Auditory and visual working memory

PACE is the best program I have found for improving working memory (both auditory and visual). Website is http://www.learningskills.com It is suitable only for someone who in general functions on about a 6yo level or better, and is best done after any sensory level deficits have been reduced as much as possible.

Nancy

rocco, I don’t know what your child’s actual diagnoses is but my 7 yr old daughter has severe working memory issues. However, her diagnoses is ad/hd inattentive with primary area of concern being temporal working memory. I suspect that the actual diagnoses depends on the doctor. Anyway, it may not be an option for you or even applicable but medication has given my daughter her memory back.

Memory is something I am trying to understand better myself. My son has superior auditory memory (when he’s paying attention!) and yet is slow to respond to verbal directions. his visual memory is weak. We just finished vision therapy, and its still a weakness. Anyone with ideas on how to improve visual memory without it seeming like more therapy? games? computer games?

Nancy,

I am seeing quite a few negative comments about PACE on this board and on others. There are those who say it was ineffective for them, and they cite the lack of empirical evidence to support it. Have you personally used it? What success did you have with it?

Can you direct me to the posts? I have seen only two cases on this board in which PACE was ineffective. In one, it seems probable that the underlying problems were neurological in nature, and in the other the program was probably started while the child was still too young.

PACE is a cognitive skills training program. Its effect is limited by any sensory level deficits that have not been remediated. These include visual efficiency problems, auditory processing problems, and sensory integration problems. In my experience, sensory integration problems are the most likely to limit gains from PACE, although the others can certainly have an impact also. Gains from PACE range from mild to dramatic, depending on exactly what underlying problems a child brings to the program.

I am trained in PACE and have put a number of children through it. The most dramatic gains were made by children (such as dyslexics) who seem intelligent but somehow don’t perform well academically. However, even my most severely affected student (IQ of 70, severe sensory integration disorder) made significant gains — in that case, a 2-year gain in working memory and a 1-year gain in visual processing. These gains clearly transferred to academics, as she was then able to get past the 2nd grade reading level where she had been stuck for a couple of years. I have had no complete failures with PACE, but admittedly my experience is limited. Sometimes the gains have not been as dramatic as parents (and I) would have liked, but there were still clear and significant gains.

Very, very few programs developed within the last 20 years have had independent research conducted on them to determine effectiveness. Funds are simply not commonly available for this kind of research. If you hear of an independent research study, I guarantee that the developers of PACE would be delighted to have the program included. Meanwhile, all they can afford to do is to continue to collect data from their providers.

Probably the best that a parent can do is to study up on the programs available for cognitive training in order to determine if it is likely to be a good match for a child. In addition to PACE, there is Audiblox (a good home program) and Instrumental Enrichment (developed in Israel by Feuerstein, considered to be the father of cognitive training). The others are good programs also, although each has a different emphasis and delivery profile. Anyone hesitant about PACE can give Audiblox a try, as it is much less expensive and can be done at home. Since I am aware of which exercises are in each program, I still have to go with PACE as being the most effective for working memory.

Nancy

I am one for whom PACE was not successful. My son was 7 at the time. He may have been too young, as Nancy suggests. More importantly, I think, is that PACE is a cognitive program and his issues seem to be more sensory in nature. We had, however, done a lot of sensory therapy already—completed Fast Forward, eye therapy, and six months of Neuronet.

PACE mostly showed me where my son’s deficits were and we returned to doing Neuronet afterwards. Neuronet has been, for us, much more successful at remediating working memory. He is not the same child neurologically as he was before. He is now 10. (This is not to say he is not still LD—he is.)

I also have a good friend whose daughter did PACE and MTC at age 11 with very good results (especially with reading—went from fourth grade level to 10th grade in two years). However, working memory, despite much dilegence, did not improve very much. A friend of hers with LD children of her own, learning of our success with Neuronet, came to Florida for training. My friend’s daughter worked with her and made substantial progress with working memory in a short time.

I think memory is very complicated and our success or anyone else’s success is not necessarily duplicatable. I also think it is often very difficult to determine ahead of time whether or not there are unresolved sensory issues that might impede progress of a cognitive program. I was aware that sensory issues could impact progress with PACE but everyone (myself, and therapists he had worked with) misjudged him. The same symptoms can have different causes—and addressing the root cause is the challenge I think. I found it fascinating, for example, that medication for ADHD can impact memory.

The other child that I think Nancy is referring to has Rapid Automatic Naming issues which impede reading. My son did too and PACE had no impact on that for him either. My son’s RAN issues were later resolved by a combination of Neuronet and Interactive Metronome.

However, to give some balance, I did PACE because another friend’s daughter, age 9, had so much success with it. She had developmental vision delays (as has my son) but unlike my son, they were not tied to the vestibular system. A combination of vision therapy and PACE did marvelous things for this child. I had hoped to duplicate her experience but found that my child’s issues were far more complicated.

Beth

Nancy,

My ds9 is diagnosed with ADHD/LD. He is in the 2nd grade, but struggling with reading. His neuropsych eval highlighted several problems, but the working memory is the most significant. As an example, if you read him three words and ask him which two rhyme, he has difficulty if the first word is one of answers because he can’t hold it in his memory.

We have worked on sensory integrations issues for several years, although some problems remain they do not have a significant impact on his motor skills. He plays baseball and basketball well, is a bike riding wiz, and can rollerblade on half pipes at the skate park. Fine motor skills are low average however.

Our biggest issue is that he is resistant to academics and remediation activities. We reinforce him like crazy, but he would rather avoid all activities that appear to be “learning” things. Obviously this stuff is hard for him and he’d rather not do it. This summer we are going to be doing some intensive Lindabell Mood for the reading issues.

My questions for you are:

Is this only done with a provider or can a parent do this at home? We don’t live in an area with a provider.

Is it interesting or mildly entertaining at any level? Or more specifically, would a 9 y/o boy think so??

Would he find it frustrating, or is it very gradable for different skill levels?

What kind of time commitment is there on a daily basis, and for how long does a child usually work on this program?

Thanks for taking the time to help me sort this out.

Rocco,

I understand where you are coming from. My son is 10, dyslexic with attentional issues.

The one program we did that made an observable difference in his reading was Lindamood Bell. We recently put him in an LD school, but if that wasn’t an option we were going to do LMB for the whole summer.

Here’s the thing, it worked b/c it was intensive. He went to their center 4 hours a day for 4 weeks. The way they arrange it at a center is that they have multiple teachers. Each teacher works with a child privately for 1 hour. Then they switch. This keeps everyone from getting burnt out. The kids all take snack/meal breaks together. This gave my son a sense that he wasn’t in it alone.

The actual instructin is very formulaic and boilerplate. In other words, any reasonably intelligent person trained in their methodology can do it. In our case the center was full of young recent college grads, something my son liked because they were more like camp counselors than “tutors”.

Whether you can implement it with the same intensity at home is another question.

I don’t think LMB is magic - honestly I think any good intervention (orton gillingham based tutoring, LMB, et al…) delivered in such an intensive manner can produce results.

Hope that helped!

Yes, that was helpful KarenN. We are doing LindabellMood this summer, and it is good to have that decision confirmed. We will be doing 2 hours a day for several months. There is not a center anywhere near where we live, but I have found someone who worked at at center in Florida for 3 years before moving here to get her PhD in Psychology. She is in school now and is going to tutor my son over the summer. Thanks for the input.

Rocco,

Could you do Interactive Metronome first? The reason I mention IM is that it has a very good track record with ADD/ADHD boys in terms of developing attention skills. Also, it is highly likely to help with the fine motor skills. Your son also might be encouraged to do it because it is considered a sports program. Many athletes use it to hone their skills. A good provider is able to motivate the child and get him through the program. There are home kits available now, but this would be a very tough program to do at home by yourself with a resistant 9yo, in my opinion. IM often makes a very good precursor to PACE. (Website is http://www.interactivemetronome.com )

There is a home version of PACE called BrainSkills. However, with the type of child you are describing, you would again be better off working with an experienced provider. The program is set up to be as much fun as possible, with a wide variety of exercises to keep the child engaged, but the child *must* put in time working on the exercises. PACE providers are trained to be cheerleaders and motivators for the program, and know how to modify exercises to suit an individual child’s needs.

All of the cognitive training programs — PACE, BrainSkills, Audiblox, TurboTutor — require somewhere in the neighborhood of 40 to 60 hours of training before significant gains are seen. With a cooperative child, a parent can easily do BrainSkills or Audiblox at home. However, it can be difficult to get a resistant child past that 40-hour or 60-hour hump. At that point most children become more cooperative, because they begin to see the results of their work. However, Audiblox and BrainSkills can get tedious long before optimal results are achieved, because they have much less variety in the exercises than does PACE.

The minimum amount of time required to get a training effect from Audiblox or BrainSkills is about 1/2-hour per day 5 days a week, and the child *must* be engaged during that time (not sulking or daydreaming). The minimum number of hours for optimal gains is probably the 72 hours of PACE (36 hours of training with the provider and an equal amount of training done at home), although many children will continue to make gains with additional training hours. Audiblox is usually done for a year. Audiblox and BrainSkills tend to be not as efficient as PACE, so as a general rule you would probably double the number of hours for these programs to achieve optimal gains (144 hours). Of course, all of these are estimates, but they’re fairly good ones.

Are you familiar with the Sound Reading CD for teens? This is a computer CD that costs about $60. I have had really good results with it and I would recommend it for your son. He could do it independently, and spend perhaps 15 minutes twice a day on it (average completion time is 14 hours). The teen CD is the same as the elementary CD, but without the cute graphics that appeal to the younger set. (Of course, if your son likes cute graphics, then you could get the elementary version.) Most children don’t have a problem working with this CD, and you might be surprised by the progress he makes. Website is http://www.soundreading.com . (I don’t care for the other reading materials on the website. My preference for a reading program is Phono-Graphix, with LMB as a fall-back if PG doesn’t work. I prefer to try PG first because it is much faster than LMB.)

Well, I didn’t mean to write this much and hope it is mostly coherent. Also hope it helps some in terms of information.

Nancy

Nancy, Thanks for the informative post. I have an OT friend who does IM, and has seen my son for SI therapy. Her concern is that he would find it too frustrating now if he can’t master it quickly. But maybe we should just do a few trial sessions to see if he could handle it. I will check out the Sound REading site also. There is not a PACE provider in my area; it would be a 3-4 hour drive to the nearest provider, so the home version would be my only option now. It is so tough to have the problems of inattention, LD, and opposition; Even though I get frustrated with it, it’s got to be so much more difficult on him. So guess I’ll keep searching for the one thing that will work….

I have a local friend who did PACE. From her experience it did help her daughter tremendously, but she said that over time her daughter lost these gains. She believes that if she had continued working with her after finishing the program, her daughter would have maintained and possibly built up the skills.

This, of course, is just one person. I believe her daughter’s problems were primarily attention and math. She did mention some reading problems, but according to her reading wasn’t as big an issue.

My personal exerperience is LMB is wonderful. I too have had to keep up with it beyond the time my son spent at their clinic (5 hrs a day at the clinic! I now only do an hour a day of SS at home with him after school— along with an hour of reading a day!). I “push” my son to visualize letters and am “forcing” him to do lots and lots of multisyllable decoding. He’s in 4th grade and I make him read my daughter’s 8th grade science text book for decoding practice. It seems like every day he’s slowly getting better at reading, particularly multisyllable words. It’s kind of hard to believe, but now I have him working on words like “electromagnetic.” That wasn’t easy for him! We had to stop, airwrite, visualize, etc… Also, verbally it was a hard word for him. But he has really made a lot of progress. At the beginning of this school year I never thought I’d get him beyond “Henry and Mudge” books!

Laura,

Have you considered using Rewards from Sopris West for development of multi-syllable word attack skills? Sounds ideal for where your son is. It’s very easy for a parent to just pick up and start the lessons, as it is entirely scripted. Website is http://www.sopriswest.com/rewards/ It has a good fluency component too, in the last eight lessons, although the text would be very challenging for a 4th grader.

Nancy

Hi Nancy,
I’ve thought about it, but I’m worried I may not have enough time. Do you know the time frame needed for implementing Rewards? If I were homeschooling this would be much easier. Also, I really want to do VV and OCN with my son (even though LMB’s testing didn’t show a need for these programs I think they’d be very helpful). Right now I’m reading the VV manual and coloring photocopied pictures —and hoping somehow I can fit this into our busy schedule!

Well, Rewards is very flexible.

The first 12 lessons (there are 20) take 40-55 minutes each if you are working one-on-one. Starting with lesson #13, each lesson takes closer to one hour and 15 minutes because of the addition of repeated readings of text (pretty difficult text, incidentally). At that point it can be nice to break each lesson into two sessions.

It is not an intensive program, so you can do as little as one lesson per week. Classroom teachers have reported significant improvements even when the lessons are presented only sporadically throughout a year. However, I would recommend two lessons per week (or more).

In terms of teacher prep time, there is none — except you need to read the introductory explanations in the teacher’s book. Basically, once you do that (don’t expect complete comprehension on your part, just an idea of what’s involved) you just sit down and go through the first lesson with your child. Every part of the lesson tells you exactly what to do and also exactly what to say. Much of it is question-answer, and the teacher’s manual gives you both. After a couple of lessons you feel very comfortable because each lesson follows the same format.

Ignore all the advice about hand signals. They are necessary only in classrooms. When you work one-on-one you don’t need hand signals.

I advise getting an easy-insert clear plastic page protector to place over the “overhead projector” pages in the teacher’s manual. Cut off the left side with the ring holes so the protector is easy to slide over the page you need. Then use a pen to make the marks you need on the plastic.

That’s about it. You don’t need the video, because it shows how to use the program in a classroom (hand signals again). However, it is rather nice to see someone actually doing the exercises, especially in terms of pacing.

If the fluency issues are severe, you might want to use Rewards in conjunction with other fluency programs such as Great Leaps, Quick Reads, or Vision Builder (depending on need). Also, be aware that the vocabulary and text readings in Rewards are quite advanced. If your child is younger than middle school level, you may want to stop after lesson #12 and wait for more language maturity before continuing.

Sounds as if your school schedule is heavy. In that case, I would plan on using Rewards over the summer. It makes a great at-home summer reading program.

Nancy