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. 

Executive Functioning and Its Impact on Learning

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!

Yummy Recipes, Vaccines and Other Things

Today I went to the doctor and have him look at my hand.  The scar from the carpal tunnel surgery is VERY sensitive and there is a lot of scar tissue forming under the scar.  It hurts!  :(    In talking to the docotor he said he thought I was healing ok still but I find that debatable.  He recommended therapy to help  decrease the sensitivity of the scar and to break up the scar tissue.  I thought this was a great idea and make an appointment.  I just realized this evening that I could not pay for the therapy because each therapy session I to pay my $20 co-pay.  This SUCKS!  So I will just have to do what I can to increase the flexibility and strength in my hand.

Joseph's Medical Summary Letter

I went to the pediatrician today.  I had worked on a medical summary letter for each of the children as a rough draft for the doctor.  Took me about 2 hours for all three children. I think a medical summary letter is fantastic when you have a child with a long and complex medical history. You can pull the letter out and just hand it to another doctor to give them a quick run down on all the medical issues of your child.  Here is an example of Joseph's letter.  (if the type is too small hit CTRL and the + sign 3 or 4 times to enlarge the font).  When I got to the doctor's office I figured out I was an idiot and FORGOT to burn a disk with the letters to give the doctor's office.  Ugh!!!  I did remember to take the WIC forms to get Margaret and Joseph their Pedisure AND I got the right form filled out to get a handicap plate for my car.  It will make taking the kids out MUCH easier in some places.  The doctor was funny.  He said which child is this for since all of them could qualify.  LOL  That was both a funny and sad statement!  I got the permit for Joseph though.  I also got the information I needed sent off to to the medical supply company to get Joseph's wheelchair.  That will be SUPER helpful!  So I did pretty did pretty good today.

Just as a quick note to people in Nevada applying for a handicap plate or placard for their minor child here are the instructions on what to do.  I called the Nevada DMV twice and waited over 30 mintues on the phone for this information because I could not find it online...lol.  IF you call talk to the Special Plates Department.  Their number for the Las Vegas area is 702-486-4368 and them wait for the options and press 2, 1, and then 5.  That should get you to Special Plates.

Online you go to the Nevada DMV page for handicap plates.  Download form SP27 Applications for Disabled Persons License Plates/Placards. Once have the form you fill it out for the child you want the plate for by putting their name and address on the form. The Nevada Driver's License or Identification Number you leave blank.  For Signature of the Applicant the parent signs the form and puts in parentheses minor child.  This lets the DMV know the child will not be on the registration of the car nor have a driver's license number.   Just have the doctor fill out the medical portion and you are all done!  I just saved you at least 10 minutes on the phone.  : )

While I was at the doctor's office the doctor mentioned getting the kids vaccinated for the flu. I just brushed it off.  He is right though in one thing.  I LOVE the kids pediatrician and he is a VERY cool doctor but he is in a VERY busy practice and he mentioned that over the winter he sees a lot of super sick children.  Just taking them to the doctor's office  during the winter would be putting them at risk of catching something. It makes me worried.  I worry EVERY winter about the children and in particular Joseph.

Speaking of vaccines there is a great article by Marcella Piper-Terry saying vaccines do not cause autism.  At first I thought, "What?!?!" Then I read the article and it all made sense.  Basically the article states that vaccines do not cause autism but a host of other illnesses and conditions that are the underlying conditions of autism.  Really great read!  Then another great article by Moises Velasquez-Manoff was published in the New York Times Opinion Section called An Immune Disorder at the Root of Autism.  The article has some sad information talking about the immune system of the mother attacks the child in the womb.  Autoimmune disorders significantly increase the chances of having a child diagnosed with autism.

Blog to mention is the Naked Kitchen.  Like Jamie Oliver's Food Network show Naked Chef the blog is about keeping food whole and simple.  It is a great blog with LOTS of good and healthy recipes!  Speaking of recipes I came across a great little recipe for making pizza dough.  SUPER simple and I am looking forward to trying this!

Two Ingredient Pizza Dough

• 1 cup Self Rising Flour
• 1 cup of Greek or natural yogurt

In a bowl combine flour and yogurt.  Stir until it forms a ball (might be a good job for a heavy duty mixer). Remove dough and turn out onto FLOURED board.  Knead dough for at least 5 to 8 minutes until the dough is nice and pliable and stretchy.

And people wonder why I cannot get anything done...

I am not sure if any of you realize, in a moment of infinite wisdom, I decided to attend graduate school. This decision came out of the need for money along with the desire to complete the master's degree I started in 2003 but did not finish. So Monday I started by reading the class material. My new class started October 3rd, Landscape Ecology and Planning, sounds like fun huh?

On Monday I also made several phone calls trying to follow up with things. Heck, I just remembered I still need to work on getting Joseph a wheelchair and fight Medicaid trying to convince them I need help with the children since Margaret and Joseph seem to have NO safety awareness skills. I am also been pulling out clothes to try and consign them.

There is a major consignment sale in Las Vegas called As They Grow (http://astheygrowlv.com/) and for the last two sales I have spent a lot of money but was able to buy entire winter wardrobes of clothes for the three children and toys. For the past week my house has looked like a clothes bomb went off in my kitchen and living room. The only good news from all that is I have realized that Joseph has SOOOO many clothes he does not need a thing but shoes. James has a lot of clothes too. Just a few size 4T shirts and pants. He fits snug in 3T now and I would hate for him to grow on me over the winter and then I would not be able to find him warm clothes. Margaret is really the only one in DIRE need of clothes. When the weather turned cool here I had to dress her in boy's clothes because she did not have any warm clothes to wear.

Then I have been dealing with the school district. I COMPLETELY spaced out on the fact I would have to have the shot records for the children to enroll into school even though they are in a homebound education program.

I have been working SO hard on the consignment sale (did my volunteer shift today from 9am to 1pm) to tag clothes that my carpel tunnel is acting up and KILLING me. Got to get home and work on it more though. John was suppose to tag stuff for me today and I was suppose to get the day out but that is not how things are going to work out.

Oh, and my cool new phone died. My LG phone that was my birthday present died. The touch screen is acting up and of course it is 10 days after the warranty date so the $200 John was kind enough to spend getting me my cool birthday present is no good. :( I am SO sad because I LOVED the phone.

I also cannot get into my online school right now to do my forum posts. I had set the time aside but the school's computer system is acting up and I cannot get in. John, I just noticed messaged me on FB saying he has a massive headache and is throwing up. Now I get to go home, deal with John, take care of the children, finish getting my consignment stuff on hangers and input into the computer tonight before 10pm when the computer system closes and keep trying my school to see if I can get in and post my four forum post responses. Wait, I forgot about cleaning the house especially the kitchen! I doubt the cleaning fairy has come over since John is sick. What is worse is I know I am forgetting at least two other things. Sigh! I am just tired thinking about it.

One final thing while I am remembering...please click on the ad box to the left (AdSense) if you see anything of interest. This is how I am trying to raise more money for Joseph's Cause. If you can please donate to his cause and feel free to share his story. There is more to tell on that one but in another post. :)