Lecture on the Neuro-Developmental-Functional Approach and the
Children-Friendly School and Kindergarten Classes
Rami Katz
It won't be an easy task to describe the Neuro-Developmental-functional Approach (NDFA) in a very short time, so I'll try to address some of the main points and give examples, to show you how we think and what we do.
Our program uses a community-approach, which allows us to respond to the needs of large populations, particularly in disadvantaged neighborhoods, via community-based institutions such as the educational system.
Therefore, we address the educational staffs – who attend to the children on a daily basis, many hours every day, year after year – and introduce them to the Neuro-Developmental-Functional Approach.
Although our main focus is on our work with the educational staff, the program addresses the parents as well. Through many meetings between the parents and their children's educators, and many visits to the kindergartens and schools, including special workshops held there, a halo effect is created. The parents learn the principles of the NDFA, and can apply them at home with the kindergarten or school child and his or her siblings.
In teaching the NDFA to educators, we wish to achieve 2 goals:
Achieving these 2 goals – understanding and accepting every child, and providing a favorable educational environment – creates our Children-Friendly Classes.
Now, what is the Neuro-Developmental-Functional Approach?
The NDFA is first and foremost "developmental". "Developmental" refers to the way we look at a problem in the here and now, but our assessment is in terms of its roots, causes, and how it emerged.
Searching for the root of the problem is very different from naming the problem. Therefore we are not too interested in finding a name or a label. Unlike the common practice, we do not believe that labeling a problem – is diagnosing it.
If, for example, I bring my child to a specialist, and the child moves around all the time and can't sit quietly, and the specialist observes him carefully and reviews the teacher's Connors report describing the child's behavior in class, and then declares: "your child is hyperactive!" – I immediately respond that the fact that my child is hyperactive – or in other words, more active than others – is why I brought him here in the first place!
In our approach, we may find that there are many kinds of hyperactivity – according to the different basic functions underlying the problem.
This means that "hyperactivity" is just a word that describes an overt behavior, but it does not clarify the developmental functional causes that led to this behavior.
Our diagnosis – aims to reveal these developmental functional causes.
For example – one of the common functional causes of hyperactivity – is a deficiency in regulating the deep muscle and joint sensation – the proprioceptive sensation.
Our brain constantly receives information from our joints and muscles through the proprioceptive channel, enabling it to organize all of our movements.
There are many adults and children whose attention system does not regulate the proprioceptive input efficiently, so that they suffer proprioceptive deprivation. As a result, their brain demands stronger activation of muscles and joints, and what we see – is excessive physical activity, bear-hugs, and rough‑housing – behaviors which are labeled hyperactivity.
Therefore the real problem of hyperactive children is not their overt behavior.
Their real problem is an inefficient proprioceptive sensation, and their behavior is their solution to this problem. They use strong movements – in order to feel their body! That is why the treatment we provide – does not address their overt hyperactive behavior – but rather is directed towards improving a more basic developmental function: regulating their attention to their muscles and joints! If they'll feel their body better – they won't need the excessive activity, and they will calm down!
As you see, this example demonstrates the essential purpose of the Neuro‑Developmental diagnosis, which is to search for the developmental causes and roots of the problem, in contrast to an effort to simply label it.
Another example that emphasizes the advantage of a developmental approach refers to a 4-year-old child who came to my clinic because of a severe language and speech problem. This child came from a healthy and supportive family. They brought with them a very detailed description, provided by the speech therapist, of the child's current lingual status in terms of the phonetic, morphological, syntactic, semantic, and pragmatic aspects of language and speech. The only thing that was missing in this detailed report of his current language functions – was an attempt to understand the developmental background of the problem.
The parents had been advised to work with the child by teaching him the different aspects of language. In other words, they were told to address the problem at its current developmental stage.
However, a neuro‑developmental diagnosis revealed that from birth, the child was very hypersensitive auditorily. He couldn't stand loud sounds, including the voices of his parents. He persistently tuned himself out, and isolated himself from sounds, including those of speech and language. Since he'd had no experience listening to language, he hadn't developed normal lingual comprehension or speech.
Therefore, the focus of treatment had to be on the early developmental function of auditory attention, by reducing his auditory hypersensitivity, rather than on his current use of language.
As soon as we treated this early problem, he began listening to spoken language, and began acquiring it. In a matter of months we saw a breakthrough in his ability to comprehend and speak.
I want to give yet another example, and this time we will follow the different causes that lead to the same label. I'm referring to the dysfunction called dyslexia.
Here we'll see that the advantage of the developmental approach is that it enables precise understanding of the problem, and consequently it can offer effective treatment and prevention.
A dyslectic may be defined as someone who has problems learning to read, has difficulty attaining a functional level of reading, unrelated to conditions like mental disability, blindness, deafness, or any other major disability, nor to a severely disadvantaged social or familial background, and for whom common teaching methods failed.
Now, it's wonderful that we have the word dyslexia, for the purpose of convenient and fast communication, instead of using a long descriptive sentence such as the one you've just heard. But does this word really diagnose someone's reading problem? Of course not! This word is only a label for the problematic condition, because in fact, there are many different types of dyslexia – each type is connected to a distinct developmental background.
Let's see: Here we have a dyslectic child who is unable to read and whose problem is connected to difficulties in phonetic discrimination and in sequencing of the speech sounds. Due to deficiencies in the development of his auditory attention, he may not be able to distinguish between different sounds, and therefore he has problems linking the appropriate sound to its graphic symbol - the letter. So, as a result, he has a reading problem.
To help him, we'll have to address his auditory and phonetic problems.
Next to him, there is another child who is also dyslectic, but she has excellent phonetic discrimination. Her problem is different. She suffers from hypersensitivity of the vestibular sensation. (Our vestibular organs are located in the inner ears, and help regulate balance, muscle tone, eye movements and more). Due to the reflex connection between the vestibular system and eye movements, she has an aroused vestibular nystagmus (that is to say - jerky movements of the eyes).
When she reads along the printed lines, her eye movements become jerky, and the letters jump around, resulting in scrambled words and sentences – which makes reading a nearly impossible task. If we try to treat her by addressing her auditory and phonetic abilities, as we did with the first child, it won't help her at all! To help her we must work on reducing her vestibular sensitivity!
And there is a third child, who gets dazzled by the reflection from the white page on which the black letters are printed. The letters begin to fade or become blurred. This child fails to read because of his visual sensitivity to all or part of the various wavelengths of the light spectrum. His problem must be addressed by treating his visual sensitivity!
The fourth and last child we'll describe (although there are still many more kinds of dyslexia) – can see the page and the letters clearly, and can even copy them easily. He discriminates between different sounds without a problem, and he doesn't have a vestibular problem. But, he has great difficulty retaining in memory the link between the sound and the graphic letter. He should be treated by improving the brain's bi‑lateral integration, through exercises that emphasize bi-lateral coordination and crossing the midline.
So, what do all of the examples described here tell us on the practical level?
We said that according to the NDFA naming the problem is not enough.
Sometimes naming can be a hindrance – as when it creates prejudice and stigma.
In order to really do something to advance the child's functional abilities, we have to recognize the sequential development of each function.
The NDFA opens up for us – educators, therapists and parents – three important paths for action:
1. Treatment.
2. Prevention.
3. Advancement of functional capacities for all children.
Let us demonstrate these three paths by using our example of reading and dyslexia (although in practice – we apply them to all areas of function and development):
1. The 1st path for action is treatment. When we meet a child who has already failed in reading (or in any other area of development) – we will use the NDFA to identify the historic developmental obstacle – at its location on the developmental continuum, and direct our treatment to that developmental stage.
(In our former examples, if we find at the root of the reading deficiency - auditory and phonetic problem, or we find vestibular or visual sensitivities – we'll treat the reading deficiency accordingly. Or another example: if the child has a severe social problem, and we find a basic tactile hypersensitivity – in other words, the child cannot tolerate touch, and keeps a distance from other kids, or attacks them defensively – we'll treat the social problem by reducing the tactile sensitivity).
2. The 2nd path for action is prevention. Since we are familiar with the sequence of early functions required for reading (as an example) – we can look for signs of deficiency in these early functions that are precursors to reading, in children in preschool and kindergarten.
Then we can work with them to build and rehabilitate these early functions – way before they even begin to learn to read. Thus we work at the level of prevention.
3. Most important, is the 3rd path for action – advancement of functional capacities for all children. Since we are familiar with the sequence of basic functions required for reading (or for other important capacities), we can incorporate these function-building experiences into the children's daily kindergarten and school routine, and thus help all children advance their competence in all areas!
This is what our program actually does in the regular kindergartens and schools.
Of course, as I mentioned before, we address not only those functions related to the development of reading. We consider a very wide spectrum of functions - that relate to areas of communication, inter-personal-relationships, social-play, emotion, behavior, learning, and movement.
The convergence of the NDFA and the expertise of educational professionals - makes it possible to integrate the materials of any curriculum into the practice of a wide variety of basic function-building experiences.
It is important to understand that for children, participating in these activities which contribute to the development of their functional capacities – is play!
- Play, which unfortunately, in our modern way of life, is heavily constrained.
This integration between function-building experiences and the educational curriculum – makes the children's learning full of play and fun – and creates the children friendly classes.
