Take the typical Dyslexic child. He will often be the Mr Fix-it in the class, the one behind the curtains making all the props in the school play and a whizz in I.T. BUT, he will be at least a reluctant reader and also a poor reader and speller. Try as his parents might to help him he simply cannot sound out words correctly, spells words as they sound, and his writing is minimalist and probably fairly illegible. What he needs is a phonics-based remedial language programme taught in a multi-sensory and by a Dyslexia knowledgeable teacher. These programmes are all carefully structured and go through all the letter and word families of the language in a cumulative and hierarchical way using touch, image, colour, sound and any other sense that be usefully invoked to strengthen memory. Some commercially available programmes are “Alpha to Omega”, “The Hickey programme”, “Beat Dyslexia”, “Sound Linkage”, “Toe by Toe”, “Units of Sound”, “The Arrow Programme”, “Lexica” or “Letterland”, which is particularly colourful and imaginative. There are also computer based programmes such as “Nessy Learning” and “Wordshark” but in the end it is more the skill and understanding of the teacher rather than the programme that counts.
The Dyspraxic or DCD child (Developmental Coordination Difficulty) stands out in the playground, mooching around by himself, because other children don’t want him in their games, he misses the ball, trips over things and generally slows things down. In the classroom he knows (and voices) all the answers but he too, can’t put these ideas on paper and might turn in two sentences on some subject he had previously held forth knowledgeably on. The best treatment for him is to improve his motor skills, either gross motor, fine motor or both. While various physiotherapy exercises seek to help hand/eye coordination in recording and writing a simpler solution is often to develop keyboard skills and use a word processor for written work. When words dominate the child’s mode of understanding the world they can be great verbalisers able to give erudite answers in the class room but because of their over reliance of words, sometimes do not notice or take account of non-verbal language, such as facial expression, body language or tone of voice. So they can be seen as a bit “black and white” in their thinking. Getting so over-enthusiastic about their subject they can ignore the normal “change the topic please” signals and go on and on excessively about their particular interest.
Thus games involving guessing a person’s intention such as mimes or watching good actors on TV can help them become more aware of others intentions and motivations. Asking questions about how an angry, happy, frightened, disappointed etc. would show that emotion in body language and tone of voice. Activities that involve hand/eye reaction (some computer games, marbles, darts, juggling etc) should be encouraged and also writing to music (or a metronome) and increasing the speed slightly over the practise sessions. There are also specialist centres using physiotherapy to improve muscles necessary for handwriting such as the palmar and plantar reflex – see www.inpp.org
Then there is the ADHD child who can be impulsive, always out of his seat, talking and distracting others, or the opposite – the dreamy, quiet child who just seems to sit and not able to raise the physical or mental energy needed to learn. The active child attracts friends with his dare-devil behaviour although most of them will disappear as soon as the teacher appears, but the dreamy child won’t have an admiring circle round them. They usually however make a few, but longer-lasting friends. Both do not match their intellectual ability with their attainments at school – even when both can read, write and calculate normally. These are all features of an underaroused nervous system which suggests an excess of low frequency brain waves that makes it difficult for the child to raise the physical or mental energy for a continuous or routine task. The best way to measure this is by a computerised continuous performance test of attention (the IVA – see www.braintrain.com) which measures the speed and accuracy of information processing under continuous conditions, and is based on DSM –1V criteria, of weak attention and a high level of impulsivity – and sometimes hyperactivity for the classic ADHD child anyway. The attention quotient measured by the IVA (or other similar measures such as the TOVA) is shown by research to the most sensitive predictor of attention span. While this is a short (20 minute) computer based test it is designed to simulate school conditions. Questionnaires such as the Connors or Brown rating scales are used by schools but these suffer the problem of lack of object.
To learn effectively the student must attend to the information. Unless the attention span is long enough to consign what is learnt to long – term memory, information is forgotten and new skills come slowly. When a task presents challenges it is easier to abandon it rather than persevere. The mental effort necessary to summon up for routine tasks can be insurmountable and the task, if completed is nevertheless slow. Thus teachers need to break the child’s work down to coincide with their attention span – so that all tasks are broken into sub-goals, each with a “completion” in sight that the child can keep in mind. This allows fast feedback which will help maintain the chemistry of motivation. Small steps towards these goals, every day, with planned success and positive reward with allow the development of some mastery over their learning. Giving rewards and consequences to shape behaviour helps develop motivation. The principle is to build in rewards after each completed goal which can be withdrawn for non-completion or refusal. Useful accommodations which should be included in her IEP are outlined in “Understanding and Managing Children’s Classroom Behaviour” by Sam Goldstein (Wiley Interscience)
Teaching style is important, with short, intensive periods of information, interspersed with humour, activity and supported by visual aids is the best means of delivering information to children with attention problems.
Changing colour of files and pens for each subject helps establish a concentration on that subject (eg red for history and so on). Seating the child near the source of the information and away from distraction is an obvious strategy, and sometimes a “privacy board” can help concentration, although this needs careful thought. On the one hand it cuts down distraction but on the other hand if badly situated it can be socially isolating and also prevent the child hearing the teacher. Light ear plugs, muffs or noise cancelling headphones can cut down auditory distraction so long as the child can still hear the teacher.
If the school could provide it, having an overall mentor to whom the ADHD or ADD child could go every day at a designated time to show her work books, plans for finding our more or any homework and to review the day, discussing which attention techniques worked best and making a daily record in a “Learning Diary” would help. The child is helped to summarize key points after each class, writing them down in ways they understand (diagrammatically) and build these points over the weeks into a coherent theme, rewriting these, using colour highlighting, diagrams, pictures etc. until they have the information in a sufficiently tabulated form in memory to be able to hold it in mind while writing.
For the most severely inattentive children a cognitive monitoring system, where the child has a schedule stuck to his/her desk with set periods written in – say every 5/10 minutes of the school day. A bleeper (many watches do this) sounds every 5 minutes and the child writes on his/her schedule key points about the information they were listening to. There is also a specialised device for this, a non-audible training watch, which can be pre- programmed with text messages see (www.watchminder.com and “motivate” from Ann Arbour ).
An American programme www.whytry.com helps to develop motivation, planning and awareness of consequences. This could be delivered by specialist teachers from ADISS – a voluntary organisation dedicating to helping children with attention deficits.
Movement is one of the means of stimulating attention via its influence on Dopamine, the presumed deficit in ADHD/ADD so encouraging involvement in sports will also help. In fact, activity involving movement in between information helps all children, refocus so wherever possible some sort of short class activity between school activities will help. For older children it should be possible to work out a “time out” system so that when the child feels they cannot maintain attention any longer, they hold up the card (unobtrusively) and the teacher allows her/him to go outside for one or two minutes, where she/he can run/jump or skip safely and then return to the classroom, with attention revived. This system would have to be understood by the child who should have some sort of timer that will allow them to return in the specified time.
Several nutritional supplements, DHA & EPA found in fish oil (Omega 3), and tyrosine, an amino acid that is the precursor molecule to Dopamine, the presumed neurochemical that is deficient in individuals with attention and concentration difficulties have been found to help attention and learning. Other therapies such as neurofeedback are successful.
The Asperger’s child also stands out, not only in the playground but anywhere there is a group interacting – in the classroom or assembly. Their main problem is getting on with others. The unwritten rules of social behaviour that children learn so quickly are not obvious to the Asperger’s child. He finds it hard to have a normal give and take relationship. He often can’t tell whether another person is felling angry, upset, tired, happy or stressed. Their anxiety means they need to have a familiar environment, they like routine and are resistant to change. They are frequently targets of bullying and cut lonely figures in the playground. Because they find group interaction difficult they usually seek to work alone or with an adult or child who is uncomplex or sympathetic. Because they are unable to generalise easily and adapt to new and variable situations and learning the Asperger’s child sometimes has a maladaptive reaction to new social situations since he is unable to understand all the requirements of social interaction. They need to more become aware of the non-verbal aspects of social interaction. It is this that allows perception of others motivations, which is the basis of empathy and co-operation. An over emphasis on words at the expense of body-language and emotional tone of speech leads to a literality, which is perceived as lack of social sensitivity.
Games involving the detection of emotional states from facial expression, body language and tone of voice will help. See the LDA catalogue for “Social Sequences”, “Photo Emotions” games and “Photo adjectives” – that will encourage a more expressive, less literal language. Point out occasions when people demonstrate emotion or emotional conflicts i.e. a person who really wants to say no, agreeing. Ask the child to comment on people they come into contact with after they have demonstrated some emotion. Get them to draw and colour anxious, sad, angry, happy etc. people. Discuss the symbolic associations of colour and how they might represent emotional state. There are social skill board games that the whole family can play. A valuable exercise would be videotaping the child in social interaction and showing this to him/her, pointing out how others perceive this and how it can be changed. Role-plays of potentially frightening situations (asking another child to stop etc.) at home could alleviate anxiety, the more a frightening situation is discussed, practised and alternatives generated the less fearfully anticipated it will be. It is important to maintain exemplar conversations at home, with co-operative turn taking observed, continuance of the topic, elaborated conversational “repair” mechanisms observed, scrupulous attention to another’s topic and so on.
Asperger’s Syndrome is the mildest and highest functioning end of the spectrum of autistic disorder. The Diagnostic Manuals list the symptoms as an impairment of social interaction, restricted, repetitive, and stereotyped patterns of behaviour, activities and interests, social impairment with extreme subjectivity, limited interests and preoccupations, repetitive routines and rituals, sometimes speech and language peculiarities, usually non-verbal communication problems and some motor clumsiness.
At school teachers should try to keep classroom routines as consistent, structured and predictable though they must be clear and explicit. It would be helpful to the Asperger’s child for the teacher to connect their teaching to the child’s interests, using visual material (pictures, charts etc.) and trying to keep the concepts as concrete as possible – avoiding figurative speech, idioms and so on. Good teaching would also require trying to anticipate when anxiety will lead to a melt-down and then avoid the build-up. Either designating a teacher to whom the child can go when they become overwhelmed or finding a mature child who might “look out” for the Asperger’s child in the playground will help prevent them getting into a state of panic.
Most children with mild Asperger’s syndrome manage life quite successfully, especially if they are able to be educated to a normal level, or have particularly pronounced artistic or musical ability. The major deficit in Asperger’s syndrome is not understanding social rules (which are unwritten) and these then have to be taught, just as other children need to be taught literacy . A normally intelligent child is quite able to learn these even though he does not have an intuitive understanding of them. Thus there will always be an element of over-rationalisation to his emotional interactions, since he/she will be acting on learnt cortical knowledge rather than feeling “heart” knowledge.
Learning to put together cause and affect means the Asperger’s child can understand the higher order social concepts – that co-operation benefits all, that people have feelings that dictate their actions, etc. even if they don’t accept this emotionally. Learning to understand the perspective of others is taught by modelling and role play in social groups. Then he/she can “join up” this disparate knowledge and come to a better understanding of social interaction. The area of most concern for such a child is the necessity for more and more appropriate social interaction as they move through school. This is the area most out of their control. More social interaction will be forced on him which will be frightening to him. Thus preparation is essential – familiarizing him or her with the route, the building, the children and teachers and so on. Allowing the child to shine through their non-verbal skills will help their self-esteem greatly and also help other children perceive them positively. Children fearful of social interaction are then better able to apply these psychological concepts to others and realise that others act in an orderly predictable way and that their actions can affect that. This is probably the most important lesson to learn. There are Asperger’s groups in the U.K. that use programmes to develop self and other awareness and run regular social skills groups which would do help the Asperger’s child.
WHO:
There are charities offering information and support for each of these specific learning difficulties;
The British Dyslexia Association www.bdadyslexia.org offer Information, training courses, assessments, books and useful products, webinars, conferences and help ( check frequently asked questions section before phoning the helpline which is 0333 405 4567 The Helpline Opening Hours are Monday-Friday: 10am-1pm and 1.30pm-4pm and Wednesday: 10am-1pm )
The Dyspraxia Foundation www.dyspraxiafoundation.org.uk offers information, courses, books and useful products and has a helpline 01462 454986
The National Autistic Society www.autism.org.uk is a large, active website offering information and advice on Autism, Asperger’s syndrome, Pathological Demand Avoidance and related conditions. This is available to people with autism spectrum disorder and their families and carers. Helpline is 0808 800 4104 10am to 4 pm Monday to Friday. This organisation supports research, runs courses and conferences and reports new insights from research.
The National Attention Deficit Disorder Information and Support Service www.addiss.co.uk – offers advice, training, courses, useful books and products 020 8952 2800.