Did you know 65% of the population are visual learners? Now, what do you do when you have a child that has vision loss in one eye, reduced peripheral vision in the other eye, BUT is STILL a visual learner?  Think about that for a minute.  Yes, Joseph, my son with only one "good" eye, is a visual learner. Joseph has problems with visual-spatial reasoning among other visual processing issues.  As it turns out, all my children have visual-spatial problems. They all score in the 5 to 18 percentile in visual-spatial reasoning.  So how does an issue with visual-spatial reasoning impact learning?  I hadn't a clue so I wrote this post to understand!  Hopefully you, dear reader, will find it helpful too!

In a paper by Franceschini et al., there is a strong correlation to visual-spatial attention and learning to read. The children who had the most difficulty with visual-spatial discrimination had most difficulty in learning to read and often went on to be diagnosed with dyslexia.  Mayer et al., found a correlation in visual-spatial reasoning, along with cognitive ability and problem-solving skills, were the deciding factors in determining the scientific reasoning skills of elementary school students. What I really found interesting was the paper by Tosto et al., which studied the visual-spatial abilities of several sets of 12 year old twins. By 12, a bit over half of your visual spatial skills you got from your parents (genetics) but the rest is learned (this was true for both boys and girls).  The part of the paper I found interesting is that the same pathways in the brain for visual-spatial reasoning is used for math and science. Who knew?  This explains a lot as to why children with developmental dyscalculia have issues with processing visual-spatial information.

What are the signs of Visual Processing Disorder?

There are EIGHT types of visual processing disorders. These are:
Visual Discrimination

• Can't match clothing, socks, or cutlery, especially when the differences are subtle
• Doesn't noticing the similarities and differences between certain colors, shapes and patterns
• Will not see differences between similar looking letters and words (eg b / d, b / p, 5 / S, won’t / want, car / cat)
• Will have a hard time reading maps

Visual Figure-Ground Discrimination

• Struggles to find information on a busy blackboard
• Finds it hard to copy work from the board as the child keeps losing his place when copying
• Loses his/her place on the page while reading
• Has poor dictionary skills
• Struggles with map work
• Struggles to find personal items in a cluttered place

Visual Sequencing

• Has difficulty using a separate answer sheet
• Cannot stay in the right place while reading a paragraph. Example: skipping lines, reading the same line over and over
• Problems reversing or misreading letters, numbers and words
• Has difficulty understanding math equations

Visual Motor Processing

• Has difficulty writing within lines or margins of a piece of paper
• Struggles to copy from a board or book
• When moving around often bumps into things
• Has problems participating in sports that require well-timed and precise movements in space

Visual Closure

• The inability to know what an object is when only parts of it are visible
• Not recognizing a picture of a familiar object from a partial image. Example: A truck without its wheels
• Misidentifying a word with a letter missing
• Not recognizing a face when one feature (such as the nose) is missing

Spatial Relationships

• Difficulty getting from one place to another
• Has a problem spacing letters and words on paper
• Cannot judge time
• Reading maps and giving directions are difficult
• Difficulty in math

Plus there are other vision processing disorders like Irlen Syndrome, visual dyslexia, and visual dyspraxia.

Who Diagnoses Visual Processing Disorders and How to Treat It?

This is hard to determine.  Visual Processing Disorder is NOT a learning disability be itself.  It is only a learning disability IF it interferes with the learning process.  Ah, the fun of public education! If you homeschool it is easier because you can implement the accommodations and modifications at home to see if academic function improves.

If you are looking to pursue a diagnosis look for an opthamologist, vision specialist, vision therapist, or a neuropsychologist. One of these professionals should be able to run the psychometric tests needed to make a diagnosis.

There are three kinds of therapies that are important to be aware of as you’re considering ways to help your child with visual processing issues.

Optometric vision therapy: It’s important to note that there is more than one kind of vision therapy. Optometric vision therapy has been proven to help with vision problems that involve eye movements or eye alignment. These eye coordination issues are different from visual processing issues. Visual processing issues involve the way the brain processes the information the eyes take in.

You may hear some kinds of optometric vision therapy referred to as “orthoptic vision therapy.” Both can help with eye muscle and eye alignment. These kinds of therapy can help with vision problems such as convergence insufficiency (when the eyes don’t work together properly when trying to focus on a nearby object).

Optometric vision therapy doesn’t “cure” learning and attention issues. But if your child has vision problems in addition to dyslexia and other issues, resolving vision problems can help him devote more energy to finding strategies that can help with the way his brain processes information.

Behavioral vision therapy: This is different from optometric vision therapy. Behavioral vision therapy involves eye exercises that are designed to improve visual perception. These eye exercises are also designed to improve visual processing skills. But there is no scientific research that shows this kind of therapy helps the brain process visual information. For that reason, behavioral vision therapy is considered a controversial treatment for learning and attention issues.

Anecdotal evidence suggests that it may help some children. But be wary of any treatment that claims to “cure” learning and attention issues. Learn more about how to know when a treatment is reputable.

Educational therapy: Children with visual processing issues may benefit from educational therapy. This type of therapy teaches kids strategies for working around their weaknesses. Learning how to approach problems can reduce frustration, increase self-confidence and lead to greater success in school.

What are appropriate accommodations or modifications? 

• Use books, worksheets and other materials with enlarged print
• Read written directions aloud. Varying teaching methods (written and spoken words; images and sounds) can help promote understanding
• Be aware of the weakness but don't overemphasize it. While helping a child work on the weakness is important; it is just as important to build other skills and function in any setting
• Break assignments and chores into clear, concise steps. Often multiple steps can be difficult to visualize and complete
• Give examples and point out the important details of visual information (the part of a picture that contains information for a particular question)
• Provide information about a task before starting to focus attention on the activity
• Allow student to write answers on the same sheet of paper as the questions or offer opportunities for student to explain answers orally
• Provide paper for writing and math work that has darker or raised lines to make the boundaries more distinct
• Organize assignments to be completed in smaller steps instead of one large finished product
• Use a ruler as a reading guide (to keep focus on one line at a time) and a highlighter (to immediately emphasize important information)
• Provide a tape recorder to supplement note-taking
• Color code important information
• Have a proof-reading buddy for all written materials
• Use a tape recorder when getting important information
• Before writing letters or essays, create an outline to simplify and organize ideas
• Have a proofreading buddy for notes and essays

I hope you found this post helpful.  I had initially started this post just to discuss visual-spatial processing but as I started to research the subject I found there was so much more to cover!  I think I did a decent job overall to cover everything in a broad way. If I missed anything please let me know!  I you have any questions you can contact me on the blog or though Facebook.

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 Achievement, Wechsler 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. 

Story Time with James_Part 2

Here is the second part of the Pinky Dinky Doo story by Jim Jinkins.

Story Time with James - Pinky Dinky Doo: Where are my shoes?

James is reading this book for the first time.  I had to help him occasionally with some of the words.  I think he did pretty good since this book is meant for ages six to nine.  Hope you enjoy!

The entire video was too long so this is the first of three parts...

Story Time - Are You My Mother

James LOVES to read.  He taught himself to read basically at 2 years-old.  He will be 5 years-old in December and he can read at roughly a third grade level.  He is very gifted in the reading department!

Here James is reading Are You My Mother by P.D. Eastman to his siblings.  I will try to get a better video of this one and I will try and record him reading other books.