From: patth@sci.ccny.cuny.edu (Patt Bromberger) Newsgroups: misc.handicap Subject: Paper on Reading Disabilities Message-ID: <27023@handicap.news> Date: 8 Jan 93 20:00:12 GMT Originator: wtm@sheldev.shel.isc-br.com Lines: 1736 Index Number: 27023 NEUROPSYCHOLOGICAL BASES OF EDUCATIONAL DISABILITIES Implications for Diagnosis and Remediation Expert Paper Submitted to the United Nations Disability Unit, Vienna February, 1990 Robert Zenhausern, Ph.D. Professor of Psychology St. Johns University Jamaica, NY 11439 USA INTRODUCTION The paragraphs below are in the form of a satire based on the essay by Jonathan Swift entitled "A Modest Proposal" in which he presented a solution to the "Irish Problem". The parallel here is Learning Disability and the inflexible ways these children are taught. It is the objective of this paper to show that the problem of the learning disenfranchised is one that can be solved by increasing the flexibility with which we teach. Another Modest Proposal: A Swift Response to an Old Problem The purpose of this essay is to examine the possibility that we are systematically doing a disservice to a large segment of the school population. Students who have auditory or visual impairments have been allowed to use artificial means, such as glasses or hearing aids, to correct their deficits. Indeed, it is considered praiseworthy to identify such problems early and then use the services of professionals who prescribe optical or electronic devices which alleviate the deficiencies. The consequences of such actions, however, have not been considered fully. Such children may become lazy and make no attempt to overcome their problems. What motivation will they have to strengthen their perceptual weaknesses when such devices make it unnecessary for them to do so? What will such people do if, for whatever reason, such devices are not available? It is the contention of this paper that artificial devices are crutches which interfere with the complete development of the child. As such, they should be eliminated. Some might argue (and not without a modicum of validity) that by eliminating those "support systems," such children may not progress beyond the elementary rudiments of learning. That, however, should be secondary to the point that we are not dealing directly with a serious problem. The fact that our present state of knowledge does not allow us to correct such deficiencies should not dissuade us from this course of action. Eventually specific techniques will be developed to meet the problems of poor eyesight and hearing in much the same way that techniques were developed to alleviate reading and mathematical difficulties -- and probably with as much success. There is a minor problem in the fact that many of the authority figures in the child's environment use those same artificial devices and thus do not serve as good role models. Aside from the educational wisdom of this proposal, it has the added advantage of eliminating the possibility of charges of discrimination. Consider, for example, if someone raised the point that a deficit in vision or hearing might be compared to a deficit in arithmetic computation. They might argue that if vision can be corrected by glasses why can a calculation deficit not be corrected by the use of a calculator? It is difficult to counter these arguments since the two deficits have so much in common. Even the poor role model problem has a parallel since most of the authority figures whom the children contact would have some difficulty in taking a square root or doing long division of decimals by hand. The conclusion is clear: take away glasses and hearing aids and give the children with sensory defects the same advantages given to children with calculation defects! * * * The essay is clearly satirical, but its point is clear. In this Decade of the Disabled it is essential to consider the human rights of the Learning Disabled to an education that more closely fits their capabilities. The problems of the Learning Disabled are unique because this is the only disabled group which is held responsible for its disability. "If he worked harder, he could do it", says the frustrated teacher. No one expects a blind person to see, if he or she "worked harder". Furthermore, to call a child "learning disabled" is to put the burden of responsibility on the wrong person! It is our responsibility to teach much more than it is the responsibility of the child to learn. It is we who should be called teaching disabled. The purpose of this paper is to focus attention on individual differences among both normal and learning disabled children and to consider alternative approaches to education and thus eliminate our teaching disability. The major emphasis will be on the theory and remediation of reading disability based on a 10 year program of research within a neuropsychological framework. The initial Chapter will introduce the concepts of cerebral asymmetry and hemisphericity and put them in perspective for education today. The second Chapter will discuss behavioral and physiological measures of individual differences in neuropsychological functioning. The third Chapter will describe a study that underlines the importance of these individual differences in an educational setting. The fourth and fifth Chapters will describe a series of studies dealing with the theory, diagnosis and remediation of reading disability that has been based on these neuropsychological concepts. The final Chapter will be a summary that includes the basic information on the Direct Access approach to reading with specific recommendations. It can serve as an abstract of the whole paper. This Introduction ends with a short quote, found hanging on the walls of an elementary school in Greensboro, North Carolina and attributed to Ken Dunn. If children cannot learn the way we are teaching them, then we must teach them the way they can learn. CHAPTER 1 THE CEREBRAL HEMISPHERES OF THE BRAIN AND THE NEW PHRENOLOGY Recent work in the areas of neuropsychology, especially that of Sperry who won the Nobel Prize, has popularized the notion of cerebral asymmetry. That is, the two hemispheres of the brain are different in terms of the cognitive processes in which they excel. There is clear evidence that the Left Hemisphere has unique control of expressive speech and operates using a sequentially organized system. The Right Hemisphere, on the other hand, has systems that are more capable of spatially and pictorially oriented processing. While there are clear differences between the hemispheres, these differences have been overgeneralized into a new phrenology of brain functions. A typical list of "Left Hemisphere Functions" reads something like: logical, verbal, analytic, inductive, controlled; the Right Hemisphere is often called: synthetic, emotional, deductive, intuitive, and abstract. Some of these labels are self-contradictory. The Left Hemisphere is called both analytic and inductive and the Right Hemisphere both synthetic and deductive. The term "abstract" has two diametrically opposed meanings: an article abstract versus abstract art. These inconsistencies aside, this neo-phrenological approach must be rejected on the grounds that it is atomistic. A hemisphere is neither verbal, logical, emotional, nor creative; it is a person who has these characteristics! All behavior flows from the integrated functioning of the whole brain. This does not mean, however, that there are no individual differences associated with the brain. The concept of Hemispheric Related Strategies provides a framework on which to base an individual difference variable. For the most part, the two hemispheres do the same things but do them using different approaches. Cerebral asymmetries reflect relative efficiency rather than a "can do-can't do" dichotomy. There seems to be one exception to this relative rather than absolute difference between the hemispheres: for most people, only the left hemisphere is capable of speech and of phonetic representation (Levy, 1974). The isolated Left Hemisphere can tell whether the two words "though" and "blow" rhyme but the isolated Right Hemisphere can not, even though it may understand their meaning. Rhyming demands that the written word be converted to an auditory form and only the left hemisphere has this capability. A second factor that differentiates the two hemispheres is their type of processing systems: sequential for the left hemisphere and parallel for the right hemisphere (see Bradshaw and Nettleton, 1981 for a review.) Compare these two situations: 1) You are given a description of someone and must then identify that person; and 2) You are shown a picture of the person and then must select the person. The first task demands the sequential system of the left hemisphere--the words, descriptive of the various facial features, are read in sequence and must be combined into an overall perception. The latter situation reflects the parallel system of the right hemisphere -- the picture is seen as a whole and various facial features can be extracted. The picture is seen all at once in parallel while the verbal description must be sequentially processed. The sequential processing system of the Left Hemisphere and its ability in speech production are the characteristics that underlie the notion that the Left Hemisphere is the verbal hemisphere. Language, by its very nature, is sequential. Word order and syntax are essential to meaning-- language cannot be easily processed in parallel. Thus the left hemisphere has been labeled the "verbal" hemisphere because its sequential processing system is compatible with the sequential nature of language, and its control of auditory linguistic processes makes it essential for speech. For other tasks, even though the processing system of either hemisphere is compatible with the task, one hemisphere is clearly superior. The example of face recognition shows intuitively that the Right Hemisphere pictorial approach is better than a Left Hemisphere written description. Note, however, that the task can be done using Left Hemisphere strategies, but it takes a thousand words to describe one picture. Spatial relations tasks are also more easily handled using Right Hemisphere processes. Other tasks can be handled equally well using the strategies of either hemisphere. For example, a list of words could be learned by converting and storing them as visual representations or in an auditory form. The term Hemispheric Related Strategies can be used to describe this relationship between observable behavior and its underlying neuropsychological bases. Hemispheric Cognitive Style Two individuals, when faced with the same task, do not necessarily use the same strategies, that is, people do things in different ways. Sometimes those different approaches can be associated with processing differences between the two cerebral hemispheres. These different approaches can be termed Hemispheric Related Traits. Hemispheric Cognitive Style is the tendency of an individual to use distinct patterns of Hemispheric Related Traits. It does not imply that one hemisphere is used exclusively, but that individuals tend to approach tasks in unique and consistent ways. For example, if a group of individuals were asked to remember the words "dog, cat, tree, table, chair", few would have difficulty. If these same individuals were asked what strategies they used, there would be wide variation. Some would report they repeated the words to themselves, others that they "saw" the written form of the word, and others would create images of the words. These differences in memory strategies can be related to Hemispheric Related Traits. A person who would be more likely to use imaginal strategies could be said to use a right Hemispheric Related Trait, and a person who used auditory strategies could be said to use a left Hemispheric Related Trait. Some individuals tend to use the Hemispheric Related Traits associated with one hemisphere more than those of the other hemisphere and others show little or no bias. Those who do favor the Hemispheric Related Traits of one hemisphere can be said to have a Right or Left Hemispheric Cognitive Style. It is important not to overgeneralize the scope of Hemispheric Cognitive Style. The fact that a person tends to use particular strategies implies neither a disuse nor deficiency in one hemisphere of the brain. On a very simple level, a right Hemispheric Cognitive Style individual has access to the speech centers of the left hemisphere just as a left Hemispheric Cognitive Style individual has access to the prosody centers of the right hemisphere. Thus both right and left Hemispheric Cognitive Style individuals rely on the integrated functioning of both hemispheres for expressive speech, and, in fact, all behavior. In an intact individual, no task can be accomplished without the integrated functioning of both hemispheres. To call an individual "left or right brained" is to ignore the fact that all activity depends on the integrated functioning of the whole brain. These differences, however, can be related to different strategies with which people approach specific tasks. One purpose of this paper is to show how these strategy differences can affect the educational system. The next chapter will describe how differences in Hemispheric Related Traits can be measured. The following chapters will focus on the application of these traits to mainstream and learning disabled education. CHAPTER 2 THE MEASUREMENT OF HEMISPHERIC COGNITIVE STYLE Two distinct tools have been used in the measurement of Hemispheric Cognitive Style, one behavioral and the other physiological. The behavioral measure is a self rating questionnaire and the physiological measure relies on the predominant direction of Lateral Eye Movement (LEM). The Hemispheric Preference Questionnaire There are many questionnaires that have been used to measure "hemisphericity" including many from popular magazines. Over the past 12 years I have developed an instrument that has been successfully used to separate right and left Hemispheric Cognitive Styles. A copy of the questionnaire and its scoring key has been included. The following studies used the instrument successfully. Coleman and Zenhausern (1979) compared those who used right and left Hemispheric Related Traits on a memory retrieval task. They found the two groups differed on processing speed and the extent of a left hemisphere bias induced by a verbal memory load. The bias was four times stronger for the those who use left Hemispheric Related Traits than for those who use right Hemispheric Related Traits. Zenhausern and Nickel (1979) found that Right style individuals learned a finger maze in fewer trials, in less time and with fewer errors than Left style individuals. Zenhausern, Notaro, Grosso, and Schiano (1981) presented right and left style individuals with auditory messages in which there was a conflict between verbal content and emotional tone of voice. Overall, those who used right Hemispheric Related Traits responded significantly more often to the inflection cues and those who use left Hemispheric Related Traits significantly more often to the verbal content. Zenhausern and Dunivin (1981) found that left style subjects were more obsessive compulsive, while right style subjects had more hysterical traits. Zenhausern and Parisi (1983) have found that schizophrenics rate themselves as using left while depressives rate themselves as using right hemisphere related strategies. The instrument has been used in the area of reading disability to distinguish two separate syndromes. Oexle and Zenhausern (1980), Golden and Zenhausern (1981), Zenhausern and Sinatra (1983), Maxwell and Zenhausern (1983) have fou