Learning Problems

There are many different types of learning problems. In fact, there are as many different types of learning problems as there are types of learners, multiplied by the number of  types of learning.  Okay, it’s impossible to calculate, but you get the idea. Lots and lots.  The idea that someone has a condition, a “learning disability,” can be more confusing than helpful, unless we’re talking about education, where the term has a very specific meaning (see: Special Education ABCs).

The term “learning” is one of those problematic words that is used both in common language and as a technical term in a specific field.  In my field, cognitive neuroscience or neuropsychology, “learning” refers to a change in the connectivity in the brain, the acquisition of a skill, understanding, or set of facts. It results from experience, and it changes us, by changing what we can do or how we think. Learning is closely related to “memory” (another of those everyday words that I get all excited and opinionated about).

There is motor learning, like how to ride a bicycle, more complex sensory motor learning like how to play a musical instrument, quick and specific learning, like humming a tune, or complex and long-term learning like learning a foreign language.   We all learn some things more easily than others. This depends on our brains, our interests, our past experience, our motivation, our health, our teacher, our stress level, and more.

Very rarely, a child has a very specific learning problem with a particular academic skill.  More often, the problem is more general, but it interferes with the acquisition of one or more specific academic skills, and that is what is focused on. Problems making friends, problems staying focused on lessons or activities, problems staying seated, behaving appropriately, whether in class or during less structured time, are all significant issues for a child, who spends most of the day, most days, in school.

A child may be too anxious and distracted to concentrate in class, either because of a genetically based anxiety disorder or because of an emotional trauma they have suffered in their life. They may have a cognitive processing deficit in an area such as auditory perception or visual spatial perception that interferes with their understanding and retention of a particular type of information. They may have a primary attentional deficit, or ADHD (rare) in which they cannot maintain their focus on the lesson. Of course sometimes a child’s problem with school is due not to the way their brain works, but to the way we are teaching them or the expectations we have for them that may be inappropriate. Or, it may be that they are unable to attend school consistently because of health issues or problems within their home or family.

A child may have difficulty learning a particular academic subject, such as reading, mathematics, or written expression. In neuropsychology, we are interested in the underlying cause of the learning problem, in order to most effectively overcome it. Because it is the brain that is doing the learning, we can identify differences in the way the child’s brain works that may interfere with their learning or performance in a typical classroom or educational program. We also nee to understand the information processing systems and component processes that are at work in performing a particular academic task, such as reading (see: The Neuropsychology of Reading) or doing Math calculations. We can then relate the child’s processing strengths and weaknesses (their ThinkPrint) to the difficulty they are having with learning a particular academic skill. In addition, we can devise alternative ways of teaching that tap their strengths and work around their weaknesses, making teaching more effective.
For many children, the problem is not so much with learning a particular academic skill, but with some other area of performance or participation in the classroom, such as paying attention to the lesson, working independently, participating in group discussions or getting along with other children. At least in the elementary grades, these children may make good progress with learning or acquiring academic skills despite these problems.

Learning problems can be understood in terms of the five SCEMA systems:

1. The Sensory (input) System – The first step in learning is getting information into the brain. A child may have an impairment of vision or hearing, so that information does not get into the brain. Problems with primary Sensory processes, such as vision or hearing must be carefully ruled out at as early an age as possible. Children who suffer from frequent ear infections often have temporary or intermittent hearing loss, and can suffer permanent hearing difficulties. Children who are delayed in developing language skills should have an audiological evaluation. Children with autism are often thought to have hearing problems, because their language development is delayed and they are often unresponsive to the people around them. One important clue to distinguish between them is that children with hearing loss will try hard to communicate, using hand gestures, body language, facial expression, pointing and tapping and tugging on you, whereas children with autism do not make such efforts, or make them only when they are hungry.

2. The Cognitive (meaning) System – There is a problem with the processing of auditory verbal information, which interferes with comprehension of spoken language, visual spatial information, which interferes with understanding written language and learning that depends on spatial position – as in Math and Spelling, or social/emotional information, which interferes with group activities, peer relationships and comprehension of material involving people and their attitudes, as in literature and Social Studies. Problems with Cognitive processes are often the cause of learning difficulties in specific academic areas, as discussed in subsequent pages in this section. The most commonly identified are auditory verbal processing deficit (central auditory processing deficit) and a visual spatial processing deficit (a common cause of reading disability or “dyslexia”).

3. The Executive (control) System – There is a problem staying focused, keeping information in mind (working memory), or retrieving information from memory. Problems with Executive processes, as in attention deficit/hyperactivity disorder, are also a common cause of learning difficulties. As discussed elsewhere, Executive processing deficits are very common because these are the highest level and most complex processes, and therefore very vulnerable to disruption. Lyme disease and other infectious or inflammatory illnesses seem to interfere with the Executive processes, as does even mild head injury.

4. The Motor (response) System – There is a problem with fine motor control, which interferes with writing and copying, gross motor coordination, which interferes with whole body activities such as sports, or oral motor control, which is necessary for the clear articulation of speech. Problems with Motor Processes such as motor coordination can interfere with learning by making writing, copying and drawing – important classroom activities – difficult and frustrating and therefore unappealing. Motor processing deficits frequently co-occur with other neurodevelopmental conditions.

5. The Affective (motivation) system – There is a problem with the positive emotional pull that motivates learning or negative emotions that interfere – either too much anxiety, which interferes with learning, too much sadness or anger, as in depression. Problems with Affective processes (mood or emotional response) can be genetically determined or inherited, the result of traumatic experience post traumatic stress disorder or secondary to physical illness or injury. Children who are anxious, depressed, angry or irritable, will have trouble participating in and absorbing information in a classroom. Pain, of course, interferes with learning; none of us can think or learn if we are suffering physically or emotionally.

Many children have processing deficits in more than one system, which is one reason why careful neuropsychological assessment is so important in addressing learning difficulties. Autism spectrum disorders always involve multiple system deficits. Children with autism spectrum disorders have learning difficulties due to problems with attention and a limited range of interest, as well as difficulty with novelty and change and emotional sensitivity that makes trying new things very risky. Children who have social difficulties will have trouble because the classroom is primarily a group learning experience.

Intellectual disability (developmental disability or mental retardation) involves limited processing capacity across all cognitive areas, and causes significant learning difficulties. Learning occurs slowly, requiring more exposure to the material and more practice, and regardless of instruction will not continue to develop beyond a certain level of skill that is significantly lower than that of an educated adult.

The highest level brain functions use up a tremendous amount of energy or resources and as such only work when the more basic and essential body systems are intact. Physical illness can interfere with Cognitive and Executive processes (thinking, paying attention, learning) presumably because these higher-level processes are non-essential in terms of survival, and are shut down in order to conserve energy for the immune system to battle the infection. Most of us recognize that with a bad cold or other virus we are not quite as sharp as we normally are. The cognitive impairment of illness seems to reflect the brain on “power saver” or brown-out mode. The “brain fog” of Lyme disease is well known, and autoimmune disorders such as rheumatoid arthritis and multiple sclerosis also cause cognitive impairment, as can the medications to treat these conditions.Chemotherapy causes significant brain fog as well.

Emotional trauma resulting from physical or emotional abuse, or the lack of experience with or exposure to healthy models for interpersonal relating, resulting from emotional neglect may result in disturbance of mood or emotional behavior, as well as a child’s ability to learn. This may result from physical pain from injury or hunger, fatigue from lack of sleep or malnourishment, or the secondary emotional issues, including anxiety, depression, anger, irritability and problems with personality development as occurs in dissociative conditions.

The Neuropsychology of Reading (the pizza example)

To become a competent reader is to acquire the key to the vast treasure of the mind of man, free passage through time and space, limitless learning and boundless adventure.   To teach a child to read well is the core challenge of elementary education. The only thing more important to teach a child is to enjoy the process of learning. In my mind, if we fail to do either we have failed the child.

Understanding the component skills and underlying brain processes involved in reading, and how they develop, will enable us to develop effective reading instruction and to prevent and remediate reading problems. Reading is a complex process that taps all five SCEMA systems in the ThinkPrint model.

To get an idea of the multiple kinds of information processing that go on in your brain when you read, try reading the following sentence aloud (quietly, if there are people around) and answer it, before you continue:

Do you like pizza?

You just did a whole bunch of information processing, activating a wide variety of neural circuits, in each of the five SCEMA systems. As you looked at the sentence, receptor cells in your retina, at the back of your eye, transmitted visual information – a pattern of dark and light spaces and curved and straight edges  – along a pathway of interconnected neurons (brain cells), your optic nerve, to your primary visual cortex of your brain, which shared it with neighboring secondary visual areas and eventually to the multi-modal areas that integrate different types of sensory information (how things look with how they sound). The incoming sensory information was matched up with stored sensory information from your previous encounters with words and sentences. Your brain found a match, and the Sensory, Motor and Cognitive circuits containing the sound, pronunciation and meaning, respectively, of the words were automatically activated.

Your Motor system directed your eye muscles to scan the sentence from left to right, a habit learned early on (if your first language was English and not Hebrew). In your Sensory system, the visual form of the words, because they are familiar, are linked in your brain with, and automatically activate, auditory circuits that contain the sounds of the words. Both the look and the sound of the words are linked with conceptual information, stored and organized by your Cognitive system, that makes up the meaning of the words, and with the oral motor patterns (movements of muscles in your lips, tongue and vocal cords) that enable you to make the sounds of the words. Meanwhile, your Executive system focused your attention on the sentence, aided by your visual perception of its bold font and centered position, which signal its importance, and your working memory circuits held the sounds of the first words in your awareness until you had read the last word, so that the receptive language circuits of your Cognitive system could put them all together to formulate the meaning of the sentence as a whole, in addition to the meaning of the individual words.

Also processed was the meaning of the distinctive squiggle at the end of the line, signaling the need to make a decision and formulate a response. Your Cognitive system was also involved in the memory, language, and decision-making process of answering the question, “Yes” or “No.” The meaning of the words “Do you like” conveys that you must refer to your own experience and preference, and the word “pizza” is meaningful because it activated neural circuits containing stored sensory information from past encounters with actual pizza. Information was retrieved from Sensory circuits containing the smell, taste and feel of tomato sauce and melted cheese, and the auditory and tactile experience of a crunchy crust. These are linked with and trigger emotional information (Affective system), depending on whether these sensations were pleasant (yum!) or unpleasant (yuck!) or neither (meh).

Though I haven’t checked the statistics, I would guess that the majority of people surveyed have had a positive experience with pizza (which is another kind of brain event), and would therefore have answered “Yes.” This is despite the fact that for many of us, past experience with pizza included a negative emotion – pain, as the hot cheese seared the delicate skin on the roof of our mouth, because we didn’t wait for the pizza to cool off. (This, by the way, is an example of a failure of response inhibition, a process of the Executive system.)

Because each of these words is familiar to you, you recognized their overall visual form, and did not have to decode them, which would have required processing the individual letters and letters sounds and blending them into a word.  The meaning of the words and the particular collection and sequence of words is well known to you, so comprehension of the sentence was automatic. The processing would have been different, however, if you were just learning to read, or if the words and their meaning were unfamiliar to you, as would be the case if I asked you to read this sentence:

Do you rauch fripanzer?

In this case, reading the sentence would have involved an additional set of processes, those involved in decoding. If you are a competent reader, the word “rauch” would be read as the “r” sound (/r/), the “au” would be identified as together making the sound “aw” as in “law,” and the “c” and the “h” together making the sound /ch/.  But if you were just beginning to learn to read, or if you had reading problems, you might have tried to pronounce it as “ratch,” or “rauk,” or even “ranch.” Similarly, “fripanzer” would have separated itself into syllables, based on your automatic decoding skills, as “fri” and “pan” and “zer.”  (Since I made this word up, I’m not sure if it’s pronounced “fry – pan – zer” or “fripp – anz – er,” so I’d give you credit for either one.) Since you have never seen this word before (I’m guessing), you had to decode it, which we have to do only rarely as competent adult readers. Although you could manage to pronounce these two unfamiliar words, you wouldn’t know their meaning (even if you Googled them).  No stored motor or conceptual information about how rauching is done, or what it feels like, and no sensory information about what fripanzer looks, smells or feels like, is available, so you are unable to understand or the question, let alone answer it. Notice, though, that you still know that “rauch” is a verb, and “fripanzer” most likely a noun, the object of “rauch,” (the thing that is “rauched”).  If I asked, “Do you rauch fripanzingly?” you would know, from the form of the word, that it was an adverb, describing a quality of your rauching.