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Drs. Brock and Fernette Eide presented these slides at the SPD Foundational International Symposium. Sensory processing disorders often present with challenges in attention and memory, reading, writing, and math. This presentation reviews common ways SPD affects this learning tasks as well as ways that therapy or educational strategies can be used to help.
Citation preview
Common Learning Challenges inSensory Processing Disorder
Brock Eide M.D. M.A. and Fernette Eide M.D.Neurolearning.com
Facebook.com/SensoryProcessing
This presentation will be posted on Slideshare.net/drseide
Flickr.com/mrhayata
Ways to Think About Sensory Processing Disorder
Dr. Jean Ayres defined the clinical syndrome of Sensory Integration Dysfunction functionally: as an impairment in the ability to organize sensation for use.
Dr. Lucy Jane Miller: “Sensory Processing Disorder exists when
sensory signals don’t get organized into appropriate responses
and a child’s daily routines and activities are disrupted as a
result.”
Both descriptions emphasize information processing in the
current moment.
We can also view SPD from the Perspective of Learning.
What kinds of learning and cognitive issues do we see in children with SPD?
What is Learning?
We can think of learning as: Information that has been encoded in memory in a form that can be used.
Memory
Long-Term Memory: Information you can use later.
Working Memory: Information you can use now. Mental Desk Space, or keyboard memory. (Also considered part of Attention)
What Kinds Of Memory Do We Have?
What Kinds Of Information DoesLong-Term Memory Retain?
Procedural Memory: How to do things.Rules and Procedures, Rote Facts, Things that become automatic through practice so you can do them without conscious effort.
Declarative Memory: Facts about the world.
Most Basic Academic Skills are Procedural
• Most language skills are rule-based, including: discriminating word-sounds; correctly articulating and pronouncing words; segmenting words into sounds; phonics (decoding and spelling); s; grammar and syntax; style and pragmatics.
• Many other academic skills are also rule-based, like: rote (or automatic) memory (e.g., math facts, dates, titles, terms, or place names); procedures like long division, carrying over, borrowing, or dealing with fractions in math; sequences, like the alphabet, days of the week, months of the year, etc.; writing conventions like punctuation and capitalization; and motor rules for forming letters the same way every time when writing by hand, and spacing evenly between words.
• Classroom schedules, rules, and procedures/organization
• Development of Automatic Skills;• Mastery of Procedures (versus simple facts); • Rote Memory;• Working Memory Overload and Attention Challenges;• Understanding of time, space, quantity, sequence;• Language Retrieval, organization, prosody, pragmatics;• Social Fluency (versus comprehension);
The Link BetweenSPD and Procedural Learning:
Same List of Cognitive and Learning Challenges
SensesMotorSpatialInteroceptive (Organs)Limbic / EmotionalLanguageAutomaticity
Neurologically, What Links
SPD and Procedural Learning?
Answer: Cerebellar Dysfunction
When the cerebellum’s working hard, you don’t have to...
Cerebellar Cognitive Affective Disorder: “Dysmetria of Thought”
Dr. Jeremy Schmamman, Harvard
Risk Factors forfor Cerebellar Dysfunction
and SPD essentially the Same
• Preterm birth• Birth injury• Down Syndrome, Fetal Alcohol Syndrome• Deprivation, Child Abuse• ADHD: the most consistent brain abnormality• Autism / Aspergers: the most brain consistent abnormality...• Dyslexia: the most commonly identified brain abnormality• Developmental Motor Coordination Disorder • Pediatric Bipolar
The Cerebellum is Particularly Vulnerable to Hypoxia / Ischemia and is the Most Commonly Affected Area in a Wide Variety of Conditions Associated with Learning Challenges
• Failure to automatize functions leads to the need for conscious compensation or oversight.
• When too many tasks require conscious attention, overloading
• of working memory is the inevitable result.
Cognitive/Learning Issues Besides Basic Skills:1. Attention and Working Memory
Sustaining Attention Is Also Harder for
Children With Cerebellar Dysfunction and
Procedural Learning Challenges
• Children with procedural learning difficulties must focus more intently
to perform the same tasks as other children, and this is tiring.
• Think of the difference in attention required to drive the same stretch
of twisty mountain road on a clear day versus a rainy night—and the
difference in resulting stress and fatigue.
Other Attention Issues with Cerebellar
Dysfunction/Procedural Learning Problems/SPD
• Selective attention/distractibility (Poor automatic
filtering)
• Difficulty with task switching (set-shifting), dividing
attention, and transitions.• Difficulty following complex instructions• Difficulty with “oversight” or executive functions due to
working memory overload• Poor appreciation and understanding of time/time
management.
2. Social Interactions
• Learning and using social and self-help rules.
• Most social interactive skills are rule-based.
• Real-time fluency/praxis versus comprehension.
• Auditory processing (telling word sounds apart, hearing in background noise, sound sensitivity)
• Speech articulation
• Prosody/tone and style (“pedantic” or “mechanical”)
• Bright children often misdiagnosed with autism spectrum disorders due to unusual style, prosody, or pragmatics, but generally language comprehension is flexible and fluid
Take Home Points about Procedural Learning in SPD
• “How” or “praxis” skills: Things that become automatic through practice, like rules, procedures, rote facts
• Most Basic Academic Skills are procedural in nature
• Square root rule: take square root longer of number of repetitions to master
• Affects implicit learning (observation and imitation) more than explicit (detailed instruction)
• Poor automaticity requires conscious compensation and working memory overload
• Often show up on WISC as slow processing speed, decreased comprehension score.
• Alternative learning strategies based on explicit learning and declarative (factual) memory mnemonics.
Common Academic Labels Given to
Children with Procedural Learning
Challenges
• Dysgraphia
• Dyslexia
• Dyscalculia
• Dyspraxia
• ADHD
• Autism Spectrum
Sensory Processing & Learning
Attention
Visual Auditory Cerebellar / Proprioceptive
Sensory-MotorSensory Input
Pattern Processing
Memory & Learning
Output
Reading
Writing
Math
SPD in the Classroom
SPD and Reading
Visual – skipped words and lines, misreading
Auditory – mispronounced words, trouble sounding out,
discrimination / phonics mistakes, poor word retrieval
Cerebellar – Impaired reading automaticity
SPD kids may have unrecognized Dyslexia
http://flickr.com/Old Shoe Woman
Scholarpedia
Visual Demands of Reading
Visual Functions and Reading
Smooth eye movements for readingEye saccades or jumps to switch between linesFocus adjustment near and farVisual recognition of letters and whole words
Flickr.com/Josh Liba
Distinguishing similar sounds – „hod‟ for „hot‟, „brush‟ for „blush‟
Quick speech, Sounds within Words
Mishear, Mispronounce, Misspell, Misfiled - „Mushy Speech‟
Misfiled Words Harder to Retrieve
Auditory Processing & Reading
Flickr.com/JKoenig
Interventions for ReadingMultisensory learning
See, hear, air write, say
Auditory discrimination
Auditory memory
Vision and visual memory
Imagery
Teachers, parents, tutors, SLPs,
audiologists, dev optometrists
reading specialists, computers
SPD and WritingAutomaticity of letter writing
Sensory feedback
Motor planning and execution
Visual and kinesthetic memory
Word retrieval and organization
Flickr.com/pyhooya
Emotional Toll of Dysgraphia
“His teacher would let him take his work home,
but even after 3 hours, there was no way he could finish…”
Flickr.com/nao.k
Depression
Severe Behaviors
School Withdrawal
Suicidal
Examples of Dysgraphia in Students with SPD
Dysgraphia and SPD
Control Cerebellar
Degeneration
(Critchley)
SPD
Impaired Motor Automaticity
“Draw several squares on top of each other”
May Avoid fingers
Handwriting and Working Memory Overload
Sentence Copy Better than Free Writing
Interventions for Writing
ACCOMMODATE ! Dictation, Typing, Assistive TechnologyTHERAPYFine motor / Upper Girdle StrengtheningKinesthetic Strategies – Air Writing / Imagery / VerbalAutomaticity Practice – over-learningLANGUAGETemplate prompts, imitation, writing tutorExpressive language work – SLPAssistive software
Flickr.com/cowtools
Assistive TechnologyWord Prediction Software
Report Writers- CoWriter 6
Spelling Prediction
Speech to Text - Dragon Dictate
Text to Speech Software and Browsers
Ginger: Context-Sensitive Grammar
Kindle, iPad, iPhone, iPod, etc.
Intel Reader, Kurzweil
Training and Support for Assistive Tech
More Resources:
DyslexicAdvantage.com
Flickr.com/neuro74
SPD and Math
Impaired Sense of Number and Quantity
Number Sense Related to Spatial Perception
Finger Agnosia Often Seen with Dyscalculia
Rote Math Facts, Procedural Memory
Normal Intelligence
Counting and Quantity
Sequence and Multiple Steps
Money, Clocks, TimeMath Facts
Flickr.com/jeffeaton
Students with SPD Often Struggle with Math
Visual Crowding
Impaired Number Writing Automaticity
Working Memory Overload
Impaired Sense of Number and Sequence
You do not have to be a great calculating wiz
To be a great mathematician or scientist
Math Problem Solving May Be Quite Strong in Dyscalculics
Wikipedia
Interventions for Math
Kinesthetic Strategies to Number, Quantity
Episodic / Personal Memory for Math Facts
Dysgraphia, Working Memory ,Vision
Accommodations
Math Reasoning ≠ Arithmetic
Flickr.com/Nexus6
Visual OverloadVisual MistakesPoor eye contactLazy eyeWorksheet Errors
Tunes Out‘Visual Learner’Trouble with Instructions
Poor PostureBodily DistractionsFidgety, HyperactivePoor Hands-OnLearners
Lazy eye, birth, dyslexia Preemie, dyslexia, ADHD Birth, preemie, ADHD, dyslexia
Sensory
Contributions
To Attention
This is hard.Visual Crowding
This is hard.Visual Crowding
This is easier.More whitespace.
Fan, Projector
Students Talking
Distracting Noise
Teacher Speaking
Auditory Attention in the Classroom
HearingReview.com
Reduce Visual, Auditory, and Sensory Distractions
Visual Focus, Convergence, Pursuits, Jumps
Auditory Background, Discrimination, Closure
Proprioceptive: Muscle Tone, Spatial Map
Multi-Disciplinary / Referrals
Sequential Multisensory Teaching
Software, neurofeedback
Flickr.com/Noel Zia Lee
Less Listening When Seeing
http://www.indiana.edu/~cnilab/multiorder.pdf
Divided Attention
Improving Divided Attention
Incremental Challenge
Mixed Sensory-Sensory and Sensory-Motor
Seeing-Hearing, Seeing-Moving, Moving-Rote
Home / Normal Kid Activities + Therapy
http://flickr.com/silkegb
Sensory Learning SurveySensory Processing Disorder and Learning
© Eide Neurolearning Clinic 2010
Visual Auditory Proprioceptive / Cerebellar
Attention Visual overload Tunes out with listening Fidgets / sensory seeking
Careless mistakes Missed instructions Flops, poor tone
Distracted by visual details Distracted by sounds Trouble multi-tasking
Memory Problems learning letters, spelling
mistakes
Problems remembering what's
been heard
Poor procedural memory
Trouble with graphs and other
visual learning
Mispronounced words, Word
substitutions
Reading Skipped words Phonics and rhyme problems Poor reading fluency
Lose place Wild guesses with words
Eyes close to page Avoids reading
Misreads questions
Writing / Speech Large messy handwriting, eyes
close to page
Phonetic errors in writing and
speech - dropped letters and
sounds
Irregularly formed letters
(impaired automaticity), overload
errors
Spelling mistakes Very poor spelling Visual monitoring of writing
Reversals Trouble retrieving words Reversals
Sensory Learning SurveySensory Processing Disorder and Learning
© Eide Neurolearning Clinic 2010
Visual Auditory Proprioceptive / Cerebellar
Math Problems with crowded
worksheets
Mistakes counting fingers, poor
approximation
Skipped problems Unable to do multi-stepped
problems
Speech / Socialization Interrupts conversation Poor back-and-forth conversation Poor back-and-forth conversation
Problems hearing in background
noise
Awkward speech – self-editing
(fluency)
Mispronounced words
Problems learning a foreign
language
Word finding problems
Play / Socialization Retreat from crowded Retreat from crowded Retreat from crowded
Misses visual signals in sports Trouble assemblies, gym, echoing
rooms
Unexpected falls, leaning on
children in line
Impaired depth perception Can't hear in PE or music Bad at sports – multitasking,
timing
Join Us on Facebook
Facebook/SensoryProcessing
Neurolearning.com
DyslexicAdvantage.comSensory DVDs
Amazon.com
Flickr.com/Inoc
The Dyslexic Advantage is coming Fall 2011