**2.3 Towards a science of learning disabilities**

The concept 'organic' is used to describe structural or 'real' diseases/disorders, "of known structural, chemical, or metabolic origin", in the domain of the neurologist as opposed to functional disorders, for example psychosomatic diseases/disorders, mainly treated by psychiatrists (Black's Medical Dictionary, 1990; The Merk Manual, 1989; Bloom & Lazerson, 1988). Body image (Schilder, 1964), for example, is based on physiological data and on the structural organization of the organism, but the final synthesis comes from the personality. However, as Bloom and Lazerson (1988) claim, the organic nature of a brain problem might be diagnosed as functional, whilst not being totally functional, due to an inability to measure the appropriate index. I will return to this problem below.

Mabel Todd, a contemporary of Larsen, Kahn and Cohen, defined proprioceptive sensations as organic (Todd, 1937) and grouped them into three types according to their origin (1). Kinesthesia, the feeling of movement. (2). Vestibular sensations, the feeling of position in space. (3). Visceral sensations, impressions from internal organs. In 1870, Ewald Hering (Finger, 1994) already used the term some what differently, in connection with memory, suggesting that 'organic memory' was more than just a part of the higher nervous system although his extension of these ideas was, and still is, very questionable. However controversial, I will return to 'organic memory' later.

In the mid 1930s, Orton made the suggestion (Ahonen, Kooistra, Viholainen, & Cantell, 2004) that 'dyspraxia' or abnormal clumsiness was a developmental disorder to be found among dyslexic children. Not only were these children late in learning to walk and run, they were also late in visuomotor and manual tasks. In his book 'Reading, writing and speech problems in children' (1937), Orton developed the idea that clumsy children could have

Could Motor Development Be an Emergent Property of Vestibular Stimulation

the floor with his eyes shut" (p.907).

learning disabilities is forthcoming".

**2.4 The present situation** 

and Primary Reflex Inhibition? A Tentative Approach to Sensorimotor Therapy 245

"A boy, aged 14, with an IQ of 139, had during the past year the lowest marks in all written subjects and gymnastics, low marks for conduct since, amongst other things, his exercise books were always full of ink-blots, etc., that it was considered due to carelessness. He showed an intense dislike of school and wanted to be a farmer. /His movements were slow, he wrote slowly and unevenly, and did up buttons slowly. He found it difficult to carry out any movements that could not be controlled visually, and could not walk on a strait line on

Under the heading 'Clumsy Children', an editorial in British Medical Journal (1962) did a follow up of Anna-Lisa Annell's article. The editor compared her observations with more recent research and concluded that clumsy children are not uncommon and, "The worst

In his book 'Reading and remedial education' (1967), the British educator A.E Tansley claimed that possible damage to the nervous system existed among children with reading and writing difficulties. A 'softer' formulation would be that there could be a physiological origin to their problems. Tansley emphasized the importance of reading readiness. Teachers, he argued, are often too anxious about getting a child to read and might push him before he is ready. It is therefore important that teachers and parents are trained to see signs of readiness. The child should have a readiness in (1) language development, (2) physical and sensory development and in (3) emotional and social development. In his book he outlined a 'remedial' treatment of a child's inability. He preferred the term 'remedial' because the treatment given is psychological, educational, social and medical relating to a scientific diagnosis of the reading disability. As the field of learning disabilities slowly grew, Ozer (1968) found it necessary to put forward the need for a more accurate neurological examination of the child with learning disabilities. This examination did not only focus on motor function, but also compared the child's brain function to its learning capacity. Still in the 1970s, when the first generation of youngsters diagnosed as learning disabled grew up (Orenstein, 2000), a true science of learning disorders seemed unreachable (Pennington, 2009). However, Chruickshank (1981) suggested a novel perspective for teacher training and proposed the 'Neuroeducator'. Thirty years later though, as far as I know, only the University of Portland, School of Education, Oregon, USA is offering courses and a Postmaster Certification in 'Neuroeducator'. The requirements set by Chruickshank were (1) an understanding of human anatomy, (2) a solid understanding of human neurology and neurophysiology, (3) a basic understanding of intelligence, (4) a basic understanding of perception and the psychology of learning, (5) an understanding of movement education and an understanding of (6) speech communication. He also required the student's ability to communicate the child's problem accurately to its parents. Mycklebust added in his article 'Toward a Science of Learning Disabilities' (1983) that the evolving definition would come to include references to both verbal and non verbal learning and concluded; "A science of

Today, different kinds of learning disabilities constitute a serious, worldwide problem. About 10% of school-age children are affected (Levin, 2003) and Orenstein (2000) estimates that as many as 20% of adults suffer from different kinds of Undiagnosed Learning

thing we can do is to call him naughty when he has a physical handicap" (p.1666).

difficulties both in learning more complex body movements and in learning movements which are necessary for speech and writing. The following citations from Orton will serve as a background and as a bridge to my argumentation for sensorimotor therapy which follows below;

"Such children are often somewhat delayed in learning even the simpler movements such as walking and running, and have great difficulty in learning to use their hands and to copy motions showed to them. They are slow in learning to dress themselves and are clumsy in their attempts to button their clothes, tie their shoes, handle a spoon, and in other simple tasks"(p.121) .

"In the case of children who have great trouble in learning complex patterns of movement – the developmental apraxias – simpler movements are often readily acquired although they may be lacking in grace or smoothness. Here the controlling sensory element is that of kinaesthesis or the registration of movement patterns" (p.148).

"Our attention has been directed to attempting to determine very simple patterns of movement over which the child has a reasonable mastery, and gradually combining these simpler patterns into more complex and difficult ones. Here again we have been guided by the belief that it is in such re-combinations of simple movements that the crux of the apraxic child's difficulty rests" (p. 191).

"It is common to assume that the simple, largely reflex patterns of movement which enter into walking and running, for example, are sufficiently well acquired by the child without training so that in the more difficult sports, such as tennis, attention need be given only to the special instruction for that game and this, of course, is true of most children. In those with a measure of apraxia in their make-up, however, this assumption is not justified and much better headway might be made by spending some time teaching the child how to run and turn and stop without losing balance, before specific training in the sport is begun" (p.192).

Today it is obvious that learning difficulties are not to do with whether one is intelligent or not but it is very likely that many children have been and still are being misunderstood. Annell (1949) described in an article a group of children with motor dysfunction. In a cohort of 600 children aged 6 to 17 yrs, either in the ward or out-patients of the Department of Child Psychiatry in Uppsala, Sweden, 78 children (61 boys and 17 girls) or 13% had motor dysfunctions. Of these children, 57 (47 boys and 10 girls) had an average or above average I.Q. Besides having difficulties in ordinary life activities (things such as threading needles, eating without spilling and doing up buttons) they often had a history of late speech development. The children briefly described in these vignettes (Annell, 1949) are recognizable even today.

"Briefly, this 8-year old boy had the physical development of an 8-year-old, the speech development of a 14-year-old and the motor development of a 5-year-old. In his class at school he is in some respects far ahead of his class mates, but as regards motor activities he is far behind them and has no normal contact with them. He tries, when such subjects are studied in school in which his motor retardation is apparent, to compensate his weakness by clowning or by distracting interest from the work he is to do" (pp.906-907).

difficulties both in learning more complex body movements and in learning movements which are necessary for speech and writing. The following citations from Orton will serve as a background and as a bridge to my argumentation for sensorimotor therapy which follows

"Such children are often somewhat delayed in learning even the simpler movements such as walking and running, and have great difficulty in learning to use their hands and to copy motions showed to them. They are slow in learning to dress themselves and are clumsy in their attempts to button their clothes, tie their shoes, handle a spoon, and in other simple

"In the case of children who have great trouble in learning complex patterns of movement – the developmental apraxias – simpler movements are often readily acquired although they may be lacking in grace or smoothness. Here the controlling sensory element is that of

"Our attention has been directed to attempting to determine very simple patterns of movement over which the child has a reasonable mastery, and gradually combining these simpler patterns into more complex and difficult ones. Here again we have been guided by the belief that it is in such re-combinations of simple movements that the crux of the apraxic

"It is common to assume that the simple, largely reflex patterns of movement which enter into walking and running, for example, are sufficiently well acquired by the child without training so that in the more difficult sports, such as tennis, attention need be given only to the special instruction for that game and this, of course, is true of most children. In those with a measure of apraxia in their make-up, however, this assumption is not justified and much better headway might be made by spending some time teaching the child how to run and turn and stop without losing balance, before specific training in the sport is begun"

Today it is obvious that learning difficulties are not to do with whether one is intelligent or not but it is very likely that many children have been and still are being misunderstood. Annell (1949) described in an article a group of children with motor dysfunction. In a cohort of 600 children aged 6 to 17 yrs, either in the ward or out-patients of the Department of Child Psychiatry in Uppsala, Sweden, 78 children (61 boys and 17 girls) or 13% had motor dysfunctions. Of these children, 57 (47 boys and 10 girls) had an average or above average I.Q. Besides having difficulties in ordinary life activities (things such as threading needles, eating without spilling and doing up buttons) they often had a history of late speech development. The children briefly described in these vignettes (Annell, 1949) are

"Briefly, this 8-year old boy had the physical development of an 8-year-old, the speech development of a 14-year-old and the motor development of a 5-year-old. In his class at school he is in some respects far ahead of his class mates, but as regards motor activities he is far behind them and has no normal contact with them. He tries, when such subjects are studied in school in which his motor retardation is apparent, to compensate his weakness by

clowning or by distracting interest from the work he is to do" (pp.906-907).

kinaesthesis or the registration of movement patterns" (p.148).

below;

tasks"(p.121) .

(p.192).

child's difficulty rests" (p. 191).

recognizable even today.

"A boy, aged 14, with an IQ of 139, had during the past year the lowest marks in all written subjects and gymnastics, low marks for conduct since, amongst other things, his exercise books were always full of ink-blots, etc., that it was considered due to carelessness. He showed an intense dislike of school and wanted to be a farmer. /His movements were slow, he wrote slowly and unevenly, and did up buttons slowly. He found it difficult to carry out any movements that could not be controlled visually, and could not walk on a strait line on the floor with his eyes shut" (p.907).

Under the heading 'Clumsy Children', an editorial in British Medical Journal (1962) did a follow up of Anna-Lisa Annell's article. The editor compared her observations with more recent research and concluded that clumsy children are not uncommon and, "The worst thing we can do is to call him naughty when he has a physical handicap" (p.1666).

In his book 'Reading and remedial education' (1967), the British educator A.E Tansley claimed that possible damage to the nervous system existed among children with reading and writing difficulties. A 'softer' formulation would be that there could be a physiological origin to their problems. Tansley emphasized the importance of reading readiness. Teachers, he argued, are often too anxious about getting a child to read and might push him before he is ready. It is therefore important that teachers and parents are trained to see signs of readiness. The child should have a readiness in (1) language development, (2) physical and sensory development and in (3) emotional and social development. In his book he outlined a 'remedial' treatment of a child's inability. He preferred the term 'remedial' because the treatment given is psychological, educational, social and medical relating to a scientific diagnosis of the reading disability. As the field of learning disabilities slowly grew, Ozer (1968) found it necessary to put forward the need for a more accurate neurological examination of the child with learning disabilities. This examination did not only focus on motor function, but also compared the child's brain function to its learning capacity. Still in the 1970s, when the first generation of youngsters diagnosed as learning disabled grew up (Orenstein, 2000), a true science of learning disorders seemed unreachable (Pennington, 2009).

However, Chruickshank (1981) suggested a novel perspective for teacher training and proposed the 'Neuroeducator'. Thirty years later though, as far as I know, only the University of Portland, School of Education, Oregon, USA is offering courses and a Postmaster Certification in 'Neuroeducator'. The requirements set by Chruickshank were (1) an understanding of human anatomy, (2) a solid understanding of human neurology and neurophysiology, (3) a basic understanding of intelligence, (4) a basic understanding of perception and the psychology of learning, (5) an understanding of movement education and an understanding of (6) speech communication. He also required the student's ability to communicate the child's problem accurately to its parents. Mycklebust added in his article 'Toward a Science of Learning Disabilities' (1983) that the evolving definition would come to include references to both verbal and non verbal learning and concluded; "A science of learning disabilities is forthcoming".

#### **2.4 The present situation**

Today, different kinds of learning disabilities constitute a serious, worldwide problem. About 10% of school-age children are affected (Levin, 2003) and Orenstein (2000) estimates that as many as 20% of adults suffer from different kinds of Undiagnosed Learning

Could Motor Development Be an Emergent Property of Vestibular Stimulation

the discussion below.

(p.191).

been considered? If so, what could they be?

**2.5 A complementary approach** 

and there is a change of the whole system (Ahrenfelt, 2001).

and Primary Reflex Inhibition? A Tentative Approach to Sensorimotor Therapy 247

and that the connection is sociological rather than biological. In their example, a correlation between obesity and non-cognitive inabilities might follow if a child is excluded from sports and social activities. Cawley and Spiess (2008) claim to have identified such a connection among children aged only 2-3 years. Although a sociological explanation seems good enough, from my point of view, it is equally likely that it might be the other way around. A child who is unable or finds it uncomfortable to move is more likely to remain outside of social fellowship. Interestingly, Lundberg *et al.* (2011) conclude that although there is a correlation between obesity, non-cognitive abilities and wages there might also be other underlying, not yet considered variables affecting all three. Such variables could be parental characteristics or aspects of up-bringing, equally affecting all siblings. I will return to this in

Generally, learning disabilities are thought about and labeled as cognitive and, accordingly, special education seems to aim at teaching children strategies to overcome their problems, which is of benefit to some. For others, however, the difficulties more or less remain and we have to ask why this is the case. Are there factors which up until now have not properly

During the last centuries, focus on cognition, teaching, information and instruction has increased. The importance of early learning is a mantra within both politics and science, and parents are instructed how to begin to teach their children as early as possible. At the same time, more children are less mobile and less time is spent playing spontaneously. Is there a too strong belief today that what comes from the outside i.e., in teaching, information, and instruction goes in? I don't have the answer but I would like to counterbalance with a reintroduction of the concept 'education' and suggest a complementary approach. Throughout history (Arendt, 2006, Furedi, 2009, Ecclestone & Hayes, 2009) and up to the present day, the schooling of children has been a matter of values and also a matter of emphasizing education, learning or training depending on the aim of the schooling and the basic assumption of what a child really is. Arendt (2006) writes; "To educate, in the words of Polybius, was simply 'to let you see that you are altogether worthy of your ancestors' "

The word 'education' is etymologically derived from the Latin word e-duco meaning 'bring out' and suggests according to Kegan (1994) "a 'leading out from' ". My view is in line with Kegan's who writes that the focus of information is to change what people know while "*education* leads us out of or liberates us from one construction or organization of mind in favor of a larger one" (p.164). This might be very close to what Watzlawick, Weakland, and Fish (1974) and Ahrenfelt (2001) define as a first-order change as opposed to a second-order change. A first-order change (Watzlawick *et al.,* 1974) follows a 'more of the same' strategy based on common sense. It will be a 'renewal' of what is already there (Ahrenfelt, 2001). On the other hand a "second-order change usually appears weird, unexpected, and uncommonsensical; there is a puzzling, paradoxical element in the process of change" (p.83)

My first assumption, which is connected to information, is that many of the remedial

teaching methods used today might create changes which are more of a first-order.

Disabilities (ULD). Using the broader term 'learning disorders' (Pennington, 2009) to connote "any neurodevelopmental disorder that interferes with the learning of academic and/or social skills" (p.3), Pennington reviewed Dyslexia, Speech and Language Disorders, Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Intellectual Disability, Developmental Coordination Disorder (DCD), Mathematics Disorder and Nonverbal Learning Disorder.

ADHD is recognized as a functional deficit that affects approximately 5% of the global population (Polanczyk, de Lima, Horta, Biederman & Rohde, 2007) and many children diagnosed with ADHD are described as awkward or clumsy. They exhibit motor-perceptual difficulties (Yochman, Ornoy & Parusch, 2006) and match the criteria of DCD (Feng, Cheng & Wang, 2007; APA, 1994). A Swedish study (Kadesjö & Gillberg, 1998) showed that almost 50% of the children matching the full criteria for ADHD (DSM-III-R), also matched the criteria for DCD. Gillberg (2010) has recently pointed out that within this field, the coexistence of disorders is a rule rather than an exception. Largely, DCD is equivalent to what was previously called 'Clumsy Child Syndrome' and refers to children whose motor development is delayed irregardless of whether neurological causes are evident. Between 5 and 9 % of all school children are affected (Cairney, Hay, Wade, Faught, & Flouris, 2006). Learning disabilities and emotional immaturity become more apparent over time, and as adolescents these children evince social, emotional, and academic difficulties to a greater extent than others. They also run a higher risk of starting to use alcohol (Rasmussen & Gillberg, 2000) and according to Levin (2003), 10% of adult psychiatric patients suffer from learning disabilities. In her book 'Smart but stuck', Myrna Orenstein (2000) uses the concept 'imprisoned intelligence' in the sense that ULD can cause feelings of shame because of the inability to fully achieve academically and the constant feeling of being inferior. Although in some circumstances shame can serve a positive purpose, for children and adults with learning disabilities who never fully succeed the outcome is negative. As another consequence of learning disabilities, whether diagnosed or undiagnosed, shame is of great importance not least because together with guilt, they are both (Nathanson, 1994) symptoms within the field of depression. Polatajko (1999) writes about low self-esteem and secondary emotional or behavioral problems in relation to children's motor problems. There is some evidence to show that a consequence of DCD may be internal disorders (De Raeymaeker, 2006; Cairney, Veldhuizen, & Szatmari, 2010) and still another consequence of DCD (Faught, Hay, Cairney, & Flouris, 2005) is an increased risk of coronary and vascular disease. Although it is likely that the DCD spectrum includes thin and energetic individuals as well as those who are more or less obese and less mobile, it is the latter who are probably more at risk. This view is proposed in three articles published in economyorientated journals.

According to Lundberg, Nystedt and Rooth (2011) there is a correlation between obesity during adolescence and wages later on in life. Of equal importance, the reasons seem to be on one hand family habits during childhood and on the other hand low physical fitness and a lower non-cognitive ability. Non-cognitive abilities are described as being self confidence, ability to interact and cooperate, motivation, time preferences and endurance. Lindqvist and Vestman (2011) confirmed in their study that non-cognitive abilities, as measured above, were as important as cognitive abilities in their impact upon salary levels. Lundberg *et al.* (2011) explain that non-cognitive abilities and obesity have only recently been correlated

Disabilities (ULD). Using the broader term 'learning disorders' (Pennington, 2009) to connote "any neurodevelopmental disorder that interferes with the learning of academic and/or social skills" (p.3), Pennington reviewed Dyslexia, Speech and Language Disorders, Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Intellectual Disability, Developmental Coordination Disorder (DCD), Mathematics Disorder and

ADHD is recognized as a functional deficit that affects approximately 5% of the global population (Polanczyk, de Lima, Horta, Biederman & Rohde, 2007) and many children diagnosed with ADHD are described as awkward or clumsy. They exhibit motor-perceptual difficulties (Yochman, Ornoy & Parusch, 2006) and match the criteria of DCD (Feng, Cheng & Wang, 2007; APA, 1994). A Swedish study (Kadesjö & Gillberg, 1998) showed that almost 50% of the children matching the full criteria for ADHD (DSM-III-R), also matched the criteria for DCD. Gillberg (2010) has recently pointed out that within this field, the coexistence of disorders is a rule rather than an exception. Largely, DCD is equivalent to what was previously called 'Clumsy Child Syndrome' and refers to children whose motor development is delayed irregardless of whether neurological causes are evident. Between 5 and 9 % of all school children are affected (Cairney, Hay, Wade, Faught, & Flouris, 2006). Learning disabilities and emotional immaturity become more apparent over time, and as adolescents these children evince social, emotional, and academic difficulties to a greater extent than others. They also run a higher risk of starting to use alcohol (Rasmussen & Gillberg, 2000) and according to Levin (2003), 10% of adult psychiatric patients suffer from learning disabilities. In her book 'Smart but stuck', Myrna Orenstein (2000) uses the concept 'imprisoned intelligence' in the sense that ULD can cause feelings of shame because of the inability to fully achieve academically and the constant feeling of being inferior. Although in some circumstances shame can serve a positive purpose, for children and adults with learning disabilities who never fully succeed the outcome is negative. As another consequence of learning disabilities, whether diagnosed or undiagnosed, shame is of great importance not least because together with guilt, they are both (Nathanson, 1994) symptoms within the field of depression. Polatajko (1999) writes about low self-esteem and secondary emotional or behavioral problems in relation to children's motor problems. There is some evidence to show that a consequence of DCD may be internal disorders (De Raeymaeker, 2006; Cairney, Veldhuizen, & Szatmari, 2010) and still another consequence of DCD (Faught, Hay, Cairney, & Flouris, 2005) is an increased risk of coronary and vascular disease. Although it is likely that the DCD spectrum includes thin and energetic individuals as well as those who are more or less obese and less mobile, it is the latter who are probably more at risk. This view is proposed in three articles published in economy-

According to Lundberg, Nystedt and Rooth (2011) there is a correlation between obesity during adolescence and wages later on in life. Of equal importance, the reasons seem to be on one hand family habits during childhood and on the other hand low physical fitness and a lower non-cognitive ability. Non-cognitive abilities are described as being self confidence, ability to interact and cooperate, motivation, time preferences and endurance. Lindqvist and Vestman (2011) confirmed in their study that non-cognitive abilities, as measured above, were as important as cognitive abilities in their impact upon salary levels. Lundberg *et al.* (2011) explain that non-cognitive abilities and obesity have only recently been correlated

Nonverbal Learning Disorder.

orientated journals.

and that the connection is sociological rather than biological. In their example, a correlation between obesity and non-cognitive inabilities might follow if a child is excluded from sports and social activities. Cawley and Spiess (2008) claim to have identified such a connection among children aged only 2-3 years. Although a sociological explanation seems good enough, from my point of view, it is equally likely that it might be the other way around. A child who is unable or finds it uncomfortable to move is more likely to remain outside of social fellowship. Interestingly, Lundberg *et al.* (2011) conclude that although there is a correlation between obesity, non-cognitive abilities and wages there might also be other underlying, not yet considered variables affecting all three. Such variables could be parental characteristics or aspects of up-bringing, equally affecting all siblings. I will return to this in the discussion below.

Generally, learning disabilities are thought about and labeled as cognitive and, accordingly, special education seems to aim at teaching children strategies to overcome their problems, which is of benefit to some. For others, however, the difficulties more or less remain and we have to ask why this is the case. Are there factors which up until now have not properly been considered? If so, what could they be?

During the last centuries, focus on cognition, teaching, information and instruction has increased. The importance of early learning is a mantra within both politics and science, and parents are instructed how to begin to teach their children as early as possible. At the same time, more children are less mobile and less time is spent playing spontaneously. Is there a too strong belief today that what comes from the outside i.e., in teaching, information, and instruction goes in? I don't have the answer but I would like to counterbalance with a reintroduction of the concept 'education' and suggest a complementary approach. Throughout history (Arendt, 2006, Furedi, 2009, Ecclestone & Hayes, 2009) and up to the present day, the schooling of children has been a matter of values and also a matter of emphasizing education, learning or training depending on the aim of the schooling and the basic assumption of what a child really is. Arendt (2006) writes; "To educate, in the words of Polybius, was simply 'to let you see that you are altogether worthy of your ancestors' " (p.191).
