Comprehension And Cognitive Processing

Phil,
Your question is a familair one, one I have asked hundreds of times myself. Apart from the , “Slow things down” and requesting that all “imlied” info be spelled out in black and white, i havent found any answers, I will watch for replies to your question, as i need help in this same area. My son has central auditory processing disorder. He is in 8th grade.

It doesn’t just “go away”. I used to think that once my child was reading at grade level that she would be fine. Oh boy was I wrong, and now that I am becoming an SLP I have seen more and more of this “phenomemon” in kids with language impairments. One can’t make up for all the lost vocabulary a child misses when they have an auditory processing problem. It is very labor intensive to help a child visualize and understand vocabulary as you have discovered. Picking up inference and jokes is really hard for kids with auditory processing and language impairments . What you have to do is to tie in the new vocabulary to something she already knows. A good program to use would be Visualizing and Verbalizing by Lindamood-Bell and the SRA Specific Skills series by Richard Boning.

She has to be taught specific skills and a Speech and Language pathologist can help this child. One other thing, her comprehension will only rise to the level of vocabulary that she has. So if she doesnt’ have the vocabulary and fluent reading she won’t have comprehension.

what would help this child most would be a cognitive training program, PACE (Processing and Cognitive Enhancement) works on all of the issues you mention, but the program is expensive. An inexpensive alternative is Audiblox (http://www.audiblox2000.com), which is not nearly as comprehensive or intensive as PACE, but can still produce significant improvements. Neither of these programs is typically provided in school. Usually parents have to pursue these therapies on their own.

If you think of development as a pyramid, sensory/motor development precedes cognitive skills acquisition, and cognitive skills underlie the ability to learn academics. The auditory and vision issues were most likely remediated on the sensory/motor level of development only. Because sensory/motor development provides the foundation for cognitive skills development, remediation on the sensory/motor level should be followed by remediation on the cognitive skills level. This is done by means of cognitive training. It may not fully remediate everything, but it can make a tremendous difference in quality of life. PACE, in particular, is good at developing speed of processing, which seems to be a major problem for this student.

Mary

Ditto to everything Pattim said.

Most LD students have trouble organizing. All the ideas they need may be in their heads, but they can’t pull them together. Whereas, non-LD people naturally come by the skill of mentally organizing and visualizing things so that they can use them, LD people need to be taught methods of organization as a specific skill. A good, experienced tutor can help.

Also, by the time an LD student has reached 4th grade, he/she has usually had a few bad experiences with learning. Some anxiety is usually present when they are working, and can cause the brain to shut down some of its higher-level functions. It may help the child to learn to relax, so that the anxiety isn’t interfering so much.

Carol

At the risk of being a bit bold, I would suggest that these kinds of issues seem to appear in two sorts of cases, at least in my experience. 1) Students who have low average or borderline ability, and 2) Students who have something on the order of a nonverbal LD. However, in one study of nonverbal LD that I read EVERY student in the experimental group with NLD also manifested ADHD behaviors. The third kind of student I forgot to mention that seems to fit this profile is a high functioning autistic child (poor reasoning skills, good decoding and spelling, factual information).

These are cognitive functioning issues. I don’t know how to REMEDIATE weak cognitive skills. I have tried to teach “thinking” skills to similar students, with varying success. The rest of the child’s profile seems to very much effect what to do and how successful you may be.

Doesn’t Lindamood’s visualizing and verbalizing explicitly target the the child with good decoding and poor reading comprehension?

Guess I am just wondering about whether these skills can be taught.

Have you tried any non-educational interventions?

You might try removing all dairy from your child’s diet and see if that brings any improvement.

How will eliminating Dairy help? We did stop the red food die and lowered the sugar.

We did LMB for 12 weeks. It helped some for reading…but we had better results with PACE and Interactive Metronome.

PACE was effective in speeding up the processing of homework and learning. It did not resolve comprehension issues.
LMB was good for reading/decoding but did not resolve comprehension issues.
FFW was good for auditory processing but again…did not resolve comprehension issues.

I also see lingering fine motor skill issues….hand writing is still larger style letters and rough…as well as slow. She takes longer than peers to write down or copy from the board…as well as to produce a document.

I am not sure how to connect all the dots….to resolve the comprehension issues and the speed/effort required for the student to comprehend.

Did you do Visualizing and verbalizing as part of that package?

I haven’t done it but have their brochure which focuses on comprehension as opposed to decoding with LIPS and Seeing stars.

Also, McGuinesses have a book called How to increase your child’s verbal intelligence—the Language Wise method. One of the exercises, for example, helps teach how to figure out meaning in context which would help with comprehension.

My 5th grade NLD son has similar issues. The trouble is, how do you slow things dwon enough that a.) they get it, and b.) they’re not totally stressed out over school, and still keep them from slipping behind?

My gut feeling for my son is that even though he’s very bright, he is NOT going to be able to handle the same volume of work and pace of presentation as the average kid. There’s nothing we haven’t been able to teach him, but it’s at his own, slow pace. The school, however wants to keep pushing, to “get him ready” for the damands of higher grades. How do you find the balance? Is it possible to find the balance?

Is it realistic to try to fit a kid like this into the typical 12 year educational mold and expect them to survive emotionally?

Gee, looks like I posted more questions than answers!

Karen

Karen,

I wonder if a program like PACE or Brainskills or Audioblox would help your son. We’ve done PACE and I have seen improvement in my son’s processing. He does things faster and can handle more. Also, he has really improved some of his visual processing (still can’t see three dimensionally though). Both PACE and Brainskills (parent version) use visual thinking cards and my son is faster than I at some of them.

I certainly wouldn’t do anything during the school year but it is just a thought. PACE has stats showing quite an impact on performance side of IQ (TONI test, I think).

Like kids with NVLD, my son has a much lower performance IQ than verbal, although it is not as pronounced as it was when he was younger.

Beth

I’ve considered a program like that. It’s just that we’ve seen that the more pressure he’s under, the slower he works. I’ve been hesitant to commit either our money or his energy reserves to a program that I’m not sure will help, and I AM sure he will look on as just another way of torturing him.

The trouble with most of these programs is that I’ve heard some people rave about the results they’ve seen, and other people say that they didn’t think it was worth the money or the time. It’s SO hard deciding which programs will really be worth it with which kid.

He had to do OT this summer, much against his wishes. The only thing that kept him going in a fairly good frame of mind was the promise of a Game Boy Advanced if he did the OT program with a good attitude! PArt of the problem is an NLD thing, in that he doesn’t recognise that he HAS problems, so doesn’t see any reason to try to improve anything.

How old was your child when you did PACE?

Karen

Karen,

My son is just 8. I got trained in PACE myself with the idea that I could do more when he was a bit older because he is on the young side for the program. I choose PaCE over Brainskills because my son has documented problems on the sensory level and PACE had more of those types of procedures.

We did PACE this past summer because I was hoping to a)speed up and improve his visual processing b) improve his auditory processing. We saw improvements but not to age level in many areas. For example, he improved a lot with directionality but still is not to age level. We stopped doing all but the auditory processing part, which he desp. needs with his CAPD, about two weeks ago. We started in the summer and doing it all became too much when school started, especially since we are still doing Neuronet as well. I plan on returning to the non AP part of PACE next summer.

When I was trained in PaCE we observed a session and frankly I suspect the usual protocol would be too high pressured for your son. I haven’t pushed my son a lot, which I think has precluded some attention gains that are normally received through the program. The reason for the pressure is to get gains in concentration. I would think about doing something you could do yourself so you could do it at a pace that would work for your son. You might think about Brainskills in the summer. Audioblox is good, I hear, but I think it takes much longer for results. People seem to do it for 1/2 hour a day for 6 months to a year and that doesn’t seem feasible from your description.

I doubt that one of these programs would be a magic cure for your son. But maybe they could help reduce his deficits and make life a bit easier for him.

We have bribed our son to do first Fast Forward and then PACE. Right now he is working on earning a speedometer for his bike. My son knows he has problems but that doesn’t make him prefer working to playing.

Beth

Many people have digestive dysfunction which is the result of subtle, low-grade toxic metal poisoning, specifically lead and mercury. A recent study publishe in 1999 found 75% of teh LD children studied (out of a total population of approx. 100,000 children) had elevated lead levels. And nearly all children have had exposure to mercury from the mother’s amalgam fillings, their own fillings, and from the thimerosal in vaccinations. Neither of these two metals have been adequately studied for bolus exposire or chronic low-grade exposure, although both are known to cause cognitive impairment and neurological damage in acute poisoning. Lead is especially prevalent in autistic and MR children, and mercury has been implicated in autistic, ADD/ADHD and dyslexic children.

Exposure to these metals damages the intestine, pancreas and kidneys in addition to the neurological issues. The effect has been called the “leaky gut syndrome” (LGS). The pancreas fails to produce the digestive enzymes needed to break down proteins properl, and at the same time the metals create small perforations in the lining of the intestine. The HCl of the stomach is only able to partially digest proteins, and the peptides created have radically different properties from the amino acids that a normally functioning gut breaks the proteins into. The peptides formed from casein (dairy) and gluten (wheat) are small enough to enter the bloodstream thru the perforations in the intestine.

Two specific peptides, gluteomorphin and caseinmorphin have properties similar to opiates, including reducing sensitivity to pain, sensory integration dysfunction, and mild hallucinogenic propertis. Other peptides cause other problems, including beta-casein 7 which has been demonstrated to induce stimming behavior when tested on rats.

If this is a factor in this case, you will actually need to eliminate all gluten as well as all dairy, but going strictly gfcf is very, very difficult. Casein however is the mroe immediate of the two proteins, and the easier of the two to eliminate, so it is suggested that you first try removing the dairy and seeing if it gives any improvement. If it does, then you may go full gfcf and see what that brings. See www.gfcfdiet.com It is estimated that between 1/3 and 1/2 of autistic children have this problem as an aggravating factor to their condition.

Recently Repligen identified two commonly known biomnarkers which would indicate LGS while conducting their phase 2 secretin trials. See www.repligen.com One shows the pancreas is failing to produce the enzyme needed to digest proteins, the other indicates chronic infection of the intestinal track, which is very common to children with ASD.

Red food dye is a phenol, and is also a very common problem with many LD children, especially those with ADD/ADHD and autism. However it is only one of the phenols, and in order to see if phenols are an aggravating factor for sure you will need to eliminate all phenols. See www.feingold.org

Good luck to you!

I think I would backtrack and work on vestibular development. There is a lot of information about how auditory problems can interfere with vestibular development, and how this in turn interferes with the ability to learn, at http://www.neuroacoustics.com. I’d seriously consider doing either NeuroNet or Balametrics, and I’d consider Interactive Metronome also.

I’d also spend a lot of time on SET, the Rush Hour game, pattern blocks, attribute blocks, the games in “How To Improve Your Child’s Verbal Intelligence”, etc. Some of the pattern exercises in Audiblox might be helpful too.

Vestibular development might be the connect-the-dots piece you are looking for. It would tie together the problems with slowness, fine motor skills, and comprehension. Somewhere there is a genetic and/or neurological ceiling on how far reasoning and comprehension can be developed. Still……

Mary

Thanks for your input. It _is_ something that I toss back and forth. But as you know, it’s so hard to decide what to do and how much. Right now, I don’t think I could load another thing on his plate, and when sometimes things get a little better for a few months, it’s such a relief that I feel like we both need a break from the torture!

They are going to start pulling him out to work on inferential comprehension, and they are pulling him during “health” which he hates anyway. I thought he’d be thrilled to get out of health, but he’s resisting even this! He’s just in one of those periods where he’s so backed into a corner that he fights back without even relaizing that this is a GOOD thing.

Karen

Our kids just don’t want to be different and you can’t blame them. I suspect that is what is behind his resistance to leave health.

McGuinesses How to Increase your Child’s Verbal Intelligence has lots of game like exercises that work on comprehension and inference that you might find helpful—in all your spare time!!! We haven’t done it yet–but it is in my game plan.

Also, you might try the games SET and Rush Hour for visual perception and reasoning work. Set works on pattern recognition and reasoning (it is incorporated into PACE) and Rush hour is visual spatial and reasoning. In rush hour, you try to figure out how to move the cars so you can get yours out. My son actually likes both of these. We didn’t play Set competitively—just took turns finding sets.

I also did Visual Percetual Skill Buidling from Critical Thinking Books with him. These are OT type visual exercises working on visual perception. He didn’t mind them but they are not like a game. (am I right that NVLD as a strong visual component)

BTW, I am still waiting for those “couple months when everything goes smoothly” so you aren’t doing badly!!! Our journey is still up and down on an almost constant basis.

>>McGuinesses How to Increase your Child’s Verbal Intelligence has lots of game like exercises that work on comprehension and inference that you might find helpful<<

Is that a book?

>>Also, you might try the games SET and Rush Hour for visual perception and reasoning work. Set works on pattern recognition and reasoning (it is incorporated into PACE) and Rush hour is visual spatial and reasoning. In rush hour, you try to figure out how to move the cars so you can get yours out. My son actually likes both of these. We didn’t play Set competitively—just took turns finding sets. <<

Are these part of the PACE program or can you get them separately? We do try to work on things that improve his visual-spatial skills, and he is in a therapy group where he works on visual-motor skills, social skills and problem solving in the context of cooperative physical games. (he doesn’t even know it’s “therapy”, so it works great!)

I’m a strong believer in life experience type learning, so we just keep throwing things at him and watching what sticks. He seems to learn better when we can grab his interest with something “real” rather than something that seems too much like a set exercize. For instance, he really, really wanted a hedgehog, and we told him that if he saved the money for the animal, we’d buy the cage and supplies for him as a birthday present. The catch was that a hedgehog costs about $125, quite a bit of money for a 10 year old!!!

So my husband taught him to mow the lawn with our garden tractor as a way of earning the money he needed. We have over 5 acres, so there’s a lot of mowing. He needed a lot of close supervision, of course, but his steering definitely improved with practice and there were less and less un-cut strips on the lawn.

He finally saved up the money, and we bought the hedgie a couple of weeks ago. Now he and my husband are designing a big “playground” for her made out of plastic stroage boxes and PVC pipe. Robbie had to draw out his design, and figure out how many boxes he needed, and how may PVC elbows and T junctions we needed to put it all together. If you’d given him a task like this with no intrinsic motivation, he would have shut down without even trying. But because it was to build something HE wanted, he worked really hard on it, and with a little guidance from us, came up with a workable design. They’re going to build it together this weekend.

I hear you re: the couple of smooth months thing… I was talking about the summer. Actually, he had a really, really good school year last year, but he had one of those incredibly gifted teachers who seems to instinctively know just when to back off, and just when they need a little push. His SPED teacher was just as good. But even with a great team, I don’t know how we could have added extra school type stuff on, he was just too exhausted, both mentally and emotionally at the end of the day.

This year we’re off to a really rocky start. He’s not handling the school work and homework load as it is… There isn’t an extra 5 minutes we could cram any more work into. I don’t think he’s turned the TV on once since school started.

Karen

Yes, “How To Increase Your Child’s Verbal Intelligence” is a book by Carmen & Geoffrey McGuiness. Well worth reading, and lots of games in it. I have seen it in several bookstores, and it’s probably at Amazon.

SET and Rush Hour are both games that are widely available. I have seen Rush Hour in quite a few different stories — probably available at Toys R Us. Both are available from Rainbow Resource. If you go to http://www.rainbowresource.com, email them for their printed catalog (will come with your order, if you order SET or Rush Hour from them). The catalog is a wonderful resource and includes good descriptions of the many different items (their online catalog does not include descriptions).

If you use SET, be sure to start with just one color at first, to simplify.

Rush Hour has different versions (the only difference is the theme) — cars, trucks, trains, safari animals, etc. My daughter likes the original version of cars the best. The game comes with a set of puzzle cards. You can buy extension sets of these cards also, to provide additional puzzles and to increase the difficulty. I would recommend starting with just the cards that come with the set. You can always add on later.

Mary

A hedgehog!!! Oh, my son would love that. And five acres, he’d love that too. We have a small yard and he constantly complains about it. I think you are right about the motivation part too. The best thing my son has going for him is that he is interested in so many things. He loves to have us read him his science and social studies books and asks a ton of questions. Now, he doesn’t like it quite so well when he has to read it….but it is above his comfortable reading level. Still, he is interested in the material and wants to understand things.

“How to Increase you r Verbal Intelligence” is a book by Carmen and Geogrey McGuinesss which has a bunch of exercises in it, in addition to a big discussion of how this is actually possible. I plan on eventually using it with my son. I know that Shay, who posts on the reading bulletin board uses it very successfully, along with Lindamood’s visualizing and verbalizing, in the classroom.

I bought SET at an upscale children’s store. PACE uses it but I had it already. We settled into a turn taking mode rather than competitive one and it seemed to work well. Rush Hour I got from Rainbow Resource Center. Their website is www.rainbowresource.com and the phone number is 1-888-841-3456. (I just looked and they have SET too). Their online catalogue is very limited but there regular one is wonderful. Ask for it, if you decide to order. The game is really fun—my 10 year old daughter and I got into a competition over who could do the most difficult cards. Nathan liked it too—we haven’t done it since starting PACE.

My son has a great teacher this year. Must have been all the whining I did last year!!! It still is up and down. He can do reading in the lowest reading group when a year ago he couldn’t read at all. On the other hand, he requires one-on -one instruction for all directions. He has moved out of resource room for math but we’re having to teach him to number a page and transfer his math answers to the right place……It all takes so much time. He is my second child and I realize how much I just took for granted with the first.

Thanks! It sounds like those could be fun to do with both of the kids so that Robbie doesn’t feel like it’s something we’re doing “to” him, yet again!

Karen

Thanks for the pointers on where to find the games. I’ll definitely look into them. As with so many NLD kids, Robbie’s verbal IQ score is very high. It’s the performance IQ score that is depressed. He reads (decodes) very well. He has no problem with adult books. And he has no trouble comprehending factual information that he reads. His downfall, again pretty typical for NLD kids, is inferential comprehension and problem solving.

The hedgehog is absolutely adorable… we’ve all fallen for her. As for the 5 acres, that’s one place that my son is COMPLETELY normal. He doesn’t appreciate it at all, because he’s always had it. He complains that we don’t live on a cul-de-sac with lots of neighbors instead of a horse farm.

I’m crossing my fingers on this year’s teachers. Last year we had such a great teacher that these two have a tough act to follow. They do seem to be willing to work with us though, so hopefully we’ll get him settled in before too long.

Karen