An Interdisciplinary Approach to
Assessing/Managing CAPD
Larry Medwetsky, Ph.D.
VP, Clinical Services
Rochester Hearing and Speech Center
585-271-680 x 245
[email protected]
Laura Riddle, Ph.D.
Assistant Professor
Department of Communication Sciences
and Disorders: Nazareth College
585-389-2442
[email protected]
Overview of Presentation
„
Overview of Processes Engaged in Spoken
Language Processing
„
Assessment of the Various Processing
Domains (Audiology and S&L Procedures)
„
Management of Processing Related
Difficulties:
„ Specific Techniques
„ Environmental
Modifications/Compensations
„ General Compensatory Strategies
Overview of Processes Engaged in
Spoken Language Processing
Transduction
Acoustic stimuli undergo many conversions,
ultimately resulting in neuroelectric impulse
patterns that convey intensity, frequency,
temporal, intonation/amplitude contours, phase
information.
Pattern Matching (Decoding)
The neuronal impulses are relayed via the Central
Auditory Nervous System to the higher order
language processing centers in the Cortex and
stimulate various neuronal combinations
“prototypes” in long-term memory (LTM).
Decoding- cont’d
Language cortical neuronal regions include:
- the language centers in the brain (for
@ 95% of the population, this is in left
hemisphere)
- the rhythmic processing areas of the brain
(for @ 95% of the population, this is in
the
right hemisphere)
The above occurs because the rapid, short duration
information is processed/analyzed by neurons in the
left hemisphere, while the slower, longer duration
information is analyzed by neurons in the right
hemisphere.
Short-Term/Conscious Memory
Neurons in LTM are in a resting state.
Stimulation of the various neuronal
synapses/connections results in activation of
these neurons, and, if sufficient attention is
allocated, results in conscious awareness of the
“item” (short-term/working memory).
Integration
Somehow, the derived segmental information
from the left hemisphere language region is
integrated with the derived suprasegmental
information from the right hemisphere.
Attentional Allocation
This is the process whereby the brain determines
which information to focus on and which to ignore.
This is because humans are limited to how much
they can process and attend to at any one point in
time.
Attentional allocation is important for:
„ initial priming/excitation of neurons engaged
in processing of selected information
„ maintenance of neuronal firing to maintain
information in short-term memory
„ selectively attending to target stimuli in the face
of competing stimuli
„ switching of attention when multi-tasking, thus,
maintaining neuronal firing for multiple regions
Short-Term Memory (STM) Span
STM span refers to the maximum number of units/
chunks that an individual can maintain and recall.
It is based on the maximum # of neuronal regions
that can be maintained in an active firing state.
Neurons can remain in an active firing state for 1-2
seconds, unless some sort of stimulation
“attention” is directed to that neuronal cluster,
resulting in renewed activation prior to returning
to its resting state.
Recent research suggests that the maximum limit
is 4-5 neuronal regions firing at a time. Chunking
allows for bigger sized units (e.g., 7 digit phone
number cab be grouped into three chunks /271/
/06/ /80/.
Sequencing
The part of the brain that directs attention
“Pre-Frontal Cortex” also somehow maintains
the sequence in which the information has been
processed (be it in the receptive or output side).
Selective Attention
This refers to the ability to focus on a “target”
stimulus and to ignore competing stimuli.
When the competing stimulus consists of nonlinguistic noise, the brain analyzes the different
acoustic characteristics and attempts to filter the
speech from the noise
Selective Attention- cont’d
When the competing stimuli consists of speech (e.g.,
group listening settings), the brain uses spatial cues,
fundamental pitch contours, etc., to perceptually
separate the incoming information and then allocate
attention to the source of interest and ignore or block
the competing source.
Divided/Shared Attention
The ability to process and activate two or more
neuronal regions simultaneously; some tasks may, in
fact, involve fast switching rather than simultaneous
processing (e.g., note-taking) but this still requires
more information to be processed per unit time.
Phonological Awareness
Over time, if everything develops normally an
individual’s brain derives and stores the
phonological codes for that language, manipulate
the phonemes (e.g., deletions, substitutions,
additions, etc.), and, learns the written symbolic
code that represents the phonemes in their
language (i.e., phonics).
Interdisciplinary Assessment
of Processing Domains
Role of the SLP
„
Use the results of the Auditory Processing
Evaluation, as well as the presenting
difficulties, to guide assessment
* Note: it is possible that an SLP may
initially have conducted a basic language
test battery but subsequent to an auditory
processing evaluation may conduct further
testing based on the new results obtained.
Phonemic Awareness
„
Audiology: Phonemic Synthesis Test
„
Phoneme Blending Test
„
Stimulus items are presented 2
seconds apart
„
3-4 phoneme words
„
SLP (most of time): Lindamood Auditory
Conceptualization Test-3
„
Discrimination of speech sounds
„
Analyzing the number and order of
speech sounds/syllables
„
Tracking speech sound changes at
both the phoneme and syllable levels
Phonemic Awareness
„
SLP: More in-depth assessment of
phonemic awareness
„
Standardized Tests
„ Comprehensive Test of
Phonological Processing (CTOPP)
(Wagner et. Al., 1999)
„ Elision, Sound Blending, Sound
Segmentation
„ Blending and Segmentation of
real and nonsense words
„ Rapid Naming (letters, digits,
colors, objects)
„ Phonological Working Memory
(non-word repetition)
Phonemic Awareness
„
SLP: More in-depth assessment of
phonemic awareness
„
Phonological Awareness Test-2
(PAT-2) (Robertson & Salter,
2007)
„
„
„
Rhyming, syllable blending and
segmentation, sound isolation,
sound blending and
segmentation, substitution
Letter-sound knowledge
Non-word Decoding
Phonemic Awareness
„
SLP: More in-depth assessment of
phonemic awareness
„
Standardized Tests
„ Pre-reading Inventory of
Phonological Awareness (Dodd, et.
al., 2003)
„ Rhyming, syllable
segmentation, alliteration,
sound isolation, sound
segmentation
„ Letter-sound knowledge
Phonemic Awareness
„
SLP: Standardized Tests – assessing
1-2 skills
„
Phonological Awareness Skills
Program Test (Rosner, 1999)
„ Deletion, substitution
„
Test of Phonological Awareness
(Torgesen & Bryant, 1994)
„ Sound Matching – initial, final
Phonemic Awareness
„
Phonemic Synthesis vs Phoneme Blending
(CTOPP)
„
„
Often see inconsistent results but are
they
inconsistent?
Difference between tests
„ Length of Inter-stimulus interval
(@ 2 secs vs 1 sec apart)
„ Live (+ lipreading) vs taped voice
„ Shorter vs longer words
Phonemic Awareness
„
Phonemic Awareness Error Patterns
„
„
„
„
„
Position of sound in word
Type of sounds, e.g., blends
Number of sounds in the word
Nonsense vs real words
Response delays
Audiological Determination of
Lexical Decoding Speed Difficulty
Background:
Individual requires more time to process and match
stimulus to what is stored in LTM.
Staggered Spondaic Word Test
Right Ear
Left Ear
Non-Competing Competing
Up
Stairs
Down
Non-Competing
Town
A pattern indicating decoding speed difficulty is more errors on second
spondee (due to slow processing, attention too long on first spondee,
and, thus neuronal representation of second spondee fades away).
For sentences: if decoding speed is the primary difficulty, may see more
word errors at the end of the sentence
Lexical Decoding Speed
SLP Testing (ruling out knowledge issues):
ƒ
Semantic Skills
ƒ Vocabulary, Antonyms,
Synonyms, Multiple Meaning
words, Word Definitions
ƒ PPVT-4, EVT, LPT3, Word
Test2-E, CELF-4, CASL
ƒ
Morphology/Syntax
ƒ CELF-4, TOLD-P3, Language
Sample
Lexical Decoding Speed
SLP Testing:
ƒ
Morphological Awareness
ƒ Spelling lists of words that are
morphologically different (e.g.,
kicked, gladly)
ƒ Cloze procedures: produce a
derived word
ƒ Word judgment tasks
ƒ Suffix addition tasks
Masterson & Apel, 2000
Lexical Decoding Speed
SLP Testing:
•
Word Retrieval Ability
•
Single-word level
•
Test of Word Finding-2 (German,
2000)
•
Discourse level
•
Test of Word Finding in Discourse
(German, 1991)
•
Language Sample with maze
analysis: Story retell and
conversation
Lexical Decoding Speed
Word Retrieval Difficulty
ƒ
ƒ
ƒ
ƒ
ƒ
Revisions
Repetitions of words or parts of words
Word choice errors (substitute one
word for the target word)
Word omissions
Pauses/delays within utterances
Miller, 1991
Fading-Memory
Background:
Individual is unable to allocate attention effectively,
consequently earlier presented information fades rapidly
from short-term memory
Staggered Spondaic Word Test
Non-Competing Competing
Right Ear
Up
Stairs
Left Ear
Down
Non-Competing
Town
Individual has more errors on the first spondee.
Also, if individual can’t blend on fly, then on a phonemic
blending task may see more errors on earlier phonemes
If predominantly fading-memory difficulty, on sentence
recall individual exhibits more errors on earlier sentence
portions.
Short-Term Memory Span Assessment
Background: STM Span refers to # of units that can
be recalled by an individual, usually assessed in
serial fashion.
Test of Auditory Processing Skills examines three
different stimuli:
• Digits
• Sentences
• Unrelated Words
The first two tests are rote-memory tasks (minimal
context present), while sentence recall engages
syntax, semantic relations, world knowledge,
prosody.
Possible STM Span Patterns
„
„
„
„
„
„
Results on all three tests within normal limits (WNL):
either no or minimal processing issues (though still may
exhibit phonological awareness difficulties)
Results on all three tests significantly below age norms:
significant processing difficulties, likely impacting on basic
language skills
Difficulty on digit/word STM span, WNL for sentences
(likely processing related issues and is the most common
finding at RHSC Audiology)
WNL for digits/sentences, difficulty with words (lexical
decoding speed likely the major issue)
WNL for digits/words, poor sentence recall (likely language
disorder)
WNL for digits, significant for words/sentences (typically
observed in individuals with Autism/Asperger’s)
Short Term Memory
SLP Testing:
ƒ
Phonological Working Memory
ƒ
Non-word Repetition Tasks
ƒ
CTOPP (Wagner et. Al., 1999)
Integration: Audiological Signs
Background:
Individual is either unable to integrate right and left
hemisphere information, or, reveals right ear dominance on
competing stimuli tasks
SSW Test
Significant Left Competing finding (relative to peers,
significantly more errors than in the other conditions )
Competing Sentences Test
Significantly poorer left versus right ear selective attention
recall score relative to peers
Pitch Pattern Sequences Test
Verbal labeling of thee tone sequence is significantly poorer
than non-verbal (hummed response)
Integration
SLP Testing:
‰ Prosody
‰ Difficulty processing prosodic cues
‰ Informal observation of
comprehension of sentences when
stress and intonation are varied
‰ Structured tasks of processing: vary
the stress on words and determine
number of units being produced
(Wells & Peppe, 2003)
Integration
SLP Testing:
‰
Prosody
‰ Difficulty processing prosodic cues
‰ Emotional Prosody – observe response
to words conveyed with different
emotions
‰
Difficulty producing prosodic cues
‰ Observe intonation and stress
patterns during a variety of
language sampling conditions
Integration
Figurative Language
ƒ Idioms, similes, metaphors, proverbs,
humor
ƒ Interpreted using contextual cues,
situational cues and mental imagery
(Nippold & Duthie, 2003)
ƒ Standardized tests can be used
ƒ CASL, TLC
ƒ Informal tasks – better option
ƒ Interpret meaning of figurative
expressions commonly heard within
environment
Integration
Conversational Skills
‰
Individual must attend to facial
expression, body language in addition
to oral language to interpret messages
‰
Individual must divide attention to
accomplish this
‰
Conversational samples in both paired
and group settings
Integration
Conversational Skills
‰
Analyze topic initiation, topic
maintenance and turn taking skills
‰
Analyze ability to look at partner,
respond with appropriate facial
expressions
‰
Analyze pre-suppositional skill; takes
listener perspective; uses clear referents
‰
Analyze repair strategies
‰
Analyze response delays
Sequencing
Staggered Spondaic Word Test
Right Ear
Left Ear
Non-Competing
Up
Competing
Stairs
Down
Non-Competing
Town
Individual has to recall at least three of the four words.
Examples of sequencing errors may be:
/Up-town/ /Down-Town/
The Lindamood Auditory Conceptualization-3 test
involves significant sequencing ability on three of their
tasks, and, it is likely that for many children with
phonological awareness difficulty, it may be due to
higher order mental manipulations of phonemes/
syllables involving sequencing difficulties.
Sequencing
„
Oral Directions
ƒ Token Test for Children-2 (McGhee et.
al., 2007); CELF-4 (Semel, et. al., 2003)
ƒ
Assess informally within classroom
ƒ
To assess sequencing, child must
have the concept knowledge
Organization
‰
Narrative Language
‰
Story Generation and Story Re-tell
‰
Test of Narrative Language (Gillam &
Pearson, 2004)
‰
Analyze for story grammar, cohesion,
inference
Organization
‰
Written Language
‰
Skills needed:
„ Planning and organizing
„ Drafting
„ Revising and editing
„ Knowledge of text structure
(narrative, expository)
„ Language knowledge: discourse,
sentences, words
„ Writing conventions
Organization
‰
Written Language
‰
‰
Standardized writing tests (TEWL-2;
TOWL-3; OWLS: Written Language
Scale)
Authentic assessment approaches
(informal assessments examining
writing samples)
Reading and Spelling
Reading Assessment
ƒ
Word Recognition Skills
ƒ Word Identification (sight
reading)
ƒ Word Decoding (decode
nonsense words)
Woodcock Reading Mastery Tests-Revised
(Woodcock, 1987)
Reading and Spelling
Reading Assessment
ƒ
Text level reading
ƒ Accuracy (words read correctly),
rate, fluency
ƒ Reading Comprehension
Gray Oral Reading Test-4 (Weiderholt Bryant, 2001)
Gray Silent Reading Test Weiderholt & Blalock,
2000)
Reading and Spelling
Reading Assessment
ƒ
Reading Miscues
ƒ Insertions, Omissions,
Substitutions
ƒ Self corrections and Repetition
ƒ Analyze for syntactic acceptability,
semantic acceptability, graphic
similarity, sound similarity, selfcorrection
Reading Miscue Inventory (Goodman, Watson & Burke, 1987)
Reading and Spelling
Spelling Assessment
ƒ
ƒ
Test of Written Spelling (Larsen, et.
al., 1999)
Spell Performance Evaluation for
Language and Literacy (SPELL)
(Masterson, et. al., 2002)
ƒ Identifies underlying linguistic
deficits in phonemic awareness,
orthographic knowledge,
vocabulary, morphologic
knowledge and mental
orthographic images
Selective Auditory Attention Tests
Background:
Individuals with processing issues are at great risk
for difficulty hearing in background noise
(surrounding non-linguistic noise, group settings)
Speech-in-Noise test: speech embedded in shower
noise
Competing Sentences Test: listen to/recall
sentences in one ear and ignore sentences in other
ear (binaural separation)
Divided Auditory Attention Tests
Background: Individuals may break down when
required to share attention among different
stimuli/multi-task (e.g., note-taking)
The following are organized by level of difficulty:
Dichotic Digits Test: recall paired digits from both
ears
Competing Word/Spondee tests: recall both
competing words
Competing Sentences Test: recall both competing
Sentences
Temporal Resolution
Background:
Individuals with phonological awareness difficulty
may have an underlying difficulty of temporal
resolution (though at older ages, this may have
become normal but still residual phonological
awareness difficulties.
Random Gap Detection Test: one or two tones
(separated by varying degrees of minimal gap
between two tones) and indicate if heard one or two
tones.
Gap-in-Noise Test: Determination of the smallest
gap threshold within embedded noise that an
individual can detect at least 66.7% of the time.
Management Techniques
„
Does knowing the results of CAP testing
inform our practice?
„
Is there a relationship between CAP and
language testing and a child’s functioning at
school or home?
„
Does therapy with children with CAPD differ
from children with language impairment?
General Management:
Language Processing
„
Gillam, et. al., (2002, p. 43):
“… good language intervention is
also good information processing
intervention.”
General Management Techniques:
Listening Comprehension
„
„
„
„
„
„
„
Determine purpose of listening
Focus attention on topic
Orient to features of the text
Assess background knowledge
Use graphic organizers
Use text with simpler language at first
Use questions/key words
www. nclrc.org
Listening Comprehension
„
„
„
„
„
„
Make predictions
Make inferences
Keep writing to a minimum while listening
Use visuals
Teach child to monitor comprehension
Teach child to ask for help
www. nclrc.org
Specific Management Techniques
Listening in Noise
„
„
„
Type of noise
„ White noise, instrumental music, music
with words, cafeteria noise, competing
speakers, monologue (Tillery & Cinotti,
2008)
„ Processing Power (Ferre, 1997)
Increase loudness in increments
Vary the complexity of the listening task
Phonemic Awareness
„
„
„
„
„
Purpose is to facilitate reading and spelling
May improve working memory/lexical
decoding speed
Teach segmenting and blending
Teach in conjunction with letters
Focus should be at the phoneme level
Phonemic Awareness
„
Treatment Options
„ Computer programs
„ Fast ForWord & Step ForWord
„ Earobics
„ LocuTour Multimedia: Literacy
(Gillam, 2008; Medwetsky in Geffner & Swain, 2008)
Phonemic Awareness
„
Treatment Options
„ Structured Programs
„ Road to the Code
„ The Phonological Awareness KitPrimary
„ Lindamood® Phoneme Sequencing
Program
„
Informal activities
Phonemic Awareness
„
Transfer phonemic awareness to reading and
spelling
„ Work on word decoding skills
„ Closed Syllables
„ Single syllables (increasing from 3 to
6 sounds), Multisyllabic
„ Vowel-Consonant-e Syllables
„ Open Syllables
Wilson Reading System (Wilson, 1988)
Phonemic Awareness
„
Transfer phonemic awareness to reading and
spelling
„ Word Sorts by different patterns
(e.g., short vowels, blends, etc.)
„ Word Families (onset rime)
„ Read words in sentences and paragraphs
Lexical Decoding
„
Semantic knowledge
„ Semantic mapping
„ Depth of word knowledge
„ Antonym/synonyms; multiple meaning
words, word definitions
„ Strategies for learning unknown words
„ Context cues, identify word roots
Lexical Decoding
„
Teach child to use context cues: Use series of cloze
sentences
„
Provide series of cues that progressively provide
more information
„
Example:
„ I went to Disney World and rode_______.
„ I went to Disney World and rode_______. It
went very fast.
„ I went to Disney World and rode sp____. It
went very fast
„ I went to Disney World and rode spa____. It
went very fast.
(technique adapted from Gillam & Gorman (2004)
Lexical Decoding
„
Syntax knowledge
„ Identifying parts of speech
„ Paraphrasing concepts
„ Formulating sentences with key words
„ Sentence combination tasks
Scott, 1995
Lexical Decoding
„
Word Retrieval (German, 2005)
„ Retrieval strategies
„ Phonetic cues, semantic cues
„ Self Advocacy
„ Accommodations
„ Extended time, multiple choice exams,
cue cards with key words and prompts
Working Memory
„
„
„
„
Phonemic awareness activities
Improve language knowledge
Active Listening; promote attention
Strategies for older children
Working Memory
„
Memory strategies (rote)
„ Rehearsal – chunking
„ Mnemonics
„ Visualizing
„
Memory strategies (sentence/discourse level)
„ Paraphrasing and organizing information
„ Cues such as key questions or words,
summaries or pictures
„ Visualizing
Montgomery, 2002; Gillam & Hoffman, 2004
Sequencing/Organization
„
Narrative language
„ Sequence events temporally and in causeeffect relationships
„ Organize events into story grammar
„ Story maps and flow charts
„
Scaffolding using key questions
Sequencing/Organization
„
Narrative language
„ Story maps, story frames, story grammar
cues and story prompts (see Roth, 2000)
„ Use oral and written narratives
„ For older children: recognize text
structure when reading to enhance
reading comprehension
Integration
„
Prosody
„ Modify prosodic aspects of input to
children
„ Higher pitch level with exaggerated
variability in pitch
„ Increased loudness
„ Slower rate
Gerken & McGregor (1998)
Integration
„
Prosody
„ Determine meanings of words based on
syllable stress
„ Become aware of pauses corresponding to
clausal boundaries
* Probably one of the most important areas in
processing needing research
Integration
„
Figurative Language
„ Strategy based intervention
„ Teach figurative expressions within a
context
„ Contrast literal to non-literal meaning
„ Explicit teaching of contextual cues
„ Role-playing scenarios in which the
expressions can be used
(Abrahamsen & Smith, 2000; Power et al., 2001;
Norbury, 2005; Paul, 2007; Nippold, 1991)
Integration
„
Figurative Language
„ Use forms in a variety of spoken and
written stories
„ Teach the communicative function of
expressions
„ Keep notebook or journal and record
expressions heard; include contextual
information
(Abrahamsen & Smith, 2000; Power et al., 2001;
Norbury, 2005; Paul, 2007; Nippold, 1991)
Integration
„
Conversation
„ Topic initiation and maintenance
„ Appropriate change of topic
„ Clarification requests
„ Clear referents
„ Teach one aspect of conversation at a time
„ Teach rules of conversation
„ Use conversational/social scripts
„ Pay attention to prosodic cues, facial
expressions and body language
Self-Advocacy
„
„
„
Comprehension Monitoring
Understanding learning styles: strengths and
weaknesses
Strategies for getting help
„ Ask for what you need, tell someone you
are having trouble
Environmental Modifications/
Compensatory Strategies
Modification of Listening Environment
The goal is to reduce noise levels and reverberation
(echoing). Examples include: carpeting, acoustically
treated tiles, drapes, balls/sliders on chairs, etc.
Overhead Projectors/Power Point Presentations
These allow for speech-reading, increased talker
loudness (projecting forward allows for increased talker
intensity), while still providing for a visual reference to
information at hand. Both of these techniques are better
than the blackboard. For middle and high school, power
point presentations allow for accompanying handouts
(3 slides/page with adjacent lines to take notes), while
overhead projector allows for ad-libbing.
Provision of Instructions
Instructions should be provided when there is little
commotion (such as students preparing to leave for
recess/lunch or when going home). If assignments
are on the blackboard, the teacher should allow the
students to write instructions down before
elaborating on the assignments. For those with
severe organizational skills, teacher check of agenda
or provision of written homework assignments.
Use of Earplugs
The use of earplugs in test taking or quiet study
times may allow the student to better focus on the
material at hand without using mental resources to
block out external stimuli.
Test-Taking in a Separate Room
This can minimize the amount of noise and less of a
psychological need to rush in order to finish at same
time as other students.
Preferential Seating
Sitting in the front rows (if traditional seating, 2nd row
to allow for better viewing of students on side/behind
when they talk) is often recommended to increase the
perceived intensity of the teacher’s voice (thus, making
it easier to process information). This is a good
technique if the teacher never strays too far from her
desk.
In reality, preferential seating does not exist too often
in real life. Thus, #7 is often recommended.
Enhancement of the Desired Speech Signal
Examples include use of assistive listening
systems such as PA systems, FM sound-field &
personal systems (that resemble hearing aids) and
the most complex technique of all, that is, moving
closer to the listener.
The key aspect of assistive listening systems is
that they mimic being close to the listener
(i.e., decreases the distance between the
talker/listener); in turn, this maintains the
intensity of the talker’s voice, thus, keeping it
sufficiently louder than the background noise.
General Compensatory Strategies
The following strategies are of benefit to individuals
with processing difficulties, hearing loss, or, even
second language learners, though the mechanisms by
which they assist the individual differ.
Modification of Talker Delivery Style
Depending on the listener’s difficulty, this may include
using clear speech “newscaster’s speech style,
insertion of pauses, extra inflection/stress, sentences
of less grammatical complexity, etc. This makes it
easier for the listener to ”keep up”.
Modification of Speaker Delivery Style- cont’d
A conceptual formula that can guide speakers
presenters is:
“The more complex the material, the more
important it is to slow down the overall rate in
which material is presented- not by
exaggerating speech patterns but by
articulating words clearly, emphasizing prosodic
stress patterns within speech, inserting pauses
between clauses and concepts to provide
additional processing time, and the use of
visuals”.
Familiarizing the Listener to Information Beforehand
The more familiarity the listener has with the
topic/content, the less they have to rely on the
acoustic signal, and, the more they can use their
linguistic/world knowledge to help process the
incoming information. For students, this can be done
by informing students/parents of the content,
vocabulary, concepts prior to being covered in class
(pre-viewing technique).
Extended Time for Task
If the individual needs additional processing time,
they would likely benefit from extended time. Selfesteem issues may need to be considered/addressed.
Presenting Directions/Instructions
The talker can state one direction at a time and have
the individual first repeat/internally visualize each
direction and then summarize these directions at the
end (unless too young or significant integration
difficulty, may not be able to internally visualize- check
if student can do it). This will ensure that the child has
retained all key information; in addition, this serves as
a training technique.
For older students/adults, may just insert longer
pauses between directions and then have them
summarize at the end to ensure what
processed/retained. An alternative is to highlight the
sequence of steps on a blackboard/paper.
Clarification of Information Presented
For important directions, content, etc., the talker can
check with the listener to determine if the information
has been perceived correctly. For example:
The talker can ask the listener to repeat instructions/
directions in their own words to ensure that the
listener has indeed processed and recalled all of the
information provided. If not, then the talker can fill-in
the missed/forgotten information.
Divided Attention Difficulties
If divided attention difficulties are present, older
individuals will benefit from outlines, handouts,
guided notes (such as power point slides, three
slides/page with adjacent lines for adding notes), and,
if necessary, a designated note-taker.
Phonics Difficulty
If student has significant spelling difficulties
present, on tests where content crucial element
(rather than spelling) then spelling variance be
applied. If spelling deemed crucial, then
notebook computer with spell checker be
provided (depends on keyboarding skills), or,
availability of word bank.
Assistive technology to minimize writing
requirements (auto-capitalization, word
predictions, punctualization) to reduce overall
mental load as well as reduce spelling errors is
another alternative.
Writing Difficulties
For older students, after having completed a written
assignment, they should either read out loud to
themselves what they have written or have someone
else read to them (while they follow along).
This may allow the student to pick up on and correct
any organizational issues, spelling errors, and any
punctualization errors.
Individuals may also benefit from writing software
that increases organization skills, such as Draft
Builder and Kidspiration.
Altering Class Schedule
If possible, difficult subject matter is covered in
the morning when the student is less likely to be
fatigued. If the child is in middle/high school,
avoid having two difficult subjects back-to-back.
If the student’s attention seems to be drifting and
appears to be becoming overloaded, listening breaks
should be provided.
For adults, the goal would be to arrange meetings in
the morning or have handouts made available.