Wednesday, June 22, 2016

Lack of Effort or Slow Processing Speed?

Kids at the aquarium.  From Left to Right is
Joseph, James, and Margaret
Slow Processing Speed.  What the heck is that and what does it mean for my child???  I know I was wondering that same thing when Margaret and Joseph tested as having impaired processing speed.  James tested average on memory processing speed.  Margaret tested as impaired on the WISC-IV for memory processing speed and is a relative weakness for her.  Joseph's processing speed is significantly slower than his other neurocognitive abilities suggest which is not surprising since considering much of the processing speed depends on visual skills (Joseph is blind in one eye). With two kids have very impaired processing speeds I needed to find out what this means for me and for them.

What Impact Does Slow Processing Speed Create? 

Don’t automatically presume that the child is being oppositional, ‘lazy’, unmotivated, etc. because he/she takes longer to initiate or complete a task, or to respond to a task demand. Keep in mind the possibility that his/her behavior is the result of slow processing speed. Processing speed is the pace at which you take in information, make sense of it and begin to respond. This information can be visual, such as letters and numbers. It can also be auditory, such as spoken language. It is important to be alert to the possible emotional impacts that a child can experience in the face of slowed processing speed, and to provide emotional support and encouragement, as well as practical interventions.

Slow processing speed can cause negative impact to three main areas of someone's life. These are
Image courtesy of
academic, social, and self-esteem. Academically, slow processing speed can lead to the following types of problems: slowed execution of easy academic tasks; slowed acquisition of new material; becoming overwhelmed by more complex academic demands; the need for extra time in responding to even well-practiced and automatic tasks; and difficulty making correct conceptual decisions quickly.

Socially, slow processing speed can lead to difficulty keeping up with normal give-and-take conversations among peers or with adults, or appearing to be ‘not-with-it’ by others, with the potential of being made fun of or mislabeled as a result.

With respect to self-esteem, the fallout from the problems described above can have a negative impact on self-esteem, leaving a child vulnerable to feelings of incompetence, self-consciousness, and/or depression. Many children with slow processing speed wrongly end up feeling that they are stupid, because they are aware that it takes them longer to get things done, or to understand some concepts.

Examples of slow processing speed, when a child with slow processing speed sees the letters that make up the word “house,” she may not immediately know what they say. She has to figure out what strategy to use to understand the meaning of the group of letters in front of her. It’s not that she can’t read. It’s just that a process that’s quick and automatic for other kids her age takes longer and requires more effort for her.

Saying too many things at once can also pose a challenge. If you give multiple-step directions—“When you come downstairs, bring your notebook. And can you also bring down the dirty glasses, and put them in the dishwasher?”—a child with slow processing speed may not follow all of them. Having slow processing speed makes it hard to digest all that information quickly enough to finish the task.

Slow processing speed impacts learning at all stages. It can make it harder for young children to master the basics of reading, writing and counting. And it impacts older kids’ ability to perform tasks quickly and accurately.

Slow Processing Speed, 2e, and ADHD

There is a newsletter for twice exceptional children (Gifted/2e) that has a WONDERFUL article on slow processing speed written in May 2013. In the article Steven Butnik, Ph.D outlines the issues with slow processing speed. It is common for gifted students to have slow processing speed.  Slow processing speed itself is not a disability.

Children with the predominantly inattentive subtype of ADHD may have a sluggish cognitive tempo. They typically daydream, stare off, and appear spacey. They may be mentally foggy, underactive, slow moving, and lethargic. Their work is often slow and error prone. Their brain activity shows patterns of under arousal in the portion of the brain associated with focus and planning.

In addition, children with ADHD typically exhibit poor executive functions, brain-based behaviors that contribute to effective functioning. (see my blog post on executive functioning) Executive functioning is often impaired in ADHD individuals.

Some children take more time to complete tasks due to trouble with activation. A student may not begin a task due to problems organizing time or materials, or due to reluctance, uncertainty, lack of confidence, or anxiety. Other children may take more time to complete tasks because of problems maintaining focus. While time is passing, these students may be distracted or daydreaming, drawn to other, more interesting stimuli.

Effort includes processing speed as well as mental stamina. When effort is a problem, the child’s work pace is very slow and he may complain that his “brain is very tired.” When the problem is emotional, on the other hand, children find it hard to regulate their feelings. They might melt down when starting to work or encountering a frustrating task; or they may refuse to work, be argumentative, or have tantrums.

Problems in working memory can add to the time it takes a child to complete tasks. After reading a paragraph, a child with poor working memory may forget what she just read and need to read it again; or he may stop working on a class assignment because he forgot the directions. Finally, when action is a problem, the child has trouble sitting still, fidgets with objects, or may want to stand or walk around when working.

An additional issue that children with ADHD face is having a poor sense of time. For them, time seems to go more slowly during the tasks they feel are boring while moving more quickly for tasks they find interesting. When planning work tasks, a child with ADHD may underestimate how long the task will take; and when playing, the child may be unaware of how much time has passed. Taken together, poor executive functions and poor time sense can make homework take hours to complete and create major stress.  Trust me on the stress!  Even homeschooling I can have issues with poor time management and starting work. I can only image if I sent my children to public school!  You can see in the image below how processing speed effects the effort (number 3) needed for executive functioning along with working memory (number 5). It is easy to see how executive functioning is impacted.
Image courtesy of

How to Test for Slow Processing Speed? 

So how do we test processing speed?  I highly recommend in seeing a neuropsychologist. If you cannot then I suggest seeing a developmental pediatrician or pediatric psychologist.  In the executive function blog post I explain why.  If you need to the school to preform the testing then I highly suggest you tell the school you want testing in executive functioning, memory (working, long-term, and short-term), sustained attention, and processing speed. At public schools you cannot specify they use specific tests, but if they ask, tell then you want the Wechsler Intelligence Scale for Children ® - Fourth Edition (WISC ® -IV).

Who can administer this test?

Tests with this qualification require a high level of expertise in test interpretation, and can be conducted by individuals with:

  • A doctorate degree in psychology, education, or closely related field with formal training in the ethical administration, scoring, and interpretation of clinical assessments related to the intended use of the assessment.
  • OR
  • Licensure or certification to practice in your state in a field related to the purchase of the test.
  • OR
  • Certification by or full active membership in a professional organization (such as APA, NASP, NAN, INS) that requires training and experience in the relevant area of assessment.

More Information and Training on Score Reading

On WISC-IV's on page, at the bottom of the page next to the product details tab, there are a couple of other great tabs you may want to research.  Under the Resource tab there are several technical reports.  A couple that caught my eye included Technical Report #6: Using the Cognitive Proficiency Index in Psychoeducational Assessment and Technical Report #5:WISC–IV and Children’s Memory Scale, and Technical Report #2: Psychometric Properties.  There are also some training on WISC-IV Interpretation & WISC-IV Integration along with a training on advanced topics of WISC-IV.  Don't forget to peek at the FAQ tab while you are there. There is also a Processing Speed Damian Case Study that has been produced.  I think it provides wonderful information if you are curious to see if your child has processing issues.

So how do we read the WISC-IV report?

This gets a bit more technical.  Please ask questions in the comment section and I will try to answer them as best as I can considering this is NOT my area of expertise (I am not a psychologist nor have I had training). 

Processing speed is an element of intelligence, as measured by many tests of cognitive ability, including the Wechsler Intelligence Scale for Children (4th Edition). Scores for both the Working Memory and Processing Speed subtests make up the WISC-IV’s Cognitive Proficiency Index. These abilities are separate from the WISC-IV’s General Abilities Index, a measure of core intelligence derived from an individual’s Verbal Comprehension and Perceptual Reasoning Indices (verbal and nonverbal abilities).

Each of these three subtests taps different abilities that contribute to the Processing Speed score. 
  • Coding, which requires children to draw symbols, is heavily influenced by grapho-motor demands. Children with poor handwriting or dysgraphia may struggle with this task. 
  • Symbol Search has less emphasis on motor output but requires rapid differentiation of abstract symbols. 
  • Cancellation, the supplemental Processing Speed subtest, makes use of concrete images rather than symbols.
According to Steven M. Butnik, Ph. D., LCP, the Processing Speed subtest assesses the abilities to focus attention and quickly scan, discriminate between, and sequentially order visual information. It requires persistence and planning ability, but is sensitive to motivation, difficulty working under a time pressure, and motor coordination. It is related to reading performance and development. It is related to Working Memory, in that increased processing speed can decrease the load placed on working memory, while decreased processing speed can impair the effectiveness of Working Memory.
The Working Memory subtest assesses the ability to hold new information in short-term memory, concentrate, and manipulate that information to produce some result or reasoning processes. It is important in higher-order thinking, learning, and achievement. It can tap concentration, planning ability, cognitive flexibility, and sequencing skill, but is sensitive to anxiety too. It is an important component of learning and achievement, and ability to self-monitor. 

Tests of educational achievements make use of processing speed on subtests that measure academic fluency. For example, the Woodcock-Johnson Tests of Achievement include three subtests of fluency:
  • Reading Fluency. For three minutes the student quickly reads simple sentences and answers yes or no to each.
  • Writing Fluency. Using three words and a picture, the student quickly writes simple sentences for seven minutes.
  • Math Fluency. The student rapidly performs simple calculations for three minutes.
Children who have trouble activating, are inattentive, or have sluggish cognitive tempo may struggle on all of these tasks. Children with slow motor output would have less trouble on Reading Fluency but would do more poorly on the Math and Writing Fluency tests. Working memory problems would likely have a greater impact on Math Fluency than on the other fluency tasks.

A subset of children with reading disorders display marked difficulties with verbal and visual processing speed and that may indicate a subtype of reading disorder. Individuals with impairments in both RAN (rapid automatic naming) and phonemic awareness had the most severe reading problems when matched on phonological skills. Individuals with worse RAN scores had poorer performance on timed word recognition and comprehension tests.

Other tests that measure Processing Speed and Working Memory

So there are other tests that measure processing speed and working memory. Other tests that may be used at the school include the Woodcock-Johnson Tests of AchievementWechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and the Wechsler Preschool and Primary Scale of Intelligence™ - Fourth Edition (WPPSI™ - IV). The last test , the WPPSI, is for children ages 2.5 years to about 7.5 years old. Each of these tests have components that can measure processing speed.

The Woodcock Johnson IV can measure cognitive processing speed and working memory. 
Cognitive Processing Speed is the ability to quickly perform both simple and complex cognitive tasks, particularly when measured under pressure to sustain controlled attention and concentration. This cluster includes Letter-Pattern Matching (locating and circling two identical letter patterns in a row of 6 patterns) and Pair Cancellation (locating and marking a repeated pattern as quickly as possible). 

In the WJ-IV the short-term memory subset measures the ability to capture and hold information in immediate awareness and then use it or manipulate it to carry out a goal. This cluster includes Verbal Attention (answering specific sequence questions when provided with a series of animals and digits from an audio recording) and Numbers Reversed (holding a span of numbers in immediate awareness while performing a mental operation on it).

Image courtsy of CultofPedagogy

Processing Speed's Impact on Learning and Emotional Issues

Slow processing speed is not a learning disorder. To be considered to have a learning disorder, a student must have the following:
  • Average or better intelligence
  • Patterns of substantial processing differences
  • A significant difference between abilities and achievements.
However, research has shown that processing speed is linked to reading development and reading performance. Specifically, processing speed may be a factor in these situations:
  • Reading disorders such as dyslexia
  • A subset of reading disorders in which individuals display marked difficulties with verbal and visual processing speed
  • Grapho-motor problems (dysgraphia). Individuals with dysgraphia have serious trouble forming letters and numbers; their handwriting is slow and labored; they may have trouble with spacing between words; they mix upper- and lower-case letters; etc. Because neatness only comes with their taking much time, their written work can be very strained and painful.
So what does slow processing speed look like?  Kids might have trouble with:
  • Finishing tests in the allotted time
  • Finishing homework in the expected time frame
  • Listening or taking notes when a teacher is speaking
  • Reading and taking notes
  • Solving simple math problems in their head
  • Completing multi-step math problems in the allotted time
  • Doing written projects that require details and complex thoughts
  • Keeping up with conversations
Image courtesy of

Parents and teachers may notice that a child:
  • Becomes overwhelmed by too much information at once
  • Needs more time to make decisions or give answers
  • Needs to read information more than once for comprehension
  • Misses nuances in conversation
  • Recognize simple visual patterns and in visual scanning tasks
  • Take tests that require simple decision making
  • Perform basic arithmetic calculations and in manipulating numbers, since these operations are not automatic for them
  • Perform reasoning tasks under time pressure
  • Make decisions that require understanding of the material presented
  • Read silently for comprehension
  • Copy words or sentences correctly or to formulate and write passages
  • Has trouble executing instructions if told to do more than one thing at once
Some key things to note:
  • Slow processing speed can affect the ability to make decisions quickly.
  • Trouble with processing speed can affect a child’s executive functioning skills.
  • Having your child evaluated can reveal problems with processing speed.

So what can I do to help my child learn?

The key instructional strategy for students with slow processing speed is to reduce the time pressure associated with a task. This can be done in three essential ways:

  • Give the student more time for their work
  • Allow longer response time for the student to respond orally to questions in class
  • Complete seatwork assignments in class
  • Allow suficient time to make decisions when offered a choice of activities
  • Allow extra time for tests, usually time and a half
  • Provide extra time for the student to complete in-class assignments
  • Develop keybording skills
  • During writing intensive exercises allow the use of a computer or other word processor
  • Reduce the amount of work the student is required to do.
  • Shorten the assignment so it can be accomplished within the time allotted
  • Focus on quality of productions, rather than quantity
  • Shorten drill and practice assignments that have a written component by requiring fewer repetitions of each concept
  • Provide copies of notes rather than requiring the student to copy from the board in a limited time
  • Allow student to answer orally for written tests and other assignments when possible
  • Provide direct and explicit instruction in strategic problem solving, reading fluency, and organizational strategies
    • I haven't read it but it looks interesting.
    • For example, teach him how to use graphic organizers to plan writing assignments or to enhance reading comprehension. Help him improve his visual imagery so as to support visual working memory, and show him how to use mnemonics such as acronyms, acrostics, and pegwords to learn new information.
Build the student’s efficiency in completing work through building automaticity.
  • Provide instruction to increase the student’s reading speed by training reading fluency, ability to recognize common letter sequences automatically that are used in print; and sight vocabulary
  • Provide timed activities to build speed and automaticity with basic skills, such as:
    reading a list of high-frequency words as fast as possible and calculating simple math facts as fast as possible
  • learning simple math calculations through flash cards, educational software exercises, and music
  • charting daily performance for speed and accuracy
Train the student in time management techniques to become aware of the time that tasks take.
  • Teach the student to use a stopwatch or to record his or her start and end times for assignments to monitor the time spent on each activity. Set a goal for the student to gradually reduce the time needed to do these tasks.
Assessment strategies emphasize power tests that focus on the knowledge the student has, rather than on speed tests to complete a large number of questions within a limited time.
  • Emphasize accuracy rather than speed in evaluating the student in all subject areas
  • Replace timed tests with alternative assessment procedures
  • Allow extra time for tests and exams. Give the student supervised breaks during the test
  • Provide a reader or text-to-voice software to read test questions to the student to accommodate for slow reading fluency
  • Provide a scribe or voice-to-text software to record the student’s answers on tests to accommodate for slow writing fluency
  • Use test formats with reduced written output formats (e.g. multiple choice, True / False, fill in the blank) to accommodate for slow writing fluency

I hope you have found this blog post helpful.  I know it was for me in researching and writing it.  I learned a lot about myself and a lot about my children.  Please feel free to leave comments including any questions or concerns.  I will answer to the best of my ability. 

Friday, June 10, 2016

Ideas for Homeschooling a 3 year old with Learning Disabilities: You Can Do It!

Photo Credit:
Three is still so young. The name of the game is to keep it fun and simple. At three they are still young. Here is what I suggest for preschool activities.

Here are some links for pre-writing activity worksheets. Maybe do one per day. It depends on your child but the hand strength and hand-eye (visual motor) coordination needs to be there or a lot of one-on-one help will be required. If you are concerned about handwriting talk to your Occupational Therapist. They should be able to help with hand strength, grip, and/or special tools to help handwriting.

Work on colors and numbers. This can be done by watching TV shows like Team Umizoomi, Blues Clues, Peg + Cat, Daniel Tiger's Neighborhood, Super Why, Word World, Veggie Tales and other educational shows. I HIGHLY recommend letting them watch TV IF it's educational. We use PBS and stream TV. To stream TV you can use a laptop connected to your TV via HDMI cable, have a smart TV, or use a device like a ROKU. We use ROKU and have for about 10 years. Netflix, Hulu, and Amazon have a TON of appropriate kid programming with little to no commercials. YouTube can be good source also but you have to monitor it. There is a KidsTube app that's more appropriate for private viewing.

There are songs for learning....
This is a good site for ANY teaching song.


Therapy apps

For PE/physical therapy we use this YouTube channel

I hope this gives you some ideas. More likely than not special needs kids will needs LOTS of repetition to be able to acquire new information and to shift it to long term memory for storage. The name of the game is to switch stuff up, keep it fun, and to teach them without them knowing. I hope this has been a help. Please leave comments below. Thanks!

Thursday, May 5, 2016

Civil Rights and Disabilities in Public Schools

Interesting and sad report! Staffing level at the Office of Civil Rights has been dropping significantly at the same time OCR complaints are at a record high (p. 8). The number of complaints over restraints and seclusion, used as a discipline measure for disabled children, is also at an all time high (p. 9). Highlights (lowlights really) from the 2011-2012 school year include: Only 50% of our country’s public high schools offer calculus and only 63% offer physics; A quarter of high schools with the highest percentage of black and Latino students do not offer Algebra II; a third of these schools do not offer chemistry; Students with disabilities are more than twice as likely to receive an out-of-school suspension (13%) than students without disabilities (6%); and about 40% of school districts do not offer preschool program with 57% of school districts that operate public preschool programs offer only part-day preschool (p. 16). There were about 4,800 complaints sent to the OCR in 2015 concerning students with disabilities on a 504 (p. 33). This is 46% of ALL complaints filed with the ORC in 2015 (p. 8. 33 &; 34)!!! It can take 120 to 256 DAYS to complete a case! This about this in terms of a school year. You lose most if not all of the school year to resolve the issue (p. 34). There were 1,489 complaints concerning FAPE (p. 35). These complaints include students with disabilities not being taught core subjects like math, science, and social studies because they were being pulled out for special education services.

Bullying of disabled students, with 552 complaints, was the second largest issue in 2015 (p. 36) due to schools failing to respond to bullying complaints. On October 21, 2014, the OCR issues a Dear Colleague letter and fact sheet regarding the obligation under Section 504 and Title II and their implementing regulations for schools to respond appropriately to bullying of students with disabilities. These documents clarify that if a student with a disability is being bullied, federal law requires schools to take immediate and appropriate action to investigate and, as necessary, take steps to stop the bullying and prevent it from recurring. Regardless of the basis of the bullying, schools must remedy the effects of bullying on the services that a student with a disability receives (such as special education or other disability-related services) to ensure that the student continues to receive FAPE (p. 36).

There were 214 complaints due to lack of access to programs, services, and facilities. Lack of access occurred in several school districts. One example is a school keeping students of disabilities segregated from all the other students including recess and lunch. Another case involved a school failing to have a sign language interrupter at school events after parental requests were ignored. One school district rescinded their offer for a gifted program after the district learned a child had a disability. Another school district refused to provide a registered nurse for a diabetic baseball player on travel to away games. There are too many examples to list here.

This is a very interesting read. I did not even cover all the other issues OCR covers. If you can take the time to read the report.

If you ever need to file a report, hopefully you will not, the link is below.

Monday, March 21, 2016

Letter Request Initial Educational Testing per IDEA

Okay, I know I homeschool but I still engage in educational advocacy for others.  Why?  Because I feel like I have a lot to offer others in the way of service, and to be honest, I HATE seeing how public schools abuse/misuse special needs students!  So my help for today is how to request educational testing. You must request the start of educational testing!  Should you HAVE to? NO! See here, here, here, here, and here on the case law.  BUT most schools will do nothing until you speak up and start advocating for your child!  Here is a sample letter to request testing by the school district.

Please double check the law quoted in here since the regulations can move from time to time.  I hope you find this helpful!

Dear (Principal,Guidance Counselor, or School Psychologist's name),

I would like to request comprehensive educational testing for my child ________________ who is in _____ grade at __________________school. 

I would like a full psycho-educational evaluation together with appropriate testing for learning disabilities. I request my child be tested in all suspected areas of disability (34 CFR 300.304), including the areas (in this area to add any specific disability such as of auditory processing, executive function, OT, speech and language, reading disability, etc).

I understand I need to sign a consent form so the school can conduct the evaluation (34 CFR 300.300). If I do not hear from you in three days I will call to set up a time to sign the consent form.

After testing, and at least 5 days prior to attending the IEP team meeting to discuss the testing results [34 CFR 300.613(a)], I request I have a chance to review the result and ask any questions I have with the evaluator so that I may be an active part of the team (34 CFR 300.321).

I understand the school system has 60 days to complete testing and hold a meeting to discuss eligibility [34 CFR 300.301(c)(1)(i)]. Please note, at the IEP meeting I will be recording the meeting and any subsequent IEP meetings. I want to make sure I do not miss anything and an audio recording will help me immensely. I look forward to meeting with you on that date. 

(your name)

When you deliver your letter to the school you need to do so in one of two methods.

Method 1: Write the letter and print out two copies.  Take one copy to the post office and send the letter certified mail with signature card and return receipt. Once you get the signature card back take it and staple it to the other copy you saved.  This copy should then be placed in a file folder, or better yet, hole punched and put into a three ring binder you use and organize for your child each year.

Method 2: Print off two copies.  Take both copies into the front office and ask the secretary to stamp both copies as received with the school stamp WITH DATE! You will give her one of the copies to deliver and the other will be retained for your files.

It is important you keep up with ALL paperwork and have it stored in one place.  I also like to scan all paperwork and store it in a cloud.  I like Dropbox for this purpose because it accepts all file types (so audio records along with paper docs) and it is easy to share files if I wish to do so.  I am not associated with Dropbox in any way.  I just like their product. :)  I hope this helps. If you have questions please write me a post.  I will answer your questions to the best of my abilities.

Thursday, March 10, 2016

Executive Functioning and the Impact on Leaning

Executive functioning is a complex issue.  I know since all my children have executive functioning issues! The real question is how does executive functioning issues impact learning in both the homeschool and public education environment?

First, let's discuss homeschool.  It is easier, when you homeschool, to address executive functioning issues because you can tailor a child'e learning environment around their disabilities.

So what is executive functioning?

WebMD defines executive functioning as a set of mental skills that help you get things done. These skills are controlled by an area of the brain called the frontal lobe.

Executive function helps you:
  • Manage time
  • Pay attention
  • Switch focus
  • Plan and organize
  • Remember details
  • Avoid saying or doing the wrong thing
  • Do things based on your experience

When executive function isn’t working as it should, your behavior is less controlled. This can affect
your ability to:

  • Work or go to school
  • Do things independently
  • Maintain relationships
This is a huge problem for children with ADHD, depression, and learning disabilities. These conditions are often associated with issues with executive functioning. 

How does executive functioning impact homeschool?

When you have a child with executive functioning problems you cannot expect them to manage their time, day, or classwork.  They will have a difficult time organizing information and paying attention to the task at hand.  They will have problems with switching between tasks and are horrible multi-taskers. This means you will need to give them more one-on-one attention in both tasks and academics.  For my three children this means I have to teach them all separately.  They cannot be taught as a group in reading and math.  We do these separately.  For science, history, and social studies we learn these together.  I often have James or Margaret read while the others listen and ask questions. Since retaining information is also an executive function issue and an issue with working memory (another common problem with EF and in my children) we often will repeat the same lesson 2 to 4 times in the same week.  This helps the children to retain the information they are learning. This is something I can do in a homeschool setting that would not typically occur in the public school setting.

How does executive functioning impact school?

Executive functioning in a public school setting can be a nightmare and this is one of the reasons why I enjoy homeschooling.  It is often called by parents an "invisible" disability.  The signs are often subtle but there. Then there is the challenge for parents to figure out the symptoms are issues of executive functioning and request a school district to test for EF issues. 

So which tests can tell if a child has a problem with executive function issues? Well, the sky is the limit!  LOL   There are a LARGE verity of tests, partially because EF covers so many functional areas, so it is hard to say which test could be used to test your child.  Some of the more common tests are:

  • Wisconsin Card Sorting Test
  • Category Test
  • Stroop Test
  • Trail Making Test-B
  • WAIS Subtests of Similarities and Block Design
  • Porteus Maze Test
  • Multiple Errands Test (MET)
  • Serial Sevens
  • Mini-Mental State Exam
These tests should be used in conjunction with other other testing to examine Intellectual functioning, Academic achievement, Language processing, Visuospatial processing, Attention/ concentration, Verbal learning and memory, Visual learning and memory, Speed of processing, Sensory-perceptual functions, Motivation, and Personality assessment. All of these tests play a role in defining issues with executive functioning and other learning disabilities. Most of these tests are best completed by a neuropsychologist.  I promise you a school district will never have a neuropsychologist on staff no matter what they say.  If it does ever happen someone please let me know but I feel confident in my statement. Why? It is because a neuropsychologist is a specialist and schools tend to only employ psychologist for testing. 

What is a neuropsychologist and how are they different from a school/typical psychologist?

There are basically three types of psychology: clinical, school, and neuropsychology. Clinical psychologists assess and treat children with a wide variety of psychological problems, but particular with emotional/behavioral issues. They may be found working in hospitals, community health centers, or private practice. Although most clinical psychologists are generalists, who work with a wide variety of populations and problems, some may specialize in a specific population and specific disorders (e.g. attachment or post-traumatic stress disorder). They are trained in universities or professional schools of psychology and may not be very familiar with school settings. Clinical psychologists provide both assessment and treatment (psychotherapy).

School psychologists are involved in enhancing the development of children in educational settings. They assess children's psychoeducational abilities and recommend actions to facilitate student learning and overall school functioning. They are typically trained in the Schools of Education at universities and work in school systems, community-based agencies, or private practice. A few may specialize in a particular school-related problem such as learning disabilities or ADHD. While specializing in educational issues, they may not be well trained in medical-based disabilities and disorders. School psychologists usually administer both norm-based psychological tests and criterion-referenced educational (achievement) tests.

Neuropsychologists represent a specialized discipline within the field of psychology that mostly focuses on cognition (the ability to think, remember, learn, etc.) in relation to the effects of brain damage and organic brain disease. A neuropsychologist can administer standardized psychological and neuropsychological tests to patients in private office and hospital settings.

Why is a neuropsychologist examination helpful? 

A pediatric neuropsychologist work closely with schools to help them provide appropriate educational programs for the child. There are five major reasons why a thorough neuropsychological evaluation performed by an pediatric neuropsychologist is superior to a psychoeducational evaluation. These are the inadequate range of a psychoeducational evaluation, the training of the personnel performing psychoeducational evaluations, the narrow focus of psychoeducational evaluations, the level of performance model employed in psychoeducational evaluations, and the failure of psychoeducational evaluations to assess brain behavior relationships. The school and general psychologist tend to focus on achievement and skills needed for academic success. Generally, they do not diagnose learning or behavior disorders caused by altered brain function or development.

Even in the homeschool setting this testing is very helpful to the parent so the parent can understand the learning deficits and strengths of their child.  This will help the parents to better teach their child in the home setting.

Children are referred by a doctor, teacher, school psychologist, or other professional because of one or more problems, such as:

  • Difficulty in learning, attention, behavior, socialization, or emotional control; 
  • A disease or inborn developmental problem that affects the brain in some way; or 
  • A brain injury from an accident, birth trauma, or other physical stress. 

A neuropsychological evaluation assists in better understanding your child’s functioning in areas such as memory, attention, perception, coordination, language, and personality. This information will help you and your child’s teacher, therapists, and physician provide treatments and interventions for your child that will meet his or her unique needs.

A pediatric neuropsychologist can evaluate school-age child many areas such as:

  • General intellect 
  • Achievement skills, such as reading and math 
  • Executive skills, such as organization, planning, inhibition, and flexibility 
  • Attention 
  • Learning and memory 
  • Language 
  • Visual–spatial skills 
  • Motor coordination 
  • Behavioral and emotional functioning 
  • Social skills 
Some abilities may be measured in more detail than others, depending on the child’s needs. A detailed developmental history and data from the child’s teacher may also be obtained. Observing your child to understand his or her motivation, cooperation, and behavior is a very important part of the evaluation. Emerging skills can be assessed in very young children. However, the evaluation of infants and preschool children is usually shorter in duration, because the child has not yet developed many skills.

So what can the results from the testing tell you?

By comparing your child’s test scores to scores of children of similar ages, the neuropsychologist can
create a profile of your child’s strengths and weaknesses. The results help those involved in your child’s care in a number of ways.

Testing can explain why your child is having school problems. For example, a child may have difficulty reading because of an attention problem, a language disorder, an auditory processing problem, or a reading disability. Testing also guides the pediatric neuropsychologist’s design of interventions to draw upon your child’s strengths. The results identify what skills to work on, as well as which strategies to use to help your child.

Testing can help detect the effects of developmental, neurological, and medical problems, such as epilepsy, autism, attention deficit hyperactivity disorder (ADHD), dyslexia, or a genetic disorder. Testing may be done to obtain a baseline against which to measure the outcome of treatment or the child’s development over time.

Different childhood disorders result in specific patterns of strengths and weaknesses. These profiles of abilities can help identify a child’s disorder and the brain areas that are involved. For example, testing can help differentiate between an attention deficit and depression or determine whether a language delay is due to a problem in producing speech, understanding or expressing language, social shyness, autism, or cognitive delay. Your neuropsychologist may work with your physician to combine results from medical tests, such as brain imaging or blood tests, to diagnose your child’s problem.

Most importantly, testing provides a better understanding of the child’s behavior and learning in school, at home, and in the community. The evaluation can guide teachers, therapists, and you to better help your child achieve his or her potential.

Wrap up

Links have been included in the blog to the sources of my information. Some of the information comes from personal experience. All of my children have executive functioning issues.  The executive functioning is also impacted by their working memory issues and ADHD. Knowing my children have executive functioning issues has really given me a lot of patience since I now understand their limitations and issues.  I don't get so annoyed when I have to repeat myself 6 times or get angry when I ask for a task to be completed and it never gets done. I understand now and know the problem.  It has made me think about how I parent my children, my expectations of them working independently, and what I need to do to help them in the future.

I am including a link to a list of accommodations written up by a school district in New York that covers all areas of executive functioning and has accommodations from Kindergarten to 12th grade. It is a great resource for both the homeschooled and public schooled child.  The link can be found here and it is a PDF.  I am also including a link (click here) to a redacted version of Margaret's last neuropsych report. It is not as comprehensive as it could be because all my children had neuropsych testing completed three years ago but it gives you a good idea how a report should be written and what to expect. I hope this has been help and always feel free to send me questions in the comment section!

Thursday, March 3, 2016

To the Doctor

Doctor Office Selfie
Thankfully this was not for me.  This visit was for the children.  I kept getting calls from Medicaid for the children.  They kept insisting I take the children in for a well visit check. They were busy reminding me vaccines are important.  Yes, they are but we will agree to disagree on that one.

This turned out to be a good time for me to visit the doctor anyways. I had wanted to talk to her about Joseph and his skinny, slow-growing self. Sigh!  We headed off in the morning to see the doctor. It was a 35 minute drive across town on the interstate.  Margaret sat in the back crying and whining the entire time I am on the highway.  I am not sure where this fear came from but I wish it would go away!

We make it to the doctor's office and there is a small playground.  I have to promise the kids I would let the play afterwards as I shove them into the office door.  I yell at everyone to take a seat on the well side of the office but they kept getting drawn back to the sick side. The LAST thing we needed is to pick up some illness visiting the office. That is why I did not want to visit the doctor yet but the calls from Medicaid were harassing!

Thankfully the Little Mermaid started to play on the well child side and the children stayed seated!

We got back into the patient room.  I swear it is the smallest room I have ever been in!  There was not enough space for me and the kids to sit much less the doctor! Kids were sitting in the floor playing their Kindles.  It was SO loud in the room!  LOL

The doctor comes in and we discuss Joseph's poor weight gain.  She said he had been putting on more weight recently.  She told me to keep it up.  I asked about tube feeding and she said we are not quite there yet. I am pleased because I really do not want to tube feed Joseph.  I think there is too much of a risk of infection. We discuss James's weight.  He could stand to lose about 4 pounds. Margaret is skinny but okay. If she is like any of the other ladies in my family I am not worried about her.  ALL women in my family are fat.  It just varies by degree.  I am one of the fattest while my aunt is rather skinny compared to the rest of us.  So I think Margaret will one day weight plenty.  No reason to rush things!
Right as they were finally settled we were called back to get weights and measures. Isn't that how it always is?  LOL   Kids take off their shoes we height and weight check. James weighted in at 72.4 pounds and 54 inches, Margaret was 48.4 pounds and 49.5 inches, and Joseph weighed in at a tiny 35.8 pounds and 45 inches!  

We discuss other issues and talk about some community supports we could look into.  Overall it was a nice visit with the doctor and I am grateful that Joseph never had to go to Urgent Care or the hospital this winter. Flu is at an all time high here. John was sick with Influenza type A but it did not really bother the kids or I so I think we are immune to that one. Now we just need to stay away from any other sickness until cold/flu/RSV season is over in about 8 more weeks.  Keeping my fingers crossed!

After leaving the doctor's office the kids wanted to play with a little girl (15 months) out on the little playground.  Since I promised I said yes.  The grandmother was outside watching the little girl.  She said she was happy my kids came along and would play with her.  They played for about 10 minuted before the mom came outside.  Then she told me that her daughter was sick.  Don't you know, no good deed goes unpunished?  LOL   Luckily I had hand sanitizer with me. I made the kids use it and get in the car.
Playing with Frisbees in the Park

I went to pick them up some cheap sandwiches and water.  Then I headed to the park for them to play.  There was no one there.  They got to play with their frisbees and basketball.  They had a blast!  They ran outside in the 90 degree weather for an 1.5 hours before I told them we needed to go.  Joseph had stopped sweating so I knew he had gotten too hot. I rubbed him down with ice and we left.  Did you know those darn kids did not fall asleep for 2 hours after bedtime!  I thought I had worn them out.
Got a picture of everyone before we left the park.

Thursday, February 18, 2016

Going to Church & Making Friends

Photo credit:
We are religious.  I may be less religious than my husband though I was raised in a religious household and went to church regularly.  John and I have discussed on many occasions what we thought we could do better with the children we have now versus my older children.  We both thought more religious and good character instruction would be important.

John is more about religion and not as concerned with denomination. I, on the other hand, was brought up Church of Christ and that is where I feel more at home. We went to several churches locally.  We had been taking the children to one Church of Christ for a while on Wednesday night. This church seems to have an older congregation that attends on Wednesday night. Overall, it has worked well for us and allows the children a chance to learn how they should behave at church.

They are learning. We still have incidences like James asking me a question in his regular voice instead at a whisper.  I swear none of the children have a volume control!  After singing a song, loudly and out of tune, Margaret ends the song by saying, "Woohoo!" or "Good job!"

Last night James sat at the end of the pew near the isle. As people passed he would say hi to each of them.  As part of James's autism "symptoms" he is often overly friendly.  We inadvertently taught this when we were teaching him social scripting. I don't mind but it can be a problem because he does not always understand when he has gone too far (crossed personal boundaries/becomes annoying) and he is very naive.  He still cannot look new people in the face when he greets them but we are making progress!

Who can say no to this sweet face?
James greeted people as they passed by and there were several elderly ladies who he had invited to sit by him.  One lady, June, was kind enough to accept his invitation.  She said she would let her sister know but she would be right back.  True to her word, she sat next to him until the children were dismissed to children's church.

While she sat there next to James he was so loving to her.  To me also as I was sitting on the other side of him.  He took her hand and held it.  He accidentally scratched himself on her bracelet. He took his hand away and rubbed his arm explaining what happened (rather loudly since he seems not to know how to whisper), apologized to her that he scratched himself on her bracelet, and then resumed holding her hand. At one point, during a story given by one of the men at the podium, James held his arms up as if was stretching and put his arm behind June and myself. Towards the end he was holding June's hand again and he took it and kissed it.

When the children were dismissed from the service James looked at her and said he would love to see her again and would she back back to church.  She said she would.  He asked if she would sit again with him. She said she would and she got up to sit next to her sister as James and the rest of the children went to children's church.

I won't lie when I said I had tears in my eyes as I watched James. We have no family here.  He knows he has grandparents but doesn't remember them. He has not seen them since he was 2. I was saddened to see the love he has and that his grandparents were not around to enjoy it.

I went to June after the service and told her how much I appreciated her sitting next to James. I told her I don't think she realizes how happy that made him!  How he had asked several people but no one accepted his invitation. June tells me she had never met such a polite and loving young man before. She goes on to tell me she never had children of her own and she would be happy to be James's friend.

James has a lot of love to give.  He is a big flirt though he does not know it. He will flatter women, all be accident, from 2 to 102. Someday, if continues along the same path,  he will make a good husband and father. I just need to make sure he finds a woman worthy of that sweet love.