors because there are three pathways and three types of input: light touch, deep contact and heat.
If the cerebral cortex controls the inhibition process properly, there is no problem. But if the cerebral cortex has been injured, this control function is impaired and the balance between exciter and inhibitor receptors is thrown askew. Essentially three types of dysfunction result: the nucleus may transmit too much information to the next nucleus by not inhibiting the input at the edge. This nucleus in turn passes on too much information so it finally reaches the cerebral cortex in too intense a form. This is called hyperactivity. Alternatively the nucleus may inhibit too much of the stimulus at the edge and in the center. In this case the stimulus is overinhibited, leading to hypoactivity.
The third type of dysfunction is called "white noise" and involves the addition of impurities in the input. Inputs are regulated by exciter and inhibitor receptors. White noise occurs when the inhibitor receptors, instead of filtering out an input, actually contribute to it so the message that reaches the cerebral cortex is not a message derived entirely from the outside world but has been polluted along the way by inhibitor receptors.
Autistic children can be diagnosed for hyper or hypo vision, hearing, touch, taste and smell or for white noise in any of these sensory pathways.
For the tactile pathway things are a little more complicated. To say that an autistic child has hyper or hypo tactile activity or white noise in the tactile pathway means nothing at all. If the type of pathway is not specified, the statement makes no sense. It may be that the child has hyperactivity of light touch, and/or hypo activity of deep touch. In other words the diagnosis is meaningful only if related to one or more of the three tactile pathways.
For example, how can you understand which tactile pathway is affected? Why does behavior often seem contradictory? Why does a child not like to be hugged but then go off and bite his own hand?
I managed to reply that close observation of an autistic child shows what the child constantly refuses and what he or she constantly looks for. The analysis of this behavior leads to a correct diagnosis of tactile disorders.
The search for strong stimuli such as beating the knees against the floor or the head against a wall, or biting the hand, would seem to indicate hypo activity of deep tactile feeling. Conversely, the inability to accept a caress or hug, or the touch of clothes on the skin (particularly socks, shoes, caps and glasses), or difficulty taking a shower, brushing one’s teeth, or combing one’s hair, suggest hyperactivity of light touch.
Hypoactivity at the deep tactile level combined with hyperactivity at the surface level occurs in 90% of cases of autism; this means the child has areas of the body, such as the soles of the feet, which are hypersensitive but at a deep level virtually insensitive. A child with this disturbance often walks barefoot or on the tips of the toes to reduce contact with the floor. But if he is forced to wear rather rigid shoes or to walk over a cobbled surface he cannot walk on tiptoes or go barefoot so he marches, slamming his feet down onto the surface in order to look for deep tactile feeling.
Hypo tactile children bite their wrists. The way to stop them biting their wrist was to massage it very firmly, replacing the search for deep tactile feeling with another stimulus. But the problem is not just hyposensitivity of the wrist. The pressure of teeth also fails to stimulate sensation, so there is a problem of hypoactivity in the mouth too.
There are other signs of this hypoactivity, children, they can eat almost the entire packet of biscuits in one mouthful. This is common in children who suffer from hypotactile sensitivity inside the mouth. Not only do they bite themselves and things in their grasp, they often eat in this way because it is the only way that they can feel what they are eating. Conversely, a child who finds it difficult to eat even soft foods, or is very sensitive to the temperature of food, or prefers eating very small mouthfuls has the opposite problem: hypersensitivity.
If the choice is based on a tactile experience (soft, crunchy) then the problem is one of feeling; if the choice is based on taste (sweet, sour, acidic, salty) then the problem is based on taste. The stronger the taste, including detergents, soil, stools and other inedible substances, the more likely the child is to be suffering from hypo taste. Hyper taste tends to lead to a choice of almost tasteless food.
But smell also plays a part in the choice of food. A disturbance to the sense of smell also determines other types of behavior, such as the child dirtying himself with excrement or rubbing saliva over his body or over things around him in order to produce an acrid smell that he can recognize.
Hyper smell can cause the child to vomit every time he smells something strong; he may also have trouble urinating or defecating because of the smell.
The control of the sphincter requires a separate discussion. A disturbed sense of smell clearly plays an important role, but other elements come into play. First of all, tactile sensation is important since these activities involve the sense of feeling. Urinating and defecating stimulate a large number of tactile sensations and a child with hyperactive surface feeling may actually feel pain and therefore not want to go to the bathroom. But not only surface feeling is involved. The toilet seat is often colder than the body temperature so a child with hyperactive feeling in relation to temperature may be disturbed. This type of child will have difficulty with potty training and will want to use nappies to maintain the temperature of the genitals.
Another factor contributing to problems urinating and defecating is related to sight. Boys often find it difficult to judge the distance and depth of the toilet and are afraid they might fall in.
Children often can’t reach the floor when they sit on a toilet and this for autistic children can cause a loss of balance that terrifies them. Sometimes it is sufficient to place something under the child’s feet—even a pile of books—to overcome this problem.
A child with hypoactive activity in the area of deep sensation tries to stimulate deep feeling with harsh impacts, such as falling, or by biting or touching parts of the body in contact with mucous, such as the nostrils, ears, eyes and genitals. They are not trying to find sexual pleasure but sensation pure and simple.
Axons (extensions of neurons) are located at the level of joints, muscles and tendons. They communicate the slightest muscle or tendon contraction and the slightest change in the angle of the joint. This enables us to understand where we are in relation to space. In other words, part of our perception of the world is our perception of ourselves within it. The inputs from muscles, tendons and joints travel along neural pathways that are adjacent to those of deep tactile sensation, so an injury impairing one pathway may also produce a dysfunction in the adjacent pathway.
Hypo tactile children have an imprecise notion of themselves in the deep feeling pathway. If you ask them to touch their nose they may touch their ears. Body contortions are quite common. An imprecise notion of one’s body means it is difficult for the autistic child to draw the human body. Autistic children generally draw the human body with massive distortions between the body and legs or the hands and head. The size of the hands or head in the drawing often corresponds to the perception the child has of that part of his body. All tests related to the interpretation of drawings should bear this in mind; otherwise the results would have no scientific foundation.
Emotions are influenced by environmental and cultural factors.
A man raised in a mountain district finds the peaks of mountains more breathtaking than the view of the sea. A sailor has a different relation to the sea than others, who have not been to sea. Their emotions are influenced by their experience. Education also has a bearing on feelings. An opera lover does not respond to jazz in the same way that a jazz fan does. The environment, culture, and education are all strong factors in our everyday emotions. But they are nothing if the perception of the outside world is incorrect.
How would we experience a sunset if we suddenly went color-blind? Our sense of the importance of color would change. Our relationship to beauty would no longer be the same. And if we had never perceived colors huge parts of popular culture related to sunsets would be lost on us.
What if we had no sense of smell? Any defect in sensory perception changes emotional capability.
But how is this possible? Aren’t emotions intimate and unique, the product of the individual mind? How can they just be the result of perception?"
Maybe the thought is not comforting, but the fact remains that they are the result of perception. Human beings are culturally inclined to think of emotions as inscrutable and private. Religion, some philosophical thought, and some psychology tend to encourage this view. But it is based on erroneous thinking. Human emotions are the product of culture, tradition and the environment because they are transformed into sensory inputs; they are perceptions. A faulty sensory mechanism precludes the proper development of emotions. This might seem rather cold, but neuroscience has proven this conclusion, and other religious and psychosocial theories—which we might feel drawn to for a number of reasons—have proven to have no scientific basis..
If the sensory mechanisms could be retrained and corrected, behavior would improve and the emotions would evolve.
Nothing is worse for a parent than to be told that nothing can be done, that it would be better to put their energies into their other children or, worse, to seek psychiatric help.

Making Sense of the Senses based on extract from publication "Children who do not look you in the eye, The Secrets of Autistic Behaviour"
Authors Dr. Antonio Parisi MD and Anna Lisa Buonomo.
With kind permission of the authors.

Robin Burn
The Autism Centre
May 2006

The Treatment of Neurologically Impaired Children Using Patterning

2006-10-22T11:24:00.000+01:00

The Treatment of Neurologically Impaired Children Using Patterning
Movement Therapy
Sensory Integration Therapy for Neurological Rehabilitation using Movement Therapy in the school environment.
The basis of a movement therapy programme being used in school environments dedicated to the education of special needs children has been established within the Westminster Governments’ Department for Education and Skills.
In their document "Planning, teaching and assessing the curriculum for pupils with learning difficulties", accessible via www.nc.uk.net/ld/index.html they offer the following guidance;
Physical education; Opportunities at Key Stage 1
Much of the programme of study at Key Stage 1 is relevant to pupils with learning difficulties. With modification, it can provide stimulating and challenging learning opportunities. All pupils can contribute in group work with others at their own level of ability.
The document suggests pupils explore basic body movements and actions using different parts of their bodies. To acquire and develope skills, suggesting, crawling, sliding, rolling, moving backwards and forwards. To select and apply skills, tactics and compositional ideas, be helped to follow and respond to simple instructions for example stop and start.
At Key stage 2, the document suggests listening and responding to action words, for example, walking, marching on the spot. Suggesting, as part of games activities, ball games, catching, throwing, on the floor foot skills of passing, dribbling. Throwing and catching bean bags, all as part of hand eye coordination programme, to develop binocular vision.
The Welsh Assembly Government, in their recently published guidance document "Routes for learning", Crown copyright 2006, reference AC/GM/0612, April 2006, affirms that, "This guidance document, written to support the use of the Routes for Learning materials, offers an overview of the main theories and background information, underpinning the effective teaching and assessment of learners with profound, and Multiple Learning Difficulties". In the Additional Guidance section, the document suggests that therapies, including movement therapy, and occupational therapy to address sensory impairment, could be included in the curriculum design. The rationale for this is explained in the premise that inhibiting factors in the student’s ability to learn is irrefutably connected to sensory impairments exhibited by students with learning delay. The document outlines the reasons for the sensory impairments linked to retained inhibitive reflexes. Addressing these inhibitive reflexes being the key to improved learning ability.
It is essential to recognise that the physical exercise components of the DfES document, and movement therapy in the Welsh Document are the core elements of Delacato Therapy, evolved from the ideas of neurologist Dr Temple Fay and propounded in his paper The Origin of Human Movement, presented to the Fourth Annual Institute in Psychiatry and Neurology April 1954 and published in Amer. J. Psychiatry 111:644-652,1955.
In the published work "Using a developmental movement programme to enhance academic skills in grade 1 learners" Fredericks, Kokot, Krog, Teacher Education, University of South Africa, Pretoria, Republic of South Africa, describe the outcomes of a rigorous experimental programme to associate the benefits of physical exercise movement to cognitive learning and academic skills and investigate the efficacy of a movement programme on the academic skills of early learners
In their opinion " The results of the pre-testing and post-testing indicate that the learners of the experimental group showed a significant improvement in spatial development as well as in reading and mathematical skills, compared to the learners in the control group, free-play group and educational toys group".
In support of the rationale behind their experimental programme, the authors cite Summerford, C. (2001). What is the impact of exercise on brain function for academic learning? Teaching Elementary Physical Education, 12(3): 6-8." that physical education is often seen as a frill, and has been discontinued in many South African schools, which might be a misguided kind of thinking "
The authors, drawing on the works of Kephart, (1975). The slow learner in the classroom. Columbus, OH: Merrill, Ayres, (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services. Delacato, (1959). The treatment and prevention of reading problems. Springfield, IL: Charles C. Thomas. . (1974). The ultimate stranger, the autistic child. Novato, CA: Academic Therapy, and the recent works, brain research of Pica, (1998). Movement and the brain: moving and learning in early childhood. Teaching Elementary Physical Education, 9(6): 18-19, De Jager, (2001). Breingim. Kaapstad: Human & Rousseau, and others suggest, "in effect, that the body, as a sensory-motor response system, causes the brain to learn and thus to organise itself ".
The premise that movement (physical education programmes) is the sole mechanism for effective remedial action has to be viewed with caution. Feigley, (1990), Should schools eliminate mandating physical education classes? School Administrator, 47(2): 15, 17, 20.proposes that physical education programmes need to more than mere physical fitness regimes. Likewise according Fredericks et al, Corrie and Barratt-Pugh, (1997). Perceptual-motor programs do not facilitate development: why not play? Australian Journal of Early Childhood, 22(1): 30-36, report on studies showing that certain perceptual motor training was not an effective intervention technique for academic cognitive or perceptual-motor variables. The results show little effect in any developmental domain, even on children's gross motor skills. Furthermore, the programmes made little difference to the reading, arithmetic, language or spelling of children with learning difficulties or of normally developing children. However, even though it may initially seem that Corrie and Barratt-Pugh) do not accept the theory that movement leads to learning, they do state that it is not the importance of perceptual-motor development that is disputed, but the way of supporting and facilitating that development that is critical.
According to the authors Fredericks et, al a sensori-motor movement programme should be aimed at the root cause of learning difficulties. On the basis that vestibular, proprioceptive, tactile visual and or auditory systems are dysfunctional, the child will fail in its attempts at academic work. Kokot,S.J. (2003a). Diagnosing and treating learning disabilities in gifted children: a neurodevelopmental perspective. Gifted Education International 17(1): 42-54.
To read the full transcript of the study carried out by the University of South Africa, visit web site www.ilt.co.za/articles3.html.

Movement for Development

2006-10-06T14:24:00.000+01:00

Movement for Development
Sensory Integration Therapy for Neurological Rehabilitation using Movement Therapy in the school environment.
The basis of a movement therapy programme being used in school environments dedicated to the education of special needs children has been established within the Westminster Governments’ Department for Education and Skills.
In their document "Planning, teaching and assessing the curriculum for pupils with learning difficulties", accessible via www.nc.uk.net/ld/index.html they offer the following guidance;
Physical education; Opportunities at Key Stage 1
Much of the programme of study at Key Stage 1 is relevant to pupils with learning difficulties. With modification, it can provide stimulating and challenging learning opportunities. All pupils can contribute in group work with others at their own level of ability.
The document suggests pupils explore basic body movements and actions using different parts of their bodies. To acquire and develope skills, suggesting, crawling, sliding, rolling, moving backwards and forwards. To select and apply skills, tactics and compositional ideas, be helped to follow and respond to simple instructions for example stop and start.
At Key stage 2, the document suggests listening and responding to action words, for example, walking, marching on the spot. Suggesting, as part of games activities, ball games, catching, throwing, on the floor foot skills of passing, dribbling. Throwing and catching bean bags, all as part of hand eye coordination programme, to develop binocular vision.
The Welsh Assembly Government, in their recently published guidance document "Routes for learning", Crown copyright 2006, reference AC/GM/0612, April 2006, affirms that, "This guidance document, written to support the use of the Routes for Learning materials, offers an overview of the main theories and background information, underpinning the effective teaching and assessment of learners with profound, and Multiple Learning Difficulties". In the Additional Guidance section, the document suggests that therapies, including movement therapy, and occupational therapy to address sensory impairment, could be included in the curriculum design. The rationale for this is explained in the premise that inhibiting factors in the student’s ability to learn is irrefutably connected to sensory impairments exhibited by students with learning delay. The document outlines the reasons for the sensory impairments linked to retained inhibitive reflexes. Addressing these inhibitive reflexes being the key to improved learning ability .
In the published work "Using a developmental movement programme to enhance academic skills in grade 1 learners" Fredericks, Kokot, Krog, Teacher Education, University of South Africa, Pretoria, Republic of South Africa, describe the outcomes of a rigorous experimental programme to associate the benefits of physical exercise movement to cognitive learning and academic skills and investigate the efficacy of a movement programme on the academic skills of early learners
In their opinion " The results of the pre-testing and post-testing indicate that the learners of the experimental group showed a significant improvement in spatial development as well as in reading and mathematical skills, compared to the learners in the control group, free-play group and educational toys group".
In support of the rationale behind their experimental programme, the authors cite Summerford, C. (2001). What is the impact of exercise on brain function for academic learning? Teaching Elementary Physical Education, 12(3): 6-8." that physical education is often seen as a frill, and has been discontinued in many South African schools, which might be a misguided kind of thinking "
The authors, drawing on the works of Kephart, (1975). The slow learner in the classroom. Columbus, OH: Merrill, Ayres, (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services. Delacato, (1959). The treatment and prevention of reading problems. Springfield, IL: Charles C. Thomas. . (1974). The ultimate stranger, the autistic child. Novato, CA: Academic Therapy, and the recent works, brain research of Pica, (1998). Movement and the brain: moving and learning in early childhood. Teaching Elementary Physical Education, 9(6): 18-19, De Jager, (2001). Breingim. Kaapstad: Human & Rousseau, and others suggest, "in effect, that the body, as a sensory-motor response system, causes the brain to learn and thus to organise itself ".
The premise that movement (physical education programmes) is the sole mechanism for effective remedial action has to be viewed with caution. Feigley, (1990), Should schools eliminate mandating physical education classes? School Administrator, 47(2): 15, 17, 20.proposes that physical education programmes need to more than mere physical fitness regimes. Likewise according Fredericks et al, Corrie and Barratt-Pugh, (1997). Perceptual-motor programs do not facilitate development: why not play? Australian Journal of Early Childhood, 22(1): 30-36, report on studies showing that certain perceptual motor training was not an effective intervention technique for academic cognitive or perceptual-motor variables. The results show little effect in any developmental domain, even on children's gross motor skills. Furthermore, the programmes made little difference to the reading, arithmetic, language or spelling of children with learning difficulties or of normally developing children. However, even though it may initially seem that Corrie and Barratt-Pugh) do not accept the theory that movement leads to learning, they do state that it is not the importance of perceptual-motor development that is disputed, but the way of supporting and facilitating that development that is critical.
According to the authors Fredericks et, al a sensori-motor movement programme should be aimed at the root cause of learning difficulties. On the basis that vestibular, proprioceptive, tactile visual and or auditory systems are dysfunctional, the child will fail in its attempts at academic work. Kokot,S.J. (2003a). Diagnosing and treating learning disabilities in gifted children: a neurodevelopmental perspective. Gifted Education International 17(1): 42-54.
To read the full transcript of the study carried out by the University of South Africa, visit web site www.ilt.co.za/articles3.html.
Sensory Impairment
"It must be considered as a basic principal that, when a lesion exists within the confines of the brain, treatment to be successful must be directed at the brain, wherein lies the cause, rather than to that portion of the periphery where the symptoms are reflected. Whether the symptoms exist in an almost undetectable subtlety in human communication or in an overwhelming paralysis, this principal must not be violated by those who seek success with the brain-injured patient", 1953, Delacato, Doman et al, presentation, New York Institute of Physical Medicine and Rehabilitation.
Today, we accept without question, the presence of abnormalities affecting the Central Nervous System (CNS) of individuals exhibiting behavioural, learning and mobility problems, after a mild diffuse brain injury.
For an in depth explaination of the effect of lesions that affect the different parts of the cortex and thus have an influence on speech, language, vision, reading and writing ability, a presentation entitled Higher Cortical Function, Language, and Cerebral Lateralisation is published on a web site emanating from the University of San Francisco via its web site http://Keck.ucsf/physio/courses/p122hcf.htm.
In 2001 The American Academy of Neurology (AAN) published in its Journal " Neurology" October 9th issue, a study undertaken by the PET Center at Children’s Hospital of Michigan in Detroit on 26 children with tuberous sclerosis complex (TSC). Researchers used MRI and PET examinations to study how brain lesions resulted in common behaviours of autism, including difficulties in social interaction and communication and narrow and repetitive stereotyped behaviour. They found that more than one area of the
brain was responsible for autistic behaviour in children with brain lesions, and that autism results from a complex combination of events in different parts of the brain, rather from one single source.
In Feb 2002 the AAN published a report of a study carried out at the Medical College of Georgia, using computerized imaging in the frontal, and temporal lobes of autistic patients, and observed minicolumnar abnormalities. A minicolumn is a basic organizational unit of brain cells and connective wiring, allowing an individual to take in information process it and respond. Thus any changes in size shape or location of the minicolumn will have an effect on the processing capacity of the brain.
The principals of the relationships between the senses, hearing, seeing, touching, which are referred to as the ‘in" channels which have a direct effect on brain development and the "out" channels of mobility, speech and hand use, which depended on the "in" channels have been established. It has been shown that a lack of opportunity for development for any of those channels, had an effect upon the development of the others, and as such showed the way in which integration of the senses into a therapy, that overcame the brain injury and lack of development opportunity.
Increased interaction produces increased development and decreased interaction results in decreased development. This interaction, which is prerequisite to development, is also a prerequisite to learning.
The brain interacts with its environment through a cybernetic loop, which begins in the environment, follows afferent or sensory pathways to the brain and then efferent or motor pathways from the brain back to the environment. Thus the environment as it reaches the brain through the sensory pathways, is the primary prerequisite for the development of the CNS, and consequently for learning. Any changes that occur which have a direct effect of the CNS to function effectively with the environment, have a profound effect on the ability of the CNS to experience the environment, and effectively learn from that experience.
Making Sense of the Senses
"If we do not try to express any psychological or behavioral theory in terms of neurons, we are unlikely to get to the bottom of the problem."
G.M.EDELMAN
"Children who do not look you in the eye: the secrets of autistic behaviour" Antonio Parisi
Most autistic children are highly sensitive to changes in the volume of noise. The louder the noise, the harder it gets for the child to tolerate, until the child bursts into tears.
This is caused by a faulty mechanism by which sound is input at the level of the hearing cortex. The first layer of the hearing system in the cerebral cortex consists of neurons that are sensitive to variations in noise levels. The same neurons also distinguish one tone of voice from another: calm or angry. An anatomical or chemical injury to this layer can cause serious disturbances making it difficult to adapt to high frequency sounds.
Human beings can hear sounds between 16 and 16,000 Hz. Clearly as the sound approaches one or other of these extremes it becomes more difficult to listen to the sound, which is either extremely dull or very acute. Brain injured children, including autistic children, have a very low tolerance for high frequency sounds, particularly if the noise is also loud.
Autistic children do not tolerate high frequency sounds but love low sounds, like whispering.
A very quiet and unruffled environment can put a stop to a whole range of strange behavior, such as hiding under the table, staying under water for long periods, sleeping with a blanket over the head, fingers in the ears, making a continuous even sound, staying in the corner of the room. Many autistic children like the corners of rooms because they feel protected against sounds.
The cheek color of autistic children changes very often. Sometimes in the course of a single day they can go from a healthy red to pale gray, particularly around the eyes. This is a symptom of great suffering.
The color changes when the noise level becomes intolerable, but this level is very low for autistic children, since they are hypersensitive to sounds. When the noise level is intolerable the child begins to behave in one of the ways described earlier (hiding under the table, fingers in the ears, etc.). If the level of intolerability is very high the child uses a different mechanism that is even more effective: he becomes pale and cuts himself off from the rest of the world. Even very loud noises no longer penetrate. Call him and nothing happens. It is as though he has suddenly gone deaf. The only way to get the child to come back into the world is to whisper something in his ear. The sound is very low, so there is no need for the nervous system to maintain a high level of defense. A low sound allows the child to lower his defenses and enables him to let sounds back in.
If the child is the source of the sound, or knows that the sound will come, the nervous system gets itself ready and copes with the noise, but if the noise comes suddenly and unexpectedly the child cannot cope and, as it were, shuts down.
A child screaming also makes perfect sense. Often autistic children react in this way to show their suffering or try to use their own voice, an instrument with which they are familiar.
Switching on the TV or staring at the washing machine as it turns and tumbles are familiar traits of behavior in autistic children with an impaired sound pathway. They use this sound, which they themselves provoke, to focus on and drown out all other noises.
For many years very little hope was held out for autistic children in terms of speech ability. But nowadays we know much more about the neurological basis of speech abilities.
Antonio and Hanna Damasio have carried out very interesting studies in this area. They and their team have investigated three different neural structures related to speech. The first structure consists of a large number of neurons in both the right and left hemispheres; these neurons process sensorial inputs. The second structure consists of a numerically smaller number of neurons located mainly in the left hemisphere; these neurons are used for the recognition of phonemes, the combination of phonemes and an understanding of syntax. The neurons of the third structure are also in the left hemisphere; these mediate between the other two. For example, if you want to say a color, the neurons of the third structure place the neurons of the other two structures in communication. The first structure contains the visual sensation of the color and the second the phonemes to pronounce the word. In other words, the memory must contain the correct phonemes and the correct sensory experience. If someone does not have the visual apparatus to perceive colors, forms or movements correctly, the concept of color, form and motion will be lacking, and hence the words relating to these things will also be lacking.
Defective perception becomes defective language and unfortunately autistic children are seriously affected by defects in sight, hearing, touch, taste and smell.
If we just think back to the example of a child hyper auditory, it is not difficult to understand the problems the child has in acquiring the proper use of language.
We know that the first layer of the hearing cortex controls the volume of sounds. The second layer is used to distinguish a series of sounds, their pitch and rhythm. The second layer enables us to understand speech. Every spoken word has two elements: volume and rhythm. The first layer of the cortex receives the sound of the word and distinguishes the volume; the second captures the rhythm. The result is that the word can be memorized and learned. The pathway is obligatory from the first to the second layer. The first layer filters sounds, especially volume, that reach the second layer and hence influences its structure. If the first layer does not carry out its filtering function properly, the second layer slows its activity and is unable to distinguish the rhythm of words and hence to distinguish and understand spoken words.
Autistic children are often unable to control the volume of the sounds they hear, although there are many different forms of this disability.
In some cases the difficulty is so severe that no sounds reach the second layer; the child is "acting deaf." In such cases the second layer is deprived of information and proper linguistic abilities are impossible. If the sensitivity to differences in volume is less pronounced, sounds do reach the second layer and hence the child is able to make certain distinctions between words. Speech is by no means perfect but the child is often able to repeat some words or to make sounds that are similar to words. If the dysfunction is quite small, the second layer is able to carry out its functions properly and in this case the autistic child acquires superior language abilities compared to the norm. If impairment of a sensory pathway is only slight, the child develops special mechanisms to offset the disturbance, and may be able, for example, to learn an entire telephone book by heart, finish a complicated jigsaw puzzle in a few minutes or reproduce a drawing at sight, and so on. Sometimes these abilities reach extraordinary heights but the other disabilities of the child are generally so severe that the child is not independent.
Children are able to juggle objects, defy gravity. But what was most astonishing is the fact that they seemed to pay no attention whatsoever to what he was doing during these moments. Their eyes are elsewhere. Children spend hours in this way, sometimes throwing things across the room or from the balcony, or leaving them neatly arranged at the edge of the table.
It is amazing the deceptive nature of the behavior of autistic children. That way of looking askance at things was not a sign of lack of interest, but the only way children could actually see things. By looking out of the corner of their eyes they perceived the object. The juggling act was actually a way of focusing on it, seeing it better.
For many autistic children the only way they can see is to move their heads sideways and look out of the corner of the eye.
The visual apparatus of human beings is quite complex: essentially it involves breaking elements down into separate entities and then recomposing the picture as it was. Of course we are not aware that this is what we do. Every time we look at an object, a person, the scenery, a group of people, neurons analyze color, form, depth and motion. The neurons that recognize color are all located in one area of the brain, and so on, for other functions.
There are five such vision areas in the brain that for simplicity’s sake we can call V1, V2, V3, V4 and V5.
The first area, V1, is also known as the layered or primary area. This area receives the images falling on the retina. These images are then passed to V2, which links up to the other areas making up the area of associative vision, or the pre-layered cortex.
Area V3 receives information from V1 and V2 concerning form. Areas V4 and V5 also receive information from V1 and V2, but V4 concerns form and color. While V5 concerns depth and movement.
Once V3, V4 and V5 have done their jobs, the message is sent back to V1 and V2 along pathways that integrate the information, so the image is recomposed.
It is as if the elements of a picture were poured into a funnel. Everything goes through the neck of the funnel and mixes together: color, form, depth and movement.
In order to see the world normally these areas must be perfectly balanced; any imbalance can cause distorted vision.
Serious damage in the V1 and V2 areas causes total blindness while damage in the pre-layered area (V3, V4 and V5) causes difficulties in perceiving form.
One of the world’s leading experts on vision in human beings, Semir Zeki, has noticed that people with brain injury in the pre-layered area, who therefore have difficulty identifying forms, tend to rotate their heads in order to create movement, or prefer objects which move such as objects seen on television.
Typical behavior of autistic children is to tilt the head in order to look at things out of the corner of the eye. Another is to frenetically rock or rotate an object, or to watch television programs featuring things in rapid motion, such as the list of characters, actors and crew at the end of a film. They also like to see the same scene of a cartoon over and over again, or watch quiz shows like "The Price is Right" or "Wheel of Fortune."
A lot of evidence concerning autistic children points to injury of the pre-layered cortex. This is not necessarily wrong, but there is also evidence of other types of disturbance such as the inability to distinguish between similar images, or to see small things on an object’s surface or to remember a visual experience such as scenery or the route along a road.
It is therefore more correct to say that autistic children process visual inputs differently. This different perception may be associated with injury in the occipital lobe (the area related to vision) and may involve one or more areas of vision.
A slight but widespread injury at an early age may not have serious immediate consequences but certainly alters the neurological organization of the central nervous system. To make things simpler we could say that the brain of a newborn child is like a building site where the engineer is running things. An injury is like a construction event that won’t change the scaffolding but causes all of the engineer’s orders to be carried out slightly wrong, with consequences that may make the building unsteady or unusable. It is as if the engineer were speaking a slightly different language from the builders following his orders. The inputs are skewed, making the building out of shape. The neurons—the builders in our metaphor—simply carry out orders as best they can, building things the way they seem to have been told. The result in autistic children is a series of neurological maps that don’t correspond with the real world, giving rise to antisocial and unusual behavior.
In the case of vision, only V1 has an efficient neurological organization at birth. This means that the baby uses this area immediately in order to see. But it also means that this area is the most exposed to injury during pregnancy.
In addition, the primary visual cortex is just like the engineer on the building site: all other areas of vision are organized by V1 despite the fact that the messages go through V2. If the orders coming from V1 are in this rather odd language the rest of the visual apparatus is built wrong.
Lack of perception of color could be caused by injury to the specific area dealing with color perception (V4) or to the primary visual cortex (V1) failing to give the right messages to V4. If the only defect in vision were the perception of color, it would probably be correct to assume the injury has occurred in V4. But autistic children generally have many defects of vision, so it is far more likely that V1 has been injured and the entire language of the engineer is off-cue. Usually V4 is unlikely to be injured since autistic children generally receive injury during pregnancy or in the first few months of life, and V4 practically does not exist at this time.
So the hypothesis is that autistic children receive injury to V1 before or just after birth. Now we need to explain how this determines their behavior.
Let us recap what we know about the primary visual cortex: first, it works from birth. Second, it receives all visual inputs. Third, it communicates with all other areas. Fourth, serious injury causes total blindness.
Now we can go backward over these points. Autistic children are very rarely blind. Usually their injury is not severe. The layered visual cortex (V1) sends information to all other areas, determining the way in which these areas develop. In order to do this, the neurons in V1 must be able to recognize each visual input and understand where to send it. The nerve cells in V1 that recognize a stimulus are contained in the layer. Nerve cells responding to movement are found in sub-layer IV c a , the cells recognizing forms in sub-layer IV c b and other cells responding to color and spatial orientation in layers II and III.
The presence of nerve cells responding to all types of visual stimulus in, V1 means, this area of the brain is independent. In other words, with this area alone we can perceive forms, colors and movement. But this does not make for proper vision. We would find it difficult to focus on nearby objects, would see few differences in color and would only be able to see the outline of an object by moving it. We would see like a newborn child who only has the V1 area of the brain available for seeing. But in the case of a newborn child, vision improves as the functions of the pre-layered cortex come into play.
The pre-layered cortex receives its orders from V1, which is organized in layers, each one responding to a particular stimulus and each transmitting input to other areas. The nerve cells in these areas activate a series of synapses that excite and inhibit, forming a kind of circuitry.
One of the circuits called the magnocellular circuit, transports information concerning depth and movement. Another called the parvicellular circuit, transports information concerning form and color.
The magnocellular circuit starts with some rather large ganglial cells (hence the name) connected to cells on the retina that recognize movement. The signal is then projected onto the V1 sub-layer IV Cc a , where spiny star-shaped nerve cells respond to the stimulus, activating an exciter synapse. The message processed by these cells is then transmitted via V2 to V5 where specialist neurons further analyze the message.
The parvicellular circuit starts with some rather small ganglial cells (hence the name) connected to cells on the retina that recognize form and color. The signal related to form is projected to the sub-layer of V1, IV c b , and to some cells in layers II and III where the remaining cells respond only to color. The messages processed by these sub-layers are sent to V3 and V4 respectively.
The cells contained in sub-layer IVC b are exciters, but those in layers II and III excite a group of cells contained in layer VI of V1—smooth star-shaped nerve cells—which inhibit and modulate the effect of exciter cells. Two observations can be made at this point. The first is that the pathway carrying messages about movement and the pathway carrying a message about color and form are completely separate. The second observation concerns the nature of some cells in V1: they are generally exciter cells but are regulated by inhibitor cells. The message that is finally sent back to V1 is the result of the balance between these two types of cells.
If the pathways are separate, one may be injured without affecting the other. For example the parvicellular circuit may be damaged but the magnocellular circuit may be intact.
This is probably what occurs in autistic children.
The magnocellular circuit is the first to develop; the receptors or rods at the edge of the retina develop and detect movement. The ganglial cells creating the magnocellular circuit start from there. Autistic children seem to be able to detect movement perfectly well, almost too well. So it is unlikely that this circuit has been damaged. It is more probable that the processing of the image in the parvicellular circuit is affected.
The balance between inhibitor and exciter cells is very delicate. A slight injury to the visual cortex can have serious consequences. For example, if these cells are not perfectly balanced, the information processed in sub-layer IV c b and in layers II and III concerning the form and outline of objects, affects perception. The alteration is transmitted to V3, which then works on faulty input. It may be that V3 receives excessively detailed information about parts of an object, without providing the outline, so that the child is bombarded with information about single parts of objects, without perceiving them as wholes. Autistic children with this vision defect recognize people not from their faces but by the shape of their ears or their shoes. They are also able to notice tiny changes in two almost identical figures and to reproduce images effortlessly. They can do jigsaw puzzles at a very astonishing speed and notice a tiny crumb on the floor.
Conversely, the effect of imbalance between inhibitor and exciter cells in the parvicellular circuit, may also send too little information to V3, so shapes are indefinite. Autistic children of this sort need to use special strategies to distinguish shapes.
It is well known that to distinguish the outline of an object motion is helpful. Autistic children are masters of this. Similarly, a child may place things along the edge of a table in order to make the edge clearer or touch things with the tips of the fingers. Another method is to create strong color contrasts. The way children played with saliva in front of the window was a way of creating light contrasts. With hands shade is created that fell over the eyes; the saliva had a prismatic effect, separating colors.
The way children continuously move their hands is a torment for parents. Even if they kept hands relatively still, they continue playing with things around him—a pen, a piece of paper, a leaf, to rock in front of their eyes.
Autistic children have problems perceiving depth. Every time they come close to a carpet they seem to raise their feet as though they were about to climb onto a step A lack of depth perception, i.e. the inability to see how far away things are, creates enormous difficulties. It is like walking in mid-air, without having any idea of how far away the floor or the wall is. It makes stairs difficult to climb and the ceiling appearing to fall. Children with this difficulty often trip over colors and designs.
One of the consequences of this problem is that in large open spaces autistic children often scream in order to receive an echo and calculate the distance to the walls. Or they throw things to see when they impact with the wall.
Our sense of depth is a complex process that requires the combination of information from both eyes. The information is sent from V1 to V5 but it would be mistaken to think that V5 is the area where the information is definitively processed. Depth information has nothing to do with objects in motion. On the contrary, it often requires the use of a distant, stationary object. An injury to the primary visual area means that all information coming from this area may be erroneous, particularly if the sensory input comes from a stationary object. Therefore the correct sense of depth is one of the most common difficulties.
Mothers try to hug her child and the child moves away as if irritated. Over the years many psychologists have investigated this problem and have come up with a number of theories, none of them satisfactory. These theories are usually based on a conflicted relationship between mother and child and have never had any scientific basis. For years, mistaken diagnoses were made on the basis of these theories and treatments often damaged the child and parents more than the illness itself.
This was happening to children and families at the same time that the world’s libraries were filling up with books dedicated to the physiology of the nervous system and the processes of responding to sensory stimuli. It would have been sufficient to read practically any one of them to come to a different conclusion. For any human being the sense of touch is intimately associated with survival. Hence the neurological organization governing the sensory pathway for touch is particularly sophisticated.
This neurological organization helps us to distinguish between light touches and harder contacts, and to feel heat. This is made possible by an inhibitory system for tactile sensations, that filter some out. It is like turning on a radio and looking for a particular station. When you first switch the radio on you cannot distinguish between all the messages arriving; it’s just noise. By turning the tuning knob one message emerges stronger than the others and then entirely replaces the previous noise. This is how the neurological organization of tactile inputs works, by choosing one sensation and removing others. Every day we are bombarded with tactile sensation—the touch of clothes against the skin, the feel of a wristwatch, and so on. All of these signals would lead to total confusion if we were not able to "tune in" to one sensation or another. The inhibitory system is exactly this form of tuning in to one signal. We use it to gain tactile information about the world around us.
Tactile information travels along pathways—nerve fibres—that go from the extremities to the center and vice versa. The nerve fibers that carry information about light touches do not carry information about heat or harder contacts; these are carried by other nerve fibers. It is like a three-lane highway where the traffic moves in parallel to the same destination.
In order to enable us to distinguish between one type of tactile sensation and another, groups of receptors on the skin carry out different activities. Some receptors are excited only by very light touches, others only by heat and still others only by deeper contacts.
When we are affected by heat, our heat receptors pick up the information but other receptors are not stimulated since they cannot read this type of input. In other words each type of receptor only picks up signals of a certain type, and is unaffected by other types of signals. We can see that the receptors are specialists, making the tactile sensory pathway extremely efficient.
When the light-touch receptor picks up information it transmits the stimulus along the correct pathway, heat receptors along the heat pathway and so on. The three types of nerve fiber carry only one type of information.
Draw a circle on the palm of your hand then try to stimulate the center of the circle with a paintbrush. In this way you are stimulating only the sensors of light touch. All the other receptors in the circle have been inactive because they cannot read the stimulus. If you then take a pin and prick the center of the circle, the receptors of harsh sensation come into play and the sensors of light touch remain inactive. If you then touch the palm of your hand with an ice cube the receptors of heat will be excited but no others.
The three pathways transmit only one type of information to the cortex, which does not accept the signal as it is, but tends to modify it. The basic function of the cerebral cortex is to receive all inputs from the outside world and to put them together into one message. To do this it inhibits certain inputs, as in the example above.
Inhibition of tactile messages takes place in the bulb and thalamus where exciter and inhibitor neurons are distributed—as in the case of all sensory pathways—with exciter neurons at the center and the inhibitor neurons at the extremities of these brain areas. The part of the input that reaches the center is transmitted to the next nucleus. The part that hits the edge is inhibited. The closer to the edge the impulse is received, the stronger the inhibition. The next nucleus receives only the portion of the input that hits the center.
The pathway hands on the message from nucleus to nucleus in this way until the input finally reaches the cerebral cortex.
All sensorial pathways—sight, sound, touch, taste and smell—have inhibitors. In the case of touch there are three types of inhibitors because there are three pathways and three types of input: light touch, deep contact and heat.
If the cerebral cortex controls the inhibition process properly, there is no problem. But if the cerebral cortex has been injured, this control function is impaired and the balance between exciter and inhibitor receptors is thrown askew. Essentially three types of dysfunction result: the nucleus may transmit too much information to the next nucleus by not inhibiting the input at the edge. This nucleus in turn passes on too much information so it finally reaches the cerebral cortex in too intense a form. This is called hyperactivity. Alternatively the nucleus may inhibit too much of the stimulus at the edge and in the center. In this case the stimulus is overinhibited, leading to hypoactivity.
The third type of dysfunction is called "white noise" and involves the addition of impurities in the input. Inputs are regulated by exciter and inhibitor receptors. White noise occurs when the inhibitor receptors, instead of filtering out an input, actually contribute to it so the message that reaches the cerebral cortex is not a message derived entirely from the outside world but has been polluted along the way by inhibitor receptors.
Autistic children can be diagnosed for hyper or hypo vision, hearing, touch, taste and smell or for white noise in any of these sensory pathways.
For the tactile pathway things are a little more complicated. To say that an autistic child has hyper or hypo tactile activity or white noise in the tactile pathway means nothing at all. If the type of pathway is not specified, the statement makes no sense. It may be that the child has hyperactivity of light touch, and/or hypo activity of deep touch. In other words the diagnosis is meaningful only if related to one or more of the three tactile pathways.
For example, how can you understand which tactile pathway is affected? Why does behavior often seem contradictory? Why does a child not like to be hugged but then go off and bite his own hand?
I managed to reply that close observation of an autistic child shows what the child constantly refuses and what he or she constantly looks for. The analysis of this behavior leads to a correct diagnosis of tactile disorders.
The search for strong stimuli such as beating the knees against the floor or the head against a wall, or biting the hand, would seem to indicate hypo activity of deep tactile feeling. Conversely, the inability to accept a caress or hug, or the touch of clothes on the skin (particularly socks, shoes, caps and glasses), or difficulty taking a shower, brushing one’s teeth, or combing one’s hair, suggest hyperactivity of light touch.
Hypoactivity at the deep tactile level combined with hyperactivity at the surface level occurs in 90% of cases of autism; this means the child has areas of the body, such as the soles of the feet, which are hypersensitive but at a deep level virtually insensitive. A child with this disturbance often walks barefoot or on the tips of the toes to reduce contact with the floor. But if he is forced to wear rather rigid shoes or to walk over a cobbled surface he cannot walk on tiptoes or go barefoot so he marches, slamming his feet down onto the surface in order to look for deep tactile feeling.
Hypo tactile children bite their wrists. The way to stop them biting their wrist was to massage it very firmly, replacing the search for deep tactile feeling with another stimulus. But the problem is not just hyposensitivity of the wrist. The pressure of teeth also fails to stimulate sensation, so there is a problem of hypoactivity in the mouth too.
There are other signs of this hypoactivity, children, they can eat almost the entire packet of biscuits in one mouthful. This is common in children who suffer from hypotactile sensitivity inside the mouth. Not only do they bite themselves and things in their grasp, they often eat in this way because it is the only way that they can feel what they are eating. Conversely, a child who finds it difficult to eat even soft foods, or is very sensitive to the temperature of food, or prefers eating very small mouthfuls has the opposite problem: hypersensitivity.
If the choice is based on a tactile experience (soft, crunchy) then the problem is one of feeling; if the choice is based on taste (sweet, sour, acidic, salty) then the problem is based on taste. The stronger the taste, including detergents, soil, stools and other inedible substances, the more likely the child is to be suffering from hypo taste. Hyper taste tends to lead to a choice of almost tasteless food.
But smell also plays a part in the choice of food. A disturbance to the sense of smell also determines other types of behavior, such as the child dirtying himself with excrement or rubbing saliva over his body or over things around him in order to produce an acrid smell that he can recognize.
Hyper smell can cause the child to vomit every time he smells something strong; he may also have trouble urinating or defecating because of the smell.
The control of the sphincter requires a separate discussion. A disturbed sense of smell clearly plays an important role, but other elements come into play. First of all, tactile sensation is important since these activities involve the sense of feeling. Urinating and defecating stimulate a large number of tactile sensations and a child with hyperactive surface feeling may actually feel pain and therefore not want to go to the bathroom. But not only surface feeling is involved. The toilet seat is often colder than the body temperature so a child with hyperactive feeling in relation to temperature may be disturbed. This type of child will have difficulty with potty training and will want to use nappies to maintain the temperature of the genitals.
Another factor contributing to problems urinating and defecating is related to sight. Boys often find it difficult to judge the distance and depth of the toilet and are afraid they might fall in.
Children often can’t reach the floor when they sit on a toilet and this for autistic children can cause a loss of balance that terrifies them. Sometimes it is sufficient to place something under the child’s feet—even a pile of books—to overcome this problem.
A child with hypoactive activity in the area of deep sensation tries to stimulate deep feeling with harsh impacts, such as falling, or by biting or touching parts of the body in contact with mucous, such as the nostrils, ears, eyes and genitals. They are not trying to find sexual pleasure but sensation pure and simple.
Axons (extensions of neurons) are located at the level of joints, muscles and tendons. They communicate the slightest muscle or tendon contraction and the slightest change in the angle of the joint. This enables us to understand where we are in relation to space. In other words, part of our perception of the world is our perception of ourselves within it. The inputs from muscles, tendons and joints travel along neural pathways that are adjacent to those of deep tactile sensation, so an injury impairing one pathway may also produce a dysfunction in the adjacent pathway.
Hypo tactile children have an imprecise notion of themselves in the deep feeling pathway. If you ask them to touch their nose they may touch their ears. Body contortions are quite common. An imprecise notion of one’s body means it is difficult for the autistic child to draw the human body. Autistic children generally draw the human body with massive distortions between the body and legs or the hands and head. The size of the hands or head in the drawing often corresponds to the perception the child has of that part of his body. All tests related to the interpretation of drawings should bear this in mind; otherwise the results would have no scientific foundation.
Emotions are influenced by environmental and cultural factors.
A man raised in a mountain district finds the peaks of mountains more breathtaking than the view of the sea. A sailor has a different relation to the sea than others, who have not been to sea. Their emotions are influenced by their experience. Education also has a bearing on feelings. An opera lover does not respond to jazz in the same way that a jazz fan does. The environment, culture, and education are all strong factors in our everyday emotions. But they are nothing if the perception of the outside world is incorrect.
How would we experience a sunset if we suddenly went color-blind? Our sense of the importance of color would change. Our relationship to beauty would no longer be the same. And if we had never perceived colors huge parts of popular culture related to sunsets would be lost on us.
What if we had no sense of smell? Any defect in sensory perception changes emotional capability.
Maybe the thought is not comforting, but the fact remains that they are the result of perception. Human beings are culturally inclined to think of emotions as inscrutable and private. Religion, some philosophical But how is this possible? Aren’t emotions intimate and unique, the product of the individual mind? How can they just be the result of perception?"
thought, and some psychology tend to encourage this view. But it is based on erroneous thinking. Human emotions are the product of culture, tradition and the environment because they are transformed into sensory inputs; they are perceptions. A faulty sensory mechanism precludes the proper development of emotions. This might seem rather cold, but neuroscience has proven this conclusion, and other religious and psychosocial theories—which we might feel drawn to for a number of reasons—have proven to have no scientific basis..
If the sensory mechanisms could be retrained and corrected, behavior would improve and the emotions would evolve.
Nothing is worse for a parent than to be told that nothing can be done, that it would be better to put their energies into their other children or, worse, to seek psychiatric help.
Sensory Therapy
The creation of a sensory integration therapy, enables the CNS to re-establish itself through the sensory pathways, to effectively integrate with the environment. The benefit from that re-establishment, is based on the premise, that, introducing new experiences to the CNS, or reliving the experience, that due to brain abnormality, were missed or not effectively experienced during childhood development. This is a valid presumption that the CNS is a plastic organ, and due to that plasticity, has the ability to readjust to those new experiences.
There is ample confirmation in the literature that brain function and structure can be altered. In 1979, in an article in the Journal of learning Disabilities, doctors Marianne Frostig and Phyliss Marlow stated, "Neuropsychological research has demonstrated that environmental conditions, including education, affect brain structure and functioning". In their book "Brain, Mind and Behaviour" Floyd E. bloom a neuropharmacologist and Arlyne Lazerson, state, "Experience i.e. learning can cause physical modifications in the brain". This is confirmed by Michael Merzenich of the University of San Francisco. His work on brain plasticity shows that, while areas of the brain are designated for specific purposes, the brain cells and cortical maps do change in response to experience (learning). It seems that, while learning causes brain growth on one hand, lack of learning, on the other hand, causes a lack of brain growth.
Delacato, as a result of his investigations, put forward the idea that learning delay, is, not only a result of changes of sensory inputs, but also as a result of missed stages in the child’s normal development through the stages of creeping, crawling, to walking. This is born out in the Delacato Clinics, that children who did not crawl on hands and knees, who went directly from floor crawling to walking, were subject to development delay. A part of the therapy is for the child to learn the missed experience. By looking at all the sensory gathering systems, sight hearing touching, tasting and smelling and evaluating which of those sensory gathering systems have become compromised either by brain abnormality or missed experience, a therapy for rehabilitation, can be devised to help the child overcome his problems. We use the plasticity of the brain and its ability to grow by effectively creating new neural pathways to store that new experience, to re-establish the CNS with the environment.
Professor Janet Eyre at the Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne has been conducting studies into children who had suffered a stroke as babies or in later childhood, reinforcing that premise that when babies suffer brain damage near the time of birth, there is considerable scope for reorganization of brain development, this reorganization to include transfer of the brains control of sensory output from damaged to non damaged areas of the brain, using the brains plasticity, for appropriate targeted intervention to improve the outcome of brain injured children.
Professor Eyre is the author of two papers on the plasticity of the brain in 2003.
"Developmental Plasticity of the corticospinal system", in: Boniface S and Zimmerman U (Eds.), Plasticity of the Nervous System, Cambridge University press p62-91.
"Development and Plasticity of the corticospinal system in man", Neural Plasticity,10,P 93.
The sensory systems develop according to a hierarchy, success on one level is vital to progress at the next, and on the basis that any one of the natural steps to learning is missed or not fully carried out then progress will be halted or delayed.
Delacato in his books "The ultimate stranger the autistic child" and "A new start for the child with reading problems" stresses the need for revisiting the missed stages during development, as do other authors proposing that retained inhibitive reflexes are the prime cause for development delay. Recapitulation and repatterning underpin sensori-motor movement therapy programmes.
Any physical movement exercise programme should incorporate exercises to remove retained inhibitive reflexes and these include crawling on hands and knees, a controlled spinning, and floor rolling programme, to improve the vestibulary system without which meaningful learning cannot progress. Both these processes are vital for the creation of a dominant hemisphere and complete lateralisation. Without this, reading and writing, are difficult for the learner.
Inhibition of Primitive Reflexes to aid Laterality, Hemispherical Dominance and Improve Reading Ability.
The human central nervous system is complex due to the fact that it has evolved over many millions of years of evolutionary trial and error. Each child must retrace much of that long evolutionary history in developing and organising his own nervous system to the fullest. Each child must follow an essential sequence of experiences and development that has been laid down by his evolutionary heritage, developing first the more ancient and more primitive sections of his brain and moving sequentially to the recent and more complex areas. Each child must retrace this progression from the primitive reflex levels of muscular function to the uniquely human functions of speech and cognition.
In the event that one or more stages are missed or not entirely completed, the final development and organisation will be lacking.
His lack of development may lead exhibit either mobility, learning problems, coordination problems leading to speech problems, reading problems or behaviour problems
This developmental and organisational sequence which begins at birth, progresses vertically through the spinal cord, then through the brain stem and medulla, the mid brain (old brain) and up through the two hemispheres of the cortex. In human beings there is one final stage in this progression. This is the lateral development wherein one hemisphere of the cortex becomes the language or dominant hemisphere of the brain. This final stage is usually completed within 5-6 years of age. As a result of this uniquely human, final, lateral stage, man becomes the only creature who is completely one sided – that is right handed, right footed, right eyed and right eared, or conversely, left hand left footed, left eyed and left eared. Only man has spoken and written symbolic language.
For whatever reason the sequential development is not satisfactorily achieved by the child, problems with speech and language will ensue.
Their are many reasons in the progress from conception of the child, prenataly through to birth and postnataly through the first year of life when events can interrupt, delay or completely stop this sequential devlopement, and the event which influences the development can occur at any stage. We know for instance that during birth if the head is in the wrong position, it must be turned to maintain the development. If this head turning is not carried out at birth, and the child is later found to have a mobility problem we can use the reflex in turning the head to enable the arms and legs to be moved as part of the treatment process to rectify the mobility problem.
In the event that the child has not crept on hands and knees at the appropriate time, goes directly to walking, the treatment is for the child to creep.
Treatment is based on recapitulation, we provide the child the opportunity to experience the missed stage of development.
Previously we have mentioned the need to progress from primitive reflex levels of muscular function through to mobility speech and cognition. For this to occur satisfactorily then the reflex which enables one function to be completed must be replaced by another reflex to progress development. Retention of any of these reflexes inhibits progress. Recapitulation is essential to replace the retained reflex.
To enable treatment through recapitulation to occur, an understanding of these reflexes and the role they play in development, must be considered.
What are primitive reflexes?
Primitive reflexes are survival reflexes occurring sequentially in the first few weeks of fetal development, automatic, stereotyped movements, directed by a very primitive part of the brain (brainstem).
Are executed without involvement of higher levels of the brain (the cortex).
Ideally short lived, and as each fulfils its function is replaced by more sophisticated structures (Postural Reflexes) which are controlled by the cortex retained if they do not fulfil their function.Considered aberrant and evidence of an immaturity within the CNS if present beyond their time.
What are the consequences?
Under normal circumstances, each set of movements identified as a reflex, plays a part, and then the CNS allows the package of interrelated movements to "break-up" and be integrated into increasingly complex voluntary controlled movement.
Many events however, can interfere with development for instance, genetic pre-disposition or inherited characteristics, stresses during pregnancy, birth trauma, and environmental deprivation are but a few examples.
Neuro-developmental delay is a term, which describes the presence of a cluster of aberrant reflexes because of an omission or arrest of a stage of early development.
Neurological Reorganisation using Sensory Integration Therapy based on recapitulation is the pathway to facilitate elimination of retained reflexes, replace them with new reflexes to complete the development process.
Neurological organisation is essential for the learning processes to develop Laterality and One-sidedness and Hemispherical Dominance essential for effective use of Reading and Writing.
The Primitive Relexes
The Moro Reflex
Emerges at 9 weeks in utero and is the earliest form of "fight or flight" (reaction to stress) which is fully present at birth is usually inhibited between 2-4 months of life.
When retained the child is acutely sensitive, perceptive, imaginative on the one hand, but immature and over reactive on the other. The child copes in one of two ways- withdrawing from difficult situations, difficulty socialising and neither accepting or demonstrating affection or becoming aggressive, highly excitable, over-reactive and dominating.
The Palmar Reflex:
Emerges at 11 weeks in utero, is fully present at birth and usually inhibited by 2-3 months of life is the infant grasp reflex and is replaced by the pincer grip at 36 weeks of age. When retained beyond 4-5 months of life will impede both manual dexterity and manipulatory activities. Is one of a group of reflexes which affect handwriting, speech and articulation.
The Plantar Reflex:

Facilitates kicking movements, muscle tone and provides vestibular stimulation which stimulates the balance mechanism and increases neural connections during uterine life, not only assists the birth process but is reinforced by it and may be one reason why caesarean babies are at greater risk of developmental delay.
If retained it will impede creeping and cross-pattern crawling which is important for hand-eye coordination and the integration of the vestibular information with other senses
Stimulates the myenilation process required to protect nerve fibres in the CNS.
Also affects balance, laterality, visual-perceptual difficulties, handwriting and written expression.
The Rooting Reflex: Sucking Reflex
Emerges at 24-28 weeks in utero, is fully present at birth, and is inhibited by 3-4 months if retained may affect swallowing, feeding, speech, articulation and manual dexterity in an older child
The Spinal Galant
Emerges at 20 weeks in utero, is actively present at birth and inhibited by 3-9 months if fully retained, or only retained on one side may affect posture, gait and other forms of locomotion. Is responsible for fidgeting, bedwetting, poor concentration and short term memory, and hip rotation to one side when walking
Asymmetrical Tonic Neck Reflex (ATNR)
Emerges 18 weeks in utero to stimulate the balance mechanism and increase neural connections. ATNR assists birth process and is reinforced by it fully present at birth
Develops eye-hand coordination, trains one side of the body at a time; extends ability to focus from 17 cm to arms length.
Inhibited about 6 months of life (so that focus on distant objects can develop) ensures free passage of air when baby is in the prone position, increases extensor muscle tone.
When retained, the ATNR can result in the following manifestations:-
Homolateral movements when walking, marching skipping instead of cross-pattern movements
Cannot manipulate objects with both hands, poor ocular pursuit movements, fails to establish a preferred hand/eye/leg/ear and hence a dominant side so that movements are always slightly hesitant.
Mixed laterality. Poor handwriting and poor expression of ideas on paper
Visual-perceptual difficulties, symmetrical representation of figures.
The Tonic Labyrinthine Reflex (TLR) Forwards:
Emerges in utero, is fully present at birth and is inhibited by 4 months- is closely linked to the Moro as both are vestibular in origin and activated by movement of the head. When retained can lead to spatial problems, motion sickness, poor posture & muscle tone, visual perceptual difficulties, poor sequencing skills and a poor sense of time.
The Tonic Labyrinthine Reflex (TLR) Backwards.
These are transformed primitive reflexes and executed by higher regions in the brain (cortex). Once present they should remain for life. Their absence is an indication that the CNS is immature.
The Symmetrical Tonic Neck Reflex- Flexion & Extension (STNR):
When the child is in the quadruped position, flexion of the head causes the arms to bend and the legs to extend, head extension on the other hand causes the legs to flex and arms to straighten.Emerges at about 6-9 months of life and is inhibited about 9-11 months, if retained affects posture, hand-eye coordination and swimming skills. Results in the tendency to slump when sitting at a desk, ape-like walk, "clumsy child" syndrome, difficulties with binocular vision, slowness at copying tasks and messy eating habits.
Landau Reflex:
Emerges 3-10 months neonate and is inhibited by 36 months, can only occur when the TLR has been integrated and adequate muscle tone has developed.
Segmental Rolling Reflexes:
Emerge 6-10 months neonate and remain for life. Are essential for the integration of cross lateral movements such as smooth walking, running, jumping, skipping, marching, and swimming. In some individuals, full integration and transformation of the primitive reflexes fails to occur and they remain active despite normal development in other areas. When this occurs, it contributes to the underdevelopment of efficient proprioceptive-motor integration, hand-eye co-ordination, lateral integration and aspects of perceptual performance.
A Reflex inhibition programme; Sensory Integration Therapy
Is based on the theory of recapitulation ie. it is possible to replicate specific stages of development through the repetition of movement patterns based upon early development.
Gives the brain a "second chance" to pass through the stages which were omitted or incomplete in the first year of life.
Establishes neural connections.
Consists of specific physical, stereotyped movements practised for approximately 2 to 3 minutes per day, the most essential physical exercises, are cross patterned crawling on hands and knees, to create laterality, controlled spinning and rolling to promote vestibulary functions, essential for balance, speech and language.
Aberrant reflex activity needs to be addressed in order to facilitate normal development and eliminate many of the physical, academic and emotional problems their presence caused.
It is essential to recognise that the physical exercise components of the DfES document, are the core elements of Delacato Therapy, evolved from the ideas of neurologist Dr Temple Fay and propounded in his paper The Origin of Human Movement, presented to the Fourth Annual Institute in Psychiatry and Neurology April 1954 and published in Amer. J. Psychiatry 111:644-652,1955.
Robin Burn
The Autism Centre
August 2006
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Education and Health policy for Special Needs Children

2006-09-18T11:48:00.000+01:00

Education and health policy for Special needs children
A need for change
In response to an extremely high level of correspondence on the vexing subject of Special needs education and the expectations of parents concerning the lack of suitable education provision, the Assembly Member for the Llanelli constituency Catherine Thomas, organised a parents, carers, public sector providers meeting to discuss the subject. This meeting was convened in the spring of 2006, the Education and Children’s Services ministers along with the Head of education for the county of Carmarthenshire, present as guest speakers
The consensus of opinion from attendees in the audience was one of frustration in the way that lack of provision and resources in the area was responsible for the failure of the system to provide the basic need of Special Need education enshrined in the Education Acts. Conversely the guest speakers were only able to reiterate statements of policy that all efforts were being made to provide the necessary provisions.
The recent initiative from the National Autistic Society "Make School Make Sense" launched at the 2006 Eisteddfod in Swansea outlines the results of parents responses to the NAS consultation questionnaire and draws the same conclusions that the process of finding the right school of their choice for their children’s education was difficult and that the final outcome of placement was not necessarily the right option.
The NAS document goes on to suggest that the right approach in every school and the right training for every teacher was paramount to achieving the best education for every child.
A conference organized by Cerebra in 2005 highlighted a presentation from an Educationalist at Trinity College in Carmarthen which came to a similar conclusion that a failure to provide the appropriate resource for Special Needs Education was the result of an inadequate training for student teachers intending to enter SNE to understand even the basics of their special needs children as to why they were of "special need". The good news is that Trinity College in their 2007 programme will address this deficiency in their teacher training courses. On this basis a requirement for an all Wales programme is desirable, promoted at the highest level and not left to local authorities to decide teacher training content policy.
Cambridge academic John MacBeath co-authored a new report, The Costs of Inclusion, which said teachers and teaching assistants were often going "beyond the call of duty" to help children with special needs. The report, commissioned by the National Union of Teachers (NUT), cites cases where teachers were regularly called on to clean tracheotomy tubes and deal with incontinence and nappy-changing in the classroom.Forcing children with special needs into mainstream classrooms that lack adequate support is a "form of abuse", academics warned. Prof. MacBeath said: "Physically sitting in a classroom is not inclusion. Children can be excluded by sitting in a classroom that's not meeting their needs." The typical secondary school timetable - rushing from physics, to history and then to French, was for some children as bewildering as being "on another planet".He said: "You might call it a form of abuse, in a sense, that those children are in a situation that's totally inappropriate for them." One teacher was quoted in the report as saying: "It's more like nursing home than education."The report found that although primary schools were more successful than secondary schools in helping pupils cope in mainstream classrooms, teachers, parents and children felt the strain of inclusion. Another experienced teacher said: "I felt it was something I was failing in. I couldn't cope with it anymore." Many teachers supported the principle of the government's policy of "inclusion", where children with special needs were taught alongside other pupils in mainstream classrooms, the study found.However, schools often could not provide the facilities needed to cope with special needs pupils, the research by Cambridge academics, including Maurice Galton, found. Teachers without expert training were placed under enormous pressure, while children - especially those who suffered from anxiety or depression were left without help, the report said.Schools had to cope with pupils with severe mental health problems, including schizophrenia, self-harming and even attempted suicides.Prof. MacBeath and Prof. Galton said the report was not "anti- inclusion", a stance echoed by the NUT, traditionally the biggest advocate of inclusion of the education unions.The NUT general secretary, Steve Sinnott, today called for an audit of special needs across England as a crucial step to address "major areas of policy failure". He described the study as both "shocking and inspirational".Mr. Sinnott said: "The commitment of staff and parents to youngsters with special needs shines out. But many are being let down by inclusion on the cheap.""It is vital that the government conducts a root and branch independent review of inclusion policies and practice. It must put an end to the stress and strain experienced by teachers, support staff, parents and youngsters alike."All children are entitled to high-quality teaching and learning and high standards in every classroom."However schools minister Andrew Adonis said the government was putting "the needs of the child first".Lord Adonis said: "Children should be taught in mainstream schools where this is what their parents want and it is not incompatible with the efficient education of other children. "We also want pupils for whom this is not an option to benefit from high quality education and for strong links to be forged between special and mainstream schools so pupils can mix with their peers."David Willetts, the Conservatives' spokesman on education, said: "This report shows too many children with special needs are being forced into mainstream schools. The obsession with inclusion is unfair on children with special educational needs, unfair on the rest of the class and unfair on teachers. This report should lead the government to a radical rethink on its inclusion policy."
In 2004, the department for Education and Skills, commissioned a Mencap led pan-disability feasability study to propose a the setting up of a centre of early intervention .In March 2005 the study which can be viewed via www.earlyintervention.org.uk was presented to Westminster with the following proposals;
The National Centre for Early Intervention should be established to meet the needs of planners, parents, practitioners, professional associations, voluntary and statutory sectors, including health, education and social care, in order to improve access to effective early interventions for all young disabled children.
The National Centre for Early Intervention is commissioned and established in a way that recognises the inter-relationships of the key roles identified in this feasibility study.
A Development Board is established to set up the National Centre for Early Intervention. A hybrid model is proposed with a semi-independent Board of Trustees operating as a registered charity and company limited by guarantee.
The National Centre is developed with strong regional and local links in order to ensure that it is able to effectively discharge its functions and meet the objective of supporting local evidence-informed service commissioning and delivery.
In the future the National Centre for Early Intervention and the Early Support Programme are integrated so that coherent and robust support is offered to families, planners and practitioners.
The National Centre for Early Intervention is developed in a way that facilitates mutually beneficial partnerships with local and regional structures.
An international role is built into the workplan of the National Centre for Early Intervention and that it arranges a biennial international conference.
The National Centre for Early Intervention is established outside London, with a location and identity that is separate from other organisations but supported by formal affiliation partnerships with more than one university.
The government supports the strategic development of the National Centre for Early Intervention through five-year funding from 2005-2010 so as to enable the Centre to establish a reputation for excellence. During this period project funding will also be sought from corporate and charitable sectors. Thereafter from 2010 it is proposed that the government contribution should taper to 85% and future funding will be sought from a wider base.
In 2003 the National Assembly for Wales embarked on a consultative programme entitled Education and Lifelong Learning Committee, Policy Review of Special Education Needs, to date having produced two documents, Part 1 Early Identification and Intervention, Part 2 Statutory Assessment Framework (Statementing) and the third part Transition has now been put out for general consultation.
The conclusion reached by the Committee in Part 1 suggested "Many respondents including parents, young people education and health professionals felt that they were expending a significant amount of effort in supporting and developing children and young people with SNE. At the same time, others felt that children and young people were not receiving the support and provision that they are entitled to as set out in the SEN code of practise for Wales.
Direction provided by the SEN code of practise was generally welcomed but practical support was needed to realise the obligations of the code and meet children’s and young people’s needs. The general message from the consultation was one of a call for increased resources/ specialist personnel, coordination between agencies and clarification on responsibilities of various agencies involved"
Part 2 concludes " there was a strong support for a change in focus to channeling energies and resources to support the needs of the child, rather than embarking on the time consuming process of statements. Statements should be aimed at children with severe and complex needs but changes should only take place after wide-ranging consultation with parents and other stakeholders.
The lack of consistency across LEAs and the issues regarding Welsh Language provision, and provision for parents whole first language is neither Welsh nor English, emerged as areas of concern that need to be addressed by the Assembly Government."
The Assembly Government agrees in response to these documents issued by the committee, that the conclusions drawn be the basis for future strategy. However no timetable for implementation is in place.
Three years of work, at great expense has been committed, and there still remain the same shortcomings in the processes, without any commitment to implement change.
On the basis that no specific time influenced action plan is in place in Wales perhaps it is pertinent to consider the utilisation of the Mencap early intervention study to lead change in Wales. A strong argument on the basis of the above- presented evidence suggests that existing local government led policies of health and education for SNE individuals are failing due to resource constraints from National Government.
The optimum requirement is for diagnoses at the point of onset to action a care plan before primary school age, to enable the Education System to cater for those individuals which will inevitably require some form of specialist education in terms of extra resources.
In the cases of individuals having acquired a disability, easily recognised, immediately after birth, the statutory authorities have instant information to action the care plan. However in the cases where diagnoses are not available until after 18 months, even as late as 4 to 5 years of age with many individuals, the authorities are at a disadvantage in planning needs.
There is a basic requirement in terms of provision of Special Needs education, in that it is provided only with a Statement of Special Needs. This statement can only be formulated on the basis of a clinical diagnosis of a condition which allies to development delay or some form of learning, behavior or mobility problem. It is therefore paramount that these conditions be identified at the earliest opportunity to enable the statement to be formulated.

.
The need for coordinated effort between the established agencies of Health, Education and Social Services has been identified as a prime issue in terms of Early Intervention. The establishment of an umbrella organisation would address these issues.
However in the lack of such an umbrella organisation, there is no physical reason as to why Health and Education should not cooperate in advance of the establishment of a new organisation.
The ability of the Education Sector to plan the future needs of Special Education is based on the need to know the number of children with special needs in the system progressing toward education age. This information is available in the Health system and a mechanism should be in place to impart this knowledge between Health and Education.
The early recognition of a child likely to require special needs is fundamental to this issue. Identification of children posing a potential risk of development delay, behaviour and mobility problems should be considered at the earliest opportunity, and this, in the opinion of the author should be at preconception.
Much has been written on the risk posed to the unborn child, in terms of miscarriage at early stage of pregnancy, increased risk of premature delivery and resultant low birth weight, to onset of neurological disturbance from smoking and excessive alcohol intake. This potential risk also applies to mature parenthood, where increased maternal age increases risk of disturbance to the offspring.
Other causes of miscarriage, prematurity, and requirement for mechanical aids intervention during birth procedures, can be attributed to maternal viral and bacterial infections acquired during pregnancy, and all such abnormal incidences are capable of being recorded to provide the basis for an early risk assessment of future problems.
It is recognised that neurological disturbances resulting from pregnancy abnormalities are increased risk potential for outcomes of Attention Deficit Disorders, Learning difficulties, especially reading, Autism Spectrum Disorder and mobility problems.
The Mencap study suggests a form of charity based private funding organisation. On the basis that National Charities are often led and supervised and overseen by eminent highly qualified professionals with a variety of management, scientific and medical skills, should the education of special needs young people be handled by such an organisation rather than Local Government in the form of LEA’s.
Robin Burn
The Autism Centre
August 2006

Early Diagnosis for Early Intervention

2006-07-18T11:07:00.000+01:00

Early Diagnoses for Early Intervention
The real growth of incidence of children diagnosed with some form of learning delay, behavioral and mobility problem has increased the activity toward developing a predictability process of the outcome at the onset of the problem, with the ability to plan a structured approach to intervention.
The optimum requirement is for diagnoses at the point of onset to action a care plan before primary school age, to enable the Education System to cater for those individuals which will inevitably require some form of specialist education in terms of extra resources.
In the cases of individuals having acquired a disability, easily recognised, immediately after birth, the statutory authorities have instant information to action the care plan. However in the cases where diagnoses are not available until after 18 months, even as late as 4 to 5 years of age with many individuals, the authorities are at a disadvantage in planning needs.
There is a basic requirement in terms of provision of Special Needs education, in that it is provided only with a Statement of Special Needs. This statement can only be formulated on the basis of a clinical diagnosis of a condition which allies to development delay or some form of learning, behavior or mobility problem. It is therefore paramount that these conditions be identified at the earliest opportunity to enable the statement to be formulated.
Anecdotally from parents with children categorised with Special Needs, the system in place can be best described as chaotic, with no uniformity of standards in place.
In 2004 Mencap, the UK learning disability charity, led a pan-disability feasibility study commissioned by the Department for Education and Skills. This has considered the setting up of a Centre for Early Intervention, and the report of the feasibility study was delivered to the Department of Education and Skills in March 2005.
A key part of the study was to identify the need for a National Centre, real or virtual, which would be responsible for coordinating the efforts of all agencies involved, to identify the relevant issues involved in Early Intervention, to identify and coordinate policy decided by the Centre.
The need for coordinated effort between the established agencies of Health, Education and Social Services has been identified as a prime issue in terms of Early Intervention. The establishment of an umbrella organisation would address these issues.
However in the lack of such an umbrella organisation, there is no physical reason as to why Health and Education should not cooperate in advance of the establishment of a new organisation.
The ability of the Education Sector to plan the future needs of Special Education is based on the need to know the number of children with special needs in the system progressing toward education age. This information is available in the Health system and a mechanism should be in place to impart this knowledge between Health and Education.
The early recognition of a child likely to require special needs is fundamental to this issue. Identification of children posing a potential risk of development delay, behaviour and mobility problems should be considered at the earliest opportunity, and this, in the opinion of the author should be at preconception.
Much has been written on the risk posed to the unborn child, in terms of miscarriage at early stage of pregnancy, increased risk of premature delivery and resultant low birth weight, to onset of neurological disturbance from smoking and excessive alcohol intake. This potential risk also applies to mature parenthood, where increased maternal age increases risk of disturbance to the offspring.
Other causes of miscarriage, prematurity, and requirement for mechanical aids intervention during birth procedures, can be attributed to maternal viral and bacterial infections acquired during pregnancy, and all such abnormal incidences are capable of being recorded to provide the basis for an early risk assessment of future problems.
It is recognised that neurological disturbances resulting from pregnancy abnormalities are increased risk potential for outcomes of Attention Deficit Disorders, Learning difficulties, especially reading, Autism Spectrum Disorder and mobility problems.
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Robin Burn
The Autism Centre
June 2006

The Role of Essential Fatty Acids on the Neurochemistry of the Brain

2006-01-29T10:22:00.000Z

The Role of Essential Fatty Acids
On the Neurochemistry of the Brain
Three singularly individual words, combined together have a profound effect on our wellbeing and ability to function as a human being. Considering each word in isolation, "fat" has acquired an unfortunate connotation that belies its importance in the neurochemistry and biochemistry of the human body.
We have become accustomed to consider fat as an unwelcome addition to our physical makeup, due to its ability to become stored in both our hips, and waistline, whereas we have not been sufficiently informed enough to recognise that, fat stored inside the protective packaging of the skull, is an essential component of our brain.
So now we have considered the second word of our triad, "essential"
The third word "acid" when combined with the word fatty becomes the scientific term Fatty Acid that describes the molecule that can exist in both water and oil. Combine two molecules of Fatty Acid together and we have the major structural component of the skin of cells, the lipid membrane. The lipid membrane is the packaging of our brain cells, neurons, which are used as the information stores and carriers necessary for all functions of our brain. Combine three fatty acid molecules, and you create a substance, which can be stored for future use. Essential fatty acids EFA’s are used to manufacture hormones and are the foundations of prostaglandins, which become the wiring circuitry of every cell in the brain.
We have at our disposal two families of EFA’s; Omega 3 and Omega 6. Omega 3 EFA is found in fish oils, and Omega 6 are contained in primrose oil, sesame oil, safflower, corn and sunflower oils. EFA’s are fats that are essential, we must have and yet we cannot make.
The question of why we must have EFA’s as part of our nutrient intake has been answered previously, to participate in the formation of cellular structure of our brain, and aid the formation of prostaglandins. The second reason and by no means less important is the role played by lipids in the metabolism and neurochemistry of the Central Nervous System. The CNS which has been compromised by an incident in pregnancy and birth, resulting in the manifestation of the conditions on the autistic syndrome disorder scale.
It appears that there is a biological electron transfer defect in autistic disorders. In simple language autism stretches out and affects the whole body not just the brain. Children with autism have immune, gastrointestinal, hormonal, hepatic, and nervous system deficits. They have difficulty detoxifying their own bodies, due to problems with their sulphur metabolism. This is why they have things like food sensitivities, digestive difficulties, toxicity, infectious manifestations, sensory abnormalities and cerebral blood flow.
By balancing the body at its most elemental level, the electrolytes, (the importance off which is discussed in article Neurology of a Problem). Building upon them in respect to interact with the bi-lipid (bi refers to two, lipid refers to fatty acid) cell membrane, we can safely correct the "biological electron transfer defect". Simply put, the effective transfer of information between brain cells is paramount on the exact composition of the electrolyte, or the electron carrying mechanism, and the effectiveness of the cell membrane to allow the information to pass to the next cell.
The effective passage of information, not only between cells in a particular part of the brain, but between the differing parts of our brain comprising the CNS, is essential for the effective working of the brain. The uninterrupted passage of information received by our sensory gathering systems, to the information processing parts of the brain, onto the command and control areas, then transformed into meaningful output, is the essence of our learning and development process.
In her publication, "The Neurochemistry and Neurophysics of Autistic Spectrum Disorders", Dr Patricia Kane observes "an enormous body of evidence, that essential fatty acids (4 to 1 ratio of omega 6 to omega 3) play a vital role in the brain, cell to cell interactions, genetic expression, and appear to be the focal point of man’s evolution. Understanding lipid and EFA metabolism is crucial for maintaining both physical and mental health. Newly documented research on targeted lipid manipulation has shown that dietary changes can dramatically influence the body human and most profoundly the brain."
Dr Kane goes on to conclude "Viewing the brain of the child with ASD as a biological orchestration as it relates and interacts with membrane lipids, offers, a new dimension into understanding the specificity of disturbances in the brain in regard to lipid/peptide interactions on a cellular level, and the intricate integration of essential fatty acids and prostaglandins. The CNS cannot be controlled without respect to lipid substrate, yet fatty acid metabolism has been poorly delineated and often simply ignored in treatment protocols."

Creeping,Crawling and Reading

2005-12-13T10:16:00.000Z

Creeping, Crawling and Reading

The ongoing debate on the subject of the most appropriate method of teaching children to read, I find sad and bemusing.
Sad, in as much as, however often we have this debate, and change the direction of the approach, there remains a high proportion of children moving from primary to secondary level, unable to read and write effectively, and eventually leave school illiterate.
Sad, as this situation has remained unchanged in the UK for more than 30 years, and remains insoluble to the teaching profession.
It is bemusing in as much as the key to the problem of illiteracy has been known for more than 30 years, and much published work has been available to those persons who play a key role, and are responsible for our children’s welfare and education.
I recently entered into a debate on a teachers forum web site when, a teacher requested information as to movement therapy programme, and I, at great length provided an explanation as to theory and practice.
The movement therapy is used to remove retained reflexes inhibiting neuro development toward the child attaining full learning capabilities. Three individuals entered the debate, one thanked me for such a detailed reply but did not understand the answer. One replied, and agreed that my answer was valid, in as much as he had a child who had missed the creeping stage, and now had speech and language problems. One replied that their child did have delayed development, but did not miss a development stage, and did not have a learning difficulty.
A few days ago, I had a conversation with a nurse in my local hospital, and the subject of learning delay was discussed. She informed me she has a son with speech and language development problem. I asked her if she was willing to answer three questions, and she agreed.
The first question related to her 4 year old and replied, that no, he did not crawl at all, but bumshuffled, and went straight to walking.
The remaining two answers informed me that, yes, she had risked a miscarriage during the first three months, with a bleeding occurrence, and she had a traumatic delivery procedure of less than 2 hours.
When I explained that these events may have led to the child having a problem, she was shocked, that, as a nurse in the system, the system had not informed here of the reasons for the problem. The health, and education system continued to inform her that there was nothing to worry about.
Her understanding was revealed when she realised that her youngest at 10 months was creeping on hands and knees and the mother was happy at the child’s progress.
Which brings us to a very important point.
It is on the basis that, evolution of our species has progressed to use of the written language, through the development stages of creeping, crawling, walking upright, onto speech, that written language usage is achieved.
When children born, without trauma, and complete all milestones in sequential order, appear to achieve learning capability, why is it difficult for our health and education agencies to recognise a problem, when an important milestone like creeping is missed, and take the child back and recover that milestone.
The recovery procedure is for the child to creep, on hands and knees, for 2 minutes, twice a day, in the morning and afternoon, for a minimum of 4 months.
Much has been written on this subject for more than 30 years, and the information is available to all those individuals responsible for the welfare of our children through various information sources.
Ignorance persists, reading difficulty persists in spite of efforts made by educators.
The solution lies in the education of all those in the teaching and welfare professions, to gain the knowledge of the relationship between pregnancy and birth traumas, missed opportunities and speech and language achievement. A basic understanding on the physiology and the workings of the brain, is vital to this understanding.
Finally a greater working cooperation is essential between professionals at all levels, in all the various disciplines associated with development, from preconception, through pregnancy, obstetrics, paediatrics, health and teaching up to secondary stage of education.
Then, and only then, will we eradicate speech and language problems.
For more detailed explanation visit web site; www.theautismcentre.co.uk.
and read the published scientific articles.

The Autism Centre Web Site

2005-12-06T11:14:00.000Z

For an in-depth overview of information regards Autism and connditions on ASD spectrum go to
www.theautismcentre.co.uk

Inhibition of Primitive Reflexes to aid Laterality, Hemispherical Dominance and Improve Reading Ability

2005-12-02T10:49:00.000Z

Inhibition of Primitive Reflexes to aid Laterality, Hemispherical Dominance and Improve Reading Ability.

The human central nervous system is complex due to the fact that it has evolved over many millions of years of evolutionary trial and error. Each child must retrace much of that long evolutionary history in developing and organising his own nervous system to the fullest. Each child must follow an essential sequence of experiences and development that has been laid down by his evolutionary heritage, developing first the more ancient and more primitive sections of his brain and moving sequentially to the recent and more complex areas. Each child must retrace this progression from the primitive reflex levels of muscular function to the uniquely human functions of speech and cognition.
In the event that one or more stages are missed or not entirely completed, the final development and organisation will be lacking.
His lack of development may lead exhibit either mobility, learning problems, coordination problems leading to speech problems, reading problems or behaviour problems
This developmental and organisational sequence which begins at birth, progresses vertically through the spinal cord, then through the brain stem and medulla, the mid brain (old brain) and up through the two hemispheres of the cortex. In human beings there is one final stage in this progression. This is the lateral development wherein one hemisphere of the cortex becomes the language or dominant hemisphere of the brain. This final stage is usually completed within 5-6 years of age. As a result of this uniquely human, final, lateral stage, man becomes the only creature who is completely one sided – that is right handed, right footed, right eyed and right eared, or conversely, left hand left footed, left eyed and left eared. Only man has spoken and written symbolic language.
For whatever reason the sequential development is not satisfactorily achieved by the child, problems with speech and language will ensue.
Their are many reasons in the progress from conception of the child, prenataly through to birth and postnataly through the first year of life when events can interrupt, delay or completely stop this sequential devlopement, and the event which influences the development can occur at any stage. We know for instance that during birth if the head is in the wrong position, it must be turned to maintain the development. If this head turning is not carried out at birth, and the child is later found to have a mobility problem we can us the reflex in turning the head to enable the arms and legs to be moved as part of the treatment process to rectify the mobility problem.
In the event that the child has not crept on hands and knees at the appropriate time, goes directly to walking, the treatment is for the child to creep.
Treatment is based on recapitulation, we provide the child the opportunity to experience the missed stage of development.
Previously we have mentioned the need to progress from primitive reflex levels of muscular function through to mobility speech and cognition. For this to occur satisfactorily then the reflex which enables one function to be completed must be replaced by another reflex to progress development. Retention of any of these reflexes inhibits progress. Recapitulation is essential to replace the retained reflex.
To enable treatment through recapitulation to occur an understanding of these reflexes and the role they play in development must be considered.
WHAT ARE PRIMITIVE REFLEXES?
Primitive reflexes are survival reflexes occurring sequentially in the first few weeks of fetal development, automatic, stereotyped movements, directed by a very primitive part of the brain (brainstem).
Are executed without involvement of higher levels of the brain (the cortex).
Ideally short lived, and as each fulfils its function is replaced by more sophisticated structures (Postural Reflexes) which are controlled by the cortex retained if they do not fulfil their function.Considered aberrant and evidence of an immaturity within the CNS if present beyond their time.
WHAT ARE THE CONSEQUENCES?
Under normal circumstances, each set of movements identified as a reflex, plays a part, and then the CNS allows the package of interrelated movements to "break-up" and be integrated into increasingly complex voluntary controlled movement.
Many events however, can interfere with development for instance, genetic pre-disposition or inherited characteristics, stresses during pregnancy, birth trauma, and environmental deprivation are but a few examples.
Neuro-developmental delay is a term, which describes the presence of a cluster of aberrant reflexes because of an omission or arrest of a stage of early development.
Neurological Reorganisation using Sensory Integration Therapy based on recapitulation is the pathway to facilitate elimination of retained reflexes, replace them with new reflexes to complete the development process.
Neurological organisation is essential for the learning processes to develop Laterality and One-sidedness and Hemispherical Dominance essential for effective use of Reading and Writing.

THE PRIMITIVE REFLEXES
The Moro Reflex
Emerges at 9 weeks in utero and is the earliest form of "fight or flight" (reaction to stress) which is fully present at birth is usually inhibited between 2-4 months of life.
When retained the child is acutely sensitive, perceptive, imaginative on the one hand, but immature and over reactive on the other. The child copes in one of two ways- withdrawing from difficult situations, difficulty socialising and neither accepting or demonstrating affection or becoming aggressive, highly excitable, over-reactive and dominating.
The Palmar Reflex:
Emerges at 11 weeks in utero, is fully present at birth and usually inhibited by 2-3 months of life is the infant grasp reflex and is replaced by the pincer grip at 36 weeks of age. When retained beyond 4-5 months of life will impede both manual dexterity and manipulatory activities. Is one of a group of reflexes which affect handwriting, speech and articulation.
The Plantar Reflex:
Facilitates kicking movements, muscle tone and provides vestibular stimulation which stimulates the balance mechanism and increases neural connections during uterine life, not only assists the birth process but is reinforced by it and may be one reason why caesarean babies are at greater risk of developmental delay.
If retained it will impede creeping and cross-pattern crawling which is important for hand-eye coordination and the integration of the vestibular information with other senses
Stimulates the myenilation process required to protect nerve fibres in the CNS.
Also affects balance, laterality, visual-perceptual difficulties, handwriting and written expression.
The Rooting Reflex: Sucking Reflex
Emerges at 24-28 weeks in utero, is fully present at birth, and is inhibited by 3-4 months if retained may affect swallowing, feeding, speech, articulation and manual dexterity in an older child
The Spinal Galant:
Emerges at 20 weeks in utero, is actively present at birth and inhibited by 3-9 months if fully retained, or only retained on one side may affect posture, gait and other forms of locomotion. Is responsible for fidgeting, bedwetting, poor concentration and short term memory, and hip rotation to one side when walking
Asymmetrical Tonic Neck Reflex (ATNR)
Emerges 18 weeks in utero to stimulate the balance mechanism and increase neural connections. ATNR assists birth process and is reinforced by it fully present at birth
Develops eye-hand coordination, trains one side of the body at a time; extends ability to focus from 17 cm to arms length.
Inhibited about 6 months of life (so that focus on distant objects can develop) ensures free passage of air when baby is in the prone position, increases extensor muscle tone.
When retained, the ATNR can result in the following manifestations:-
Homolateral movements when walking, marching skipping instead of cross-pattern movements
Cannot manipulate objects with both hands, poor ocular pursuit movements, fails to establish a preferred hand/eye/leg/ear and hence a dominant side so that movements are always slightly hesitant.
Mixed laterality. Poor handwriting and poor expression of ideas on paper
Visual-perceptual difficulties (symmetrical representation of figures)
The Tonic Labyrinthine Reflex (TLR) Forwards:
Emerges in utero, is fully present at birth and is inhibited by 4 months- is closely linked to the Moro as both are vestibular in origin and activated by movement of the head. When retained can lead to spatial problems, motion sickness, poor posture & muscle tone, visual perceptual difficulties, poor sequencing skills and a poor sense of time.
The Tonic Labyrinthine Reflex (TLR) Backwards
Emerges at birth and is inhibited gradually from 6 weeks to 3 years, is involved in the simultaneous development of postural reflexes, symmetrical tonic neck reflex and the Landau reflex can result in poor balance and coordination, organisational skills and stiff jerky movements if retained.
POSTURAL REFLEXES
These are transformed primitive reflexes and executed by higher regions in the brain (cortex). Once present they should remain for life. Their absence is an indication that the CNS is immature.
The Symmetrical Tonic Neck Reflex- Flexion & Extension (STNR):
When the child is in the quadruped position, flexion of the head causes the arms to bend and the legs to extend, head extension on the other hand causes the legs to flex and arms to straighten.Emerges at about 6-9 months of life and is inhibited about 9-11 months, if retained affects posture, hand-eye coordination and swimming skills. Results in the tendency to slump when sitting at a desk, ape-like walk, "clumsy child" syndrome, difficulties with binocular vision, slowness at copying tasks and messy eating habits.
Landau Reflex:
Emerges 3-10 months neonate and is inhibited by 36 months, can only occur when the TLR has been integrated and adequate muscle tone has developed.

Segmental Rolling Reflexes:
Emerge 6-10 months neonate and remain for life. Are essential for the integration of cross lateral movements such as smooth walking, running, jumping, skipping, marching, and swimming. In some individuals, full integration and transformation of the primitive reflexes fails to occur and they remain active despite normal development in other areas. When this occurs, it contributes to the underdevelopment of efficient proprioceptive-motor integration, hand-eye co-ordination, lateral integration and aspects of perceptual performance.
WHAT IS A REFLEX INHIBITION PROGRAM?
A Reflex inhibition programme; Sensory Integration Therapy
Is based on the theory of recapitulation ie. it is possible to replicate specific stages of development through the repetition of movement patterns based upon early development.
Gives the brain a "second chance" to pass through the stages which were omitted or incomplete in the first year of life.
Establishes neural connections.
Consists of specific physical, stereotyped movements practised for approximately 2 to 3 minutes per day, the most essential physical exercises, are cross patterned creeping on hands and knees, to create laterality, controlled spinning and rolling to promote vestibulary functions, essential for balance, speech and language.
Aberrant reflex activity needs to be addressed in order to facilitate normal development and eliminate many of the physical, academic and emotional problems their presence caused.

Learning Connections to Reading Skills by Creeping and Crawling

2005-11-20T10:16:00.000Z

THE ONTOGENY OF READING PROBLEMS

Dr Carl H Delacato
The ability to learn to read, the ability to learn to express oneself starts from birth on. If one is not afforded the opportunity to develop total neurological organization, the child cannot become totally human and as a result cannot communicate at the level, at which the child might have been able to, had neurological organization been completed.
Based on the rationale of neurological organization, prevention of communication dysfunction is very possible. It must be based, however, on the premise that there are significant developmental stages of neurological organization which cannot be bypassed, and as the child reaches each stage chronologically he must be given every opportunity to master the functional neurological activities at that level before moving on to the next. With such a logical approach to child education we could, in the future, become able to prevent the problems which face us today by seeing that every child is given opportunity to develop wholly and completely in terms of functional neurological organization.
The title, " The Ontogeny of Reading Problems" is I am sure somewhat surprising. Instead of this title, we could entitle this paper, " The Development of a Reading Problem". In the field of the language arts, we have spent our greatest efforts in attempts to ameliorate such problems and it is my purpose here to present to you the development of such problems. Perhaps, viewing, our language problems from this point of view might give us a somewhat different form of insight into the types of problems which we encounter with children who are disabled in some phase of language and communication functions.
We would all agree that reading is a developmental process. I am sure that we would all agree that agree that reading is basically a receptive act, that it consists primarily of visual reception and, at some levels, auditory reception and perhaps kinesthetic reception are involved. We also know that we, as educators and as a reflection of a culture, measure the proficiency with which a human being deals with the process called reading, via expressive modalities. We, therefore, measure what is basically a receptive act by its expressive concomitants.
If we follow this sequentially we have the fact that the reading process is basically receptive and that we measure the effectiveness of the reading process primarily expressively .If one, therefore, has difficulty with the reading process, we know that he has difficulty with it because he lacks expressively, since we measure his function via an expressive mode.
Carried on step further, we ascertain the aggregate expressive distillate of the perceptual process of reading .We evaluate the percepts by measuring and evaluating the concepts formed on formed on the basis of those perceptual skills.
In the past we have confused the process of learning and mastery of communication skills by going from concept, which, we use as our measuring technique, back to percept. We must all agree that logically we develop perceptually and then move on to concept in the development of language abilities.
The great majority of our reading problems are receptive problems. They are problems of perception .We find that, even those children suffering from a lack of comprehension, which certainly indicates a conceptual lack, are suffering, not from conceptual problems but from perceptual problems. When we give such children instructions orally we find that they can understand and comprehend and conceptualize the same words and sentences which they cannot comprehend and conceptualize via reading. Our natural conclusion must be that this is the result of poor percepts on which they are basing their resulting inadequate concepts.
Receptive problems are the result of faulty or incomplete neurological organization. These problems are created long before educators, ever see the children. These perceptive problems can be diagnosed long before children are generally seen in pre-schools. These problems can be treated long before educators see them in schools. Finally these problems can be can be prevented.
A lack of adequate neurological organization can be the result of a genetic bias. This represents a very small percentage of our problems .A second area of etiology is a trauma This again is a small percentage of our population .The third etiological area is the area of lack of environmental opportunity for complete neurological organization. This group represents by far the greatest majority of our problems in the area of communication.

Diagnostically we can begin to assess the etiology of such problems prior to birth. A family history helps to give us an insight into the existence of that small group which is potentially genetic in etiology. Birth data of early childhood illness and trauma give us an insight into the second small group, the group which is the result of a traumatic etiology.
The third, and by far the largest group (that group which is the result of environmental deprivation) can be seen if we view the child in sequential stages from a developmental and functional neurological bias.
For our purposes of looking at the development of a reading problem, let us look at this largest group. Let us look at the significant stages of development to see how the lack of opportunity for complete neurological organization at each successive stage of neurological development relates to the ontogeny of a reading problem. For our purposes, let look at the successive stages receptively in terms of audition, vision and expressively in terms of movement.
As the child who has had a non-traumatic birth arrives at 3 to 20 weeks of age we find that his mobility consists of creeping on his stomach in a homolateral pattern. That is, the child moves forward with the arm and leg on the same side of the body extended and the arm and leg on the opposite side of the body flexed. His head turns toward the flexed side and as he moves, this body position is reversed. The mobility is aimed in a two-dimensional world toward seeking vital and basically crude comfort. If we view the child at this age from a visual point of view, we note that this body position places eyes in such a position that the child is binocular in visual performance. That is, as the right arm and leg come up, the right eye looks at the right hand, the left eye does not. It remains somewhat strabismic. As the position is reversed, the left eye looks at the left hand and the right eye has no part in the visual process. At this stage the child operates visually binocularly, using only one eye at a time just as one side of the body at a time in the homolateral pattern.
The same is true in audition. At this stage the child cannot place sound in space simply because auditorially the child receives the stimulus from one ear or the other. This total performance lies performance lies in terms of neurological organization at the level of the Pons. This is basically a one-sided level of function. Mobility is homolateral, or one side used for propulsion at a time, vision is binocular, audition is binaural.
When the child moves on to the level of the mid – brain at the age of 7-9 months, we find a whole new area of function arising. The child, in terms of mobility, adds the third dimension to movement. The child now crawls on hands and knees and the stomach is no longer in contact with the floor. Significantly, as the child moves now, the opposite appendages are used for propulsion. In other words as the child moves, the right hand and left knee are used at one time and then the left hand and right knee are used for propulsion. The child has become a cross- patterned organism. The child no longer one-sided, but now is distinctly two -sided. The child has become a bilateral human being.
In vision, at this stage, the child begins to use eyes in concert. The child no longer uses one eye at a time in a monocular fashion. Instead, the child uses the two eyes in concert and here is the beginning of binocularity. Those children who present to us later in the developmental picture a lack of good binocularity are children who have not been given adequate opportunity to develop binocularity at this stage of development, which is the responsibility of the mid-brain. Such children, who are not given adequate opportunities for creeping, later develop problems for which binocularity is a variable.
In audition the same phenomenon takes place at the level of mid-brain. During the 7 to 9 month development levels the child learns to place a sound in space. The child becomes binaural, that is, tends to use two ears in concert. The stimuli are mediated and the child can place a sound in space.
We have all seen these children to whom we could not teach phonetics, no matter how hard we tried. In our investigations we find that those children are lacking in this very basic binaural skill, which is a function of mid-brain and not of the cortex, as we had assumed in the past. Children who are not afforded the opportunities for development at the level of mid-brain in the area of vision, mobility and audition at the ages of 7 to 9 months are beginning to develop significant problems in communication. If they lack binocularity, binaural function and mid-brain overall responsiveness we have started them on their way toward a disability in language.
As children reach one year of age they become cortical creatures and they move from bilateral activity, binocular and binaural, to a new level of function, that is stereo or depth within their receptive and expressive mobilities. Children from the age of one on begin to develop stereopsis in vision. This must be superimposed upon strong binocularity. They begin to develop stereophonic abilities in hearing which must be superimposed upon strong binaural activities. They begin to develop true cross –patterned walking which must be superimposed upon the more elemental mid-brain cross-pattern crawling. Indeed at this time in the other areas of receptiveness they have developed from the level of the Pons, at which they were able to receptively discriminate between very painful and very strong stimuli along to the point at the level of the cortex wherein they have developed complete stereagnosis receptively.
In a few short years from birth the child has moved from being one-sided to being two-sided and now must move on to the final human level, that of developing or superimposing upon this developmental continuum cortical hemispheric dominance. Here is where man is unique in neurological terms. Man is the only creature who has developed one hemisphere, which is dominant over the other hemisphere. As a result man is the only creature who has a symbolic language.
As a child begins to make early choices of sidedness, the culture must give opportunities to reinforce this sidedness so that the child develops complete unilaterality, which results in one-sidedness, the child can begin the process of becoming completely human in terms of his receptive and expressive abilities.
This sequential continuum, called neurological organization, ends at about the age of six, or about the age when generally we begin the formal teaching of reading. To recap, the whole process of development of readiness to read begins at birth. It goes on to the level of Pons , which functions in an alternating one-sidedness, to the level of the mid-brain which is two-sidedness, to the level of the cortex, which encompasses stereo functions, to the level of the development of complete cortical hemispheric dominance. This continuum forms the basis of human perceptual abilities.
Perception is a fundamental process. We learn to see in varying stages and in varying ways; we learn to move in varying stages and varying ways; we learn to hear in varying stages and varying ways; we learn to feel in varying stages and varying ways. There are no shortcuts to these developmental processes in any of the sensory modalities, sequentially, logically and according to the development of the human nervous system. Only by going through the process as nature intended it to be can we form good perceptual abilities.
Superimposed upon the development of perceptual abilities are the apperception’s which we build from our experiences which, in turn, result in conceptualization and the ultimate in reading, which is human conceptual comprehension. The ability to learn to read and the ability to learn to express oneself starts from birth on. If one is not afforded the opportunity to develop this total neurological organization, they cannot become totally human, and as a result, cannot communicate at the level at which they might have been able to, had the neurological organization been complete.
To diagnose our language problems, therefore, we must start at the age at which we first see the child, but we must look back developmentally to the original area of the dysfunction. As a result, it may be that in terms of the diagnosis, some of our children are not well developed at the level of the Pons, some at the level of the mid- brain, some at the level of the cortex and some at the level at cortical hemispheric dominance. If we are to diagnose validly and reliably, we must go through each succeeding stage to assess the mastery of function at each stage.
Treatment must also follow this sequence. In treatment we must go back to the original point of departure from development norms and we must re-create for that brain level and that chronological level, those functions so that the child can go through the proper developmental stages and begin to move on to the establishment of complete neurological organization .In, we must start at the lowest level at which there appears to be a lack of neurological organization and we must give the child the opportunity to master the activities and functions of that level and of each succeeding level until we have mastered complete cortical hemispheric dominance.
Based on the rationale of neurological organization, prevention of communication dysfunction is very possible. It must be based, however, on the premise that there are significant development stages of neurological organization which cannot be by-passed and as the child reaches each stage chronologically he must be given every opportunity to master the functional neurological activities at that level before moving on to the next. With such a logical approach to child education we could, in the future, become able to prevent the problems which face us in education today by seeing that every child is given opportunity to develop wholly and completely in terms of functional neurological organization.

Presented to Claremont Reading Conference 1963

PART TWO
Neurological Organisation

The Delacato Method for the Rehabilitation of Neurologically Dysfunctional Individuals

In his paper "Ontogeny of Reading Problems" presented to Claremont Reading Conference in 1963, Dr Carl Delacato, ED. D reasoned that the process by which one attains the ability to learn to read - the ability to learn to express oneself starts at birth .If the child is not afforded the opportunity to develop total neurological organization, the child cannot become totally " human ", and as a result cannot communicate at the level at which the child might have been able to, had neurological organization been completed.
Based on the rationale of neurological reorganization, prevention of communication dysfunction and, as well, the development of meaningful communication is very possible. It must be based, however, on the premise that there are significant development stages of neurological organization which cannot be bypassed, and as the child reaches each stage chronologically, it must be given every opportunity to master the functional neurological activities at that level before moving on to the next. With such a logical approach to child development, we could become able to deal with the problems that face us today, by seeing that every child is given the opportunity to develop wholly and completely in terms of functional neurological organization.
Prior to the presentation of this paper at the Claremont reading Conference, Carl Delacato had spent over 10 years developing the theories on which his paper was based; studying cultures around the world and working with and studying children and adolescents with varying degrees of communication and development delay problems. This research led to his premise that all the affected individuals studied, had either an incomplete neurological development, or had received, or been subjected to an event which interrupted the natural sequence of development leading to complete neurological development. His two books published in the period up to 1963 outline his rationale and treatment regime, which leads to neurological completion and thus to the individual to achieving meaningful communication.
It is the contention of Delacato International, that individuals exhibiting development delay, neurological dysfunction, behavioral problems, learning delay, communication problems, etc essentially came to be as a result of incomplete or disrupted neurological organization.
A lack of neurological organization can be the result of a number of factors. It can be the result of a genetic bias; this is known to represent a small percentage of the problems. It should be pointed out that genetic research in this area is still ongoing, and experts agree that there is still not enough knowledge to be absolutely certain that this is a contributor. A second area of etiology is trauma (by this we mean physical, biological or environmental). The third etiological area is the area of the lack of environmental opportunity.
Diagnostically we can begin to assess the etiology of such problems prior to birth. A family history helps to give an insight into the existence of that small group, that which is potentially genetic in etiology. Birth data, early childhood data, illness, and encephalitises give us an insight into the second group of a traumatic etiology. The third, and that group, which lacked environmental opportunity, can be seen if we view the child in sequential stages from a developmental and functional neurological bias

Data collected from our clinics in Europe suggest that one third of children not attaining successful neurological development, were born with a problem which hindered complete neurological development, another third were subjected to birth trauma. The last third appear to be the result of environmental disturbance or environmental deprivation.
At the start of this treatise it was argued that neurological reorganization is the pathway to help neurological dysfunctional individuals overcome their problems. We now know that the root cause of neurological dysfunction that creates conditions that we lable Dyslexia, Dyspraxia, ADD, ADHD, PDD, Asperger Syndrome, Autism etc, has its origins in a mild organic diffuse brain injury acquired by the individual in early stages of development, or as a result of incomplete neurological organization during development.
The acquired brain injury disturbs the functions of the central nervous system (CNS) and thus disturbs the sensory perceptual systems (i.e., hearing, seeing, smelling, touch and taste).
The use of EEG tracings, CAT scans, MRI scans, or other high definition images, can now detect even the smallest discontinuity or anomaly in the brain.
As an example, a recent study published August 2002 by Sommer, et al based at the Universities of Hamburg and Goettingen, who conducted research into individuals who stuttered using the latest high definition scanners, found structural anomalies in the left hemispherical cortex region of the brain.
Analysis of data available to Delacato organizations worldwide concerning individuals presenting with some form of brain scan and EEG’s showed the following. There was a preponderance of mild dilation of the ventricular system visible in scans leading to a natural conclusion that these children surveyed as a group, lacked gross pathological defects of the structure of the brain, but still showed evidence of mild changes to the structure, and hence function of the brain. EEG studies tended to show dysrythmia. Typically these disorganized EEG’s showed a preponderance of slow wave activity with a significant percentage showing "spiking" as well. Most of the EEG’s were abnormal and non-specific.
All individuals displayed soft neurological signs, lack of coordination, development delay, strabismus, laterality dysfunctions, toe walking, attentional aberrations, and significant learning delay.
Studies of individuals were and are carried out to ascertain the incidences of various types of sensory perception problems; within the groups the findings are as follows;
Tactility problems 90-100%.
Auditory problems 80-90%.
Visual problems 60-70%.
Taste and smell 25-30%.
Children with tactility problems presented a hypotactile picture in a 2:1 ratio over hypertactile. A great majority of hypertactile individuals present a sensitivity and or hyper-reactivity to food colourings, preservatives, drugs and certain food types.
A 3:1 ratio of hyperauditory over hypoauditory patients was observed.
A 3:2 ratio of hypervisual over hypovisual was reported.
Only a small percentage presented problems of smell and taste.
Children with at least 2 hyper areas (excluding taste and smell), e.g. vision, auditory or tactility, have a prognosis for progress is quite good, children with no areas of hyper senses but with all areas as hypo made least progress.
The basic treatment technique for all patients visiting the Delacato Clinics is firstly, an evaluation, secondly an individualized home programme specifically designed to normalize the sensory channels of that child. This programme is taught to the child’s parents to carry out at home. Later programmes are aimed at improving each patients general development based on progress and observations made during follow-up consultations.
The second stage of rehabilitation is to address the sensory problems identified and administer the programme therapy.
At this point it is important to understand what is termed neurological organization. Previously brain growth was considered a static and irrevocable fact, completed and unchangeable at birth and if injured could not be altered.
The theory of neurological organization views the growth and organization of the brain very differently. Recent studies confirm the ability to influence brain injury, growth and recovery.
Each child must follow an essential sequence of experiences and development laid down by revolutionary heritage. This development and organizational sequence begins prior to birth, progresses vertically through the spinal cord, then through the brain stem and medulla, the middle brain up through the two hemispheres of the cortex. In humans uniquely, there is one final stage in this developmental progression. This is a lateral development wherein one hemisphere of the cortex becomes the language or dominant hemisphere of the brain.
As a result of this uniquely human final lateral stage, man becomes the only creature who is correctly one sided, that is right handed, right eyed, right eared and right footed or conversely, left side usage of all sensory gathering organs, and thus only man has been able to develop written or spoken language.
Treatment is based on recapitulation. If a development stage is missed or not completed, the child is given the opportunity to go back through the experience. We have seen many children who have completely missed the creeping stage (on hands and knees) of progression. It is known that the brain can become better organized if significant development milestones are retraced, and re-experienced. Children are taken back to a function typical of a younger age, we then have to practise the related motor functions that reinforce their sensory and neurological development. When lower level stages have been mastered, lateralisation can then take place making them all one sided.
Based on this theory, the child’s development is evaluated based on significant areas of development. These areas are subdivided into the sequential order and time schedule in which they appear in non compromised children.
There are three major intakes or sensory areas.
1] Vision; beginning at birth with a light reflex and progressing through 7 stages to understanding writing.
2] Hearing; beginning at birth with a startle reflex and progressing through 7 stages to understanding speech.
3] Tactility; beginning at birth with tactile withdrawing reflexes and progressing through 7 stages to the ability to recognize two-dimensional objects through manual tactility.
The profile also contains 3 expressive areas each of which also progresses through 7 development stages.
1] Mobility; 7 stages through movement without mobility to normal walking.
2] Manual function; 7 stages from grasp reflex to ability to write.
3] Language ;7 stages from birth cry to human speech.
Treatment consists of providing the child with the opportunity to go back and re-experience the stage(s) in which it exhibits a weakness. Remember steps to speech and language reading and writing are through crawling on the stomach to creeping on hands and knees, to walking upright to language and recognition.
Final development only takes place when intermediate stages have been successfully accomplished.
At this point we can start to address the sensory perceptual problems of the individual.
Recall we mentioned the senses, which govern our lives and enable us to understand and interpret the world around us and survive in that world.
There are two major sensory dysfunctions, hypersensitivity and hyposensitivity plus a third, less prevalent one we call white noise. Hyper individuals receive to much information from the environment which overloads them, and may result in their "switching off" as a form of defense mechanism. Hypo individuals do not receive enough stimuli and are starved of outside information. White noise, like static on a radio also blocks out the normal stimuli.
To read the sensory problems of the individual, one need only observe the individual; the actions will point the observer to the problem. These actions can be viewed as the individuals attempt to treat it himself.
A fish out of water placed near to water will flap itself vigorously on the land. We may view its convulsions as a sad reminder of the frailties of life – the death throws of a "lost cause", or are they an attempt to move itself back into the water its natural environment? If the fish is close enough to the water it will often succeed and thus save its life.
Recall the conclusions of studies of sensory impaired children. 90-100% have tactility problems.
Hypertactile children shy away from touch, they do not welcome contact and are sensitive to certain types of fabrics, are happier wearing loose fitting garments rather than tight fitting ones and take off any garments they are not comfortable with. These are the children you cannot take out of the bath, and the ones you cannot get into the shower.
Hypotactile children are the self mutilators, biting hands, fingers, hitting heads, sometimes against walls, doors, anything to try to induce a sensation.
Recall an earlier comment about children showing reactions to certain food types and foods containing preservatives flavour enhancers, food colourings, these are the children with severe hypertactility problems. The surface hypersensitivity is skin deep as our skin layer contains millions of nerve cells transmitting information back to the central nervous system. From a perceptual point of view, the skin on the outside of our bodies is essentially the same skin lining of our total digestive system. Hyper sensitivity on the outside becomes hypersensitivity on the inside increasing the chances of the chemicals in the food we eat, and the liquids we drink, reacting adversely on children with hypersensitive stomach linings.
Now to Auditory problems, we know that three times as many children are hyperauditory than hypo. These are the children who put hands to ears, put fingers in ears, run away from busy environments, scream in noisy rooms. These are the children, who can and do fail the standard listening tests because they have the ability to switch off their hearing when it becomes an overload for them.
In the inner ear we have the mechanism which maintains our balance, as hyper auditory children do not use their auditory system efficiently this balancing system is not being used effectively. Hyperauditory children often have no fear of heights can perform amazing balancing acts and can spin themselves without becoming dizzy.
Turning now to visual problems, again hypersensitivity is prevalent. This manifests itself by the children who do not make direct eye contact; often looking at you sideways. They blink in bright sunlight, and often perform visual stereotypes involving hands, paper, or strings.
These children are trying to reduce the amounts of visual stimuli entering the system, turning them off when they cannot cope.
Finally we come to taste and smell, usually these act in tandem, as these two sensory gathering systems are intimately connected. Only a small percentage of autistic children are affected. Hypertaste / smell children tend to be picky eaters, eating mainly bland foods, sometimes no solids at all, while hypotaste/ smell children eat and drink everything, especially strong taste and strong smell items – often to their own detriment.

As a rule, mildly affected individuals show two or more hypersensitivities and no hyposensivities, and are the easiest to rehabilitate. Individuals with hyper and hypo take longer and need much more therapy.
On the positive side children having had hypervisual and hyperauditory sensory problems essentially see everything better than the average child, hear everything, miss nothing and have an incredible memory. This child has the ability to learn better than the average child yet is often misdiagnosed as mentally retarded.
These children do not have learning difficulties; they have essentially no problems with input only output. What underlines the sensory perceptual problems are development delays due to their adversely affected sensory systems. Once these sensory problems have been rectified, and the ability to learn and develop has been given back to our children, (ideally with hemispherical dominance being attained), the ability to master written and spoken language can be achieved.

Copyright The Autism Centre Oct 2003
Robin Burn Director

A NEW START FOR THE CHILD WITH READING PROBLEMS:
A MANUAL FOR PARENTSBy CARL H. DELACATO, ED.D
This exciting book details a curative therapy for the serious reading difficulties which afflict many children. It presents Delacato’s developmental approach to reading and learning; moving through creeping and crawling, through walking and on to brain and language dominance
In "A New Start for the Child with Reading Problems" Dr Carl Delacato suggests reimprinting the early stages of dominance training by repeating the early steps of crawling and other physical exercises that properly develop the receptivity of the language area of the brain.

Other Books by Dr Delacato;
"The Treatment and Prevention of Reading Problems"
"The Diagnosis and Treatment of Speech and Reading Problems"

Laterality,and Hemispherical Dominance by Cross Pattern Creeping

2005-11-11T15:17:00.000Z

Anatomy of a Problem
Reading and Language Difficulty

For decades, it has been well established that one child in five has serious reading difficulties. Many systems of special teaching have been tried. (1)
In his paper "Ontogeny of Reading Problems" presented to Claremont Reading Conference in 1963, Dr Carl Delacato, Ed.D reasoned that "the process by which one attains the ability to read – the ability to learn to express oneself starts at birth. If the child is not afforded the opportunity to develop total neurological organisation, the child cannot become totally "human", and as a result cannot communicate at the level at which the child might have been able to, had neurological organisation been completed."
In 1970, Carl Delacato proposed a new revolutionary concept together with a new curative therapy, outlined in his book, " A New Start for the Child with Reading Problems".
The 1963 paper, and his book in 1970, both stem from original research presented to the Institute of Physical Medical and Rehabilitation, New York in 1953,by Delacato, Doman and Doman, entitled "Behaviour, Learning and Mobility, cause and effect of Rehabilitation". In this paper the principles of Sensory Integration Therapy are proposed.
To put this theory into its simplest terms, systems of reading and language difficulty, show up where there is conflict between one side of the brain and the other to gain language dominance.
In the human brain the language area is usually located in either, the left, or right side of the brain. Likewise, man is usually left- handed or right- handed.
Normally, dominance in the brain begins as soon as baby learns to speak, total dominance achieved around 7 to 8 years of age. Theoretically, a missing of any stage of development between crawling, creeping, walking, seeing, talking and writing creates problems in reading.
Accordingly, for the poor reader, the method suggests re-imprinting the early stages of brain dominance, by repeating in the brain, the early steps in creeping and crawling, and other physical exercises that develop the receptivity of the language area of the brain.
Here is now outlined a beginner’s guide to the causes, recognition of, and description of how to overcome the child’s difficulty.
There is an increased risk of mild diffuse brain injury, leading to reading difficulty and learning delay, from, difficult pregnancy, difficult birth procedures, including emergency and elective Caesarian section delivery, and early post natal period up to 6 months.
The child who misses a stage of development i.e. crawling and creeping increases the risk of reading problems and learning delay.
In the event that the parent believes that such an event, like viral or bacterial infections, risk of miscarriage during pregnancy, premature birth, a birth procedure longer than 12 hours or less than 2 hours, has occurred, should be aware of increased risk to the normal development of the child. A Caesarean Section birth, increases risk as this is invariably less than 2 hours.
The next critical stage is at approximately 5 months when the child should start to creep on hands and knees. In the event that the child wants to start to walk without creeping, the parent should not ignore this wish, and encourage the child to creeps on hands and knees for at least 4 months. After which, walking erect is then allowed.
Should you now recognise that you have a problem with your child, then the following rehabilitation can be practised.
For children over the age of 2-3 years and up to the age of 5 years, the following exercises can be carried out.
Each exercise to be carried at least twice a day, for a duration of 2 minutes each exercise, for a minimum of 4 months until you believe your child has improved to your satisfaction
Creeping on hands and knees for at least 4 months.
Rolling the child on a well-carpeted floor or alternatively on the bed up and down. You do the rolling, do not allow the child to do it itself.
Slow controlled spinning in a revolving chair, alternatively rotating 3 times to right and 3 times to left. You spin the child, remember that children spinning and rolling themselves are self-stimulation, you spinning the child are therapy.
Catching and throwing balls, rolling balls, catching after one bounce, catching balloons, chasing bubbles, kicking balls.

Record the preference of which hand the child uses to pick up objects and holds a pencil. If the predominance is right hand, then you will create the brain dominance on the left side of the brain, left-hand preference creates right hand side dominance of the brain.
For the child older than 5 years of age the encouragement of the use of hand, eye, foot, and hearing on one side of the body only, is necessary to create the condition for effective reading and writing.
When you have determined which hand your child prefers to use you can then reinforce this preference to fix the handedness and make your child all one-sided, and achieve hemispherical dominance.
This you can do by ensuring he always uses his preferred hand to write, pick up objects, throw and catch balls.
Next ensure that when he starts to walk from a standing or sitting position, he starts to walk always using his leg which is on the same side as his preferred hand. With ball games roll the ball to the foot you want your child to kick back to you with.
A good exercise for footedness is to stand the child at the bottom of the stairs and have the child place the preferred foot on the first step and then return to normal standing position. Repeat the exercise until this becomes a natural instinct.
To ensure he only uses the correct eye we can use the effect of red/red or red/green filters when the child is writing or reading.
When writing with a red/orange pen/crayon/pencil the words disappear when viewed through a red lens.
Putting a green filter on a page of a book, the words disappear when viewed through red lenses.
To enable the child to use the correct eye, we cover the other eye with a red lens.
The child uses the red lens for 2 minutes twice a day for reading and writing exercises. These exercises continue until you the parent are satisfied that your child has successfully mastered reading and writing.
To complete the handedness and create one- sided dominance in the brain, hearing needs to be addressed. Spend two, five – minute periods each day talking or reading to your child. While sitting on the right side, ask your child to cover the left ear while listening to you. If left- handed, sit on the left side and cover the right ear during listening.
When your child is all one-sided, using eye, ear, hand and foot, on one side of the body only, neurological organisation is complete.
For further reading go to article "Revealing Autism" on web site www.theautismcentre.co.uk.
Reference;
"A New Start for the child with Reading Problems" Carl Delacato, Ed.D. 1970
ISBN 0 – 679 – 50765 - 5
Robin Burn
The Autism Centre
March 2005

Education – Teaching or Learning?

2005-11-09T12:13:00.000Z

Two quite important events have taken place recently, both of which have created debate; both will have a significant impact on teaching, learning and education.
The first is the reintroduction of teaching children to learn to read by the use of phonetics, and the other is the announcement of a new assessment, of the way of educating special needs children, announced by the author of the original report, into the setting up special needs education, Baroness Warnock.
Ironically, whilst the use of phonetics is not a new technique, the use of which, is, totally inappropriate to those children with neurological dysfunction’s, incapable of being taught without first addressing the dysfunction.
In fact, any form of learning technique will not teach children to read who are incapable of learning to read.

The ability to read, and communicate with the written word has never depended on the ability to speak.
The ability to read and write efficiently, only is available to the individual whom has successfully achieved complete neurological organisation.

The ability to speak comes when children have successfully achieved the following conditions;
The ability to listen 80% of the time to ambient, not direct speech.
The ability to respond to “no” 80% of the time.
The ability to respond to commands 80% of the time.
The ability to repeat vowels.
The ability to repeat consonants.

Throughout The Autism Centre website www.theautismcentre.co.uk reference is made to rehabilitation programmes to help overcome the neurological dysfunctions, impairing output, which are a result of brain injury. As soon as the child can successfully receive inputs, then learning and confirmation of that learning by output, has been achieved.

Since the mid 70’s, a number of rehabilitation approaches based on the premise of sensory integration therapy using physical exercises, originally proposed in the early 50's by Temple Fay’s team in Philadelphia, were devised, and currently practised in some schools in the UK.
One particular approach is currently practised in Australia, set up by parents, after a visit by Dr Carl Delacato, in the 1970’s.and forms the basis of remedial practise in the schools in that state. The organisation has done trials with local schools and has devised procedures for trials.

A number of similar projects were conducted in the 1960,s in the United States and one such reported project is reproduced for comparison in website www.theautismcentre.co.uk

The debate, which should be considered, is, whether the strategy for rehabilitation should be in the remit of Health, Education, at home with help by the parents or a balanced mixture of all three options.

The announcement by Baroness Warnock of a review of special needs education will come as no surprise to the great majority of parents with children requiring special education. Those parent’s who have struggled against beurocracy, with LEA’s, committed to inclusion with no back up plan, will applaud this decision.
The ethos of giving every child irrespective of its background, an opportunity for a well meaning education is laudable, but to achieve this end, means that enough suitable resources must be in place. Sadly from the beginning of implementation of this inclusion policy, this has never been totally achieved to promote best practise universally.

The rising numbers of children on “inclusion policy “ programmes being excluded from school, and parents opting to educate “otherwise”, simply because the school resources are inadequate, or not utilised to full advantage, is witness to the failure of the programme.

My concern has been that the conditions, in terms of suitable resources, has never been universally available from the onset, there is goodwill in place, trained knowledgeable teachers, suitable education establishments having the right teaching environments, calm, quiet, not too bright, resourced with suitable learning aids.

PLD children, all being, hyper sensitive, hyper active, hyper visual, and hyper auditory can be successfully educated given the right conditions and resources.

Inclusion policy of integration in mainstream therefor, whilst laudable is not practical. Perhaps now is the time to put the education of such children into small units with their allotted “one-to-ones”, with input from parents, alternatively allow children to be educated “out of school”, fully funded by the appropriate authorities.

Creeping for Reading Skills

2005-11-09T09:18:00.000Z

Many years of working with children with delayed development in terms of their reading and writing skills,has shewn that many of these children missed a stage in their childhood development and did no ccreep on hands and knees, or did so for only a very short time before walking.

To rectify this situation, parents can visit my website www.theautismcentre.co.uk and click into articles referring to reading help.

The Anatomy of a Problem Reading
The 3 R's Reading Righting and Rehabilitation
A number of visits to my website worldwide have been looking at creeping and effect on reading over the last 24 hours

Robin Burn
The Autism Centre/ Learning-Connections