Hands On Learning Solutions, a business in Gig Harbor, Washington, evaluates and treats children for learning disabilities and claims to identify the underlying causes and help eliminate the symptoms. Much of what they do is questionable, and at least one of their methods is clearly bogus. Their program is reminiscent of the Brain Balance program that I wrote about in 2010. I’ll describe one child’s encounter with Hands On Learning Solutions and let you decide for yourself whether it sounds like a legitimate, helpful service.
Billy (not his real name) is an 11-year-old boy who is in the fifth grade at a Catholic school. He didn’t learn to talk until age 3, but he got speech therapy and is currently doing well in school, with a GPA of 86%. On his last report card, the section on “Successful Learner” rated him above average on working cooperatively with others, and satisfactory in all other categories, such as organizational skills, using time well, listening attentively, following directions, and completing work on time. His mother took him to Hands On Learning Solutions on the recommendation of a friend. On the intake questionnaire she expressed concerns about his written/oral expression, organization, study skills, attention focus, and motivation/behavior. She did not check the boxes for concerns about reading, spelling, comprehension, letter reversals, graphomotor skills, math, memory, poor grades, or slow work.
At age 5 Billy’s primary physician had him evaluated in the neurodevelopmental clinic at a children’s hospital because of concerns about speech and social delays and possible autism spectrum disorder. The clinic felt that he had shown some autistic features in the past but that these had improved over time, and he did not meet the criteria for autism spectrum disorder. They recommended he enter special education kindergarten and get speech therapy.
At age 9 he was evaluated by a specialist in developmental behavioral pediatrics because of continuing concerns about atypical social skills, repetitive behaviors, and possible autism spectrum disorder. His mother reported that he performed repetitive behaviors like circular wrist and rhythmic finger movements when excited or bored. His teacher reported that he had a hard time working with other students and tried to hide his work so others wouldn’t copy. He was in public school where he was getting speech therapy. He was also receiving counseling for social skills, self-esteem, and pragmatic skills. The specialist felt his developmental attainment was at or above his age. He thought Billy met some of the diagnostic criteria for Asperger’s disorder including atypical pragmatic communication skills, delayed and/or atypical socialization and play skills, variably decreased eye contact with others, variably decreased and/or atypical joint attention and social referencing, intense interests and/or behavioral preferences, sensory and/or emotional regulation problems, and repetitive movements when overly excited or unfocused. But he did not feel that Billy met the diagnostic criteria fully, and he was not willing to make that diagnosis. His only recommendation was continued monitoring by his primary physician and continuing individual and/or family counseling as long as clinically indicated.
The Hands On Learning Solutions evaluation
The report runs to 19 single-spaced pages plus several attachments with photos and examples of Billy’s writing. It describes the results of a battery of tests including the Gibson Cognitive Test Battery, the Test of Auditory Processing Skills (TAPS-3), the Test of Visual Perceptual Skill 3rd Edition (TVPS-3), the Ekwall/Shanker Reading Inventory, Neurology of Learning Screening, a Neuro-Reflex Assessment, and the Learning and Behavior Rating Scale. They reported scores as low as 6.7 years behind his “developmental” age (I think they meant chronological age). And the scores on different tests were all over the map: for instance, visual memory corresponded to age 5 and sequential memory to age 18! They report a huge mass of confusing data; I don’t know how to interpret it all, and I’m sure most parents wouldn’t know either.
They made detailed observations of his behavior during the testing, such as swinging his feet, rubbing his eyes, yawning. The testing session lasted 4 ½ hours, and I would expect an 11-year-old to show signs of fatigue and boredom. They commented that he tends to look to his right side before answering a question. (The idea that the direction of gaze means anything is a myth from neurolinguistic programming (NLP), a largely discredited pseudoscience.)
They diagnosed abnormalities or “challenges” in these eight areas:
- Food issues: sugar
- Un-integrated reflexes (12 items listed, including Moro, palmomental, rooting, sucking, and head righting reflex)
- Auditory processing
- Oculomotor skills
- Visual processing
- Study skills
- One of three neuro-reflex integration programs with a professional trained in that program.
- Movement programs to improve organization movement issues; he should start at the lower level of the Learning Skills Pyramid in the neurology of learning area.
- An auditory stimulation program to improve auditory memory, social skills, organization, and attention. (They recommend Samonas Sound Therapy.)
- Evaluation by a specialized developmental optometrist for possible eye tracking, saccade, and teaming issues.
- Attention and organization training, preferably through the Processing and Cognitive Enhancement program.
- The Visualizing and Verbalizing Program to address his weak concept imagery and support his oral expression, auditory comprehension, reading comprehension and written expression skills.
- The On Cloud Nine math program to develop the underlying sensory-cognitive functions needed for math processing.
- A study skills program.
They gave the mother a statement of fees:
- Foundational Learning Skills: 1 ½ hours 3 days a week in clinic for 13 weeks for $5,510 with additional sound stimulation at home requiring rental or purchase of ILS unit at $195 a month.
- Memory, Comprehension, and Expression: Visualizing and Verbalizing program and On Cloud Nine programs for 150 hours at $95 an hour.
- Study Skills: Study Smart for 36 hours at $95 per hour
That all adds up to around $14,000. They require a non-refundable $475 deposit.
Examples of their reasoning
They are concerned about sugar simply because Billy told the examiner that he has dandruff and that he believes his body is exceptionally sensitive to sugar. “If Billy is eating food that is negatively affecting his body his reflexes can become un-integrated and contribute to low muscle tone.”
They attached a number of photographs of Billy during the long testing session. He slumps, holds his head close to the desk or supports his head with his hands. They interpret this to mean he has an unintegrated STNR (Symmetrical Tonic Neck Reflex) that will not support muscle tone in the upper back. I interpret it to mean he is bored and tired.
Retained neonatal reflexes
The term “Retained Neonatal Reflexes (RNR)” was coined by Keith Keen, an Australian chiropractor who registered it as a trademark in 2009. He uses bogus techniques like applied kinesiology and craniosacral manipulation. He provides a list of questions that would indicate “retention of retained neonatal reflexes [sic]” such as “Did your child have recurrent ear infections?” “Does he suffer from motion sickness?” “Does he wet the bed?”
He describes tests parents can do at home. In the Galant reflex, when the newborn is supported face down by a hand under its stomach and one side of the spine is stroked, the trunk curves towards the side of the stimulus. In Keen’s instructions for home testing he has the child supporting himself on hands and knees and he gets the direction of the curvature exactly wrong, saying the trunk should curve away from the stimulus!
The Hands On Learning Solutions people seem to have fallen for this chiropractic nonsense hook, line, and sinker. They diagnosed Billy with the following “un-integrated” reflexes: fear paralysis reflex, Moro, Palmar, Palmomental, Grasp, STNR, ATNR, rooting, sucking, tonic labyrinthine reflex, head righting reflex, and hands-pulling. They convinced themselves that Billy was “extremely sensitive to touch on cheeks, feels hunger sensation,” indicating a retained rooting reflex (the reflex that helps the newborn infant find the nipple to nurse). They convinced themselves he had a retained left grasp reflex because “examiner can remove finger from grasp in left hand easily [wouldn’t it be just the opposite?]” They thought he had a retained palmar reflex because his pencil grip was maladaptive. They were clearly imagining subtle abnormalities where none existed and interpreting them as retained neonatal reflexes that were causing learning problems and needed to be “re-integrated.” I shared the report of retained neonatal reflexes with my colleagues. Pediatrician Clay Jones found it “jaw-dropping.” Neurologist Steven Novella further confirmed my opinion that it was utter nonsense by pointing out that if these reflexes persist beyond the appropriate developmental stage, they are signs of serious brain disease or damage, not of learning disabilities.
From the documents I reviewed, it appears to me that Billy is a likeable, essentially normal although somewhat “quirky” kid who has overcome a speech delay and some early Asperger-like problems and is coping well in school. That is also the opinion of his primary physician, who has known him and his family for many years. Because of his early problems, his mother is naturally concerned and wants to do the best for him. In my opinion, Hands On Learning Solutions is taking advantage of a vulnerable mother’s anxiety. I can’t help but wonder if Hands On Learning Solutions evaluations have ever found that a child was perfectly normal and needed no interventions.
They are doing bogus tests along with legitimate ones, and they are accepting false positive results as real and over-interpreting every little observation of his behavior as a sign of a neurologic disorder. They are recommending very expensive interventions that have not been adequately tested. Most often the “scientific evidence” behind those interventions consists of poorly designed studies that measure performance before and after the intervention rather than comparing it to a control group. Uncontrolled studies are particularly problematic for learning disabilities, because children naturally learn and improve over time, and they respond to any kind of attention and tutoring.
When a child is labeled as having problems like these, it affects his self-image; and the idea that he has a learning disability may become a self-fulfilling prophecy. Perhaps the saddest thing was one of Billy’s writing samples, where he expressed a belief that he was “losing his memory” because of an injury at age 6 where his head hit the sidewalk. One wonders where he got that idea, since his mother didn’t express any concerns about his memory and his school performance doesn’t suggest any difficulties with memory. This belief doesn’t augur well for his future: if you believe your memory is deficient, you tend not to try as hard to remember things.
I couldn’t help comparing what happened to Billy to what happened to a family member of mine. He was highly intelligent but was getting barely passing grades in high school; he showed little interest or motivation and neglected his homework. His parents took him to a child psychiatrist who evaluated him and reassured them that there was nothing wrong with him. And there wasn’t. He grew up to be a well-adjusted adult with a successful career and no mental health problems. I shudder to think what might have happened if he had gone to Hands On Learning Solutions… Just as I weep to think how much better it might have been for Billy if, instead of being labeled as defective, he had been praised for overcoming his early difficulties and encouraged to continue doing his best.
On a final humorous note, at the top of the report they list Billy’s date of birth as 07/22/2015. Apparently he hadn’t even been born yet when they did their evaluation!
This article was originally published in the Science-Based Medicine Blog.