Robert J. Doman, Jr.
The term “neurological organization” means that the brain can take in and store information in an orderly and “organized” fashion. A child lacking in complete neurological organization is to some degree neurologically dysorganized. To a large extent, this is an environmental or inherited problem as opposed to the organic dysorganization found in a child suffering from a brain injury.
The first step in detecting neurological dysorganization is to evaluate the child against the developmental profile and to have him tested to rule out the possibility of an organic problem.
NACD’s evaluation of these children begins by determining the organization at the brain level of the pons. This is ascertained while viewing the child’s ability to crawl on his stomach. The child should be able to crawl on his stomach in what is termed a “cross pattern” without receiving specific instruction. Cross-pattern crawling is forward movement where the child extends his right arm and pulls up his left leg, pushing and pulling with the right arm and left leg. He then alternates his movement so that he is pushing and pulling with the left arm and right leg. If the child crawls in what is called a homolateral pattern (which is pushing and pulling with the right arm and right leg, and then the left arm and left leg) he is exhibiting a degree of dysorganization at that level. If the child crawls without a pattern or in a manner where he is extending both arms forward and pulling both legs up, he is also reflecting dysorganization in the pons area of the brain.
Advancing to the mid-brain, organization or dysorganization can be assessed by examining the child’s ability to creep on his hands and knees. Remember, you crawl before you creep. Crawling is on the stomach, and creeping is on the hands and knees. The child should also creep in a cross pattern. Properly, the child’s hands should be extended flat on the floor with fingers pointing forward. Ideally, the child should be looking forward at the extended hand. Again, if the child creeps in a homologous (bunny hop) or a homolateral pattern (right arm and right leg) he is exhibiting a degree of dysorganization. In assessing your child’s ability to creep, it is necessary that you have him creep at various speeds, with varied amounts of starting and stopping. A child properly organized at this level should never go into the homolateral pattern or homologous pattern.
Progressing up into the lower cortex area of the brain, you may evaluate organization by viewing the child’s ability to walk. Instruct the child to walk across the room while he points at his feet, and assess whether he is walking in a homolateral pattern or a cross pattern. You may wish to demonstrate to the child what you intend him to do, then have him mimic your actions. Have the child follow your instructions while starting and stopping his movement several times. Any hesitation he displays about which hand to point is an indication of dysorganization. He should be pointing opposite hand to opposite foot, and should not walk in a homolateral pattern. There are many children who lack this cross-pattern function, and they reflect coordination problems to a certain extent. Coordinated gross motor action culminates in a cross pattern whether it’s bowling, doing a basketball lay-up, or throwing a baseball pitch. A child who lacks complete organization will display a loss of coordination to some degree. Interestingly, there is the rare child who is neurologically dysorganized but has good coordination. Such children generally have other inefficiencies, particularly mixed dominance.
Neurological organization culminates at the top cortical level of the brain. This organization is the establishment of cortical-hemispheric dominance. This is the establishment of a dominant hemisphere, or side. A completely organized child should be right-handed, right-footed, right-eared, and right-eyed, or left-handed, left-footed, and so on.
To assess your child’s dominance, begin by evaluating the function of his hands. You can find out if he has a dominant hand, as this will be the hand he writes with, throws a ball with, etc. These functions should all be done with the same hand. If a child writes with one hand and throws a ball with the opposite hand, he obviously is displaying mixed dominance. Assessment of foot dominance is essentially done by using the same method, observing which foot the child kicks with, hops with, etc.
To assess auditory dominance, have the child put his ear next to the door and attempt to listen to conversation that is emanating from the other side. Speak very softly so that the child leans toward you. The child will turn his head to either the right or left so that the dominant ear is closest to the source of the sound.
Assessment of visual dominance is accomplished at what is called near point and far point, using vision as close as three feet and at a further distance. To assess the child at a distance, have him point his finger toward your finger while you extend your arm and point your finger toward the child. If you sight along your finger to his finger, you can find out which eye he is using. You may wish to have him alternate his extended arm from right to left to double check your findings. Also have the child look into a telescope or kaleidoscope, as he will invariably use the dominant eye.
At near point place a one-eighth inch dot on a piece of paper and put another paper with a one-eighth inch hole in the center on top. Line up the hole with the dot so that the child can see the dot by looking through the hole on the top piece of paper. Have the child grasp the paper with the hole in both hands and slowly move the paper up to his eye, watching the dot the entire time. Again, watch which eye the child brings the paper to, as it will invariably be the dominant eye.
A completely organized child will have a dominant hand, foot, ear, and eye, which will be all on the same side. If the child lacks complete dominance in any area or does not exhibit dominance on the same side, it’s a reflection of a degree of neurological dysorganization.
If the child lacks a controlling hemisphere of the brain organization is lacking because the influx of information to the brain is not occurring correctly. For instance, a child may take visual information through his right eye and store it in his left hemisphere. When a child neglects to take in information from one side and place it in one hemisphere he is not establishing firm pathways into the brain. The child cannot efficiently process that information. You might view the dysorganization as a room filled with filing cabinets. If he is properly organized all of the files are in alphabetical order and he can place a piece of information in and extract it efficiently. A dysorganized child’s files are not alphabetized, and he may absorb the information but when he attempts to retrieve it he may be unable to do so. These children are classically the ones who study for a test one night, only to fail when they go in to take it. They took in the information but lost it when they attempted to retrieve it. When you place these children under any type of stress, the system immediately begins falling apart, and their function diminishes. Often these children neglect to remember a homework assignment from the previous night, yet they can remember what color dress mother wore on Christmas two years previously. These individuals are not lacking innate intelligence. They just cannot properly take in information, assimilate it, process it, and bring it back out again.
The NACD Foundation offers a six-hour parent training seminar on cassette that explains in detail how children develop neurological organization and how they learn. The Foundation also provides neurological evaluations for children and programs to improve their neurological organization. For more information on the tapes and the evaluations, parents may call.
Reprinted from the Journal of The NACD Foundation (formerly The National Academy for Child Development)