All Children Great And Small
|To pediatrician Mel Levin, labeling is destructive and misguided.|
Interviewing Mel Levine at his sprawling farm in North Carolina may not have been such a good idea, I'm beginning to think some 20 minutes after I arrive. It's not that the 30-acre farm isn't beautiful—called Sanctuary, it has a lake, meadows, tall grasses, and other splendors of the kind that populate the poems of William Wordsworth. Levine is a gracious host, too, even though his farm and home have been invaded repeatedly over the past two years by reporters. Winner of the prestigious C. Anderson Aldrich Award—an honor bestowed on such renowned child experts as Dr. Spock and Terry Brazelton—Levine already enjoys considerable celebrity, and he is on the brink of becoming a household name. In the coming months, he'll publish two new books on children and learning. PBS will air a documentary this spring about his work. Levine, a slight man whose voice sometimes fades out in the middle of his sentences, appears rather pained by this attention. Nevertheless, he is answering all my questions patiently and will later take me to meet his donkeys.
Actually, it's the donkeys that are spoiling the interview. Levine's farm is a veritable menagerie, and the dozens of animals are driving me crazy. As we talk on the patio outside his house, 10 donkeys bray persistently for him from the pasture below, not because they're hungry, Levine explains, but because "they love me." Meanwhile a pair of Great Danes the size of Toyota Corollas, two of the seven dogs on the farm, bark endlessly. They are afflicted, Levine asserts, with "severe attentional problems." He has hundreds of geese as well, some of which are endangered species from the other side of the globe, but many of which are honking. In a tree above the table where Levine and I sit, monkeys dangle. These are actually Levine-commissioned sculptures, but I almost expect them to start screeching, too.
The bucolic remoteness of the farm—it is almost an hour's drive from the University of North Carolina at Chapel Hill, where Levine is a professor of pediatrics—seems to suit the doctor and his work perfectly. Over the past three decades, he has disassociated himself from conventional thinking about children and schooling. He refuses to accept the validity of such labels as "ADD" and "learning disabled," and he insists that there is no one way in which children learn. With such views, Levine has stood far from the maddening crowd of medical experts who see drugs such as Ritalin as a cure-all.
In recent years, however, Levine has attracted a loyal following of fellow dissenters. Thanks to generous funding from financier Charles Schwab, he founded an institute, All Kinds of Minds, that has waged an aggressive public relations campaign to promote his ideas about children and learning. He also is working to establish Student Success Centers across the country that will bring together teams of edcation specialists, pediatricians, and psychologists to work with struggling students. But by far the biggest of Levine's initiatives is Schools Attuned, an increasingly popular professional development program for teachers. Started as a series of random lectures given by Levine, it's evolved into full-service training, with weeklong workshops attended by 1,200 teachers every year. Expansion plans call for the program to enroll at least 15,000 teachers over the next five years. The goal: equip educators with the latest research about children's brain development, and then help them put that knowledge to use in the classroom.
While I'm at the farm, Levine tells me stories about children he's encountered in his medical practice and his work for All Kinds of Minds. The kids are different ages and come from various backgrounds, but they face the same problem—a mysterious meltdown in school. Take "Kevin," for example, a creative and gifted 13-year-old. Seemingly overnight, the boy stopped turning in assignments. School specialists evaluated him and concluded that he did not have a learning disability. His parents and teachers were baffled. Had Kevin become lazy? Rebellious? Depressed? Eventually, the boy visited Levine's clinic—the doctor is the director of the university's Clinical Center for the Study of Development and Learning—and went through a battery of tests. It turned out Kevin had a problem, far from uncommon, with graphomotor function. Specifically, he had a condition called finger agnosia, which often results in an awkward writing grip. In Kevin's case, the physical act of writing words on paper had become so torturous that he stopped doing assignments.
"Many teachers do not even know that there is such a thing as graphomotor dysfunction, which often surfaces in children who have trouble learning cursive," Levine comments. "Kids with this problem are often called messy or lazy, when in reality they just are not able to write any neater or faster."
Levine also told me about a high school girl named "Laura," who had great visual and artistic skills and even designed some of her own clothing. But she struggled academically. The high-powered private school she attended in New York City placed a premium on verbal skills, in which she was noticeably weak. Her failings in class were magnified by the fact that her parents were both lawyers who were extremely articulate—exactly what she was not.
When Levine met the girl, she had hit rock bottom, having been suicidal, hospitalized, and placed on various medications. This was an extreme situation, he says, but not unusual. Students with learning problems—and language difficulties in particular—almost always blame themselves and sometimes sink into severe depression. Schools unwittingly make things worse sometimes by affixing the label of "learning disabled" or "emotionally disturbed."
To Levine, labeling is destructive and misguided. A student identified as dumb, hyperactive, dyslexic, depressed, or simply bad at math may carry that stigma for life. Yet the brain is too complex and varied to be characterized in such broad strokes, he argues. Minds are configured an infinite number of ways (hence, the name All Kinds of Minds for his institute), and learning difficulties can stem from a host of problems. To Levine, the brain's circuitry is as complex as the electrical system on a 747 jet: A short can occur at any juncture along literally miles of wiring. Yet teachers too often assume a student's failures are due to something big, like engine failure.
Consider attention deficit disorder. ADD, Levine argues, has become a catch-all diagnosis for learning problems that stem from distinctly different neurological glitches. It's often assumed, for example, that students who become distracted when a teacher is lecturing or giving directions are not capable of sustained concentration. But that's too simple an explanation, the doctor insists. In fact, those students may struggle with language processing and find it hard to follow a sequence of sentences. Or they may struggle with what Levine terms "saliency determination," meaning that they have a hard time determining what information is important, and what's not.
To Levine, it's critical that teachers understand the brain's complexity and resist the temptation to slap labels on students. Through Schools Attuned, he wants to arm teachers with the knowledge and techniques to diagnose children's learning problems in a nuanced, sophisticated way. Educators, he argues, should be able to build neurological profiles of students and then teach accordingly.
"We are striving for much greater specificity in understanding students' learning difficulties," Levine says. "We believe that it ought to be possible to dissect, say, a child's attention issues without saying, 'This is a pathology'—to look at his neurocognitive profile without being judgmental."
Such ideas have made Levine a pioneer in pediatrics, but until recently, he's worked quietly, without fanfare. A charming but reticent man, he's so uncomfortable with small talk that he doesn't attend his college reunions. Indeed, his idea of a good time is to dine alone in an empty restaurant. Yet now, with the publication of his books and the PBS special, he's stepping into the limelight. And with good reason, he says. Having just turned 60 years old, he feels an obligation to push his ideas publicly, to court a little fame in the hope that more people will hear his message. "For me, it's therapy to be a nonentity," he explains. "But I'm getting to the final chapter of my life's work now, and I know that if I want to get this thing up to scale—to do the greatest good for the greatest number—I've got to make myself available."
Levine's office outside Chapel Hill is decorated almost exclusively with prints of his beloved geese. Among the few knickknacks scattered around are amethyst rocks and quartz, baubles for the children who come to see him as patients. Above his desk, Levine has prominently displayed several Robert Frost poems. Frost, he explains, is his favorite poet. "The Road Not Taken" seems to have particular relevance. "At my age you realize that you only have a finite amount of time left, and so I think quite a bit about the road I didn't take." Levine, who was once an English major at Brown University, says he might have been a novelist. "Writing has always come easy to me," he explains, "and I love telling stories." Levine has written several books setting out his ideas, including Educational Care and Keeping a Head in School, a guide for students struggling with school. The two books he will publish next year, The Ways of Learning and The Myth of the Lazy Child, are both intended for mass audiences.
At times, Levine muses about how he might have been a teacher. "I want to come back in my next life as an English teacher. I would enjoy coming home each night and reading my students' stories."
Though Levine occasionally laments the road not taken, the road he chose was seemingly mapped out for him at a very young age. His exploration of the way people learn began with his compulsive reading of biographies. As a boy, he would curl on the floor of his house in Long Island and spend hours poring over everything from Irving Stone's account of Vincent Van Gogh's life to Thomas Edison's biography.
"I had this fascination with reading about people with very different interests," he explains, "especially in terms of the different kinds of careers they chose. What led someone to become an artist? Or a doctor? I wanted to know more about the pathways people took over time."
Levine's own biography begins with his birth to parents whose lives are a storybook rags-to-riches tale. His father, Rubin Levine, a Russian immigrant, was, quite literally, a rag salesman who rose through the ranks of the garment industry to become a successful executive. Later in life, he managed the finances of two chums from his boyhood in Brooklyn, opera stars Robert Tucker and Robert Merrill, with whom he had sung at weddings and the like. "From my father I acquired a love of classical music," Levine says. "However, neither my mother nor my father cared anything about animals, so I don't know where I get that from. My parents told me that when I was 18 months, the sight of a dog or cat would send me into ecstasy."
As a boy, Levine went to a summer camp at the foot of the White Mountains in New Hampshire. He was an awkward child so inept at sports that during baseball games, he played right field for both teams, passing the time by hunting in the grass for snakes. Despite his failings on the ball field—the camp director declared him the worst athlete—Levine was well-liked, largely on account of his smarts and the wickedly self-deprecating sense of humor that he still brandishes today. Everyone, Levine learned, enjoys a brainy kid who makes clever fun of himself.
After high school, Levine enrolled at Brown and returned to the camp during the summers as a counselor. As he matured, he found he was a reasonably adept mountain climber and regularly took campers on treks. On these trips, he grew intrigued by the differences in children. "I thought a lot about why some kids would just run up a mountain whereas others would get completely stressed out," he explains. "I was fascinated by the potential in each and every kid."
After Levine graduated from Brown in 1961, he attended Oxford University as a Rhodes Scholar. There he studied philosophy, and existentialism in particular, because he was infatuated with the idea that "nobody around you can create a beautiful life for you—you have to create it out of this meaninglessness." After Oxford, he enrolled at Harvard medical school, where he found himself much more interested in patients' social well-being than their physical health.
This fascination with psychology, combined with a newly minted pediatrics degree and a draft notice, led to his 1969 posting to a school for American kids on a Philippines military base. Working with children and their learning problems for the first time, he found his calling.
"I realized that you had to know what was going on with kids in school if you wanted to help them," Levine explains. "School is the outcome for so many things. Health care issues, learning issues, emotional issues, social interaction, parenting practices—everything converges on the way children are functioning in school. And the outcome a student has depends, to a great extent, on how optimistic or pessimistic a teacher is regarding a specific child."
Levine became convinced that learning problems are no one's fault.
Upon returning to the United States, Levine became director of outpatient services at Boston Children's Hospital, where he saw a lot of kids who were struggling in school, though they suffered from no apparent disability and came from loving families. Learning problems, he became convinced, are no one's fault.
Such views rendered him somewhat of an outsider in the medical establishment, which tended to assign blame when children stumbled in school. "At that time" he recalls, "whenever a kid wasn't doing well in life or in school, [the experts] would explain to the parents that that they were not sufficiently motivating the child. Or alternately, they'd offer up a very psychoanalytical explanation—the parents were putting too much pressure on the kid."
In the mid-1970s, Levine founded an informal group of like-minded pediatricians who called themselves "splitters." These doctors eschewed the common practice of lumping children into broad categories and chose instead to try to pinpoint children's specific learning problems. The splitters, of which there are now several hundred across the country, devote one or two days a week to evaluating and helping kids having trouble in school; they also meet every couple years to present and discuss cases.
Levine and the splitters' group changed the outlook of many doctors. "Mel took us beyond labels, further into the complexities of the brain," says Skip Baker, a pediatrician and splitter in the Los Angeles area, who first heard Levine speak at a conference more than 20 years ago. "He's brought our profession back to looking at kids on an individual basis instead of just making a pat diagnosis."
Still, Levine was not satisfied. Doctors can only do so much to influence children's learning, he reasoned; teachers are the key. But how could he reach them with his message?
The opportunity to do just this presented itself when he and his wife, Barbara, left Boston in 1985 for North Carolina. They were enticed in part by a tour of farms in the state—there was plenty of room for animals—but Levine was also excited about the job available as head of UNC's child development center. At the time, the center focused on mental retardation issues, but Levine quickly broadened its mission to include children who simply had difficulties in school. Two years later, in 1987, he started the Schools Attuned program.
In the early years, Schools Attuned was pretty much a traveling road show, with Levine giving talks to educators at colleges, workshops, and seminars. Despite his shyness, Levine is a captivating speaker, and he wowed his audiences. Teachers at the time were especially primed to rethink their practice. Harvard psychologist Howard Gardner's "multiple intelligences" theory—first outlined in his ground-breaking 1984 book Frames of Mind—was popular in schools, and Levine's neurocognitive scheme, while clinical in nature, seemed to ground Gardner's ideas in science. Teachers are nurturers by nature, and it was easy for them to buy into the idea that there are no "smart" or "dumb" children but rather kids whose lack of intelligence in one area is inevitably offset by an abundance in another.
Levine, however, wasn't satisfied simply to do a series of talks. In 1994, he founded All Kinds of Minds, now the parent institute for School Attuned and Levine's other initiatives. Five years later, Charles Schwab gave the institute a $10 million challenge grant. Schwab, who was dyslexic as a child, serves with Levine as co-chairman of All Kinds of Minds.
Today, Schools Attuned consists of 10 regional sites across the country. Levine's role is something akin to a guru: Though he still gives occasional talks to teachers, and though he watches over the workshops and their content, he doesn't have a day-to-day role in Schools Attuned. He recruits teachers to lead the classes and pass on his method of diagnosing learning problems. "I leave it to other people to figure out the best way to teach it," he explains.
One day this past August, about 120 teachers arrived at the Children's Health Center in Palo Alto, California, just down the road from Stanford University, for a weeklong Schools Attuned workshop. They came from all over the country, and some school districts had sent three and four representatives, ponying up $1,200 for each.
During breaks, the teachers gathered in the center's sun-filled quad, sipping juice and mineral water as they gushed about the transformative power of Levine's ideas. Most had attended a Levine lecture or watched an All Kinds of Minds videotape before the workshop, and they were uniformly enthusiastic, almost like athletes at a pep rally raving about their coach. "Levine completely changed the way I teach," said a middle school teacher from Denver who had first heard Levine speak in 1990. "He asks us to take a phenomenological approach with kids, paying very careful attention to how they learn. Once you buy into this approach and realize that different kids learn in very different ways, it's no longer possible to label kids."
A high school teacher from nearby Marin County explained why he was at the Schools Attuned workshop. "I've got a 16-year-old kid in my class the school is destroying. He's designing Web pages and writing a novel, and instead of encouraging his efforts, they're saying he has 'conduct disorder.' You should see the staff meetings—the labels they slap on kids are incredible. We are here to learn how we can get rid of the labels."
For the workshop, teachers were divided into classes of about 25, each led by a facilitator—usually a teacher or former teacher—who had completed intensive School Attuned training. The activities were varied, participatory, and fast- paced, shifting every 20 to 30 minutes. During one session, teachers were asked to draw a straight line with their eyes closed as well as render by hand a complex geometric figure. This was followed by a Levine video on graphomotor dysfunction and a discussion.
Key to the training was a detailed analysis of Levine's "neurocognitive constructs," which are groupings of brain functions correlated to specific learning tasks. Under the "attention" neurological construct, for example, Levine includes any brain activity related to the ability to concentrate and to finish tasks, among other things. The other constructs include memory, language, and neuromotor functions.
Each day of the workshop was devoted to the study of one or two of the constructs and the symptoms that suggest a possible breakdown within them. With this information, teachers can evaluate a student's neurological strengths and weaknesses. During this evaluation—a process Levine calls "attuning"—the parents and student work with the teacher, who observes the child and records his or her behaviors. Together, they create a "learning profile" of the student.
To demonstrate the attuning process, the facilitator at the Palo Alto workshop showed the teachers documents from the case of a middle school student named "Carmen." As part of her self-evaluation, Carmen had responded to a long series of statements, her answers offering clues to her neurological makeup. In the segment focused on the attention construct, for example, Carmen had responded to the statement "I want to get up and move around class" by checking "almost always." Another statement—"I'm fidgety. I need to keep doing things with my hands and feet"—elicited the answer "always." Carmen's teacher and parents had responded to a similar battery of statements.
Attuning is an intensive endeavor. Sally Peck, a 5th grade teacher from nearby Menlo Park who had taken a Schools Attuned workshop the previous summer and was now back for a refresher, said evaluating her first student, a boy with writing and reading comprehension problems, took nearly six months. "After you've gone through the process once you can tighten it up, but it still is going to take at least a few weeks of observing a student very closely."
Eventually, the teacher, student, and parents assemble the learning profile, a document that summarizes the child's strengths and weaknesses as identified through the attuning process. In Carmen's case, the evaluation noted her considerable strengths—she was popular, an excellent athlete, and a creative writer—while identifying weaknesses in the attention construct. She was a poor speller, for example, and her writing included many incomplete sentences.
|Simply alerting the family to the nature of a child's problems— a step Levine calls "demystification"—usually yields big results.|
While these are common sense observations, teachers who have used Schools Attuned say that simply alerting the family to the nature of a child's problems —a step Levine calls "demystification"—usually yields big results. "Demystification—making parents and children aware of the learning issues—is probably the biggest part of the intervention process," says Peck. "It is impossible to overestimate the importance of making students aware of the areas they are strong and weak in."
Levine and his colleagues say demystification is the most important step of the attuning process, as it often reveals to children and their parents what has sometimes been hidden for a lifetime. Karen Grites, who facilitated several of the Palo Alto workshop sessions, told me: "This is the only reform, with its emphasis upon demystification, that makes kids savvy agents of their own learning. We very consciously bring children into the conversation regarding their own learning. The goal is to make children less dependent on teachers and parents in terms of addressing their learning issues."
Gena Overbey, an award-winning former teacher who is now director of North Carolina Schools Attuned, believes that demystification eases often crippling fears for kids. "Kids will think that there's something very deeply wrong with them and then find out that they have, say, a sequencing problem," Overbey says. "It's such a relief."
After the learning profile is complete, the parents, teacher, and student agree to a few remedies. In Carmen's case, Ritalin was not prescribed. Instead, it was decided that Carmen would get more frequent breaks and would tape-record lectures; Carmen was also to work on pacing herself when writing and to use some mnemonic strategies for recalling details.
Levine insists, however, that "fixing" problems should not always be the goal of attuning. Often, he recommends strategies to bypass children's weaknesses and play to their strengths. A child whose gross motor difficulties hinder his ability to play baseball may want to hone his musical gifts instead. A child who is a weak speller may want to spend more time building her organizational skills, which may be more important for success in the long run.
Of course, some learning difficulties can't be ignored. Certainly, a 2nd grader needs help if his or her trouble with phonics is making reading difficult. And a child who is susceptible to bullying obviously needs help acquiring key social skills. But "build on strengths" seems to be the unofficial motto of Schools Attuned. Adults, Levine notes, typically succeed in careers when they choose work that emphasizes their strengths. In this way, their weaknesses become more or less irrelevant. Silicon Valley, Levine told me at one point in our conversations, was in large part built by engineers who had suffered while in school from various language dysfunctions.
"From a neurological standpoint," Levine says, "it's harder to be a kid than an adult. Kids are asked to be generalists in school, to do everything fairly well. We adults don't ask that of ourselves."
Though Levine is well-regarded by pediatricians and educators, he does not go unchallenged. Critics contend that his ideas aren't rooted in science, that he is serving up a warmed-over version of Howard Gardner's theory of multiple intelligences. And they argue he has yet to prove that Schools Attuned workshops will boost student performance. A researcher at the University of North Carolina is studying just that, but the results won't be in for some time.
Levine also faces the practical problem that his Schools Attuned approach asks a lot of teachers. Learning Levine's neurocognitive terms and concepts is no easy feat. At the Palo Alto workshop some of the teachers called his terminology "difficult," "challenging," and "a bit esoteric." Plus, the process of attuning even just one student is exhaustive.
Some school reformers say Levine's methods may be too complicated and too extensive to translate to widespread change in schools. Barnett Berry, director of the Southeast Center for Teacher Quality, thinks there are substantial obstacles to doing high-quality professional development on a large scale. "Levine's strategy, to his credit, is that teachers need a heck of a lot of time to figure out why Johnny can or cannot learn. His training is very respectful of the intellectual nature of teaching and learning. But even in the culture of good schools, there is little sharing of knowledge—the kind of sharing Schools Attuned will need to really grow. And to get into the schools of education in a pre-service way would be very expensive."
Levine, however, insists his program is not all that arduous. "How complicated would it be for a teacher to know what kind of memory is involved in physics? What kinds of spatial abilities? What kind of reasoning abilities? Similarly, I don't think it is asking a 2nd grade teacher too much to know what language and spatial abilities her students need to learn. If you teach 2nd grade, you should know what its cognitive challenges are."
Still, Levine and his staff suggest that teachers attune only one or two students their first year after taking the workshop. The program's impact is measured in more than just the number of students attuned, they say; it forces teachers to see all their children in a new light. Claire Wurtzel, a professor at the Bank Street College of Education in New York City and director of the first Schools Attuned site, says that the training "changes teachers over the course of the year. You hold up a mirror to your own teaching and question some of the things you've always been doing. It's not so much a question of attuning one or two children, but of re-examining your entire approach. And as you re- examine your approach, other teachers in your school will hopefully do so, too."
Before I leave Levine's farm and escape the clamor of his animals, the doctor talks a bit about one of his favorite novels, The Plague, by the existentialist philosopher Albert Camus. In the novel, dying rats appear on the streets, followed by the deaths of tens of thousands of people. A plague is raging though France.
"I relate to the doctor in the novel, Rieux," Levine says, referring to the protagonist. "Everyone around him was asking why all these children were dying. 'They never did anything wrong—why is God punishing them?' Rieux kept saying: 'I really don't know, but it's not my job to find out. It's my job to arithmetically reduce the total amount of suffering.' That's the kind of philosophy I subscribe to."
Vol. 12, Issue 4, Pages 25-29Published in Print: January 1, 2001, as All Children Great And Small