by Jill E. Adaman, Ph.D.
Imagine the following scenario: It’s the first day of school, and Mrs. Smith is showing her second-grade students how to arrange their school supplies inside their desks. She draws a picture on the blackboard to demonstrate the proper placement for pencils, erasers, crayons, rulers, and other supplies. After a few minutes, most of the students’ desks begin to resemble the teacher’s diagram. But several students encounter difficulty. Johnny’s supplies have been carefully arranged on top of the desk, instead of inside it. Jennifer’s supplies are crammed into the left side of her desk, while the right side remains nearly empty. David’s desk contains a heap of jumbled supplies with no apparent organizational scheme whatsoever.
Although all three children have trouble arranging school supplies in the desk, the causes of their problems are quite different. Johnny and Jennifer show deficits in perceptual processing (the ability to interpret information they see or hear), while David shows deficits in executive functioning (the ability to manage complex information and carry out goal-directed behavior). To help each child, we need to understand the nature of their deficits and what kinds of compensatory strategies can help in each case.
Three levels of processing
The brain processes information at three levels. The most basic level is sensory processing, which involves the intake of information from the environment through one of the five senses. If one of the sensory organs or associated pathways does not function effectively, information is not transmitted to the brain. Blindness and deafness are examples of sensory processing deficits.
Once information is taken in by the senses, the brain must make sense of it in some way. This intermediate level of processing is called perceptual processing. There are several types of perceptual processing, corresponding to the various senses. For example, visual processing occurs when the brain takes in the information received by the eye and recognizes a pattern of darkness and light as letters or numbers. Auditory processing occurs when the brain takes in a sequence of sounds received by the ear, and recognizes it as a word.
Higher-level processing occurs when the brain uses the patterns recognized through perceptual processing to form new and complex combinations. One type of higher-level processing involves complex sequences of motor skills, such as learning to ride a bicycle or use a computer keyboard. Another type of higher-level processing, called executive functioning, involves complex sequences of thought. Executive functioning is the ability to combine ideas and organize one’s efforts to plan and carry out goal-directed behavior.
Let’s return to our classroom now, and let’s assume that Johnny, Jennifer, and David have no sensory processing deficits. What, then, is causing their difficulty in following the teacher’s instructions?
Auditory processing deficits
Johnny has a deficit in auditory processing. He hears sounds accurately and would have no trouble passing a hearing test, but he has trouble making sense of what he hears. He confuses similar-sounding words; when the teacher said to “arrange the supplies in your desk this way,” he heard “arrange the supplies ON your desk this way.” Auditory processing deficits can show up in other ways too. Young children with auditory processing deficits may mispronounce letters (e.g., throw/frow). Some people confuse the order of letter sounds or words they hear. Others become confused in noisy environments; they have trouble distinguishing between the information intended to be heard (e.g., the teacher’s instructions) from incidental noises (e.g., people talking in the hallway outside the classroom). Still others can accurately process information they hear, but their processing is very slow. Auditory processing deficits can significantly interfere with a student’s ability to understand and remember instructions given by parents and teachers, and with their ability to participate in conversations and social activities with others their own age.
People with auditory processing problems need information provided in short, easily understood steps. They often need oral information repeated, and usually benefit when a visual aid (such as a diagram or written checklist) is provided. They should be provided with ample “think time” when giving oral responses. At school, they need to sit away from noisy areas and close to the teacher. At home, it may help to use sound-absorbing materials such as carpets or draperies to block out extraneous noises. Parents should be sure to find a quiet place in the house before attempting to talk to the child about an important topic.
Visual processing deficits
Jennifer has a visual processing deficit. Her eyes work just fine and she would pass a vision test with flying colors, but she often has trouble making sense of what she sees. When she looked at the teacher’s diagram on the blackboard, she didn’t understand that the school supplies were to be distributed evenly throughout the space available inside the desk. When she looked at the supplies she had crammed into the left side of her desk, she didn’t seem to notice that her arrangement differed from the diagram on the blackboard. People with visual processing deficits have trouble understanding spatial relationships. They may confuse left and right, and they may get lost easily. When writing, their letters and numbers are irregularly spaced, and they may skip lines or omit words. When reading, they make mistakes because their brain interprets letters or words incorrectly. For example, they may read “pan” for “ban,” or “no” for “on.” This significantly interferes with reading comprehension. People with visual processing problems often misinterpret others’ facial expressions, and may have trouble with sports which require precise hand-eye coordination.
What will help students like Jennifer who have deficits in visual processing? In the classroom, they need to sit close to the blackboard and away from visual distractions such as windows or hallways. Worksheets should provide lots of “white space,” and visual cluttering of the page should be avoided. Students with visual processing deficits often benefit from using graph paper for writing and math; this helps them line up margins and numbers accurately. They may benefit from enlarged text, or from using colored transparencies when reading. Parents and teachers need to remember that these students often get confused when they see a page of written instructions. It will help to explain the instructions orally, help the student highlight or circle important words, and ask the student to repeat the instructions back to you before beginning to work independently.
Executive functioning deficits
David has a deficit in executive functioning. As noted above, executive functioning is a higher-level processing skill that enables us to make plans, set goals, and regulate our behavior until those goals are met. People with executive functioning deficits have no significant sensory or perceptual problems, but they have major difficulty combining bits of information to form organized thoughts and plans. Their thoughts tend to jumble together. They have trouble following instructions given by parents or teachers. When reading, they can’t form a mental “outline” of the material; it just seems like a lot of information without a beginning, middle, or end. When writing or talking, their thoughts jump from topic to topic. People with deficits in executive functioning have significant difficulty planning their approach to long-term projects, or managing their time at home and at school. They are often late to sports practices, forget their equipment, or can’t find things they need. Parents or teachers may misinterpret this behavior as careless or oppositional, when in fact the child is trying very hard to cooperate. Many people with executive functioning deficits also meet criteria for Attention Deficit/Hyperactivity Disorder (ADHD).
People with executive functioning deficits need explicit structure at home and at school. Complex tasks should be broken into small steps, with clear instructions and a well-defined time frame accompanying each step. Calendars and assignment books can help with time management, but the person must be shown how to use them and regular follow-up from parents and teachers is needed. Color-coding can help people with executive functioning deficits keep track of their possessions at home and at school. For reading assignments, making an outline or using the SQ3R strategy (survey the material by looking over headings and bold print, turn headings into questions, read the material to answer the questions, recite the material to yourself after reading it, review the text to check your accuracy) can be helpful. For writing, these students often benefit from using an outline or visual mapping strategy, and/or using a computer software program such as Kidspiration or Inspiration. For general problem-solving, the University of Kansas suggests the SMART strategy (set a goal, make a plan, attempt your plan, review your results, try something else if necessary). For students with ADHD, medication and/or behavioral strategies can help improve concentration and extend the attention span.
Accurate diagnosis makes the difference
As we’ve seen, students with deficits in perceptual processing or executive functioning often show similar symptoms: trouble understanding or remembering instructions, difficulty completing assignments independently, and trouble getting along with others. By carefully observing the pattern of accompanying behaviors and identifying the nature of the processing deficit, we can implement strategies to help students progress at a level that reflects their full capabilities.
Jill E. Adaman, Ph.D. is a licensed psychologist in private practice in Bryn Mawr, PA. Since 1994, she has specialized in the assessment of learning disabilities and ADHD. For additional information, please contact Dr. Adaman at 610-449-4014 or visit her website at www.drjilladaman.com.