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 profound processing speed problems. Margaret tested as profound (60) on the WISC-IV for memory processing speed and is a relative weakness for her.  Joseph tested in the 0.1 percentile in processing speed (standard score of 45; there is no lower score). Joseph's processing speed is  slower than his other neurocognitive abilities suggest which is not surprising since many of the processing speed tests depend on visual skills (Joseph is blind in one eye along with working memory). I think Margaret and Joseph developed their issues with processing speed due to their premature birth and very low birth weight.  James was blessed to have tested average (89) on processing speed.  With two kids having VERY impaired processing speeds I needed to find out what this means for me and for them.

What is the Impact of Slow Processing Speed? 

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 ilslearning.com
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 2enewsletter.com


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 sideshare.net

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?

INSTRUCTIONAL STRATEGIES:
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:
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 Kindergartner/Preschooler with Learning Disabilities: You Can Do It!

Photo Credit: https://onlinestudyaustralia.com
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.


http://www.kidzone.ws/prek_wrksht/dynamic.htm

https://www.pinterest.com/elmorekt/ot-kids-pre-writing/

http://teachingmama.org/prewriting-activities-for-preschoolers/

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.


https://itunes.apple.com/us/app/youtube-kids/id936971630?mt=8

https://play.google.com/store/apps/details?id=com.google.android.apps.youtube.kids&hl=en

There are songs for learning....
This is a good site for ANY teaching song.
http://www.songsforteaching.com/preschoolkindergarten.htm

https://www.pinterest.com/explore/preschool-songs/

http://www.learninggamesforkids.com/preschool_kindergarten_videos.html

Apps

https://www.commonsensemedia.org/lists/best-preschool-apps

http://coolmomtech.com/2014/08/best-educational-apps-for-preschoolers-back-to-school-tech-guide-2014/

http://www.icanteachmychild.com/the-10-best-iphoneipad-apps-for-preschoolers/

Therapy apps

http://nspt4kids.com/parenting/our-10-favorite-speech-and-language-apps-for-kids/

http://www.smartappsforkids.com/2013/08/top-free-apps-for-language-therapy.html

https://www.webpt.com/blog/post/ipad-and-tablet-apps-pediatric-occupational-therapist

https://www.pinterest.com/rarollston/ot-therapy-apps/

http://www.aota.org/practice/manage/apps.aspx

http://dexteria.net/

https://www.webpt.com/physical-therapy-apps

https://www.pinterest.com/lasenders/gross-motorptpe-apps/

For PE/physical therapy we use this YouTube channel
https://www.youtube.com/user/CosmicKidsYoga

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!