“All great change in America starts at the dinner table.” 

— Ronald Reagan

If your children are infants, toddlers, of school age, or adults, or somewhere in between, family meals can be incredibly important. Whether our motivation is teaching a skill (such as eating or participating in meal preparation) or fostering family dynamics (such as communicating about the day, participating in discussions, building independent thinking), family meals may not just be the most important meals of the day, but the most important times of the day, or even their lives.

We are all aware that times have changed and that all the changes have not been for the better. Some of the more significant changes involve family, perception of family, and perhaps even the definition of family. There are many family traditions that are being lost in our fast-paced consumption-driven society. One very important piece that has been lost in many families is simply family meals. As a society and for the sake of our children, we need to revisit what has been the norm virtually throughout human history and has been lost to a great extent over just the last 50 years.

In many homes today, family meals are becoming more and more something that is part of family history or perhaps something reserved for special Sundays and holidays. For most families, breakfast is something you grab on the way out the door or something that gets shoved into children before they start the day. Today, rather than someone taking time to prepare a healthy breakfast meal for the family, most people grab the home equivalent of fast food. How about lunch? Lunch is rarely something that is done as a family. Everyone is off doing school, work, or whatever. In most families the best shot at getting the family together for a real meal is dinner. Let’s look at some of the problems being caused by the loss of family meals, as well as the benefits that we can derive from this old foundational family institution.

Over the past number of decades, I have observed an increase in several issues negatively affecting virtually all children that can be associated with missing family meals.

Just last night I had a family dinner with my son, Laird, his lovely wife Sadie, and my grandchildren, 5-year-old Arielle and just-turned-two Lachlan. Lachlan sat across the table and as he typically does, he kept an eye on me throughout the meal. The degree to which he observed me became obvious when he carefully nudged a piece of carrot to the edge of his plate, then onto the table with his fork. I had not had a chance to comment before he looked up at me and did an amazing job of imitating my head tilt and disapproving expression, which resulted in my smiling at him in spite of the fact that I knew I shouldn’t do it. (Lachlan fits “too cute for his own good.”) This was followed by my tilting my head and making different expressions that Lachlan mimicked beautifully. This went on for about 90 seconds, following which he picked the piece of carrot up and put it back on his plate. The degree to which children observe us and learn from us when we are in close proximity is greatly underestimated. Rarely throughout a typical day do these opportunities present themselves as they do during a family meal.

Although at two Lachlan has yet to learn that experimentation has its limits at the dinner table, there are many things he has learned from eating meals with his family and observing, things that many children who are fed by themselves or eat by themselves often do not learn until much later, and some of which are sadly never learned.

Optimally a family meal entails having the whole family together—Mom, Dad and all the kids. The only thing that generally beats this is when the extended family is included, as this grandfather can attest. Although we realistically can’t always, or even often, create the ideal, the closer we can come to it, the better. A parent, or a parent and a sibling, having a meal with a child is preferable to the child just eating alone or being fed, while the parent or caregiver simply attends to getting the food into the child. Part of this equation is delineating between eating as in consuming food vs. sharing a meal together, a learning experience. Eating is a process by which you get food from your hand, a utensil, or some container to your stomach, generally as quickly and as unceremoniously as possible. Having a meal together, sharing a meal, is often the most educational part of the day for children and parents alike. I grew up in the ’50s outside of Philadelphia. In the ’50s most mothers’ job was the family—period. Moms had time to cook and to sit down and share good meals with their family. Sunday dinners and extended family dinners often meant coats and ties for the guys and dresses for the girls. These meals were treated as significant events, even if they were frequent. I recall as a child learning early on that at a meal you talked. There was no TV, you didn’t read at the table, and an effort was made to include everyone in some form or level of discussion. Everyone participated or received some attention. I was in a restaurant recently and was shocked by a large family that was seated near us. You might not define eating at home as “dining,” although one would hope to approximate that as often as possible; but if a family goes to a restaurant and makes that financial and time investment, you might hope that the experience would approximate “dining.” On this particular evening while I was dining with my family, I noticed the large family next to us that consisted of both parents and six children who ranged from about six to sixteen. All sat the entire time staring at their phones. It would have been bad enough if they had answered calls, but not a word was spoken. Throughout the entire time they were in the restaurant, the only words spoken were to the waitress who took their orders. This was not a family sharing a meal together; it was an opportunity missed and lost, and sadly a statement about this family and many others.

Let’s look at our children of various ages and families at different stages and explore the significance of the family meal.

• Part 1 Infants and Toddlers
• Part 2 Three to Five Years
• Part 3 Five to Eighteen +

Part 1

Infants and Toddlers

Learning to chew, self-feeding, eating a variety of nutritional foods, auditory processing and language development

Learning to chew

As part of our program at NACD, which entails working with the whole child, we have families post many videos of their children on our NACD Portal. These videos provide our staff with vital information and insights that help us educate the family and assist in the child’s development. Observing many parents spoon feeding their little ones is often a bit of a painful experience. In these instances, it is very apparent that the obvious goal is to get the food from the bowl to the child’s stomach as quickly as possible. To accomplish this goal, the parent is often using an amazingly large spoon. Not only do we observe food being shoveled into the child’s mouth, but the rate at which the food is shoved in is such that the child has no opportunity to learn how to use their tongue to manipulate the food in the mouth. Learning how to use the tongue is a significant component of a child learning to chew and to speak. In order for the child to progress from purees, to chewable foods, to self-feeding, they need to learn how to chew. Chewing is a very important part of digestion, and children who do not chew well often have digestive issues and constipation. In addition, chewing is the first big piece of oral motor development that establishes the foundation for good articulation. If Johnny was being fed while some of the family was eating, it would be a much slower process with a significantly different goal. The goal would be to assist the child in eating, teaching them how to eat, and interacting, not simply filling their stomach. The children who are fed as previously described often are very slow to learn how to chew because they are not only being deprived of the opportunity to learn how, but deprived of the opportunity to observe Mom, Dad, and big sister chew.

Expanding taste, accepting a variety of foods

A side effect of delayed chewing is the slow introduction of a variety of identifiable foods. Pureed foods all tend to look and feel the same in the mouth and are often all mixed so that the child cannot differentiate between specific flavors and odors. It’s experiencing a wide variety of food, textures, tastes, and smells that develops the acceptance of a wide range of food and teaches the child not only to eat, but enjoy a variety of nutritional foods. Guess what else the child who is fed alone misses? The opportunity to observe what other people eat and enjoy. The nature of the beast is to want what others have; and observing what other family members have and then being offered the same thing contributes to the child’s trying and enjoying different foods and textures. The child who is fed and eats alone is deprived of these very important opportunities that can lead to picky eaters and lifelong rejection of many nutritious foods. The first tastes that a child perceives are sweet and salty. Delaying the introduction of other tastes often leads to the child rejecting the more nutritious foods and craving sweet and salty food.

Self-feeding

As we move from baby to infant to toddler, we want to be teaching the child how to feed themselves, moving from finger foods to utensils. Self-feeding is a very important step toward independence. The more independent a child becomes, the more the child initiates doing more things on their own; and nothing is perhaps more significant to independence than feeding oneself. The longer a child (or adult for that matter) is dependent, the harder it is to foster independence, initiation, change, and progress. The more the child initiates, the faster their global development. There are many other pieces to this, including the child who eats alone and is trained to need a distraction for meals, such as a screen or toys.

Moving along in the child’s development, eating with the family teaches many important things, from how to eat appropriately with utensils, to table manners, to simply sitting at the table until the meal is finished. Children learn how to be civilized from adults who are and who model appropriate behaviors. Eating with your child is an important modeling and teaching opportunity.

Family meals often present one of the most important opportunities for the child to observe and learn. Young children learn visually, by observing. If a child is eating alone and not sitting next to family members who are feeding themselves, they do not even have a mental picture of someone feeding themselves. As a result, they are slow to initiate self-feeding and are content to continue being fed. Conversely, the child who closely observes people eating with utensils learns how to eat with utensils.

One disturbing thing that children who are learning to self-feed, but who are eating by themselves, commonly learn is to throw food or drinks and plates and whatever is within reach. Why not, if they do not have sufficient modeling to show them how to eat and act appropriately or do not have the opportunity to simply observe and interact with other members of the family during a meal? If they are eating with someone else and happen to throw something, someone is there to give them immediate feedback. 

Processing, receptive and expressive language

Young children learn by being in close approximation to other people and observing. They also tend to observe some more than others. The family meal affords them the opportunity to focus and learn from specific family members. The family meal is an ideal time for the child to observe, listen, and begin to understand and process language and produce sounds and language themselves. Auditory processing (the ability to process a word, then phrases, then sentences) is of paramount importance to the development of cognitive function. The child at a family meal is a relatively captive audience who can observe and listen to what is being said and learn.

One of the keys to development is neuroplasticity. The child’s brain develops from specific input being provided with sufficient frequency, intensity, and duration. Children need consistent opportunities to observe, interact, and learn.

Part 2

Three to Five Years

Table manners, expanding taste, attention, processing and language development, chores, responsibility and independence

We often think the goal of meals is simply to eat, to get nourishment; but as already discussed, there are many associated pieces that are extremely important. At each stage of the child’s development, there are important developmental pieces that relate to, and are aided by, family meals.

Table manners—taming the beast

It’s often easy to spot a child who typically eats alone: their table manners are horrific, and it takes longer to clean up the table and the floor after a meal than it was for the child to consume it. Teaching a child appropriate table manners requires first and foremost modeling appropriate table manners and then providing the child with appropriate instruction and feedback. The more often someone else is present and demonstrating appropriate table manners, the more quality input the child receives, and the faster they learn what they should do and how to do it.

Expanding taste—nutrition

Children who eat meals alone tend to learn to want the same things at every meal. Breakfast and even lunch is often the same every day. It is often easy for parents, once they discover what the child will eat for breakfast and lunch, to give the child the same thing every day; and unfortunately the child learns to want the same thing. So they both establish a pattern that neither is motivated to change. Eating the same thing daily is not nutritious, particularly if we look at what the children typically get for breakfast and lunch. Often the only opportunity the child has to learn about different foods is at dinner, assuming that the child is eating with the rest of the family. Healthy foods are rarely a child’s preferred foods, which again tend to be sweet and salty foods, which are often followed by grains. Gluten is becoming of greater concern in regard to allergies and intolerances. Children eating cereals, breads, and pastas often become addicted to these foods and reject what they should be eating. The taste for a variety of foods needs to be developed for the child to not only learn to eat, but enjoy the variety of meats, fruits, and vegetables that contribute to a healthy diet. The greater variety of foods we can introduce, and the earlier, often the better.

One good example of children learning to eat more sophisticated foods if exposed to them from an early age is what I observed in southern California in the ’80s. The first couple of times I saw this I was honestly a bit shocked; but it occurred so often that it became almost the norm in southern California. The snack food of choice of these families for their children under five and often as young as eighteen months was sushi. And the kids loved it! It was a great demonstration of how rapidly taste can be developed if given the opportunity.

Processing—cognition

Young children, when seated at a table with family members, attend to those family members. If they are not offered distractions like the TV, iPads, crayons and toys, they pay attention to what the other members of the family are doing and saying. Hopefully the family members try to engage these little ones during the meal. This process of attending without distractions helps build the child’s processing and attention span, which is a key to learning.

Perhaps the most important thing that drives the development of receptive and expressive language, cognition, and global development is the development of sequential processing. Building sequential processing develops short-term memory, then working memory and executive function, the pieces that determine our level of function even more so than innate intelligence. The primary thing that pushes processing is specific targeted auditory and visual input. One of the things that most children do well is let you know whether what you are saying to them, showing them, or doing with them is targeted to them or not. The test is their attention to it. If you are hitting the nail on the head, the child attends; if not, they don’t. Children sitting at a table with family members can be relied on to give the rest of the family feedback as to whether they are being included or not. The children tend to shape the family’s behavior. The more targeted the input, particularly from a family member, the faster the development of these vital processing abilities that will influence how the child ultimately learns, thinks, and functions.

Language development

Teaching a foreign language is not an easy task. It’s important for parents to understand that any language is a foreign language to a child learning their first language. The best way to teach any language is through immersion. Immersion simply means that you are living with the language and learning from your observations and involvement and out of need. Throughout the course of the day, the child has an opportunity to observe and interact and start to learn the language; but throughout most of the day there are many things going on, and it’s difficult to isolate words and their meanings. The family meal gives the child an excellent opportunity to isolate, observe, model, and learn to understand and then use language. It’s not a shock that one of the first words that a child learns is “more” and that one of their first word combinations is “Mom more,” followed by the phrase “Mom more please,” to using full sentences. The family meal should be a focal time in the day for relevant talk that contributes to the child learning the structure of the language and developing their own receptive language abilities. The language function of most children in this age group is a direct reflection of the targeted interaction between the child, parents, and siblings who naturally expand their use of language to fit the child they are speaking to. No one is better suited to this job than the people who know the child best; and no time may be better suited to this development than the family meal.

Chores, responsibility, and independence

I have written several articles talking about the importance of teaching a child to do, be responsible for, and to own chores. Most parents grossly underestimate their child’s capabilities and the global importance of their children learning to be capable, contributing, and independent and “owning” chores. The best initial chores to teach a child to own are those that are associated with specific events that occur daily. The first such event is simply getting up in the morning, but following that are meals, and again, particularly family meals. It is important to separate “helping” from “owning” a chore or job. Many children learn to follow specific helping directions and prompts even before the age of three and can be helpers. This period between three and five years, however, is an ideal time to teach your child not only how to do chores, but to own them. In response to the questions asking what chores children have, I often hear such things as “Johnny takes his dish to the sink.” My response to that is often, “If Johnny is capable of taking his dish to the sink, why not everyone else’s, and how about him completely cleaning the table?” Sadly, the parents’ response to that is often that Johnny eats alone, and if not, the parents do not even perceive that Johnny could do it if taught. They totally miss the understanding of the huge benefits Johnny would derive from doing it.

Unless children learn otherwise, they are egocentric, believing that the world revolves around them. Unfortunately, egocentric children can become narcissist adults. At three or even before, most children are ready to learn and own jobs and to learn that they can contribute; and they will learn to welcome and seek other ways to serve and contribute.

Ownership of a chore or job means that the child owns a particular task and preferably that they alone do it, so if they don’t do it, it doesn’t get done, which creates a problem. One of the first meal-associated jobs is teaching the child how to put silverware away from the dishwasher. Most children enjoy doing this job and can see that they are contributing and like it. Other meal—associated jobs that children in the 3-5 year range can do includes setting the table, cleaning the table, cleaning the floor under the table (even three year olds can learn to use a dust buster well), moving into washing dishes, loading, and unloading a dishwasher and even initial food preparation. Family meals can provide consistent opportunities for children to learn that they can be capable, contributing, members of the family. The earlier our children learn to happily and competently contribute, the sooner they start on the path of learning to be responsible, altruistic and selfless, self-reliant, contributing members of the family and society. Learning to be responsible with definitive chores helps children understand intention, which generalizes to other things including academics.

The more our children learn to do independently, particularly things that go beyond their own needs, the more they perceive what they could do, and the more things they initiate doing on their own, creating attributes that will serve them well in everything they do.

Part 3

Five Years to Eighteen Years +

Language development and social skills, processing (short-term memory, working memory and executive function), communication between parents and children, education, learning family values and history, learning critical thought and expression, becoming highly capable.

Theoretically a child moving from five years through adolescence to eighteen year of age is taking a young child and creating an adult. Unfortunately, there are not many eighteen-year-olds who we can confidently consider adults today; and that number appears to be shrinking every year. If you have a child five years of age, it’s not too early to remind you that your job is to put together the pieces to turn that child into a functional adult, who is equipped to go off to college or trade school by themselves, seek full time employment, start a business, join the military, or explore other adult options. These years pass at an amazing speed, and the target needs to be kept within the sights. This job requires putting together a lot of pieces. At NACD we know the need to work with the whole individual and the need to have someone at the helm steering the ship. No one knows a child as well as the parent. Teachers, relatives, coaches, clergy, and friends do not know as many pieces of the child as do actively involved parents. I have built several houses which have all come out well. Each one required my vision and design, the help of an architect, an engineer, a head contractor, and sub-contractors. The vision for the houses were mine, and I needed and used the various folks to help put the projects/visions together; but the houses were my babies and from concept to completion they were my responsibility. If they had not turned out as I envisioned, it was my fault and no one else’s. Building a house, even a large, complex house, is nothing compared to helping to assist a child in becoming a happy, successful, capable adult. And the need for attention to detail and ongoing participation cannot be overstated. One needs not to look too hard at society in general to see and hopefully understand the need to have actively involved parents steering the ship.

Language development and social skills

One of the most important jobs as parents is simply to talk to our children. In our busy lives meals are often the best, if not the only, regular opportunities parents have to get and hold the attention of their five-to eighteen-year-old and speak with them. A parent innately knows how to speak to a specific child. You innately use sentences of a length they can process and language they can understand. You have a pretty good idea as to what your child knows and doesn’t know, so you know if they have a frame of reference for a topic or not. A parent with the knowledge of their whole child is better suited to provide this invaluable input than anyone else. We call this targeted input. This targeted input and verbal interaction creates the building blocks of language and much more. If we are verbally interacting with our children throughout the day, it is often language that is directing them to do something or stop doing something; and although there may be opportunities throughout the day, particularly for families who are home educating their children, to really talk and communicate, the family meal can and should be perceived as a daily unique opportunity to have Dad, siblings, and even extended family participate. Language development occurs most rapidly when verbal interaction is of interest to the child, meaning you are talking about things your child has a frame of reference for, knowledge and interest in, and when the actual language being used is targeted to them. Parents almost universally use language that their children can understand and process, and constantly, even though they are rarely aware of it, they use language that is always just a notch above their child’s, which helps develop their language skills. This targeted interaction can be tremendously more efficient in building the child’s language structure and vocabulary than most group classroom instruction or interaction between children. Such group or child-to-child interaction is either not targeted to an individual or, as in the case of verbal interaction between children, they are modeling sentence structure and language that is not developmentally advantageous and perhaps not even acceptable. Children often speak to each other in abbreviated code, economizing on words and using vocabulary that Webster would scratch his head over. That’s not exactly conducive to proper language development.

Verbal interaction during a family meal is also an opportunity for parents to model and guide their children in proper table manners and acceptable ways to have a discussion, to agree or disagree appropriately. We all have many patterns of behavior that affect virtually all aspects of our lives. Children interacting with other children without the benefit of quality targeted parental modeling and feedback can lead to negative patterns of behavior, which can be difficult to modify or develop.

Processing (short-term memory, working memory, and executive function)

A major key to global development and function is processing power. Most children today have better visual than auditory processing power as a reflection of opportunity or lack of such. Children generally develop visual processing before auditory simply because until they can understand language, they learn and understand their world based on what they see.

As children develop, we need to provide as much targeted auditory language input as possible to balance these critical pieces. Ultimately, auditory processing is the more significant piece relative to cognitive development. Auditory processing facilitates thinking in words, and as it develops, so does the complexity of thought, language, maturity, behavior, attention span, and so on. The importance of auditory processing cannot be overstated. And what builds auditory processing? Targeted language input. Targeted language input is that which builds auditory processing. I believe that over the past decades as we have seen the increase in mothers working outside of the home, we have seen a corresponding increase in attention disorders, which are largely a reflection of auditory processing issues. You attend to what you can process, and the more and better you can process, the longer you attend. Parents talking to children is hugely important to the development of processing and its associated pieces. To learn more about processing, please read the associated article.

Communication between parents and children

If you are aware of a problem, have a misunderstanding or a question or just feel out of touch with someone you work with or a friend, your first thought should be to talk about it.

As important as it is to establish this relationship and open and maintain the avenues of communication, this often does not exist between many parents and their children. Ongoing, regular family meals do, again, provide rather special opportunities to establish this open communication. Parents can throughout the course of busy daily interaction with their children throw out questions in an attempt to find out what is happening with their children, but often this is not sufficient to facilitate good responses and open good lines of communication. As a case in point, ask the majority of kids upon their return from school about what they did at school and most parents get the same response—“nothing.”

Family meals can be used to open these critical lines of communication. If families simply talk during meals, the meal becomes this regular time to talk and communicate, and a question like “What did you do at school today?” is much more likely to produce a very different answer and open the door to further exploration, teaching the child how to express feelings and problems and to share their lives with their siblings and parents.

Education 

Most parents miss the boat when it comes to taking advantage of their unique position in helping, if not taking the lead, in their child’s education.

To understand how significant the parent’s role can be in education, let’s start by separating “what was taught” from “what was learned.” Schools and most curriculums are packed full of tons of “stuff,” and we tend to confuse all of this “stuff” that was “taught” with what was learned. If you learned something, you know it. If you don’t know it, you didn’t learn it. Pick a subject, any subject, from the explorers, to anatomy and physiology, trigonometry, astronomy, chemistry, or whatever you were “taught” and today write down everything you remember about that subject. This might not take long. Some of these things you might have been “taught” for years, and what do you remember? Perhaps not much, and certainly the more years that have passed since you were “taught” these things, the less you remember. But what you remember is very important and significant.

We tend to remember the more important pieces, the pieces that were reviewed over time, that were practical, interesting, or relevant to you—knowledge and information that helps you make connections between what you learned and understanding your life and the world today. These gems should be shared with your children, before, during and after they have been “taught” these things as part of their curriculum. “Did you know that…”. “Would you believe…” “That reminds me of…” are all phrases you can use at these family meals to introduce subjects; and over the course of a few meals, you can plant seeds, create interest and relevance, or even provide an entire foundation so that when these gems are part of your child’s curriculum they have more relevance and significance; and perhaps because of your meal discussions, your children will learn more of what is “taught.”

Talking at meals is different for your child than when you are sitting down to “teach.” Topics at dinner are presented in a more relaxed manner and are felt to be more like sharing than “teaching.” For this reason they are generally more welcome and have a greater impact. Another great benefit of sharing your knowledge at meals is that you get to pick and choose the topics. There is nothing wrong and everything right about first teaching your children about your interests, interests that you hope would be shared by your children and lead to lifelong shared interests and sources for ongoing interaction between you and your children. It’s often more important for your child to learn about your family business, your favorite sport, or any other of your interests and things that bring you joy and that you can possibly share with them for the rest of your lives than many of the subjects taught in school.

Family values and history

I recently had two visits from family members who I haven’t seen for many years. I live in Utah and most of my family still lives in the greater Philadelphia area where I’m from. It was great seeing them and reconnecting. A lot of our time together was spent sharing memories and getting confirmation of our joint recollections. The foundation of many of our memories came from recollections of extended family meals that generally occurred around holidays. These events were always opportunities to explore family history and values and to connect as a family. Family history offers perspective, perspective that is often missing from our lives. One of my visitors was a cousin whom I was very close to as a child and who I haven’t seen for about forty years. His short visit offered an opportunity to get him and his wife together with my extended Utah family and explore family history together over dinner. As it happened, my cousin, a recently retired judge, had done some searching and discovered that both our fathers had lived as children with their parents and grandfather in a very modest 700 square foot row home in Philadelphia. His father became a physical therapist and mine a physician. Both were innovators, and their service made great contributions to the treatment of brain injured children and others, and all from their very humble beginnings. Our families’ histories are rarely documented, and if not for the verbal communication of our families’ legacies that often only gets communicated at family meals, most of it gets lost; and our children and grandchildren are deprived of the history and perspective that helps give meaning to their lives and has the power to influence their futures.

Learning critical thought and expression

We want to create a safe welcoming environment around our family meals that produces a safe place for the exchange of ideas and views. Today more than ever, our children are exposed and often bombarded with a plethora of opinions and views that they have difficulty sifting through. Without a safe place to communicate what they have heard and a forum to openly discuss these views, they are often left with simply accepting what they hear at face value and following the latest and loudest voice.

Family meals can provide our children with the forum they need to safely talk about what they have seen and heard and learn how to speak of it and, with help, to critically evaluate it, form their own opinions, and learn how to appropriately express those opinions. Through healthy discourse with people they love and trust, they can also learn how to respect and value other opinions and learn not to be threatened by differing opinions. As parents, at family meals we need to understand that we are models, and how we react and what we say, and how we say it will teach our children how to think critically and express their views and listen to others. Often our softly spoken, non-confrontive words provide the food for thought that our children can later digest.

Becoming highly capable

Several years ago, I was a keynote speaker at the Washington State Conference on the Gifted and Talented and had the opportunity to help the educators see the correlation between cognitive processing and creating higher functioning students. At that conference they were using a new term, replacing “gifted and talented” with the term “highly capable.” I liked the term and have since redefined it and now use it more globally to mean essentially an individual who knows how to function in their world independently and competently. As I see it, helping our children become highly capable adults means that we are teaching them from an early age how to be independent in all aspects of their daily lives, understand responsibility, and develop qualities that will permit them to be confident, capable, and successful adults.

Relative to the discussion at hand of family meals, we can start the process of creating highly capable adults when our children are 5 years old. Hopefully by 18 we have succeeded in helping our child well down the road of becoming highly capable. As mentioned in the previous 3–5-year section, we can start teaching chores that the children own associated with meals. As we proceed in the development of our children, we want to continue to build on this by progressively adding to these pieces. By the time our children are 18, they should know how to plan meals, shop intelligently, understand budgets, prepare meals from A-Z, and clean-up and much more; but we can use the family meals as the foundation.

I had one of our NACD graduates who chose to go off to start her college career in England from her home in the U.S. An 18-year-old with the guts to go off to college in another country says something about confidence and capability. Shortly after beginning life in her new dorm, she made a discovery that most of the other students were lost. They had kitchens in the dorms, but the other students didn’t know how to cook or even buy food for that matter and couldn’t budget. The result was that they ate out and burned through their monthly allowance halfway through the month and had to beg Mom and Dad to send more money. As our highly capable young lady discovered, these other students also didn’t know how to clean or take care of their rooms or wash and iron their clothes. They also didn’t know how to be responsible for organizing their time, getting up in the morning on time, studying, and doing class assignments. She ended up holding classes for her dorm-mates to teach them how to take care of themselves and how to become more capable. Learning the pieces involved, learning to be responsible for all these pieces surrounding planning and seeing a meal accomplished from concept to fruition can be a significant piece that fosters the confidence and independence that can help turn a helpless child into a highly capable adult. Independence produces initiation, which in turn creates the impetus to learn more and assume more and more responsibilities.

Use family meals as the foundation to start building an adult. Do not underestimate what your children are capable of doing if given the opportunity and the responsibility. They will rise to your level of expectation.

Adults

The fabric that largely defines and holds our society together is the family. The fabric that is the family is woven together, built, and reinforced by the threads of our ongoing connection and interactions as a family. This connection needs to be reinforced and built upon on a regular basis. Sadly, for many, the connection between family members often only consists of short calls or text messages. The need for real connection is perhaps greater today than ever before, as we all shift though the bombardment of media that on a daily basis questions and even attacks many of the basic tenets that have formed the foundations of our beliefs.

Speak with most any adult about their close family times and recollections growing up and they will often speak of family meals, particularly meals with the extended family.

Speak with seniors and you will discover that past family meals are memories that last when others have long faded away. You will also discover that if such family meals are now available with children, grandchildren, and extended family that these events don’t just keep them connected to family, but to themselves.

Our sense of self, our identity, who we are and continue to be is woven into the fabric of the family.

The family meal is the foundation upon which our family is built and upon which we learn to know and maintain ourselves.

What’s for dinner?

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If you’re looking for questions to get the conversation started, we built something for that: Family Conversations

Reprinted by permission of The NACD Foundation, Volume 35 No. 3 , 2022 ©NACD

The post The Most Important Meal of the Day is Not Breakfast, It’s the Meal(s) the Family Has Together appeared first on NACD International | The National Association for Child Development.

I will never forget the feeling I had the day when Jack was labelled as autistic, he was five years old and had received a heavy educational input from myself and my supportive family with reading, math and general learning. My husband and I had left our jobs to take our son to “the best” child psychologist in London, primarily because the private school Jack was attending in Andorra had asked us to withdraw him. The schools’ headmistress said that they did not know what was wrong with him, but they did not have the facilities to educate him. This was quite a shock to us because from when he was a baby, I had seen how intelligent he was and I thought the milestones he wasn’t making was a result of him going to a multi-lingual school for the past year, as before he went to school, he was reading well for his age and showed a great memory for stories and I had no reason to believe he had any issues. My husband and I work on Super yachts, myself as a captain and he as a chief engineer. Before we left our jobs for the trip to London, we had had an amazing guest, who was a pioneer in reducing biological age and in practical uses of increasing knowledge of neuroplasticity. We had mentioned to him why we were leaving our jobs and he gave us the following parting words of advice:

1. Do not take the psychologist’s opinion as the only option, because they specialise in only one specific part of the child, which is a result of the problem.
2. Ask about possible effects of other factors, such nutrition and genetics.
3. Read the book “The brain that changes itself” before you make any major decisions. (This was key to us understanding what to look for in the solution which we finally found in NACD).

After a very expensive, one hour evaluation of Jack, the psychologist in London advised us, in no uncertain terms, that I should move to London and put Jack in a school specialising in children with autism (which he was the resident phycologist for), he advised us that Jack would regress and he would be nonverbal by the time he was 8 years old, he would never be very academic, although he was clearly intelligent by nature and if he did manage to have a career as an adult, he was very likely to grow up to be a selfish and self-involved, egotistical adult, who would have little thought for others. He would not be able to do math or learn to play music, as that part of his brain would never function properly.

My whole world fell apart, we asked the psychologist if there could be any links to genetics or diet that could help him, but he shut us down. We left his office feeling completely overwhelmed. How could we have an autistic child, could there be such low expectations of child of whom we had seen had a natural high intelligence level, who was happy and fun to be with and furthermore, what could we do to help him?

Luckily, throughout our training and careers, we have been taught not to mop up the symptoms of a situation but to find the root cause of the problem and to find a solution to fix these problems. My husband instantly identified that we should find somebody who understood how the brain works and how to fix the neurological root cause of Jack’s disability.

After over a year of home schooling and trying different methods to help an autistic child without improvement, I came upon The Listening Programme (developed by NACD), which is a music recording on an iPod, linked to bone conducting headphones, which trains the ears to learn audible frequencies. Within the first month of using TLP, I saw the first real step forward, in what had been over 12 months of intensive and soul-destroying work, one-on-one with speech therapists, occupational therapists and many other experts with no steps forward and so I read all the recommendations that parents had given on TLP’s website, hoping to find like-minded parents that had found the solution we were looking for; luckily, one of the recommendations mentioned NACD. I searched the internet and was so delighted when I realised that their method of working with disabilities was based on fixing the root cause of the problem, through a series of proven exercises, based on an understanding of the ‘plastic brain’, the effects of neurological issues and how they manifest themselves in symptoms. NACD had managed to help a range of children with disabilities of all kinds of different labels as well as “normal” and gifted children.

After an initial interview with an assessor, we were sent an introductory audio file to listen to, where the NACD method was outlined. I was a little overwhelmed hearing about digit spans etc, but intrigued and totally onboard, so a short while later, in September of 2014, with full enthusiasm, we went to Chicago for Jack’s assessment. Ellen Doman completed a one-on-one assessment of Jack in a hotel room office, whilst we sat anxiously in the foyer. She then brought us into the room and explained how she had identified a number of issues including: sensory dysfunction, developmental motor issues and poor auditory sequential processing amongst other developmental problems. She explained that he was ‘stimming’ and told us what this meant, I still remember being on the phone to my mum during the 4-hour drive home, explaining that Jack was watching movies in his head at hundreds of times the speed and getting a dopamine kick from it, and that this was more addictive than morphine and when he was ‘in a world of his own’ he was actually completely immersed in these movies. It took a long time for this to sink in. I was hesitant at first, as it seemed so far-fetched, but over the years, the theory was proven again and again and when Jack was communicating well enough, he explained this in his own words. Ellen also told us where he was in his fine and gross motor skills, specifically linked to where he was neurologically and noted that Jack was using his peripheral vision over his central vision and she explained why this was not good.

Ellen reassured me that there was a lot we could do with Jack to get him back on track and I was very impressed with the systematic and detailed approach. She said that she would send me a program for Jack and to contact them with any questions or concerns, but in the next few days, while she put the program together, we should avoid dairy, reduce sugars and gluten, not watch any movie or TV shows more than once and get as much time reading together, engaged in games and conversation and to go on walks etc as much as possible. We saw a big improvement within two weeks, particularly in Jacks’ responsiveness and use of language, which we later confirmed was due to stopping milk is his diet as he was lactose intolerant (something I did not really believe in before I saw the evidence in Jack). Our journey on a new path had begun.

The First Program

We were somewhat overwhelmed with the first few programs as they were educating us on how to help and improve Jack’s issues. With the whole family completely involved in every step of the way on how to teach and retrain Jack. NACD reset the way we understood education (My mother lives with us and was the primary teacher because I have a demanding job and my Mum is trained in educating young children and so it took her a while to adapt to these new methods). The program made sense as a whole, but we could not quite see the reasons for some of the tasks until a year or so later, but we started working on the basic fundamentals of a properly functioning brain, starting with developmental motor activities, as well as continuing with TLP and implementing many basic sequencing exercises. Ellen explained where Jack was with math (which was a lot lower than we had realised) and how to teach him the meaning and sequence of number and the difference between math facts and math problem solving. We learned how to teach reading with flash cards of the first 1,000 words and the importance of frequency, intensity and duration. Having the training videos online to access whenever we needed a refresher of how to complete a task has been incredibly useful and the simplified approach to teaching math has helped us teach the children in a fun and engaging way.

The program progressed with Jack and was adapted to suit his level of ability rather than his age. We hadn’t realised how far behind he was on basic neurological assessments initially, but over the years, he has caught up substantially and academically, he has overtaken his peers.

One of my most vivid memories from before NACD, was watching a mother with her 7-year-old boy in Barnes and Noble, she was discussing a topic in the Encyclopaedia with him and they were happily engaged in a two-way conversation. My heart sank and my world fell apart as, I thought, I would never have this relationship with my son, as he would be non-verbal, never mind able to hold a conversation, but now Jack is thriving, he is almost fluent in Spanish, has basic Chinese and French, is learning to study independently and is able to take on any chore in the house. Jack has also just published his first book called “Albert and the Karnikans” in the UK, a process that he had a lot of involvement with, (this is one of many stories he has in his creative space at home). Jack enjoys playing the piano and cello, which I will admit was a struggle for the first few years, he has a very high level of vocabulary, actively engages in conversation and discussions (although his is still quite shy in social situations) and last year, at aged 11, he scored at sophomore college level on his math test. Jack loves to read philosophy and history and writes his own computer code to make basic computer games. In his free time, he draws comics and tells and re-enacts stories and plays with his sister for our entertainment. In short, he is thriving.

Our daughter, Charlotte, is now 10 years old. She was an “average child” when she began NACD at 4 years old (we removed her from school when they asked us to take Jack out). Charlotte loves maths and she tested sophomore level math at 9 years old. She scores 12 in her digit spans in person, 9 on Simply Smarter, which makes more advanced learning in STEM subjects and coding more enjoyable and engaging for her. About a year after starting on NACD, Bob and Ellen discovered she had issues related to reading that a psychologist would have labelled as dyslexia and with early intervention we were able to fix this issue with simple methods that we easily implemented into our daily program, she now tests at reading grade 12 and is an avid reader. She is happy, highly capable and is becoming an independent learner who loves history and science. She plays the harp, piano and violin and is almost fluent in Spanish and is learning Chinese and French.

NACD has made us realise that we can all reach our full potential. The methods we have learned and implemented into improving ourselves has had an everlasting positive influence on us as individuals and as a family. We have all developed with Jack and Charlotte in the process of learning the NACD methods, we have a greater understanding of how the brain works, specifically, how we learn, which has led to a great desire to help other families and children who are experiencing the fear and frustration that we had in our lives only six years ago. All of our family have improved in so many ways and as a result of NACD our lives are so much more enriched, we have become better leaders, communicators and able and willing to take on new academic challenges that otherwise may have been daunting.

My mother, who is now 72 years old, is improving her own brain capability and is reaching her own true potential by completing NACD’s, Simply Smarter in her free time. She is learning Spanish and is still teaching both children English and math.

If I could give advice to other parents it would be to trust the incredible knowledge that the team at NACD have from their education, training, years of experience and teamwork which they draw on with great care, when making up a new program which is specifically designed for each child.

Myself and my family will be forever grateful to Bob, Ellen and everyone at NACD for giving my children the chance to realise their true potential and for making us a stronger and happier family, we intend to continue with NACD for the rest of our children’s journey through education.

The NACD Foundation, Volume 34 No.1, 2021 ©NACD

The post Our Journey With NACD appeared first on NACD International | The National Association for Child Development.

These COVID-19 Coronavirus times have certainly turned many of our worlds upside down. We now virtually have a world full of homeschoolers; more parents are at home with their children than at any time in the history of the world. Exceptional times and exceptional circumstances can also result in exceptional opportunities. Many of us are rediscovering and redefining basic things like family, work, school, and our relationship to institutions and society. I would like to talk with you about redefining potential and intellect and how while you are all at home, you have the potential to change the lives of every member of the family.

I would like to share a personal story. I grew up in a family of pioneers in human development. My father, a physician, and my uncle, a physical therapist in the ‘50s, worked with brain injured children and discovered that with the proper stimulation, healthy parts of the brain could learn to carry out the functions of damaged areas of the brain. This was ground breaking work that was originally seen as heretical, but is now after decades universally accepted. Changing perceptions is not an easy task, as I can certainly attest to after fifty years of trying to do it.

When I started studying psychology in the sixties, I had a tremendous advantage over others studying and working in the field. I came to understand that all development was possible through this amazing mechanism called neuroplasticity. If you understood neuroplasticity, development was no longer such a great mystery. The brain changed and developed as a reflection of specific stimulation, not because it just got older. Armed with this understanding, I looked at the brain as dynamic, changing, and most significantly, as changeable.

One area of early interest for me was learning and memory. At that time it was just beginning to be understood that there were various components of memory. Memory was being broken down into short-term memory, working memory, and long-term memory. The focus was on testing it and looking for correlations between these pieces and how people learned and functioned. At that time and for decades, the worlds of psychology and education did not have a perception that you could actually help develop or change memory; and even today, they are not really working to do that. My perception, based on an understanding of neuroplasticity, was that these components of memory didn’t just pop up as adult abilities, but they developed; and what developed changed; and what changed was changeable. I set out to understand all of these pieces and to find ways to change, develop, and accelerate that development.

Decades later I am proud to say that we have developed a great understanding of all of these foundational pieces that we now lump together and refer to as “processing.” Armed with this knowledge and the tools we have developed, we have helped change many thousands of lives. Improving these pieces of auditory and visual short-term memory and working memory is quite simply making people smarter. From our first software that ran on a Commodore Pet computer with a cassette drive in the early eighties, to the Brain Builder software in the nineties, to the present online Simply Smarter program and many dozens of one-to-one activities, we are working to change lives. From brain damaged individuals to those on the autism spectrum, to those with learning and attention issues, to typical children and adults, we can build all of these foundational pieces of memory that literally have the potential to make everyone smarter.

At NACD we work with “whole children,” designing home based comprehensive programs that address everything from a child’s sleep and behavior to how they walk and do algebra, including innovative comprehensive homeschool/home-based educational programs. But there is something that in one way or another is on every child’s program, and that is processing activities.

We are fortunate that we can work via Skype with any family in the world who has Internet access and give them the tools designed to develop and improve their brains. Today everyone doesn’t need to come to NACD to work on their processing. You can take advantage of this expertise and go online and in about fifteen minutes a day put together the pieces that can help you and your children work to become smarter. The tool that is available to you is our Simply Smarter program, a tool that your children can use all by themselves!

Let me help you understand what this all really is and what it can mean for you and your family.

What is “smart?” Can you define it? Do you think you would like your kids to be smarter? How about you?

You can define “smart,” possibly, but even more so, you probably know it when you see it. Smart has to do with being present, being aware, being able to take in and process a lot of information, being able to manipulate that information, think with complexity, put ideas together, focus, and communicate.

Smart doesn’t necessarily mean knowing that the capitol Nevada is Carson City, or that Sir Walter Raleigh was beheaded, or that the First World War ended on November 11, 1918, or what your bile duct does, or that “or” is a conjunction. But smart does mean that you are more likely to find such things interesting and you can learn them more easily than most. Knowing “stuff” doesn’t make you smart. (You are going to actually forget most “stuff” unless you are smart enough to make associations and connections between “stuff” and use it.) And smarter also means that it’s easier to understand and learn everything.

What is the foundation of “smart?”

The foundation of smart is the ability to process and take in a lot of information that you see and hear and to manipulate that information and think.

The more you can process and take in what there is to be heard, the stronger your auditory short-term memory. Your auditory short-term memory provides the fuel for the development of your auditory working memory, which is how many pieces or words you can hold together and manipulate, which equals your complexity of thought, or “smart.” How many pieces of visual information you process from what you see, whether from observation of your world or from reading, relates to your visual short-term memory; and as with auditory processing, your visual short-term memory provides the pieces you use to create your visual working memory and visual-spatial abilities. These fundamental, foundational pieces ultimately determine how much information you take in and use, which translates to how much knowledge you gain and your complexity of thought. All this equals “smart.”

How does processing “smart” develop?

Processing develops primarily from birth to about seven years. The rate and degree it develops is a reflection of the targeted stimulation and opportunities that you receive. In general the more quality one-to-one interaction between a child and an involved adult, the faster and the further it develops. The more enriching the environment, the faster and the further it develops. With specific targeted input designed to build processing skills, processing not only can be accelerated, it can be developed to superior levels.

When does the development of processing abilities stop?

Without specific intervention, the development of processing abilities almost comes to a halt at about seven years of age. From seven into our twenties, it typically develops perhaps another ten to fifteen percent; and after our twenties, without specific intervention it goes into a slow decline. You can continue to learn more, but your ability to do so declines, as does your ability to manipulate the information. As you continue to learn, you can become wiser, but not necessarily smarter, unless you are stretching your processing through complex cognitive activities or actively working to preserve or develop it.

How can you build processing ability and get smarter?

Everyone, from infant to geriatric, with input that is targeted to them, can incrementally build and improve processing ability and get smarter. We at NACD have been developing methodologies and improving processing abilities for the full spectrum of children and adults for over forty years. NACD designs specific processing programs for families who are members of NACD and who wish to utilize comprehensive developmental and educational programs designed so that they can be implemented in the home by parents and caregivers. But as mentioned earlier, NACD also has developed a very comprehensive targeted program for all children five years old and older and for adults up to and including seniors—Simply Smarter.

What is Simply Smarter?

The Simply Smarter program is a dynamic online system that constantly develops and modifies itself, adapting to the individual user to help produce maximum change. Specific activities work progressively to address focus, attention, intensity, auditory and visual short-term and working memory, visualization, conceptualization, and visual-spatial abilities, all of the pieces that help make everyone learn, think, and function better. The program first assesses your baseline and then builds from there, tracking and graphing progress. It has the capability of adjusting from basic levels of a child to levels of incredible function.

What can you do with children under five?

Children at or functioning under five years of age generally need specific one-on-one activities that are designed as part of NACD’s individualized programs. But in addition children from toddlers to five years old can use NACD’s Cognition Coach apps to build processing skills.

How long does it take to get smarter?

With motivation and consistent use, measurable changes can occur in a couple of weeks; and with continued use of Simply Smarter, virtually unlimited improvements are possible. Over the course of the present lockdown, you have the potential to produce a significant change.

Who has used Simply Smarter and what have the results been?

The range of those who have used NACD’s processing activities and Simply Smarter is as broad as the population. NACD’s Simply Smarter and other processing programs have been used by thousands of typical and gifted children and adults, those with learning and attention issues, as well as those with significant developmental issues such as autism spectrum disorder, Down syndrome, and brain injuries. Most everyone working on our comprehensive home based programs not only knows about processing, but is actively working on processing every day and understands the correlation between their child’s processing and global function and abilities. We have seen exceptional changes along the path of many thousands of children’s development and are continually heartened as we see their potential being redefined. Processing is a huge key to success and potential.

Please take this opportunity to change your child’s life trajectory. My mission in life has been to help change the perception of potential and to help develop the tools to do it. Today with more parents and children at home than ever before, I see this as a unique chance to change many lives and potentially change the perception of what can be.

To read an incredible testimonial from a couple about Simply Smarter and see what incredible things even a child can do, please read the following article and watch the video.

Reprinted by permission of The NACD Foundation, Volume 33 No. 4, 2020 ©NACD

The post My Greatest Discovery – How to Make Everyone Smarter appeared first on NACD International | The National Association for Child Development.

You say nice things –I like you!

You’re fun to be around!

You think I’m good-you like me!

I’ll be good for you and try hard!

You just say ugly things to me!

You think I’m bad and dumb—then I’ll be bad and dumb!

Simple statements: The more positive you are with a child, the more they will like you, respect you, and work to please you, because they will feel better about themselves when they are with you. What we and others say to them forms their self image. We tell them who they are.

Good quality positive feedback develops positive attitudes, good self-image, and it motivates. Providing quality feedback is not necessarily easy nor does it come naturally to many of us. Please see my article Feedback Part 1 to get a better picture of what good quality feedback needs to be.

The more problems and issues a child has, the fewer obvious opportunities there may be to give them positive feedback; but the more problems and issues they have, the more they need positive feedback.

Most children who are high functioning and doing well receive lots of positive feedback. Every good grade on a test provides positive feedback; if they made a basket or scored a goal, they receive positive feedback; if they look nice, they receive positive feedback; if they have friends, they receive positive feedback. High functioning children tend to do well socially and have friends and positive social relationships—all things that provide positive feedback and, in turn, motivate and encourage the child to try more and do more. If you do a lot of things well, you receive a lot of positive feedback, generally feel pretty good about yourself, and on the occasion when you receive criticism, you accept it, learn from it, and are better for it.

Children who do not do well academically or in sports or socially tend to receive very little positive feedback. Their life is often filled with poor grades and failures in many, if not most, of the things they do. On the occasion when they receive positive feedback, they don’t believe it; and when they receive negative feedback/attention, it’s an affirmation that they are “dumb” or “bad” or whatever.

The children who receive the least positive feedback are the ones who need it the most.

Who children think they are is primarily a reflection of the feedback they receive. The feedback they receive determines how they define themselves.

Giving children real, true, and positive feedback is imperative.

One very important way to help every child is to create a positive environment for them. A positive environment helps motivate them, helps them develop a positive self-image, and it provides you the parent, caregiver, coach, or teacher with power to influence them in a positive way.

I define a positive environment as one that has a ratio of four positives to every one negative. The ratio of 4:1 is strong enough on the positive side to provide all the benefits of a positive environment, but also provides the opportunity for constructive criticism or feedback to extinguish unwanted behaviors and make corrections.

Think of a common scenario involving a child with a developmental, learning, or behavior problem or combination of all three. Typically such a child may live in a world where they receive only one positive to every four negatives. The sad reality is that for many such children that ratio is 1:10 or more, much more. Imagine their life–they are doing math and they hear, “That one is wrong. So is this one and that one and…”

When they are reading, for every word missed they hear, “Wrong!” and every word read correctly gets ignored. They play appropriately by themselves and get ignored. Then they poke their sister, who squeals, and they get a quick sharp, intense response from Mom. This is their day. Do something right—minimal or no feedback; do something wrong, and you are “bad” and “dumb” at math, reading, and even playing, or simply just “bad” and ”dumb.”

When balanced, negative comments and reactions generally have a significantly stronger impact on us than do most positives. Also, most negative responses are delivered with greater intensity than positives, thus the need for the ratio of 4:1 positives to negatives to create a good positive environment.

Parents, caregivers, and teachers need to learn how to find the opportunities for positive feedback. Mark and comment on everything that is right; don’t emphasize what is wrong, comment and emphasize what is right. Take note of those things that are wrong and come back and teach them. For children with behavior issues, catch them being good and let them know it. Perceive the struggling child as a child with the potential to do well, and work to help them develop that new perception.

We change the brain through the neuroplasticity fundamentals of frequency, intensity, and duration. It’s important to understand that neuroplasticity is how the brain changes and develops. Consistent positive input/feedback helps produce positive outcomes–motivation, good intentions, good self-image, and happy children. Consistent negative input/feedback creates negative self-image, poor attitudes, and unhappy children and helps produce negative outcomes. Negatives impact the brain, and if delivered with sufficient frequency, intensity, and duration, we do change the brain, building negative perceptions and making the brain more receptive to interpreting even positive comments as negatives.

Creating a positive world for your child goes a long way toward gaining their attention and cooperation and toward developing the strengths and abilities that you want to foster.

Your goal: four positives to every negative.

Reprinted by permission of The NACD Foundation, Volume 33 No. 3, 2020 ©NACD

The post Feedback and Its Impact on Behavior, Learning, Development, and More – Part 3 appeared first on NACD International | The National Association for Child Development.

by Bob Doman

Was that right or wrong?

Did I do well or not?

Was that important or not?

Does getting it right matter, and if so how much?

Should I care—do I care?

Is it fun?

Do I like this and want to do it again?

Am I good at this?

Am I smart or dumb?

Most children’s answers to these questions are based on the feedback they receive. It’s not the actual performance at the moment that counts; it’s the response they get from it.

Your children, regardless of level of function, are reacting, changing, and developing based on how targeted the input, the frequency, intensity, and duration of the input, and the feedback they receive or not. Most children’s direction and rate of development can be significantly, if not dramatically, altered based on the feedback they receive.

At NACD we are fortunate to have a Portal upon which our families post videos that show how children’s programs are being implemented, and also how the children are functioning. One of the things we watch for on these videos is the feedback that the children receive and the general tone of the session. Inevitably we see a correlation between the quality and consistency of feedback and the rate of development of the child.

One glaring area where the feedback, or lack of, is easily seen is when we see a video of family or caregiver doing an activity that is repetitious. A common activity is working on sequential processing in which a child listens to or sees a sequence of items, then says or demonstrates in some way what they saw or heard. The feedback we observe varies from negative, to nothing, to fair/poor, to good, up to spectacular. We can fairly accurately predict the child’s rate of progress, or lack of, based on the feedback they are receiving. Let’s look at examples of each:

Negative Feedback

Essentially here we are seeing correct responses ignored and errors acknowledged. If the only attention the child receives, even if negative, comes when they make an error, you are actually increasing the odds of getting incorrect responses.

No Feedback

This is perhaps the most frustrating interaction to observe. Regardless of whether the response was correct or incorrect, the response is to simply give the child another sequence. If they don’t know if their answer is correct or incorrect, that is essentially communicating that it doesn’t matter one way or the other. So who cares and why try? The message is, “Let’s just get this over with.”

Fair/Poor Feedback

In these instances the child receives a relatively neutral response, such as “good” to every response whether it was correct or not. Or the child receives a low intensity “right” or “wrong” or “yes” or “no” response, or the equivalent. The reality of these responses is that the negative “wrong” or “no” has a greater impact on the child than do the affirmative responses. This makes the entire experience negative. These responses have low intensity and essentially communicate that it’s not really a big deal if you get this right or wrong, so why put yourself out. It also says, “This really isn’t fun, and I stink at it.”

Good Feedback

In giving good feedback, there is strong acknowledgement of correct answers: “Super!” “Great—you got it!” “Wow- you got another one!” And in response to incorrect answers, there is encouragement: “Almost, you’re going to get the next one,” “Oh, close—come on, let’s get the next one!” With good feedback the child should be feeling good, the emphasis is on their success, there should be smiles from both the caregiver and the child, and the child should be motivated to try hard and welcome the next session.

Excellent Feedback

Excellent feedback requires attention and preparation. The caregiver needs to observe the child and determine if it’s a good time to do the activity. Is the child wide awake? In a reasonably good mood? Are you making sure you’re not pulling them away from something fun? Part of the preparation is also getting yourself pumped so that you can start the activity with energy and the intention that you are going to be successful. And in some cases, part of the preparation is setting up some kind of reward system. The excellent feedback doesn’t need to sound significantly different than the “good feedback,” but the energy level is higher, the intention acknowledged before the activity is even started, and if needed some kind of reward system beyond the social/verbal acknowledgement is employed. What this additional reward system is would be very child specific. For young, lower processing children, that reward would need to be immediate and could range from a little food reward, to physically picking the child up and dancing around the room, to them engaging in one of their very favorite activities. For older, higher processing children, some form of a positive token economy system is often effective and appropriate. If you value the results you are trying to achieve, then give value to the results.

Whenever possible you want to teach your child to love whatever it is that you want them to do and do well. Simply put, if they love it they are going to do the activity with a lot of positive intention and intensity and do well. You really have the power to do this with virtually anything. One of the things I hate to hear from parents and caregivers is that Johnny is bored with the reading, math, processing activity, or whatever. In any activity that you are engaged in with the child, you are the one in control of how much fun it is, how much positive intensity there is, and ultimately how much the child loves the activity and thus their success.

Reprinted by permission of The NACD Foundation, Volume 33 No. 1, 2020 ©NACD

The post Feedback and Its Impact on Behavior, Learning, Development, and More – Part 1 appeared first on NACD International | The National Association for Child Development.

by Bob Doman

I’m good at reading!

I love to read!

I stink at reading—I hate it!

I’m great at soccer!

I really like playing soccer; let’s play some more!

I’m lousy at soccer—I hate it, I quit!

Simple statement: You like what you think you’re good at. The ramifications of this simple truth are tremendous.

If you feel you are doing well at something, you are motivated to do it more. You approach each new event with a positive attitude. You approach each new event with intensity, and you want to keep doing it, and you want to do it again. The key to triggering neuroplasticity is providing specific targeted input with the necessary frequency, intensity, and duration. Learning is changing the brain—physically changing the brain by growing connections and building networks. The process is what it is—the components are written in our DNA; we can’t escape it. We need to understand it and use it to the child’s advantage.

For fifty years I have been preaching that the first thing, the first goal when trying to teach a child anything is to first teach them to love it. Whether we are hoping to teach a child to crawl, walk, run, read, do math, or do chores, we need to teach them to love it or at the very least, like it.

“You can’t teach a child to love cleaning a toilet!” I beg to differ. If you know your child, you should be able to use that knowledge to create a fun, motivating environment around teaching them how to do it; and once learned, give them a lot of real and positive feedback. You can teach them to love cleaning a toilet.

One of the first things I often have to encourage parents and caregivers to do before starting to teach a child anything is to remember school. Odds are fairly good that if you replicate a lot, if not most, of what you remember school being like, you’re doing it wrong. But it doesn’t have to be that way. Learning can be and should be fun.

Back at the beginning of my career, I was a special education teacher. I worked hard to teach the eighteen children in my class, who all had serious learning challenges and labels like Down syndrome, cerebral palsy, and autism, to love reading and math. Randomly throughout the day I would have class question sessions and would throw out questions to a few of the kids in each session. I knew the kids and knew what they knew, so I would call out a child’s name and ask them a question that I felt confident that they could answer correctly; and when they did, I would wing a poker chip at them that they would have to scramble for. The token bought them time at the reward table at the back of the room. I taught the group to cheer at every correct answer, and the lucky child would grab his poker chip and go back to the reward table, where there were math papers with their names on them and books with their names as well. The kids loved doing math and reading and loved earning the reward of doing more math and reading. The tone, the environment, and the feedback can make most anything fun and positive. If the child likes whatever is to be taught and feels they do it well, they are going to approach the session with intensity and are going to want to do it frequently and to continue to do it (duration).

Another thing I did as a teacher was to mark only what was right/correct on a paper. I could give a child ten math problems, and if they only got one right, that gave me the opportunity to say things like, “Wow, you got that tough one right,” “See? You’re getting it—you got that one!” “Great, I bet next time you’re going to get more of them.” Why do schools always mark what’s wrong not what’s right? Typically if a child is given ten problems or questions, and if they got nine correct and one wrong, there is a big red mark on the one they got wrong. This essentially communicates to the child that you don’t care what they know, the emphasis is on what they don’t know.

We aren’t going to change what is happening in school very soon. I’ve spent fifty years trying to do it, with minimal success. But we can change how we do things at home.

I have spoken to groups of parents who have opted to keep their children home rather then send them to school, and I have actually encouraged them to refer to what they are doing as “home education,” not “home school,” because so many homeschoolers work very hard to replicate just what they do at school. We can do so much better.

You have the power to create fun, positive environments around teaching most everything. And you have the power to control the feedback and to make it positive. If your children approach what you are doing with positive intention and intensity, you are going to see them progress well, and you and they are going to enjoy doing it.

Reprinted by permission of The NACD Foundation, Volume 33 No. 2, 2020 ©NACD

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Back in the ‘80s I traveled around the country, lecturing to parents and professionals. On many of these occasions I spoke to them about the importance of understanding and utilizing neuroplasticity, which with rare exception none of them had ever heard of. I also spoke about how the model of providing therapeutic intervention on a weekly or biweekly basis was contrary to what was needed to really utilize neuroplasticity. I also emphasized the importance of working with the whole child, understanding the whole child, and coordinating efforts based on the whole child.

 When I refer to the whole child I mean exactly that, not just “important” or “broken” pieces, not just what is obviously relevant to gross motor (physical therapy), fine motor (occupational therapy), speech (speech therapy), behavior (psychology), reading or math (education), or those pieces that are the specialty of everyone else from the neurologist to the ENT to the dentist.

Working with the whole child requires working closely with the parents, the people who know their whole child best, and gathering the information about the entire child. This includes their developmental and medical history, health, diet, sleep, self-help skills, sense of responsibility, chores, daycare, academic function and interests, schools, baby sitters or caregivers. Also important are the specifics regarding therapies and therapeutic approaches; interests, from playing with cause and effect toys to video games; activities, from church groups to horseback riding; sports, behavior at home and away, and their daily schedule. And then there are the specifics relative to how they see, hear, feel, and how they perceive what they should taste and smell; gross and fine motor function; how they swallow, drink, chew, articulate, and communicate, as well as all aspects of cognition which provides a global overview of where they are and should be functioning. Every piece is significant to the whole; and combined, the sum is greater than the collection of pieces. This defines what is referred to as the “gestalt.” If children are not viewed as whole and unique, they tend to be viewed as disassociated pieces and labels, not as unique individuals. This is only one of many significant pieces that underscore the importance of understanding the whole child.

The more issues a child has, typically the more pieces the child is broken up into, and the more people are involved in addressing those pieces individually, mostly in isolation.

Back very early in my career in the mid ‘70s, I was the Educational Director for the Center for Neurological Rehabilitation outside of Philadelphia. In many respects I was doing what our staff and I are still doing today, except with a much smaller toolbox, which is designing comprehensive targeted home-based programs for a wide range of children. Back then part of our team included neurologists and neurosurgeons, headed by the brilliant pediatric neurosurgeon Eugene Spitz M.D., who amongst other things was the developer of the shunt for hydrocephalic children. The structure back then was that the evaluators would each meet with our respective families and their child and conduct the evaluation so that we could create a profile/picture of the child. The profile was the foundation for creating their individualized program. The majority of the children would then go through a battery of tests that had been ordered by Dr. Spitz and his team, which were all carried out onsite and included everything from comprehensive blood work to CAT scans, EEGs, and cerebral blood flow studies. Following the testing Dr. Spitz would then meet with me and discuss the results of my evaluation and the testing that had been done. He would then call in the family so that he could make his recommendations, following which I would create their neurodevelopmental/educational program. This process was incredibly educational for me and for Dr. Spitz as well.

Being in a position not only to re-evaluate the children every 3-4 months as we did, but also to compare what I was seeing functionally to what Dr. Spitz saw with his testing, was invaluable. The tests and the EEGs were no longer these isolated pieces of data; they were part of a complete picture. One example of many of what turned out to be learning experiences for both Dr. Spitz and me was the observation I made that when kids were having dental issues, their EEGs were worse, often substantially worse, and that those kids who were prone to seizures often had more seizures. After observing this a few times, I very tentatively mentioned to Dr. Spitz that I was seeing this correlation. He listened to me, and he acknowledged that not only did it make sense, but he realized if it had not been for my knowledge of the broader issues, he would not have thought to ask the family about such issues. This piece of information affected how he adjusted medications and opened the door to our making other associations between health related issues-triggers and what he saw on EEGs and how the children were or were not medicated.

There are many examples of how a view of the whole child can have an impact on medical treatment. One of the more glaring issues that I have written about before is the effect of chronic middle ear fluid and its impact on the development of auditory processing and language. Another piece of this is that some speech therapists will make the recommendation to teach a child to sign, rather than working at getting the child to speak, not understanding the effect and ramifications of the child’s middle ear fluid, and not understanding that the child’s auditory and visual processing (short-term and working memory) determines their global level of function, not their chronological age

Well-meaning teachers generally perceive children with developmental issues as their chronological age, rather than where they are really functioning as reflected in processing ability and global neurological maturity. A six-year-old who is neurodevelopmentally three should not be expected to do the same work as their neuro-typical peers. If the educational input is not targeted to the developmental and educational level of the child, it is going to be ineffective at best. Inclusion is great, I fought for it for many decades; but if the instruction is not targeted to the individual, it really is only pretend education.

The group of people with their fingers in the pie that exists for most special needs children is presented as a team; but that is very rarely, if ever, true. A team implies a group working together in a coordinated fashion. Most therapists work in relative isolation from every other therapist who is working with the child. Each therapist establishes their own priorities, even though when viewed from the perspective of the whole child many of their “priorities” would not reach the level of even being significant. Some would define this as fine; however when viewing the total child, it is important that priorities be the whole child’s hierarchical priorities so that time, focus, and energy can be directed when and where it is needed most. There are only so many hours in the day, and we can only ask so much of a child in a day if we are going to maintain any respectable level of intensity. For a child with a developmental problem, we are always fighting time. They can ill afford to be directing minutes, if not hours, working ineffectively in the wrong direction.

Historically the educational, therapeutic, and medical treatment of children with developmental issues has become more and more compartmentalized. The net result is that vital information is often not shared between players, and the various people involved remain ignorant of significant correlative information. Furthermore, it is impossible to target, prioritize, and coordinate efforts and to raise and meet higher expectations without the direct involvement of parents and coordinated efforts focused around the whole, intact, total, and complete child.

Effectively and efficiently helping any child reach their potential requires targeted coordinated intervention that is not only mindful of the whole child, but that is led by an understanding of the gestalt. The child is more than just the sum of their pieces.

Reprinted by permission of The NACD Foundation, Volume 32 No. 3, 2019 ©NACD

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It appears that middle ear fluid (otitis media with effusion) is a significant problem for children with Down syndrome. Our experience at NACD with literally thousands of children with Down syndrome indicates that middle ear fluid issues are ubiquitous and are of tremendous concern relative to the global development in this population.

For forty years NACD at any given time is working with approximately 300 children and adults with Down syndrome from all over the world. We work with the “whole” individual and look for correlations between issues to determine how to best address problems and global development.

One of the ongoing issues affecting overall medical care and therapeutic intervention, particularly as is it impacts children with developmental issues and complex interdependent issues, is the compartmentalization of the care. At NACD we are acuity aware of the importance of working with the “whole” child. Looking at isolated pieces can lead to ongoing issues that can have very significant impact on the child’s development and could possibly be remediated if the need were perceived based on the totality of the impact.

When looking at the “whole” child, it is possible to identify discrepancies in development. Development in children with Down syndrome typically follows “normal” development. This development, albeit slower than normal, follows the same patterns and exhibits the same associated developmental pieces as ‘typical” children. In areas where there are inconsistencies in the development of associated pieces, it is necessary to identify underlying cause. Often when language is delayed more than other areas, the underlying cause is something that is adversely affecting the hearing.

When dealing with a problem such as middle ear fluid, we want to address cause when possible. Mucus and congestion are virtually synonymous with middle ear fluid. It would appear that we could avoid at least part of the fluid problem by more aggressively addressing the cause of mucus. Many children have allergies that can be treated, but mucus-producing foods are in most every child’s diet. It would appear that if we could eliminate dairy and gluten from our children’s diets, we would probably go a long way toward avoiding or mitigating these issues.

Children with DS have anatomical issues that increase the prevalence of middle ear fluid. These issues include large adenoids, small nasopharynx, impaired swallowing, and narrow and abnormally horizontal Eustachian tubes. These anatomical issues, coupled with the fact that children with DS tend to have excessive mucus and excessive earwax, further complicates the problem. Middle ear fluid issues often resolve themselves in typical children; but the anatomical issues associated with DS make this substantially more difficult.

One of the issues that appears to create problems for children with DS is that middle ear fluid, even if considered in the “normal” range based on tympanic testing, can still have a significant impact on the hearing and development of this population. Over the course of decades, we have seen numerous cases where at parents’ insistence tubes were inserted even though tympanograms indicated that fluid was still within “normal” ranges.¹ Following many of these procedures the doctors commented after the procedure that there was much more fluid than expected. It appears that for the majority of children with DS having received tubes, even when the need based on the exams and testing was questionable, there were virtually immediate positive changes in language development. I leave it to the ENTs (otolaryngologists) to research and determine if different testing, norms, or criteria are needed. This is clearly an area requiring further investigation.

Complicating the issue as to whether or not to place tubes is the issue of what level of baseline testing is needed. Often children will have a flat tympanograms, and the doctor’s recommendation is to wait two, four, or even six months to repeat the testing. For a child, particularly a child with delayed language and cognitive development, two months or more can have tremendous impact on the child’s future development. If the doctor wishes to be cautious, repeat the tympanogram in two weeks. One might also consider the child with chronic congestion who will have some degree of associated chronic middle ear fluid. Why not in such cases insert tubes to assist with the mechanics and help drain the fluid? When this issue is seen relative to its global impact on the development of the child with DS, I believe aggressive treatment can be justified. Tubes would appear to be a relatively simple, inexpensive, benign treatment that can have significant, if not dramatic, impact on a child’s development and future.

To understand the significance of this issue, let’s look at developmental issues that can result from perhaps even a moderate issue with middle ear fluid.

Middle ear fluid issues have a negative developmental impact on numerous foundational developmental issues including:

• Hearing

• Receptive language development

• Expressive language development

• Speech/articulation

• Auditory sequential processing, short term memory, working memory, and cognitive development

• Attention

• Reading

• Balance, mobility, walking

• Visual tracking, convergence, strabismus

Hearing

Hearing involves sound waves moving into and through the outer ear and impacting the eardrum. The sound waves vibrate the eardrum, which in turn produces movement of the three small bones of the middle ear. The middle ear is a cavity containing air that should have the same atmospheric pressure as that outside the body. The pressure is regulated by the Eustachian tubes, which go from the middle ear to the upper part of the throat. The sound waves then produce vibrations on the oval window that then transmits the vibrations to the fluid in the inner ear, which in turn stimulates the hair cells of the cochlea, transforming the vibrations into nerve impulses that enter the acoustic nerve and then the brain. It is the brain that actually interprets the information and “hears” the sounds or words.

One of the immediate issues with middle ear fluid is resulting hearing loss. Numerous studies have equated hearing loss in DS to middle ear fluid. ^2,3 Conductive hearing loss, which is common in DS, is usually caused by middle ear fluid, but can also be caused by excessive wax.

Receptive Language Development

Receptive language refers to the ability to understand language. Every child begins learning to understand language by hearing specific words in association with specific objects or events with sufficient frequency, intensity, and duration. The consistency of this input is imperative for the child to literally learn to hear and understand. A completely deaf child receives none of this auditory input; a child with a hearing loss receives poor input; and a child with inconsistent input resulting from variations in middle ear fluid receives often less than the necessary quality of input needed for receptive language development. Receptive language is the first step in the development of expressive language, speech, and cognition.

Expressive Language Development

Expressive language/talking has been historically one of the biggest concerns for children with DS. Sometimes those not understanding the foundational issues will out of vexation resort to sign language or augmentative communication to facilitate communication and avoid frustration. Lack of function should not be perceived as a lack of potential or inherent ability to develop that function. If a child with DS is not talking, there is a reason that needs to be identified and addressed. Rarely do children with DS have oral motor issues or apraxia to such a degree that it prohibits the development of basic language, even though such issues can affect the speech. Significant delay in the development of language in a child with DS is virtually always a reflection of an issue with hearing or inconsistent hearing.

Speech/Articulation

Developmentally we refer to speech/articulation as the production and clarity of speech. A significant component of speech is oral motor function, which is a very common issue with children with DS. However, you cannot reproduce what you cannot hear. Middle ear fluid issues can produce issues with learning to process specific frequencies of sound. If you cannot hear, or if your brain does not learn to hear, a specific frequency, then it can’t be reproduced. Case in point, there is not an “r” sound in Japanese, and even for a native Japanese speaker who becomes fluent in English, the “r” sound may be next to impossible to learn because when their brains were learning to hear, the opportunity to hear that sound did not exist. Repeating the word “rice” typically comes out as “lice,” regardless of the number of times they hear the word spoken correctly. Audiograms, which only measure typically six frequencies, do not identity very specific frequency issues. We have used voice analysis to gain a better understanding of specific frequency issues and have discovered that they are extremely common. I would like to see research directed at seeing whether voice analysis could be used to accurately assess hearing more specifically and objectively than an audiogram or in conjunction with and audiogram.

Auditory Sequential Processing, Short Term Memory, Working Memory, and Cognition

Language and the development of language is primarily a reflection of the development of auditory sequential processing. Expressive language will not exceed the ability to sequentially process, hold, and mentally manipulate auditory information. Auditory sequential processing/short term memory is measured in pieces of auditory information that can be processed in a sequence or chain. This is often tested and measured by how many numbers you can hear presented in a sequence at one-second intervals. It could also be measure by the ability to listen to and repeat random words also heard at one-second intervals and repeated or how many simple directions one can hear in a sequence and then carry out. Generally, a child who can follow one simple direction will use random isolated words, working into functional use of individual words. As the child moves into being able to follow two-step directions, they will begin using two and then three-word phrases. When they can sequence three pieces, they will start using four, then five words in a sentence. As their auditory sequential processing increases, so does their receptive and expressive language.

The foundation of working memory, which is now appropriately being called the new IQ, is built upon the short-term memory. Working memory essentially represents complexity of thought and is reflected in global maturity and executive function. All of this put together represents cognition, which is simply that which permits us to learn, think, and communicate.

Issues affecting hearing in the first few years can have a negative impact on the development of all of these critical pieces, an impact that may not be able to be entirely remediated, or which requires years of extensive specific targeted intervention.

Attention

Over six million children have been diagnosed with the mysterious “disease” of ADHD, which is termed as a mental disorder, rather than a developmental disorder. Perhaps this delineation is based on a perception that a mental disorder can be treated with drugs, as opposed to a developmental issue that cannot. I believe that one of the most common issues affecting attention is auditory sequential processing and that one of the primary causes of auditory processing issues is recurrent middle ear fluid in children. The inconsistencies in hearing adversely affect the child’s ability to attend to and process language, resulting in slow or underdeveloped auditory development, including auditory sequential processing. Negatively impact auditory processing and you subsequently negatively impact auditory short-term memory, auditory working memory, executive function, and global maturity. The term ADHD is at times used as a secondary or dual diagnosis for those with Down syndrome and other developmental problems, but the symptoms that result in this label exist in every child with a developmental cognitive delay. It is questionable at the very least to ignore the cause or causes and needed developmental intervention by attempting to mask the symptoms with medication.

Reading

Learning to read can be very negatively impacted by even minor hearing or specific auditory tonal processing issues. Teaching reading using an auditory tonal and auditory sequential processing approach, such as phonics, is often disastrous for those with Down syndrome because of their auditory issues. However, children taught reading through a more visually based sight word approach do much better. A visually weighted word attack approach still has a significant auditory component. Issues with auditory tonal and sequential processing have a negative impact regardless of the reading approach, but significantly less of an effect with a sight-reading foundation.

An additional issue relating middle ear fluid and reading is the role of the vestibular-ocular reflex in reading and writing. The vestibular-ocular reflex is a reflex that associates activation of the vestibular system and eye movements. Any interference in this reflex adversely affects the ability to maintain focus. There is almost constant slight head movement when one is reading or writing. Interference in the vestibular-ocular reflex negatively impacts the compensatory eye movements that permit the child to sustain focus.⁴

Balance, Mobility and Walking

Walking has a profound effect on neurological development and is associated with language and cognitive development. Children with DS often have issues with tactility, muscle tone and strength that can delay and or complicate gross motor development and walking. These issues are only compounded if the development of balance is compromised. Middle ear fluid has a negative impact on the inner ear’s balance/vestibular system, as well as the vestibular–ocular reflex, further complicating the development of balance, depth perception and thus walking.⁵

Visual Tracking, Convergence, and Strabismus

The vestibular system plays a significant role in the development of ocular control, tracking, and the development and severity of strabismus. The vestibular system as mentioned previously affects the movement and control of the extraocular muscles that are responsible for visual tracking and which need to work in concert to keep the two eyes working together.

It is not unusual to see children with DS suddenly develop a strabismus or to see it suddenly get worse.⁶ When we become aware of these issues, we suggest that the family visit their ENT first, not their optometrist or ophthalmologist, because the most likely cause of the issue is middle ear fluid. Strabismus, which is a misalignment of the eyes, can take many forms, but generally the family will observe one eye or the other going in toward the nose or out toward the ear. If a strabismus exists the child is unable to perfectly align the eyes together, with a resulting loss of depth perception. It would appear that even slight issues with middle ear fluid could have a negative impact on ocular control and a negative impact on a wide range of functions. 

Conclusion

Seen in isolation some degree of middle ear fluid may not appear to be of great significance. However, in viewing the global aspects of middle ear fluid we have an issue that can have wide ranging and significant impact on a child’s future development.

We urge parents and professional to be vigilant and to address ear fluid aggressively. Remediation of issues associated with middle ear fluid generally requires targeted, vigorous, dynamic, and coordinated intervention.

References

1. Ear Center: Ear Tubes (Bilateral Myringotomy & Transtympanic Tubes)
   http://www.earcentergreensboro.com/medical-education/ear_tubes.php
2. Otitis media with effusion with Down syndrome
   Int J Pediatr Otorhinolaryngol. 2013 Aug;77(8):1329-32. doi: 10.1016/j.ijporl.2013.05.027. Epub 2013 Jun 20.
   In this study one in three eight-year-old children with DS had current middle ear fluid and had verified hearing loss.
3. Balkany, T.J., Mischke, R.E., Downs, M.P. & Jafek, B.W. (1979). Ossicular abnormalities in Down’s syndrome. Otolaryngology: Head and Neck Surgery, 87, 372-384. Middle ear fluid issues account for 83% of hearing loss in children with DS
4. The influence of eye movement and the vestibular-ocular reflex in reading and writing. Rev. CEFAC vol.16 no.6 São Paulo Nov./Dec. 2014 http://www.scielo.br/scielo.php?pid=S1516-18462014000601791&script=sci_arttext&tlng=en
5. The effect of otitis media with effusions on balance in children. Clin Otolaryngol Allied Sci. 2004 Aug;29(4):318-20. https://www.ncbi.nlm.nih.gov/pubmed/15270815
6. Ophthalmic complications of otitis media in child J AAPOS. 2011 Jun;15(3):272-5. doi: 10.1016/j.jaapos.2010.12.018.ren https://www.ncbi.nlm.nih.gov/pubmed/21777800

Reprinted by permission of The NACD Foundation, Volume 31 No. 9, 2018 ©NACD

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Decades ago, I worked with a mental health service that is called “wraparound.” It provides Mobile Therapists and Behavior Specialists in family homes to work directly with children and their parents when the children are believed to be high risk for placement in residential treatment programs. I had the great opportunity of working with a very diverse population, both in very urban settings and suburban settings. Many, if not most, of the children with whom I was working had very poor auditory processing, as well as weak working memories and executive function. They were also, not surprisingly, very often weak in both receptive and expressive language skills. I noticed it quite often because my language would often confuse them and vice versa.

With many of the children, for example, the word “cup” was used to denote anything that held something to drink. To me a cup was either a teacup or a measuring cup. A light was anything that gave off light, such as an overhead lighting fixture, a table lamp, or even a flashlight. The word “mad” was used to communicate anything from intense anger bordering on violence to mild annoyance and irritation. “Over there” could mean anything from two feet away to two miles away. At any rate, I realized that there was an enormous gap not only in their vocabulary, but also in their ability to communicate with me and to interact with their environment with any detail.

As I spent more years working with a great array of children and young adults, I really began to appreciate that functioning with a very limited vocabulary and having poor auditory processing often went hand in hand, and that how we think is drastically altered by both. Working with children in treatment facilities, I had firsthand experience with children thinking in very circular ways, rarely seeking additional information or looking for explanations. The children seemed stuck in certain behavioral patterns that were not constructive, fun, or rewarding in any way.

As a principal for the school at one of these facilities, I worked with children who had such repetitive behaviors that I could do the talking for them and for the teacher. They essentially had the identical argument with their teacher every single day, which resulted in detention every day. I would go into specific classrooms each day and re-enact some of these arguments, saying all the parts for both people, much to the amusement of my students. The sad thing was that the children could not think how to interact in a different and more productive way. So then I scripted both these students and their teachers to say different things to each other, more complex things, and more positive things. We became “unstuck” and were able to help the students think better, think smarter, and communicate more productively.

We worked hard to improve not only their processing, but their levels of language, their richness of experience. We worked hard to create curiosity, a sense of joy in learning and exploring. We built river rafts, planted elaborate gardens, and learned many new things together. What we discovered was that these children became joyful. They began asking lots of questions. What would happen if you drilled a hole through earth and dropped a rubber ball down the hole? What if we attached a camera to a comet? What could we discover? Where does this creek go and where did it start? These same children who lacked vocabulary to think outside of their limited experience became excited by learning. These children who had exhibited such repetitively negative behaviors became such smart and fun kids to be around that I enjoyed my work tremendously. One great thing about getting a bit old is that you get to see how things turn out. To hear that many of those kids who are now middle-aged adults still remember that big, dramatic change in their life when they learned language, when they learned how to process information and how to learn is a wonderful thing. To hear that my former students when in their mid-forties still remembered that great Astronomy unit study with joy is really wonderful news.

By improving processing and expanding vocabulary, we open doors to a new and exciting world full of possibilities and things to explore. Everything is potentially interesting! It is a quality of life issue that I feel is really central to helping children and young adults move toward a better life. No child would choose to restrict themselves from faster learning, deeper understanding, or richer and more meaningful communication skills. No child would choose to limit their lives to seeing few options, being aware of only a small number of opportunities, and repeating the same non-productive conversations every day.

Many of the individual programs that we write are filled with language-based activities in many different forms. We seek to develop short-term memory, working memory, executive function, receptive language, expressive language, and the language that enables complexity of thought. All of these strategies change how an individual learns and how they think. It drastically changes how they view the world around them and how they interact with it.

I have really terrific grandchildren, and I say that with all of the modesty of any grandmother. One of my grandchildren is two and a half and very outgoing. I have told her countless times how very cute she is. As a result, when she greets someone and decides that she truly likes them she tells them, “Oh! You’re so cute.” She does this to complete strangers, males and females, adults and other children. She means by this an array of things, ranging from being delighted to meet them to wanting them to play with her. She lacks the vocabulary and the processing, however, to say all of these diverse things such as, “Will you play with me?” or “I’m really happy to meet you and you seem quite nice.” Children and young adults with delayed processing and limited vocabulary are in a similar situation, being restricted in the range of what they can communicate and unable to keep enough pieces together in the working memory to form and express really novel thoughts.

On the very long drive from northern New Jersey where I do evaluations to western Virginia where I live, I listen to the radio or audiobooks to stay awake and, hopefully, learn something as well. It was during one of these drives that I learned about a study of a group of adults who were deaf and had learned only a very limited sign language vocabulary due to a lack of education and opportunity. These men would get together in the very small village where they lived and talk about something that had happened that day or on previous days. Each time another man began to talk he would repeat the “story” already told using the identical signs the man before him had used and then add one or two additional pieces of information. In this way, the men talked to each other, always repeating and then adding.

As some of you very familiar with NACD may have guessed, this is really a version of chaining. The previous sequence is “rehearsed” with something small added, rehearsed again and more added again. With this strategy the working memory load is greatly reduced. In the case of these adults, having such a limited vocabulary changed the extent to which the language-based part of working memory had developed. With limited working memory comes this difficulty in holding on to multiple pieces of information and changing how they are being expressed. Think of how limiting this is!

So as we help children and young adults progress, as we help ourselves progress, let’s keep in mind the power of expanding our language abilities and the power of developing working memory to change how we and our children interact with our world and with each other. Let’s open more doors to more complex thinking, more precise communication, and the realization of more opportunities. As Madeleine L’Engle wrote, “We think because we have words, not the other way around. The more words we have, the better able we are to think conceptually.”

Reprinted by permission of The NACD Foundation, Volume 31 No. 4, 2018 ©NACD

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Are you tired hearing us talk about tympanograms yet? We’re not tired of talking about them or recommending that you get them yet. Obviously we’re not afraid to admit that we’re pretty opinionated on the subject of how significantly middle ear fluid can affect a child’s development.

For years there has been conflicting information by researchers regarding a correlation between speech and language delays/disorders and history of middle ear fluid. Studies that support each side are criticized by the other side for having design flaws, and nobody can seem to decide if having transient hearing loss (sometimes very frequently or else ongoing) and hearing a distorted speech signal affects how a child develops communication skills and phonology (speech sound development). A little common sense and some consideration of anecdotal data go a long way here. Because we’ve been at this business of observing and assessing lots and lots of kids for a very long time, we have some opinions on the subject. And because of these opinions, we frequently recommend to parents that they take their child for a series of tympanograms to see what the trend is over time with the status of their middle ears.

In the following article, pediatric audiologist Jessica Messersmith comes to the same conclusion when her own daughter regresses in language development during a period of ear infections. (It’s a short article and worth reading.)
http://leader.pubs.asha.org/article.aspx?articleid=2432364&resultClick=3

As she mentions in the article, the American Academy of Pediatrics supports the recommendation of ear tubes if fluid persists for three months. To really be proactive and collect strong data, tympanograms every two weeks over a three-month period is your best course of action.

That being said, as objective as tympanograms appear to be, here are a few points of caution:

• The established “normal” range may not apply to everyone equally. Our own observations in children with Down syndrome (one of the populations for whom this whole subject is especially critical) has been that many children have a tymp reading with compliance scores at the lowest end of the established (for the typical population) “normal” range. Because of history and functional observations, there has been a high suspicion of fluid in many of these cases. Some have had fluid confirmed when they had tubes placed and fluid was found (in spite of the tymp measurement). It raises the question of whether different norms might apply in this population. Or, as will be discussed below, whether kids with Down syndrome simply need to be tested differently due to their structural differences.
• In their chapter on tympanometry in Handbook of Clinical Audiology, Shanks and Shohet suggest that what is “normal” may vary by age and also by race. So again, as above, the current normative standards may not be valid for every individual.
• Some studies discussed that typical testing with the 226 Hz probe tone may not be an accurate assessment in the Down syndrome population. There was discussion of whether the 1000 Hz probe may yield more valid results.

That is all to say that even with something as seemingly simple and straightforward as a tympanogram, sometimes and for some kids, results need to be interpreted with caution. If all signs point to fluid issues and the tympanogram doesn’t support it, don’t just assume that your observations are wrong. Find a practitioner who will work with you and who is open to discussion and critical thinking and assessment.

References:

Messersmith, J.J. (2015). Eardrum Perfs and Language Spurts. The ASHA Leader, 20(9), 72.

Shanks, J. & Shohet, J. (2009). Tympanometry in Clinical Practice. In J. Katz, L. Medwetshy, R. Burkhard & L. Hood (Eds), Handbook of Clinical Audiology (6^th ed., pp. 157-188). Baltimore: Lippincott Williams & Wilkins.

Reprinted by permission of The NACD Foundation, Volume 28 No. 2, 2015 ©NACD

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