A Path to Better Learning
It’s Tuesday afternoon on a cool, cloudy August day, in one of the waning weeks of summer before the frenzy of back to school time in New York City. Ian, age 14, seems a little nervous, glancing around as he fidgets with his smart phone in the colorful waiting area of New York University’s Child Study Center (often referred to as “the CSC”). He taps his Converse sneakers, hand decorated with marker, on the quiet carpeted floor.
Moments later, he lights up as a familiar face rounds the corner from the offices in the back. He greets Dr. Daniela Montalto, a neuropsychologist at the CSC, giving her a quick, loose limbed embrace.
Shortly thereafter, Ian has folded himself into an upholstered chair in Dr. Montalto’s cozy office. The lighting is soft, a far cry from the fluorescents Ian would be under if he was consulting most other clinical specialists. A robin’s egg blue wall creates an atmosphere of cheerful calm, the better to put Ian and Dr. Montalto’s other patients at ease.
“I’m going to read you a sentence out loud, and I want you to just repeat it back to me,” Dr. Montalto tells him. They are seated opposite each other across a small table, almost as if they were playing a board game instead of the actual task at hand. In fact, they are in the midst of the delicate process of figuring out what might be holding Ian back at school.
Like many kids, there is michael kors australia a gap between Ian’s scores on intelligence tests meant to predict how well he could do in school, if he were working up to his potential and his achievement, or how much he is actually learning. “If you’re bright, and in fourth grade, but your achievement in reading is at a second grade level, that’s going to suggest a learning disability,” explains Dr. Glenn Hirsch, medical director at the CSC.
There are dozens of reasons why such a gap might exist, of course, from family stress to emotional or behavioral problems, all of which are part of the expertise of child psychologists or psychiatrists.
But in Ian’s case, the issue seems even closer at hand, a slight variation in the way his brain is wired that makes learning a little harder than it should be. One in five kids in the United States has some form of learning disability, and it’s the job of Dr. Montalto and her team of neuropsychologists at the CSC’s Institute for Learning and Academic Achievement (ILAA) to figure out exactly what Ian’s specific learning challenge is, and most importantly, how to help.
The exercise Ian and Dr. Montalto are engaged in is a receptive language subtest called Recalling Sentences that is meant to pinpoint Ian’s ability to take in information, and seems simple enough. But the sentences become increasingly complicated, and he occasionally pauses, biting his lip.
“If we had gone straight home after the game, we would not have missed our curfew,” Dr. Montalto reads, her warm voice implicitly encouraging Ian along.
“Can you repeat that one?” he says after a minute. Unfortunately, the sentence can only be read once. After another sentence in the test, he expresses worry and notes that many of the words sound similar.
“So the thought that the words sound the same made it difficult for you to determine what was said,” Dr. Montalto responds, eliciting a nod from Ian.
After around 15 minutes of back and forth, the exercise is over, and Ian smiles in relief. “What did you think of that task?” Dr. Montalto asks, adding, “It’s really important for me to know what’s really easy and what’s hard.” Though he is able to repeat almost every sentence perfectly, Ian’s halting speech and concerted effort seem to indicate that for him, this first exercise falls somewhere in between.
Still, he is obviously happy to be there. As Dr. Montalto pulled that first test from what they joke is her “magic bag,” he calls her “my Mary Poppins.” Just as that fictional character turned the world around in an amazingly positive way for her charges, Dr. Montalto and her team strive to do the same with each of their patients. “Our job,” she says of herself and the other neuropsychologists at the CSC, “is really to figure out how to make learning easier for them, and fun.”
Neuropsychology can sound a bit intimidating, and despite growing cultural awareness of learning disabilities, many parents and educators remain in the dark about what it is and how it can help kids.
Understanding what neuropsychology is “is probably confusing for most families,” Dr. Hirsch says, before explaining that the field has “one major purpose to understand how kids learn. That’s really what we’re trying to accomplish most, is to understand what kids are good at, in terms of learning, and to determine what they are less proficient at.”
Once an educator realizes that there is a gap between a child’s intelligence and her achievement, the first stop may be the school itself. Most school districts offer some form of what’s known as psycho educational testing, which can be a first step in identifying the general area that’s causing problems for a child, whether it’s reading or math, for example.
In certain cases, that information may be enough for a child to get the help they need. But it’s far from the michael kors australia whole picture. As Dr. Hirsch explains, “What neuropsychological testing does is go beyond those basics and try to figure out a lot more. It tries to sort out issues of memory, of executive functioning, of how fast you process information, in ways that give us a very fine tuned picture, and that enable us to make very specific recommendations: Are you in the right school environment, what kind of teaching do you need, do you need tutoring, do you need language therapy, what kind of language therapy? What is the best path for an educator working with your child to take?”
One thing that distinguishes neuropsychology from other approaches, and also gives the field its name, is that it is brain based. Dr. Montalto explains, “We know that certain tests we are administering tap into certain brain areas. For instance, we have attention tasks, and we explain to parents that if we see weaknesses in attention, and difficulties with what we call executive abilities, which include things like our ability to plan, to generate hypotheses and to problem solve if that’s something that’s giving a child trouble, we know, in terms of our brain development, that those areas are controlled by the frontal area of the brain. We’ll provide parents with some information as to the developmental trajectory of that area, explaining that kids, all the way through their twenties, are still forming that area.”
Because issues with learning can b michael kors australia e so clearly linked to physical regions of the brain, research being done at the CSC has pushed neuropsychology forward by leaps and bounds in recent years. “We’re very focused on the empirical work, that’s what guides us,” Dr. Montalto says. “We need the research in order to know that the measures we are using are valid and reliable.”
She continues, “I think that’s what’s exciting, is that the research is showing us that there are many things that we can do to help kids with a variety of difficulties, whether it be a learning disability or ADHD, or something more social or emotional.”
Neuropsychologists like Dr. Montalto and her team have undergone two years of specialized training just in neuropsychological testing after completing their doctorates in psychology. The first step when they are presented with a new patient is to meet with the parents, as well as talk with teachers, tutors, or anyone else the child may have worked with, to get a complete picture of the level she’s reached in terms of learning and school, in addition to talking with the child herself.
Neuropsychologists at the CSC typically meet with a child for at least four sessions of testing, each of which last three hours, before providing any recommendations. The recommendations come in the form of a comprehensive, individualized plan that is written out and given to the family at the end of the process. If a family chooses, the neuropsychologist will also meet personally with a child’s teacher and/or educational team to go over the plan and help integrate it into their classroom and remediation, or help sessions.
Perhaps most importantly, the child is always included michael kors australia . “We send every child a letter after our evaluations are done and we offer to have them come back in, and we give them a mini feedback as well, so that they know exactly what our ideas are for them, what areas they did really well in and what things we saw that might be giving them trouble,” Dr. Montalto says. “So they leave here with some answers. We want them to be a part of the whole process.”
Being evaluated at the CSC, while time intensive, can reap enormous rewards in terms of a child’s ability to succeed in school and, by extension, in life. Dr. Montalto remembers one boy, age 6, who came in for specific help rather than a full evaluation after having already been diagnosed with a reading disability.
“I started doing some reading remediation with him,” Dr. Montalto recalls, “and I realized that he had really no problems with reading. He was actually a very fast reader, he understood everything he read. And so I questioned the diagnosis of a reading disability, of dyslexia.”
She asked his parents if she could do some follow up tests and if they and his teacher would complete some questionnaires, all of which indicated that his problems were rooted in inattention. She ended up referring the child to a psychiatrist at the NYU Child Study Center, who treated him for Attention Deficit Hyperactivity Disorder (commonly known by its acronym, ADHD).
After he began the treatment, he excelled in school. The year after being properly diagnosed at the CSC, he was invited to join his school’s gifted and talented program. “Had he just been targeted as dyslexic all his life,” Dr. Montalto says, “he really would have been steered in the wrong direction.”