In a small medical office building in Toledo, Ohio, children and their parents gather in a standard patient lobby at the Children’s Neurology Center and wait to see the doctor, a pediatric neurologist. There is nothing out of the ordinary about this scene; it would match the one in the office next door and the office next to that, and so on.
But something about today is a little different. As neurologist Dr. Donald Cameron and his staff prepare this morning, the exam rooms are filling with children and their anxious parents. It is Friday, and so Cameron is seeing only education cases today. These children are here because they are having problems reading or learning. One 8-year-old boy is struggling to learn the basics of reading, says his mother, while his 11-year-old brother can’t seem to concentrate in class.
This is where things get interesting. On Fridays, Cameron works with a team of educational specialists from Bowling Green State University’s Martha Gesling Weber Reading Center. Over the last three years, Cameron and the director of the reading center, Dr. Michael French, have forged a partnership between their two operations to help solve some of the toughest cases among children’s learning problems.
Cameron and French’s partnership began after a long-time cross-referral system: French was sending children he suspected of having neurological problems north to Cameron and Cameron was sending children he suspected of having reading difficulties south to French. Eventually, they decided to join forces. If successful, they determined, not only would the partnership cut down the drive-time of their patients’ parents, but it might also help to fill in the missing pieces in each other’s work. This, they say, is exactly what they’ve done.
“Research has told us that there’s a relationship between a children’s brain and what he or she actually does in terms of reading and writing," says French. "We’re trying to look at those patterns and see what we can do to help these kids. We’re asking, what can a pediatric neurologist do that is going to complement what an educator can do in a way that’s going to have a direct impact on the child learning better?"
French’s team, which includes his colleague, Martha Sears–and occasionally one or two of his graduate students–shares a room at the Children’s Neurology Center with an old brain-scanning machine. From here, they administer an informal battery of learning assessments they designed called the Quick Literacy Screening Inventory, QLSI. The QLSI, which is current being published and will be widely available soon, samples reading, writing, oral language, and phonological processing skills. The test takes about 15 minutes and gives Sears and French a good idea about a child’s learning and language skills. The reading team also takes an education history on each child.
"We’re working with Dr. Cameron to help ferret out exactly why a kid isn’t learning," says French. “[Dr. Cameron] might ask a particular child: has the school done anything? But I’m there to get more specific information, like what has the school done? A Multifactored Evaluation (MFE)? What kinds of IQ tests? What kinds of processing tests? What kinds of perceptual tests?”
By the time they arrive at the Children’s Neurology Center, many of these children—and particularly their parents—have been frustrated by a fragmented system that always seems to pass them on to somewhere else. But as far as French and Cameron are concerned, this is the end of the line; this is where children can be accurately evaluated and then begin to receive the help and support they need to start learning.
Following the learning assessment portion of the visit, a child then sees Cameron. Being a physician, Cameron does a physical examination—listens to a child’s heart and all the other things a pediatrician does—as well as a neurological exam. This examination looks for symmetry and asymmetry in processing, movement, muscle tone, etc. In addition, he has the child read to him, both real words and pseudowords.
Each specialist then comes to his own conclusion about a child’s particular situation and then they confer and discuss all the possibilities for intervention. Cameron relates a case that he feels illustrates the strength of the collaboration.
"There was a boy this afternoon presenting with ADD," he says. "His parents were beside themselves, you know, because the last thing they saw in their kid, who is meticulous, is a deficit of attention. They came in here a 4 out 5 on the anxiety scale.
"I’m doing the examination and I’m noticing the child having a little tick of his head. Very, very subtle. It lasts literally about one half of a second. I saw him doing it three times. I do the rest of my exam and figure out that he has some difficulties with reading. I then look to Mrs. Sears with the observation of the tick, and she tells me that she has made the same observation."
Sears had made other observations that Cameron says enabled him to confirm a diagnosis: Tourette syndrome and a reading difficulty.
"The family walked out of here ecstatic because they’ve been exposed to all sorts of specialists—pediatricians and so on—but they weren’t satisfied with what they were being told. Finally, they had a diagnosis," says Cameron.
"Even if we don’t have the final answer" he continues, "this collaboration allows us to at least eliminate a whole set of diagnoses and interventions. And that’s a big jump from where we were before."