We all want our children to have every opportunity to succeed in life. We want them to be the smartest, the most talented, the most athletic. As a parent, it can be difficult to hear your child is struggling in school. However, there’ çs a lot of hope for children with learning differences, especially with the help of early intervention.
My guest today is Dr. Matthew Housson, who is the founder of The Housson Center located in North Texas. Dr. Housson and the clinical team at the Housson Center provide psychoeducational and psychological assessments for children and also work with parents and children to provide therapy. I first got to know Dr. Housson several years ago as a parent.
Dr. Matthew Housson received his Ph.D. in Clinical Psychology from The University of Texas Southwestern Medical Center in 1996. He began his career at The University of Texas at Dallas, Callier Center for Communication Disorders. Dr. Housson has extensive experience diagnosing autism, attention disorders, learning disabilities, and emotional and behavioral disorders.
He is here today to talk about the opportunities there are for parents to raise a child who has a different way of learning. It is my privilege to welcome him to the show today.
- Is “learning differences” the right language to use when a child presents with challenges in the classroom?
- How early are learning disabilities detectable in young children?
- Are learning difficulties usually noticed first by the parents, pediatrician, or teachers?
- What is a psychoeducational assessment and how does it differ from a psychological assessment?
- For parents, if a teacher isn’t suggesting that there’s a problem, is it still worthwhile to have an assessment done?
- What do you say to parents who are concerned that getting a learning disability diagnosis will ‘label’ a child?
- How do you help parents whose child has come back with lower scores than they were expecting?
- How do you help parents decide what is going to be the best option for a child?
- How can parents encourage the development of grit in their child?
- In terms of depression and anxiety, what are teens experiencing these days?
- What guidelines do you use to help parents understand whether medication or other remedies should be used?
- How do you know if your child is really struggling with depression or if they are just copying their peers?
- What role does sleep play in our children, and why is it so important?
- Are devices having an impact on the kids that you’re evaluating and treating in general?
- Has Covid had an effect on learning?
- How can I help my child to fill in the gap?
- Is tutoring a good idea or is it just more pressure on a child?
- What therapy does the Housson Center offer families?
- What message of hope do you have for families with children who are struggling with emotional or educational learning differences?
Is “Learning Differences” The Right Language To Use When A Child Presents With Challenges In The Classroom?
It’s a good starting place. Learning differences imply that a child’s in school, and we’re seeing differences in their learning. But, technically when we do an assessment, we’re looking more at learning disabilities. The way we think about the difference between those two things is that with a learning disability, you’re seeing a discrepancy in what you would expect based on a child’s intellectual capacities or the educational opportunities they’ve had. You’re seeing a discrepancy that’s more than what’s expected. We look for statistical deviations from what’s expected. So I think that that would likely help listeners understand the difference between a difference and a disability.
How Early Are Learning Disabilities Detectable In Young Children?
It’s a really common question. My perspective on it is the earlier, the better. Now, it’s very difficult to be definitive with a diagnosis of dyslexia prior to the second semester of kindergarten or first semester of first grade because there are different developmental trajectories that children are on. However, we know so much about family history and the heritability of learning disabilities. And I tell families if they’re worried about a child, bring them in. We can do some screening measures, so we don’t have to spend a lot of time and a lot of money looking at a full evaluation.
We can start with speech-language therapy. We can start with occupational therapy with three and four, and five-year-olds so that we’re trying to mitigate the frustration the early learners experience when there is a difference in their motor system or their language system. Those underlying areas may predispose them to a future diagnosis of a learning disability. And so what we think about is RTI, Response To Intervention. We want to take children who have vulnerability as early as we can and give them intervention. And then, we want to come back and monitor their progress over time.
Are learning differences usually noticed first by the parents, pediatrician, or teachers?
It’s commonly teachers who notice first. We have good relationships that we’ve established in the Dallas area with both private and public schools, where a teacher may text me, or they may call me and say, “Hey, I have this child, and this is what I’m seeing. What do you think?” But I would say, most commonly, learning issues are usually first noticed by teachers.
And then, for attention or social communication differences, it would be a pediatrician or a parent who is saying, ” I’m worried about the way my child relates socially.” “I’m worried about self-control and overactivity.” And it’s at that point we want to bring the family in without the child and do a good case history and look at symptoms, sleep, exercise, and so on. I kind of joke a lot of times and say I’ve treated more children with attention problems by changing their sleep than by any other methods such as medication.
What Is A Psychoeducational Assessment And How Does It Differ From A Psychological Assessment?
Yeah, that’s a great question. So both of the assessments start with appearance and getting to know the family history, and vulnerabilities for different learning issues. That’s usually about an hour appointment. What I think is really important is going to see the student at school, though that’s been difficult with COVID, like with a lot of things. We like to do a classroom observation.
First we got the family’s perspective, and now I want to hear the teacher’s perspective. I just feel teachers are invaluable resources when I’m doing an assessment because they really know that student. We’re spending six to ten hours with a child, but the teachers are with the child every day. So I want to know from teachers. In addition to the school visit, we’ll have teachers and parents fill out questionnaires. And these are norm-based questionnaires that look at executive functions skills. “Are they within range or outside of the range?”
And then, it proceeds to one-on-one testing with a child where we do cognitive or intellectual testing, and look at verbal abilities and visual-spatial skills. We look at working memory and remote memory. We look a lot at language with young children. 50% of children who have dyslexia also have a language processing disorder. And so these are children that, as they get older, may have difficulty with reading comprehension if you don’t take care of some of those underlying language processing weaknesses.
Then we’ll then go to the academic part, where we look at reading decoding and reading fluency, and reading comprehension. We’ll look at math word problems versus math calculation versus time tests. The time test is important because a lot of children have cognitive processing disorders where they’re just much slower than you would expect, given how high-level they can process. So they may be very good at conceptualizing and telling you how two words are alike or putting blocks together, but they’re very slow in terms of just their pace or tempo.
During the latter part of the assessment, we do computer measures of sustained attention. And then we do the psychological part; it’s a little bit more than a screening where we talk to the children and have them fill out rating forms, and that kind of rounds out a psychoeducational evaluation when we meet with parents and go through the results. The psychological piece is everything I said, plus sometimes we’ll use much more intensive psychological assessments, like projective tests, self-report personality questionnaires, which are usually for middle school and high school kids.
Having gone through the process, I know when you get the results back, it really is like a key to unlocking your child’s strengths and where their areas of challenge will be.
If A Teacher Isn’t Suggesting That There’s A Problem With Your Child, Is An Assessment Still Worthwhile?
I played sports when I was younger, and I like watching sports. And so I think about what college athletes do. After they graduate from college and they want to go to the NFL, they go to the combine to test their performance characteristics. And so I feel like our testing is similarly about going through different measures and looking at not how high you can jump or how fast you can run, but what are your different assets?
Rather than it being a diagnostic test, just to get the diagnosis, I want to know a student’s profile. When I say profile, we want to know what his or her stamina is, at what point does that student lay his head on the desk and say, “Gosh, I’m tired.”
We have norms when we do that, and we put breaks in just to prevent fatigue. But if a child’s getting fatigued very quickly in our office, it’s happening at the kitchen table after school.
I think that’s the part where having a diagnostic team where you can look at both the educational and psychological parts allows for a much richer profile. And it’s with that profile that we can make recommendations of, “Even though we have a very bright student developmentally, they may not be ready for that accelerated school.” And so we say that some students are accelerated or ready in first grade, and there some others aren’t ready to go to the school that teaches one or two standard deviations above the mean until they’re in middle school or high school. They’re just not developmentally ready to work that hard.
And so that doesn’t mean that they won’t ever be ready; it just is tailoring the education experience to meet their needs.
Yes, my favorite word is ‘yet.’ We basically say, “We see these capacities, but we may not yet be ready for this accelerated high school.”
So you’re looking at gifted as well as learning challenges.
Yeah, we really look at learners across the spectrum. I mean, I always have kind of a bell curve in my mind, and I’m saying, “This student’s a 50th percentile learner.” “This student’s an 84th percentile learner,” which is one standard mediation above the mean or a 98th percentile. And then, we also have students who struggle a little bit more. And so it’s that delta between their higher-end scores and their lower-end scores that I’m really interested in because that tells me a lot about what we do developmentally. Do we gear schooling based on their social-emotional stamina needs, or do we gear their program based on their academic strengths or weaknesses?
What Do You Say To Parents Who Are Concerned That Getting A Learning Difficulties Diagnosis Will ‘Label’ A Child?
I think it’s a legitimate concern. Especially in mental health, a lot of times, diagnoses have been used for unintended or even negative purposes. And so I joke and say, “I think diagnoses are interested in insurance companies, but I’m really interested in profiles.” And a lot of that, we understand from either parent, whether married or going through a divorce or divorced, it’s fear-based, and it’s worry-based. I mean, I think the essence of parenting is wanting to do the best.
I’ve never met a parent who didn’t want to do the best, even though their actions may not have been the best, but their desire was. And so their fear a lot of times does interfere with maybe wanting the assessment. And so I think it’s important just to talk to that parent and say, “Here’s what’s going happen to the student.” Kids almost always love coming in. They like getting goldfish, or they like individual attention from an adult. So it’s rarely the child that comes in and who has a negative time.
But we want to educate the parents and help them to understand that through this process, we’ll come up with a profile, and then that can then help you make informed decisions in terms of what’s the right intervention. Do we need a really intensive reading tutor, or do we just need someone who’s working on academic confidence? So the testing’s pretty good about telling us those more nuanced decisions that people can spend lots of time and energy arguing with each other over. We have the data, let’s just do the data, and then, as parents, you can make really good informed decisions.
How Do You Help Parents Whose Child’s Scores Are Much Lower Than They Were Expecting?
It happens. And that’s the benefit of being a psychologist who’s practiced twenty-five years; my wife’s a psychologist as well. We have four children. And it is a laboratory. I’ve seen my oldest, Elizabeth’s friends, they went to a whole range of colleges and they are sophomores now. And we see that their outcomes are so dependent on work ethic, grit, persistence, distress tolerance. And so, I never have parents say, “What’s my child’s distress tolerance index?” But they always say, “What’s their IQ?” IQ is important, but we know from all the research that people who can handle distress and show grit and persistence are going to be successful.
And so a really important thing – I haven’t figured it out yet – but I want to come up with something like an IQ number that I can share with parents and say, “Their grit number is this.” And I think it would be a lot more reassuring for parents. I think it’s important for parents to understand that if your children are mentally healthy, if they’re sleeping well, if they’re exercising, if they have some form of faith that’s guiding them, if they’re goal direct and they have good adults around them, we all become who we’re going to become, who we’re going to be.
I remember when we were deciding on school, it was like the weight of the decision and that I was going to get it wrong. And it felt at the time like it was an intractable decision. As if, once you decide that part, then you can’t make any other choices.
How Do You Counsel Parents In Terms Of Trying To Decide What Is Going To Be The Best Option For A Child?
Sometimes, I’ll say to the parents that this student is a one to three school kid. The school that’s right for a kindergartner may not be right for a ninth-grader. And so that again gets at that developmental perspective that we take. When we do an assessment, we’re taking a snapshot of a student at that point in time, and we’re trying to take that snapshot and make it into a video that’s predictive.
Sometimes you can’t do that because the next time you test them, hopefully within three years, those two pictures may look different, and then that totally changes your trajectory. And so some of my favorite children to work with are the ones who are three and four years old. And we say, “Okay, here’s the plan for pre-K.” And we do that. And then we’re going to test right before kindergarten, and we’ll know what we do there, public or private, specialized services through public or private school or more typical.
And that, for me, is fun and engaging, but for parents, it’s really anxiety-provoking. But I think for me, it’s fun to then make predictions and say this is where we want to be. And a lot of times it works out because we have parents who are following good advice and we have experience. We don’t know, we don’t have a crystal ball, but the data that we get through these assessments, because we’re asking teachers and we’re seeing the child, and we’re talking to parents, we can take that information and assimilate it so that we hopefully can be a little bit better than other parents in the carpool line, about which school’s the best.
I love that, and it is super helpful. And I think that idea that this could be a one to three school child, that just because you set out on a path doesn’t mean you’re going to have to change.
Well, I think parents now, especially with the pandemic, are just anxious. In Texas, we have lots of families moving from other areas, and so it feels more competitive. I think it is more competitive. So, there’s that rush to get into that school and not have to deal with this awful admissions process for private school-driven families or even families in magnet schools and public schools. So it’s just a more anxiety-provoking time.
It absolutely is. I want to go back and touch on grit real quick because I would imagine that that is something that is malleable and can absolutely be influenced in a child’s life.
How Can Parents Really Help Encourage The Development Of Grit In Their Child?
When I think of grit, I think of what is the precursor to it, which is distress tolerance. In order to be able to persevere through difficult times, one has to be able to regulate emotion. And I think that helping parents to understand that temperament drives so much of emotional regulation and usually, parents who get thrown off kilter easily have children who get thrown off kilter easily. And so we want to make sure that if we’re starting at the earliest ages that we focus on attachment, we focus on sleep, and we focus on predictable structures and the ability to soothe the child.
And so, be parents who are emotional thermostats rather than emotional thermometers. There’s a big difference in how you help your child regulate. When children are able to regulate their emotions, then they get better when they’re losing in a soccer game, when they’re crying, and they’re upset. Their coach can go and not yell at them and kind of be a thermometer with them, but bring them to the sideline, help them to get regulated, and say, “Look, we’re gonna be better. This is a hard game”. Then that builds grit and distress tolerance. So I think grit is a marathon, and distress tolerance is the daily workouts.
So what I hear you say is that it’s important for our children to experience some distress in their lives?
Yeah, absolutely. We all get overwhelmed. I think of it on a 10 point scale, and we all get into 7, 8, 9, and 10’s of emotion where we yell and cry and scream. And we’re in our limbic system, which is our lower brain or our downstairs brain. We have to help children get back into their upstairs brain where they can start thinking and reasoning. And so, I think an important area in parenting is just helping parents understand the neuroscience of emotion as we understand how emotion works. Then I think we can get to these higher-level goals of grit and emotional intelligence.
In Terms Of Depression And Anxiety, What Are Our Teens Experiencing These Days?
Two years ago, we saw rates of anxiety and depression really higher in teenage populations. And then the pandemic came, and everything doubled. So we were already high, and then it just doubled. So teenagers lost the ability to connect with their primary sources of support during the pandemic, which were their friends, not their parents, and that’s normal, right?
And so I think we just saw teenagers really get gut-punched emotionally. And so, I feel like that’s been a real struggle for that age group. We have periods where we come out of lockdowns and mask mandates, and then we go back into it. And so I think it’s that topsy-turvy nature of just dealing with a pandemic that’s been difficult for everybody underneath a more contentious environment where everyone’s more emotional, and everyone’s more anxious. And so I feel like the important thing for teenagers right now is just parents connecting with them and basically saying, “I get it. It’s been hard.” “How can we work through this?” But those rates have really gone up quite a bit during the last two years.
Another issue that I see that comes up quite a bit has to do with the use of medication; medication for depression and anxiety or whether it’s ADD or focus.
What Guidelines Do You Use To Help Parents Understand When Medication Is Useful Or If Other Remedies Should Be Used?
When you look at things from a neuroscience perspective, we know what a calm brain is like and what a dysregulated brain is. And so, first of all, when we speak about medicine, most people think about attention deficit medicine. Those medicines are called stimulant medications. And very, very simply put, what they do is activate a neurotransmitter called dopamine. And when our brain gets dopamine, it’s more alert.
The analogy I use a lot of times for families is, you’re driving on a long trip, and you’re just really bored, and you start to get under-activated, and your brain waves slow down. And then someone honks at you, and you get a surge of adrenaline and just kind of a neurotransmitter boost. And then your dopamine is activating all of a sudden; you’re focusing better and doing better.
So those medicines are very effective. They are 70 to 85% effective if you’ve been accurately diagnosed. So for attention disorder medicines, we find that if a student’s struggling, that intervention as well as sleep, exercise, and structure and cognitive behavior therapy is the goal standard. But not every child who has an attention problem needs that level of intervention. So I think that’s where it starts with a good assessment and a good idea of what’s going on so that then parents can be educated about what’s the effectiveness of this, or what’s the effectiveness of that.
If you go onto the internet and you google treatment for ADHD, there are a lot of things. And all of those things work about 30% effectively. The placebo response rate is 30%. And so parents will say, “We’re trying to fill in your favorite supplement.” And then I say, how’s it working? And a third of them, a little less than 30% of them, are going to say it’s really effective. Well, the standard is, is it 70 to 85% effective? That is the treatment for attention deficit.
Interesting research on medicines that we use to treat anxiety and depression, called SSRI, Selective Serotonin Reuptake Inhibitors, we have found through studies that were actually done here in Children’s Medical Center in UT Southwestern that when we treat depression in children with those medicines for nine to 12 months, it significantly reduces the risk of relapse as they get older.
So those medicines almost seem to be helping the brain recalibrate those neurotransmitter systems that are dysregulated. And it’s really critical research. That’s not true for ADHD medicines, but we’re finding some research that if you treat depression younger and quicker and earlier, then you can reduce the risk of relapse as children mature and the brain gets older.
It’s new research. It’s pretty cool.
How Do You Know If Your Child Is Really Struggling With Depression Or If They Are Just Falling In With Their Other Peers?
One of the things I noticed having raised teenagers and still raising teenagers is that it seems that right now, the teenagers are very aware of depression. I think there’s a lot of social media hype about depression.
It’s hard. We’re seeing that around other aspects of mental health, identity, and gender and a lot of these things, and children and adolescents have to filter through that. I think that’s again where your relationship with your child is important in helping them to understand that we all have days. Monday’s a common day where we feel a little undermotivated, but we can get ourselves up.
The most common symptom of clinical depression for adolescence is not sadness, it’s irritability. So that’s hard to tell because adolescents are often irritable. But if you have irritability, drop in grades, loss of motivation, sleep changes, appetite changes, children who just no longer want to go out and see their friends, that’s time to go in and speak to your pediatrician or come and see a psychologist.
What Role Does Sleep Play In Our Children, And Why Is It So Important?
Sleep is to a child what a charger is to your iPhone, right? I mean, if you’re not getting the right amount, then you’re going into the day with an uncharged battery. And as a result, you’re going to be more reactive, be more unfocused. And so, children under six need 12 hours of sleep, that’s 7 o’clock to 7 o’clock.
And for teenagers, 9 hours and 20 minutes. A study showed that if kids could get nine hours and 20 minutes of sleep, then the range is eight to nine hours for teenagers. I just tell teenagers, think of eight as your minimum. They are all underslept. And as a parent, you can’t make someone eat something they don’t want to eat, and you can’t make someone sleep. You just want to educate them. And when I’ve gotten less than eight hours of sleep, I can feel it the next day. And then I just have to autoregulate. So sometimes we have to learn the hard way.
What Are The Effects Of Lack Of Sleep On Teenagers?
“You’re just not the best version of yourself” is what I tell them. If they’re coming in concerned about their grades or about not making as many baskets in the game or whatever, I can say, “Well, let’s try to get you optimized. Let’s look at what you’re eating. The fuel you’re putting in the body and the fuel you’re getting through sleep.” Because what happens when we don’t sleep enough is we’re just not giving our brain an opportunity to regenerate, rest and build neurotransmitters to the level that they need to be.
What Impacts Of Devices Are You Seeing On The Kids That You’re Evaluating And Treating In General?
I don’t want to leave our discussion without talking about COVID and talking about distance education. One of the things that occur to me as we’re talking through this are devices, right? As a parent, I try to minimize devices, and then COVID happened, and everybody’s on their devices all the time.
Anytime you have individuals who overdo anything, whether thats gambling or anything that’s negative for their brain, then when you take that desired activity away, they’ve got high amounts of neurotransmitters pumping through their brain, and they go through an immediate dip in mood.
And so when you take away the iPad of a five or a six-year-old, they throw a fit. And so on, across the age spectrum. I think it’s important with the youngest children that some of them don’t need to be on media. We’re getting research that’s saying that for some children, their brains can’t take it, so you see these behavioral issues.
For teenagers in general, the way that I think about this is what is the most proactive way you can work with them, and that’s a schedule. So you come home, after being at school all day, get on your iPad and check out your YouTube videos that you like to, give yourself a time limit, and then go and do your thing.
I think it’s important that we all do it; whether it’s your favorite news outlet or your favorite YouTuber, we all do that as a means to rest and relax. But if we have a schedule we have to get back to, it prevents us from just staying in that world. And I think that what was hard during COVID is that we all got sophisticated in having the person we were talking to on that secondary device or secondary thing that we could look at, just because the social strictures against doing so weren’t as apparent in those situations.
Well, devices became a means to having some connection with the outside world because our extracurricular activities were also online.
And so I think that that’s what’s difficult. There’s something therapeutic about being in a relationship with someone. When you put a medium in between that, a computer screen, it’s still a connection, but it’s not the type of connection that involves the sensory experience of being with someone and all the things that go along with that. The ingredients were there, but it was a very planned diet of social interaction.
Are You Seeing Learning Gaps Since Covid, That We’re Having To Make Up For Now?
Yeah, some families are testing for private schools right now, and there’s an independent school entrance exam, and all the scores are lower than they’ve been in times past, and we’re seeing it on the STAR test. So we are seeing learning loss and its consequences because even as good or bad as we thought we were as parents, we were not professional teachers. I think there is going to be a ripple effect that comes along with COVID that we’re already seeing in test scores.
How Can I Help My Child To Fill In The Gap?
We have to be patient; we have to understand that it’s a collective setback. And that if we return to what we’re doing, getting kids in school, letting teachers deal with learning and not some of the ancillary things that are being talked about in schools right now, they’re going to get where they eventually need to get.
And that includes not only academically but also the social part of it?
Some kids will need tutoring, but I really want to be reluctant to say more tutor, just because I think I see more kids who are over-tutored than under-tutored, which worries me more for their social-emotional development than for anything else.
When Is Tutoring A Good Idea Or Just More Pressure On A Child?
Outside of doing an evaluation, the person who has the best read on that is your child’s teacher. These are professionals who are with your child every day. And if they say you need tutoring for your child, get tutoring. If they say, I don’t think so; I would listen to them.
What Therapy Is The Housson Center Doing With Families?
I feel lucky; I feel like my day is a different day. I meet with parents, and then we work with young children. After school, kids will come in, and we provide a range of therapy. So for children with social communication differences, we have speech-language pathologists who are experts in developing eye contact and social and emotional reciprocity or just traditional speech-language intervention. Most of the counselors do a form of therapy called cognitive behavior therapy, which focuses on the relationship between a person’s thoughts, feelings, and actions.
I really like family therapy for adolescents because a lot of times, it’s nice when there is a parent-child conflict to come in as a family and do a lot of problem-solving and working with them. So therapy can take so many different forms. I think what’s important is having the right intervention geared for the right students. So whether it’s a social intervention, an anxious-depression-type intervention, or if it’s academic, a lot of kids need therapy for their executive function skills. These are things like organizing and planning, and self-monitoring. So those are just different types of interventions that we have available at the Housson center.
And I know in the past, like during the summer, you’ve done camps for things like executive functioning and getting organized.
We geared up for that this summer. It’s been difficult since it’s something social. But we’re getting geared up to do more executive function camps. One of the clinicians that we have, she and her husband, are doing a parent training series that is virtual, looking at the neuroscience behind ADHD and autism spectrum. So there are just a lot of services that are available for families who are wanting help.
What Message Of Hope Do You Have For Families Whose Children Are Struggling With Either Emotional Or Educational Learning Differences?
The thing I noticed the most in my work is that the brain is built to get better the older we live to a certain point, right? But I would just say with identifying learning issues, there are a lot of resources that are available for students. The expectation is that each child diagnosed and appropriately given the right profile and a plan all go on to do the things they’re supposed to, whether they go to college or start working and then go back to college or start their own businesses. I’m just so optimistic about child development when we understand the vulnerabilities to that normal development. If you put the guardrails up at the right times, children just soar.
That’s great. Thank you so much for being here. This is really helpful for me as a parent and as a professional.
It’s been fun. It feels like we’ve been talking for five minutes. I know it’s longer, but it’s been great.
If you want to learn more about Dr. Housson or The Housson Center, we will include links to his website below. And I hope you’ll reach out if you need an assessment for your child. Thank you so much.