Carl U. Weitman, PhD. Clinical Neuropsychology
In complex cases you do have to look in many direction. IQ would be of interest but…
My experience with children and adults with low IQ’s, has reinforced, over and over again, to consider the IQ test as ‘an achievement test’ and not a measure of the person’s potential. My favorite patient was a man with Down Syndrome with a 31 IQ. Although his IQ remained essentially unchanged, in 2 1/2 years he learned to speak, read, sing a bit, make little jokes and he was my assistant giving part of the Phonemic Training Program to another person with a 40 IQ.
Regardless of IQ levels a child struggling with listening issues in the real world will benefit from Auditory only based therapies
Carl U. Weitman, PhD. Clinical Neuropsychology
Fake Bad for some secondary gain, legal advantage or medical advantage or disability advantage.
Fake Good (although the term is not often used this way) to obtain tangible advantage or social approval. There is also the so-called Munchausen Syndrome, faking by proxy i.e. on another person’s behalf. At the more normal level, there is the so-called cry for help (e.g. exaggerate in an Emergency Room to avoid being consigned to the long term waiting room).
At the even more normal level, there is performance anxiety or stage fright.
Malingering is usually measured by failures on “simple” items that are inconsistent with failures on more complex items that subsume the content and process of the easier items.
At the less deliberate level, there is either innocent false conclusion or self-deception
Errors may be due to:
- A person does well on a complex test, then blows it on a subsequent easy task…often due to fatigue from the hard test.
- A person does well on a complex test, marked by forced coherence in the items, then does poorly on an easy task, because an element of the easy task is not easy for the subject. This happens in variant verbal vocabulary tasks all the time
60 years ago, when working in 3 central schools, I found that Phonemic Synthesis Program works better than I could have imagined. I used it with 16 of the 17 kids who took the PS test (1 kid passed with flying colors). When I saw such great improvement, so quickly, for some reason I thought that all the kids in 1st grade should get this help. In those days we did not have phonics, as reading was done visually only, so this was a virgin group. The 1st grade teacher let me work with her kids 30 minutes a week for the rest of the semester. At the end of the term I thanked her for letting me work with her children. I said next semester I’d be working with the kindergartners. She looked so disappointed and said, “You mean you are not going to be working with my children?” I was so surprised and asked why she was so disappointed. She said all the wonderful things that she saw (I don’t remember the specifics as I was shocked). The next semester I worked again with the Kindergarten kids but still didn’t realize the broad potential for this training. I had to leave the school as I started my PhD program in another state.
In the early days of Learning Disability- LD, they said that 20% of all school children had it. We did a study in a middle-income group district in the Kansas City area. The head of the counselors in the district applied for a grant from the state of MO to fund our study. She trained counselors, teachers and parents about LD and then she asked the teachers to indicate which children they thought had LD. She reviewed the submissions to be sure and then referred those kids to our medical center for Psychological, Speech, Language, Hearing, Auditory Processing evaluations. We used SSW and PS as our APD battery. Of the various tests the Auditory Processing Disorders-APD procedures were more significant than the other 4 types of tests. 77% of the children tested were LD (that was 20% of the school population). In those days they did not think that children with psychological disorders, autism, neurological conditions, hearing loss, etc. could also be considered LD, so they were never evaluated. So, when considering those higher risk children, it accounted all together to about 20% of the entire district with APD! In the 50 years since then I have seen nothing to make me question about 20%.
If LANCB, would be given to each Kindergarten or 1st grade class, it would give this valuable training to all children, quickly, and I think, inexpensively at an ideal time to form important foundations in their brains. It will not solve all the problems but will help the average kids, the mild-moderate kids even more, and even the severe kids to some extent. It could have some value to the above-average kids too.
The training could directly affect speech, reading, spelling and be reflected in memory, language, and academically because of improved decoding (thereby opening new opportunities for them). The therapy would not need to be limited to Decoding. Speech-in-Noise would be possible and perhaps memory. Working with one class would help to figure out what would work best. E.g., the students with more challenge would be seated close to the front and middle. If this program works well in Kindergarten, then some aspects could be used with preschool children also (that would be super!).
This would eventually to make a huge difference in almost all children in the state or country. It would have to start somewhere. This is the first thing I would recommend as the most economical approach with the broadest effect!
- Speech leaves the speaker’s mouth and thins out in all directions. So, distance from the speaker’s mouth to the listener’s ears is extremely important.
- Most of the energy goes forward from speaker’s mouth. So, when possible speak close by and face-to-face with her to give her the most and most accurate speech message.
- Speech from another room is dramatically reduced by the walls and the small opening. This is especially true for the high pitched (extremely important) speech sounds.
- The person who initiates the conversation must go to the listener. But, if the person with auditory weakness talks to you from another room remind them to come to you using any predetermined code (Example: you can say “Rule 32”)
- When looking at one another, they should be able to see your lips, facial expressions as well as gestures. This should be especially helpful because they depend so much on vision.
- Clear Speech is how you speak when it is very noisy. It is slower and more distinct. It is also a louder, but with no noise competition it could be just a little louder. With people who are hard-of-hearing, it increases understanding by 20%. It will likely have a similar effect with those with auditory weakness.
- Background noise is harder for everyone, but especially for people who have APD (or hearing loss). When conversing reduce/turn off TV, ask people to quiet down, or move away from noise.
- If they are otherwise preoccupied, touch them on the shoulder and when attention is established, say/ask what you wanted.
- When reading a book, if the child is on the left lap, the next time have the child on the right lap (so that both ears get the benefit).
- Especially when giving instructions, try to use clear speech and pause after each instruction (to let it sink in and not be erased by the next one) and then give the next. Don’t hesitate to briefly reiterate what you told her, or ask her to tell you what she is going to do. You could put up one finger and give the first instruction etc. to give some visual support.
- They will do best facing the teacher less than 10-12 feet away.
- Depending on how much the person can understand or retain, it might be helpful for the teacher to write things on the white board. This will be more helpful as she is able to read more.
- These may be more difficult to carry out in a Montessori setting, it would be best to provide face-to-face instructions, in a quiet/quieter area.
- Children who have APD are working much harder than the other children and so they tend to tire more quickly. A little time in a quiet/quieter area a few times a day (especially toward the end of the school day or when they look tired/stressed) would be very helpful
- Preferential seating
- Quiet classroom
- Loud with clear speech
- Provide extra time for processing and response
- Verbal rehearsal of oral directions prior to execution of directions
- Chunking of information
- Use gestures
- Repeat rather than rephrase
- Repetition of new material for long term retention
- Avoid multi-level processing, multi-tasking, and/ or multi-step directions. Limit information input with new material for better comprehension and retention
- Provide appropriate pauses in conversations
- Pre-teach new vocabulary to increase familiarity, provide visual list on the board
- Assistive listening device- FM system
- Frequent breaks
- Buddy or peer helper
- Testing in a quiet room or in small group
- Teach organizational skills by an educational specialist
- Present information at a slow pace for effective information processing (Like Mr. Rogers!!)
“When your heart becomes 2”
Recently in my clinic, my 5 year old patient was asked come back to his seat to work on phonemic synthesis. He had not yet seen my dog in the clinic at that time. As he hesitatingly came to sit at his seat he noticed my puppy and said, “My heart is 1 again!”. I was perplexed and asked him what he meant. He said, “You know when you asked me to come to do the sound game, my heart became 2, but when I saw Pinto, my heart became 1 again.”
Wow, only then I realized that he was anxious about doing the phonemic synthesis work, and probably felt like he skipped a heartbeat when I told him that it is time to work.
I was never trained in APD (undergrad, masters or doctorate. When I returned for my doctorate and expressed interest in APD, I was “pushed” toward vestibular training instead). Over the years, the longer I worked as an audiologist, the more time and energy I seemed to be spending trying to AVOID APD, as I did not feel very smart with it and in fact, was scared of it. I had tried talks at the usual conferences but it all seemed too complex and daunting. I jumped on the nay-sayer bandwagon just so I would not have to deal with APD.
Years later I took a new job as an educational audiologist and during my first year there, I started getting very nervous again about APD. The referrals were starting to stream in from the schools, there was talk of audiologists being asked to sit in on IEP meetings when APD was involved, particularly in litigious cases. Yikes! I better get educated. Some time after that I saw some registration papers floating around for a 2 day training on the “Buffalo Model Approach to Auditory Processing” in Chicago. I didn’t know what Buffalo had to do with APD, but as long as someone promised to teach me about APD, I was in! Plus, the training was being hosted by another special education cooperative in the area so I figured at the very least, I’d likely be among my “own” and in my own city.
Day 1 in Chicago on the BM approach, there stood Jack Katz. Hmmm…he couldn’t be the same Katz from the “Katz book,” as we so affectionately called our “purple audiology handbook” in school. Right? Wrong. It WAS the same Katz. WOW! This was like meeting a movie star…only BETTER! By the end of Day 1, I was hooked on APD and hooked on Katz. I couldn’t get enough of this Buffalo stuff. My head was spinning (in a good way this time). “Simple and Effective,” Katz repeated over and over. Excellent! I love simple. After Day 2 it was time to return to work and share my newfound knowledge, expertise and excitement. Few caught my APD bug, however, but they were happy to let me “be the expert” and take all the referrals. So, I did. I bought the CBT for my clinic and the therapy book and materials I bought for myself, personally. Therapy would come later maybe for the job, but I wasn’t going to sit back and wait.
The referrals continued to come to me and I followed exactly what Jack told me to do with the BM tests. I did all 3 and carefully analyzed each. But with each case, I found myself emailing Jack asking, “well, what about this…and that..and what if…?” Jack responded to me each time and I was so grateful for that but I knew I needed more; something was still missing. I found too many blank spots in my memory of the 2 day training in Chicago and when I returned to my notes/slides, I was missing the details I felt I really needed now after using the 3 BM tests on many different children. I don’t play the lottery but my luck came in when Jack happened to mention to me about another 2 day training on the BM that was taking place in Kansas City. He offered me a spot in the “observation area” in his office if I wanted to see him doing therapy with some kids. It was a no brainer. I packed my bag and my husband and we drove to KC. I re-introduced myself to Jack and I also met Sarah Zlomke there as well. She, too, graciously offered me a spot in her “observation chair.” Oh!! Ok! Now I see BM in action with the experts! Let me try it. I went back and rearranged my office furniture just like Jack and Sarah had their furniture. (I’m still working on my Oscar look-alike.)
I did more and more evaluations. I was really getting the hang of it now. Except…yikes!! Everyone has APD? Is that true? Uh oh, am I doing it wrong? And what is this IX and IW on the summary sheet? Wait, what part of the brain is this and how bad is bad and…am I sure? How do I really know? Wait, here is someone who doesn’t look APD on the tests but he sure sounds like APD from the parent and school reports. What do I do with him? And this lead me to…ADVANCED SSW Workshop in HOTLANTA, GA! The third time is the charm…Jack will be able to make it all “simple and effective” again for me.
Day 1 in Atlanta. What? I missed the “observation seat” in Christa’s clinic???? Boo hoo. No problem, this life story about the SSW has me too engrossed to think about anything else. Chasing potential subjects that looked paralyzed and with a scar on the skull down the hall..?? Wow, this is good, really good. Now here comes the BRAIN talk. Uh, oh..did I mention I never took neuro either in school? Leave it to Jack to take the complex and put the “simple” in it. Ok, now let’s plug all those parts of the brain and brain function into the SSW. Voila! Site of Dysfunction test! BM categories. Academic/behavior problems. AND……TREATMENT! So..let’s do this.
Pick the right analysis (NOE, TEC, Traditional), look at all the qualifiers, don’t forget to adjust for young kids and difficult to test (split half rules) and gosh darn it…just GET IT RIGHT! By Hook or by Crook, Jack says.
Maybe the APD component is being underestimated. Maybe it is being overestimated. No worries. Do the treatment. “The proof is in the pudding.” Don’t be fooled and don’t dismiss it. Just do it…and don’t forget the jumping jacks, breaks and lots of humor.
Thank you for mentioning the Woodcock-Johnson.
The tests and treatment—the go together…
“Like rama lama lama ka dinga da dinga dong Remembered forever As shoo-bop sha wadda wadda yippity boom de boom Chang chang changitty chang sha-bop That’s the way it should be.”
Advanced in Atlanta filled in all the missing pieces. Reading about the SSW was like watching my favorite movie, “Somewhere in Time,” with Christopher Reeve. Except this was with Christa Reeves! Yes, sir, Dr. Jack, let’s protect the tests, the author, the audiologist, and the patient. Get the training! You will not regret it.
Thanks to all of my SSW friends for a fantastic, fun-filled, enlightening learning experience. I’m ready for more BBQ any time now!