Gray Matter, Matters: Reflections on Child Brain Injury and Erroneous Educational Practices

By Dr. Jeheudi Mes Onyemachi Vuai

Gray Matter, Matters is a book that will revolutionize school and clinical practices. For the first time, professionals in the educational domain will be challenged to rethink by which method children with brain injury are to receive services. Neurodevelopmental disorders are frequently misdiagnosed as learning disabilities." These disorders of childhood are presumed to be of psychological origin. This book discusses the myth of learning disabilities, emotional disturbances and "other health impaired." The use of labels to remediate neurodevelopmental disorders is inappropriate and may lead to school dropout.

Nontraumatic brain injury (NTBI) typically results from biological and/or environmental factors. As such, NTBI will be manifest as learning, speech and language, motor, emotional and behavioral disturbances. These children do not have a history of traumatic brain injury (TBI). The lack of knowledge of the brain-behavior relationship leads to erroneous educational practices. When these practices are applied, children are punished for their inability to attain academic mastery. Teachers may be incorrectly blamed for failing to help children move out of the cycle of failure. When children present with learning, emotional or behavioral difficulties, professionals in the schools typically overlook biological antecedents. In this book, childhood disorders will be explained from a neurodynamic perspective. Now children with nontraumatic brain injury will finally get the recognition and assistance they need. Educators are challenged to embrace the tenets of cognitive neuroscience.

This is a must read for parents and professionals who desire to move children through the continuum of academic progress.

• Language: English
• Publisher: AuthorHouse
• Release date: Dec 16, 2011
• ISBN: 9781463441739

Dr. Jeheudi Mes Onyemachi Vuai

As a clinician, Jeheudi Vuai, is both a neuropsychologist and school psychologist. He holds the Diplomate in School Neuropsychology from the American Board of School Neuropsychology (Inactive). He teaches in the School of Arts and Sciences, Department of Psychology and the School of Education, Department of Counseling and School Psychology at Barry University, Miami, Florida. His clinical experience includes providing neuropsychological evaluations and diagnosis, psychoeducational testing and assessment and treatment planning. His fifteen years’ experience includes educational, medical and residential treatment settings. He provides comprehensive evaluations for a wide range of neurodevelopmental disorders including traumatic brain injury, autism, executive function deficits, dyslexia, attention deficit disorder, dyscalculia, apraxia, ataxia, written language disorders and other brain based disorders of childhood and adolescents. As an educator, Jeheudi Vuai serves as adjunct professor of psychology and neuroscience in the departments of psychology and school psychology at Barry University, Miami, FL. He taught specialization courses on the neurobiological foundations of autism and neuroanatomy and neurophysiology at Jose’ Vargas University. He has taught at other universities in the departments of education, exceptional student education (ESE) and psychology. He has taught students from kindergarten to graduate level. He has served as special education educator, supervisor, principal and district director of counseling and exceptional student education. He has provided seminars and workshops to physicians, scientists, pre-medical students, school administrators, parents and educators. He has presented widely at conferences, workshops and staff development trainings on various topics related to neurobiology, neuropsychology, neurobehavioral and neurocognitive disorders, neurodegenerative disorders and cognitive neuroscience. As a scientist, Jeheudi is an active researcher in the fields of education, psychology, neuroscience and neuropsychology. He is recognized for his contribution to the fields of education, psychology and neuropsychological theory and practice. He is a scientist-practitioner who incorporates the latest research into clinical practice and articulates effective interventions to professionals in the fields. He delineates neuropsychological theory, dynamics of executive functions, learning disabilities (reading, writing, and math disorders) and well as right hemisphere dysfunction (i.e., attention disorders and non-verbal learning disabilities). He is currently studying biomedical science to enhance the understanding of the brain behavior relationship.

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© 2012 Dr. Jeheudi Mes Onyemachi Vuai. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 8/10/2012

ISBN: 978-1-4634-4173-9 (e)

ISBN: 978-1-4634-4171-5 (hc)

ISBN: 978-1-4634-4172-2 (sc)

Library of Congress Control Number: 2011913023

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Dedication

This book is dedicated to Emily Kinkot Dikong,

who is resting in the valley of our ancestors.

May you rest in eternal peace in the fields of the Tuat.

To the children who struggle daily in classrooms and wait endlessly

for the help that never comes; may this book

open the eyes of the blind who lead them.

Acknowledgements

I want to thank God for his love and grace throughout this project. Additionally, I want to thank the following individuals for their helpful suggestions that made me aspire to a higher level of achievement: Desiree Perkins, Speech and Language Pathologist and Reading Specialist, professors Jesus Avilas, Jennifer Casani and Pamela Hall, and my students Afua Asantewaa Guyapong and Chemica Daniels. Moreover, I want to thank Dr. Nina Morgan, counselor par excellence for her continued support and guidance and Susan Levin, who believed in me. To the specialists at Author House Publications for their wonderful and helpful suggestions in making this project a dream came true.

Table of Contents

Introduction

Chapter One  On the Brain

Chapter Two  On Non-Traumatic Brain Injury: The Myth of Learning Disabilities and Erroneous Practices

Chapter Three  On the Misconceptions of the Emotionally Disturbed Child: Frontal Lobe Pathology and Dysexecutive Syndrome

Chapter Four  On Failure, The Meaning of Educational Practice, and Non-Traumatic Brain Injury

Chapter Five:  On Rats, Pigeons, Dogs and Children

Chapter Six  On Numbers and Brain Injury

Chapter Seven  On Myths and Assumptions Regarding Child Brain Injury

Chapter Eight  On Waiting, Critical Periods, and Learning in Child Brain Injury

Chapter Nine  On Inclusion, Nature, Nurture, and Child Brain Injury

Chapter Ten  On Compensatory Education, Extended School Year and Child Brain Injury

Chapter Eleven  On Reading Disorders and Aphasia: The Missing Word in the Educational Domain

Chapter Twelve  On Unbelief, Denial and Child Brain Injury

Chapter Thirteen  On Philosophy, Education and Child Brain Injury

Chapter Fourteen  On Suffering and Child Brain Injury

Chapter Fifteen  On Cognitive Neuroscience and the Necessity of a Brain-Based Model

Introduction

In the make-believe world of Alice, the wonderland became a nightmare. One day she found herself looking up at the moon; the same day she fell into a deep hole and ended up on the moon. She, in her amazement looking up in the sky, beheld the earth and lo it was high in the sky; then the rabbit, seeking directions came to Alice and asked, which way is up? (Jeheudi Vuai)

This book is about children who fail because of practices that fail to address their specific problems. Unfairly blaming others and finger pointing serves no real purpose. At the center of the matter is the lack of knowledge that exists between biomedical science and educational practices. This is particularly true for professionals who provide a wide range of services for children believed to have psychological issues. We will discover that the human brain is the most complex organ known to man. It is often taken for granted, unappreciated, and misunderstood. Ironically, professional educators, for the most part, consider it inconsequential for the learning process. However, we will discover that it has everything to do with one’s ability to master academic skills. In this book, educators are defined as those professionals who influence policy, administrators, teachers, and other experts. These specialists have direct or indirect contact with children.

Many educators have good intentions in their attempts to assist children who struggle with learning and behaving. Efforts to rectify these problems often fall short of accomplishing their mission. The reason for this failure could be attributed to the lack of knowledge regarding the brain-behavior relationship. Childhood disorders would be better understood within a neurodevelopmental context. Too much attention is given to numbers, which rarely tell the whole story. Whenever learning and behavioral problems lack a theoretical or conceptual framework, the probability for failure is high.

What are the guiding principles of assisting children with deviant behaviors? It will be demonstrated throughout this book that learning and behavioral difficulties are often related to brain dysfunction. Generally, educators operate independently from scientifically based models of neurodevelopment. As such, many children are left behind in America’s schools. They have a difficult time reaching their full potential and many ultimately lose hope. In order to understand the complexities of these disorders of childhood, it is necessary to have a conceptual model based in biomedical science. It is an essential component of other disciplines, but sorely lacking in the educational domain.

Investigative statistics are clear. There exists a high drop-out rate in America’s schools. Many will explain away the occurrence as being related to sociological or psychological factors. Others will place blame on teachers, administrators, or parents. Few will understand that this problem may be related to neurodevelopmental factors. This book will explain the link between brain dysfunction and attrition among children with learning difficulties. You will learn that your child is a biologically complex organism. The term used in biomedical science emphasizes the complexities of the human child as a system. He is a living entity composed of five body systems. These involve complex biochemical processes to which pertain to functionality, which pertain to life.

Gray Matter Matters, has three essential purposes. The first is to raise awareness regarding erroneous educational practices. Secondly, to raise awareness that children with brain injury are typically punished unfairly. Lastly, to enhance skills and knowledge of professionals. This is highly critical if we are to break the repeated cycle of failure of America’s children.

The brain can be injured from many events known and unknown. Many assume that brain damage means a traumatic brain injury (TBI). These are frequently impact injuries, and the range of deficits depends upon the patient’s age and severity of the damage. They are traumatic because of damage incurred to the patient’s brain. These incidents sometimes result in serious injury, coma, or death.

There are many circumstances that may result in injury or damage to the developing brain. For example, prolonged labor, poor environments, and genetic disorders may cause brain damage—often with dire outcomes. The author refers to these events as nontraumatic brain injury (NTBI). The need to understand the underlying factors of learning and behavioral deficits is essential. Troublesome behaviors that fail to respond to interventions mean that one must look to the brain to find answers.

Non-traumatic brain injuries can have an enormous impact on the learning process. The child’s ability to process incoming stimuli will be impaired. This will result in behaviors that will deviate significantly from the norm. These children look normal, and when their problems in learning are explained from a neurobiological framework, strategies to assist them increase. Even TBI children with an absence of outward signs of injury may look normal, but they are likely to experience a wide range of behavioral problems. If the educator is unaware of the brain injury, the child’s difficulties will be attributed to other factors outside the brain.

They are silent

The voices of these children are often silent within the educational domain because few listen to them. When they are heard, one realizes that they are pleas for help. They suffer in silence because few understand the neurological basis of their difficulties. This is understandable because of undocumented history of head injury. This is what makes it so difficult to help them. In the absence of documented head trauma, it is assumed their problems are psychological. This population will be the major focus throughout this book. The author will discuss various issues related to such injuries and how they are manifested in the classrooms of America and throughout the world.

Gray Matter, Matters deals with punitive policies directed at children with brain dysfunction. That is to say, they are penalized for their inadequacies in performing tasks beyond their capabilities. These practices are indeed erroneous because they are based on non scientific foundations. This book proposes to present the child from a completely different perspective. This remarkably diverse point of view may be undesirable among educators, but the principles set forth are well understood by cognitive neuroscientists. Within the biological domain, behavior is understood to be a complex byproduct of neurophysiology. It presents the child as a multifarious individual that not only interacts with and is a byproduct of the environment, but one that has the potential of mastering it.

Neuroscience addresses the complexities of the brain behavior dynamic at a different level of analysis not fully understood by educators. It analyzes the brain-behavior relationship at the molecular and cellular level and has often been attacked by some educators as being impractical in the classroom. It is not easy to fit complex terminology of neuroscience neatly into educational curricula; some wish it to be simple. Why should it be since it involves complicated biological processes that are unfamiliar to those working with children? As previously mentioned, the relationship between behavior and brain function are complex. It is important to avoid oversimplifying this connection as a simple matter of left brain (analytical) versus right brain (creativity) modalities.

Many questions posed by scientists and philosophers of the past regarding how the brain influences behavior are now being answered. This is due to the advances in medical sciences, thus bringing new-found information about the brain-behavior relationship. It is within these various disciplines that many of the correlates of the brain will be addressed in this book. Perhaps some of the criticisms by educators are valid. Maybe more needs to be done to bring applicable neuropsychological and neurological terminology into meaningful classroom practice, thus aiding children with brain injury. As mentioned, this is not an easy task.

Gray Matter Matters is fully intended to narrow the gap between the educational and neurobiological domains and to assist those working with non-traumatic brain-injured children to have a better understanding of why they perform poorly in school and at home. It will attempt to do so by breaking down the complex terminology and to elucidate on matters using actual case studies from clinical practice. The use of case studies will not be presented in the usual format because they tend to be informal and impersonal.

The format chosen makes such cases personal—making you, the reader, experience the feeling of being in attendance during the meeting. After all, they are discussing your child. It will also greatly assist professionals from other domains providing services with children who present with various neurodevelopmental disorders to become more efficient in service delivery. These disorders will no longer be understood solely within a psychological framework. They will benefit because of fresh knowledge that was previously unknown to them, namely, that behavior results from complex neurophysiology. Behavior is a byproduct of complicated biochemistry in the cells of the brain. Making the link between brain and behavior is not necessarily an easy task.

The neurons of the cerebrum consist of gray matter and are estimated to be about ten percent of brain tissue. Ninety percent consists of white matter. It is the ten percent that we are concerned with, but fully understand that the other ninety percent plays a significant role in brain functions. We will deal with the whole brain because damage to white matter can also result in various types of neurological and neuropsychological problems in the child.

Many children with brain injury who have not been identified as such are in serious trouble in the educational domain. For example, the child who has a learning deficit in reading will be assumed to have a learning disability. That is to say, the fact that she struggles with reading will be necessarily attributed to a skill deficit and not the brain. Can you understand this? In these cases, the educator can become the victim of blame and harassment if the child fails to progress in the curriculum. The educator is unaware that the child’s inability to master a skill may be the result of brain injury. Depending upon the age of injury, the child may not acquire the ability to master a skill. The erroneous practicing of blaming the classroom educator for the lack of student progress should come to an end when these matters are discussed in this book. For the adult who experiences a cerebral vascular accident (CVA), he may lose the ability he once had. In time, he may be able to regain some aspects of function, especially language. The child who experiences a CVA may not ever acquire the ability to master a skill.

How does the educator help a student who struggles with reading, but mistakenly assumes that it is due to a developmental lag? What if she knew that reading was not the problem? Would it change her attitude? What if she learned Sam’s brain was injured pursuant to having lost oxygen during the delivery stage? Suppose she learned that as an infant he had to be resuscitated to regain consciousness. Would this cause a change in educational practice, knowing that his problems in learning were due to damage to the hippocampus? If she continues to assume that his deficits in learning new information are presumed to be the result of laziness and lack of motivation, he will most likely become frustrated. If Sam struggles with reading, his teacher may employ inappropriate practices that will become exasperating. In time, he will fall further behind. However, he has no history of traumatic brain injury (TBI), but due to other factors (hypoxia) that injured his brain. So he struggles with learning information at home and school. This is so confusing because he looks normal.

Reflections on matters of the brain concern themselves with the author’s over-fifteen years’ experience in both educational and medical settings. One is amazed at how much has changed over the last fifteen years regarding our understanding of neurodevelopmental disorders. These impressions come to mind unabated regarding the number of children seen in clinical practice. We will discuss issues pertaining to shrinking resources that ordinarily would be beneficial to those children with mild to severe brain injury. The terminology and languages of the scientist practitioner and how to bridge the ever-widening gap with education will be conveyed. Thus, the frequent use of endnotes will be used to delineate further complicated terms used in the field. These notes will be particularly useful to students wishing to enter the field or professionals who enjoy the more complex orientation of neurological and neuropsychological terms and concepts.

Erroneous educational practices result from a lack of knowledge of the brain. Unknowingly, educators often function from a behavioral paradigm. The underlying assumption is that the child is phylogenetically related to the rat and as such, learning is limited to environmental antecedents. These assumptions lead to practices that view the child as rather limited in one’s ability to master the environment. This perspective incorporates a passive style of learning. It reduces the child to a fixed pattern of stimulus-response (S-R) learning. This model fails to recognize the human child as a complex being with higher potential. It fails to address the issues of the principles and functionality of the nervous system of the human which is the more complicated among various species of the planet earth.

When the brain is injured and learning is impaired, erroneous practices are implemented in the form of suspensions, retentions, expulsions, failures, and stagnation or flat lining. These methods have no real benefit. They are implemented outside the conceptual and theoretical frameworks of neuroscience, but within a behavioral paradigm that assumes the human is a victim of the environment. This then leads to the notion and conclusion that educators believe that some children can’t succeed. It is the application of fatalism that ignores the complexities of brain function. All children can learn, if only the perception that the child would change. He is quite capable of mastering his environment given the appropriate tools of its culture. This book is written to break the cycle of failure.

The author’s ultimate intention is to become a voice for the children who have experienced various kinds of brain injury, whether traumatic or non-traumatic. They are the ones who enter the school or classroom where sadly as previously mentioned, most professionals lack training, skills, knowledge, and understanding of how to educate them appropriately. Too often their voices are ignored because no one knows how to help them. The ever-widening gap between science and educational practice is disturbing. The time has come that their voices are heard—to build understanding and raise issues in light of changes in policy regarding the exceptional student education (ESE) and school psychology. Thus, the cases will be presented to you as if the author was sitting next to you. This book is written primarily for those who work with children, but specifically, those children whose lives have been changed pursuant to suffering a non-traumatic brain injury.

This book could clearly help those who are in training to become child specialists in thesvarious fields that serve children. Professionals currently working with such children who have no formal training or knowledge in the field of neuroscience will have a superior way of understanding their problems and providing effective educational interventions to assist them. Educators, who are part of the inclusion model, will greatly benefit from the information presented herein, as many of these children are now being integrated into their classrooms. A child who has experienced a TBI is likely to present with a wide range of neurocognitive, neurobehavioral, and neuromotor difficulties. Unprepared professionals will be at a loss to develop effective treatment programs because the presenting problems will be thought to be based in environmental antecedents. In this book, the author will stress and parcel out the subtle difference between psychological and neurological factors in light of a brain injury. The hope is that these often misunderstood children will be viewed in a new light and ultimately given attention and help.

Chapter One

On the Brain

The task of neural science is to explain behavior in terms of the activities of the brain. How does the brain marshal its millions of individual nerve cells to produce behavior, and how are these cells influenced by the environment?

Eric Kandel,

Principles of Neural Science, Fourth edition

The problem in helping children with non-traumatic brain injury who struggle with learning in schools is that a wide gap exists between educational practice and the basic tenets of cognitive neuroscience. This will be the most salient theme that will be repeated throughout this book. The importance of the brain was penned by Hippocrates in the fourth century BCE as follows:

Men ought to know that from nothing else but the brain come joys, delights, laughter and sports and sorrows and griefs, despondency and lamentations. And by this we acquire wisdom and knowledge, and see and hear and know what are foul and what are fair and what is good, what is sweet and what are unsavory…In these ways I am of the opinion that the brain when healthy, exercise the greatest power in man. (– Hippocrates, On the Sacred Disease (Fourth Century).

The Brain’s Incredible Power

It is almost unbelievable when one thinks about the brain’s incredible power. It is said to be responsible for our imaginations, fears, desires, drives, memories, and intelligence. It controls our movement and hormones and regulates our breathing and heart rate. It gives meaning to things that happen in the world. Moreover, it receives messages from the periphery such as the eyes, nose (olfaction), skin (touch), and tongue (taste) to interpret what we experience. It regulates our emotions (depression, joy, pain, memory, imagination, sleep rhythms). It controls how you move (e.g., running, walking, skipping, hopping, crawling). It closely regulates the organs in the body, including the liver, kidneys, heart, lungs, etc. It strictly controls the endocrine system (i.e., pituitary gland, thyroid), breathing, heart rate, and how you react to stressful situations. It is the amazing brain, called the most complex organ known to man.

The word brain comes from a Greek word brekhmos front part of the skull, top of the head.¹ A baby’s brain weighs between 350 – 400 grams. The adult human brain weighs between 1300-1400 grams. The elephant’s brain weighs about 6,000 grams; however, the human has the largest brain of all animal species with regards to the ratio of brain volume to body weight.² Yet one wonders how it does what it does! It is a question posed by philosophers of the past. It is a blob of mass fueled by glucose and oxygen and regulated by chemicals and electricity. How does it give us what we call consciousness? The ironic thing about the brain is, despite its power, it is incredibly influenced by the environment and as we will discover; could be its greatest weakness.

Why Neuroscience?

The necessity of understanding the neurobiological foundations of learning is critical to our understanding of academic and behavioral problems. The renowned neuroscientist Eric Kandel writes, The brain is the last frontier of the biological sciences to understand those [neural] processes by which we act, learn and remember (p.5).³ This will be a complex and difficult journey providing many answers, yet leaving so many more questions. We shall begin our expedition in the hopes that the following pages will raise awareness of how complex learning can be. Additionally, we hope to increase your understanding of the importance of bridging the gap between education and neuroscience. When knowledge of the brain-behavior relationship is embellished, then the practice of teaching will inculcate fresh dimensions and be understood in a new light. This is indeed the challenge of educators, clinicians, and psychologists in the twenty-first century; namely, to embrace neuroscience as a guide to educating and assisting children with brain injury.

Moving away from the simplicity of the stimulus response (S-R) type of passive learning is only a matter of time. The need to transition towards a proactive and higher order curriculum that challenges and engages the learner will be the common practice. In clinical settings, children who present with a wide range of emotional and behavioral problems will be better served. New methods of assessing children with non-traumatic brain injury will involve the understanding of integration and not merely that of processing; this will be explained in subsequent chapters. It is one’s thorough understanding of the brain and how it is involved in the learning process that cannot be over emphasized. Understanding neurodevelopment is essential if these children are to advance in knowledge and become productive citizens of a democratic society.

What is Cognitive Science?

As we explore together, let us now develop an understanding of cognitive science in an effort to assist professionals providing services to children and adolescents. It will be through an understanding of the term that will help raise awareness of the importance to link the brain to behavior. Cognitive science is defined as follows:

The interdisciplinary scientific study of minds as information processors. It includes research on how information is processed (in faculties such as perception, language, memory, reasoning, and emotion), represented, and transformed in behavior, (human or other animal) nervous system or machine (e.g., computer). Cognitive science consists of multiple research disciplines, including psychology, artificial intelligence, philosophy, neuroscience, linguistics, anthropology, sociology, and education. It spans many levels of analysis, from low-level learning and decision mechanisms to high-level logic and planning; from neural circuitry to modular brain organization research. (wikipedia.com).

The New Challenge to No Child Left Behind

Cognitive neuroscience is a challenge to the No Child Left Behind rhetoric echoed in educational circles. It answers the why questions as it pertains to learning and behavioral disorders. For example, Robert may have a problem learning how to read. Traditional assessments based upon psychometrics dealt with what the problem is based upon statistics called the discrepancy model. Today, there is also emphasis upon a discrepancy now called the gap analysis. In either case, one may only know what the problem is but not why the child has the problem. The gap analysis as its predecessor, the discrepancy, falls far short of truly understanding the nature of childhood disorders. That is to say, many children with non-traumatic brain injury are consistently being left behind in schools across the United States. Good intentions are noteworthy, but in the case of a child with non-traumatic brain injury, it could be catastrophic. Knowledge from neurobiological science is an attempt to build collaboration with those in the educational domain, suggesting ways to improve student performance. It provides answers to difficult questions when children do not respond to intervention. For educators, it is a challenge to rethink the educational process. This provocation is presented by the words of the renowned cognitive neuroscientist Phillip Defina, who writes, "The challenge of changing brain chemistry through systematic instruction in order to produce academic growth is a process known as education."⁴⁴ [Italics mine]. Educators want children to learn information, but learning is an active process, thus indicative of movement. This movement is called behavior. This is the primary function of the brain, which is to say to produce behavior and create one’s subjective reality. Neuroscientist Bryan Kolb informs us:

To produce behavior as we search, explore and manipulate our environments, the brain must have information about the world, about the objects around us, their size, shape and movement. Without such information, the brain cannot orient and direct the body to produce appropriate response to stimulation (p. 36, 37).⁵

In order to read, solve mathematics problems, write or move, the brain must produce them. The process involves the integration of sensory inputs within cells. However, if interrupted, learning—among other things—can be greatly compromised. We will discuss this further in subsequent chapters. Let us now begin our journey into the most complex organ known to man.

The Beginnings

She doesn’t even realize she is pregnant and the child’s nervous system is already developing rapidly. It all begins with the development of the neural tube, which begins twenty-five days after gestation (Rayport 1992). What a speedy development! The neural tube, which literally begins as a sheet will later become the brain and spinal cord.⁶ This is a very important beginning because deficits in the neural tube can lead to potentially dangerous problems and/or life threatening events. This is a delicate time for the developing nervous system of the child. If the anterior portion of the tube doesn’t fully close, the child can be born without a brain.⁷ The bottom portion of the neural tube becomes the spinal cord. If this area fails to close completely, the child may be born with a hole in her back.⁸ It is crucial that mother has good prenatal care because researchers found that women who lack adequate amounts of folic acid are at higher risk to bear children with neural tube defects.⁹

Brain growth and development

The neuron is the basic unit of the nervous system. The human brain is said to contain about one hundred billion neurons. They are more in numbers than the stars of the Milky Way. Their connections between them are said to be one thousand trillion. The cell contains organelles, the nucleus and the chromosomes of which are found the DNA, the code of life (Barish 1965). These are specialized cells, enabling the child to maximize her potential later in life, especially when she attends school. Yes, this is the genetic blueprint that allows for brain development and it occurs in a quite orderly fashion. By forty weeks gestation, the spinal cord, brain stem and part of the frontal cortex can be seen and at birth, the cerebellum has maximum growth.

The initial stages of pregnancy are critical because between weeks twenty-five and forty, rapid cell growth occurs. The brain grows like a loaf of bread. Initially the loaf sits down in the baking pan, and as it begins to bake, it rises. Like the loaf of bread, the brain begins to rise in like fashion developing from inside out, as neurons migrate to their targeted destinations. Ultimately, they will make up six layers of the cortex. It may be hard for the mother to believe, that by the tenth week of her pregnancy, the longitudinal fissure and sulci will be visible; by the fourteenth week, so too will the parietal-occipital sulcus. This is indeed a miraculous beginning because by the time the fetus is in the sixth month of development, she will have reached her full quota of neurons. This will be necessary in order to develop a healthy beginning so that ultimately she will be able to maximize her full potential. Table 1.1 illustrates the rapid development of the brain.

Table 1.1 Time Table for Normal Growth and Development

Source: Adapted from: Lowrey, G.H. Growth and development of children, 6th edition. Chicago: Year Book Publishers. 1978. In S. Spreen, et. al., Developmental neuropsychology. New York, Oxford University Press. 1995. Used with Permission.

The neurons will make connections with other neurons. It is said that one neuron can have as many as ten thousand connections with other neurons. These links are crucial because if something disrupts this delicate process, they may not reach their target destinations. This disruption could lead to serious neurodevelopmental problems that may not be seen until later in life.¹⁰ By eight weeks, the embryo responds to touch of the cheeks and by fourteen weeks, responds to touch on other parts of the body (Hepper, inTeeter and Semrud-Clikeman, 1997).

Is it a small thing for educators or parents to emphasize touch in the learning process? The full use of the sensory system can be most beneficial to children’s learning ability. Thus these connections are an important part of early brain development because it is suggested that some neuropsychiatric disorders, like schizophrenia and autism may be the result of abnormal cell connections (Weinberger 1987).

Eventually, there will be trillions of neural connections that will make an intricate network that forms the basis of our reality. Initially, nature produces an overabundance of neurons. It is nature’s way of protecting the brain if damaged and to develop the greatest efficiency to achieve particular skills. Many will be destroyed pursuant to pruning; a rather delicate process that allows the brain to slough off, as it were, extra cells it won’t need. Can you now understand how complex this process can be?

As the cells make their connections, they will grow branches, called dendrites. When one is able to look at the individual neuron under a microscope, one notices how some resemble a tree. It has a trunk like a tree, called an axon, and its function is to send messages to other cells in the brain. In fact, they do not touch; a gap lies between them called the synaptic gap. The terminal buttons allow neurochemicals to be released and captured by dendrites of the receiving cell. These are important chemicals that also provide our basis of reality. It then becomes mind boggling to learn that our reality is created through the combination of electricity and chemicals in our brains. Imbalances in these important chemicals can also cause a wide range of neuropsychological and neurological problems ranging from depression, learning problems, attention and perceptual deficits, disturbances in personality and behavioral problems. Neurons do not all look alike; they have different shapes and sizes. Some receive sensory inputs, others motor inputs. There are other neurons that are highly specialized to integrate sensory and motor inputs. In all, they help formulate subjective reality.

Like wires that are insulated with a plastic covering found in your home, likewise many axons are covered with a coating of specialized cells called myelin. It is white in appearance and is needed to help brain cells transmit messages rapidly.¹¹ Some brain cells do not have myelin. Nevertheless, for those that do, this covering is indeed important because in some cases, some viruses, bacteria or other agents can invade the brain and destroy this covering. When this delicate covering is destroyed, the person can experience serious neurological problems, namely multiple sclerosis or its subtype Devic’s disease.¹²

Sometimes, due to genetic errors as in the case of mental retardation, now called intellectual disability(InD) among educators, the cells resemble trees that have died and they no longer have full branches. They resemble what trees often look like in the dead of winter. Sometimes, disruptions in brain development are the result of genetic programming that has gone awry or to environmental factors (i.e., bacterial or viral infections) and imaging studies have revealed that there is a difference (Nadich 1990). These events can occur in the absence of head trauma. For this reason, prenatal care is very important.¹³

The Building of a Masterpiece

Imagine taking a stroll through a large city. By chance, you happen to observe the construction of a skyscraper or building. You notice how the workers lay the foundation from the blueprints that was initiated in the mind of the architect. These workers lay the foundation, from which selected materials (i.e., bricks, steel, iron, cooper, wood, etc.) will all be used. They work in unison, building floor by floor, room by room, until it becomes a wonder to behold. Upon completion, the building will be occupied by its various tenants. They will use switches to turn lights on and off, elevators to go from one floor to the next, air conditioning to keep them cool in the hot summer days, and heaters to warm them from the cold of winter. It is such a wonder that from one designer, an incredible piece of architecture results.

Suppose the plan of the designer was not followed. Will the office manager be able to attend her meeting at ten o’clock if the switch to the elevator fails? What if that switch was connected to another circuit? Likewise, the brain must also follow a strict genetic path set forth by DNA, the codes of life. As such, the brain cells will migrate to regions that will later become the frontal lobes, others the hypothalamus and yet others the cingulate gyrus. By the time the baby is born, the brain although very immature, has all the requisites to help the child reach her maximum potential. In the beginning, her brain may overproduce brain cells and it is believed that this is genetically determined. If her brain is damaged early in life, extra cells are there to replace damaged or dead ones.

When bad things happens to the brain

As mentioned, brain development follows a specific genetic path. A number of factors can occur during this delicate process, which can disrupt brain development. She, being unaware of her pregnancy, may use drugs or alcohol. Depending on the stage of embryonic development, the brain may be damaged and the consequences of such may not be known until later in life. As the fetus enters the third trimester, it will experience a growth spurt, which will continue into the second year of life. If there are problems in development due to genetic or environmental factors, they could result in cerebral palsy syndromes. For this reason, many parents are perplexed when they learn that their child struggles with learning after entering school. She fails to make the connection between her child’s developing brain and drug use while she was pregnant with her child. She may even be told that her child’s Apgar scores were normal (Apgar and Beck 1972). Table 1.2 shows the importance of these scores related to the health of newborns.

Table 1.2 Apgar Scores

Source: (Black in O. Spreen et. al. 1995). Used with Permission.

It is only after obtaining a comprehensive developmental history in which she reports her early drug and alcohol use that it becomes clear why the child is experiencing difficulties with learning. Good prenatal care will assist the mother to make wise choices during pregnancy. It will make her aware of the antenatal risk factors. Can the importance of prenatal care be emphasized more? It is important to obtain a thorough history to uncover possible neurodevelopmental factors. It is the missing link that now unravels the mystery, as it were, that explains the reason why little Sally cannot read, write, or solve mathematical problems.

Information from Table 1.2 is helpful for clinicians to have when attempting to understand the nature of a child’s behavioral,