Common Learning Challenges in Sensory 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.

What Kinds Of Memory Do We Have? 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 Information Does Long-Term Memory Retain?
Declarative Memory: Facts about the world. 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.

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

The Link Between SPD and Procedural Learning:
Same List of Cognitive and Learning Challenges
• • • • • • • 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);

Neurologically, What Links SPD and Procedural Learning? Answer: Cerebellar Dysfunction
Senses Motor Spatial Interoceptive (Organs) Limbic / Emotional Language Automaticity
When the cerebellum’s working hard, you don’t have to... Cerebellar Cognitive Affective Disorder: “Dysmetria of Thought”
Dr. Jeremy Schmamman, Harvard

Risk Factors for for 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

Cognitive/Learning Issues Besides Basic Skills: 1. Attention and Working Memory

• 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.

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

Sensory Input
Attention

Visual Auditory Cerebellar / Proprioceptive Sensory-Motor

Output

Pattern Processing Memory & Learning

SPD in the Classroom

Reading

Math Writing

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

Visual Demands of Reading

Scholarpedia

Visual Functions and Reading
Smooth eye movements for reading Eye saccades or jumps to switch between lines Focus adjustment near and far Visual recognition of letters and whole words

Flickr.com/Josh Liba

Auditory Processing & Reading
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

Flickr.com/JKoenig

Interventions for Reading
Multisensory 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 Writing

Automaticity 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…”

Depression Severe Behaviors School Withdrawal Suicidal
Flickr.com/nao.k

Examples of Dysgraphia in Students with SPD

Dysgraphia and SPD

Impaired Motor Automaticity

Control

Cerebellar Degeneration
(Critchley)

SPD

“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 Technology THERAPY Fine motor / Upper Girdle Strengthening Kinesthetic Strategies – Air Writing / Imagery / Verbal Automaticity Practice – over-learning LANGUAGE Template prompts, imitation, writing tutor Expressive language work – SLP Assistive software
Flickr.com/cowtools

Assistive Technology

Word 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, Time Math Facts

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

Sensory Contributions To Attention

Visual Overload Visual Mistakes Poor eye contact Lazy eye Worksheet Errors
Lazy eye, birth, dyslexia

Tunes Out ‘Visual Learner’ Trouble with Instructions

Poor Posture Bodily Distractions Fidgety, Hyperactive Poor Hands-On Learners
Birth, preemie, ADHD, dyslexia

Preemie, dyslexia, ADHD

Visual Crowding

This is hard.

Visual Crowding

This is hard.

More whitespace.

This is easier.

Auditory Attention in the Classroom
Fan, Projector

Students Talking
Distracting Noise

Teacher Speaking
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

Divided Attention

Less Listening When Seeing
http://www.indiana.edu/~cnilab/multiorder.pdf

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 Survey
Sensory Processing Disorder and Learning
© Eide Neurolearning Clinic 2010

Visual

Auditory

Proprioceptive / Cerebellar

Attention

Visual overload Careless mistakes Distracted by visual details

Tunes out with listening Missed instructions Distracted by sounds

Fidgets / sensory seeking Flops, poor tone Trouble multi-tasking

Memory

Problems learning letters, spelling mistakes Trouble with graphs and other visual learning

Problems remembering what's been heard Mispronounced words, Word substitutions Phonics and rhyme problems

Poor procedural memory

Reading

Skipped words

Poor reading fluency

Lose place Eyes close to page Misreads questions Writing / Speech Large messy handwriting, eyes close to page

Wild guesses with words Avoids reading

Phonetic errors in writing and speech - dropped letters and sounds Very poor spelling

Irregularly formed letters (impaired automaticity), overload errors Visual monitoring of writing

Spelling mistakes

Reversals

Trouble retrieving words

Reversals

Sensory Learning Survey
Sensory Processing Disorder and Learning
© Eide Neurolearning Clinic 2010 Visual Math Problems with crowded worksheets Skipped problems Auditory Proprioceptive / Cerebellar Mistakes counting fingers, poor approximation Unable to do multi-stepped problems Poor back-and-forth conversation Poor back-and-forth conversation

Speech / Socialization

Interrupts conversation

Problems hearing in background noise Mispronounced words

Awkward speech – self-editing (fluency)

Problems learning a foreign language
Word finding problems Play / Socialization Retreat from crowded Misses visual signals in sports Retreat from crowded Trouble assemblies, gym, echoing rooms Can't hear in PE or music Retreat from crowded Unexpected falls, leaning on children in line Bad at sports – multitasking, timing

Impaired depth perception

Join Us on Facebook Facebook/SensoryProcessing Neurolearning.com DyslexicAdvantage.com
The Dyslexic Advantage is coming Fall 2011
Sensory DVDs Amazon.com

Flickr.com/Inoc

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