In his most recent book, The Myth of Laziness, (Simon and Schuster, New York, 2003) Dr. Mel Levine, a developmental-behavioral pediatrician, author, researcher, teacher and lecturer describes himself as a "top down" person. By that he means that he marches to his own drummer's beat. "Throughout my career," he writes, "I have continued to tread my own original pathways and often found myself repeatedly rejecting the intellectual structures (such as labels for kids with learning and behavior problems)…the ways of thinking I had been expected to assimilate." Out of this rejection has come a cascade of ideas that has benefited countless children, their parents and their teachers.

In The Myth of Laziness, Levine once more steps out of conventional boundaries to construct another new approach to understanding how children learn, specifically understanding the child who is called "lazy." First of all, he firmly believes that children are not lazy. Secondly, he believes that everyone wants to be productive. "We gain energy and feel good about ourselves whenever our personal output wins the approval, the acceptance, the respect of our friends, our families, our bosses (or teachers) and, most of all, our own self-critical selves." The child who is not productive suffers from what Levine calls "output failure," which he carefully defines:

Output failure is not a distinct syndrome, nor should it be understood as any sort of label or category. It is a result, not a cause. Low output occurs when one or more neurodevelopmental dysfunctions interfere with productivity.

Neurodevelopmental dysfunctions is one of Levin's key concepts. He attributes them to faulty misfiring in the brain. Levine describes neurodevelopental dysfunctions in detail in his best-seller, A Mind At A Time, using research in the neurosciences and related fields as the basis for his work. The neurodevelopmental areas that impinge on output failure are "memory, language, attention, motor function."

At first glance, it might seem that the term neurodevelopmental dysfunctions is simply another way of describing typical learning problems a child can have trying to become a good reader, doing math computations and the like. Not so writes Levine. He calls such problems "totally transparent." There is another group of children, "a substantial group with hidden miswiring." And these are the students who are least understood and suffer the most from output failure.

In linking the brain to learning behavior, Levine is keeping abreast of the giant strides in understanding brain development and how the brain affects how we learn.

Levine has identified eight common forms of mind misfiring that lead to output failure:

Impoverished ideation [ideas];

Language dysfunction;

Disorganization;

Low mental energy;

Insatiability and/or social distractibility;

Weak production controls;

Insufficient memory;

Ineffective motor output.

In order to determine which of these misfirings, or dysfunctions, applies to a particular child, Levine asks the following questions:

1. Could there be a motor breakdown?
2. Could there be a memory shortfall?
3. Could there be a verbal production problem?
4. Could there be an impairment in the generation of ideas?
5. Could there be poor regulation of mental energy and therefore low working capacity?
6. Could there be a weakness in the regulation of output (production control)?
7. Could there be insatiability and/or social distractibility deterring output?
8. Could there be a deficit in one or more forms of organization?

Levine draws on his clinical experience and his research to create this whole new frame of reference with which to identify hidden neurodevelopment dysfunctions and provide ways to locate them . It is like learning a new language. One additional note: Levine has found that difficulty with writing is one of the most telltale signs of output failure.

Let's take a look at some of the children Levine has helped at the University of North Carolina Medical School Center For Development and Learning, which he directs. He does a thorough assessment of the child's neurodevelopmental functions. Parents may be interviewed and school reports reviewed. Psychologists and social workers may be included in the evaluation.

Here are few of the children with whom Levine worked (all names are disguised to protect confidentiality). What is most striking is his caring for each child and his ability to establish a rapport with them. Not that they were all success stories. Clearly some were not. And they came from all different backgrounds. Scott, age 17, son of wealthy parents, had an insatiable appetite for pleasure. He acted on the spur-of-the-moment, never giving thought to consequences. His major neurodevelopmental dysfunctions were in the area of controls, specifically production controls, that begin with previewing the job, followed by thinking ahead, looking at options, pacing himself, monitoring the quality of his work and taking away from this experience what he can apply elsewhere. Clearly, Scott's greatest gaps were in this area.

Ginny, age 12, from a working-class family, also was insatiable but in a different way. She could be utterly charming and utterly unpredictable. She seemed to have an unending appetite for attracting friends, but buckling down to work was another matter. She was a night owl. She was always tired. She simply did not get enough sleep, although she tried going to sleep earlier. She would study for a test and then couldn't concentrate enough to remember the answers. One teacher observed that while Ginny was fidgety, she wasn't actually hyperactive. Levine diagnosed Ginny's neurodevelopmental dysfunctions as twofold: one, mental energy controls and two, active-working memory. The former is located in the brain stem and consists of four basic controls: "alertness, mental effort, sleep arousal, and consistency," which all were poorly regulated in Ginny. Her active-working memory was also very weak.

Both children were unable to resolve their individual problems, but it is interesting that they sought out Levine again as young adults. Ginny asked for Ritalin to help her concentrate, because it worked for a friend of hers. Levine carefully reviewed Ginny's problems with her and her parents before prescribing the medication; she improved dramatically.

Scott's story did not have such a positive ending. College life was an unending party. Scott tried to commit suicide. About a year later he sought out Levine. He had chosen a new major, and he vowed to succeed — as he had done so many times before. Levine thought that this time Scott was serious. He remarked when leaving, "By the way, Doc, I think my production controls have tightened up a lot in the last few months." Levine told him to stay in touch.

Scott knew his diagnosis because Levine made it a point to explain it to him. Levine called this process demystification. He feels it is important that the child fully understand his problems and his part in it.

No two children struggling with output failure — or as Levine also puts it — success deprivation — are alike. They each have a different mix of neurodevelopmental dysfunctions. Levine primarily studies children ages 5 to 18 since he sees them in his pediatric practice. However, his findings can be applied to older children and adults.

A child's neurodevelopmental profile is constantly interacting with external and internal factors. Among the latter is the influence of the parents. Levine writes, "It is my stubborn contention that schools are supposed to teach kids how to learn, and parents are responsible for teaching them how to work." And that includes not only making sure homework is done but also modeling intellectual roles for their children through their own interest in books and intellectual activities.

Poverty and stress, competition that stirs the child to action — or, conversely, dampen his hopes — are some other external factors. Optimism, opportunity, timing and, yes, luck are some internal factors.

Reading The Myth Of Laziness opens a new way of thinking and a new language to learn. Levine founded The All Kinds of Minds Institute to help teachers, parents, clinicians and children use this new way of thinking in order to examine differences in the way children learn. Looking at these differences is the key to understanding Levine's original teachings. He has deep respect for the individual child and for each child's particular style of learning.

Levine doesn't disappoint the reader. He is truly a "top down" person.

Ruth H. Lebovitz is a clinical social worker and writer in Baltimore.