Mind At A Time - 02 edition

Levine, Mel D. : University of North Carolina

Dr. Mel Levine is a professor of pediatrics at the University of North Carolina Medical School and the director of the university's Clinical Center for the Study of Development and Learning. He is the cofounder and cochair of All Kinds of Minds, a nonprofit institute that develops products and programs to help parents, teachers, clinicians, and children address differences in learning. A Rhodes scholar and graduate of Harvard Medical School, Dr. Levine lives in the Raleigh-Durham with his wife, Bambi, and many animals.

Chapter 1

The Ways of Learning
The mosquito is an automaton. It can afford to be nothing else. There are only about one hundred thousand nerve cells in its tiny head, and each one has to pull its weight. The only way to run accurately and successfully through a life cycle in a matter of days is by instinct, a series of rigid behaviors programmed by the genes....The channels of human mental development, in contrast, are circuitous and variable.
Edward O. Wilson, On Human Nature

Fritz wore very thick lenses in his wire-rimmed spectacles. He was an awkward kid who mostly liked being by himself. At age eight he was becoming an insatiable glutton for the printed word, devouring all manner of written nourishment wherever he found it. At first, his parents were vexed by his marathon stays locked in the bathroom, until they found out that that was where their eccentric Fritz felt most comfortable savoring his reading. Fritz came to see me because of some motor problems, including difficulty writing, along with some seeming leaks in his memory.

On several occasions, his mom and dad mentioned that Fritz was fascinated with gadgets of any kind. He relished getting his hands on whatever seductive apparatus was within reach. In the car he would studiously detach or disassemble ashtrays, loudspeakers, and door handles. His extraordinarily tolerant father observed that Fritz was much more talented and enthusiastic when it came to taking things apart than when putting them together! But Mr. Powell did admit that his son was nothing short of remarkable at fixing objects around the house.

I was able to confirm this finding when one day I was doing a physical examination on Fritz in my office. He saw that one of the lights I use for examining ears (my otoscope) was not working. I told him it was broken and that I had changed the batteries and the bulb to no avail. I had also used a well-established, arguably primitive, Mel Levine technique; in vain, I had shaken it repeatedly and briskly. Anyway, Fritz pounced on my otoscope and immodestly proclaimed, "I'll fix it for you." Of course, I consented to the proposed surgery. Fritz then inspected the instrument, and thought out loud, "Let me see now, how is this supposed to work?" I never would have asked myself that question. Fritz then used his fingers and his voice to trace and talk through the way an otoscope is supposed to work. Only then did he go back and determine where the breakdown was occurring. In doing so, he encountered a loose connection in the switch, which he remedied with leverage from one of his handy talonlike fingernails. What struck me and what I never forgot after that was that Fritz was unwilling to repair my light without first determining how such lights were supposed to work. I have since applied the "Fritz Principle" in my career. That is to say, I should never try to understand and deal with differences in learning until I know how learning works when it's working. So I can't figure out why a kid is enduring serious grief in algebra unless I understand what it ordinarily takes to master algebra -- in other words, how that kind of learning works.


How Learning Works

The most basic instrument for learning is something called a neurodevelopmental function. Our own minds and those of our children are like tool chests. They are filled with these delicate instruments, neurodevelopmental functions, the various implements for learning and for applying what's learned. Just as a carpenter might deploy different groups of tools to complete various projects or a dentist might use different sets of tools for different tooth tasks, our minds make use of different clusters of neurodevelopmental functions to learn specific skills and to create particular products. One committee of neurodevelopmental functions enables a student to master subtraction; another squad participates in the recitation of the Pledge of Allegiance, yet another neurodevelopmental task force makes possible riding a scooter.
A neurodevelopmental function may be one component of memory, such as the ability to recall things that have been seen in the past (i.e., visual memory), or it may be the awareness of where within the letter "g" your pencil is located during each instant while you form that letter. The capacity to store and retrieve chains of information, such as the alphabet or the events leading up to World War I, is another example of a neurodevelopmental function. As you can surmise, the brain's toolbox is vast, the total number of neurodevelopmental functions inestimable. On top of that, the range of different combinations of functions called upon to accomplish academic tasks is mind-boggling. In view of all these moving parts, it should not surprise us that breakdowns or specific weaknesses are commonplace. We call these deficiencies neurodevelopmental dysfunctions. We as well as our kids all live with our share of these flaws. Often the dysfunctions do not seriously obstruct roads to success. But sometimes they do.

Here are some examples of neurodevelopmental dysfunctions. Some children have difficulty writing, even though they have lots to say. They just can't seem to form letters quickly and accurately enough to keep up with their flow of ideas and words. So their writing is dramatically inferior to the richness of their thinking or speaking. When kids write, their brains assign specific muscles to specific aspects of letter formation; certain muscles are supposed to handle vertical movement, others create rotary movement, others assume responsibility for horizontal movement, while still others operate to stabilize the pencil so it won't fall on the floor while they write. Some kids endure agonizing difficulty with such motor implementation; they simply can't assign the proper muscles consistently. Therefore, writing looms as a tormenting problem for them. This inability to assign specific muscles to operate in the right way at the right time during letter formation is a perfect example of a neurodevelopmental dysfunction. Other kids have trouble finding the exact words they need when they talk, difficulty remembering the associations between sounds and symbols when they read, or trouble understanding complex sentences and thereby following directions quickly and precisely enough in the classroom. Each of these deficiencies is a specific neurodevelopmental dysfunction and in each instance the dysfunction is likely to interfere with learning.

All too often a neurodevelopmental dysfunction goes undetected -- much like an unsolved crime. As was the case with Carson, the assumption may prevail that somehow a floundering student is not really trying, that he is lazy, unmotivated, or, perhaps, even worse, that he's "just not too bright." A child like Nana may be discovered to be daydreaming and fidgeting in class, dreadfully out of focus. She is told she needs to start paying attention in class or she'll get detention. She comes to believe she is somehow bad. No one seems to realize that her fragile concentration is a kind of mental fatigue or burnout; she has neurodevelopmental dysfunctions interfering with her mind's ability to turn on and keep up the flow of mental energy that she needs to concentrate in class. Her neurodevelopmental dysfunction is misread as a behavior problem when she has to combat serious mental fatigue. She's an innocent victim of her own wiring.


Eight Systems

Approximately 30 trillion synapses or nerve linkages exist within the human brain. That crowded network allows for plenty of strong connections, disconnections, and misconnections -- in short, a nearly endless combination of neurodevelopmental possibilities. As we have seen, designated teams of neurodevelopmental functions join together to enable kids to acquire specific abilities. When one or more members of a team fail to show up or fail to do their share, performance suffers. Such negative results can bring on a backlash of emotional and motivational complications. Fortunately, we have the wherewithal and the knowledge to mend these problems before they get out of hand.
Schools and parents share the job of ensuring the healthy growth of vital neurodevelopmental functions. How then do we keep track of a mind's growth processes over the course of a child's school career? The answer is that caring adults need to know how these functions are supposed to be operating year by year -- just as they might be tuned in to a child's ongoing nutritional needs or rate of growth. At first glance, staying on top of the many facets of a child's mind development might appear to be a daunting, unrealistic undertaking in view of the vast constellation of important neurodevelopmental functions. But don't despair; to aid us in our surveillance mission, all of the different neurodevelopmental functions can be sorted into eight manageable categories, or neurodevelopmental systems. In my work with schools and clinicians I have called these "the neurodevelopmental constructs," but they are perhaps more helpfully thought of as the systems of a mind.

In medicine we are accustomed to thinking about overall health as the sum total of the health of various systems, such as the cardiovascular system, the nervous system, and the gastrointestinal system. Similarly, we can think about your child's learning health in terms of the well-being of the eight learning systems I am about to describe. As with the systems that operate in our bodies, the neurodevelopmental systems are dependent on one another. They have to work together if learning is to occur, just as the cardiovascular system has to team up with the pulmonary system to promote the delivery of oxygen to various parts of our bodies.

These systems are like the major characters in an unfolding drama. As we watch our kids grow and develop over their school years, we need to focus on the progress of the eight systems. At any point, the strength of functions within each system directly influences performance in and out of school. Systems change in their capacities. The functions can grow in their effectiveness. They can level off. They can deteriorate. Therefore, it is important that caring adults keep an eye on the progress in each system, promptly detecting and dealing with any important impairments or signs of delayed development.

The eight neurodevelopmental systems are depicted in Figure 2-1. Individual chapters in this book focus on each system. But first, I will provide a brief description of each.

The Attention Control System
Jesse gets a traffic ticket for speeding; he's all riled up over it and defends (pardons) himself by proclaiming to his parents, "I just wasn't paying attention to the speedometer. I had other things on my mind." But Jesse often experiences such mind lapses, and has had a long-standing difficulty directing his attention. His mom once pointed out, "That's my Jesse. It's absolutely incredible how he can be doing one thing and thinking about three other things at the same time! He's concentrating on everything but what he's doing."

Attention is the administrative bureau of the brain, the headquarters for mental regulators that patrol and control learning and behavior. The attention controls direct the distribution of mental energy within our brains, so that we have the wherewithal to finish what we start and stay alert throughout the day. Other controls of attention slow down our thinking so we can plan and complete tasks competently and efficiently. An example of attention control is a child's ability to resist the temptation to think about the party she's invited to tonight so she can concentrate on the word problem her math teacher is explaining. Attention keeps your child focused while filtering out distractions. Children vary widely in how often their attention controls function effectively.

The Memory System
Elsa keeps "bombing out" on tests or quizzes that force her to memorize and later answer questions that have only one correct response. She recently flunked a quiz on plant structure despite studying like a devout monk. "I thought I knew all that stuff, but it must have just leaked out of my brain while I was sleeping." Our school years involve more strenuous exercising of memory than at any other time in our lives. In fact, much more memory is needed for school success than is required in virtually any career. To varying extents, every course in school is a memory workout. And memory is downright complicated with countless little facets to go with the many different kinds of things we try to remember. Every student has memory compartments that serve him well, while other parts of memory bring on varying degrees of frustration. There are countless intellectually competent kids who unravel in school because they understand far better than they remember. Ironically, there are many students with superb rote memory who succeed with flying colors through their school years simply by regurgitating factual data. They may be far less successful during adult careers when memory plays much less of a starring role.

The Language System
Riley just received an A+ on a highly original short story; he's always gotten As in English and he loves to read and write. This guy makes most schoolwork look like the proverbial piece of cake. That's because school is a perfect fit for born linguists like Riley. The language ingredients of learning include, among other things, the ease with which a brain detects differences between the forty-four or so different English language sounds (an indispensable ingredient of reading skill), the ability to understand, remember, and start using new vocabulary, the capacity to express thoughts while speaking and on paper, and the speed of comprehension needed to keep pace with a seemingly supersonic flow of verbal explanations and instructions. Learning a second language is another example of an academic demand that calls for strong verbal capacity. Not surprisingly, kids who are good with language are more likely to succeed throughout school. On the other hand, those poor souls with even the mildest (often unapparent) language inefficiencies are apt to suffer agonizing pain trying to make it in our schools.

The Spatial Ordering System Marcus's parents fret over his inability to distinguish left from right; more often than not, he puts his shoe on the wrong foot. Marcus's father once commented to me, "It's as if this kid is completely lost in space. He never remembers where he's left anything and he puts his shirt on backward more often than not -- even when he thinks about it." Also, his confused drawings in school are a source of shame to Marcus. These shortcomings reveal his weak spatial ordering. The spatial ordering system is designed to enable us to deal with or create information arranged in a gestalt, a visual pattern, or a configuration. Through spatial ordering we perceive how parts of things fit together. We are able to study and later recognize familiar shapes, their relative positions, and what goes with what to make a pattern, such as the letter "h" or an octagon or your boyfriend's face. Spatial ordering also helps us organize the various material necessities of the day, such as pencils, notebooks, desks, locker contents, and other props needed for academic efficiency and proficiency. Spatial ordering calls for the use of closed circuits between our eyes and our brains, wiring designed to discern patterns and discriminate between them. People with strong spatial ordering are not likely to waste much time searching for lost objects; they know where things are. On a more complex level, spatial ordering enables us to think with pictures, so a child hearing a story about Robin Hood can visualize the dramatic events, while a student in art class can picture the steps needed to undertake a ceramics project.

The Sequential Ordering System
If you tell Suzanne to do three things in a row, she appears dazed and ends up fulfilling only the last step of the instruction. Her teacher describes her as "strictly a one-step processor." She has trouble recalling the steps required to tackle a long-division problem. This girl is contending with her inadequate capacity for sequencing. This system, a working partner of spatial ordering, helps us deal with the chains of information that come into or depart from our minds coded in a particular serial order or sequence. Throughout their day, kids are under attack by a furious onslaught of sequences, which range from the steps in balancing an algebraic equation, to the order of digits in a new friend's telephone number, to the chronology of events culminating in the election of a president. A teacher's directions are transmitted in a verbal sequence. But the most challenging and insidious sequence of all is called time. Sequential ordering forms the basis for time management, for understanding time, estimating time, allocating time, and being aware of time's passage. On a higher plane, sequential ordering is involved in many forms of reasoning, perhaps most vividly showcased in a tenth grader's geometric proof.

The Motor System Alcindor is frustrated and exquisitely self-conscious about not being able to ride a two-wheeler when all of his buddies can do so effortlessly. He feels like a klutz. The poor kid is living with a breakdown in his motor system, at least at this point in his development. The motor system is supposed to govern the very precise and complex network of tight connections between the brain and various muscles all over the body. A child's motor functions determine whether or not she will excel in sports and, if so, whether it will be field hockey, tennis, or track. Other neuromotor functions make possible cursive writing, playing the fiddle, and guiding scissors. Motor coordination is important to children; being able to show off proficiency makes an important contribution to overall self-concept and confidence. Clumsy children may come to feel globally inferior to their agile classmates.

The Higher Thinking System Melinda just can't seem to grasp the concept of mass in her high school physics class. The difference between velocity and acceleration, the meaning of resistance in a wire, and the phenomenon of static electricity have also eluded her. She willingly fesses up, "I don't get physics; I don't get it at all." Melinda is struggling with inadequate higher thinking, a system that represents the real summit, the very peak of our thinking abilities. Jackson can't seem to decipher the symbolism in a poem by T. S. Eliot but has no trouble with symbols in his advanced algebra class. He has a very specific breakdown in higher thinking when he is using language. Myrna is great at figuring out what's wrong when her computer isn't functioning but she has trouble figuring out the point of view expressed in an editorial on global warming. Higher thinking includes the ability to problem-solve and reason logically, to form and make use of concepts (such as mass in physics), to understand how and when rules apply, and to get the point of a complicated idea. Higher thinking also takes in critical and creative thinking.

The Social Thinking System Bethany never gets invited to parties. The phone rings off the hook for her brother and sister, but never for her. At school she is picked on, jeered at, taunted, and avoided like a venomous snake by her classmates. She has no friends and is understandably crushed. Bethany is lacking in the kind of social thinking that is needed for maintaining successful relationships. Her mother laments, "Bethany would give her right arm to have a true friend, but it seems as if every time she comes close to having a satisfying relationship, she messes up. She either says or does something that upsets and puts off her new friend. And Bethany has no idea what she's doing wrong, no idea at all."

Children's social abilities occupy center stage in school. The social spotlights are glaring. They illuminate a galaxy of interpersonal strengths and shortcomings. Interactions with peers yield the bulk of the gratification or humiliation a student experiences in life. Some kids seem to be born with distinct social talents that allow for friendship formation and a solid reputation; others have to be taught how to relate. A child (or adult) may be strong in the seven other neurodevelopmental systems yet seem to fail in life because he or she is unable to behave in a way that fits appropriately with others of his age group. He may have trouble establishing new friendships and keeping old ones afloat, working collaboratively in groups, or coping tactfully with flammable conflicts involving classmates. Even the most brilliant child can end up frustrated if he is too shy, socially inept, or antisocial. School affords little or no privacy. Those who have stunted functions for social interaction are condemned to feel the pain of exposure and daily humiliation. They are likely to be the most downtrodden students in a school (and also the most anguished employees on the job).

Parents and teachers experience satisfaction watching children's neurodevelopmental systems expand in their capabilities over days, months, and years, especially when the functions are put to good use, exercised like limber muscles. Caring adults have to realize that a system deteriorates drastically when it is underutilized. For example, if a child almost never elaborates on ideas, rarely talks in complete sentences, and instead overindulges in words like "stuff" and "thing," or else in profanity, then his verbal skills will stagnate, fail to grow, and even diminish. If you never do any running, the neurodevelopmental functions needed for running are likely to starve, inevitably eroding your overall gross motor performance.

Your child's neurodevelopmental systems never get a chance to perform as soloists; they constantly join forces to accomplish good results. Memory partners with language to help your third grader recall the words to "Silent Night." Attention control reacts with gross motor ability to produce the sinking of a long putt on the eighteenth green. Sequencing, visual memory, and language combine with social awareness to let you explain to a friend the plot of the science fiction thriller you saw on TV last night.


Neurodevelopmental Profiles
Every one of our children ambles down the highly judgmental corridors of school each day dragging along his mind's profile, a partly hidden spreadsheet of personal strengths and weaknesses. And throughout every moment of the school day that profile gets put to the test. Some of our children are blessed with profiles that are magnificently matched to expectations, while others are saddled with profiles that fail to mesh with demands -- an all too common disparity that can arise at any age.

If a child you know has a profile that's not conforming to demands, don't give up and don't allow him to give up either. That very profile has a good chance of coming into its own sooner or later. That's because we know a pattern of strengths and weaknesses may operate particularly well at specific ages and in certain contexts but not nearly so optimally in other times and under alternative circumstances.

This was just the case with Toby. He was a kid who had a lot of trouble with the memory demands of both elementary and middle school. He had trouble remembering facts and skills quickly and automatically, and it was hard for him to hold several things in his mind at once while completing an assignment. As a result he was wiped out in algebra and had a very hard time with writing assignments. In the latter case, he kept forgetting what he was going to write whenever he paused to think about spelling. But Toby was brilliantly creative, and he was a phenomenal conceptualizer and a razor-sharp critical thinker. After barely surviving daily disgrace in elementary and middle school due to his memory shortfall, he rose like a ballistic missile when he was allowed to take advanced placement courses in history, English, and art in high school. A guidance counselor had been humane and perceptive enough to know that sometimes you fix a weakness by pursuing strengths. His honor classes all downplayed sheer memory work and stressed instead original and critical thinking. Graduating near the top of his class, Toby majored in political science at Brown University, and is now a Ph.D. candidate with an interest in the career pathways of successful national leaders. He has just written an important book on the subject of political motivation. He still claims to have trouble with his memory, but that doesn't seem to matter or interfere anymore. Computers have helped enormously. As he reflects, "My hard drive is sitting on my desk, so it doesn't need to be housed in my skull! Besides, no one around here gets tenure because of his memory."

I think a big part of teaching and parenting entails helping kids make it through periods when they feel inadequate. It happens to everyone once in a while. And that is why we need to think about how a particular mind is fitting in at a particular time of life. It means we need to consider "a mind at a time" (a second meaning of the title of this book).

Not only may a mind come into its own at any time, but also a profile that is perfectly set up for success in school may not be nearly so well fitted for career attainment. A kid's profile may win all sorts of praise throughout her elementary school years, but that in no way guarantees that her particular profile will satisfy career requirements at age twenty-three. Clearly then, some profiles work better at certain ages than at others. Sometimes the very same traits that jeopardize your kid in third grade could evolve into his prize assets during adulthood. Distractibility and daydreaming during reading class may be an attention deficit yet may also be early indicators of creativity and innovative thinking, "symptoms" that will bolster her career as a scriptwriter or music video producer. A student's trouble understanding language may cause him to do much less of his thinking with words, as a result of which he strengthens his visual and spatial thinking, destined to serve him well two decades later in his career as a mechanical engineer designing nuclear power plants.

When a child brings home disappointing grades, parents can take solace in the well-documented finding that report cards are notoriously poor at predicting how your child will eventually do in a career. In fact, sometimes when I see a child in my office who is failing or perhaps just floundering in school, I love to rev him up by saying something like this: "Hey, Reginald, when you go back to school on Monday, take a good look around your classroom and pick out a kid you really envy, someone who gets fantastic grades, is good-looking and is a super jock too, you know, a kid who always seems to do everything right. And who is popular. Look closely at that kid, and seriously consider the possibility that this may well be his finest hour! There is a good chance he'll be working for you someday." I guess that's another way of saying that different profiles are destined to make the grade at different times of life and when the conditions are right. Adult life offers many more opportunities for infinitely more kinds of minds than are available during child life. Parents need to find things to praise in a struggling child and make sure that he doesn't give up on himself and get depressed and distressed while waiting for his day to come.

Not only do different profiles have their day in the limelight eventually, but also children are capable of changing their strengths and weaknesses over time. Take heart, parents: neurodevelopmental profiles are not like computer hardware or fossils. They are resilient. One despondent mother confided, "My daughter Cathy is so sweet and kind. She will do anything for anyone. But school is such a frustration for her. I sometimes wish we could just trade in the learning part of her mind." Well, it turns out you can change your mind but not exchange it. For instance, some individuals plagued with language impairments in school become fluent and articulate speakers and have phenomenal reading comprehension by the age of thirty. They actually have built up their language system after having been nonverbal schoolchildren. Through extensive use of language (often within their chosen careers), they become respectable linguists. Of course, there may be some ceilings, limitations on how strong a weakness can become. If I, an inept athlete, were given batting lessons in baseball, I could improve some (there is a lot of room to do so), but no matter how dismal a season they were having, it is highly unlikely that I could ever play shortstop for the Boston Red Sox.

Many individuals grow up in homes that are dysfunctional, neighborhoods that are violent, environments that seem to starve their minds, yet somehow they manage to salvage their minds, to discover some ways of learning and succeeding despite biographical odds that are so stacked against them. Some of this resiliency may result from hidden neurodevelopmental strengths that they discover and ignite within themselves. There are well-known attorneys, preachers, and playwrights who grew up in poverty but had superior innate verbal wiring. Having a talent as an orator, actor, or comedian can be the wellspring of resiliency. Of course, sometimes hidden talents remain forever hidden and go to waste instead of triggering resiliency. That means parents and teachers have to be on a constant, diligent quest for buried treasure within children.


How a Mind's Profile Comes to Be
What shapes your child's profile? Can you influence the process? These are thorny questions, ones we shall confront throughout this book. No doubt multiple forces interact to determine a child's strengths and shortcomings. And parents are in a pretty good position to influence most -- but not all -- of these forces.

Genes
For better or for worse, mothers and fathers don't get to select or reject the traits a child inherits. Sandy is just as absentminded and disorganized as her mom, who says, "How in the world am I supposed I help my daughter get her act together when I'm even more discombobulated than she is?" Many strengths and weaknesses appear to be inherited -- either completely or in part. In the best of all possible worlds sharing aspects of your child's profile can make you a more sympathetic parent. You know what he's going through. In my experience, often when a child has a particular kind of learning weakness, much the same pattern will be plainly evident in one or both parents or else in a sibling. When parents observe us testing a child, it is very common to hear from a father or mother: "I had trouble with the same things he did!"

Joey, an absolutely delightful patient, came to me recently for a follow-up visit. This country boy with his close crew cut and his reversed baseball cap permanently bonded to his skull actually lives on a farm close to my own. Despite being only ten, Joey always talks like a venerable elder statesman. During a recent visit to my office, when I inquired about how things were going in school, Joey replied, "Not so good, Doc." When I asked what he meant by that, he responded, "It's my handwriting, just my handwriting, same ole thing. My teacher, Mrs. Bailey, she says she can't read nothin' I write." I asked, "Well, Joey, what are you doing about it?" The boy reported in a slow, almost fatherly voice, "Well, Doc, I did what I needed to do. I had a long, long talk with her. I told her, Mrs. Bailey, you know my granddaddy wrote like that, and my daddy writes just like that, and I been writin' like that since I been six years old. Mrs. Bailey, in my family, that's as good as it gits." Joey was pleading for the weighty influence of genetic factors. With all due respect to Joey, genes are powerful but they don't prevent us from working on our weak spots, especially if we decide they're worth working on.

Family Life and Stress Level
Billy's family has been so overwhelmed with financial, marital, and other domestic problems that his mother has not been able to help him with schoolwork. She complains, "I have all I can do to get by, to earn some money, to keep our place looking decent, to feed the kids the right food, and to make sure the dogs get some exercise." She herself had a hard time in school and never got through ninth grade. Billy has no interest in school and derives little if any positive feeling from learning. Clearly when families feel as if they are buried beneath the stresses and strains of daily existence, it may be hard to foster a stimulating intellectual life through shared experiences and high-level discussions at the dinner table regarding current events. Cassandra's is a very different story. Cassie (to her friends) has a mother who is a dermatologist and a father who's a trial judge. At home there are frequent discussions about the world of ideas. Both parents love to read. They value their intellectual life and share it abundantly with their only daughter. They have infected their daughter with intellectual curiosity. Cassie excels academically and has an unquenchable thirst for new knowledge. Contrast her with Billy. Socioeconomic realities exert powerful influences on a child's development. Poverty has its risks, as does being overprivileged and overindulged. The neighborhood, the community, and local resources of many different kinds impinge upon a mind's evolving strengths and deficits.

Cultural Factors
Suzie comes from a family recently emigrated from Hong Kong. Her family has always had a very powerful work ethic dating back generations. All of her Chinese friends share the same background, one that takes education seriously. Suzie comes home from school and works for four to six hours without a break. She assumes that this is the way people are, even though her classmates are out playing volleyball and planning the weekend's parties. Suzie's neurodevelopmental capacities keep on getting stretched, perhaps even stretched to the limit. She has developed extraordinary powers of concentration and can exert mental effort whenever she needs to. Her teacher has marveled at Suzie's tenacity, as he comments, "This girl is the ultimate plugger. She won't give up ever until what she has produced is of the highest quality no matter how long it takes her." Her flawless honor grades testify to this. A student's cultural background may help determine which neurodevelopmental strengths get stronger and which ones do not. In some cultural settings athletic prowess is considered valuable; in others, sports are deemed trivial pastimes. Whether or not a teenager reads novels, does crossword puzzles, repairs jeeps, attends Italian opera, engages in household chores, or hunts white-tailed deer vividly reflects the culture in which he or she is growing up. These activities, in turn, profoundly influence a child's profile of strengths and weaknesses.

Friends
Christian has pretty much stopped doing any schoolwork. In ninth grade, he is very popular. Most of his friends feel that homework completion is not cool; rather it's a pursuit designed exclusively for geeks, dorks, and other weirdos. Christian, who savors his popularity like a rare vintage Burgundy, has caved in to the social pressure and is failing several subjects. According to his father, "My kid has been lost to his friends. They're all he cares about. I feel as if he has fled from our family and cares only for the approval of his peers. He performs for his friends like a puppet; he'll do whatever it takes to win their applause. And he's with kids who live only in the present. They couldn't care less about school and about their minds."

Friends play a dominant role in shaping the brains of their friends. Children who have no intellectual interests become negative role models for one another. Learning and succeeding in school may be perceived as some kind of social taboo. On the other hand, I have one patient, a thirteen-year-old boy from New York, whose friends and he have a strong interest in politics. They worked on a local campaign last summer and are incessantly talking politics, discussing editorials in the New York Times, and debating raging political issues. He told me they consider themselves "local political dissidents," as their views are pretty radical. In the meantime, they are developing extraordinary language, critical thinking, and reading ability, bolstering their minds' profiles. Their parents are in awe of these boys and girls. One mother confessed, "Half the time I don't even understand what they're talking about, but it sure sounds impressive -- and a little intimidating. I love listening to them. I'm proud of them all. I think they are becoming the leaders of the future. They are really lucky to have each other and we parents are so fortunate to have them as our children."

Health
Deanna suffered a bad case of viral meningitis when she was fourteen months old. Following her illness she developed a seizure disorder, one that has been difficult to control ever since. She is delayed in reading and math. There is a strong suspicion that her medical history played a role in weakening certain neurodevelopmental functions important for acquiring basic skills. Deanna has noticeable gaps in language function and in certain parts of her memory, and she becomes frustrated in school. Her older sister, Beth, worries about her all the time. She always accompanies Deanna when she comes to see me in my office. Beth informed me once, "Deanna really feels dumb. Between her seizures and her trouble at school she feels like she just can't do anything right. I feel so bad for her." Numerous medical factors either foster or impede brain development during the school years. Nutrition, certain illnesses, and physical trauma all may play a role in the shaping of a profile.

Emotions
Geraldine has been depressed all year. Her parents got a divorce, she broke up with her boyfriend, and her grandmother died last summer. Her mother and father feel guilty, as they worry they have damaged their daughter permanently. Geraldine feels sad much of every day. She's lost interest in school; her grades show it. Students with anxiety or depressed feelings often lose all interest and become inhibited about performing in school, which then begins to stunt their academic and neurodevelopmental growth. Geraldine has closed her mind to new learning during a period of school in which kids ordinarily develop their ability to absorb and think about highly abstract terms such as creationism, symbolism, altruism, and imperialism. If her mind stays absent from school, this important growth spurt in higher-order thinking may fail to take place. Emotions and neurodevelopmental functions are like a two-way street: emotional problems may weaken the functions and weakened functions can cause emotional turmoil.

Educational Experience
Arturo had been in first- and second-grade classrooms in which there were forty-two students with one teacher and only an occasional aide. His parents are utterly frustrated. His mom complained to me at a conference where I spoke, "Arturo is lost, totally lost in that school. He's the kind of kid who doesn't make trouble for anyone but you might not even notice he's around. And he'll never ask for help. He pretends he does understand when he doesn't get it half the time. But the school's so big; they don't see that he's getting nowhere. I'm so nervous about him." Arturo's reading instruction was inadequate, and he fell further and further behind in math as well. Now in sixth grade he remains seriously delayed and has lost his drive, having given up on himself. He is starting to get some individualized help, which is just beginning to make a difference in his performance and his self-esteem. Hopefully, it's not too late. The quality of a child's teaching most certainly affects his or her mind profile. In fact, recent studies using sophisticated brain scans have shown vividly that good instruction can actually result in positive changes in brain structure. It is possible to see increases in brain tissue when parts of the brain get properly stimulated after having been neglected. Also, a child's educational track record profoundly affects motivation, as kids like Arturo, who have failed over and over again in the past, may be sapped of motivation and sink even further into failure. Success, on the other hand, has a way of breeding more success.


How Lifestyles May Affect Learning Styles
Increasingly over the years, I've heard a succession of mothers, fathers, and educators grumble about contemporary children's ways of life and all the ways in which those ways of life are "dumbing them down." A middle school English teacher voiced her concerns as follows: "I feel I'm at a real disadvantage. The students I teach have spent so much of their lives on couches watching sitcoms and violent videos, all of which require negligible concentration, have only sparse details and no implications or hidden meanings in them, and resolve nearly instantaneously any conflicts in their trite plots. How can I then expect my kids to come in here and delay their gratification to wade through A Tale of Two Cities or write a creative short story of their own? So many of their brains are just plain out of shape for what I think they need to be doing, and even enjoying, in my English class." I had to agree. Rapidly paced entertainment can make school content seem like a colossal bore!

I have been finding in all my clinical work that many aspects of contemporary life can stunt the growth of key neurodevelopmental functions. First, there are the effects of all the electronic experiences children and teenagers take in and savor. Television is the most well established culprit. Aside from the violence that may model impulsive, acting-out behaviors, there is the passivity involved in watching most TV programs. Inactive information uptake while lying on your back and consuming buttery popcorn eclipses opportunities for creative thinking, brainstorming, and the development of products and hobbies -- all more active and proactive mind-strengthening activities. For the most part, television shows offer stimulation in small chunks without much call for sustained attention and deep concentration. At times I think certain television shows serve as models of attentional dysfunction for their young viewers. Canned laughter during situation comedies is a major offender in my opinion and should probably be banned as a form of intellectual child abuse! Imagine being told when something is funny -- the ultimate affront to language processing and higher thinking. Moreover, the verbal content of television tends to be woefully unsophisticated, and the stress is very much on vivid visual imagery rather than complex language use or interpretation.

Unsophisticated language is also a feature of much of the music that interests children. There was a time when a composer would hire a lyricist, a kind of poet, to fashion the words to his music. Lyricists are now mainly unemployed, as the person who creates the melody also produces the language accompaniment, which is often grammatically and semantically impoverished, simply everyday language rather than language that plays on words and cleverly turns a phrase. Thus, music no longer reinforces verbal abilities. Also, much of the music to which children are exposed tends to make use of very brief themes or melodic lines, which keep on coming back monotonously. As a result, the ability to retain patterns in memory is not strengthened through music (as I believe it once was).

Electronic games have also taken their toll, although sometimes they have a positive effect on eye-hand coordination and spatial ordering. Unfortunately the latter capacities do not make an enormous contribution to a child's intellectual development. One of my patients, a nine-year-old boy, let me know, "I love my games more than anything else. I hate to read because it's not as exciting and fun. I can beat all my friends and my big brother even when it's a new game. I would play all day and skip school if I could. That would be neat. When I grow up, I want to be a game designer."

Use of the Internet is a mixed blessing. On the one hand, leaning to surf the Internet for specific bits of information can become a powerful research skill. However, some students have made use of Web sites to download information without really understanding or integrating it. Thus, the process runs the risk of becoming a new mode of passive learning or perhaps even a way of acquiring plagiarizing skills.

Family life can also deter mind development. When families feel overwhelmed, life can be nothing short of frenetic at home. As one mother told me, "We barely see each other. We're always on the run or getting ready for some major event. I can't remember the last time we sat down and had a decent dinner table conversation. In fact, with my job and my husband's job, and all the kids' activities, most nights we don't even eat together." That makes it hard for family life to reinforce communication skills, doesn't it? The lack can be even more pronounced among the many single-parent families whose daily lives can be even more logistically consumed with little or no time for any mind-enhancing reflection and discussion. Frazzled lifestyle patterns can also cost something in terms of children's nutrition. Skipping breakfast, overindulging in convenient junk foods, and becoming addicted to empty calories of various sorts may be taking a hidden toll on brain development and mental energy.

Nightlife is yet another potential invader. I find that kids are orienting increasingly toward nighttime pleasures, often getting to sleep late and having trouble functioning in school the next day. TV, the Internet, social life, e-mail, instant messaging, and a multitude of other thrilling forms of nocturnal experience make homework and other educationally useful activities seem like impositions or chores to get over with as expeditiously as possible. And students who rush through their work derive little intellectual benefit or stimulation from it. As one mother recently exclaimed over the phone, "I'm not surprised he's having trouble staying awake in class, the kid's up until 2:00 a.m. listening to music, watching TV, and doing his instant messaging, and if we're lucky, rushing through his homework at the last second." I think that mother's right. Suddenly, more and more kids are becoming night people. What used to be the downtime of the day has now become for so many children the most stimulating and distracting interlude.

I sometimes refer to a state of mind (or body) that I call "visual-motor ecstasy." In this form of nirvana kids seem to derive excessive pleasure from the movement of their bodies through space. Activities such as skateboarding, Rollerblading, driving a car fast, or even skiing can become obsessive experiences for some kids. These are all nonverbal activities that are certainly good as somewhat mindless forms of entertainment, but they become hazardous to mind health when they are pursued in excess to the exclusion of learning. An excessive interest in sports may also qualify as a form of visual-motor ecstasy.

Contemporary culture values visual appearance, perhaps too much. Lots of students become preoccupied with their bodies and their physical appearance. As one father noted, "I can't believe it, my eleven-year-old son spends what seem like hours in the morning inspecting himself in the mirror and making all sorts of minor adjustments to his appearance, like making sure his dirty blue jeans and torn T-shirt look just right. I wish he'd expend that much time and energy on his homework."

Lifestyle issues also arise when a child becomes overly programmed. Schools that are highly and tightly structured so that there is little time for original thinking can short-circuit brainstorming in students. This is especially the case when a child is also heavily laden with scheduled activities after school and on weekends. One girl complained to me, "I have no free time at all. It's as if I'm in the army. Every day, I have to report somewhere at some time to do something I'm not sure I want to do or need to do. I keep wishing I had nothing to do." I think having nothing to do is plenty to do. I always admire kids who can entertain themselves for hours on end; that is an important strength, often the forerunner of creativity and resourcefulness.

Millions of teenagers have jobs after school, often for more than twenty hours a week. Frequently, these jobs entail little or no mind work. A cashier at a supermarket uses a scanner to do the math work and has only repetitious, rather undemanding verbal exchanges (e.g., "Paper or plastic?") for hours on end. A working student may be more likely to give homework short shrift and find school an irritant if he is trying to make money and save up for a car. It looks as if these kids should be working somewhat less than twenty hours a week if that's economically feasible.

Adolescence is also the time when kids are most prone to the effects of drugs and alcohol, both of which can have negative effects on brain growth and development. Teenagers need to be made aware of such risky addictions.

Clearly, there are plenty of kids who grow up in our contemporary culture with all its potential sidetracks and hidden traps yet thrive in school and go on to develop great kinds of minds. On the other hand, I have met so many others with subtle or not so subtle learning difficulties whose weaknesses have been further weakened as a direct result of some negative lifestyle forces such as the ones I have enumerated. In some instances students who have been frustrated in school seek refuge in intellectually void pursuits as they try to escape from the pain of their educational wounds. In all likelihood, television, visual-motor ecstasy, a strong interest in appearance, as well as the other distractions I have mentioned, are pretty benign until they start to occupy too much of a kid's time and focus, to the exclusion of essential mind-cultivating experience. That means that as parents you have an obligation to keep things in check, to gauge whether a cultural phenomenon is somehow out of control and then to make the critical adjustments. Contemporary lifestyles are desirable in moderation.


Splitting Rather Than Lumping
I've noticed that the people who study or work with kids can be divided into lumpers and splitters. I must confess to being a splitter, quite possibly a terminal case. That is to say, I am steadfastly unwilling to lump children into categories and then assume that all members of each category are pretty much alike. To the contrary, to me kids have more differences than resemblances. In fact, every time I meet a child in my office, I encounter some phenomenon that I have never seen before in any other child. Each kid unrolls an original mural of mind traits. The challenge is to understand his or her special wiring and its implications for parenting, counseling, and educating.

In A Mind at a Time I will advocate and demonstrate an approach that stresses close observation and accurate description instead of lumping kids together in a category (such as ADD). Teachers, parents, and even the children themselves need to be able to observe, talk about, and work with profiles. They need to locate those trouble spots where facets of a profile don't mesh with facets of school. In this way, we can understand what's blocking the way when a child is stymied.

The identification and celebration of strengths may well be even more important. I believe that when your child has strengths that are suppressed, abilities he is prevented from using while growing up, he becomes a virtual time bomb primed for detonation. Gerard was a fourteen-year-old from a small town in North Carolina. He was short and razor thin and looked more like ten than fourteen. Gerard harbored neurodevelopmental dysfunctions in language, memory, and his attention, but had brilliant mechanical problem-solving abilities, along with strong social skills. Nevertheless, he was in serious jeopardy in ninth grade. Gerard was a discipline problem. He often tried to act defiant, ultra-cool, and tough in class, probably to conceal his physical immaturity and academic humiliation. There were multiple charges against him, including that he would not remove his jacket in English class, chewed gum (a school felony), mumbled offensive language in front of his teachers, refused to "suit up" for physical education (protecting his undeveloped body from peer scrutiny), insisted on wearing his baseball cap permanently, and sported lewdly suggestive T-shirts. He had stopped submitting homework, and his report cards were saturated with acerbic moral condemnations.

Gerard's father was the manager of a service station. He commented to me that on weekends Gerard would come to work with him. He stated that Gerard "is no problem at all when he's with me on Saturdays and Sundays. In fact, that kid's the best worker I have. Folks come in and ask for Gerard when their car breaks down. That little guy can stick his blond head under a hood and figure out almost anything that's wrong, and you know, he never studied cars. He just senses how things work and why they don't work. He's got common sense but no book sense. I was just like him when I was young. He also has the best people skills, the best sense of humor. And he's real kind to everyone. Everybody wants to talk to Gerard. You know that boy has all he needs to be a successful grown-up, but to tell you the truth, I doubt I'm ever gonna get him there."

Gerard's mechanical aptitude and people skills were not valued or even recognized in his high school. But then Gerard's father had a brainstorm. He heard about a vocational school in the next town. Overcoming all kinds of red tape and bureaucratic barriers, he managed to get Gerard into that school for tenth grade. Gerard flourished in the auto mechanics class, but interestingly he started to make extraordinary gains in English and in math. In eleventh grade his terrific people skills got him elected to the student government. Now in twelfth grade, he recently told me, "This is a great school. I really fit in. I love cars, but I don't think I want to be a 'wrenchy' type forever. Someday I'm planning to design cars or be some kind of a sports car dealer." Gerard is finding his niche, and that is making all the difference. Discovering a place for your kind of mind, a place where your profile can thrive, almost always works wonders. Sadly, vocational schools, such as the one Gerard has been attending, are not as prevalent as they once were. This shortage discriminates against great minds like Gerard's. As his father relates, "This boy would be in jail now if he couldn't practice his specialty in school. He's so happy and so are we."


The Early Detection of Dysfunction
It is a commonly held belief that the earlier you detect and deal with your child's dysfunctions, the more likely you are to prevent disastrous behavioral complications. I believe there is some truth to that. It might seem odd, therefore, that this book deals exclusively with school-aged children rather than beginning with infancy. In part, this is because my expertise is limited to school-aged children and adolescents. Additionally, so many of the neurodevelopmental functions needed for learning cannot be assessed until they are called for in school. Problems with memory, with time management, with the understanding of abstract language, along with hundreds of other breakdowns in learning are just not detectable until kids are actually attending school. As the demands keep changing, learning differences can and do crop up for the first time at all grade levels from kindergarten through the final year of college. I'm bothered by the fact that some academicians, policy makers, and early educators have maintained that if you don't fix a learning problem before age six, it will be impossible to deal with later on. This assertion is false. As we shall see, even adults can show remarkable improvement in one or more of their neurodevelopmental systems. It's never too late to understand and strengthen a mind.


Some Adult Implications
Although this book concentrates on neurodevelopmental variation during the school years, any reader is likely to perceive its implications for adults. In fact, I daresay no one will be able to read this book without feeling as if he's gazing into a mirror while encountering the descriptions of individuals who struggle with the features of their wiring. The very same dysfunctions that trip up so many children often snare unsuspecting adults -- in their careers, in their avocations, and in their functioning within families. Here are three examples:

Donna is a middle school principal. She is an efficient manager and a popular leader among the kids and teachers. But she has serious problems with public speaking. She chokes up and often feels she makes a fool of herself at PTA and school board meetings. As a student in school, she had always been very quiet. She doesn't realize she is battling a lifelong problem with her own wiring; Donna has serious difficulty transforming her ideas into words and sentences. She has timely things to say and excellent insights into key issues, but finding words and constructing sentences are painful brain activities for her. She suspects her problem is "just anxiety," but her apprehension is justified when it comes to oral presentations. As she puts it, "I get so uptight when I have to speak in public. My ideas come out sounding too simple or even distorted. Yet I can write well and I do just fine talking slowly in a conversation. But I can't find words fast and organize my thoughts when I give a speech, and that's a real problem in my job, especially since I'd like to be a superintendent someday."

Kathleen is a young CPA who entered her father's accounting firm last year. An only child in a closely knit loving family, she chose this career mainly to please her parents (something she had always sought to do). But her work has been uniformly poor, disappointing, and exasperating, especially for her dad. She consistently reveals her superb social and communication skills and is richly creative and affably energetic, but Kathleen is hopelessly distractible and tends to rush through every assignment she undertakes, often leaving behind a hazy cloud of careless mistakes and gaping oversights. She possesses the kind of mind that favors and savors the big picture while often glossing over smaller points. Her brain just abhors minute details, such as the ones on an accountant's spreadsheets. Kathleen is wired for conceptualizing, creating, and theorizing. She probably should not be a CPA, but she doesn't seem to understand and perceive the career implications of her brain's characteristics. Her remarkable strengths are going untapped. She is now showing classic signs of depression and says that her "everyday existence feels so meaningless and aimless."

Brad loved orthopedic surgery in medical school. He had always been a sports fanatic, and the lure of sports medicine as a career enticed him to endure medical school (which was tedious and difficult for him). He is now an orthopedic resident. Sadly, he has been totally incompetent, possibly hazardous, in the operating room. No one can fathom it; he was such a motivated medical student. It turns out that this bright guy lacks the spatial perception and nonverbal problem-solving skill (a form of mechanical aptitude) needed to function as a skilled orthopedic surgeon. He is struggling with an all too common insidious plight, namely the chaotic career of a person whose interests don't coincide with the wiring of his particular kind of mind. Brad is in pursuit of what he's unlikely to succeed at. He's unaware of this risky discrepancy. He has found no channel for his many assets. The chief of orthopedic surgery has recommended that he leave the department because of "persistent incompetence as a clinician."

Each of these individuals is highly capable. Each has a niche out there somewhere they can fit into. None of the three has much understanding of her or his profile, of its lack of fit with current demands. The cost of their lack of insight will be high for these three bright and motivated people. They have lots of company. There are countless highly competent people who contend with the same sorts of poor fit without knowing it. They would be on the road to recovery if only they could see clearly the mismatch of their occupations with their minds.

Now over the next seven chapters of A Mind at a Time, I will elaborate on the eight neurodevelopmental systems and the potent ways in which they affect lives.

Copyright © 2002 by Mel Levine

"Well organized, easy to read, not so technical that it will bore the general public who desperately need this information. As a veteran public school teacher, I especially agree with the need for more "vocational" schools rather than continuing with this neverending assembly line production of semi-presentable plastoids we call public schools. A good primer for future teachers. Thanks."

--Lynn Casey on March 27, 2002

Simon & Schuster, Inc. Web Site, June, 2002