Saturday, December 23, 2017

The smartest guys in the room

I am about to date myself. I distinctly remember the fall of Enron; not because I was a teenager paying attention to the news, but as an adult, more than a decade out of school. It was a huge event. When I saw a copy of The Smartest Guys in the Room: The Amazing Rise and Scandalous Fall of Enron by Bethany McLean and Peter Elkind, I picked it up nostalgically.

The authors detail the Enron story with its lead players much like the characters in a Shakespearean tragedy. The protagonists suffer from hubris that brings about their ultimate demise. They blindly followed their greed and allowed their brilliance- yes, these were seriously smart guys- to skirt the edges of legality, often falling off the edge, but obscuring it with confidence and financial maleficence.

What I found interesting is this. The outsiders who profited from the deal were traders who read the reports that were being published, realized they did not make sense, and guessed that the gobble-dee-gook was about hiding the true state of affairs. The big lesson for us today is that we need to be informed and not be cowed into accepting answers that do not actually answer the question. We let our politicians not answer questions all the time and much of the time it is because they do not want to state unpleasant truths. We would be better off if we were willing to swallow bitter pills and not shoot the messenger so long as we had the facts- not alternative facts- just the facts. As educators, it is part of our civic duty to teach this. We need to teach a quest for the truth and a facing of reality. When we make a bad decision, we need to face the music not kick it down the road. Unfortunately, this does not seem to be a part of our national character. We should work to make it so.

Tuesday, December 12, 2017

The Woman who Changed Her Brain

Barbara Arrowsmith-Young's book, The Woman who Changed her Brain: And Other Inspiring Stories of Pioneering Brain Transformation, discusses her life story and captures vignettes of students of her Arrowsmith Schools. Currently there are 32 schools, mostly parochial programs, in the US using the Arrowsmith program. Details about their program may be found at their website. Barbara details her struggles with multiple severe learning disabilities and what she did to overcome them.

Her program is based on training the brain to complete tasks that are in areas of difficulty without using compensatory strategies. Much evidence for this type of approach exists. We know, for example that the brains of novice readers process reading using far larger portions of the brain than experienced readers do. The act of developing proficiency results in neurological changes in the way the way the brain processes text. Research demonstrated that when chimps had fingers sewn together, the brain started to process input and responses for both fingers collectively as one unit. Learning and experiences do change the brain. Further, we know that neuroplastisity exists. People who have had portions of their brains removed have demonstrated an ability to learn motor skills for regions of the brain that had been removed.

I know that as a child, I had abysmal handwriting. I was a good student whose handwriting grades were always U- unsatisfactory. In elementary school we had an activity period during which teachers and parents ran clubs for 5 week sessions. I participated in the "ornamental writing" or calligraphy activity for at least two sessions. While we learned the formation of elaborate capitals for a single script, we spent lots of focused time practicing handwriting. I made rows of circles and zigzags and fat and thin sideways number eights. Then I wrote one letter over and over and over. Using a pen with a nib and dipping in ink I learned about pressure to make the correct effects. This was hard work for someone whose handwriting was often illegible. Ultimately, however, I enjoyed the practice and became good at it. Hours of practice finally paid off and I have very legible writing now. We do not dedicate the time to handwriting practice and guess what- our children do not have good handwriting. Yes, it can be tedious, boring and hard work, that occupies that most precious school commodity-time- but it does pay off. This is the premise of the Arrowsmith program: practice in the area of difficulty in order to improve brain function.

The program begins with an analysis of skills which can be found on their website, cited above. Once the assessment is complete, they compose a report detailing areas of concern such as symbolic thinking, auditory speech discrimination and symbol recognition. These areas are mapped to specific brain sites which are then tasked with completing activities at graded levels of difficulty, often within a timed opportunity. The exercises, some of which are lightly described in the book, focus attention on the primary task of the region of the brain, exercising it to make it work harder and develop more capacity.

It would be interesting to see her list of exercises so that we could try and implement them with integrity. There is a training program that lasts for 3 weeks offered during the summer in Toronto. Rhonda Hawkins wrote a dissertation, which may be found here, reviewing the program and its impact. Many of the improvements were in areas difficult to assess with standardized assessments.

The book is an inspirational read that holds out hope for individuals struggling with significant disabilities. It does, however, put out there that the path forward is intensive practice. Unfortunately many students do not have the motivations to pursue intensive and monotonous practice and schools often do not have time to facilitate such practice that does not directly relate to a content area. Practice tracing and copying a set of simple of Hebrew or Cyrillic letters for an hour a day to develop fine motor and motor planning skills does not fit into the average school day.

Tuesday, December 5, 2017

Calm Seas

Mental illness is an often negatively stygmatized, undertreated concern that impacts a huge part of our society. I have long felt that if we could remove the stigma and provide early intensive, high quality treatment, our country would have far less trouble from people suffering with mental illness. Calm Seas: Keys to the Successful Treatment of Bipolar Disorder by Roger Sparhawk, discusses one segment of this complex web of mental health. His book is almost bipolar in its nature. Some sections seem to target service providers, offering lots of research and best treatment ideas, where others seem to target patients and their advocates. It is written in a first person format, almost as a discussion with a peer. As such, parts of the book are easier to read than others. Case studies throughout the text showcase discussion points, but the manner in which they are included does not highlight their importance.

He highlights a few points. First is the importance of accurate diagnosis. Bipolar disorder responds very differently to interventions than unipolar depression, even though they share the affect of depression. He also notes that long term bipolar disorder's symptomology becomes increasingly similar to that of unipolar depression. Since there is usually a large gap between onset of symptoms and initiation of treatment, a thorough history is required to identify episodes of mania.

Second is the existence of sleep disturbances. People with untreated bipolar disorder have disruptive sleep patterns. In depressed times people sleep more than 10 hours a day and during manic times they sleep less than 5. Patients that present with sleep disturbances should be identified and interventions attempted. This could be adjusting medication times to be more at night so that they do not encourage daytime sleepiness, implementing good sleep hygiene, and/or adding sleep aid medications. When people have the correct amount of sleep they are significantly more likely to have better mental health.

Third is medication. Antidepressants help very few people with bipolar disorder. Older mood stabilizers have a far higher rate of successful results. These include lithium. People with a diagnosis of bipolar disorder should actively discuss medications with providers. Those unwilling to consider maintenance with mood stabilizers should raise a red flag.

Fourth is a concern about other tier one concerns: Organic brain syndrome, schizophrenia, substance abuse and severe anorexia. All tier one concerns need to be addressed in treatment if there is to be success. Since patients often self medicate mental health concerns with alcohol and other substances and often do not report use of illegal substances, careful consideration needs to be given to them. Comprehensive, multipronged therapy is effective whereas single issue therapy is doomed to failure.

Finally acknowledgement needs to be made that bipolar disorder is a life-long diagnosis. Monitoring and treatment need to continue for the long haul. Patients need to be aware that although they can be treated they cannot be cured. Comparing with a medical diagnosis like diabetes might be helpful. This book is an interesting read, but be prepared for lots of medicaleze intertwined with highly readable portions.