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

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The Dyslexic Advantage is coming Fall 2011