Diet plays a crucial role in neurological health as well as physical health. As the saying goes, “We are what we eat.” If a child does not eat well, there can be numerous repercussions. In addition, the foods of the past were possibly of higher quality than those that we eat today.
More plants were organically grown and soils were rich in a wide range of important minerals. Today’s commercial farmers use fertilisers, herbicides, fungicides, pesticides and bactericides. In the past, meat products were also raised in a more natural and less polluted environment.
Animals are no longer free-roaming and their feed contains many pesticides and even antibiotics. In many countries, fish are found to be polluted with mercury. Food manufacturers can put hormones and other undesirable substances into food without our knowledge.
Processed foods in particular lack essential nutrients and a diet containing too many of these may negatively affect a child’s health and neurological development. It is important to remember that the further removed a food is from its natural form, the more likely it contains additives. So foods that are boxed or canned usually have more additives than those that are frozen. Fresh foods have the least amount of additives and sometimes none at all.
This website is too restricted in scope to thoroughly address the many factors related to diet that can cause underachievement in children. It needs our careful attention to aspects of your child’s diet (or your own) that may help to identify nutritional sources of learning and behaviour difficulties.
There are three other important sources of problems related to diet. It would be well worth your while to read about them.
They are:
Allergies can play havoc with a child’s ability to benefit from teaching. Some forms of ‘hyperactivity,’ short attention spans and mood swings are caused by allergies and intolerances for certain foods and other environmental factors.
There is much controversy in the medical and related fields concerning allergies and their identification, including the types of tests used to identify allergens (the substance that causes the body to show an allergic reaction). In fact, much about allergies is unknown.
What is known?
We know that the white blood cells (also known as lymphocytes) are a fundamental component of the immune system that protects our bodies from invaders. When they make a mistake, an allergic response can occur. When a lymphocyte encounters a particle or cell and identifies it as a foreign invader, it produces antibodies specifically engineered to fight that particular threat.
There are five basic types of antibodies, called immunoglobulins, or Igs. Each is classified by type with a letter suffix: IgA, IgD, IgE, IgG and IgM. The Ig known to be responsible for most allergic reactions to food is IgE, although IgG is also commonly mentioned.
IgE allergies occur when the immune system, in an effort to reject a certain food or other substance, creates an antibody to that food, immunoglobulin E. In other words, the blood cells of an allergic person are “misinformed’ at the genetic level and cause the production of large quantities of IgE antibodies.
The antibody becomes attached on one side to the food/substance molecule and on the other side to a mast cell (mast cells are a type of cell containing histamine and other allergy mediators instrumental in the allergic response).
When this happens, histamines and other chemicals are released from the mast cells, causing such immediate responses as runny nose, itchy eyes, skin rashes and indigestion. IgE can cause anaphylaxis, an extreme, sometimes even life-threatening response in which the airways swell, sometimes to the point where the person cannot breathe.
The most common tests for food allergies are IgE skin tests, where the skin is scratched or pricked and allergens such as wheat, eggs and milk are applied. Within 15 to 30 minutes, local reaction may occur. Other types of tests include blood tests and patch skin tests.
However, there are reports that blood testing for food allergies provides more reliable results than skin testing. The latter are problematic because of their tendency to yield false positives. This means that people may show a positive result but are still able to eat a certain food.
To summarise this difficult and confusing field, it appears that the efficacy of all allergy testing is under suspicion.
Less is known about the other allergies, which are far more difficult to research and subsequently seldom mentioned or tested for by doctors.
Some theorists are willing to explain the fairly common IgG allergies, where the body produces an abundance of immunoglobulin G in reponse to certain foods/substances.
The body normally produces IgG antibodies to foods that one consumes regularly, yet in cases that involve allergic responses, supporters of the theory say, great amounts are released. The IgG antibodies attach directly to the food, but not the mast cells, creating what is called an “immune complex.” The allergic responses, which may include constipation, headaches, joint pain and depression, can be immediate or delayed, appearing up to several days after the food is consumed.
But testing for IgG allergies is infrequently done. Hugh Sampson, chief of pediatric allergy immunology at Mount Sinai Medical Center in New York states that the validity of IgG tests has not been proven. He says that everyone makes IgG antibodies when they eat food and so IgG is not going to have any specific effect in allergy. Other doctors claim that extraordinarily elevated levels of IgG can indicate an allergic response.
But what exactly is an allergy?
According to Dr Leo Galland, the director of the Foundation for Integrated Medicine in New York, which deals with environmental illness, “allergy” is not a scientific term but means ‘altered reactivity.’
Generally speaking, allergists tend to agree that when IgE is involved, one’s sensitivity to food is called an allergy. If some other immune mechanism is involved, which might be IgG or something else, some call it an allergy and some would not. The term ‘intolerance’ means that an enzyme is involved and the immune system is not.
So, for example, lactose intolerance – the inability to break down lactose sugar, causing bloating, cramping and diarrhoea – is an intolerance because the enzyme lactase, which breaks down that sugar, is missing. Galland suggests that if we use the term “allergy” in the broadest sense, there are a number of non-allergic diseases in which allergy to food may nevertheless play a role.
For example, controlled studies have shown that something like 40 to 45 percent of patients with rheumatoid arthritis are affected by specific individual foods. This is not an IgE type of reaction, so it might not be called a food allergy, but i is an intolerance of the food and it acts to cause inflammation, so it could be called an allergy. Galland believes that IgG may play a role in allergy, but he is one of many who believes that the test for IgG-mediated allergies is not valid.
Signs of allergies and intolerances
(The following section is summarised from Rapp, 1996:67-114)
Take a long, serious look at your child. Obvious changes sometimes occur in the physical appearance of children and adults who have typical allergies, or food or chemical sensitivities. Perhaps you recognise a characteristic “spacey” or at times almost “demonic” look in a child’s eyes when he or she suddenly becomes “impossible.”
These looks are sometimes accompanied by characteristic sounds, such as throat-clearing and clucking. The latter is typical, in particular, of a dairy or milk sensitivity. Some mothers complain that their children make strange noises at home or at school. A few whine and say the same phrase over and over.
In addition, children (and adults) can develop a hoarse voice or red ears or cheeks due to food or chemical exposure. Other symptoms include slurred or rapid speech.
The effects of chemical odours, such as perfume or certain cleaning materials, tend to occur within seconds or a very few minutes. Food reactions take fifteen to sixty minutes to become apparent. A reaction to dust or moulds usually occurs within an hour. Parents can often pinpoint the cause merely by thinking back over what happened.
For example, if red earlobes, a severe headache, or wiggly legs occur half an hour after lunch, it would be logical to assume the symptoms are possibly related to something that was eaten. If the problem is eczema, watch the arm and leg creases: these areas commonly become red and itchy during meals or immediately after contact with dust, moulds, or certain foods. The actual rash, however, will not develop until the next day.
Also suspect food allergies if your child has any form of intestinal complaints after eating. If dark eye circles and muscle aches routinely occur after gym, art, chemistry or biology class, or after a shower, suspect a reaction to a chemical exposure.
If these changes occur after play on freshly cut grass, suspect grass pollen. If a child’s nose becomes itchy and drippy, or if asthma and coughing get worse after tumbling on gym mats or playing on an old carpet, the cause could be dust, moulds, or both. If a youngster becomes wild and uncontrollable and has a peculiar spaced-out look after using a bathroom that smells of scented body preparations, deodorants or disinfectants, suspect chemicals.
Parents should learn to watch for dark eye circles (which can be black, blue or pink), red earlobes (sometimes becoming so hot that ice is needed to provide relief), nose-rubbing, skin-scratching, wiggly legs, yawning and various throaty sounds. Small, horizontal wrinkles under the eyes are typical of allergic children, especially those who have eczema.
Abnormally red rosy cheeks can occur in anyone, but they are particularly characteristic of allergic children two to four years old and of adult females who have multiple food or chemical allergies. Facial twitches or tics, along with restless legs, are very common in some children. Other muscles also can go into and out of spasm causing discomfort or pain. Foods, moulds and chemical odours, such as the smell of tar or perfume, are common but unsuspected causes.
Hives, which look like mosquito bites, are often caused by foods, dust, moulds or chemicals. More generalised rashes can be caused by a chronic yeast infection (often following anti-biotic treatment), by contact with formaldehyde in polyester clothing or bedding or by some chemical found in a laundry detergent or fabric softener.
Stomach pains, ‘winds’, nausea, diarrhoea, constipation or halitosis are commonly caused by an allergy to food or drink. Recurrent headaches are another very common allergic symptom in all age groups. The pain may occur above or behind the eyes or on the sides, back or top of head.
Sudden unprovoked aggression in both children and adults can be related to allergy. It is often associated with red earlobes, wiggly legs, dark eye circles and a special ‘look’. Behaviour may include hitting, biting, kicking, spitting and punching.
Yeast overgrowths may be caused by repeated courses of antibiotics (in children, frequently used to medicate ear infections or tonsillitis. A white-coated tongue is a common indication of excess yeast. This condition is different from the mottled ‘geographic’ tongue, which suggests a possible food allergy in children or adults.
If the tongue is extremely white but also has bald, pink, spotty patches, that person may have a combination of a yeast overgrowth and food allergies. In young children it may be worth looking for a red ring around the anus, which is typical of a yeast overgrowth.
Lastly, a bloated or abnormally large abdomen may also be a sign of problems. This sometimes occurs with food allergies, but other digestive problems, such as chronic yeast infections and parasites are also common causes. The presence of parasites may also cause ‘difficult’ behaviour and underachievement. It is well worth checking that all children are given parasite (‘deworming’) treatments on a regular basis.
Handwriting and drawing changes
Handwriting and drawing changes can provide visible clues about what is happening within a child. Sudden changes are often related to specific chemical exposures, to contact with dust, moulds, pollen and to allergenic foods or beverages.
How breakfast can affect a child’s drawing
The figure below shows a series of drawings made by a six-year-old boy before he ate a breakfast of toast, apple juice, egg and butter. He continued to draw every few minutes over the next half hour. You can see the gradual deterioration of his drawings.
Imagine how difficult it would be for him to learn each school day if this were his routine breakfast. It’s important to investigate whether food packed for his school snack could produce similar changes.
When another child, Robert, was allergy tested for oats and wheat, his handwriting and behaviour changed at the same time.
Food allergies and intolerances are more common than we may believe. In the case of milk, many people confuse milk allergy and lactose intolerance, but they are two different conditions. The enzyme lactase is needed to digest lacrose (milk sugar).
Most of the world’s populations, excluding Northern Europeans and isolated groups in Northern India and Africa, are deficient in lactase. Many people of African, Latino and Mediterranean descent develop gas, bloating and intestinal cramping after having dairy products.
For this reason, before labelling learning problems and poor behaviour, consider the role that chemicals, food and other environmental factors may be playing.
HYPOGLYCEMIA – OR LOW BLOOD SUGAR
Not all changes in handwriting are due to food allergies. For example, sometimes a child’s handwriting gradually deteriorates late in the morning or afternoon. If eating eliminates this problem within a few minutes, it might be evidence of a low blood sugar level or hypoglycemia.
What is hypoglycemia?
This refers to a deficiency of glucose (sugar) in the blood. All cases of behavioural and emotional problems should be evaluated for blood sugar abnormalities as well as food allergies and sensitivities, or endocrine imbalances.
New medical research supports the view that the effects of hypoglycemia may be behind a significant proportion of mental and emotional disturbances, including hyperactivity, anti-social behaviour, criminal personalities, drug addiction and allergies. In a large-scale study, 200 hyperactive children had low blood sugar often enough that it started or aggravated typical hyperactive behaviour. Many of these children also had allergies to common foods.
These were usually those foods that they favour and eat whenever possible. This sets off abnormal behaviours, many of which are the same ones found to be characteristic of underachieving children. In another study with 265 hyperactive children, it was found that glucose tolerance tests were abnormal in 76%. This suggests that abnormal glucose metabolism may be a factor in the cause of hyperactivity.
The following shows the deterioration in Erik’s handwriting late in the morning. Erik was then fed, and within less than ten minutes his writing returned to normal.
(The following section is summarised from Weintraub, 1997:101-104)
What causes hypoglycemia?
The two most significant factors contributing to hypoglycemia are diet and emotional stress. The average Western child’s diet is almost a prescription for hypoglycemia. Common foods like white bread, sugar and fizzy drinks contain refined carbohydrates which absorb very rapidly into the bloodstream since they require little digestion.
Most people fail to recognise that excess table sugar is not the only refined carbohydrate that may lead to hypoglycemia. Excess honey, fruit, fruit juice, dried fruit and sometimes vegetable juice will cause a rapid rise in blood glucose levels.
Stress also affects blood sugar levels. First, stress depletes the B-vitamins and vitamin C, both necessary for proper functioning of the adrenal glands. Stress requires adrenal glands to work overtime yet at the same time strips them of what they need to function. Refined foods also negatively affect the adrenal glands because they are stripped of needed vitamins.
Complex carbohydrates, found in vegetables and whole grains, help to avoid hypoglycemia by replenishing glucose at regular intervals. This keeps the body’s energy constant.
A hypoglycemic child often needs to eat every hour or two during school hours, as well as at home, to avoid low blood sugar reactions, which cause recurrent fatigue, irritability, tension, hyperactivity and aggression.
One clue in spotting hypoglycemia is the way young children ask for food. Do they request food, or demand it? The latter suggests low blood sugar. It can happen on and off all day, but it is most apt to occur between 10:30 and 11:30 and again between 15:00 and 16:00. Some children are ‘impossible’ when they awaken in the morning until they eat. Their brains may need glucose (sugar).
Other symptoms of hypoglycemia include an inability to concentrate, mood swings, anxiety, depression and being more emotional than usual. Asthma, fatigue, headache, nervousness, insomnia, irritability, restlessness, poor memory and indecisiveness are also frequently reported.
THE ROLE OF ESSENTIAL FATTY ACIDS
Apart from hypoglycemia, intolerances and allergies, there is another nutritional factor that frequently interferes with a child’s ability to cope with the demands of school. This concerns the possible deficiency in a child of what is termed ‘essential fatty acids (EFAs).
If a child does not get enough EFAs, the myelin sheath protecting the axons of billions of neurons may not be adequate.
Research shows that children showing the signs that are associated with “ADD” have EFA deficiencies (Stevens, L. et al, 1995:000-000) and similar deficiencies are possibly responsible for the symptoms of dyslexia (Stordy & Nicholl, 2000:105).
There are two essential fatty acids – commonly referred to as Omega-3 (Alpha-linolenic Acid) and Omega-6 (Linoleic Acid) – that are indeed essential for life because they are vitally involved in the proper functioning of every cell, tissue and organ in the human body.
The Omega-6 EFAs are distributed evenly in most tissues, but Omega-3 EFAs are concentrated in a few tissues including the brain. More specifically, a substance termed ‘docosahexaenoic acid’ (DHA), converted from Omega-3 EFAs, is the most abundant Omega-3 EFA in the brain.
The brain has the greater percentage of fat than any other organ in the body – 20% of the dry weight of the brain makes up EFA. We are, in fact, all “fat heads”! (Stordy, 2000:83).
Like vitamins, EFAs cannot be produced by the body. They have to come from the food we eat. Omega-6 (LA) is found in seed oils like sunflower, corn and sesame oils. Omega-3 (ALA) is found mainly in cold water fish, such as salmon, tuna, sardines, pilchards and trout, and vegetable oils, such as flaxseed oil. It is also found in walnuts and pumpkin seeds.
The human body cannot make Omega-3 from Omega-6 and vice versa. Therefore, we need to get both from food and we also have to be able to metabolise the EFAs adequately.
Remember here that food taken into the body is not ready for use. Food has to be metabolised. The term ‘metabolism’ comprises the whole series of transformations that food undergoes in order for the body to exploit it (think: digestion!)
Apart from these essential fatty acids, other substances are classified as essential, which the human body is unable to synthesise, and which must be absorbed by way of food. They include certain amino acids, inorganic elements and vitamins.
So, in spite of an adequate diet, some individuals are not able to convert EFAs into essential components (for example, DHA and EPA from Alpha-linolenic acid) and this may lead to behavioural, learning and health problems.
To complicate matters further, it seems that consumption of foods with high levels of trans fatty acids (as found in overheated cooking oils, margarine, etc) blocks the production of DHA and EPA from the original food source.
In addition, the fact that our diets have deteriorated over the past years increases the possibility of EFA deficiency. Previously, animals hunted by man that were free-ranging and fed by grazing off natural veld, had much higher levels of Omega-3 EFA than domesticated animals.
Today, much of our farmed meat supply (chicken, beef and pork) is fed on large amounts of corn and soybean meal that contain Omega-6 EFAs but little or no Omega-3 EFAs. This is the reason for the recent interest in free-range meats, and eggs from free-range chickens.
It has not yet been determined how much EFAs we should ingest every day. However, it seems that in the past, the ratio of omega-6 to omega-3 in the human diet was about 1:1.
These days, the modern diet contains far more omega-6, from oils used in the preparation of foods as well as green, leafy vegetables and the ratio of omega-6 to omega-3 has been calculated to be as high as 20:1.
For this reason, it is important to consider a supplement of omega-3, preferably in the form of fish oil, for all children showing learning problems, but particularly those showing signs of a deficiency. These signs include dry hair, dry skin (often noticed as a “goosebump” rash on the upper arms and/or upper thighs), excessive thirst, frequent urination, problems with attention and so on.
To promote the metabolism of these EFA’s, it may also be wise to avoid foods prepared in heated oils and margarine. Margarine is oil that becomes hydrogenated through a heating process and which is transformed into a trans fatty acid. This can also impede the metabolism of EFAs.
These days, though, the manufacturers are becoming wiser about the danger of hydrogenation and the health risks of trans fatty acids. You need to read the labels on the food you buy.
In South Africa (and no doubt elsewhere as well) there are margarines and other cooked produce (cookies, biscuits) that contain no trans fats. If the label does not state this, be cautious and avoid the product.
To summarise, modern eating means that many children (and adults) are eating too much of some fats – the omega-6 fats and hydrogenated and trans fats – in manufactured and fried foods. They are not eating enough of the omega-3 EFAs that the brain needs to function properly.
So not only are such individuals getting less of the good fats in their diet, they are also greatly diminishing the value of the good fats that they do consume. This can severely damage brain development and functioning.
As A. Schmidt, author of Smart Fats wrote in response to several research studies published at the end of the twentieth century: “Our increasing knowledge of the way in which fat affects the brain … may turn out to be one of the most important discoveries of the century” (Stordy, 2002:102).
The labels that many children are given do not mean that they have a life-long disorder or illness or mental problem. They are merely short-hand ways of describing a cluster of behaviours that are telling us that her neurological system is disorganised or immature or in some other way slightly dysfunctional.
By carefully looking for clues that tell us what she can do, when she can and can’t do things, what stresses her and is difficult for her to do, it is possible to identify which systems are functioning irregularly. Once this has been done, certain activities and exercises can be given to help those systems function optimally. After this, it is usual to see an improvement in school work, behaviour and self-confidence.
What are some of these neurological systems?
The following describes the functioning of some of our most important sensory systems and explains why they are crucial to our being able to learn and function.
1. The Vestibular System
The first sensory system to fully develop by six months after conception is the vestibular system, which controls the sense of movement and balance. This system is the sensory system considered to have the most important influence on the other sensory systems and on the ability to function in everyday life.
Directly or indirectly, the vestibular system influences nearly everything we do. It is the unifying system in our brain that modifies and coordinates information received from other systems. The vestibular system functions like a traffic cop, telling each sensation where and when it should go or stop.
The sense organs for the vestibular system are located within the inner ear and consist of three semicircular canals, the utricle and saccule (see figure 4). Projections from the vestibular system to other parts of the brain and sensory organs serve as communication channels.
One of these projections is the vestibulo-cerebellar projection. Through this connection, the vestibular system influences the autonomic nervous system. This explains why individuals may have problems breathing or may develop nausea or irregular heart rates when the system is overwhelmed.
The ear, showing the position of the vestibular apparatus
Other functions directly governed by the vestibular system include:
- Auditory functions via the vestibulo-cochlear nerve
- Visual functions
- Muscle tone, balance and proprioception
Smell, taste and touch are the only three modalities of human processing that are relatively unaffected by vestibular function, therefore the list of functions which may be irregular if the vestibular system is compromised is extremely diverse and expansive. Many of those irregularities will be mentioned in relation to the other systems supported by the vestibular system.
The following problems may be part of the past history or present problems in children with irregular vestibular systems and could serve as indications to you that he or she may be showing difficulties with school work and/or behaviour because of vestibular problems:
- premature birth and a fairly long period of incubation after birth
- exposure to excessive movement or invasive sounds as a foetus or infant
- neglect (little handling and moving) during infancy
- repeated ear infections or severe ear infection
- tubes (grommets) having been inserted in the ears to drain excessive fluids
- excessive use of infant seat, jumper, swing and/or playpen, thus restricting or limiting natural movement
- avoidance of movement except as absolutely necessary
- avoidance of head movement
- head banging
- motion sickness (car, boat, airplane)
- avoidance of merry-go-rounds
- excessive watching of things spin, or excessive spinning of self
- dizziness or nausea caused by watching things move
- inability to read or write in cursive
- hearing problems
- inability to sustain listening without moving or rocking
- problem with balance (static or moving) and/or vertigo
- difficulty walking on uneven ground
- history of traumatic brain injury, shaken child syndrome, ear cuffing, etc.
- need to move fast
2. Proprioception
Proprioception refers to the brain’s unconscious sense of body-in-space. Essentially we use five systems to determine where our bodies are in relation to their environment and where various parts of our bodies are in relation to one another:
- The information received by the brain from the inner ear regarding the position of our heads, the pull of gravity, the speed and acceleration of our movement.
- The interpretation of messages received by our eyes about both the space and our position and posture
- The assorted information received by our brain from tactile, kinesthetic and proprioceptive sites located throughout the body
- The messages received by the brain through smell, a sense on which we unconsciously rely to discern direction and distance from objects and events in our environment
- The interpretation of the messages we have received through hearing, which also helps us orient to specific objects and events in our environment.
If any of these functions are irregular, we either have a diminished sense of body-in-space or place greater reliance on another system (such as vision) to compensate which in turn causes us to use our eyes inefficiently for broader or higher level visual functions.
Proprioception differs from kinesthesia in that kinesthesia is the sense of relative muscle, joint and tendon position in specific situations. Kinesthetic memory involves learning these positions and the sequence of shifts in these positions for rote, repeated movements (such as gymnastics).
Proprioception is a dynamic sense, allowing continuous accommodations and adaptations to a shifting environment (such as in dance, or moving through a crowded room).
The following issues are some of those that may occur in a person experiencing proprioceptive weaknesses and irregularities:
- A need as a baby to be held, swaddled, snuggled
- Unusual need to have physical contact with another person; clinging
- Hysteria over hair washing or pulling tee shirts over the head
- Avoidance of eyes closed activities (such as Pin the Tail on the Donkey)
- Discomfort or disorientation in the shower
- Difficulty falling asleep and staying asleep
- Sleep walking
- Falling out of bed
- Feeling as if he/she is floating in space or tipping in space while in bed
- Extreme restlessness while sleeping
- Difficulty getting up and moving after sleep
- Need for heavy covers or clothing or a back pack to feel grounded
- Need to have the light on to sleep
- Avoidance of team sports
- Aversion to crowds
- Preference for and greater skill in swimming than in other sports
- Clumsiness, tripping over own feet, bumping into things
- Swinging between pieces of furniture
- Unusual degree of stretching and yawning
- Difficulty grasping mathematical concepts
- Inability to accept physical (and social) boundaries
3. Differentiation
Differentiation of response is the inhibition of primitive reflexes and more. It is the ability to direct one part of the body to move according to plan while all other parts remain still. It is the precursor to the development of lateralisation, and helps the brain establish specialised centres.
Children with immature differentiation may demonstrate overflow movements. This means that when one part of the body (e.g. a hand) moves, other parts move as well.
Immature differentiation also accompanies an apparent weakness in kinesthetic memory (the memory that the muscles have for movement), since overflow movement defocuses the brain’s processing of the intended movement.
Such children may not realise that they are kicking, knocking over, or in other ways disturbing people and objects in their environment. They disclaim responsibility for these actions and may be viewed as liars. It is usually evident that there was no malice in their actions.
However, after prolonged periods of receiving blame and punishment for these problems, an individual may begin to exhibit the behaviours that his/her peers seem to expect. It becomes easy to see how irregularities in differentiation can cause poor academic learning and also serious social problems.
The following are some of the issues that may occur in a person experiencing difficulties with differentiation:
- overflow movement to the head or jaw when eyes are tracking (e.g. reading)
- overflow movement to the opposite hand when one hand is engaged
- overflow movement to the legs when one hand is engaged
- tics that involve more than just the eyes, including Tourette’s Syndrome
- inability to sort out each finger for fine-motor coordination
- overflow movement to the tongue and/or mouth when concentrating
- knocking things over at the table
- startle reactions
- difficulty ‘turning off’ obsessive compulsive thoughts and actions
4. Lateralisation
Lateralisation refers to development of lateral dominance (right or left eye, ear, hand, leg) and development of specialised centres and functions in the left and right brain hemispheres.
The right side of the body sends messages to and is controlled by the left side of the brain, and the left side of the body by the right side of the brain.
Differentiation is a precursor to the development of lateralisation. The ability to cross one’s midline is also a necessary component for mature lateralisation.
Most people develop unilateral cerebral dominance – that is their dominant eye, ear, hand and leg are on the same side of the body. Approximately 20% of the population has mixed dominance or other irregularities in the development of dominance.
Those irregularities of dominance that are the most difficult to resolve without therapeutic help involve alternating reliance on one side or the other without conscious decision to do so. Such children will use first one hand when writing and then the other, for example.
This causes instability in perception and performance. Immaturities and irregularities in lateralisation can cause perceptual, organisational and performance problems in all areas of life.
The following are issues that may occur in a person experiencing difficulties with lateralisation:
- Delayed decision of lateral dominance
- Tendency to scatter and misplace objects in personal space
- Extreme rotation of writing or reading surface
- Unusual tip of the head while writing (30-40 degree tip usually indicates crossed dominance between eye and hand)
- Difficulty perceiving left and right sides of objects and letters
- Uncertainty about personal left and right body sides
- Tendency to move toward the non-dominant hand in motor activities
- Need to rotate surfaces to complete motor activities that cross the midline
- Difficulty making decisions
- Difficulty accepting a change in a rule or decision once it is made.
- Excellent batting in cricket or baseball but difficulty with many other sports.
5. The Visual Sense
Vision exerts strong and sometimes supreme command over our other senses, as optical illusions demonstrate, and it exercises similar effects on our posture and locomotion (movement).
With one’s eyes closed, standing soon becomes difficult, and, unless by luck, we would find it impossible to thread a needle.
Most people think that if a child’s vision is 20/20 then everything is fine. This is usually tested by a nurse with a Snellen chart (containing letters of different sizes that have to be identified at a certain distance). What needs to be understood is that vision is more than just clarity.
It also includes binocular coordination, speed accommodation, vertical movement and other visual functions necessary to visualise, understand and apply the information that comes through the eyes.
Children may not have these abilities in spite of having ‘good eyesight’ and this results in learning problems. Difficulties arise because vision impaired children rarely report symptoms. They think everyone sees the same as they do.
Our two eyes are supposed to work together – to perform as one entity. This is a skill that must be acquired through use during the preschool years. Not all children adequately develop visual skill and this can interfere with comprehension, the ability to perceive spatial relations, and the ability to concentrate. For example, there may be visual discomfort or distortions of the text while reading.
This reduces close attention to details and sustained mental effort. As a result, a child will be easily distracted. The signs of inattention are not only observable, but also many times interpreted (or misinterpreted) simply as Attention Deficit Disorder. The following are two vital functions of vision which may impair learning.
Binocular functions
Binocular functions refer to the ability of the eyes to coordinate their activity so that we can merge the visual fields of both eyes into one distinct image.
The most commonly observed aspects of binocular functions include convergence (the ability of the two eyes to team and focus on the same object), and accommodations (the ability of the eyes to shift their focus from near point to far point or vice versa). Each eye can have normal acuity (20/20 vision) but unless the eyes team, visual functions are impaired.
The following are issues that may occur in a person experiencing difficulties with binocular functions:
- Difficulty going down stairs
- Poor eye-hand coordination
- Pain, watering, discomfort when required to perform visual work
- Inability to read without losing place
- Rubbing eyes after use
- Frequent headaches after visual work
- Frequent stomach aches after visual work
- Difficulty copying from the board
- Generalised light sensitivity (photophobia)
- Poor three-dimensional perception
- Difficulty in sustaining eye contact
Ocular motility
The oculomotor system is the system that controls eye movement. The function of this system is to bring the fovea of the retina (the region where vision is sharpest) into alignment with a visual target of interest and to maintain this alignment.
In such a seemingly simple movement such as the control of the eye, there are distinctive movement: rapid search or saccadic eye movements, movements governed by the semicircular canals (the vestibulo-ocular reflex) and smooth pursuit tracking (ocular motility).
Saccadic eye movements represent a scanning of the field of view – a search for targets. We are constantly shifting our eyes from position to position from one object to another, often without a head movement.
There are alternate periods of fixation and shift, fixation and shift, etc. These eye movements are enormously rapid and is the fastest movement the body performs.
Vestibulo-ocular reflex is a reponse that makes it possible to maintain visual fixation on a target no matter how the head is moved. For example, if you are looking at this page and you turn your head, your eyes will turn in the opposite direction so that you do not lose focus.
This is made possible by input from the vestibular organ that generates and equal but oppositely directed eyemovement that corresponds to the speed of the head movement.
Smooth pursuit tracking is known as ocular motility (frequently called visual tracking). This voluntary eye movement is used for tracking an object (a fly or an airplane, for example) as it moves in the visual field. It requires the eyes to move smoothly through all planes of the visual field without blurring or loss of image.
This ability is dependent on the muscles and cranial nerves that service the eyes, as well as on the vestibular system which provides information and regulation. It is very important to ease of reading and writing.
The following are issues that may occur in a person experiencing difficulties with ocular motility:
- Inability to hold head still while tracking
- Dizziness and/or nausea when required to track
- Pain, watering, discomfort when required to track
- Reporting that objects blur or are lost in the field of vision when required to track
- Rubbing eyes after use
- Frequent headaches after visual work
- Frequent stomach aches after visual work
- Eyes move with a jerky or bouncy pursuit when tracking
- Eyes stop tracking an object that continues to move
- Overflow movements to other parts of the face or body when attempting to track
- Inability to read aloud, although can grasp meaning from silent reading
6. Interhemispheric integration
Interhemispheric integration refers to the communication between the left and right cerebral hemispheres.
To function efficiently, we need to integrate information from various specialised centres and to coordinate a planned response. Efficient binocular functions require interhemispheric integration of the two hemispheres.
Children who are cross dominant (e.g. right handed but left eyed) require very efficient interhemispheric integration to compensate for additional demands to integrate information from two competing or differing perceptual and operational modes.
Sucking and crawling are two activities of infancy that assist in developing interhemispheric integration. Furthermore, interhemispheric integration is interdependent on differentiation and lateralisation.
The following are issues that may occur in a person experiencing difficulties with interhemispheric integration:
- Delayed language acquisition
- Difficulty understanding directions
- Significant difficulty with reading
- Problems of word finding
- Perseverative behaviours
- Lack of crawling in infancy
- Weak or limited sucking in infancy
- Delayed accomplishment of tying shoe laces
- Immature dressing skills (e.g. pulls on pants, two legs together, needs help getting arms into sleeves)
- Great difficulty learning to swim; to pedal a bicycle
- Difficulty with organisational skills
- Diminished concept of consequences
- Impulsivity
The underlying cause of your child’s problems may be due to problems in one or more of these systems. This we refer to as neurodevelopmental delays or concerns.
The development of the neurological pathways in the brain that make the integration of sensory information possible, increases as children grow. If children do not have the opportunity to do activities that correspond with each stage of development, then they will not reach their neurological potential.
Examples of these necessary activities are using both eyes at the same time, recognising and distinguishing symbols, understanding words, touching things, crawling, walking upright, running, swinging arms, skipping, other activities that require coordination and balance, communicating with speech and picking up and manipulating small objects.
Sensory input and motor activities develop the proper sequence of neurological functioning and are essential for the development of learning. Learning is a sensory process that must be reinforced by motor functioning. If input is nonexistent, limited, or confused, the sensory pathways will not develop correctly.
The person has to begin again with activities and sensory inputs that have proven beneficial in promoting effective neurological organisation from early infancy on.
Children who have not reached the peak of their neurological development find it difficult to do the required classroom work. Children with immature nervous systems often seem to be misbehaving, or not making an effort. They may not have the capacity to meet these challenges yet.
It is also possible that other influences may be contributing to the problems. This is why we follow a truly holistic approach to helping children overcome barriers to learning.
