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Larry Medwetsky, Ph'D'


Informal observation of comprehension of sentences when stress and intonation are varied ... Observe intonation and stress patterns during a variety of language ... – PowerPoint PPT presentation

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Title: Larry Medwetsky, Ph'D'

An Interdisciplinary Approach to
Assessing/Managing CAPD
Larry Medwetsky, Ph.D. VP, Clinical
Services Rochester Hearing and Speech
Center 585-271-680 x 245 Laur
a Riddle, Ph.D. Assistant Professor Department
of Communication Sciences and Disorders
Nazareth College 585-389-2442

Overview of Presentation
  • Overview of Processes Engaged in Spoken Language
  • Assessment of the Various Processing Domains
    (Audiology and SL Procedures)
  • Management of Processing Related Difficulties
  • Specific Techniques
  • Environmental Modifications/Compensations
  • General Compensatory Strategies

Overview of Processes Engaged in Spoken Language
  • Transduction
  • Acoustic stimuli undergo many conversions,
    ultimately resulting in neuroelectric impulse
    patterns that convey intensity, frequency,
    temporal, intonation/amplitude contours, phase
  • Pattern Matching (Decoding)
  • The neuronal impulses are relayed via the Central
    Auditory Nervous System to the higher order
    language processing centers in the Cortex and
    stimulate various neuronal combinations
    prototypes in long-term memory (LTM).

Decoding- contd Language cortical neuronal
regions include - the language centers in the
brain (for _at_ 95 of the population, this is
in left hemisphere) - the rhythmic
processing areas of the brain (for _at_ 95 of
the population, this is in the right
hemisphere) The above occurs because the rapid,
short duration information is processed/analyzed
by neurons in the left hemisphere, while the
slower, longer duration information is analyzed
by neurons in the right hemisphere.
Short-Term/Conscious Memory Neurons in LTM are in
a resting state. Stimulation of the various
neuronal synapses/connections results in
activation of these neurons, and, if sufficient
attention is allocated, results in conscious
awareness of the item (short-term/working
memory). Integration Somehow, the derived
segmental information from the left hemisphere
language region is integrated with the derived
suprasegmental information from the right
  • Attentional Allocation
  • This is the process whereby the brain determines
    which information to focus on and which to
    ignore. This is because humans are limited to
    how much they can process and attend to at any
    one point in time.
  • Attentional allocation is important for
  • initial priming/excitation of neurons engaged
    in processing of selected information
  • maintenance of neuronal firing to maintain
    information in short-term memory
  • selectively attending to target stimuli in the
    face of competing stimuli
  • switching of attention when multi-tasking,
    thus, maintaining neuronal firing for multiple

  • Short-Term Memory (STM) Span
  • STM span refers to the maximum number of units/
    chunks that an individual can maintain and
    recall. It is based on the maximum of neuronal
    regions that can be maintained in an active
    firing state.
  • Neurons can remain in an active firing state for
    1-2 seconds, unless some sort of stimulation
    attention is directed to that neuronal cluster,
    resulting in renewed activation prior to
    returning to its resting state.
  • Recent research suggests that the maximum limit
    is 4-5 neuronal regions firing at a time.
    Chunking allows for bigger sized units (e.g., 7
    digit phone number cab be grouped into three
    chunks /271/ /06/ /80/.

  • Sequencing
  • The part of the brain that directs attention
    Pre-Frontal Cortex also somehow maintains the
    sequence in which the information has been
    processed (be it in the receptive or output
  • Selective Attention
  • This refers to the ability to focus on a target
    stimulus and to ignore competing stimuli.
  • When the competing stimulus consists of
    non-linguistic noise, the brain analyzes the
    different acoustic characteristics and attempts
    to filter the speech from the noise

  • Selective Attention- contd
  • When the competing stimuli consists of speech
    (e.g., group listening settings), the brain uses
    spatial cues, fundamental pitch contours, etc.,
    to perceptually separate the incoming information
    and then allocate attention to the source of
    interest and ignore or block the competing
  • Divided/Shared Attention
  • The ability to process and activate two or more
    neuronal regions simultaneously some tasks may,
    in fact, involve fast switching rather than
    simultaneous processing (e.g., note-taking) but
    this still requires more information to be
    processed per unit time.

  • Phonological Awareness
  • Over time, if everything develops normally an
    individuals brain derives and stores the
    phonological codes for that language, manipulate
    the phonemes (e.g., deletions, substitutions,
    additions, etc.), and, learns the written
    symbolic code that represents the phonemes in
    their language (i.e., phonics).

Interdisciplinary Assessment of Processing
  • Role of the SLP
  • Use the results of the Auditory Processing
    Evaluation, as well as the presenting
    difficulties, to guide assessment
  • Note it is possible that an SLP may
    initially have conducted a basic language test
    battery but subsequent to an auditory processing
    evaluation may conduct further testing based on
    the new results obtained.

Phonemic Awareness
  • Audiology Phonemic Synthesis Test
  • Phoneme Blending Test
  • Stimulus items are presented 2 seconds apart
  • 3-4 phoneme words
  • SLP (most of time) Lindamood Auditory
    Conceptualization Test-3
  • Discrimination of speech sounds
  • Analyzing the number and order of speech
  • Tracking speech sound changes at both the phoneme
    and syllable levels

Phonemic Awareness
  • SLP More in-depth assessment of phonemic
  • Standardized Tests
  • Comprehensive Test of Phonological Processing
    (CTOPP) (Wagner et. Al., 1999)
  • Elision, Sound Blending, Sound Segmentation
  • Blending and Segmentation of real and nonsense
  • Rapid Naming (letters, digits, colors, objects)
  • Phonological Working Memory (non-word repetition)

Phonemic Awareness
  • SLP More in-depth assessment of phonemic
  • Phonological Awareness Test-2 (PAT-2) (Robertson
    Salter, 2007)
  • Rhyming, syllable blending and segmentation,
    sound isolation, sound blending and segmentation,
  • Letter-sound knowledge
  • Non-word Decoding

Phonemic Awareness
  • SLP More in-depth assessment of phonemic
  • Standardized Tests
  • Pre-reading Inventory of Phonological Awareness
    (Dodd, et. al., 2003)
  • Rhyming, syllable segmentation, alliteration,
    sound isolation, sound segmentation
  • Letter-sound knowledge

Phonemic Awareness
  • SLP Standardized Tests assessing 1-2 skills
  • Phonological Awareness Skills Program Test
    (Rosner, 1999)
  • Deletion, substitution
  • Test of Phonological Awareness (Torgesen
    Bryant, 1994)
  • Sound Matching initial, final

Phonemic Awareness
  • Phonemic Synthesis vs Phoneme Blending (CTOPP)
  • Often see inconsistent results but are they
  • inconsistent?
  • Difference between tests
  • Length of Inter-stimulus interval (_at_ 2
    secs vs 1 sec apart)
  • Live ( lipreading) vs taped voice
  • Shorter vs longer words

Phonemic Awareness
  • Phonemic Awareness Error Patterns
  • Position of sound in word
  • Type of sounds, e.g., blends
  • Number of sounds in the word
  • Nonsense vs real words
  • Response delays

Audiological Determination of Lexical Decoding
Speed Difficulty
  • Background
  • Individual requires more time to process and
    match stimulus to what is stored in LTM.
  • Staggered Spondaic Word Test
  • Non-Competing Competing Non-Competing
  • Right Ear Up Stairs
  • Left Ear Down Town
  • A pattern indicating decoding speed difficulty is
    more errors on second spondee (due to slow
    processing, attention too long on first spondee,
    and, thus neuronal representation of second
    spondee fades away).
  • For sentences if decoding speed is the primary
    difficulty, may see more word errors at the end
    of the sentence

Lexical Decoding Speed
  • SLP Testing (ruling out knowledge issues)
  • Semantic Skills
  • Vocabulary, Antonyms, Synonyms, Multiple Meaning
    words, Word Definitions
  • PPVT-4, EVT, LPT3, Word Test2-E, CELF-4, CASL
  • Morphology/Syntax
  • CELF-4, TOLD-P3, Language Sample

Lexical Decoding Speed
  • SLP Testing
  • Morphological Awareness
  • Spelling lists of words that are morphologically
    different (e.g., kicked, gladly)
  • Cloze procedures produce a derived word
  • Word judgment tasks
  • Suffix addition tasks
  • Masterson Apel, 2000

Lexical Decoding Speed
  • SLP Testing
  • Word Retrieval Ability
  • Single-word level
  • Test of Word Finding-2 (German, 2000)
  • Discourse level
  • Test of Word Finding in Discourse (German, 1991)
  • Language Sample with maze analysis Story retell
    and conversation

Lexical Decoding Speed
  • Word Retrieval Difficulty
  • Revisions
  • Repetitions of words or parts of words
  • Word choice errors (substitute one word for the
    target word)
  • Word omissions
  • Pauses/delays within utterances

  • Miller, 1991

  • Background
  • Individual is unable to allocate attention
    effectively, consequently earlier presented
    information fades rapidly from short-term memory
  • Staggered Spondaic Word Test
  • Non-Competing Competing Non-Competing
  • Right Ear Up Stairs
  • Left Ear Down Town
  • Individual has more errors on the first spondee.
  • Also, if individual cant blend on fly, then on a
    phonemic blending task may see more errors on
    earlier phonemes
  • If predominantly fading-memory difficulty, on
    sentence recall individual exhibits more errors
    on earlier sentence portions.

Short-Term Memory Span Assessment Background
STM Span refers to of units that can be
recalled by an individual, usually assessed in
serial fashion. Test of Auditory Processing
Skills examines three different
stimuli Digits Unrelated Words
Sentences The first two tests are rote-memory
tasks (minimal context present), while sentence
recall engages syntax, semantic relations, world
knowledge, prosody.
Possible STM Span Patterns
  • Results on all three tests within normal limits
    (WNL) either no or minimal processing issues
    (though still may exhibit phonological awareness
  • Results on all three tests significantly below
    age norms significant processing difficulties,
    likely impacting on basic language skills
  • Difficulty on digit/word STM span, WNL for
    sentences (likely processing related issues and
    is the most common finding at RHSC Audiology)
  • WNL for digits/sentences, difficulty with words
    (lexical decoding speed likely the major issue)
  • WNL for digits/words, poor sentence recall
    (likely language disorder)
  • WNL for digits, significant for words/sentences
    (typically observed in individuals with

Short Term Memory
  • SLP Testing
  • Phonological Working Memory
  • Non-word Repetition Tasks
  • CTOPP (Wagner et. Al., 1999)

Integration Audiological Signs
  • Background
  • Individual is either unable to integrate right
    and left hemisphere information, or, reveals
    right ear dominance on competing stimuli tasks
  • SSW Test
  • Significant Left Competing finding (relative to
    peers, significantly more errors than in the
    other conditions )
  • Competing Sentences Test
  • Significantly poorer left versus right ear
    selective attention recall score relative to
  • Pitch Pattern Sequences Test
  • Verbal labeling of thee tone sequence is
    significantly poorer than non-verbal (hummed

  • SLP Testing
  • Prosody
  • Difficulty processing prosodic cues
  • Informal observation of comprehension of
    sentences when stress and intonation are varied
  • Structured tasks of processing vary the stress
    on words and determine number of units being
    produced (Wells Peppe, 2003)

  • SLP Testing
  • Prosody
  • Difficulty processing prosodic cues
  • Emotional Prosody observe response to words
    conveyed with different emotions
  • Difficulty producing prosodic cues
  • Observe intonation and stress patterns during
    a variety of language sampling conditions

  • Figurative Language
  • Idioms, similes, metaphors, proverbs, humor
  • Interpreted using contextual cues, situational
    cues and mental imagery (Nippold Duthie, 2003)
  • Standardized tests can be used
  • Informal tasks better option
  • Interpret meaning of figurative expressions
    commonly heard within environment

  • Conversational Skills
  • Individual must attend to facial expression,
    body language in addition to oral language to
    interpret messages
  • Individual must divide attention to accomplish
  • Conversational samples in both paired and
    group settings

  • Conversational Skills
  • Analyze topic initiation, topic maintenance and
    turn taking skills
  • Analyze ability to look at partner, respond with
    appropriate facial expressions
  • Analyze pre-suppositional skill takes listener
    perspective uses clear referents
  • Analyze repair strategies
  • Analyze response delays

  • Sequencing
  • Staggered Spondaic Word Test
  • Non-Competing Competing Non-Competing
  • Right Ear Up Stairs
  • Left Ear Down Town
  • Individual has to recall at least three of the
    four words. Examples of sequencing errors may
    be /Up-town/ /Down-Town/
  • The Lindamood Auditory Conceptualization-3 test
    involves significant sequencing ability on three
    of their tasks, and, it is likely that for many
    children with phonological awareness difficulty,
    it may be due to higher order mental
    manipulations of phonemes/ syllables involving
    sequencing difficulties.

  • Oral Directions
  • Token Test for Children-2 (McGhee et. al., 2007)
    CELF-4 (Semel, et. al., 2003)
  • Assess informally within classroom
  • To assess sequencing, child must have the
    concept knowledge

  • Narrative Language
  • Story Generation and Story Re-tell
  • Test of Narrative Language (Gillam
  • Pearson, 2004)
  • Analyze for story grammar, cohesion,
  • inference

  • Written Language
  • Skills needed
  • Planning and organizing
  • Drafting
  • Revising and editing
  • Knowledge of text structure (narrative,
  • Language knowledge discourse, sentences, words
  • Writing conventions

  • Written Language
  • Standardized writing tests (TEWL-2
    TOWL-3 OWLS Written Language Scale)
  • Authentic assessment approaches (informal
    assessments examining writing samples)

Reading and Spelling
  • Reading Assessment
  • Word Recognition Skills
  • Word Identification (sight reading)
  • Word Decoding (decode nonsense words)
  • Woodcock Reading Mastery Tests-Revised
    (Woodcock, 1987)

Reading and Spelling
  • Reading Assessment
  • Text level reading
  • Accuracy (words read correctly), rate, fluency
  • Reading Comprehension
  • Gray Oral Reading Test-4 (Weiderholt Bryant,
  • Gray Silent Reading Test Weiderholt Blalock,

Reading and Spelling
  • Reading Assessment
  • Reading Miscues
  • Insertions, Omissions, Substitutions
  • Self corrections and Repetition
  • Analyze for syntactic acceptability, semantic
    acceptability, graphic similarity, sound
    similarity, self-correction
  • Reading Miscue Inventory (Goodman, Watson
    Burke, 1987)

Reading and Spelling
  • Spelling Assessment
  • Test of Written Spelling (Larsen, et. al., 1999)
  • Spell Performance Evaluation for Language and
    Literacy (SPELL) (Masterson, et. al., 2002)
  • Identifies underlying linguistic deficits in
    phonemic awareness, orthographic knowledge,
    vocabulary, morphologic knowledge and mental
    orthographic images

Selective Auditory Attention Tests
  • Background
  • Individuals with processing issues are at great
    risk for difficulty hearing in background noise
    (surrounding non-linguistic noise, group
  • Speech-in-Noise test speech embedded in shower
  • Competing Sentences Test listen to/recall
    sentences in one ear and ignore sentences in
    other ear (binaural separation)

Divided Auditory Attention Tests
  • Background Individuals may break down when
    required to share attention among different
    stimuli/multi-task (e.g., note-taking)
  • The following are organized by level of
  • Dichotic Digits Test recall paired digits from
    both ears
  • Competing Word/Spondee tests recall both
    competing words
  • Competing Sentences Test recall both competing

Temporal Resolution
  • Background
  • Individuals with phonological awareness
    difficulty may have an underlying difficulty of
    temporal resolution (though at older ages, this
    may have become normal but still residual
    phonological awareness difficulties.
  • Random Gap Detection Test one or two tones
    (separated by varying degrees of minimal gap
    between two tones) and indicate if heard one or
    two tones.
  • Gap-in-Noise Test Determination of the smallest
    gap threshold within embedded noise that an
    individual can detect at least 66.7 of the time.

Management Techniques
  • Does knowing the results of CAP testing inform
    our practice?
  • Is there a relationship between CAP and language
    testing and a childs functioning at school or
  • Does therapy with children with CAPD differ from
    children with language impairment?

General Management Language Processing
  • Gillam, et. al., (2002, p. 43)
  • … good language intervention is
  • also good information processing intervention.

General Management Techniques Listening
  • Determine purpose of listening
  • Focus attention on topic
  • Orient to features of the text
  • Assess background knowledge
  • Use graphic organizers
  • Use text with simpler language at first
  • Use questions/key words
  • www.

Listening Comprehension
  • Make predictions
  • Make inferences
  • Keep writing to a minimum while listening
  • Use visuals
  • Teach child to monitor comprehension
  • Teach child to ask for help
  • www.

Specific Management Techniques
  • Listening in Noise
  • Type of noise
  • White noise, instrumental music, music with
    words, cafeteria noise, competing speakers,
    monologue (Tillery Cinotti, 2008)
  • Processing Power (Ferre, 1997)
  • Increase loudness in increments
  • Vary the complexity of the listening task

Phonemic Awareness
  • Purpose is to facilitate reading and spelling
  • May improve working memory/lexical decoding speed
  • Teach segmenting and blending
  • Teach in conjunction with letters
  • Focus should be at the phoneme level

Phonemic Awareness
  • Treatment Options
  • Computer programs
  • Fast ForWord Step ForWord
  • Earobics
  • LocuTour Multimedia Literacy
  • (Gillam, 2008 Medwetsky in Geffner Swain,

Phonemic Awareness
  • Treatment Options
  • Structured Programs
  • Road to the Code
  • The Phonological Awareness Kit-Primary
  • Lindamood Phoneme Sequencing Program
  • Informal activities

Phonemic Awareness
  • Transfer phonemic awareness to reading and
  • Work on word decoding skills
  • Closed Syllables
  • Single syllables (increasing from 3 to 6 sounds),
  • Vowel-Consonant-e Syllables
  • Open Syllables
  • Wilson Reading
    System (Wilson, 1988)

Phonemic Awareness
  • Transfer phonemic awareness to reading and
  • Word Sorts by different patterns (e.g.,
    short vowels, blends, etc.)
  • Word Families (onset rime)
  • Read words in sentences and paragraphs

Lexical Decoding
  • Semantic knowledge
  • Semantic mapping
  • Depth of word knowledge
  • Antonym/synonyms multiple meaning words, word
  • Strategies for learning unknown words
  • Context cues, identify word roots

Lexical Decoding
  • Teach child to use context cues Use series of
    cloze sentences
  • Provide series of cues that progressively provide
    more information
  • Example
  • I went to Disney World and rode_______.
  • I went to Disney World and rode_______. It went
    very fast.
  • I went to Disney World and rode sp____. It went
    very fast
  • I went to Disney World and rode spa____. It went
    very fast.
  • (technique adapted from Gillam Gorman

Lexical Decoding
  • Syntax knowledge
  • Identifying parts of speech
  • Paraphrasing concepts
  • Formulating sentences with key words
  • Sentence combination tasks

  • Scott, 1995

Lexical Decoding
  • Word Retrieval (German, 2005)
  • Retrieval strategies
  • Phonetic cues, semantic cues
  • Self Advocacy
  • Accommodations
  • Extended time, multiple choice exams, cue cards
    with key words and prompts

Working Memory
  • Phonemic awareness activities
  • Improve language knowledge
  • Active Listening promote attention
  • Strategies for older children

Working Memory
  • Memory strategies (rote)
  • Rehearsal chunking
  • Mnemonics
  • Visualizing
  • Memory strategies (sentence/discourse level)
  • Paraphrasing and organizing information
  • Cues such as key questions or words, summaries or
  • Visualizing
  • Montgomery, 2002 Gillam Hoffman, 2004

  • Narrative language
  • Sequence events temporally and in cause-effect
  • Organize events into story grammar
  • Story maps and flow charts
  • Scaffolding using key questions

  • Narrative language
  • Story maps, story frames, story grammar cues and
    story prompts (see Roth, 2000)
  • Use oral and written narratives
  • For older children recognize text structure when
    reading to enhance reading comprehension

  • Prosody
  • Modify prosodic aspects of input to children
  • Higher pitch level with exaggerated
    variability in pitch
  • Increased loudness
  • Slower rate
  • Gerken
    McGregor (1998)

  • Prosody
  • Determine meanings of words based on syllable
  • Become aware of pauses corresponding to clausal
  • Probably one of the most important areas in
    processing needing research

  • Figurative Language
  • Strategy based intervention
  • Teach figurative expressions within a context
  • Contrast literal to non-literal meaning
  • Explicit teaching of contextual cues
  • Role-playing scenarios in which the expressions
    can be used
  • (Abrahamsen Smith,
    2000 Power et al., 2001
  • Norbury, 2005
    Paul, 2007 Nippold, 1991)

  • Figurative Language
  • Use forms in a variety of spoken and written
  • Teach the communicative function of expressions
  • Keep notebook or journal and record expressions
    heard include contextual information

  • (Abrahamsen Smith, 2000 Power et
    al., 2001
  • Norbury, 2005
    Paul, 2007 Nippold, 1991)

  • Conversation
  • Topic initiation and maintenance
  • Appropriate change of topic
  • Clarification requests
  • Clear referents
  • Teach one aspect of conversation at a time
  • Teach rules of conversation
  • Use conversational/social scripts
  • Pay attention to prosodic cues, facial
    expressions and body language

  • Comprehension Monitoring
  • Understanding learning styles strengths and
  • Strategies for getting help
  • Ask for what you need, tell someone you are
    having trouble

Environmental Modifications/ Compensatory
  • Modification of Listening Environment
  • The goal is to reduce noise levels and
    reverberation (echoing). Examples include
    carpeting, acoustically treated tiles, drapes,
    balls/sliders on chairs, etc.
  • Overhead Projectors/Power Point Presentations
  • These allow for speech-reading, increased talker
    loudness (projecting forward allows for increased
    talker intensity), while still providing for a
    visual reference to information at hand. Both of
    these techniques are better than the blackboard.
    For middle and high school, power point
    presentations allow for accompanying handouts
    (3 slides/page with adjacent lines to take
    notes), while overhead projector allows for

  • Provision of Instructions
  • Instructions should be provided when there is
    little commotion (such as students preparing to
    leave for recess/lunch or when going home). If
    assignments are on the blackboard, the teacher
    should allow the students to write instructions
    down before elaborating on the assignments. For
    those with severe organizational skills, teacher
    check of agenda or provision of written homework
  • Use of Earplugs
  • The use of earplugs in test taking or quiet study
    times may allow the student to better focus on
    the material at hand without using mental
    resources to block out external stimuli.

  • Test-Taking in a Separate Room
  • This can minimize the amount of noise and less of
    a psychological need to rush in order to finish
    at same time as other students.
  • Preferential Seating
  • Sitting in the front rows (if traditional
    seating, 2nd row to allow for better viewing of
    students on side/behind when they talk) is often
    recommended to increase the perceived intensity
    of the teachers voice (thus, making it easier to
    process information). This is a good technique
    if the teacher never strays too far from her
  • In reality, preferential seating does not exist
    too often in real life. Thus, 7 is often

  • Enhancement of the Desired Speech Signal
  • Examples include use of assistive listening
    systems such as PA systems, FM sound-field
    personal systems (that resemble hearing aids) and
    the most complex technique of all, that is,
    moving closer to the listener.
  • The key aspect of assistive listening systems is
    that they mimic being close to the listener
    (i.e., decreases the distance between the
    talker/listener) in turn, this maintains the
    intensity of the talkers voice, thus, keeping it
    sufficiently louder than the background noise.

  • General Compensatory Strategies
  • The following strategies are of benefit to
    individuals with processing difficulties, hearing
    loss, or, even second language learners, though
    the mechanisms by which they assist the
    individual differ.
  • Modification of Talker Delivery Style
  • Depending on the listeners difficulty, this may
    include using clear speech newscasters speech
    style, insertion of pauses, extra
    inflection/stress, sentences of less grammatical
    complexity, etc. This makes it easier for the
    listener to keep up.

  • Modification of Speaker Delivery Style- contd
  • A conceptual formula that can guide speakers
    presenters is
  • The more complex the material, the more
    important it is to slow down the overall rate in
    which material is presented- not by exaggerating
    speech patterns but by articulating words
    clearly, emphasizing prosodic stress patterns
    within speech, inserting pauses between clauses
    and concepts to provide additional processing
    time, and the use of visuals.

  • Familiarizing the Listener to Information
    Beforehand The more familiarity the listener
    has with the topic/content, the less they have to
    rely on the acoustic signal, and, the more they
    can use their linguistic/world knowledge to help
    process the incoming information. For students,
    this can be done by informing students/parents of
    the content, vocabulary, concepts prior to being
    covered in class (pre-viewing technique).
  • Extended Time for Task
    If the
    individual needs additional processing time, they
    would likely benefit from extended time.
    Self-esteem issues may need to be

  • Presenting Directions/Instructions
  • The talker can state one direction at a time and
    have the individual first repeat/internally
    visualize each direction and then summarize these
    directions at the end (unless too young or
    significant integration difficulty, may not be
    able to internally visualize- check if student
    can do it). This will ensure that the child has
    retained all key information in addition, this
    serves as a training technique.
  • For older students/adults, may just insert longer
    pauses between directions and then have them
    summarize at the end to ensure what
    processed/retained. An alternative is to
    highlight the sequence of steps on a

  • Clarification of Information Presented
    For important
    directions, content, etc., the talker can check
    with the listener to determine if the information
    has been perceived correctly. For example
  • The talker can ask the listener to repeat
    instructions/ directions in their own words to
    ensure that the listener has indeed processed and
    recalled all of the information provided. If
    not, then the talker can fill-in the
    missed/forgotten information.
  • Divided Attention Difficulties
  • If divided attention difficulties are present,
    older individuals will benefit from outlines,
    handouts, guided notes (such as power point
    slides, three slides/page with adjacent lines for
    adding notes), and, if necessary, a designated

  • Phonics Difficulty
  • If student has significant spelling difficulties
    present, on tests where content crucial element
    (rather than spelling) then spelling variance be
    applied. If spelling deemed crucial, then
    notebook computer with spell checker be provided
    (depends on keyboarding skills), or, availability
    of word bank.
  • Assistive technology to minimize writing
    requirements (auto-capitalization, word
    predictions, punctualization) to reduce overall
    mental load as well as reduce spelling errors is
    another alternative.

  • Writing Difficulties
  • For older students, after having completed a
    written assignment, they should either read out
    loud to themselves what they have written or
    have someone else read to them (while they
    follow along).
  • This may allow the student to pick up on and
    correct any organizational issues, spelling
    errors, and any punctualization errors.
  • Individuals may also benefit from writing
    software that increases organization skills, such
    as Draft Builder and Kidspiration.

  • Altering Class Schedule
  • If possible, difficult subject matter is covered
    in the morning when the student is less
    likely to be fatigued. If the child is in
    middle/high school, avoid having two
    difficult subjects back-to-back.
  • If the students attention seems to be drifting
    and appears to be becoming overloaded,
    listening breaks should be provided.
  • For adults, the goal would be to arrange meetings
    in the morning or have handouts made available.