Helloooooo! Can you hear me?
"Ever since Ayala was little, there were complaints, first from her morahs in gan and later from her teachers in school, that Ayala was 'floating'. Not listening, not focused, off in a world of her own, and the pace… so slow! Sometimes Ayala would surprise everyone, but not in a good way… That happened when she wanted something very, very badly: then nothing and no one could stand in her way. But when she needed to get moving, it was a real struggle. Her parents were already sure something was wrong with her hearing, but a hearing test ruled that out…
"As Ayala got older, her parents thought the problem would go away, or at least ease up, and that she'd take more responsibility. Instead, it only got worse. Ayala could lose herself in the middle of a book and miss appointments and events along the way. On top of all that, Ayala always has all the time in the world. Her mother is truly anxious: what will be with her? How will she get married and run a home of her own, when right now she's so irresponsible?
"Don't think Ayala's parents didn't try to help her over the years. She was in OT for a long time, they signed her up for after-school activities, and they even tried emotional therapy, but they didn't see any real change. At one point they thought medication would be the big rescue, but the higher the hopes, the harder the disappointment."
It was so frustrating. Then one day Ayala's mother poured her heart out to a friend, and the friend suggested: "Why not do a cognitive-developmental assessment? You'll see what's really behind this, and you'll know where to focus."
Ayala's mother was surprised: "What's a cognitive-developmental assessment? I've never heard of it! We had her assessed with the TOVA, we did a psycho-educational assessment, and nothing gave us any clarity about Ayala's difficulties. They told us it wasn't a learning issue, but it affected her learning. They also said it wasn't an emotional issue, but it affected her emotionally. Between us, I really don't think emotions are her problem. But after so many remarks, something did develop, and not in a good direction. How many comments can a girl get, always feeling she can't keep up…"
So, on her friend's advice, Ayala's parents came in for an assessment, with new hope that maybe, b'ezras Hashem, they'd finally find the right path.
And Baruch Hashem, they did…
Ayala's mother came to the assessment and told us everything they'd been through and all the things they'd tried. She wanted to understand what was actually different here, and why this might be the place where they'd finally get the right answer.
So let's take a closer look together: what exactly is a cognitive-developmental assessment?
A cognitive assessment looks at the brain. The brain is the root: every action comes from it, or doesn't. You can think of the brain as a 'control center'. It's in charge of how every organ works, every system in the body, in short, our whole being. But its most important job is running and directing our mental abilities: understanding and thinking, perception and memory, alertness and attention. All of these are things the brain does. When there's a problem, when something isn't moving and the whole works are grinding, something in the brain isn't working right. Something in it has gone slack.
And like any problem in life we want to solve, we go to the root. Here too, since the root of everything we do is in the brain, we simply go to the brain. When something in life is stuck, you can be sure something in the brain is what's holding it up. Most likely there's a weak brain cell that isn't active enough.
The good news: we can reach these brain cells and build them up!
The explanation is very simple. Surprisingly, the brain works like a muscle. Like any muscle in our body, it can be trained and strengthened. So cognitive assessment and therapy are like its 'gym'. At the gym, you get precise instructions: which exercises work each specific muscle, and at what level and pace to build up the weak one. In exactly the same way, we can stimulate specific brain cells, the weak ones causing the trouble, through play.
In the assessment, we watch the brain cells at work. We find out what the child's strengths are and where the weak spots lie, and we understand where the problem, or problems, come from. Now, with a map of the brain in hand, we understand the problem, or more precisely, its root, and we see that it really comes from that one weak cell. From here, b'ezras Hashem, we can walk a clear path to the goal: strengthening the slack cell and getting things working well, with siyata d'Shmaya.
And now, back to Ayala, and what we saw in her assessment…
The assessment showed us that everything Ayala struggles with comes from difficulty paying attention to the space around her. We discovered that her field of view is narrow. Not because of any damage to her eyes or optic nerves, chas v'shalom, but because the brain cells responsible for her alertness are dozing. Ayala sees only what's right in front of her; everything around it goes unnoticed. It's like looking through a pipe: you see one spot, and can't take in the whole space. Ayala, too, can't turn her attention to the space around her, beyond what's right in front of her eyes.
Healthy alertness, on the other hand, lets you see the whole space. Seeing the space around you matters a lot, because it makes you more active, more engaged and more alive. A person who looks around and notices what's happening takes in more stimulation, and does more as a result.
A difficulty with alertness is one of the main causes of attention problems, and of trouble 'dividing attention'. Listening takes awareness of the space around you, plus the ability to filter out what's going on in it and focus on what's being said. That's why a child with low alertness can seem not to be listening, and doesn't answer when called.
People with low alertness can come across as irresponsible, passive, slow and dreamy. It's hard to expect them to be on time or to remember things. Related issues can include sensory problems, trouble with sensory regulation and balance, and sometimes daytime wetting.
Sometimes you can recognize low alertness by a loud voice. When someone loses their sense of the space around them, and all that's left is their own voice, the volume goes up accordingly…
So what can we do?
There are definitely ways to strengthen Ayala's sluggish brain cells. Mainly, we recommend daily physical activity and gross motor exercises, especially ones that take balance. These are very good for building attention, because they require seeing the space around you. You'll find more tips for improving alertness at the end of this article.
And if that doesn't do it? Then Ayala probably needs something more intensive than exercises at home. In professional therapy, she'll practice exercises tailored to improve her awareness of the space around her, and that will stimulate her brain cells to start working, b'ezras Hashem.
And now, the happy ending...
Now that we've told you what goes on in Ayala's inner world, listened to the problem and heard the solution, let's come back to her mother…
After the assessment, which was fascinating in itself, Ayala's mother felt relieved. Not that everything was solved on the spot, but knowing the problem is half the solution. First of all, she let go of a lot of guilt. It's not that she's doing something wrong! It's not because she took on responsibility in Ayala's place! It's not spoiling! She isn't just raising a lazy girl who couldn't care less what she's told and does whatever she likes! No.
This is a developmental difficulty Ayala was born with!
In the assessment, without her describing exactly what she goes through with Ayala, and without detailed questions about the past, she was told what Ayala is like, the good and the hard: her talents and her stumbling blocks, her strengths and her weaknesses.
The way Ayala plays shows, like an X-ray, what's going on in her brain.
Ayala got to work. Adam l'amal yulad: we're made to work hard, and there's no harvest without effort. After each challenging session, full of games and exercises that demand alertness, Ayala could feel herself coming out of the dark into the light. The therapy was demanding. It took consistent sessions and serious practice. But the harder the work, the more precise the aim: it targeted exactly the area of the brain that needed this 'workout', and the results have been a real bracha. Ayala feels more focused, more responsible and more grown-up.
Today, Ayala's mother isn't afraid for her future anymore. She knows she gave her daughter the best push she could!
Tips for children who struggle with alertness:
- Make eye contact with your child when you speak.
- Help your child manage time: a clock, reminders, a timer that sets a time limit for each task.
- Go to the playground and encourage climbing, swinging and bike riding.
- It's a great idea to sign them up for gymnastics, aerobics or swimming.
Names and identifying details have been changed.
Sarah Shugerman · Cognitive assessment and therapy through play
