Maarch 18, 2004

Lindamood Bell Conference

Author: Siegfried Othmer

This year the 12th annual Lindamood-Bell Conference overlapped with our Woodland Hills training course, but nevertheless I was able to take in two days of the conference in Anaheim at the invitation of Pat Lindamood. Some years ago we visited the Lindamood-Bell operation in San Luis Obispo, and we found considerable openness to our view of the world, even though our respective methods of remediation are worlds apart. Since that time there have been a number of cross-referrals. The Lindamood-Bell program focuses on reading disorders specifically. This is another field dominated by strongly held opinions that often go well beyond what solid research can support.

Pat Lindamood and Nanci Bell stepped onto this terrain many years ago with a targeted, intensive approach to training specific aspects of the reading process. Initially, they were driven by empirical findings of success. More recently, research has begun to backfill with supporting models. By now the Lindamood-Bell program is well-established nationally, and their conference attracts nationally known researchers.

James Milliken, a retired judge from the San Diego Juvenile Court, talked about a successful collaboration between Lindamood-Bell and the San Diego Juvenile Courts. This evolved out of a recognition by Judge Milliken of the large role played by functional illiteracy in the perpetuation of both juvenile and adult crime, with some 70% of adult inmates exhibiting severe literacy deficits. The huge meeting room was packed for his presentation.

Milliken spoke of average gains of 2 years in reading ability with 90 contact hours in this most challenging population (and he cited one particular example of a youngster who went from second-grade reading skills to 16.5 year equivalent in a 12-week program). More significantly, however, he also remarked on systematic improvement in emotional regulation. With such intensive engagement with the teaching team, improved emotional regulation could be ascribed to the context of the training. But it is also possible that the brain organization brought about with this training has direct implications for emotional regulation. In any event, juvenile recidivism is reduced to about twenty percent, from more than sixty percent, among the trainees. This all sounds very similar to what we expect for neurofeedback as well. One wonders what could be accomplished with the addition of neurofeedback in terms of quicker and even more profound change.

Judge Milliken went on to criticize fervently the foster care system that is supposed to manage children at risk. The risk is largely due to drug-impacted parents (85%). But the remedy may be worse than the disease. Children move from one temporary foster placement to another, and effectively learn that it is pointless to establish deep attachments. By the time the birth parents get drug treatment in a non-responsive system, they may well have lost the rights to have their child returned to them. The child may be on a path to adoption somewhere, or more likely will be ruled unadoptable. That lasts only until age 18, when the state loses custody. Soon after being dumped out of the foster care system at maturity, these dead-end kids end up homeless with great regularity. It is a monstrous system, in the sober appraisal of this recently retired judge.

Remarkably, this paragon of the American Way also referred wistfully to Cuba, where all the children go to school in starched uniforms and truly no child is left behind. One fears that no matter how high the tide that lifts all boats, our children at risk will fare no better than they do now because the problems are built into the system.

Jane Healy talked about language ability being a casualty of the modern video culture. She recommends no TV exposure at all before age 2, and no more than an hour per day after. Also no computers before age 7. She reports an Oregon-based research effort that documented high correlation of TV exposure with subsequent development of ADHD symptoms. One might argue that our society is geared to the promotion of addictive propensities, and that we may be seduced at an early age by the kind of environment created for us by the world of TV and video. This seduction having been successfully completed, we may suffer truncated development of capacities for abstraction, for extended logical argument, and for verbal expression. Not to mention a truncation of the capacity for attachment (my editorial addendum).

Laurie Cutting talked about other contributors to reading deficits in dyslexics beyond the basic decoding problem, such as poor listening comprehension. When both of these elements are separately assessed, there are still poor readers who rate well on both of these variables. Yet another variable must be involved. An executive function deficit or poor verbal working memory are suspected. With my neurofeedback bias, I am of course tempted to conjecture that the farther one gets away from problems such as specific decoding deficits and toward higher-level problems such as executive function and working memory, the more neurofeedback should be able to play a useful role. I am thinking here of the more generic approaches that we favor. More specific approaches, such as those identified through Kirt Thornton’s challenge procedures, might also be helpful for the decoding problems. But that is another matter. Right now it is much more important to potentiate the work of Lindamood-Bell, not endeavor to displace it.

[My editorial commentary on this is that the scientific bias will always remain to dissect the problem into its constituent parts, buttressed in this case by the practical reality that the Lindamood-Bell program is all about addressing specific pieces of the puzzle. Badly needed is the complementing network perspective.]

I finally got to hear Temple Grandin lecture on visual thinking. Hers is certainly an interesting perspective on the world. She emphasizes the continuum between autism and ADHD, and sees the issue of sensory hyper-excitability broadly. She is aware of Irlen Syndrome, and asks that it not be completely dismissed. She said that in one American study Irlen lenses were found not to work, but then they did put blue lenses on everyone! Such idiocy among ostensible scientists defies belief. Why bother to do the research when Helen Irlen’s prescription is not going to be attended to in any event?

Grandin has several standard questions to tease out Irlen sensitivity at the outset:
Ask about escalators. Does the person have trouble deciding when to step on or off escalators?
Does the person have difficulty driving at night (higher contrast scenes)?
Is there fluorescent light sensitivity? And
Is the person bothered by flicker on computer screens?

But there is a larger issue here than just the Irlen Syndrome, or even sensory hyper-excitability in general. It is quite simply the fact that a visual person of the autistic or Asperger’s persuasion is immediately seduced by visual interest such as screen savers that change continuously. If one of these falls into her field of view, Grandin cannot take her eyes off it without deliberate effort. We might see this as an extreme form of the Grand Seduction of the modern Western world, a feast of largely visual, transient experience that keeps us externally focussed and superficially engaged. Such a grand seduction would be expected to wreak particular hardship on those who have poor resources for integrated functioning and internal engagement in any event.

Grandin suggested that some deficits in autism may just be the result of excessive inhibition. She cites as an example of this phenomenon the finding that during a certain stage in the development of Alzheimer’s, sufferers may exhibit quite extraordinary artistic abilities. These fall away again as the disease process continues, but it is as if the artistic ability had to be disinhibited in order to surface. The impact of Alzheimer’s on left-hemisphere function apparently effected that transitory disinhibition.

Tongue in cheek she suggested that NASA was the world’s largest workshop for the socially challenged. Pressing that model, perhaps it is ok to allow autistics to develop their particular talents, and that may take a particular environment. “Is it really very important for people to learn how to socialize with teenagers?” she asks. She saw autistics as having large RAM and small CPUs. [I wondered whether it was the social introversion of engineers that might have been partly responsible for the inability to surface problems with the space shuttles Challenger and Columbia to the NASA management. But then we also struggle to understand how modern corporate boards became complete patsies to charismatic corporate chieftains—presumably no similar social introversion was involved there.]

It was enjoyable—though marginal to my interests—to hear Michael Pressley talk about the history of the major debates about teaching literacy in the United States, mainly around phonics and whole language learning. He had obviously stepped on some precious toes with his various opinions along the way, as fissures in the field survive to this day. His own observation, upon formal investigation of teaching methods over the years, was that “the poorer the teaching, the greater the arrogance.” Similarly, one might observe that a vacuum in scientific knowledge is filled with the aggrandizement of authority. Such appears to be the case for language learning. Pressley strongly indicted competitive schooling in the elementary grades. “Competitive education kills motivation for everyone.” His model: scaffolding. Every child should be motivated to be just a little bit better than he was before. But when you survey the scene, children may be all over the scaffold, high or low. Each must be concerned with his or her own progress. Come to think of it, that is the way we do neurofeedback.

He said that sometimes we may have to content ourselves with inadequate research. He cited an example from his own medical history: He had suffered esophageal cancer back in 1996, and benefited from the finding in a small study that an experimental drug treatment reduced mortality from 50% to six percent. When the government subsequently wanted to mount a large-scale controlled study of that same substance, researchers were unwilling to assign people to the placebo group---not surprising since that entailed a 50% mortality risk. Hence, it will remain true that this strong claim will continue to have only meager scientific support.

On the last day we got to hear the story of the remarkable recovery from a brain tumor of a youngster who was first diagnosed with cancer at age 4. After a number of treatments, including radiation and surgery, she was declared cured some five years later. But the radiation had damaged her white matter, and she lost a lot of mental function. Yet certain functions, such as verbal speech, remained quite intact, and she had obviously benefited a great deal from the Lindamood-Bell program, so considerable recovery capacity had been demonstrated. The girl herself spoke at the meeting, though sometimes haltingly. Her speech would move smoothly for a while, and then she would stick. Of course I thought immediately in terms of our instability model---here were obvious discontinuities in her mental function. Discontinuity was the problem, not the function.

After this presentation, therefore, I talked to the mother and asked whether she had heard of neurofeedback. Why yes she had, but the neurofeedback therapist she had talked to was unwilling to risk working with her daughter…. We hope that in time there will be more to tell of this evolving story. The girl will take up additional training at San Luis Obispo, and Pat Lindamood told me that she would support a trial of neurofeedback in this case.

The final presentation of the conference, in the research track that I was attending, was on dual coding of information in both verbal and imagery forms. Here was thought to be another specific problem area for reading competence---the ability to immediately image, and thus to transform, the matter being attended to verbally. Research has shown that recall can be aided immensely with a strategy of tying the object to be remembered with something else. We all know that this true, although it may be less straight-forward in practice than in theory.

So, why is it easier to remember two things than one, I wondered? First of all, this puts matters into a process that is entirely self-generated. It is possible to read something aloud and not really attend to what is being read. One does not own it yet. But when one images something, it becomes involved in the brain’s self-generated processes. This also speaks to the fact that memory is a distributed network process. More attachment points mean a firmer entrenchment of the memory. So here we have another motivation to adopt the network perspective on reading problems. Perhaps the time will come when we are able to talk about that at a future Lindamood-Bell conference.