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November 1, 2001
Vol. 59
No. 3

Fragile Brains

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A better understanding of brain impairments can help teachers improve learning for struggling students.

For years, educators have been trying to help students by using technology, applying an understanding of multiple intelligences and learning styles, creating smaller class sizes, and developing higher standards. But can we create a successful program for learners without considering how the brain learns? Absolutely not—no more than an auto mechanic can fix an automobile without first understanding the functions and inner mechanisms that led to its breakdown. Students who are failing often have brain-based biological problems that positive changes in the environment can help solve.
Is the human brain really fragile—delicate and easily damaged? I wish it weren't so, but it is. Despite an encasement in tough dura mater, the three pounds of gelatin-like matter that constitute the brain are vulnerable to assaults by unfortunate genetic variations, misguided environmental adaptations, and toxic intrusions. Of the more than 25 types of brain-based disorders, three kinds—the sluggish (caused by prenatal ingestion of toxins); the oppositional (related to a chemical imbalance in the cingulate gyrus); and the depressed (linked to vulnerability to stressful life traumas)—present the student and educator with special challenges. Responding effectively to these difficult conditions, however, can improve students' learning.

The Sluggish Brain

Jason is a 13-year-old middle school student. At first, he seems like a regular kid; he is likable and sincere. But Jason has been suspended more than a dozen times in the first three months of school for behavior problems. He never seems openly defiant, but he fails to follow the rules. The old-school behaviorist method of tough love is to treat the behavior and not blame the student. The principal tells Jason that he cares about him, but "the rules are the rules," so he sends Jason home. This method clearly isn't working.

Gathering Information

The answers do not emerge until a thoughtful school counselor begins asking hard questions. After interviewing former teachers, the parents, and the student, the counselor discovers that Jason suffers from fetal alcohol effect, a condition similar to fetal alcohol syndrome. He knows the rules for proper school behavior but cannot link them to his own actions. His condition is not obvious enough to be easily diagnosed, nor does he have the physical abnormalities sometimes associated with fetal alcohol syndrome, but the subtle effects of his mother's drug use during pregnancy create a serious problem. In Jason's case, he is unable to link cause and effect.
A leading cause of retardation in the Western hemisphere is maternal drug use during pregnancy. The number of those affected is difficult to determine because the symptoms of retardation often mimic those of such other conditions as Attention Deficit Disorder. Although studies of pregnant women who report their own drug use can be problematic, best estimates are that a blind urine toxicology test would show that 10–15 percent of them would test positive for cocaine, alcohol, or marijuana (Bennett & Woolf, 1991). About 18–20 percent of pregnant women smoke, which presents another risk for the cognitive and behavioral development of their children (Olds, Henderson, & Tatelbaum, 1994).
Jason shows other symptoms, but teachers have never put them together. Jason has memory lapses and difficulties with coordination and tactile and visual perception. Tasks as simple as tying shoes, copying, and tracing are difficult. What brings attention to the problem is his inability to follow cafeteria rules. Can anything be done to repair Jason's brain? We don't know any cures yet, but we can do a lot to improve his learning.

Educator's Toolbox

  • Use structure, consistency, variety, brevity, and persistence.
  • Establish routines so that learners can predict coming events.
  • Break lessons down into smaller units to avoid overwhelming students.
  • Give advanced warning of activity changes.
  • Provide prompts, signs, learning partners, and checklists.
  • Be concrete when teaching a new concept. Use a model.
  • Be positive and expect improvement.
  • Rituals are important—create plenty of daily, predictable events.
  • Give explanations and directions one at a time, and keep them brief.
  • Learn to repeat.
  • Establish a few simple rules. Use identical language to remind learners of rules. "This is your study area; this is where you are supposed to be."
Be patient. Take the daily and weekly small miracles and appreciate them. When setbacks occur, take a deep breath and pause. Affirm progress and set new goals. Teachers and parents who work with students who have been exposed to prenatal toxins should not label or blame anyone but work to understand and accommodate these students.

The Oppositional Brain

Ashley is 8 years old and smart. Yet she's managed to get just about everyone in class mad at her. She is impulsive, has a low tolerance for frustration, and often loses her temper. Known to argue openly with her teacher, she rejects most adults' requests. Her habits are deliberate. She purposely annoys others, often for no apparent reason. Ashley blames others for her mistakes or misbehavior, commonly using obscene language. Her teacher, refusing to back down, often finds herself in shouting matches with Ashley. With each confrontation, Ashley ends up in the principal's office or being sent home. The school has branded her a problem case and the result of bad parenting.

Gathering Information

Ashley is not alone. Oppositional Defiant Disorder is an increasingly serious and chronic psychiatric condition afflicting up to 16 percent of the population (American Psychiatric Association, 2000). Verbal aggressiveness, a tendency to bother others, a confrontational attitude, and a disregard for how others feel characterize the disorder. Academic failure and poor social adjustment are common complications. More than 65 percent of those who suffer from Attention Deficit Disorder also develop this problem (Barkley, 1990). Usually appearing around age 8 and not later than 15, Oppositional Defiant Disorder is more common in boys than in girls at the younger ages but afflicts an equal number of boys and girls in adolescence.
Surprisingly, students with this disorder are actually victims. Ashley does not choose to act out in this manner. Her brain-based condition is a result of both environment and genetics. A negative, traumatic, or neglectful environment may be a major contributing factor, but not necessarily. Usually several problems contribute to this problem, but an imbalance of the brain's chemical system—especially norepinephrine and serotonin—is the primary cause.
Many who suffer from this disorder produce an unusually high level of noradrenaline (also known as norepinephrine), which is the neurotransmitter of arousal, high energy, and urgency. Even a small stimulus will create unusually strong arousal reactions. At the same time, sufferers' brains produce too little serotonin, contributing to an overactive cingulate gyrus, the structure between the midbrain area and frontal lobes that is responsible for allowing the person to move smoothly from one mental state to another. Without enough serotonin, this area overheats in its unsuccessful effort to switch mental gears, with the result that the person fights to protect a mental state that is stuck (Amen, 1997). Whatever Ashley is doing is better, in her mind, than what someone else wants her to do. She resists nearly every request.

Educator's Toolbox

  • Schedule plenty of time for writing and drawing. These activities foster positive and appropriate expression and help this type of student sort out thoughts and feelings.
  • Use distraction strategies if a student gets stuck on a negative.
  • Use a mix of negative and positive reinforcements, such as extra time or privileges.
  • Do not bend the rules. A consistent approach by everyone on the team is crucial.
  • Set priorities for which behaviors you wish to address first.
  • Focus on specific behaviors. Instead of insisting on a general standard of good behavior, make a rule, for example, that all students keep their hands to themselves. When students have learned to follow that rule, focus on another specific behavior.
  • Provide encouragement, just as you do with all students.
  • Don't give ultimatums. Give choices, presenting options where both outcomes are acceptable: "Would you rather finish this today or later this week?"
Finally, avoid becoming obsessed by this student. Work instead for slow and steady progress.

The Depressed Brain

Kevin, 16, has a history of good grades. In his junior year of high school, however, he has begun to fall apart. Suddenly, he has no appetite or energy. He has lost weight and feels worthless and guilty. He can't think clearly or concentrate. He even has thoughts of death and suicide. This persistent, sad, anxious, and empty mood catches the attention of his school counselor, who has noticed that Kevin is beginning to lose friends and that his grades are slipping.

Gathering Information

Suspecting that something is wrong, the counselor calls Kevin's parents and discovers that Kevin's father has cancer. Depression in adolescence is not unusual. Among adolescents, 6–8 percent will experience either a major or minor depressive disorder (Berg, 1996). Recurrent episodes of depression in adulthood are more likely if the initial onset occurred during adolescence. Suicide rates among children and teens in the United States tripled between 1962 and 1995, and approximately 10 percent of children who develop major depression will commit suicide (U.S. Department of Health and Human Services, 1999).
Depression is a brain-based, biological problem that correlates with heredity and vulnerability to stressful life traumas. Because of the increase in cases of depression during the past 50 years, many experts suspect that lifestyle choices, diet, technology, and changing social structures play a role in its development. The brain's temporal lobes, amygdala, stress-response pathways, and hippocampus are all involved in this disorder (Andreasen, 2001). Many psychiatrists treat depression as a chemical imbalance and base their recommendations on correcting that side of the problem. Patients' failure to take prescribed medications, however, is a recurring problem.

Educator's Toolbox

  • Incorporate physical activities—walks, relays, field trips, stretching, and aerobics—into your curriculum to help produce the feel-good chemicals necessary for coping with the negative emotions of depression.
  • Build strong social support by fostering team and community spirit.
  • Create structured, positive social activities.
  • Encourage students to think positively about themselves and to view their problems as opportunities to generate new options for their lives.
  • Help students recognize multiple interpretations of any event and support them to choose the most empowering one.
In general, strong social support, plenty of movement, and letting students write about their feelings and interpretations will contribute to a reduction in symptoms.

Accommodating Different Learners

Less than a generation ago, few believed that children got depressed or stressed in the ways that adults did. New technologies have allowed us to study the brain more closely, and we now know that many children and adolescents suffer, much as adults do, from specific brain disorders. In short, it's not all in their minds—it's in their brains.
Learners with healthy brains can learn without special accommodations. But what about the students whose brains have been exposed to chronic distress, trauma, or drugs or whose brains suffer from impairments, chemical imbalances, significant lesions, or genetic defects? We are more likely to be accommodating when we can easily see the disability—a student with a spinal cord injury who requires a wheelchair, for example. Many learning problems, however, are not easy to see (Jensen, 2000).
To identify and accommodate these learning differences, every teacher should have dual certification in general and special education. Schools of education and staff development programs should help teachers better reach these students.
In studies of rodents, the experimental groups that had been selectively bred as "learning disabled" showed far greater gains each day of enrichment compared to those that were bred as "smart mice" (Kempermann, Kuhn, & Gage, 1997). These results suggest that the potential for raising test scores among the underperforming and demotivated may be greater than it is among high-performing learners (Kempermann, Brandon, & Gage, 1998). Moreover, the accommodations that educators make for different learners benefit all students.

Amen, D. G. (1997). Images into the mind. Fairfield, CA: MindWorks Press.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Andreasen, N. (2001). Brave new brain: Conquering mental illness in the era of the genome. New York: Oxford University Press.

Barkley, R. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford Press.

Bennett, G., & Woolf, D. (Eds.). (1991). Substance abuse. Albany, NY: Delmar Publishers.

Berg, B. (Ed.). (1996). Principles of child neurology. New York: McGraw-Hill.

Jensen, E. (2000). Different brains, different learners. San Diego, CA: The Brain Store.

Kempermann, G., Brandon, E. P., & Gage, F. (1998). Environmental stimulation of 129/SvJ mice results in increased cell proliferation and neurogenesis in the adult dentate gyrus. Current Biology, 8(16), 939–942.

Kempermann, G., Kuhn, H., & Gage, F. (1997). Genetic influence on neuro-genesis in the dentate gyrus of adult mice. Proceedings of the National Academy of Sciences, 94(19), 10409–10414.

Olds, D. L., Henderson, C. R., & Tatelbaum, R. (1994). Intellectual impairment in children of women who smoke cigarettes during pregnancy. Pediatrics, 93, 221–227.

U.S. Department of Health and Human Services. (1999).Mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services, National Institutes of Health, National Institute of Mental Health. Available: www.surgeongeneral.gov/library/mentalhealth/pdfs/front.pdf

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