Special: Lazy, stubborn, and badly behaved

Have you ever silently applied one of these labels to a student in your studio? I know I have, and now I look back and wonder how accurate I was. Some students have been truly stubborn or lazy or badly behaved for reasons that varied from situation to situation. I wasn't always patient enough to work through these situations either, nor did I think my time and the student's money were being well spent when the resistance level was too high.

After reading "The Woman Who Changed Her Brain" by Barbara Arrowsmith-Young, I suspect that some of these situations were created by an unidentified learning disorder. Often the only recourse for a student who is cognitively challenged is to act out (stubborn, badly behaved) or act in (lazy, unresponsive).

Arrowsmith-Young was a student with multiple cognitive limitations as well as innate genius. As a young adult, she began to push her way through the fog, one limitation at a time. She devised a series of exercises that directly addressed each challenge. She then applied them to other students and realized how successful they were. She now continues this work in Toronto and has trained teachers to take her approach forward.

Here are some key points from Arrowsmith-Young's approach:

•  She is not teaching compensation. She is attacking each limitation head on, pardon the pun. Music teachers are familiar with this idea. She takes it to a universal level.

•  She is retraining the brain to change itself so that it can function normally or, in some cases, beyond normal.

•  She is identifying cognitive challenges based on the processing required for a task, not on the subject matter. A person who has trouble with math may have more than one processing challenge, including the inability to hold information in working memory, for example. It is quite a different limitation from the dreaded being "bad" at math, and it probably crosses over into other subject areas.

•  She realizes that the brain-changing work is best done outside a traditional school setting. Her school-age students will be removed from regular school for a period of time, then returned after they are well under way toward overcoming their limitations.

•  She works with adults of all ages, proving that there is no fixed "window of opportunity" to change the brain.

I was fascinated to read about improving spatial awareness as I am a Wrong Way Corrigan or, if you remember Rocky and Bullwinkle, a Wrong Way Peachfuzz.  I swear that the GPS was designed just for me!  Before that, I leaned on my husband and daughter, both of whom have excellent orientation skills. Now I am thinking that maybe, just maybe, I could retrain my brain to get better at finding my way without GPS or familial support.

We all have strengths and weaknesses which we can recognize. Most of us have moved forward in life by playing to our strengths. Arrowsmith-Young did the opposite; she played on her weaknesses. I think there is much to learn from this approach as we work with students who need specific cognitive training.You can learn about her school at www.arrowsmithschool.org/.

Special - Asperger's Syndrome

"knock, knock, knock, 'Penny?'...knock, knock, knock, 'Penny?'.... knock, knock, knock, 'Penny?' "

If you recognize this, you have seen at least one episode of The Big Bang Theory television series. The character Sheldon, referred to as a brilliant über geek, always knocks three times at neighbor Penny's door. Here is part of the description of Sheldon from The Big Bang Theory fansite: "He lacks empathy, is unable to discern sarcasm, doesn't like change, and has an inflated ego. He does not understand social norms, and makes little attempt to do so."

From WebMD, here are the main characteristic of a person with Asperger's syndrome:
* Problems with social skills
* Eccentric or repetitive behaviors
* Unusual preoccupations or rituals
* Communication difficulties
* Limited range of interests
* Coordination problems
* Skilled or talented

Sounds like Sheldon to me. What is also missing from this list is a high sensitivity to sensory input.  Sheldon is extremely fussy about where he sits, evaluating all the possible sensory parameters that could interfere with his ability to focus in any given spot in a room. He also likes to have clean hands at all times and isn't tolerant of sticky fingers. Watching The Big Bang Theory as a person familiar with Asperger's syndrome, I am continually amazed at how accurate it is. And it is funny.

Living with a child with Asperger's syndrome is not generally amusing, however. It can be extremely challenging. The show gives a nod to this whenever Sheldon says, "No, I don't have (fill in the blank with some abnormality). My mother had me tested." Parents of children with Asperger's syndrome will spend hours and hours visiting specialists of all sorts, going to a variety of therapies, and working with school officials to get the needed resources for their children. Asperger's children can be disruptive in class because of their lack of understanding of social patterns and their challenges with processing sensory input.

Since Asperger's syndrome is generally considered to be high-functioning autism, it is not unusual for medication roulette to be involved. In some cases, especially with young children, the medication is designed to keep them focused during the school day, but it wears off not long after the last bell. This is usually when you will be working with this student in your studio.

When working with a student with Asperger's syndrome in a one-on-one music lesson, it is possible to be able to work around some of these behaviors by gearing everything to that child's ability to focus. Just as with autism in general, Asperger's syndrome creates challenges for maintaining healthy, flexible focus. A student with Asperger's may either exhibit hyperfocus - staying on a conversation topic for a very long time,  for example - or may have intense but limited intervals of attention.

However, this student may very well have a remarkable memory and be talented in some way beyond the norm. If this student shows outstanding musical ability, your efforts to accommodate could be well-rewarded.

Some basic tips on working with a student with Asperger's syndrome:

* Be organized. Have a pattern of teaching that gives this student security from lesson to lesson.

* Be very clear with instructions, and avoid double-meanings in conversation. Being literal is one of the communication trademarks of an Asperger's student. He or she may not understand metaphorical language or even common idiomatic expressions. Recently I was joking with my Asperger's nephew that his mom couldn't even remember her own name - we've all had those days, right? He said, yes, she can remember her own name and wondered why I even said that.

* Build on the student's ability and desire to find patterns. Again, this is a comforting way of functioning for this student.

* Avoid too many visual distractions in the studio. (This is a tough one for me!)

* Be aware of when the student is losing focus. Once it goes, it is usually gone. While all kids have "bad" days in school, Asperger's children have a harder time to shake them off. They may go into tantrum mode without warning, in which case you are probably not equipped to work with the student that day.

* Set up studio rules for behavior, especially with younger children. Since they don't automatically understand social norms but like structure, rules can be the key to keeping things moving in the right direction. You may also allow the student to be part of the rule-writing process.

* Enjoy this child. Asperger's students are often unwilling to work with people they don't like or that they sense don't like them.

* Most importantly, stay in contact with the parents. If the process is not going well, either at home or in the studio, you need to re-evaluate. Parents can also let you know whether the child is adapting to new medication and to expect some disruption while that is happening.

Special - autism

When my very young nephew was identified as autistic, his parents were told that he may spend much of his time rocking and staring at the wall. In extreme cases of autism, this is an unfortunate truth. My nephew developed quite differently, however.

The biggest challenge in discussing autism is that the scientific community is not yet in agreement on its definition. Currently the American Psychiatric Association is updating its Diagnostic and Statistical Manual of Mental Disorders for the first time in 17 years, the last edition having occurred around the time my nephew was diagnosed.  When the definition of autism is rewritten by December of 2012,  the identification of the disorder will change accordingly. This will no doubt affect statistics on the prevalence of autism, which now stands at about 1 out of every 110  children, with males being four times more likely to be identified than females. At this point, there is no ability to predict the impact of these changes.

The current definition classes autism as a developmental disorder which appears between birth and the age of three and continues throughout life. The cause is unclear, despite several attempts to link the disorder to vaccines and other causal factors.  Current thinking includes genetic predisposition and the potential impact of various environmental factors. The symptoms include difficulties with social interactions, delayed speech, constant movement, need for routine, hyper-sensitivity to sensory input, abnormal response to pain, challenge in shifting focus, and tendency toward repetitive actions and/or speech patterns (perseveration). Some autistic children will be extremely literal and not able to translate symbolic language such as metaphors.

What is commonly acknowledged is that autism is a spectrum disorder. A child with a spectrum disorder may exhibit the described behaviors connected to the disorder but to varying degrees. It is for this reason that one autistic child may be more socially skillful than another, for example.  My nephew has quite a good sense of humor, even though he sometimes misses teasing jokes that are based on double meanings, and not all children on the spectrum are as able to be purposefully amusing.

Because of the inability to reach complete agreement on the definition of autism, medical professionals may present a variety of diagnoses for the same child. It is not clear as to whether forms of autism mimic attention deficit hyperactivity disorder (ADHD) or whether they are the same condition, for example.  Many children exhibiting the behaviors of autism are treated with medications intended to calm the nervous system, as are children identified with ADHD. The efficacy of treatments for children with autism involves a reasonable amount of experimentation with prescription medications, and this experimentation may go on for years and have side effects that require maintenance.

Take some time to digest this information before the next blog on the autism disorder known as Asperger's syndrome. There are many excellent websites dedicated to information on autism, if you are interested in more details. The site at www.fightingautism.com will link you with many of these sites. 

Special - identifying the challenges

If you have never heard Steven Blier perform live, please put this experience on your bucket list. Steven Blier is a co-founder of the New York Festival of Song and coaches singers at the Juilliard School.  He collaborates and records with top artists. (http://www.juilliard.edu/journal/portraits/faculty/archive/2011-12/1112.php) His knowledge of songs is bested only by his joyous ability to play them.  He gets on stage by riding a mobility scooter to the piano, at which time he gets to the bench with a little assistance. From that point on, you will completely forget that he has a debilitating muscular disease.

Because he learned to play well early in life, he has strong neuromuscular connections already in place. He continues to perform in order to keep these connections strong, and because he loves performing, but he does need some help getting around. Would you want him in your studio?

A student with mobility challenges is going to require a level of access that you may or may not have at present. My studio does not have a ramp, for example, so I would need to build one and make other changes to the entryway. I would probably need to clear some pieces of furniture out of the way, and I don’t have a bathroom with handicap access.  This may be a student I would choose to teach at his home rather than in my studio, or I may able to search out a grant for equal access modifications.

However, if I were introduced to a student with muscular control problems who had no past history of pianistic development, I would have to think about the probability of his being able to achieve much as a pianist. In that case, I would weigh both the architectural mobility issues and the determination of appropriate goals.

As you can see, when deciding how best to work with a potential student, it is necessary  to understand what your instrument requires and the physical set-up of your studio. I once had a Vietnam veteran in my university piano class. He was a solid percussionist, despite having lost several fingers in an explosion. Could he play the piano? Yes. Did he require modifications to his piano assignments? Definitely. But he could be very successful as a percussionist even with a few missing digits. He also didn’t require any changes to the physical set-up of the piano lab or the percussion room, unlike a student who requires mobility assistance.

Here are examples of some of the types of challenges a student may present: 

• Medical: disease, congenital impairment, catastrophic injury

• Social/emotional:  interaction problems, behavioral problems, unsupportive family or personal environment, inappropriate response to learning or performing situations

• Processing and perception: limited ability to process sensory input effectively, attention disorders, color blindness, auditory processing disorders

• Cognitive impairment: learning disability (Dyslexia is usually considered a learning disability, although people with dyslexia may be very “intelligent” in the traditional sense, think Warren Buffet), brain disorders, low IQ

• Communication: speech impediments, stuttering, hearing impairment that affects speech and ability to follow directions, low verbal and syntactic skills due to motor limitations or other neurological impairment

Be aware that some students will demonstrate more than one challenge. Also, be aware that the student’s personal motivation is key to success.  Reading all you can read about autism won’t necessarily result in your autistic student wanting to learn what you want to teach him or her. For some special needs students, music is the best part of their lives, but not for all.

In the next blog, I will present some ideas about working with students with autism. Stay tuned.

Special - build on what you know

Many years ago I attended a week-long piano master class at the Peabody Conservatory of Music. One of the presenters was Tinka Knopf, who was leading the Preparatory Program at Peabody and  becoming increasingly interested in working with special needs learners.  She told the story of helping design a prosthetic left hand for one of her students. She didn't know anything about constructing prosthetics, but she knew a lot about what a left hand does in piano literature. When the engineer asked her how wide the hand would need to open, she simply opened her left hand on his desk to the span of octave. When he later double-checked this distance on an actual piano, he discovered that she was 100 percent accurate. She was literally helping him build on what she knew.

As I stated in the first of the Special posts, I'm not an expert on special education, but I can build on what I know. As both an Alexander Technique Teacher and a piano teacher, I have worked with students with a variety of challenges. Here they are, in alphabetical order:  allergies, arthritis, asthma, Asperger's syndrome, attention deficit disorder, auditory processing challenges, Bell's palsy, blindness, broken bones, congenital eye muscle problems requiring surgeries, cystic fibrosis, epilepsy, fibromyalgia with lesions, focal dystonia, Irlen syndrome, leukemia, loss of fingers, Lyme's disease, Meniere's disease, muscular/skeletal injuries, obsessive compulsive disorder, Parkinson's disease,  profound hearing impairment, scoliosis, sliced tendons, symbol recognition challenges, and tendinitis.  Time to hang out my medical shingle, right?

Some of these students were in my studio for a very short time or were students that came to workshops where I was teaching. Some of them were in my studio for extended periods of time. I think in particular of Amy, a bright and talented young woman with cystic fibrosis who played piano and flute well. When she came for a lesson I never thought, "here comes cystic fibrosis," but "here comes Amy, that delightful student." She rarely missed a lesson, and I loved working with her all through her public school career. I did not love sitting in the pew at her funeral, a potential piece of working with students dealing with serious health conditions.

Some of these conditions, dire as they may sound, did not require any adaptations out of the normal. Amy would occasionally cough due to the build up in her lungs, but I knew that it wasn't contagious. She also had slightly clubbed fingertips, but that did not stop her from moving her fingers well. Even though she had a life-threatening illness, she functioned extremely well in her lessons and practice.

Students with symbol recognition challenges are more than likely to live a full, healthy life, but they require accommodations for score reading and hand-eye coordination development. This is the sort of thing you will recognize rather quickly, even if you have no idea what axons and dendrites and neurons and grey matter actually are. Have courage! You will build on that discovery in the best way you know how.

If you are a public school teacher, you will have access to private records about your students that will reveal challenges. Legally you are required to make accommodations for identified students. A private teacher does not have that access, and some parents will not tell you that their children have been identified in the hope that music lessons will somehow be easier than other learning situations. If you are noticing learning patterns that are not close to normal, you may need to go the parent and get more information to make proper adaptations. Or you may decide that you don't have the skills and/or tools to work with that student, which is also fair to all.

The best way to guide your decisions is to place the well-being of the student first. Decide what goals are appropriate and what tools and common sense you can access to reach those goals. Build on what you know as well as what you are willing to learn.

The next part of this series of blogs will be devoted to some of the common challenges you may find in your students and some basic suggestions for each of these. Keep in mind that flexibility is key.

Special - the ground rules

If teaching special needs students is something you are considering, it is best to start with some very basic ground rules:

1. Abandon perfectionism. Embrace creativity.
Most independent teachers have figured this out already and do this with all of their students,  but it is a mindset that is required when working with special needs students.  This doesn't mean they can't be successful. It does means that the road to success is likely to be a little different, taking more time and more twists and turns. If your studio goals center on competitive settings with high-level performers, maybe special needs students will not fit your agenda. If you like to encourage students to get just a little better, and then a little better, go for it.

2. Student first, label second.
One of my wonderful and wise friends taught a student with Asperger's syndrome (usually defined as high-functioning autism)  to become a fine pianist. The student developed excellent listening and improvisatory skills.  I was not alone in begging her to give a presentation on the teaching techniques she used.  She refused, explaining that this was the only Asperger's student she had ever worked with, and that she couldn't possibly generalize.  Right. Like I said, wise. Every student is different, no matter the diagnostic label. The labels give you a general outline of what you may experience, and that is all.

3. You are a teacher, not a diagnostician or therapist, unless, of course, you are.
I know one person who gave up a career as an MD to become an independent piano teacher. This person is legally allowed to diagnose. If you are a person with some kind of legal authority to diagnose or provide therapy, you will know this. If you don't know this, you can't. However, you may recognize certain traits in students that could benefit from further exploration by people who can diagnose. Likewise, you are not a magician or healer. You are a facilitator.

4. Throw a wide net.
Be open to a large number of resources because you will need them. Your best help may come from someone you already know, or from recently printed resources, or from information-rich websites. Parent involvement is a must in order for you to get information about your students that will allow you to plan a course of action.

My resources include Dr. Kimberly Councill, music education specialist, and Kathy Morris, retired special education teacher and supervisor. The text they suggest is Teaching Music to Students with Special Needs: A Label-Free Approach, by Alice M. Hammel and Ryan M. Hourigan, published by Oxford University Press.

I am in the learning stage here, so I don't consider myself to be my best resource. I'm keeping my eyes and ears open. I do have some common sense, however, and that is also very important. More on this as the blogs continue.

Special - an introduction

True confession - I could not believe that one of my colleagues had no idea what ADD is. We were discussing a common student whose challenges were in line with what I had read and experienced concerning attention deficit disorders when I casually dropped in the three-letter moniker as an umbrella explanation. I had no idea that he had no idea.

IDEA, by the way, is the abbreviation for the Individuals with Disabilities Education Act, started in 1975 around the time I was finishing my masters program. I had no idea what IDEA was when studying music education because, well, it wasn't. We were taught in a time of smart, dumb, lazy, responsible, talkative, shy, stubborn - not in the time of OCD, ODD, LD and the increasingly long list of acronyms for manifestations that prevent students from learning the way we think they should.

For my generation, learning about learning differences and challenges had to be done the old-fashioned way, by trial and error, talking to parents, and self-motivated study. As tutors/mentors, independent teachers have the freedom to do this, and we gain a lot from doing so. We also have the opportunity to provide a positive learning experience for students who find traditional learning settings less friendly.

In Pennsylvania students in teacher education programs are now required to complete 9 credits of special education courses. This semester I'm sitting in the back row of one of these classes. I'm quietly linking the research and suggestions to students past and present. I'm keeping up with the reading assignments and asking questions and making mental notes of the ways I could help certain students.

I'm also realizing that a lot of these approaches work with any student, but perhaps in differing proportions. Ways to improve listening through tools and adaptations are not just useful for hearing impaired students, for example. Many of my students enjoy hearing themselves sing into my "elbowphone", which is a PVC elbow pipe purchased for a few bucks at the local hardware store. And students who are identified with particular challenges also have accompanying strengths, exactly like the so-called "normal" students.

With this blog as an introduction, I will follow up with information I'm learning that could be applied in the private lesson situation. There is a lot of information out there, making it a much better time to "specialize" private teaching than when I started decades ago.