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Bright, Underachieving and Struggling: Understanding the Cognitive, Social and Emotional Landscape of Processing Deficits

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Sarah Wagner

on 7 October 2013

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Transcript of Bright, Underachieving and Struggling: Understanding the Cognitive, Social and Emotional Landscape of Processing Deficits

Bright, Underachieving and : Understanding the Cognitive, Social and Emotional Landscape of Processing Deficits
Why Processing Speed?
75-85% of students at Shortridge Academy demonstrate a relative weakness in processing speed
This pattern of relative weakness in processing speed compared to verbal intelligence has been found in only 21% of the general population (Donders, 1996).
Sarah Wagner, M.Ed.
Director of Academic Support, Shortridge Academy

Hannah Mariotti, LCMHC
Director of Sales and Marketing, Vive

Processing speed underlies other cognitive abilities:
working memory
executive functioing
integral to academic achievement

"...the speed of processing is critical because it determines in part how rapidly limited resources can be reallocated to other cognitive activities (Kail, 1991, p.152)."

Processing speed (PS) appears to have neurological basis:
Decreases in PS are associated with deterioration of white matter
Greater white matter volume positively correlated with faster information processing during adolescence
PS is lower in pre-term children compared to full-term children
Low PS found in Multiple Sclerosis patients
"Students with slow processing speed may have problems with rate of learning, comprehension of new information, speed of performance, and mental fatigue (Calhoun and Mayes, 2005, p.339)."

Lack of production - struggles with task-initiation and/or completion, does little homework
Slow to follow directions
Low motivation, especially for rote and/or repetitive tasks
Appears inattentive, lazy, oppositional
Impacts self-esteem and academic identity

Dimensions of slow processing:
Difficulty with activation
Trouble understanding symbols
Difficulty interpreting words
Memory difficulties
Trouble with expressive language
Difficulty with motor expression
"I have worked with dozens of students with testing reflecting low processing speeds, the majority of whom had tested with above average IQ scores. It seems to me that the low processing speed results in particularly negative experiences for these bright students...They have decided school is stupid. After all, they understand what's going on, they just can't succeed at the "game" of school. They are very confused about their own intelligence. They usually get that they are smart, they just don't understand why they can't seem to do anything with that intelligence. These students have often used drugs as a way of dumbing themselves and their friends down. Drugs and alcohol are a great leveler for them..."
-- John Burton, Math Teacher
What is Processing Speed?
Slow processing speed is correlated with a number of different disorders including:
ADHD
Depression
Emotional/Behavioral Disorders (EBD)
Learning Disorders
Substance abuse
Impulsivity
Anxiety?
What alternative interventions might improve processing speed?
Cognitive training programs involve structured, repetitive exercises, often on the computer, designed to improve attention, memory, concentration, speed of processing, inhibition and visual-motor coordination
Based on the concept of brain plasticity
Cognitve training has been found to be effective in children with traumatic brain injury, ADHD and dyslexia.
One study, using fMRI scans to examine the impact of cognitive training on neural mechanisms in young adults, found that processing speed improved
References
Fry, A. F., & Hale, S. (1996). Processing Speed, Working Memory and Fluid
Intelligence: Evidence for a Developmental Cascade. Psychological
Science (Wiley-Blackwell), 7(4), 237-241. Retrieved from EBSCOhost.
Gorlyn, M., Keilp, J. G., Oquendo, M. A., Burke, A. K., Sackeim, H. A., &
Mann, J. (2006). The WAIS-III and Major Depression: Absence of
VIQ/PIQ Differences. Journal of Clinical & Experimental
Neuropsychology, 28(7), 1145-1157.doi:10.1080/
13803390500246944
Kail, R. (1991). Development of processing speed in childhood and
adolescence. In R. Hayes (Ed.) Advances in Child Development and
Behavior, Volume 23, pp. 151–184.
Kail, R. V., & Ferrer, E. (2007). Processing Speed in Childhood and
Adolescence: Longitudinal Models for Examining Developmental
Change. Child Development, 78(6), 1760-1770. doi:10.1111/j.1467-
8624.2007.01088.x
Kesler, S. R., Lacayo N. J., & Jo, B. (2011). A pilot study of an online
cognitive rehabilitation program for executive function skills in children
with cancer-related brain injury. Brain Injury, 25(1), 101-112.
doi:10.3109/02699052.2010.536194
Learningrxcom. (2010). Increae Brain Power - How to work out your brain
and get smarter. Retrieved from www.youtube.com
Benner, G. J., Allor, J. H., & Mooney, P. (2008). An Investigation of the
Academic Processing Speed of Students with Emotional and Behavioral
Disorders Served in Public School Settings. Education & Treatment of
Children (West Virginia University Press), 307-332. Retrieved from
EBSCOhost.
Benner, G. J., Nelson, J., Allor, J. H., Mooney, P., & Dai, T. (2008).
Academic Processing Speed Mediates the Influence of Both
Externalizing Behavior and Language Skills on the Academic Skills of
Students with Emotional Disturbance. Journal of Behavioral Education,
17(1), 63-78. doi:10.1007/s10864-007-9057-7
Bracy, O. L., Oakes, A. L., Cooper, R. S., Watkins, D., Watkins, M., Brown, D.
E., & Jewell, C. (1999). The effects of cognitive rehabilitation therapy
techniques for enhancing the cognitive/intellectual functioning of
seventh and eighth grade children. Cognitive Technology, 4(1), 19-27.
Retrieved from http://www.challengingourminds.com/tour/
CognitiveTechnology.pdf
Calhoun, S. L., & Mayes, S. (2005). Processing speed in children with
clinical disorders. Psychology in the Schools, 42(4), 333-343.
doi:10.1002/pits.20067
Donders, J. (1996). Cluster subtypes in the WISC-III standardization
sample: Analysis of factor index scores. Psychological Assessment, 8(3),
312-318. doi:10.1037/1040-3590.8.3.312
Mayes, S., & Calhoun, S. L. (2007). Learning, Attention, Writing, and
Processing Speed in Typical Children and Children with ADHD, Autism,
Anxiety, Depression, and Oppositional-Defiant Disorder. Child
Neuropsychology, 13(6), 469-493. doi:10.1080/09297040601112773
Schrank, F. A., & Wendling, B. J. (2009). Educational interventions and
accommodations related to the Woodcock-Johnson® III Tests of Cognitive
Abilities and the Woodcock-Johnson III Diagnostic Supplement to the Tests
of Cognitive Abilities. Woodcock-Johnson III Assessment Service Bulletin No.
10. Rolling Meadows, IL: Riverside Publishing. Retrieved from
http://www.riversidepublishing.com/products/wjIIIComplete/pdf/
WJIII_ASB10.pdf
Takeuchi, H., Taki, Y., Hashizume, H., Sassa, Y., Nagase, T., Nouchi, R., &
Kawashima, R. (2011). Effects of Training of Processing Speed on Neural
Systems. Journal of Neuroscience, 31(34), 12148-12139.
What do you see in your setting?
How is Processing Speed Measured?

WISC-IV, WAIS-IV
Coding - transcribe a digit-symbol code
Symbol Search - students given rows of symbols and targed symbols, mark whether target symbol appears in each row
WJ-III Test of Cognitive Abilties
Visual Matching - student circles two identical numbers in each row of six numbers
Decision Speed - student tries to find the two pictures in each row that are most similar conceptually (e.g., sundial and stopwatch)
Measures visual-perceptual processing speed and visual-motor integration
Low WM and PSI scores may lead to lower FSIQ on WISC-IV than former tests

Cognitive Testing
Academic Testing
WJ-III, WIAT-III, KTEA-II
Reading Fluency - read simple sentences and respond to true/false statement
Writing Fluency - formulate and write simple sentences
Math fluency - solve single-digit addition, subtraction and multiplication calculations
Measures speed at which basic academic tasks are performed
What are the challenges related to slow processing?
Slow Processing in the Classroom
The Twice-Exceptional (2e) Student:
Gifted with learning differences
Slow processing speed often associated with giftedness

1. Identified gifted students who start to struggle in school, remain unrecognized until far behind
2. Identified LD students whose intellectual gifts go unrecognized
3. Students whose abilities and difficulties mask each other


School is particularly frustrating for 2e students
"You're so smart, why aren't you living up to your potential?"
They don't understand why they aren't performing
Need both intellectualy challenging content and support for learning difference
Social/Emotional/Behavioral Challenges
What strategies support students with processing challenges?
Teaching/Counseling Approach
Allow more time for students to respond
Frequent repetition of key concepts
Directions stated simply, few at a time
Break large tasks into smaller chunks
Utilize all pathways for learning - visual, auditory and kinesthetic
Demystification - help students understand their learning style, strengths and weaknesses
- explain test results
- administer self-assessments - Multiple Intlligence inventory, VARK, LASSI

Explore related emotional issues
- reflect on past experiences in school and how those impact present behavior and attitude toward school
- work through feelings of grief, shame and anger around their negative experiences in school
- address sense of identity and self-worth
Engaging and stimulating curriculum
Focus on higher order thinking - problem-solving, critical and analytical thinking
Depth over breadth
Allow for creative expression
Less emphasis on production
Alternative assessment

Accommodations/Modifications :
Extended time on tests/quizzes/assignments
Allow for oral responses vs. written
Copies of lecture notes
Written and oral directions
Use of technological supports: calculator, word processing, voice-recognition software, audio books
Reduce load on working memory - cheat sheets
Modify length of assignments
Choice in how students demonstrate knowledge
Classroom Strategies
Audio-Visual Stimulation
Interventions
General - Speed drills, repeated practice, computer games

Target the distinct dimensions
Activation
Cognitive - provide scaffolding for planning, breaking task down, use graphic organizers
Emotional - provide encouragement, help getting started
Focus/attention - Eliminate distractions, provide white noise, cue student, use incentives
Working memory - Provide templates, graphic organizers, cheat sheets, word banks, gentle reminders
Auditory processing - increase exposure and opportunties to explore and manipulate sounds, music, and language, utilize books on tape.
Visual processing - provide activities to develop discrimination of visual features, matching and recalling visual information, use language to describe visual information, teach private speech
Enhance Academic Skills
Reading fluency
Short, frequent periods of fluency practice, e.g. speed drills
Teach active reading
Read text multiple times
Read aloud (modeling)
Math fluency
Practice basic math facts to build automaticity
Timed drills
Computer games
Specific strategy instruction
Writing fluency
Short, daily, writing tasks, (e.g. journaling)
Utilize graphic organizers
Strategy instruction (e.g. SRSD - Self-regulated strategy development)
A skills-based approach
Build Executive Functioning Skills
Teach students to become metacognitive learners – think about how they think and learn
Use strategy reflection sheets
Daily 5-10 minutes strategy reflection discussions
Use peer tutoring to help students brainstorm about effective strategies
Use peer mentoring to help develop self-understanding, effort, persistence, resilience
Systematic, explicit strategy instruction:
Goal setting
Planning and prioritizing
Organizing
Remembering information
Self-monitoring, self-checking
Cognitive flexibility
Emotional regulation and inhibition
Self-Advocacy
Understand learning style
+
Know what strategies to utilize
+
Understand which accommodations/
modifications are useful
+
Sense of self-efficacy and empowerment
Cognitive Training

According to Kaufman (1994), the PSI is “related to clinical, personality, behavioral, and neurological variables” (p. 209).
Children with ADHD, LD, and autism score low on PSI relative to VCI.
Children who are neurotypical or who have mild mental retardation do not.
Neurological basis = PSI is negatively impacted by neurological variables
Research on PSI:
Children with Clinical Disorders
Impact on PSI

Children with depression?
Children with Oppositional Defiant Disorder (resistance and low motivation)? Can they be motivated?
Children with generalized anxiety disorders? Motivating or paralyzing?
Adding anxiety to other clinical disorders (e.g. ADHD) What happens to PSI?
ADHD vs. ADD? Both scored low on PSI relative to IQ.
PSI as a way to distinguish between ADHD and ADD (underarousal, low energy, lethargy).
Controversial issue – poorly understood relationship between depression and cognition.
Difficulties in concentrating can be a symptom of depression, and this may “masquerade” as other cognitive problems such as “variability in memory performance.”
Processing speed was found to be the cognitive function most often affected by depression
No clear link between other types of cognitive abilities like attention, etc.
Confounding factors: age and education variables, severity and duration of each depressive episode.
Depression and Cognitive Function

Children with ADHD have consistently been found to have increased slow wave Theta (4-7Hz) activity, and reduced fast wave Beta (16-20 Hz) activity in their EEG, when compared to age matched controls.
During Neurofeedback therapy, real-time QEEG is displayed on a computer in the form of a game, and the patient is given contingent audio-visual rewards for producing less Theta and more Beta waves.
Significant evidence in the literature, which suggest that most ADHD children can learn to produce a brainwave pattern with more normal theta/beta ratios.
Effective Treatment for about 80% of students with LD and ADHD
At least 60 studies corroborating this finding
Improvement in impulsivity, attention, response time and increase in IQ among other things.
Neurofeedback
Neurofeedback therapy vs. stimulant medication: Rossiter and La Vague compared the effects of Neurotherapy to stimulant medication in reducing ADHD symptoms. The study compared the effects of a medical treatment program to 20 sessions of Neurotherapy.
The Neurotherapy group of 23 subjects was matched with a stimulant group, also of 23 subjects, by age, IQ, gender and diagnosis.
The Test of Variables of Attention (TOVA) was administered pre and post treatment. Both groups improved significantly on TOVA measures of inattention, impulsivity, information processing, and variability, and did not differ from each other on TOVA change scores. Rossiter suggested that Neurotherapy is an effective alternative to stimulants and may be the treatment of choice when medication is ineffective, produce unacceptable side effects, or when compliance to medication is a problem.
Neurofeedback vs. Stimulant Medication
Aerobic Exercise for children. 20 minutes = PS increase of 16 milliseconds. Short term.
Strength training: increase in BDNF – brain derived neurotrophic factor
Another problem for these kids is that, in computer terminology, they have an extra small “buffer” and that buffer fills up very fast and they are quickly overwhelmed. This can happen frequently, and often does in the classroom. I’ve always described this to parents as their “bucket” filling up well before anyone realizes it’s full and overflowing. Once that bucket is filled up, or the buffer is maxed out, there’s no room for more learning. Thus, these kids quickly get behind and it’s no wonder they feel so frustrated.
- Todd Corelli, Ph.D., Licensed Clinical Psychologist
I think these kids are much more at risk for emotional disorders because of their slow processing speed. They get frustrated quickly, are often left feeling overwhelmed, don’t know why, and get the label of being lazy and unmotivated. They become discouraged and develop a poor self-concept.

- Todd Corelli, Ph.D.
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