Integrated Learning Therapy (ILT)

For Parents and Teachers
How children develop learning readiness
Written by Dr Shirley K***t

At Integrated Learning Therapy (ILT) we understand the importance of children developing learning readiness. If you understand what that means, then it becomes easier to understand your role as a parent to help them become ready for school learning. This is why it is important to know about child development. If a child enters school without being ready to learn, we have to know why. What is missing? What stage of development was missed or became disrupted to cause learning difficulties?

ILT practitioners are virtual detectives in their work with children. We look for clues to tell us what might underlie a child’s neurodevelopmental delays or other brain irregularities causing them problems.

Here are some of the stages that babies go through in a sequence . If a child doesn’t develop in this normal sequence then learning might be more difficult than it should be. It isn’t complete, but should help alert you to what stages are particularly important for later learning.

By 6 months
A child should be able to roll over from back to front and front to back. This movement helps break down the imaginary midline, which exists vertically down the middle of the body. Only when this midline is broken down will the child be able to show coordinated activities.
Babies will be learning through the skin (touch and taste), the muscles and the eyes as they reach, grasp and transfer things from hand to hand. They touch everything and everything possible goes into the mouth because they learn a lot from taste and smell.
Language skills are being laid down by listening, cooing and squealing.

By 12 months
A child should have had plenty of pulling herself along the floor prior to many months of crawling in a coordinated way on hands and knees. This lays the basis for the two sides of the body to become integrated. Crawling also gives the eyes good focusing practice at reading distance. A child of a year old should be able to use his eyes in a coordinated way, to investigate everything with his hands and have learned to release objects. Ears should be giving more accurate messages so that language will have progressed to naming special things and a few other words.

By 18 months
The child should be walking quite well and throwing, kicking and chasing balls. Eyes should work well together. There should be a love of blocks, sand and water and a lot of self-talk.

By 2 years
She should be walking smoothly, running well and jumping. Slides and swings are enjoyed. Visual skills should have improved to the point where things inspected by the eyes are not always touched. Language usage includes short sentences.

By 3 years
He can climb stairs with alternating feet. Eyes follow objects without any accompanying head movement. The eyes are used more than the hands when solving simple puzzles. Language usage has improved to the point where he asks and answers simple questions.

By 4 years
The midline wall should be completely gone. This means that the specialized areas of each brain hemisphere can develop and the hemispheres are able to communicate rapidly, leading to later efficient brain use. Balls can be thrown at targets and he can catch balls. Fine motor has developed to the stage where she can cut and colour between the lines. Self talk continues!

By 5 years
Most children will show hand, eye, ear and foot dominance – which hopefully will be on the same side. This might take until the 7th or 8th year in some children but it is always important to allow the child to decide by herself. Language should show basic, adequate grammar.

By 7 or 8 years
It is important at this age that the child is fully integrated, meaning that both sides and the body and brain work together efficiently. This allows the specialized areas of each hemisphere to be accessed for optimal learning and performance.
The symptoms of inadequate integration are poor concentration, inability to do more than one thing at a time, confusion over left and right and reversals.

This is a rather sketchy list, but these and other milestones are important indicators of healthy brain development.

Many children showing learning difficulties did not crawl correctly or for long enough. Some did not crawl at all. This will have affected coordination, focusing of eyes and the exploration of the space in the world surrounding them. Other children with learning problems regularly display difficulties in one or more of these developmental sequences. Some don’t put things in their mouth during babyhood. This lack of tactile experience means that they don’t learn enough about their own bodies. This means they can’t make sense out of the space around them due to being uncertain of their own bodies’ shape, size and ability to move. This flows over to two-dimension things like placing drawings or writing on a piece of paper. Children may try to do maths with crooked columns, or put numbers and words too far over on one side of the paper. They get mixed up as to which number is in what column when writing figures for number work.

Many children who are not learning ready still move their heads with their eyes when reading. They also cannot cross the midline, meaning that they lose their place in written work because their eyes ‘jump’. The presence of a midline beyond the age of 4 years is a noticeable characteristic of children experiencing school problems.

Lack of good balance and a stable posture are also telling signs of a developmental delay. A child who is unstable will have a risk of strained handwriting.

The good news

It is heartwarming to know that all of these areas can be attended to and corrected. Immature symptoms can be a guide for an informed professional as to what gaps need filling through a careful movement programme. It is especially worth noting that when the earlier sequences are taken care of, higher level functioning often spontaneously improves and might never need attention.

The key is to know whether there are signs of irregular development in your child and find help to intervene as soon as possible. Having an area of immaturity doesn’t mean that the child has some mental disorder. For this reason, ILT avoids labelling a child. Instead, we try to understand the root cause of an observed difficulty. Rather than diagnosing a ‘condition’, we give the brain a second chance by helping to develop areas that are needed to support a child’s learning and expected behaviour.

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For Parents and Teachers
Does your child need a Fiddle Toy?
Written by Dr Shirley K***t

Most of us like to fiddle and find it helps us focus. Some don’t and can keep quite still while attending to important matters. In general lots of children benefit from being allowed to engage in some subtle behaviours when rooted to their school desks and listening to the teacher. Those benefitting most from ‘fiddling’ tend to have problems with concentration. It’s become customary for helping professionals and even teachers to suggest fiddle toys to improve attention span.

But what kinds of fiddling would be most helpful, and following this, what kinds of fiddle toys would be really beneficial?

It’s easy to figure this out with a little knowledge of how the brain is structured and how it functions.

An area of the brain called the sensory cortex receives and processes information coming in through the senses, including hearing. So in order to attend and listen to spoken language, this area needs to be functioning well. A closer look at the sensory cortex (known as the homunculus) will show that the brain pays a great deal of attention to information coming in from the fingertips and hands. It also pays much attention to the lips and mouth. This is shown by the huge area of brain dedicated to processing information from these body parts.

In practical terms, this means that when we engage our hands or mouths, we are stimulating large areas of the sensory cortex – leading to better processing of, amongst other things, auditory information. We are even more efficient in processing information when we combine mouth and hand movements, such as you might see children doing when they continually put their fingers in their mouths.

This tells us that activities engaging the hands will help focus. So fiddle toys are useful.

But what kinds of fiddle toys?

A second fact to know about the brain is that for most efficient functioning, we need to use both sides of the brain. The specialised areas of the right and left brains are needed in order to hear and also understand what we are hearing. This means that a way of fiddling that will help to stimulate both hemispheres and improve rapid communication between the two brains will be most beneficial.

This would involve integrating the two sides of the body. As an example, rolling a pencil between the thumbs and fingers of both hands requires coordination of the hands and so good communication between the two brains. This is an excellent way of fiddling!
Less effective would be to twiddle a pencil in one hand, with the other lying idle. That would not allow for brain integration.

Other examples of excellent ways of fiddling that need the use of two hands working together:
• take a ball of plasticine or prestik or any other material and use both hands (thumb and forefinger) to mould it into a cube
• twist a paper clip or pipe cleaner into a design
• link the forefingers and make first the right finger pull the left finger and then switch. Repeat a few times, then link the remaining fingers in the same way, one at a time and have them each alternatively pull one another.

These activities need next to no financial investment yet can be hugely beneficial to improving focus through brain stimulation. They are also not causing visual or auditory distractions in class, nor causing envy and desire in young children.

From a neurodevelopmental perspective, fiddling is a valuable tool to use for improving brain function. Toys that fail to engage both sides of the body equally might be less effective. As with all therapeutic movements, it is seldom necessary to buy expensive equipment.

Integrated Learning Therapy (ILT) strives to uncover the root causes of puzzling behaviours and learning difficulties in children. Visit the website www.ilt.co.za to learn more about this approach and find a practitioner near you to help.

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For Parents and Teachers
Is your child ‘sound safe’?
Written by Dr Shirley K***t

Sound and hearing are vital aspects of being human, learning and functioning optimally in the world. If our ability to hear is hampered, the effects are widespread. A weakened auditory system may result in auditory sequential processing problems. This affects short-term memory – the important ability to link pieces of auditory information. Auditory processing can also lead to difficulties focusing listening – another symptom of auditory dysfunction. These weaknesses negatively affect communication, language learning and attention skills. It seems reasonable, in the light of this, to ensure that your child is ‘sound safe’.

There are two primary forms of hearing and listening impairment . Noise-induced hearing loss (NIHL) occurs when protracted loud sounds damage the inner ear. The delicate cilia hair cells in the inner ear are destroyed and cannot be repaired.

In addition, stress can interfere with the way we absorb sound. This is called Stress-induced auditory dysfunction (SIAD). An expert in auditory impairment claims that “Poor listening can begin at any age and for any number of reasons. “It might result from a health problem, an accident, a major lifestyle disruption or from stress.”

Hearing loss, be it noise or stress induced, with the addition of auditory dysfunction, can result in muddled thinking and out-of-balance emotions. For this reason, we need to become more sound aware. Sound can be healing, comforting and an aid to learning. In the form of noise, it can also disturb us and negatively affect our functioning. We need to help our children take precautions to protect their ears.

The word noise comes from the Latin nausea meaning seasickness. Noise generally refers to any loud, unmusical or disagreeable sound. Your classification of noise will, of course, depend on your subjective opinion. What you call loud and noisy may reflect your audiological health and personal taste. What I call unmusical and disagreeable depends entirely on my taste in music; one person’s noise is another’s delight.

Nevertheless, noise damages ears. Acoustic trauma happens when an extremely loud sound strikes in an instant. One blast from an explosion can rip apart the ears’ inner tissues, leaving scars that cause permanent damage. Noise-induced hearing loss (NIHL) develops more insidiously over a period of time. Repeated or extended exposure to dangerous noise levels attacks the delicate sensory cells in the ear. Their function is to transport airborne vibrations from the inner ear to the brain. Without them, hearing is inefficient. In addition, loud sounds cause constriction of blood vessels in the cochlea, which is the hearing organ in the inner ear. A lack of a proper blood supply may result in damaging changes in the inner ear.

For these reasons, workplaces try to protect workers from hazardous noise levels, but what is being done to protect children?

In human adults, 80 dB is the maximum sound intensity that will not produce hearing loss. Above 85 dB, you run a risk of damage which worsens with length of exposure and higher dB levels.

Here is a table showing the decibel levels of common noises:

Watch ticking – 20 decibels
Whisper – 30 decibels
Average conversation – 40 decibels
Dishwasher, microwave – 60 decibels
City traffic – 70 decibels
Noisy restaurant – 70 decibels
Vacuum cleaner – 80 decibels
Busy city pavement – 80 decibels

Then we move into danger zones:

Lawn mower – 90 decibels
Screaming child – 90 decibels
Power drill or chain saw – 100 decibels
Blow dryer – 100 decibels
Car ho**er – 110 decibels
Noisy video arcade – 110 decibels
Rock concert – 100–130 decibels
Jet engine at 40 metres – 140 decibels
Jackhammer – 180 decibels

While we can cope with a certain amount of noise (if our auditory system is healthy), we should avoid prolonged exposure. The next table shows a 1984 standard of noise-level safety based on decibels and time-exposure levels. It was created for the workplace and the duration per day may be higher than what is truly healthy for your children’s ears.

90 decibels – not more than 8 hours
92 decibels – not more than 6 hours
100 decibels – not more than 2 hours
102 decibels – not more than 1.5 hours
115 decibels – not more than 0.25 or less hours

So how do you teach your children sound safety? You don’t want to be paranoid but neither do you want them to innocently damage their wonderful auditory systems. The result of damage is not always hearing loss; sometimes damage substitutes sounds for others and they are replaced with tinnitus, or ringing or buzzing sounds in the head. Hearing damage is not something to take lightly.

Here are some precautionary measures:

• Limit exposure to sounds over 85 decibels. If you have to be exposed for longer, wear ear protection. Ear plugs must be worn to really noisy events such as rock concerts or firework displays. Earplugs are made of foam, silicone or wax and are designed to reduce noise levels from between 20 to 30 dB. Cotton wool doesn’t effectively diminish excessive sound waves.
• When using headphones, do the following: Keep the volume down. If your child listens with headphones to music with a ten-digit volume wheel set at 4 or higher, hearing loss may result. Limit listening to one hour at a time and let the ears rest. Be very careful if using headphones when exercising.
• Give the ears a rest. Alternate quiet and noisy activities. Don’t go to a noisy party or club after a loud sports event.

Our ears don’t actually bleed after a blast of fireworks or a rock concert. That doesn’t mean that we have incurred self-inflicted damage. Our society is an increasingly noisy one. Sound pollution means that we have to teach our children to be aware of sound and to practice sound safety.

Integrated Learning Therapy (ILT) practitioners take a keen interest in auditory functioning. If you would like to read more about our approach, visit our website www.ilt.co.za. We also have a list of practitioners around this country and others.

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For Parents and Teachers
Understanding an anxious child
Written by Dr Shirley K***t

You may wonder why your child is prone to anxiety. Why she so often resorts to tears, fears and avoidance behaviours. While there are many possible reasons for this, it is sometimes useful to consider the actual development of the brain and how this may contribute to becoming an anxious person.

A principle of brain development that was described by the neurologist John MacLean, demonstrates that the brain develops from the bottom to the top and from inside out. The more primitive systems, being the brainstem, pons and medulla, develop first. This makes sense because they are our survival systems, controlling unconscious functions like heartbeat, breathing and so on. The systems regulating our emotions (the limbic, thalamus, hypothalamus and so on) develop next. Finally, the cortical systems that act as an executive control centre including decision making, problem solving, attending, controlling impulses and more, complete development at about the age of 25 years. These are the ‘smart’ brain systems.

Brain scans and imaging have shown how the primitive brain systems take over higher systems in situations of danger or threat. This is due to the natural need to enhance our survival and explains why when faced with a threatening situation, we cannot think clearly or act rationally. Oxygen supply to higher brain systems is reduced so that more oxygen can be directed to muscles and other body parts required to protect ourselves by fighting or running away. When in imminent danger, we don’t need to stop to problem solve – we need to react instinctively to survive. This summarises the stress responses of fight or flight and is a useful mechanism when really needed.

The downside is that if the stress response is activated too much or too intensely at a very early age (within the first twelve months from birth), the development of neural pathways to the brain’s frontal systems becomes compromised.

The reasons for this are threefold. First, the primitive systems are activated very strongly and stronger wiring in the survival brain systems results in weaker wiring in the higher level ‘smarter’ brain systems. This results in the development of the ‘anxious brain’. Secondly, chemicals are produced that are linked to the primitive brain structures. These chemicals (adrenalin, cortisol and others) are geared towards enhancing primitive survival and inhibit chemicals such as serotonin, which is geared towards smart brain development. Thirdly, ongoing electrical activity (firing between neurons) in the primitive systems strengthen the neural connections so a viscous cycle results – with primitive brain areas being gradually more and more in control with less ability to use the higher level smart brain systems.

This is why a well developing brain needs a safe, enriched environment to develop. Secure, enriched environments downregulate the overactivation of primitive systems that result in an anxious brain developing. If the child’s environment is compromised, it constantly activates threat or risk of not surviving, leading to the protective behaviours that are seen in stress responses. It is simply devastating for healthy neural development. Remember too that it isn’t only an emotionally unsafe environment that can predispose a child to becoming anxious. Physically illnesses also convey a sense of dis-ease and insecurity so even in the most loving and attentive families, a child prone to illnesses may be at risk for developing an anxious brain.

In order to help, what is needed is a bottom-up approach. It doesn’t help to ‘talk’ a child out of being anxious. Remember that the higher brain systems aren’t functioning efficiently. You are not going to want to discuss philosophical matters while a snarling dog is rushing towards you. The child has to be helped to feel safe both physically (including health) and emotionally.

Some of the basic needs that should be met in order to promote development and wellness are:
• The need for control (having our survival needs met, such as being fed when hungry, comforted when distressed) and understanding the situation. The latter refers to a child needing help to appraise a situation and to understand why she feels as she does)
• The need for attachment (closeness of the primary caregiver; trust)
• The need for distress avoidance and pleasure maximization. (We are all motivated towards pleasant experiences and avoid unpleasant or painful ones. This includes physical, psychological, emotional or social states, which we automatically evaluate as either ‘good’ or ‘bad’.) A child needs more ‘good’ experiences than ‘bad’ in order to develop optimally.
• The need for self-esteem enhancement and self-esteem protection. A child needs to evaluate her or his worth as a person as valuable and worthy. Positive feedback from others and unconditional love are important to developing a healthy self-esteem.

Fortunately, we know that the brain is plastic and can be changed. Neural connections can be established or weakened so by contributing to the child’s sense of security, her brain can reorganize the neural networks and begin to shift the firing of primitive systems to those of the higher level systems.

Stress is a major factor in children with learning difficulties, which is why Integrated Learning Therapy (ILT) practitioners address signs of stress in our clients. For more information about ILT, visit our website www.ilt.co.za. We also list practitioners around the country and elsewhere if you are looking for help.

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For Parents and Teachers
What may cause concentration problems?
Written by Dr Shirley K***t

Teachers have so many roles to play and balls to juggle that for many, life can seem overwhelming for much of the time. Added to that is the expectation that they have to be able to meet the needs of children with a wide variety of abilities and challenges. No wonder they feel unraveled by the end of term!

But is there something they can do to perhaps better understand the causes of the frustrating behaviours they are faced with in their classrooms every day? When some children continually daydream, fail to listen, seem to be unable to follow simple instructions and are incapable of completing any work, it is understandable that their thoughts turn to ‘ADHD’. Perhaps this is a mistake.

South Africa is reputed to have one of the highest rates in the world of prescribing medication for ADHD. Parents are lamenting that sometimes a third of their child’s class is on some or other psychostimulant or other brain-altering drug to control difficult behaviour.

It is easy to believe that ADHD is a widespread mental disorder but that is a fallacy. In our work, Integrated Learning Therapy practitioners and teachers who have studied with us see how other underlying causes can be ignored in favour of an ‘easy’ diagnosis, with a seemingly quick fix of a drug to quieten children down and calm the classroom. When we take the time and the trouble to investigate more closely, we have found there are many other causes for children’s inability to behave appropriately and learn efficiently.

Some of these causes are due to neurodevelopmental problems, meaning that brain development did not proceed optimally. These we can identify and correct. Other causes are linked to nutrition intolerances and poor diets. Others may be due to lifestyle, anxiety and so on.

My wish is that teachers could be better equipped with the knowledge and skills to understand what lies beneath the surface. We see the iceberg, but have no understanding of what is invisible to us below the level of the water.

Integrated Learning Therapy is an eco-systemic approach that has been helping children for nearly twenty years now to shed the label of ADHD and other incorrect diagnoses. Teachers who understand our approach stop insisting that children have a mental condition and pushing parents towards medications. Schools have made changes to tuck shops and lunch boxes too and even added brief periods of movement to help children’s behaviour improve. This is the natural, sensible and intelligent approach to the torrent of behavioural challenges we experience in the classrooms.

Visit our website www.ilt.co.za for more information about us and articles to explain our approach. Pactitioners that can help unravel the causes of a child’s puzzling behaviour are also listed.

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For Parents and Teachers
Close the gap: using food to help learning problems
Written by Dr Shirley K***t

When I meet a child with learning or behavioural difficulties, their parents very often tell me that the child has no nutritional problems and no symptoms of an unhealthy gut. This is ironic, because I’ve very seldom met a child with sensory processing irregularities, ADHD and other learning difficulties who has an adequate diet, no bowel or malabsorption problems, or all of these. It does happen but so rarely that these days, nutrition is being considered an essential part of the treatment plan.

Slowly but surely, people are accepting that nutrition drives not only physical development but learning ability as well. Children need an adequate diet and healthy intestines to absorb those diets in order to grow and have efficiently functioning brains. It does happen that a child shows no clear symptoms of nutritional imbalances but these can be disguised in subtle ways. When a learning or puzzling behaviour is the symptom of a child’s difficulties, It is always worth looking deeper into his or her nutritional status.

Using food as a therapy is not an easy matter and a haphazard, trial and error approach will seldom bring significant results. If your current family doctor, paediatrician, nutritionist or dietician is not fully on board to help you with current, evidence based approaches to restore health to your child’s body and brain, then you may want to look further. Try finding a Functional or Integrative Medical practitioner to give you an opinion. They are trained in medicine but specialise in looking at the individual in an holistic way – seeking to treat for health rather than tackling the symptoms of a disease or other problem. You’ll find them with a Google search.

Individualised nutrition is best

Special diets and supplements for children with ADHD, autism and other disorders have been popular for several years but there is no consensus about whether they really work. This is because nutrition care must be individualised to work best. It is important to go through a process that identifies what would work best for a particular child. There is no one special diet (or even one medication) that works for all children.

To help you to begin, here are some steps to follow in the order given

1. Check your child’s basic nutrition status first. Make sure that your child is growing as expected and that his or her current food intake is adequate. Some developmental, learning or behaviour challenges can be due to insufficient total food intake so it is really important to complete this step first. You may need help if you are unsure as to what comprises an adequate diet and growth rate for a child but you will find guidelines on the internet or from your health practitioner. So often picky eating accompanies learning problems – but while maintaining body weight may be possible on a diet of milk and wheat products, for example, other nutritional essentials may be missing.

2. Correct bowel flora. Bowel flora are the bacteria and other microbes that humans need in the digestive system to help digest and absorb food and to fend off invasive viruses, parasites or detrimental bacteria. Good bowel flora is also essential for optimal immune system functioning. Antibiotics, toxic metal exposures (lead, mercury, etc) and certain viral or bacterial exposures can disrupt the health of the gut. Restoring a healthy gut may need cutting out certain inflammatory and other foods and giving a good probiotic.

3. Replace foods that your child doesn’t tolerate with foods of equal or better nutritional value. The usual suspects are gluten, casein (the protein found in dairy products) and soy. You may consider having tests to identify exactly which foods are most inflammatory for your child’s immune system or digestive tract. A common mistake is to replace cow’s milk with other milks made from rice, almonds or even potatoes. While these are suitable for baking or cooking, they are nutritionally low in value. Children rely on fluid milk for protein and fats so are not adequate substitutes. Try instead to replace the protein and fats with other foods that contain adequate amounts. Very often, the food your child craves is the one that may be causing problems in the gut – be prepared for some resistance.

4. Replace micronutrients – that is, vitamins and minerals. Don’t supplement blindly – you need to know which are needed. Ways of finding out are using clinical signs and symptoms that the child shows or having tests done.

5. If your child shows distinct signs of digestive tract problems that have not resolved after you’re used the first four steps for at least four to six weeks, you’ll need to revisit the first three steps with the help of a professional. Your child may need to be checked for gut inflammation or disruptive gut microbes, which may need aggressive dietary restrictions and additions.

6. If your child is on the autistic spectrum, your medical practitioner would probably have advised you to consider heavy metal screening and treatment. If not, you need to ask for this to be done.

If you implement the first four steps yourself, prepare to wait six to eight months to see dramatic changes. If you don’t see any, something will be missing. In this case, you’ll need to dig deeper with specialized professionals helping you.

For children, growth comes first. For this, they need macronutrients which include proteins, fats/oils, and carbohydrates. While adults can get away with big deficits in any of these for a while, children simply can’t.

Micronutrients include vitamins and minerals, supplemented by available products, ideally after proper diagnosis has been made of which the body needs. It seems easier to simply give the child supplements. Indeed, if the child responds to a supplement, should you give up other efforts to balance his or her nutrition? The answer is NO. If the basics aren’t met with an adequate diet, children simply do not function well, no matter how many supplements they eat. You have to fix the food part, full stop. Supplements (except for omega-3 oils and probiotics) can’t stop inflammation or toxins from the wrong foods, and can’t fix growth deficits caused by imbalanced total food intakes.

The link between food and learning difficulties is well established. The question of addressing food intolerances, nutritional imbalances, unhealthy gut and picky eating isn’t an easy one. Parents and professionals struggle with stubborn children who simply refuse to eat healthily. The key is to persevere. Most children will take medication on the firm insistence of a parent. Well, food is the best medicine, so insisting that it is taken, if only in very small quantities to begin with, needs the same firm approach.

ILT practitioners focus closely on the role of good nutrition. See our website to find a practitioner or for more information about our approach. www.ilt.co.za.

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