Thursday, August 10, 2017

The Burden of the Sibling of Special Needs Children

From L to R: Margaret, James, & Joseph
In my case all the children are special needs but James is, by far, the highest functioning child of my three surviving quadruplets. Though it feels vastly unfair I have all ready told him he may have to be the caretaker of his brother and sister one day.  Nothing like that settling into a nine year old's psyche. Sigh! I wish I could live forever and not saddle him with this possible burden but I doubt I will live to be Methuselah's age!

All this was brought up last night during dinner.  James was discussing that he wanted to visit Tokyo. He was talking rather animatedly about the subject and then stopped and looked at me and asked, "What would I do with Joseph?" I asked him what he meant and he said he would worry about taking Joseph with him and how would he keep Joseph safe if he was not there. At that moment, my heart broke a little. It makes me sad that James thinks Joseph is so disabled he would not consider taking Joseph with him. Joseph is actually quite a smart little guy. And James was concerned on who would watch Joseph while he was gone!

James asked me if I could watch Joseph. I told him, if I was around, of course I would watch him!  Then he asked what he should do if I was not around and I said he would have to find a reliable caretaker for him. Margaret said she wanted to go to Tokyo too. James said he would take her ONLY if she would listen to him and stay close. That is brave of him since Margaret is the wanderer and I can see her getting distracted and lost in Tokyo.

This conversation poignantly reminded me that having disabled sibling(s) may be a life-long burden for one of the other children. I am going to do the best I can to plan for Margaret and Joseph. I pray James will find, and marry, a very understanding wife! In the meantime, we live our life with purpose and plan for the future.

Tuesday, August 1, 2017

Educational Versus Medical: Why You Need to Understand the Difference!

Photo Credit:

Medical Versus Educational Diagnosis

The word diagnosis is thrown around a lot when it comes to educational issues. This is VERY important: the school CANNOT make a MEDICAL diagnosis for your child! When the school says your child has autism and they will provide special education services to your child they are NOT medically diagnosing them with autism! What the school is saying is that your child fits the educational definition of autism as defined by your state.  

Under federal law (IDEA) there are only 13 categories that are recognized. These are autism, emotional disturbance, hearing impairment (including deafness), intellectual impairment, other health impairments, orthopedic impairment, specific learning disabilities, speech or language impairment, traumatic brain injury, and visual impairment (including blindness).  A school will only provide special education services IF your child falls into one of these categories.  Also, each state may have further refined how each category is defined making things more complicated.

A medical diagnosis is made when someone fits a medical definition for a condition.  This definition is found in the Diagnostic and Statistical Manual (DSM V).  We are currently on the fifth edition.  The medical diagnostic criteria for autism is:

Diagnostic Criteria for 299.00 Autism Spectrum Disorder
  • Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
  1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
  2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
  3. Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
There is more to the definition but you get the idea.

You will often see a doctor use a ICD 10 billing code. Autism is F84.0. For medical billing you WANT SPECIFICALLY F84.0 versus F84.5 which is Asperger's syndrome. Why? Because your insurance company will probably reimburse you for F84.0 but not for F84.5! It is very important to pay attention to medical billing codes! Medical billing codes dictates what an insurance company will cover in the way of therapy and equipment. If you ever want to look at 

Related Services

These are the services you get from a school district like occupational, speech, and physical therapy.  These are the most common related services but there are many more that you can get in the educational setting.  I want to explain the difference between medical therapy and educational therapy.  This is VERY important for parents to understand since it is the source of many disagreements parents have with their local school district.

Medical versus Educational Model of Therapy

Educational Model
The Educational Model focuses on the skills impacting educational performance in all subject areas. Deficits are addressed through an Individual Education Plan (IEP) or 504 Plan that is agreed upon by the school-age child’s educational team. This model will focus solely on the outcome that enables a child to benefit from his/her educational program. Therefore, the school therapist(s) [Physical Therapist (PT), Occupational Therapist (OT), Speech Therapist (ST), or a combination thereof] will direct therapy so the child will gain skills to maximize his/her opportunities within the school environment. Therapy services are provided in school and most often within a group or classroom setting.

Eligibility: Eligibility for related services must be based on assessment, an educational need for service, and there must be approval of the IEP team.

Medical Model
The Medical Model generally focuses on the impairment regardless, of severity level to ensure that the child can successfully perform the basic activities of daily living (i.e., putting on their clothes, feeding themselves, speaking clearly their wants and needs, walking). Services are performed on a one-on-one basis in an outpatient clinic.

Eligibility: The physician or other certified practitioner along with a child’s parents/ guardian and licensed therapist determine the severity and impact on developmental areas or self-care skills and develop a Plan of Care (POC) for the therapist to follow.

Why is this Important?

Personally, I prefer medical therapy. Why?  The child gets direct one-on-one service with a therapist, there is no need to call a meeting to determine service, and the parent gets to help determine the goals of the therapy while educational therapy has the goals determined by others. I have rarely had my children in public school to take advantage of educational therapy.  We tends to stick with medical therapy. When they were small (4 years old) we got both educational therapy through the school and medical therapy from our insurance.  Yes, you can do both!  I HIGHLY urge you to do both if you have the opportunity! Why? Because it is practically impossible to get too much therapy!  Therapy is VITAL to resolve educational and sensory issues that impair learning! Even now, while we homeschool, therapy is the main goal for my children; not academics! They can learn better when their issues are addressed so it's worth spending the time on therapy.

I know this is a brief explanation but I hope this helps you understand the subtle but important differences in the medical versus educational model of therapy.  Please feel free to contact me if you have any questions.  You can also join my Facebook group at IEP Assistance and Special Needs Parenting Advice. 

Tuesday, July 11, 2017

Fluid Reasoning: What Does it Mean?

Photo Credit:
Fluid reasoning.  I often see this listed on neuropsychological and psycho-educational testing but what does it mean and how does it impact education? Fluid reasoning is the ability to solve new/unusual problems without relying completely on past experiences and information. Fluid reasoning is related to math achievement, written expression, and to a lesser degree, reading skills.

James, my most academically skilled child has a relative weakness in fluid reasoning.  He falls into the borderline range (below low average) with a standard score of 74.  James is a great problem solver as long as the problem is straightforward. If you confuse him in ANY way in the problem he has NO idea how to find the solution.  This is an example of a problem with fluid reasoning skills.  Margaret has a fluid reasoning standard score of 85 which puts her in the low average range.  I know her fluid reasoning ability is greatly impacted by her inattention (executive functioning) issues. Joseph scored a 79, which is right at the borderline/low average score range, meaning his fluid reasoning impacts his learning.

Working memory impacts fluid reasoning. Many tests that determine fluid reasoning use one of two methods to determine fluid reasoning.  One is using a rapid-timed test.  This method relies more heavily on someone's capacity for working memory. The second method uses an untimed test. The untimed method does not rely as much on working memory and gives more time to use other cognitive functions to complete the task. I know for Joseph, due to his slow processing speed, he can show his intelligence and fluid reasoning skills better with an untimed test. If you have a child with impaired processing speed it is important you ask for some of the testing to be untimed to allow your child to show their ability!

What is the Impact of Fluid Reasoning?
Fluid intelligence or fluid reasoning tends to be lower in children who met the criteria for the following psychiatric disorders: bipolar disorder, attention-deficit/hyperactivity disorder, oppositional disorder, conduct disorder, substance use disorders, and specific phobia. James, my child with the lowest fluid reasoning score, has ADHD and Autism along with battling low levels of depression so I see this correlation personally. Academically, here are some things you may see your child exhibit if they are struggling with fluid reasoning:
  • Has difficulty with recognizing, forming, and understanding concepts.
  • Has difficulty with determining a relationship in a pattern.
  • Has difficulty with drawing conclusions from information that is given to them.
  • Has difficulty with understanding the consequences of an issue or action.
  • Has difficulty with solving complex problems.
  • Has difficulty with understanding and using "and logic."
  • Has difficulty with  understanding and using "or logic."
  • Has difficulty with following a logical pattern through to the end.
  • Has difficulty with math and math reasoning.
  • Needs to rely on language to help with comprehension of new concepts and complex problems.
  • Displays difficulty with using past knowledge in new situations.
  • May appear confused with demands when given a task.

What can be done to help my child learn?
Classroom modifications, whether the child is homeschooled or in a public school setting, are important things to consider to help your child succeed in their education.  Here are some examples of classroom modifications:

  • Rely more on verbal instruction than visual instruction or aids.
  • Pair verbal instruction with visual information so you can verbally explain what the child is viewing.
  • Ask clear, concise questions versus open-ended questions.
  • Rely more on verbal responses versus production of graphic material.
  • Test verbally for knowledge whenever possible.
  • Ask students to show all their work when possible and give partial credit if they can show the correct process.
  • Explain to the child how they will be graded on an assignment so they understand the assignment requirements.
  • Use a testing strategy familiar with the child and keep the questions simple and straightforward.

Besides classroom modifications here are some classroom accommodations to help your child/student:

  • Provide all instructions for tasks verbally if the child is verbal.
  • Encourage the child to verbalize thought processes to help clarify their thinking.
  • Rely on the students verbal memory skills to teach problem solving though repetition and recall (kill and drill).
  • Teach strategies for problem solving including giving the proper sequence of a process so it can be memorized.
  • Provide repetition and review of concepts to ensure over-learning of concepts.
  • Teach mechanical arithmetic in an organized, simple, step-by-step fashion with verbal instruction.
  • Use real objects and manipulative when teaching concepts.
  • Teach using strategies that increase understanding and learning, such as verbalizing thought processes on a problem or procedure, along with providing lists of steps to take to complete a concept or task.
  • Teach problem-solving techniques in the context where they will most likely be applied.
  • Teach and emphasize reading comprehension so the student can learn to read and re-read material for learning comprehension.
  • Teach verbalizing strategies to help the student organize written work into sequential steps.
  • Adjust the difficulty of the task where possible and keep instruction simple and straightforward.
  • When teaching concepts avoid complex instruction, figurative language, and complicated or lengthy directions/instructions.
  • Watch for problems with organizational skills and social skills since these are often impaired.
  • Locate a peer helpers to help the child stay on task.
  • Start a task and complete one example with the child so the child has a correct model to use to solve the rest of the work.
  • Provide a practice test with questions similar to the actual test.
  • Weight grades in favor of concrete information and skills acquired instead of creative use or application of concepts and skills.
  • Due to difficulty with deductive reasoning, the student may experience problems using a learned procedure or rule to solve problems, so provide various examples of how the rule or procedure can be used across different situations. 
  • Due to difficulty with inductive reasoning, the student may experience confusion with discovery learning in which the student is expected to arrive at a rule to explain examples, so the student appears to work best when a rule is stated or a well defined set of steps is established to solve a problem.
  • To promote understanding and generalization in use of a rule or procedure, clearly describe the rule or procedure and provide numerous concrete examples.
  • Break complex tasks or procedures into component parts.
  • Help the student sort our relevant from irrelevant information when solving a problem.
  • Move slowly when presenting new information and tie new concepts into previously mastered concepts and information.
  • Teach new information in groups or families and clarify how the items or examples are alike.
  • Provide a routine or practiced sequence for approaching a difficult or complex task.
  • Provide structured opportunities for the student to use a concept or skill in real life contexts.
  • Consider using a teaching assistant, volunteer or peer tutor to work individually with the student to teach and demonstrate a new skill or concept.
  • Explain the purpose of an assignment in order to make the task meaningful to the student, since they may not independently perceive the relationship between completing a task and greater learning outcomes.
  • Make an effort to explain in clear, concrete terms why a procedure is being used in a particular problem.
  • The student demonstrates reasoning difficulties that might impede understanding of instruction. A study guide might be beneficial to help the student organize information, identify the most relevant information and provide a conceptual framework to understand instruction (or passage reading).

Here are some specific suggestions for math:
  • Model problem solving through talking aloud.
  • Teach math mnemonic strategies that specifically identify the steps for solving problems.
  • Teach patterns and relationships such as skip-counting or patterns on 100s chart to help learn multiplication facts. 
  • Attach number-line to desk to help with number sense and pattern recognition. 
  • Specifically teach the way a number or problem can be represented.
  • Provide manipulatives in order to help make information concrete and less abstract.
  • Have students explain their strategies when problem solving to expand solving options.
  • Require the student to show their work.

Here are some specific suggestions for reading and reading comprehension:
  • Use graphic organizers to help summarize information.
  • Model self-monitoring skills while reading, demonstrating how to stop and ask oneself if material/words have been understood.
  • Teach cues for identifying main ideas such as looking for transition words.

Some suggestions for writing strategies:
  • Use graphic organizers to help sequence information for effective communication.
  • Model brainstorming for generation of ideas.
  • Explicitly teach about genres and writing to an audience.
  • Present models of good writing with guidance in determining why the writing was effective for its purpose.
Current Studies on Fluid Reasoning
Fluid reasoning, beyond any other cognitive or numerical ability, predicts future math performance. This study by Green et al. (2016) is small, only 69 kids, but the results of the study showed children with higher levels of fluid reasoning have a higher likelihood of showing higher levels of math achievement beyond what can be explained by age, vocabulary, or spatial reasoning skills.

In a study by Pagani et al. (2017), all most 5,000 students at the 7th grade level had their scores in fluid reasoning examined and tracked in Canada.  As students dropped out of school or failed to graduate within two years after expected graduations their fluid reasoning scores were examined. It was found that for every standard deviation a child fell below the norm increased their risk of dropping out of school before graduation by 21%!  This shows you how big an impact fluid reasoning can have on a child and a low score in fluid reasoning IS a learning disability!

Dehn (2017) acknowledges the strong relationship between working memory and fluid reasoning.  What was interesting is he went further and conducted neuroimaging (brain scans) and found the prefrontal cortex is active during fluid reasoning/working memory tasks.  This area of the brain (dorso-lateral prefrontal cortex) is the SAME area that controls attention and inhibition.  So if your child has ADHD then they likely have lower working memory and fluid reasoning abilities since that is the same area of the brain. 

A watershed model was proposed by Kievit et al. (2016) to show the interdependent relationship of fluid intelligence (fluid reasoning)  with processing speed and working memory.  This paper says that white matter organization affects processing speed and processing speed affects fluid intelligence. Again, I see this in my children.  I suspect Joseph has diffuse white matter brain injury across his entire brain.  He does have the lowest processing speed and; therefore, low fluid reasoning. Margaret, who I KNOW has diffuse white matter brain injury to part of her brain has a low score for processing speed (but higher than Joseph) and, again, I see an impact to her fluid reasoning.
Wrap Up
I hope this post has been helpful!  As always, the links to resource material are embedded into the post for your reading pleasure! Researching the impacts of fluid reasoning has been valuable to me since I am the teacher of my children.  It explains many of the issues I see in my children and their learning process. I hope you will be able to find ways to help improve your child's learning! 

Sunday, July 9, 2017

Feeling Recharged For Homeschooling!

Photo credit:
My blog has been slow since I have been working on many things including my children being in a public school online.  Once we got done spending our time in public school online to qualify the Empowerment Scholarship I think we all needed a break!  So we took a break and just relaxed for a bit.  Now that July is upon me, my thoughts are back to homeschooling, and what we are going to do this school year.  This year I was able to attend my local homeschool convention.  I must say, if you have never gone to one, GO!  I feel recharged and full of some good ideas to help my children!  What a great way to feel to start the next academic phase of my children's education!

I was able to attend several workshops at the Arizona Families for Home Education (AHFE) convention. There were some that I thought were a real stand out and I wanted to share with you some of the ideas I learned. One of the workshops I liked was Monica Irvine's discussion on scheduling.  Having multiples we live, and died, by the schedule from the time we brought the children home until they were five and I went back to work for awhile.  I have tried to make a schedule once or twice before but we did not stick to it.  This year, since I have the addition of ESA money, it is vitally important to make a schedule and stick with it.  A schedule will be the only way we can time manage our day with therapy and the schooling that needs to be completed.  The second, and truly most important thing I learned, is to make sure I schedule some fun time in with the children.  I often forget that the kids need some time to just have fun with me versus being the person always making them do the not so fun things in life (grooming, cleaning, and school).  I will be putting game/fun time with mom into our schedule this year so that will be my commitment to them!

The workshop by Heather Haupt discussed why movement helps the brain to form neural connections.  I have experience this first hand!  The way I got Margaret to learn spelling words was to make a cheer out of them.  Joseph likes to march to the letters or drum.  He LOVES drumming ALL OVER EVERYTHING!  LOL  So he taps out a beat on the table as the learns his words.  Now I know why this is an effective teaching technique for them and I need to work on incorporating more movement into their lessons.

Beth Mora gave a great presentation on how to develop an educational plan for children with ADHD, Dyslexia, and Dysgraphia.  Honestly though, her S.O.A.P. method is great for any child with a disability or not.  She explains we need to study our children.  We need to understand their quirks, when they learn best, how they learn best, their love language, and to put all the information into a notebook.  By doing this we can remind ourselves WHY we are homeschooling in those tough moments and HOW we can help our children best by using their love language.  She covered a lot more but her lecture notes can be delivered to your email box by simply clicking on her name.  I hyperlinked all the speakers to their website.

Overall, I really enjoyed the convention.  There was a lot of great moments, I got to meet a lot of great parents, and I am looking forward to the next convention in October for special needs and gifted students.  I am hoping I can get a speaking engagement there so I can discuss the Empowerment Scholarship, the law, how to advocate for your children with their doctors/therapists, how to interpret testing in IEPs or testing completed by neuropsychologists or psychologists for the homeschool environment, how to teach multiple disabled children at one time, and how to fit therapy and everything else into your day.  I know I would be happy to share what I have learned homeschooling my children since they have been old enough to sit up in a high chair.  I have learned a lot over the last ten years and would love to share!

Sunday, June 11, 2017

The Fun (NOT!) Of Online Public School for Special Needs Children

Image from
It has been awhile since I was last able to post.  So many things have happened with the online public school my children were attending.   I will explain the challenges I have seen in having children with special needs trying to complete an online public education.

One of the first problems that comes to mind is: Do the online public schools realize they MUST follow IDEA? Right before Christmas break I was able to get the IEPs for the children completed with the school.  As a parent who has not had their children in online public school before I did not really understand the 2 tiers of service offered by the school. There was no real continuum of service at the school.  You either get A or B; there is no other choice!

James was placed in Tier A.  There he was expected to attend two online classes a day and still carry the load of online lessons.  This was not what I was initially told. I was told he would no the classes and the lesson would be completed in the class.  Nope.  Margaret was placed in Tier A for English and Tier B for Math. The common core math concepts taught (base 10, confusing work problems, and multiple ways shown to solve a problem were confusing) were WAY over Margaret's head.  She was not learning anything.  Her dyscalculia is quite severe.  :(  Joseph was placed in Tier B.  The pace there was WAY behind and WAY too slow!  Joseph would never learn much information of quality and he would never have caught up (or had a chance to catch up) with the pace he was being taught.

The biggest issue I had with the school was the expectation I was to drive all the children to their various therapies AND get them back in time to make it to their online classes.  One therapy for Joseph was 45 minutes away, one way, for a 45 minute therapy.  I complained to the school and was told they would only reimburse me for part of my travel expenses.  Nope, that is wrong!  Via IDEA, there is regulations on how much I would be reimbursed (think IRS mileage expense). Anyways, it was either fight the system to get therapists to come to my home OR pull the children from the school.  So I pulled the children.

In Arizona we have the Empowerment Scholarship.  This gives me the money the state would pay a school to educate the children and I get to decided (within limits) how to spend the money.  This will allow me to pick how the children will be taught, get them tutors, aides, and other help.  I am quite excited about the prospect and so are the children!

Monday, November 7, 2016

Working Memory: The RAM of the Brain

Photo courtesy of
So what the heck is working memory?  I think of it as the RAM of our human computer, our brain. James has a relative weakness in his working memory. His score on the WISC -V was a standard score of 85; however, a score of just 79 is considered borderline. So this is quite a low score, overall, for James who is my highest cognitively-abled child. Margaret got a standard score of 62. This puts her in the severely impaired.  Joseph has a standard score of 79.  If you knew him you might find this surprising since he is SO slow due to his processing speed. Over time though, I have noticed that both Margaret and Joseph are both quite impaired.  I know now it is in different way.  Margaret has major working memory problems but is much faster at processing information.  Joseph on the other hand is SUPER slow in processing speed BUT he mas better working memory and long term memory.  Over time, I think, this will serve him better.

So what exactly is working memory? 

The computer, so useful a metaphor in cognitive psychology, offers an intuitively appealing model for thinking about the nature and structure of working memory.

Simplifying the workings of a computer, there are two means by which information is stored, the hard disk and random-access memory (RAM). The hard disk is the means by which information is stored permanently in a stable and reliable form; all software programs, data files, and the operating system of the computer are stored on the hard disk. To use this stored information you must retrieve it from the hard disk and load it into RAM. Now for the analogy: the information stored in the hard disk is like long-term memory, RAM corresponds to working memory.

How well does this metaphor fit with actual human working memory structure and function? The evidence is not all in, but cognitive and neuroscience approaches to the study of working memory have in many ways revolutionized the types of questions that can be asked and provided new insights into how working memory works.

memory is the mind’s ability to keep information for a short span of time, as you utilize such facts for the tasks and activities you need to do. It makes use of two lobes: the frontal lobe, which is responsible for planning, reasoning, emotions, problem-solving, movement and speech; and the parietal lobe, which governs the perception of stimuli such as pain, pressure, touch and temperature.

Since working memory is naturally brief, it makes use of attention and memory, but only for a short span of time. It is considered the foundation of the mind’s executive function, a group of mental processes that allows an individual to solve problems, plan ahead, pay attention and organize activities.

There are two types of working memory used by all individuals. They are:

1. Visual-Spatial Working Memory

Defined as the brain’s ability to use an ‘imaginary sketchpad,’ it enables a person to visualize something – and keep it in his mind’s eye. Individuals can use this type of working memory to remember images, sequences and patterns. It is also useful for computing mathematical equations in the mind.

The visuo-spatial sketch pad (inner eye) deals with visual and spatial information. Visual information refers to what things look like. It is likely that the visuo-spatial sketch pad plays an important role in helping us keep track of where we are in relation to other objects as we move through our environment (Baddeley, 1997).

As we move around, our position in relation to objects is constantly changing and it is important that we can update this information. For example, being aware of where we are in relation to desks, chairs and tables when we are walking around a classroom means that we don't bump into things too often!

The sketch pad also displays and manipulates visual and spatial information held in long-term memory. For example, the spatial layout of your house is held in Long Term Memory (LTM). Try answering this question: How many windows are there in the front of your house? You probably find yourself picturing the front of your house and counting the windows. An image has been retrieved from LTM and pictured on the sketch pad.

Evidence suggests that working memory uses two different systems for dealing with visual and verbal information. A visual processing task and a verbal processing task can be performed at the same time. It is more difficult to perform two visual tasks at the same time because they interfere with each other and performance is reduced. The same applies to performing two verbal tasks at the same time. This supports the view that the phonological (verbal) loop and the sketch pad (visual) are separate systems within working memory.

2. Auditory/Verbal Working Memory

This area of working memory makes use of the mind’s phonological or sound system. A good example is repeatedly dictating a phone number while dialing it. While it cannot be retained while doing a certain a task, it is touted by many as a common learning disadvantage in most activities like tasks that make use of verbal working memory include comprehension and language activities.

The phonological loop is the part of working memory that deals with spoken and written material. It consists of two parts. The phonological store (linked to speech perception) acts as an inner ear and holds information in speech-based form (i.e. spoken words) for 1-2 seconds. Spoken words enter the store directly. Written words must first be converted into an articulatory (spoken) code before they can enter the phonological store.

The articulatory control process (linked to speech production) acts like an inner voice rehearsing information from the phonological store. It circulates information round and round like a tape loop. This is how we remember a telephone number we have just heard. As long as we keep repeating it, we can retain the information in working memory.

The articulatory control process also converts written material into an articulatory code and transfers it to the phonological store.

How is your working memory?

Have you ever wondered if you have a good working memory?  If so, take this test to find out!

IS (5 x 3) + 4 = 17? BOOK
IS (6 x 2) - 3  =  8?  HOUSE
IS (4 x 4) - 4  = 12? JACKET
IS (3 x 7) + 6 = 27? CAT
IS (4 x 8) - 2  = 31? PEN
IS (9 x 2) + 6 = 24? Water

To take this test yourself, cut out a window in a blank sheet of paper so that it exposes only one line at a time. For each line, determine whether the arithmetic is correct or not: say, out loud, “yes” or “no.” Then look at the word that follows the problem and memorize it. Move through each line quickly. After you have finished all the lines, try to recall the words in order. The number you get correct is an estimate of your working memory capacity. Very few people have a working memory as high as 6; the average is around 2 or 3.

Working Memory and the Brain

A good example of an everyday activity that uses working memory is mental arithmetic. Imagine, for example, attempting to multiply two numbers (e.g., 43, 27) spoken to you by another person, without being able to use a pen and paper or a calculator. First of all, you would need to hold the two numbers in working memory. The next step would be to use learned multiplication rules to calculate the products of successive pairs of numbers, adding to working memory the new products as you proceed. Finally, you would need to add the products held in working memory, resulting in the correct solution. To do this successfully, it is necessary to store the two numbers, and then systematically apply multiplication rules, storing the intermediate products that are generated as we proceed through the stages of the calculation. Without working memory, we would not be able to carry out this kind of complex mental activity in which we have to both keep in mind some information while processing other materials. Carrying out such mental activities is a process that requires effort and prone to errors. A minor distraction such as an unrelated thought springing to mind or an interruption by someone else is likely to result in complete loss of the stored information, and so in a failed calculation attempt. As no amount of effort will allow us to remember lost information, the only course of action is to start the calculation again. Our abilities to carry out such calculations are limited by the amount of information we have to store and process. Multiplying larger numbers (e.g., 142 and 891) “in our heads” is for most of us out of the question, even though it does not require greater mathematical knowledge than the earlier example. The reason we cannot do this is that the storage demands of the activity exceed the capacity of working memory.

In an experimental setting, an individual’s working memory capacity is reliably assessed by tasks in which the individual is required to process and store increasing amounts of information until the point at which recall errors are made. An example of such a task is reading span, in which the participant makes judgments about the semantic properties of sentences while remembering the last word of each sentence in sequence. Tasks of short-term memory, in contrast, place menial demands on processing and are often described as storage-only tasks. Verbal short-term memory is traditionally assessed using tasks that require the participant to recall a sequence of verbal information, such as digit span and word span. Visuo-spatial short-term memory tasks usually involved the retention of either spatial or visual information. For example, in the Visual Patterns Test, the participant is presented with a matrix of black and white squares and has to recall which squares were filled in. The Corsi blocks task is an example of a spatial memory task, and participants have to recall the sequence of blocks that are tapped. Individual differences in the capacity of working memory appear to have important consequences for children’s ability to acquire knowledge and new skills.

Working Memory, Reading, and the Dyslexia Connection

Children may be described as dyslexic if their reading, writing and spelling skills are significantly worse than those of their typically developing peers. Dyslexia is now understood as a problem with Verbal Working Memory, where the Phonological Loop (verbal short term memory) does not function as it should, and the verbal portion of the Central Executive, responsible for concentration, attention, planning and other executive functions, is also affected.

Some symptoms of dyslexia arise as a direct result of poor Verbal Working Memory, such as poor reading, spelling, verbal comprehension, difficulty learning sequences and problems with organisation. Children with learning difficulties may also suffer from a lack of confidence and poor self-esteem.

A full diagnostic assessment is required to discover your child's pattern of strengths and weaknesses.  This can be done by request a full psycho-educational testing from the school.  If you homeschool you can request testing from your local school district under the Child Find guidelines, you can request a referral from your child's pediatrician to a pediatric psychologist, or you can request a referral and evaluation from a neuropsychologist.

What is Reading Comprehension?
Comprehension describes the interactive process between the reader and the text. Children with similar decoding and word recognition skills may vary in their understanding of material because their comprehension skills are at different levels. Listening and reading comprehension depend on language and cognition. Listening comprehension also depends on well-developed auditory skills. Prerequisite skills are:
  • vocabulary
  • grammatical skills
  • pragmatic skills
  • meta-linguistic awareness
  • shared understanding (social; cultural)
  • attention; sequencing
  • monitoring
  • working memory
When Working Memory skills are poor, children will struggle to retain information they read or hear for long enough to integrate it with existing understanding. This is particularly important when listening to, or reading, sentences with embedded clauses. Center-embedded clauses can be really difficult because this structure creates three sections to be analysed, overloading children with poor Working Memory. As we hear or read new information, we continually recode the material into chunks, discarding irrelevant detail and retaining the gist. Working Memory is crucial for this level of processing and enables us to manage longer texts. Working Memory is crucial for generating inferences because the reader needs to keep in mind a representation of the relevant section of text, while conducting searches for information, either in long term memory or other places in the text, before checking that the inference makes sense. Working Memory is also crucial for monitoring that incoming information makes sense. Children need to notice words they don't understand as well as contradictions and anomalies. Strategies to clarify information they don't fully understand may involve looking back to check that a word has been read correctly, or formulating and asking clarifying questions, all of which place demands on Working Memory.

Working Memory and Math (Dyscalculia)

It was found that the children in the dyscalculia and maths anxiety groups showed different types of working memory impairment. The dyscalculia group, when compared to the typically developing group, performed worse on the visual-spatial working memory task. This agreed with previous research which showed a link between developmental dyscalculia and poor visual-spatial working memory ability3. The maths anxiety group, on the other hand, were more impaired in verbal working memory than the dyscalculia group. The maths anxiety group was also impaired in visual-spatial tasks but only when a higher working memory load was used (i.e. there were a large number of objects to be memorized). This finding supports the idea that anxiety may use up working memory resources which leads to poor maths performance4.

Working Memory and General Academic Performance 

Let’s say a child, Margaret, is presented with a mental math calculation such as, “find the sum of 2, 5, and 10”. She must remember all of numbers that need to be added, hold that information in mind while adding the numbers and ignoring distractions in her environment, and then produce the sum of 17. Children with poor working memory like Margaret might miss the middle number and produce a sum of 12. For reading comprehension of a passage, Margaret would need to read each sentence and hold them in mind while also making sense of their meaning. She would need to simultaneously process and store the information in the passage over a short time period. Common failures of working memory during academic tasks are reflected in skipping letters or words, blending together different words or sentences, and losing track of sentences or numbers (Holmes et al., 2010). All these working memory related failures result in Margaret being unable to correctly calculate a math problem or make sense of a reading passage.

It is estimated that 80% of children with poor working memory struggle with math, reading, or both (Gathercole & Alloway, 2008). Further, low achievers are three times more likely and students with special educational needs are six times more likely to have low working memory compared to typical learners (Holmes et al., 2010). What this tells us is that the majority of students that perform poorly in school or that require additional support have working memory deficits. It is these kids who become overloaded during regular classroom activities, such as those involving multi-step instructions, and miss important learning opportunities (Gathercole & Alloway, 2008). It is these children with low working memory that we find staring out the window with their minds wandering (Kane et al., 2007) when tasks get too tough and working memory gets overloaded.

Working Memory Training...Real or Hype?
Working memory training information is ALL over the place on the internet.  There are a TON of programs on how to increase working memory.  Sadly, there is nothing that can really help with poor working memory. There has been research showing memory training is more helpful in reading versus math.  There has been no research showing memory training helps overall cognitive ability.  You can do programs training working memory but the effects have been shown to be short term and with the high cost of the programs it just is not worth pursuing.

Sign of Working Memory Deficits

If your child exhibits 3 or more of these behaviors in this checklist there may be some cause for concern:
  • A need to re-read text
  • Test anxiety, especially on multiple choice tests
  • A need for more time and repetition
  • Inconsistent performance
  • Lack of focus and attention deficit disorders
  • Is easily distracted when working on or doing something that is not highly interesting.
  • Has trouble waiting his/her turn, for example in a conversation or when waiting in line to get help.
  • Struggles with reading comprehension and has to read through texts repeatedly to understand.
  • Struggles with problem solving that require holding information in mind, for example mental math calculations.
  • Is inconsistent in remembering math facts.
  • Struggles with completing tasks, especially multiple step tasks.
  • Has difficulty remembering long instruction given in several steps, for example following recipes, directions or school/work assignments.
  • Struggles to understand the context in a story or a conversation.
  • Has difficulties when planning and organizing something that needs to be done in separate steps.
  • Has difficulty staying focused during cognitive demanding tasks but attends well when cognitively demands are minimal.
  • Has difficulty integrating new information with prior knowledge.
  • When called on, forgets what he/she was planning to say.
  • Has difficulty taking notes and listening at the same time.

Several of these working memory-specific symptoms are associated with multiple learning diagnoses, and indication of how critical working memory is to many learning abilities.

Learning Efficiency
Academic success is dependent on a number of skills working at a high level, many of which involve working memory: for instance, being able to retain information in class, reading with comprehension, and attention stamina.

Attention Deficits
Poor working memory skills impacts attention because if students cannot hold information as it is coming at them, it is harder to engage. These children tend to be more easily distracted and are often diagnosed as having inattentive ADD.

Reading and Dyslexia
Several of the symptoms above impact reading — both in learning to decode, and in reading efficiency for comprehension. Most of the time in reading though, the true difficulty is phonological awareness. An inability to retain text while reading more often not due to inefficient and exhausting decoding, not working memory problems.

Testing for Working Memory

One of the most common tests used to determine working memory capacity is the WISC V (Wechsler Intelligence Scale for Children®-Fifth Edition).  This test has a whole subsection for Working Memory. 

Another test that may be used is the WAIS IV (Wechsler Adult Intelligence Scale®- Fourth Edition).  This test also has a subsection for Working Memory testing.

Both tests are highly recognized and work well in measuring Working Memory. 

Working Memory Accommodations and Modifications

Ask the student to verbalize their steps in completing tasks they often struggle to complete. This can provide important information about where the breakdown is occurring and what supports are likely to work best. 
• Evaluate the working memory demands of learning activities. A student with working memory difficulties will need more support as tasks get longer, become more complex, have unfamiliar content or demand more mental processing. 

• Break tasks into smaller chunks. One task at a time is best, if possible. 
• Reduce the amount of material the student is expected to complete. 
• Keep new information or instructions brief and to the point, and repeat in concise fashion for the student, as needed. 
• Provide written directions for reference. 
• Simplify the amount of mental processing required by providing several oral “clues” for a problem and writing key words for each clue on the board or interactive whiteboard. This way the student does not have to hold all of the information in mind at once. 
• Increase the meaningfulness of the material by providing examples students can relate to. 
• Provide information in multiple ways: speak it, show it, and create opportunities to physically work with it or model it. 
• Develop routines, such as specific procedures for turning in completed assignments. Once a routine is practiced repeatedly, it becomes automatic and reduces the working memory demand.

• Be prepared to repeat information. 
• Use visual reminders of the steps needed to complete a task. 
• Provide opportunities to repeat the task. 
• Encourage practice to increase the amount of information encoded into memory. 
• Teach students to practice in short sessions, repeatedly throughout the day. Spaced practice is more effective than massed practice. Have students practice new skills or information in short sessions over the course of the day rather than in one long session. For example, give the student a set of key facts to review for a few minutes two or three times during the school day, and encourage them to review again at home both at night and in the morning. 

• Use advance organizers and teach students how to use them. For example, KWL (What I Know, What I Want to Know, What I Learned) is a graphic organizer that helps students focus on what is to be learned. This tool activates prior knowledge, helps generate questions to explore and then assists students to connect what they learn to what they already know. 

• Teach one strategy at a time in brief, focused sessions. 
• Teach students when, where, why and how to use the strategy
• Review and activate prior knowledge. 
• Be overt and explicit. 
• Model and think aloud. 
• Have skilled students model steps.
• Encourage use and practice. 
• Evaluate and recognize effort and success. 
• Encourage self-monitoring. 
• Promote transfer to other situations, times, activities and groups.

• Use visual posters, e.g. of multiplication tables. 
• Create posters of commonly used words. 
• Provide instructions in written form – could be a handout, whiteboard, or simply a sticky note. 
• Provide a key word outline to refer to while you are teaching. 
• Encourage the use of checklists for multi-step tasks (e.g., steps for editing written work, timelines for assignments). 
• Encourage students to make lists of reminders regularly. 
• Use graphic organizers to teach new concepts and information. When the student can picture how the ideas are interrelated, they can be stored and retrieved more easily. 
• Consider educational technology that reduces the demand on working memory, such as calculators, word processors, spell-check devices, grammar-check devices, and voice dictation and text readers. 
• Use rhymes, songs, movements and patterns, such as ’30 days hath September’ rhyme for remembering the number of days in each calendar month. Music and physical routines linked to fact learning can help students memorize faster and act as a cue for retrieving specific information. 

• Stop at least two times per lesson and request a quick summary from students – “what have we learned so far?” – followed by quick notes on the board. Research overwhelmingly indicates that at least 40% of total learning time needs to be spent reviewing new material. 
• Request students to paraphrase, or have another student paraphrase verbally delivered directions. Research has repeatedly shown that youth are more likely to “hear” and “remember” if they hear their own voice or a peer’s voice. 
• Allow time for rehearsal and processing. 
• Allow extra time for the student to retrieve information. These students benefit from advance warning that they will be asked a question. 
• Avoid open-ended questions. 

• Active participation with the material such as repeatedly hearing it, seeing it and moving it, holds the information in working memory so it can move to long-term memory. Let the students move around, use hands-on material and put information on file cards so they can be manipulated. 
• Wherever possible, use games such as Jeopardy® and Scrabble®, drama and art to reinforce concepts. 

• Physical coding, such as consistent colors for different subject areas, can act as triggers to help students remember information. o Try coding when teaching new concepts: when teaching sentence structure nouns are always red, verbs are always green etc. o Spelling – highlight difficult parts of new words. 
• Vocabulary – teach new words in categories or families and color code the categories. o Encourage the use of colored pens or highlighters (remember, yellow is the LEAST effective). 

• Try to get the students to link new information to prior knowledge – encourage drawing, writing and verbal reflection. The use metaphors, analogies, imagery or induced imagery (where the image is generated by the individual, rather than given to them) can help. 
• Start each lesson with a quick review of the previous lesson – always write down key words as the students recall information to model “trigger words”. 
• End each lesson with a summary of what was learned. 

• Teach students to listen for key words. Post the words in the classroom and frequently use them as cues while you teach. 
• Often students with working memory difficulties also exhibit word and information retrieval difficulties. They frequently experience the “tip of the tongue” phenomenon, or may produce the wrong details within the correct concept. The student may need additional time to retrieve details when answering a question. Cues may be necessary to help them focus on the correct bit of information or word. 

• Allow extra time, or reduce the number of questions. 
• Consider requiring recognition vs. recall. 
• Teach students to scan the test and plan their time allocation. 
• For essay tests, teach students to create an outline, write key words in point form and then expand on the key words and ideas. 
• Where possible, allow students to use reference sheets during tests (e.g., math formula, chronologies of events), or encourage students to create reference sheets at home, to rehearse the information frequently and then to rewrite the information at the beginning of the exam before attempting to answer the questions. 
• A student with difficulties sustaining working memory often needs frequent short breaks. Breaks typically only need to be one or two minutes in duration. Observing when the student’s ability to focus begins to wane will help determine the optimal time for a break. 
• Use technology such as word processors, speech-to-text, and text-to-speech programs to reduce working memory demand, and allow for additional time to complete tasks. 

• Encourage self-reflection for yourself and the student. What worked for me? What could I do next time? If this strategy worked for this task, could I use it anywhere else? 
• Many software programs and applications can provide rehearsal in an entertaining fashion and are often less demanding of working memory.

Wrap Up

I hope this article has been helpful.  Please click on the embedded links for source material.  I know this has helped me understand the importance of Working Memory and I hoped it helped you do the same.  Please leave any questions or comments below.

Saturday, October 15, 2016

October Pregnancy and Infant Loss Awareness 2016

Time to come of the shadows and stigma of pregnancy and infant loss.  Though it hurts me to talk about my daughter I would not have it any other way.  She was here, she was alive, and she deserves to be remembered. I love you my sweet baby Martha.