by Maude Leroux | Dec 18, 2018 | Parenting
I sit here this morning and my heart is full. I want to write something eloquently and yet it feels difficult to express what I want to say in words. This time of the year is always a time of reflection and what I always want to write most about is the child’s right to simply “be”. This is at the core of everything that I do and that I stand for.
In today’s society we are moving at an ever-increasing faster pace and the value placed upon creating “product” and being “productive” grows in importance. Of course, it is important, but somehow the thought was created that by focusing on “product”, we will gain productivity. The value of “process” is undermined by what we can see and the mind that creates the thought is not valued as much. We forget that in order to produce, we need creativity, thought process and logical thinking skill. We also need intrinsic drive to please ourselves, which in turn would create and grow the self-discipline we need in order to produce according to the time lines set as well as maintain focus on quality. Let me give you a story that warmed my heart last week.
I returned from New York to the office late one evening and Noel, one of our Occupational Therapy team, was still at the office. With a great deal of emotion and some tearful joy she related an occurrence to me. We serve a family with an older autistic boy for a number of years now. The dedication of this family to their son, like so many others, continues to amaze me strongly. Our OT and Speech Language Pathologist, together with his mother, took him to J. Crew to purchase clothing for himself. Over the years he has developed some deeper sense of self with capability of understanding emotion, and this past year he developed an important milestone of riding a bicycle independently.
The staff at J. Crew was incredibly understanding and a mature gentleman was assigned to support this young man. He immediately grasped the situation and addressed him personally each time. It also is the first time that he was going to wear jeans in 10 years and they set off to find what he would like. Choices were provided, respect and warmth were relayed and he had his first shopping experience in his life. He chose, he fitted, he struck poses and displayed his sense of humor by choosing the funkiest socks available in the store. The gentleman even bought him a gift at the end of his visit, a gesture that had everyone tearful. His mother was elated and her joy was a sight for everyone to enjoy. This experience clearly left an imprint on our OT’s mind and now mine as well.
As my eyes teared up at the telling of this story, I reflected on how much good came of this situation. The gentleman at the store created a moment, not simply because of an action, but because he cared and he could care because he had a mind that grasped the situation, a mind that could stand in our young man’s shoes and be empathetic and warm to our cause. His mother understood the value of experience and creating opportunity for her son to enjoy the things in life we all take for granted. Our therapists understood that function was not related to “being social”, but being “present”. It is our presence of mind that creates the product we need in order to be functional.
There is so much talk about “mindfulness” and “mindful” meditation, yet in many instances it has just become another “buzz word” of the day. I remember when this trend started, I was wondering why this was suddenly so important. Are we not supposed to be mindful already in terms of each other and the place we hold in society? Where are we going if one of the most basic human concepts shared in empathy and relationship is now a “trend”? Are we so fixed on outcomes that the process of “being” is taken out of the equation? What happened in this store was an act of human kindness, an act of understanding that today’s experience counted and that this young man could feel his power in effecting choices of his own. It would help if he could do the math, it would also help if he could write his own check, but what mattered on this day was that an experience was created that would support his sense of self, support his identity and create everlasting meaning for all that were in that store on this day.
During this Christmas Season let us celebrate our ability to experience each other, to truly experience the gift of giving and feel the thrill of being able to simply just “be”!
by Maude Leroux | Nov 23, 2018 | Programs
This time I want to write you about the project I have been working on that has kept me very busy over the past months. Over the past 8 years, my training travels has taken me far and wide as the amount of trainings increased every year. I am honored by so many invitations of parents and professionals wanting to hear about my model of assessment and intervention. It is truly humbling. At this time though; it is beginning to become an entity that simply is too busy!
For this reason, I am opening my own online academy starting in January 2019. I have 3 major goals in mind. The first is to share my passion that change is possible in developmental delay if you know what to look for and where to begin. It is not about doing “more”, it is about the timing and sequence of what you put in place. We follow typical development and target intervention in different phases so the parent can follow and be released from the pressure of what I call the “catch-up” theory. In fact, intervention goes faster this way. If typical development was good enough for the typically developing child, it has to be good enough for the atypically developing child!
My second passion is to inform and equip families to the best of my knowledge. My wish is for parents to find joy in their children, to focus on their strengths while therapy intervenes on their child’s challenges. I want parents to feel they understand their child and their own position as an anchor for their children. Magic starts happening once the parent understands the value of “connection before correction”. Each behavior has a story, a reason and encourages the challenge of “chasing” the “why”. Nothing provides me more joy than when parent and child come together in harmony, when the parent knows how to challenge their child towards growth and feels the power to do so.
Finally, in order to create the above missions, we have to share our clinical skill with professionals, who like to exercise judgment and clinical thinking. What we learn at college (university) provide the foundation of working within our scope of practice, but it is the actual practice afterwards that informs clinical thinking. I have taken what I have learnt from children, families and other experts over 3 decades of practice to share a model of intervention that will promote specificity, individualization, clinical thinking and improve outcomes with clients. Of course, I do not believe that one person has the total answer for anything, and I do not pretend to think this is the “only” way of intervention. My hope is that this venture will spur other clinical experts to share what they know and create a base where knowledge can keep transforming our practice.
Courses will stretch over a number of weeks (6 to 12), meeting one time per week for 90 minutes. This allows for integration and reflection before adding more information each week. Webinars will occur in 90-minute sessions and will cover additional topics of interest. We also will have “track” courses, that will cover 4 levels of clinical practice. The first would be the bronze level, discussing theory and open to anyone to join. The silver level will target assessment for this specific population and the gold will target intervention. The final platinum level would consist of an individual practitioner presenting two cases, starting with assessment through intervention describing clinical thinking through their process. The last three levels will be applicable to only clinicians. These courses will follow a clinical model, but no one specific method of intervention will be over emphasized. The emphasis will be on broadening the mind to choose from a variety of tools to explore for each individual child.
The first 4 tracks we are going to kick off with in January would be Autism, The Reading Brain, Dyspraxia, and ADHD/ADD/Executive Functioning. We are also starting two single courses with regards to “Golden nuggets for Parenting” and another one explaining the concept of timing as a crucial building block in the brain. I am so excited about this venture and relieved that we are finally there. My hope is that it would be beneficial, insightful and promote the kind of thinking that will inspire parents and professionals to want to learn more. Children deserve the chance to be all that they can be. They deserve to be children who can play to their heart’s delight with joy and exuberance. They should be able to walk into every classroom with confidence, curiosity and a mind that looks forward to what the teacher has in store for them. I welcome any thoughts for future courses. We are working fast and furiously on the website, so please keep checking back in to know when the website is up and ready to go! Any day now!
by Maude Leroux | Oct 16, 2018 | Reading
I have been so very busy with different trainings these past months that I know my blogs have been slow in coming! But I hope to be back on track now as we speak. We already discussed the impact of the different sensory systems on reading as well as the influence of praxis, timing and bilateral integration for interhemispheric organization. All of these would majorly impact on decoding skill, though also on our comprehension of what we read. Learning to decode occurs for a certain period in early school years and has to become an automatic skill. Comprehension skill continues to develop throughout our adult lives.
The integration model of Kintsch and Rawson (2005) state that when we read, we create a personal representation of its meaning, a mental model of sorts. This mental model is derived from information from text and our general knowledge of the words and topic. Once again this takes us back to development. In order to create this mental model, we have to be able to visualize, which calls on abstract formation, the ability to see what is not concretely in front of us. This skill develops through play as we imagine and play out stories and everyday scenarios. So many children today are over exposed to visual media taking away the responsibility of the mind to need to visualize for itself. Many children can use the visual media to store information in long term memory and then retrieve their story line, sequence and all through long term memory. Teachers and parents may think this is a wonderful accomplishment and it certainly is good for sustaining long term memory. But it fails in the integration work that occurs when we create stories ourselves, from our own mind with our sequence, timing, characters and visualization of different plots.
It is the development of working memory that enables the mind to bring the story to life so that as we decode the letters, the words are shaped into meaning and at the same time we can reflect and recall past information of concepts already known to us, all done simultaneously as we also sequence and prioritize the information at the same time. Our ability to use working memory is tested by neuropsychologists (educational psychologists) through assessments that incorporate the visual and verbal stream of information. It is the ability to integrate what we see and what we hear at the same time in the cortex that provides the adequacy of our working memory capacity. If there is a delay in either stream of information, a “mismatch” of information occurs in the cortex. It is almost akin to watching a badly dubbed movie where we see the mouth move in a certain way, but the words we hear do not match. This causes the student to sometimes need to forfeit one stream of information for the other, which shortens the availability of working memory and it becomes too much hard work to read.
Of course, comprehension also depends on the ability to use and understand language and vocabulary is one of the largest predictors of later reading proficiency. My colleagues in Speech Language Pathology can speak far more eloquently than I on the topic of language, as this certainly is an important consideration for reading comprehension. On the linguistic level individual words and the meaning of the words are considered. There is also the construct of “Microstructure”, wherein we recognize and process larger chunks of text. Finally, we also consider “Macrostructure”, wherein we recognize and process themes, topics and genre information. Different aspects of language in reading include phonology (sounds of words) and semantics (meaning of words). Grammar would be the structure of words and sentences, which could lead to struggles understanding complex sentences and working out “who” did “what” to “whom”, as well as experiencing difficulties structuring sentences. Pragmatics, which contains the social use of language, is included. Finally, there is also the aspect of figurative language, which occurs when we take language at face value and attribute multiple meanings, not only a literal meaning. Students who struggle in this area find jokes, sarcasm and wordplay confusing.
Reading comprehension is a developmental skill and requires processing speed and working memory along with imaginative thinking and creativity derived from the ability to visualize a mental representation of what we read, while we also have to understand the language we are encountering. It is complex, but if we target the different components through a multidisciplinary approach, there is no reason why children with adequate intelligence could not learn to read and do it well. I hope you enjoyed this series with me. Next time it will be on to a different topic for us to peruse and ponder.
by Maude Leroux | Sep 10, 2018 | Reading
In the previous blogs we covered the influence of the senses (auditory and visual), as well as timing on the development of reading. There is one more component to consider in order for us to decode the sound / symbol adequately and efficiently. Timing is one component of praxis (motor planning), though yet another component would be bilateral integration. Bilateral integration would be best described as the ability of the body to use the left and right side of the body in different functions at the same time. A good example would be the ability to hold the paper in one hand, turning it, as the other hand cuts the same paper. But there is more to consider.
At the most primitive level, the baby requires the assistance of the Asymmetrical Tonic Neck Reflex (ATNR) in order to move the body in a reflexive way. This reflex is developed in utero and assists in the birth process as the baby pushes head first to gain access to a world of light, sound, and movement. This reflex causes the baby to extend the upper and lower limb to the side the head was facing, while the opposite side of the body flexes. Turn the baby’s head and the opposite happens. This is the beginning of understanding laterality in the body. The development of the Symmetrical Tonic Neck Reflex (STNR) is also important as it assists the baby to move reflexively with upper and lower body. Essentially it is like a cat drinking milk. When the head goes down, the bottom goes up and when the bottom goes down, the head comes up. This is more evident during the baby’s first attempts to crawl and as the baby steadily gains control over crawling, this reflex would then become integrated.
When the baby starts rolling over from supine to prone position or from prone to supine position, they would require the upper body to be able to turn with clear segmentation through the trunk, separating the upper body from the lower body in a “turn” position. This would be the beginnings of integrating both the ATNR and STNR reflexes and also coincides with the baby’s ability to reach with his arms across midline of the body to grab hold of something.
The crawling action refines the integration of the ATNR and STNR and, over time, it steadily builds the ability to use effective bilateral integration. At first we see the same side upper and lower body complete similar actions, after which the body would then develop where upper and lower body in all 4 limbs could be acting in opposition of each other with fluidity and efficiency.
As bilateral integration ability in praxis grows in becoming more adept, the developing child starts developing an internal sense of left and right and we gain the earliest beginnings of establishing different dominance areas. Research does not support the specificity of a specific hand or foot dominance, but this innate sense of laterality becomes an important marker for school readiness in general. As the body develops this feature of laterality, it also supports the development of directionality. Directionality would be the ability to use the sense of laterality in space, such as planning ahead which direction to go or following multi-step directions to get from our office to a new store. As someone provides the directions our mind is able to follow the directions with the correct orientations of left and right in an automatic way.
It is at this level where we can really start using our eyes and hand easily from left to right and not be confused with this action during reading or writing. It is also here where developing efficiency in interhemispheric organization with specialization of reading occur in the left-brain. When we see reversals in both reading and writing, it is this interhemispheric organization that is not quite efficient as yet. And this specific organization is arranged in different systems, such as vision, auditory and the body and they all integrate together at this stage in order to create an efficient reader.
Haabib (2000) noted that there is a great overlap in cases of dyspraxia with dyslexia. The development described in this writing would be the essential overlap between these systems and it makes much sense when one considers the different components of development together with the different components of reading. In order to truly remediate decoding, it is never going to be sufficient to target one system at a time, or think that the student simply “needs more practice at a slower pace”. This type of intervention will only reinforce the difficulties that the student is already facing.
In our final blog on reading (for now), we will discuss the reading process and the impact of working memory (not long-term memory) for the act of reading.
by Maude Leroux | Jun 19, 2018 | Executive Functioning Skills
We discussed the impact of the visual and auditory system in the process of reading in the last 2 blogs. Not only do these processes have to be in good order on their own, but also, according to Keith Rayner’s research, they have to at least operate within 5 to 20 milliseconds from each other. This intricate timing involves several stages of development.
After a baby is born, the baby has to find him / herself in this world of space and time. Hopefully the sleep / wake cycle is an easier one for parents, but this, and developing a feeding cycle, starts setting up the first sensorial experience of time lapsing between events. At the same time, the cooing between mommy and baby starts a back and forth cycle that occurs within a rhythm of back and forth and sets up that lovely co-reciprocity. Quite soon, the developing baby starts experiencing another rhythm of day and night. In the second year of life some understanding starts to dawn that there is time and space between morning, noon, and night.
If the pressure of reading is too early for the child, it may contribute to distortions or building inadequate pathways of compensations that grow into habits we do not want.
At about 2 years (of course more or less for some), the child starts to understand that there is a yesterday, today, and tomorrow, including these time concepts into play with rapidly developing language and vocabulary. All of this timing though, does not rely on our cognitive ability, but rather on the wiring of our sensory systems. This is important, as without this “time travel”, it is very difficult to integrate older learning into new. We are essentially living only in this moment and in the “here and now”. During ages 2 to 4, we are refining the incorporation of timing within our body coordination. Now that our reflexes are integrated, our voluntary movement flows with a certain coordination between different body parts and we are learning to grade our movement while incorporating timing.
The child is now ready to want to “read” the book by him / herself, as the world is also transitioning between being a picture thinker, to using words to visualize your own picture. We are able to coordinate our “looking” and “listening” in order to pay attention with both systems simultaneously, while also being able to use the timing between these sensory systems to develop an adequate working memory span for the comprehension of reading.
By the way, the process still undergoes refinement until the ages 5 to 7. If the pressure of reading is too early for the child, it may contribute to distortions or building inadequate pathways of compensations that grow into habits we do not want. Exposure to words, stories, and narration is important from very early on, but the reading process itself is a sensory experience and the automaticity of decoding relies on this intricate development. It is important to understand that we cannot “teach” timing, we can only understand it within our senses in our cerebellum as a developing feature. Yes, the child with body timing issues can learn the cognitive concept of time and use a watch or clock to guide this structure externally, but this cannot be applied to the important development of an inner timing between the senses in order to truly read with fluidity, rhythm, and automaticity.
Recent Comments