If there’s one thing that the study of neuroscience has convinced me of, it’s this: who and how we are is not a life sentence. It’s more than possible to foster unfathomable change. In fact, it’s a neurological mandate. And nothing confirmed this for me more than a recent trip I took with friends up to British Columbia to visit an Arrowsmith School. Using her own disorganized brain as a template, Barbara Arrowsmith-Young developed effective protocols for treating many common conditions that teachers and parents and people who should know better simply write off as “just how kids are.”
Well, Barbara’s recent book, The Woman Who Changed her Brain is proof that such a perspective is seriously misguided. Below is a list of 19 common brain deficits that she and her program have treated successfully, along with descriptors of the common features and a phrase (in italics) typically used in connection with each one. Someone with that particular deficit is likely to utter that phrase, sometimes in an effort to explain the deficit away. As you read the descriptors, keep in mind that the list is neither exclusive nor exhaustive. The intricate and constant interplay of various brain areas makes it difficult to offer a fixed list of symptoms for any one cognitive challenge.
As Barbara notes, some of the same symptoms may be listed in more than one area. This is because those particular indicators (inability to plan, for example) may occur as a result of a deficit in several areas (symbolic thinking, artifactual thinking, predicative speech, for example); the manifestations can look the same to an observer but have different underlying causes.
Motor Symbol Sequencing
“Please don’t erase that blackboard yet.”
This capacity, centered in the premotor region of the left hemisphere of the brain, is involved in the process of learning motor plans necessary to consistently and sequentially produce a set of symbols (the alphabet, for example, or numbers). When there is a weakness in this capacity, processes involving input through the eye (reading) and output through the hand (writing) and mouth (speaking) are impaired to varying degrees.
This deficit means the eyes can’t track properly, so that misreading becomes an issue (You read step hall for a road sign that says steep hill). Your handwriting is messy, irregular, and not automatic. You must focus so much on writing itself that copying material (from, say, a blackboard to a notebook) is difficult. Your spelling is erratic, your speech is rambling. In telling a story, you leave out chunks of critical information, making it hard for others to follow you.
“I just don’t get it.”
This capacity is involved in understanding the relationships between two or more ideas or concepts. The deficit is centered in the juncture of the occipital-temporal-parietal region in the left hemisphere of the brain. In more severe cases, you reverse letters, such as b and d or p and q, long after this is developmentally appropriate. You have trouble learning how to read an analog clock.
You can learn math procedures, but not the “why” of the procedure. Math and logic are often about relationships (percentages, fractions) that you cannot fathom. When the weakness is severe, you have trouble understanding cause and effect relationships or why events happen. This has implications for learning in school, on the job, and in social situations.
Prepositions (with, without, in, out) are also about relationships, so they too are hard to understand, as is grammar. Despite reading material repeatedly, you are never certain you have understood.
Memory for Information or Instruction
“I have a memory like a sieve.”
This is the capacity for remembering chunks of information. You have trouble remembering and therefore following lectures or extended conversations or instructions. Instructions have to be repeated several times before you retain them. This deficit, like the others named so far, involves the left hemisphere of the brain – the temporal region in particular.
Following a radio program or newscast can prove difficult. You tend to hang back and not participate in conversations. You tune out conversations because so much effort is required to retain the information.
“My words don’t always come out in the right order.”
With this deficit, the neurological process that converts thought into an organized sequence of words is flawed. You cannot learn the rules governing sentence structure. You speak and write in short sentences and have a hard time following long sentences. As compensation, you may keep a store of memorized short phrases. And worse, because you can’t mentally rehearse through internal speech what you’re going to say or do, you cannot anticipate the consequences of your words and actions and may appear to be rude and lacking in tact.
Oral, written, and inner speech expression are all affected.
Broca’s Speech Pronunciation
“People say I mumble.”
People who struggle to pronounce words have a weakness in the frontal lobe area in the left hemisphere of the brain known as Broca’s area, named after the nineteenth-century French anatomist Pierre Paul Broca, who first discovered the link.
You mispronounce words or avoid using words you know and understand because you’re uncertain about pronunciation. This may restrict spoken vocabulary to simpler words.
Since speaking requires concentration, it’s hard for you to talk and think at the same time, and you easily lose your train of thought. Unless you work from a prepared text, public speaking is hard. At a severe level, your speech tends to be flat and monotone, with a lack of rhythm and intonation. There is a tendency to mumble. This impairment also interferes with the ability to learn a foreign language. Additionally, when learning to read, you have difficulty converting letters into sounds.
Auditory Speech Discrimination
“I’m sorry. Could you repeat that?”
“Planning was never my strong suit.”
This is the capacity for mental initiative. The left side of the brain (specifically the prefrontal cortex) is the one implicated.
You have great difficulty developing strategies for studying. If shown a study method, you may be able to follow it, but you cannot develop your own. You are easily distracted and frequently called to task for having a short attention span. Organization, planning, self-direction, and establishing long-term goals are all major challenges. As a result, you live for the moment, and others may view you as untrustworthy or flighty.
“I was never a great reader.”
The part of the brain not working here is in the left hemisphere, more specifically the left occipito-temporal region, which allows us to recognize and remember a word or symbol.
You have to study a word many more times than average before you can memorize it, and thus recognize it and say it correctly the next time you see it. In many cases, you cannot learn sight words even with multiple repetition, and every time you are presented with a word that should be familiar, you need to sound it out as if you are seeing it for the first time. As a result, leaning to read and spell is a slow process.
“I’m not good at remembering the names of things.”
This is the capacity for remembering words. You have trouble remembering individual words and the names of things or the days of the week, the names of colors and the names of people. The temporal region in the left hemisphere of the brain is the one involved.
“I am such a klutz.”
This is the capacity to perceive where either side or both sides of your body are in space. The part of the brain not fully engaged is the somato-sensory area in the parietal lobe in either the left or the right hemisphere, and sometimes both. You have a tendency to bump into objects with the affected side of the body. Driving a car or using power tools can be risky. If the problem occurs in your writing hand, there is uneven pressure, and you may wander off the line.
“I slur my words sometimes.”
In this deficit, there is a lack of awareness of the position of the lips and tongue, resulting in slurred speech. This is very much a kinesthetic perception problem, but in this case, what’s affected is the specific area in the brain that controls feedback to the tongue, lips, and mouth for clear articulation of speech. You have trouble rapidly repeating a tongue twister such as “truly rural” or “three free throws.” The left or right hemispheres of the brain might be involved, or both.
“I’m just not good at reading people.”
This capacity is necessary for you to interpret emotions and modify your behavior accordingly. The right side of the brain, and specifically the prefrontal cortex, is the one implicated.
You cannot interpret nonverbal cues and information such as facial expressions and body language, and as a result you can’t modify your behavior according to the signals people send you. Unable to “read” non-verbal information coming from your boss, your teacher, or your friends and relations, you don’t always act appropriately and you can’t self-correct. There is a failure to understand others coupled with a failure to understand yourself.
Narrow Visual Span
“My eyes hurt when I read.”
This is the capacity responsible for the number of symbols or objects one can see in a single visual fixation. The occipital lobe – in the left, right, or both hemispheres at the back of the brain – is the problem area. When the span is restricted, you cannot see whole words in a single visual fixation. You must make three to ten times the normal number of eye fixations to read a line of printed material. You suffer easily from eye fatigue, and your reading is slow.
“Have we met?”
This is the capacity for recognizing and remembering the details of visual objects, including faces. This deficit is centered in a network of right hemisphere areas. You take longer to recognize and locate objects – when shopping or looking for something in the refrigerator or landmarks in your own neighborhood. You have trouble recognizing and remembering faces and miss details in facial expressions, which creates social and interpersonal problems for you.
“I am forever getting lost.”
Spatial reasoning, linked primarily to the right parietal area of the brain, is the capacity to imagine a series of moves through space before executing them. When this capacity is weak, you cannot map out inside your head how to get from one place to another or rotate the map inside your head. You forget where you’ve left objects because you aren’t able to create a spatial map of those objects and their location. Your work space tends to feature material stacked in piles, within sight. If you put something away in a filing cabinet or drawer, you later have trouble imagining in your head where it is.
“I’m not handy.”
A mechanical reasoning problem, centered in the right hemisphere, means you have difficulty imagining how machines operate and how their parts interact with one another. You also have trouble handling tools effectively.
“I couldn’t program the VCR to save my life.”
Some tasks require an internal sequential logic, and the order of procedure is paramount. A persona with an abstract reasoning problem, also a right-hemisphere issue, has trouble carrying out in sequence a series of steps in a non-language related task, such as navigating a computer program, preparing a complex recipe, or programming the VCR. Computer programmers are often good chefs; they know about the proper order of things. With this deficit, you don’t.
“My reaction time is a bit slow.”
This problem interferes with the speed, strength, and control of muscle movements on one side of the body or the other. This results in awkward body movement and less articulated movement on the affected side of the body. The primary motor “strip,” as it’s called, behind the prefrontal cortex, is the region of the brain affected. The left, right, or both sides may be affected.
Unlike kinesthetic perception, which provides feedback to guide and modify movement (think of a receiver in football running an intricate pass pattern), primary motor simply tells your muscles to move (enabling that same receiver to almost reflexively catch the ball). And as with so many parts of the brain, kinesthetic perception and primary motor work together.
“I’m not a numbers person.”
A problem in this area means you can’t do math in your head. Simple counting, calculating change, learning to add, and the multiplication tables can all be problematic. The deficit is centered in an area in the parietal lobes related to understanding quantity and number.
Human behavior is complex, and no single factor can explain it all. We can be affected by psychological trauma, our cultural background, our personalities, our upbringing. But these nineteen cognitive areas, though clearly not an exhaustive list of all the areas in the brain related to learning, are key pieces. A strength or weakness critically shapes how we participate in the world.
Many students come to an Arrowsmith Program with half a dozen or more deficits, some of them rated severe. Individually, these deficits can be a great burden in those who have them, and more so when deficits coincide and conspire with one another. This is a description of much of my experience in public school growing up. I would have been a prime candidate for Barbara’s program. In some respects, I still am.