Learning: Many Problems but Many Remedies

They stood face to face, the doctor and his patient, thumbs in their ears, fingers wiggling.

The doctor was Mel Levine, a pediatrician winning praise nationally for his diagnoses and theories about learning difficulties. The patient was Teddy Shinkle, a 13-year-old from Michigan dressed in an oversize flannel shirt and Doc Martens.

What they were doing was trying to pinpoint why Teddy, a bright, hard-working kid with ambitions of becoming an architect or a lawyer, writes sentences like this: “If I happen to get of this I would start a small company.” Before the exam in his cramped office, Levine was reassuring.

“We could do this with all the kids in your class and we’d find different strengths and weaknesses,” Levine said as he administered the first of 31 tests, including the finger-wiggling, to see if Teddy could keep track of his hands without seeing them. “We’ve never found a perfect brain.”

That philosophy--which stresses learning differences rather than learning disabilities--is at the heart of Levine’s pioneering approach.

Drawing on more than 20 years as a clinician as well as the research of cognitive scientists, Levine compiled what is the only comprehensive model of the components of learning.

Laid out on a placemat-size sheet of paper, it is daunting in its complexity. It has eight “constructs,” such as language, memory, attention and social cognition (important for reading cues from fellow students or the teacher).

Levine says every person has a neuro-developmental profile that combines strengths and weaknesses. “Everyone has dysfunctions. It’s all a question of which ones they have.”

What schools should do, he says, is play to individual students’ strengths and figure out ways to bypass or strengthen their weaknesses. But schools rarely are that flexible. Instead, he says, they tend to slap labels on kids who don’t measure up, calling them slow, lazy or learning disabled. And that narrow approach, he says, has caused the number of learning-disabled students to rise 38% nationally in a decade.

To decide who is disabled, schools generally rely mostly on tests of IQ and academic skills.

But such tests are widely discredited, even by top special education officials with the U.S. Department of Education. They can be very inaccurate. And they don’t result in a diagnosis or a prescription. They merely produce a label.

Such labels, Levine says, discourage kids. “They interpret it to mean their brain isn’t very good.”

Levine acknowledges that his approach to learning has yet to be scientifically validated. He also agrees that its successes are anecdotal.

But as he presents his theories to teachers across the country, support is growing.

Last summer, 1,800 teachers completed two weeks of training in his theories, observation techniques and teaching methods at 10 regional “Schools Attuned” centers, including three in California: the Etta Israel Center in Los Angeles, UC Irvine and the Children’s Health Council in Palo Alto.

Among the high-profile backers of such ventures is Charles R. Schwab, the stockbroker and financier who discovered as an adult that he is dyslexic.

“Mel is a real pioneer,” said Schwab, whose family foundation recently put up $10 million in a matching grant to support the spread of Levine’s ideas. “There isn’t just one mind that fits all sizes, just like there are many sizes of shoes.”

But, in most cases, Schwab said, teachers think “there’s only one way to teach kids.”

Many parents and students wind up searching for help outside schools. “I just want him to reach his potential,” said Linda Shinkle, Teddy’s mother, explaining why she sought out Levine, who is director of the Clinical Center for the Study of Development and Learning at the University of North Carolina.

Ruling Out Various Problems

Teddy’s learning problems started in the first grade with reading. He could memorize words fine. But he had trouble linking letters to their sound. By second grade, Teddy was leaving the house each morning in tears, telling his mother he wasn’t smart enough for school. A school psychologist told Linda he would never learn to read.

But Shinkle, an attorney in private practice in the town of Williamston, near Lansing, didn’t accept that dire prediction. She hired a tutor who worked with Teddy an hour a day on letter sounds. She also put him in a private school with small classes.

Today, Teddy reads fine, if slowly, and has some lapses in spelling. He’s strong in math and science, enjoys art and is popular and athletic. But his writing is laboriously slow. Even his speech is halting. “In school, I want to say things, but I have a hard time putting it into words,” he told a therapist.

In Levine’s office, Linda Shinkle watched anxiously as Levine had Teddy touch his fingers to thumbs in a rapid-fire sequence, draw a long line between two other lines, and write the alphabet as one long word as fast as he could. That told Levine that Teddy’s small motor functions were fine and shouldn’t hinder his writing.

Other tests, such as a game of pig Latin and answering questions such as “What is a piece of clothing that rhymes with the word ‘ox?’ ,” showed that he had no trouble with language. And further exercises revealed that his memory and conceptual understanding were intact.

Teddy stumbled only when asked to make up a sentence and to orally summarize a paragraph Levine read to him about pollution’s effect on birds. He understood it, but when he tried to retell it he got it all out of order and even made up details.

Levine said the tests showed that Teddy’s dysfunction is isolated and relatively mild. He has a rich imagination and is thoughtful, but has trouble getting ideas across.

“It’s like a marvelous factory that creates all sorts of wonderful packages, but there’s not enough delivery trucks to get the product out,” Levine told Linda and Teddy after the exam.

Because difficulties like Teddy’s are not severe, they would probably be overlooked initially in school. But that could be disastrous, with frustration leading to anger. “When you neglect these language expression problems, these are the kids who get put on Prozac in the 11th grade,” Levine said.

He recommended a long list of ways for Teddy’s teachers and mother to help him practice expressing himself, by summarizing a book or the action in a football game, for example. He also recommended that Teddy use a computer, and dictate the first draft of essays or reports into a tape recorder.

“There’s a lot of stuff you could do for him that wouldn’t cost a penny,” Levine said.

Obviously, teachers have neither the time nor the expertise to conduct as extensive an exam as Levine. But, he said, they can learn to observe students in a variety of settings and can consider all the factors that go into learning.

Take writing, for example. A student must have ideas, must access the words to get them across, and must form them into phrases that conform with the rules of English. Beyond that, forming letters involves four neurological processes: visualizing the shape of letters and words, accessing the sounds of words from their storage place in long-term memory, creating letters, and monitoring one’s progress, which Levine calls a feedback loop.

Interest in Learning Developed in Philippines

Levine, 59, was a Rhodes scholar, then attended medical school at Harvard University. After that, he enlisted in the U.S. Air Force and it was while stationed in the Philippines that he became interested in learning, volunteering to be the local school’s doctor.

Back in Boston, he was on the faculty at Harvard and also became the chief of ambulatory pediatrics at Children’s Hospital. While there, he helped write the special education law for Massachusetts, which did not require students to be diagnosed as disabled to receive services. Federal law, only recently changed, did.

Because he’s a doctor, not an educator, Levine said, his ideas are not always popular in schools of education. So he’s had to take them directly to teachers and parents.

Helping him do that have been some powerful allies.

The Geraldine R. Dodge Foundation supported the compilation of his model of learning with a $1.2-million grant. Then the Harvard Graduate School of Education convened a meeting to see how Levine’s work might be shared more widely.

It was there that Levine met Schwab. Together, they formed an institute called All Kinds of Minds.

Two purposes of the institute are the support and development of the regional centers, which help classroom teachers understand Levine’s model and how to use it to help their students. Another powerful ally is the family foundation of Disney Chairman Michael Eisner, which recently donated $1 million to Levine’s institute.

Another boost will come a year from now, when public television will broadcast a major series featuring Levine that will be accompanied by books, videos, audiocassettes and a Web site.

Parents, many of whom have grown discouraged by their children’s lack of progress in traditional special education courses, tend to be devoted fans.

Jim McCarthy, a public affairs executive with Citgo Petroleum in Tulsa, Okla., has seen positive effects from it with his fifth-grade daughter, Caitlin.

She has great difficulty writing. Her attention span is short. And it’s hard for her to understand speech, but it’s easier if she can focus on someone’s lips when they talk.

So, to help her, her teachers at Monte Cassino School, one of the city’s top private schools, make sure she is looking at them when they talk. She’s allowed to use a computer to write her assignments, which seems easier for her than writing by hand, and she completes her spelling tests orally.

“The game is to find a way to unlock that ability to learn . . . so they have that joy and excitement,” McCarthy said.

Teachers Also Like Levine’s Work

Teachers too find Levine’s work valuable. They say his model gives them terms and justifications for some of the things that good teachers do instinctively, such as breaking up long lessons into shorter chunks. But it also helps them consider other explanations for an apparent lapse in learning.

Barbara Smith, a second-grade teacher at Mangum Primary Center in Durham, N.C., is in her first year of using Levine’s ideas. One of her students, Morgan Parks, would read a particular word perfectly, but “then when it comes up again, he wouldn’t have a clue.”

After consulting her materials from the Schools Attuned training, she decided he needed to work on decoding words. Smith sent home word games. “Now,” she said, “he’s making a lot of progress.”

But Smith and other teachers also say that Levine’s model can be overwhelming, especially for young teachers who are merely trying to get through the material they need to cover.

Part of it is that each of the eight “constructs” Levine describes could be the topic of a dissertation itself. And part of it is that Levine uses terms such as “temporal-spatial organization” and “ideational linkage cohesion.”

G. Reid Lyon, director of federal reading research programs at the National Institute of Child and Human Development, praised Levine’s emphasis on improving teachers’ level of understanding. “There’s no doubt that teachers are going to be much better practitioners, the more they know that is valuable to know,” he said.

But Lyon too worries that Levine’s model is overly complex. Plus, he said, it includes concepts not yet proven to be germane to effective learning.

In response to such concerns, Levine and his staff are rewriting the Schools Attuned curriculum to make it less theoretical and more practical.

Celia Ripke, principal of Gardner Elementary School in Los Angeles, and two of her teachers spent two weeks last summer being trained in Levine’s work at the Etta Israel Center. They decided to try it out immediately, rather than wait until they had mastered all of the ideas.

Teachers at the school gave them the names of 22 children who seemed ripe for referral to special education. After observing them closely, as Levine does, Ripke and her teachers decided that 10 of them were not learning disabled. Instead, they had other issues that could be addressed in alternate ways.

“In the past,” Ripke said, “all of them would have been referred to special education because we wouldn’t have had that tool.”

Tips to ‘Manage’ Learning

Dr. Mel Levine, a North Carolina pediatrician who has specialized in learning and behavior difficulties for 25 years, contends that schools are far too quick to label children as learning disabled. Learning is complex, requiring the smooth meshing of different skills, such as memory, attention and language.

All people have strengths and weaknesses in various areas, he says. Teachers, therefore, should modify their classrooms in response to those differences in help students “manage” their learning as effectively as possible.

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ATTENTION

As alternatives to Ritalin or other stimulants prescribed for students with problems paying attention, teachers can try:

* Front-row seating. The child is closer to the teacher and in a direct line of sight.

* Special signal. A prearranged cue can tell the child to get back on task without humiliating him or her.

* Attention meter. When the teacher is giving directions, for example, he or she could put a cardboard meter’s pointer at 100%.

* Frequent short breaks. The child should be allowed to stretch or walk around before getting back down to business.

* Breaking up lessons. This can help maintain focus.

* Color-coding. On overheads or handouts, most important information should be in one color with nonessential information in other colors.

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MEMORY

Schools require students to memorize massive amounts of information, but a poor memory does not necessarily indicate poor understanding. Also, there are different types of memory: short term, long term and active. Some tips:

* Practice. Build working memory with mental math. Give students a list and have them repeat it--backward.

* Repetition. When giving directions, have students repeat them.

* Multi-mode. Give directions orally, but also write them on the board.

* Modify assignments. Allow students with long-term memory trouble to write key information on cards to use during tests.

* Technology. Students with short-term memory trouble often have difficulty putting their ideas on paper in cursive writing. A computer keyboard seems to be easier for many students.

* Modify tests. Oral tests place less drain on memory than do written tests, while still determining whether concepts have been learned.

* Strategies. Teach children to picture something they need to memorize. Then, keep checking to make sure they are using it.

Sources: Schools Attuned; Bina Varughese, coordinator of educational services, Summit View School, North Hollywood