I’ve been a clinical speech-language pathologist for 25 years. In the course of my career, I’ve worked in every environment possible from skilled nursing facilities, outpatient rehab, acute care, home health, schools, and clinics and worked with nearly every type of disorder from voice, stuttering, swallowing, aphasia, dementia, dysarthria, expressive language delay, autism, cleft palate, degenerative disease and cognitive impairment, and every age from infancy to adult. I finally found my place in private practice in 1998 with a specialty in written language development, specifically, reading development. I’ve gone from being a generalist to becoming a specialist. A broad view down to a narrow one. I see patterns and apply the similarities to greater understanding of the individual in front of me. This, in short, is the way I think. And it was my students who taught me that this way of thinking is because of the way my brain is wired. It is my cognitive dominance. And we all have one.
But I didn’t know this at first. It took twelve years and countless students, a PhD, and the birth of the field of Epigenetics for me to understand that the brilliance I saw in these children was due to their divided brains and the resulting dominance of one hemisphere. Yet it is the pressure of the educational environment and a system that is built on a cultural preference for left hemisphere dominance, that causes these brilliant children to appear less than brilliant to the adults that teach them and who are guiding their lives as learners.
I came to understand this idea of hemisphere dominance by seeing it in the children with whom I worked. Specializing in reading development gave me a unique context in which to see brain lateralization in its developmental stages. And because of my training as a speech-language pathologist, I always viewed individuals as intact before seeing the disorder. This was a fundamental principle of the training I received during my master’s program at Emerson College: never speak of a child as being Autistic, or an adult as being Aphasic. We were taught to always see the person first. And our language mattered because it shaped our thoughts about, and actions toward, the individuals with whom we would work. Thus, it was a child with Apraxia of speech, or an adult with hearing loss, instead of an Apraxic child or a hearing-impaired adult. So, when children were referred to my office by teachers, psychologists, or their parents because they saw a problem, I understood this was the main concern, but then I went to work looking for what was intact, what was working, what were the strengths. And I saw them in abundance.
When Evan was in second grade, his mother called my office because he was still reading at a first-grade level. He was fine in math and his school did not see a need for any formal evaluation, but his classroom teacher thought he would benefit from some one-on-one instruction in reading. Evan had been in the “pull-out” reading group all through first grade (for those the teacher thought needed more attention), but his mother explained that “a lot of the kids were pulled out, even if there wasn’t really a problem.” This small group instruction had helped (we know from research that one-on-one, or small group instruction is the most effective for learning), but Evan was beginning to get bored with the books his teacher was selecting for him. In his mother’s words, “They’re too easy for him and the content is too basic.” His teacher, however, insisted that he couldn’t access higher level, more interesting books on his own yet.
“Evan can tell that something is wrong,” his mom told me, “and it’s starting to affect his self-esteem.”
When she’d pointed this out to his teacher, the teacher reported that Evan “spaces out” when he’s asked to read to himself for thirty minutes. Instead of seeing that as a sign of boredom, she interpreted Evan’s lack of interest as lack of ability.
Evan hadn’t repeated any grades, was not identified as gifted, and hadn’t had any previous speech-language therapy or any remedial reading instruction (the small group “pull-out” was considered part of the regular reading groups). His hearing was normal, he didn’t wear glasses, and had not undergone any previous cognitive evaluations. He was the product of a full-term pregnancy without complications and all his early developmental milestones had been met within normal limits: he’d crawled at eight months, spoken his first words at ten to eleven months, walked at twelve months, and was reading by age five and a half. He had a right-handed preference for writing and throwing. His mother and father, both professionals with advanced degrees, did not know what might be contributing to his difficulty and were very concerned that he might quickly fall behind in school. There was no family history of learning challenges or any events in the home that could be adversely affecting Evan and his ability to learn. They hoped if they addressed this quickly, they could preserve his self-esteem and help him feel good about school and learning.
Evan attended a small elementary school that ranked in the top five percent in the state. Families often moved into this neighborhood so their children could attend it. It boasted a ten percent gifted and talented rate among the less than 500 students, and the instructor to pupil ratio was 19:1. Evan’s classroom teacher was trained to know the early signs of reading difficulty and to address them immediately. She noted that Evan had trouble sounding out words, did not remember all the phonics patterns, and read slowly. The district-wide academic assessment at the end of first grade showed Evan made little to no growth in reading and placed him at a first-grade level for the beginning of second grade, with one exception: his comprehension. Evan understood what he read. In fact, his comprehension was well above all the other scores on his placement testing. His teacher reported Evan loved to listen to stories read aloud to the class and he consistently contributed meaningfully to the book discussion with insights about things that were not stated in the story.
This was part of what confused his parents. “He seems so smart, and we’re not just saying that because we’re his parents—he has a great vocabulary, he really follows adult level conversations at home, and we read to him from books that are way above what he can read on his own. He loved the entire Harry Potter series, and the Hardy Boys are a favorite request.”
His teachers and parents were stumped. Evan was obviously bright, so why was he having trouble reading at his level? What was tripping him up? Why wasn’t the classroom instruction or the small group intervention able to close the gap?
Ryan, was a happy, spritely little girl with chestnut brown hair, an impish disposition, and a laugh that made her whole-body bounce. She was the product of a pre-term pregnancy, so even at seven, she was small for her age and also the youngest in her class with an August birthday. Despite her early arrival in the world, Ryan had met all her developmental milestones on time and was thriving at school, again, except in the area of reading. She had never required supplemental therapy or remediation for any of her skills, but like Evan’s parents, hers were hoping some help could get her back on track with the rest of her peers.
Ryan had a creative streak. She loved drawing and painting in every free moment (her favorite subjects were PE and art) and playing make-believe with her little sister, who at the age of two and a half, was more of a prop for Ryan’s active imagination than a playmate. There seemed to be obvious sibling tension between Ryan and her older brother, however, who was an early reader and would often be found head down in a book ten times thicker than his glasses[RK2] . He often teased Ryan about “the baby books” she read.
Ryan’s mother remarked that self-esteem was her biggest concern for Ryan, who had begun to notice that her classmates were reading at a higher level, so she started hiding out in the class’s cubby corner during reading time, burying her book in her lap or a pillow so no one could see what she was reading. Her mother told me she and her husband made constant positive comments about her ability to read and learn, but the encouragement was overshadowed by her experience in the classroom. Her father felt that Ryan should be as avid a reader as her older brother and expressed that she simply wasn’t trying hard enough. Her mother felt Ryan was being forced to read before she was ready by a school that was aggressively oriented toward grades and competition.
As a 3rd grader, Jeremy was a sweet, sensitive, cheerful child who exhibited a strong interest in puzzles, Legos, drawing, art, mazes, computers, and numbers from an early age. His parents and teachers reported Jeremy having a vivid and active imagination. He began reading from Dr. Seuss books when he was five and listened to his parents read him Harry Potter when he was six, fully understanding and enjoying the story. In addition, Jeremy exhibited advanced social skills, so he was accelerated past first grade into second upon entrance to elementary school.
However, as a result of skipping the early literacy instruction he would have received in first grade, Jeremy showed difficulty acquiring advanced reading skills in second grade. His 3rd grade teacher was concerned that Jeremy was having difficulty paying attention. He was “wiggly and often off in another world.” She recommended that he have a full cognitive evaluation and be tested for ADHD. His parents didn’t see this difficulty. At school, when she volunteered in the classroom, Jeremy’s mother observed her child attending and participating to the same degree as any of the other children. At home, Jeremy was capable of playing quietly for periods of time and easily switched focus between tasks when he was asked to. Jeremy’s science and art teachers similarly did not see any issues with attention, nevertheless, they had Jeremy tested in fourth grade. The results placed Jeremy in the average range for reading skills for his grade (at 4.5 grade level), but his passage comprehension score was at the sixth-grade level and his reading fluency at the third-grade level. In math, he exhibited low average ability with math calculations at the 3.2 grade level, while his math reasoning was average at the 4.1 grade level.
Further cognitive testing that same year showed Jeremy performing in the gifted range on verbal comprehension, picture concepts, and perceptual reasoning, which were all at the 99th percentile. His full-scale IQ was recorded at 145 with a 53-point discrepancy between composite scores (processing speed and verbal comprehension). Despite the suspicion of his third-grade teacher, Jeremy was never diagnosed with ADHD or any other learning challenge.
By the time he reached sixth grade, Jeremy still loved art and all things creative, drawing and doodling every chance he got. He liked math, but still had difficulty with calculations, recalling how to set up problems, and knowing which sequence to follow to solve them efficiently, but he often estimated answers within a digit of the correct response. Under timed conditions on tests and in-class work, he performed poorly, forgetting operation signs in his calculations. When writing, he often excluded correct grammar, when asked to respond to comprehension questions on paragraphs pulled randomly from books, he also struggled. He seemed to take longer to process new information than his classmates, often provided unusual or creative responses rather than the one his teacher expected. He read slowly but still loved literature and writing. His spelling was a blend of accurate complex advanced patterns and misspelled high frequency words.
Again, his parents were perplexed, and his teachers weren’t sure how to work with him. Jeremy confused them with his obvious intelligence in the midst of basic errors they felt he should have mastered. They seemed stuck for a label to give him that would help them know how to teach him, or perhaps a way to let someone else address his challenges.
The Evans, Ryans, and Jeremys are all amazing at creative skills like drawing and problem solving with puzzles, mazes, and blocks. They like cursive and have neat handwriting; some of them love calligraphy. They have advanced vocabularies and comprehend adult language better than some adults. They like individual sports like Parkour, rock climbing, or skateboarding—sports that are about achieving new skills and aren’t by their nature competitive or based on a scoreboard and winning or losing. They tend to see the big picture or the overview before the details, are incredibly kind, sensitive, and make friends easily. They see patterns between ideas and draw connections and inferences in usual and unique ways. Most distinguishing of all their strengths is the fact that they think in pictures. They are natural visualizers, making mental representations of everything they hear or read.
In other children, I notice an opposite pattern of strengths. Instead of the creative, problem-solving skills of the Evans, Ryans, and Jeremys, I see incredible abilities in recalling facts and noting specific details: they easily remember dates, names, and places that they heard or read about. They are great at memorizing multiplication tables and performing calculations and problems with embedded sequences of steps like the ones needed for long division. They often play a musical instrument or three, excel in their foreign language classes, and participate in debate club. They like rules, excel at competitive, organized sports, and do well on timed tests and tasks that required processing abstract information without context (like those little paragraphs on the SAT test that have no title and seem randomly pulled from classic texts that we then have to answer multiple choice questions about).
This personal ideology of seeing the person before the problem and the strengths before the struggle was tied to my training in child language development. In my first year of graduate school, I was introduced to the work of Lev Vygotsky, the Russian psychologist that every graduate student in Communication Disorders knows from his theory on the Zone of Proximal Development. This theory says that when a child is in the “zone,” the distance between where a child is in their independent development and where they are capable of arriving, their potential, is made shorter by the right kind of help and guidance from a caring adult. In all cases, “the right kind of help” is, in my view, working from their strengths—what I eventually came to recognize as their cognitive dominance.
So, I applied evidence-based methods to address the challenges they were coming to me to resolve, but instead of applying the programs, methods, and techniques the way they were intended, to their weaknesses alone—a classic deficit view approach to remediation—I used the students’ strengths to bootstrap the learning of the new skills I was helping them develop.
With Evan’s extremely advanced comprehension skills for spoken language, I knew he was a picture thinker. His strength was visualizing. Visualizing is the key to understanding and memory. I learned this when I was a consultant at Lindamood-Bell Learning Processes in 1998 and was training other clinicians to deliver their Visualizing and Verbalizing® program to children with poor comprehension skills. As Einstein said, “If I can’t picture it, I can’t understand it.”
I observed that picture thinkers didn’t like to sound out words, one at a time, in order. They wanted to grab chunks or whole words off the page, seeing the big picture before—or sometimes instead of—the details of the letter/sounds. Similarly, their spelling tests reflected an uncanny ability to recall complex and irregular letter patterns they’d seen like ough, ight, tion but when their teachers told them to “sound out” words they often substituted or omitted single letters or letter chunks that represented crucial sounds in the word thinking trapped is spelled chrapped and shine was sine. They were also often described as “early readers” by their parents, devouring Dr. Seuss books by the age of four or five. But in reality, they were memorizing the word forms and using their comprehension and the predictive nature of the text (“Left foot, left foot, right foot right, feet in the morning, feet at ____”) to “read” without knowing the letter-sound combinations. This ability to fill in the blanks when information was not provided was a consistent super power of these visualizers. They were great at making meaningful connections between ideas and using the context to glean understanding when they couldn’t read the actual words.
While they displayed these wonderful abilities, they also experienced a comparative set of weakness in the skills for decoding, sounding out words, and deciphering spelling taught from the sound-it-out approach they learned in school. Instead of reinforcing their sense of failure and frustration by teaching these discrete concepts as unitary, isolated abstractions without context and with a focus on the symbols, sounds, and rules, I explicitly taught these concepts using the strengths and preferences from their profile: pictures, color, context, and story, encouraging their natural visualizing and overview ability. And I allowed them to read using context to close the gap between known words and words they hadn’t yet encountered by skipping the unrecognized word, reading past it and gathering more understanding from the words around it, then going back and popping the word off the page from the initial letter or two and their formidable comprehension ability. It was a strengths-based approach to developing their discrete sound awareness and knowledge of the alphabetic principle—the idea that letters map onto sounds and there are patterns to how letters and sounds are used in English (phonics). It honored who they were as learners, how they thought. My visualizers loved this approach to reading. It immediately made use of their dominant abilities and made them feel successful with a skill that they previously felt incapable of achieving. Their reading took off and so did their confidence.
