Nurturing Nature and Environment

After Jack M. Fletcher was born in a Tallahassee hospital in 1952, his parents took him half an hour west to their home to Greensboro, Florida. Greensboro was so tiny that the entire town’s 400 or so children, from kindergarteners to high school seniors, attended classes in a single school. As a boy Fletcher helped run his father’s farm, in the family for five generations since the mid-19th century and whose unusual crop, shaved tobacco, was used as the wrapping leaf around cigars.

Jack M. Fletcher records information as a research assistant looks into a tachistoscope to evaluate interhemispheric transfer. Fletcher uses imaging techniques that map the brain to identify and successfully treat children with learning disabilities.

Farming was hard work, and, unchallenged at school, Fletcher escaped into books. He developed a lifelong love of reading, which, he says, helped him get into college a year before he was supposed to get his high school diploma. “A lot of people find out that a psychologist has that sort of background and they’re just flabbergasted,” he said with a laugh. “Some people hear about my background and just think, well you must be really smart. And my answer to that has always been it has nothing to do with being smart. I was a really good reader. I was able to go to college early because I had really good reading ability, and that’s been the key to everything I’ve ever done.”

These days Fletcher is a professor in the department of pediatrics at the University of Texas-Houston Health Science Center and associate director of the Center for Academic and Reading Skills. A neuropsychologist, Fletcher is involved in a wide range of studies, including research on brain injuries in children and spina bifida, a congenital defect in which the spinal column is imperfectly closed, often resulting in neurological disorders. His most powerful work may be studies that appear to tell us how to identify and successfully treat children with learning disabilities using sophisticated magnetoencephalographic imaging techniques that map the brain, along with using those same techniques to track improvements in their reading skills.

Asked whether his own hard-won knowledge on the importance of reading has anything to do with his interest in helping children learn to read better, Fletcher quickly dismissed any linkage. “I think that’s coincidental. It probably has more to do with how irritated I get with people invoking concepts like IQ and intelligence to explain individual differences in achievement. I am very aware in my case that wasn’t it – it was because I could read.”

Fletcher enrolled in Emory University as an undergraduate, with a course of action clearly laid out. “I went into college fairly determined to be a philosophy major,” he said. “Then I realized that you couldn’t get a job as a philosophy professor. People were showing me stories about deputy sheriffs with PhDs in philosophy. So I started looking at alternatives like psychology.” He took his first psychology class in his freshman year. “I liked it a lot, because I looked at it as a philosophy course. I looked at psychology as a form of epistemology; psychology was about how people know things.” Eventually, however, he made the leap into psychology and wound up getting his doctorate in clinical psychology from the University of Florida in 1978, subsequently moving to the University of Texas-Houston in 1989.

The lab he’s a part of is home to a large group of researchers in what’s called the Division of Developmental Pediatrics. While lots of pediatrics departments have child development programs, this one is unusual because it’s made up almost exclusively of behavioral scientists, and the lab is centered on research. Fletcher’s work is focused on children with disabilities, but it’s extremely collaborative and embraces many specialties, which, Fletcher said, leads to unexpected advances.

For example, Andrew C. Papanicolaou, director of the university’s clinical neurosciences division at the medical school, was working with Fletcher some time ago on ways to help surgeons better visualize the brain using new technologies that can present images of neural function in a noninvasive way.

The need was pressing. About 10 percent of people with epilepsy have seizures that cannot be controlled with medication or other modalities. Surgery on the brains of those so afflicted can often help, but the surgeon needs to map critical areas of the brain – such as the speech center – before operating to avoid damaging those areas. Typically the way this has been done is for the surgeon to open the skull up while the patient is in a semiconscious state. The surgeon then sends tiny jolts of electricity through specific areas of the brain while the patient, usually with the aid of a psychologist, is asked to read certain words or identify pictures. Electricity flowing through the speech center will make such a simple task impossible, and that area of the brain is noted before the surgery begins.

Doctors have been trying to develop a less stressful and more reliable technique for some time. “Andy settled on magnetoencephalograpy, largely because they had just come out with machines that would let you do the whole head simultaneously,” said Fletcher, who helped out with the research. “So we did our noninvasive study. The patient reads or listens to words, we use the machine to record magnetic signals put out by the brain and use the computer to figure out what neurons are generating current. Then we create a kind of map that displays what’s going on. It’s basically an index of neuron engagement. Now what you basically expect to see in any single individual is that maps should be pretty much the same whether the patient is reading words or listening to words. But we had people come through and they were giving us diverging maps, where you have one map for listening to words and another map for reading words. Eventually we realized that these were adults that, in essence, had reading problems. So we started studying kids with dyslexia and found the same thing: They had divergent maps. Then, once we felt like we had a good understanding of what the neural mechanism was, we asked, ‘Can this map be changed?’ ”

The answer was yes. And not only could the map be changed, but the more the two maps converged, the more reading skills improved. The research was a breakthrough on several different levels. Prior to the neural mapping, just diagnosing conditions such as learning disabilities had been difficult. The new technique offered a profound improvement, and demonstrated that many traditional concepts were inaccurate. “What I think is our most significant finding is we’ve demonstrated that the way IQ tests are used in schools – for example, to identify kids with learning disabilities – is basically invalid. The whole concept of ‘slow learners’ is one that’s impossible to support,” Fletcher said.

He believes the research will prevent future generations of children from being marginalized. “We’ve done studies with kids that have dyslexia. We put them into fairly intense interventions and then image the brain before and after. These studies are important because they show that we really can teach even the most severely impaired kids to read, and when we do, we get a lot of normalization of brain function.

“The prevention studies are interesting because we go out into the schools into the first grade, identify kids that are risk for a reading problem, put them into interventions, and image their brain before and after,” he said. “Then we can track not only what happens in kids that are at risk, but also what happens in kids who are not at risk, and we’ve shown that as kids learn to read, regardless of risk status, there are major changes that occur in certain areas of the brain that seem to be necessary in order for kids to learn to read. But we tend to emphasize the idea that it’s really the impact of learning and that it’s the environment in the form of instruction impacting the brain.”

Fletcher sees these rigorous empirical studies as a solid refutation of years of dogma. “The traditional theory is that people inherit bad genes that make bad brains, and therefore it’s difficult for the child to learn. What we know from the explosion of research in genetics is that there certainly are genetic factors that lead to differences in brain organization that undoubtedly make it more difficult for some people to learn how to read, and there’s enormous variation in how easy it is to teach kids to read. So that some kids can learn with relatively little environmental input and others need really intense intervention. What the genetic studies show is that even though the genetic contribution is very large, there’s also a substantial contribution of the environment.”

Fletcher puts the genetic component at about 55 percent, while the environmental component – such as growing up in an extremely impoverished background – makes up the rest. “What you inherit is not constellations of genes that make you a poor reader. You inherit susceptibilities to learning to read. The environmental factors are things like your language and literacy environment, growing up economically disadvantaged, or growing up in home where people don’t, or can’t, read to their kids. The other big factor is instruction: Kids don’t get the instruction they need when they need it. If we don’t do something about these sorts of environmental factors, then lots of kids will emerge from school not being about to learn to read. But if we get in and get pretty aggressive around instructional issues and start with kids in pre-kindergarten who are at risk, we have an excellent chance of actually preventing some of these difficulties.”

Two former collaborators said Fletcher’s work isn’t just groundbreaking, it’s impeccable. “Jack’s work is always very rigorous methodologically, but more importantly is always well thought out conceptually,” said Keith O. Yeates, associate professor of pediatrics at the Ohio State University and director of the Center for Biobehavioral Health at Columbus Children’s Research Institute. Fletcher’s collaborative approach means he isn’t afraid to bring fairly complex specialists together and integrate their work.

Maureen Dennis, senior scientist at the Hospital for Sick Children in Toronto and professor of surgery at the University of Toronto, said Fletcher has an uncanny ability to get high-powered academics from various disciplines to produce extraordinary work. “He’s addressing real world issues, not abstract concepts,” Dennis said. “He’s really answering fundamental questions that were so complex and difficult to measure that most people had just forgotten how to ask them. How do people read? How does the brain change when we learn how to read? These are not trivial questions.”

While much of the research on children tended to take what we knew about adults and scale it down a bit, Fletcher’s research has taken the opposite approach, Dennis said. “He starts off with what we know about normal development in children and then asks how it could get off track. It’s a very different approach from the one used by many researchers, who often act as if children are just little grownups,” she said. “[Fletcher] has a faith in science as a kind of lodestar; he’s always saying that if we just keep doing the best science we know how, everything else will take care of itself. And he’s never stopped doing that in the 25 years I’ve known him.”

Fletcher said he trained as a clinician and went into psychology because he wanted to help people, and that translated into an interest in children. “What I personally realized pretty early on is that what we had to offer children and their parents was, I thought, pretty limited. I did a lot with learning disabilities, and I think it’s fair to say that, as far as evidence for efficacy, there was absolutely none. And if you ask those sorts of questions – do we really have any evidence that this actually does anything helpful – people look at you like you’re a nut, and as a result I’m commonly at odds with other people in education. So I became pretty disenchanted with it. But I always believed in doing research as much as I could to try and enhance our ability to provide effective interventions for people, and I think we’ve done that.”

Fletcher hopes that the results of the reading disability research – which, he is careful to point out, involved a great many people, not just him – will lead to a dramatic decline in the number of people who have trouble with the written word. “What all this has shown is that effective instruction along a variety of dimensions will often prevent kids from ever developing learning disabilities in reading. That’s why I’m in this area, it’s the idea of preventing disability,” he said.

In the end, Fletcher remains interested in the philosophical underpinnings of reality, and cultivates science as his own philosophical identity. “I am personally interested in the application of science so that there is an epistemological basis for what happens. When people talk about the need for evidence-based approaches to education, I resonate with that. I have a pronounced belief in the importance of the empirical foundations of what we do, and I have a heavy buy into science as a way of knowing things, because I think that’s the most effective, most reliable way of understanding ourselves.”