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Unpacking the School Neuropsychology Evaluation Report (e.g., What the heck does all of this mean for the classroom teacher?)

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Unpacking the School Neuropsychology Evaluation Report (e.g., What the heck does all of this mean for the classroom teacher?) Presented by: Phyllis G. Paro, MA, ABSNP – PowerPoint PPT presentation

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Title: Unpacking the School Neuropsychology Evaluation Report (e.g., What the heck does all of this mean for the classroom teacher?)


1
Unpacking the School Neuropsychology Evaluation
Report(e.g., What the heck does all of this mean
for the classroom teacher?)
  • Presented by
  • Phyllis G. Paro, MA, ABSNP
  • Vermont Licensed School Psychologist
  • Diplomate, American Board of School
    Neuropsychology

2
Topics
  • TBI Stats (from the CDC)
  • Pictorial Overview of Brain
  • The School Neuropsychology Evaluation Report
  • Cognitive Processes Sensorimotor
  • Cognitive Processes Visuospatial
  • Cognitive Processes Auditory/Phonological
  • Cognitive Processes Learning/Memory
  • Cognitive Processes Executive Functions
  • Facilitators/Inhibitors Allocating and
    Maintaining Attention

3
  • Facilitators/Inhibitors Working Memory
  • Facilitators/Inhibitors Speed, Fluency, and
    Efficiency of Processing
  • Acquired Knowledge Acculturation Knowledge
  • Acquired Knowledge Language Abilities
  • Acquired Knowledge Reading Achievement
  • Acquired Knowledge Written Language Achievement
  • Acquired Knowledge Mathematics Achievement
  • Social-Emotional Functioning and Adaptive
    Behaviors

4
TBI Statistics(From the Centers for Disease
Control)
  • TBI in the United States
  • An estimated 1.7 million people sustain a TBI
    annually. Of them 52,000 die, 275,000 are
    hospitalized, and 1.365 million, nearly 80,
    are treated and released from an emergency
    department.

5
  • TBI is a contributing factor to a third (30.5)
    of all injury-related deaths in the United States
  • About 75 of TBIs that occur each year are
    concussions or other forms of mild traumatic
    brain injury (MTBI)
  • During  the  last  decade,  emergency department
     visits  for  sports  and  recreation related
     TBIs,  including concussions,  among  children
     and  adolescents  increased  by  60
  • Overall,  the  activities  associated  with  the
     greatest  number  of  TBI-related  emergency
    department  visits  included bicycling,
     football,  playground  activities,  basketball,
     and  soccer

6
  • National  surveillance  in  9  high  school
     sports
  • TBI  represents  almost  9  of  all  injuries
     reported  in  the  9  sports. Numbers  and
     rates  are  highest  in  football  (55,007
     0.47  per  1000  athlete exposures)  and girls
     soccer  (29,167  0.36  per  1000  athlete
     exposures)

7
Picture copied from Brain Injury A Manual for
Educators, Colorado Department of Educations
8
Basic Sensorimotor Functions
  • Sensory functions encompass our ability to
    process visual, auditory, kinesthetic, and
    olfactory information. Dysfunctions in any single
    sensory system can have a dramatic effect on a
    childs learning capabilities and behavioral
    regulation. Motor functions encompass both fine
    motor skills (e.g., picking up or manipulating
    small objects, holding a pencil correctly,

9
  • buttoning a button) and gross motor skills (e.g.,
    walking in a balanced and coordinated manner,
    running, jumping, riding a bike, etc.).

10
Basic Sensorimotor Functions Specific Skills
Measured
  • Lateral Preference Measures the degree of
    handedness or preference of which side of the
    body used for fine motor activities.
  • Sensory Functions Measures of auditory and
    visual acuity (how well can the student hear and
    see) and measures of tactile sensation and
    perception (how well the student can respond to
    touch).
  • Fine Motor Functions Measures the students
    ability to movement fingers and hands in a
    coordinated manner.

11
Basic Sensorimotor Functions Specific Skills
Measured
  • Visual - Motor Integration Skills Measures the
    students ability to copy objects on paper.
  • Visual Scanning Skills Measures the students
    ability to visually scan a horizontal line for
    information.
  • Gross Motor Functions Measures a students
    ability to use his/her large muscles in their
    body in a coordinated manner.

12
What it might look like in the classroom
  • Behavior Implications for Sensory Issues
  • May appear to be overwhelmed
  • May emotionally melt down
  • May be irritable or have a short fuse
  • May be fidgety
  • May bump into others when in line
  • May become overly excited on the playground
  • May become more tactile (touching people or
    things)
  • May tune out due to being over stimulated

13
  • Academic Implications
  • Messy papers, poor organized of school work
  • Incomplete work
  • Poor handwriting
  • Excessive erasing, crossing out of words
  • Difficulties completing worksheets with cluttered
    visual fields
  • Difficulties shifting from workbook/textbook to
    writing on an answer sheet/paper
  • Difficulties reading due to visual stimuli

14
  • Difficulties with group work and/or group
    discussion
  • Difficulties with seat work
  • Becoming overwhelmed in crowded environments

15
Suggested Classroom Accommodations
  • Allow the student to use a computer for written
    work
  • Allow the student to dictate the first draft of a
    written assignment rather than write it
  • Break down written work into chunks
  • Use color overlays
  • Reduce visual and auditory distractions
  • Reduce the number of problems on a page
  • Use a guide to assist with visual tracking

16
  • Allow the student to have preferential seating in
    order to reduce auditory and visual stimulation
  • Make use of study carrels

17
What it might look like in the classroom
  • Behavior Implications for Fine Motor Issues
  • May have shaky hands/tremors
  • May have difficulties with fasteners
  • May have difficulties holding a pencil correctly
  • May have difficulties using small manipulatives
  • Academic Implications
  • May have poor handwriting
  • May have difficulties with drawing
  • May have difficulties with cutting

18
  • May take extra time to produce written work
  • May avoid tasks that require writing
  • Behavior Implications for Gross Motor Issues
  • May stumble and/or bump into things
  • May be clumsy and/or fall
  • May avoid sports (even those they had previously
    engaged in)
  • May have difficulty carrying lunch tray without
    spilling things
  • May be unsteady on the stairs, on playground
    equipment, or in crowds of people

19
  • Academic Implications
  • May have difficulties with or demonstrate an
    avoidance of Physical Education
  • May avoid recess
  • May have difficulties sitting upright

20
Suggested Classroom Accommodations
  • Allow student to use the computer for written
    work
  • Develop pre-prepared materials (i.e., shapes
    already cut out, etc.) so that the student can
    focus on content rather than fine motor skills
  • Provide the student with notes (can be copied
    from another student or taken by an adult)
  • Provide the student with guiding notes and/or an
    outline

21
Cognitive Processes VisuospatialSpecific
Skills Measured
  • Visuospatial Perception Measures a students
    ability to make visual discriminations, locate
    objects in space, and construct objects.
  • Visuospatial Reasoning Measures the students
    ability to recognize spatial configurations,
    identify objects with missing parts, and match
    similar visual patterns.

22
What it might look like in the classroom
  • Behavioral Implications
  • Student may have difficulties organizing
    materials
  • Student may experience behavioral difficulties
    due to his/her inability to understand visual
    materials
  • Academic Implications
  • Reading difficulties
  • Difficulties organizing written work
  • Issues with handwriting
  • Difficulties with math

23
  • Difficulties with depth perception
  • Spatial perception and orientation difficulties
  • Difficulties with mental rotation
  • Difficulties with object construction
  • Distance perception difficulties
  • Difficulties visualizing mental maps

24
Suggested Classroom Accommodations
  • Provide verbal directions
  • Check-in frequently to ensure understanding
  • Enlarge written materials
  • Reduce visual clutter at the students desk
    (and also within the classroom)
  • Provide support in aligning math problems (e.g.,
    use graph paper)
  • Provide support in organizing writing from left
    to right and organizing/expressing thoughts

25
Cognitive Processes Memoryand Learning
  • Memory is a significant contributor to the
    learning process. Memory is comprised of multiple
    interactive systems immediate memory, working
    memory, and long-term retrieval.

26
Memory and LearningSpecific Skills Measured
  • Overall Memory Indices overall indicators of
    memory and learning
  • Rate of Learning measures the students ability
    to learn new information over repeated trials
  • Immediate Memory measures the students ability
    to immediately recall information presented
    either verbally or visually in a variety of
    formats

27
  • Delayed Memory Recall versus Recognition
    measures the students ability to recall or
    recognize information that was presented verbally
    or visually after a 20-30 minute delay
  • Verbal Visual Associative Learning and Recall
    measures the students ability to learn and
    recall information that requires verbal and
    visual associations

28
What it might look like in the classroom
  • Behavioral Implications
  • May become easily frustrated
  • May seem spacey forgetful
  • May make things up in order to save face
  • May seem defiant
  • May be seen as lazy or unmotivated
  • May copy others behaviors or work
  • May demonstrate angry outbursts or meltdowns
  • May not remember more than one things at a time

29
  • May not remember recent events
  • May be disorganized
  • May develop an attitude
  • May appear to be manipulative
  • May get lost frequently and easily
  • Academic Implications
  • Has difficulties re-telling a story
  • Forgets assignments, people and names, events,
    etc.
  • May fail tests in spite of studying
  • Experiences difficulties with spelling

30
  • Has difficulty retaining new skills
  • May demonstrate inconsistent performance
  • May not remember information they have been
    taught
  • May put in a lot of effort and still get poor
    results
  • May be able to memorize, but seems unable to
    apply this information
  • Fails to see the big picture

31
Suggested Classroom Accommodations
  • Repeat instructions out loud
  • Have the student repeat back instructions in
    order to demonstrate he/she understands
  • Use multi-modal teaching
  • Practice instructions out loud
  • Use pictures or visual cues
  • When introducing new skills, provide the student
    with concrete pictures to look at, hands-on
    activities, or other ways to visualize and form
    associations regarding what is being learned

32
  • Tie learning tasks to the students areas of high
    interest as this will maximize its storage into
    long-term memory
  • Keep oral requests short and simple and pair with
    visual cues whenever possible
  • Provide intensive repetition, practice, and
    review in learning activities. To promote
    retention, provide activities to reinforce the
    skills or content at frequent and regular
    intervals, gradually increasing the intervals to
    less frequent and intermittent
  • Teach to learning style strengths and reinforce
    with different types of learning methods

33
  • Teach the student specific memory strategies and
    how to recognize which strategy may be most
    useful in a variety of situations, such as taking
    notes versus memorizing rote information for a
    test. Examples include using verbal rehearsal,
    chunking, making ridiculous visual images
    composed of items that one has to remember, and
    reading first-letter mnemonic strategies
  • Present all types of verbal information
    accompanied by visual stimuli that clearly
    illustrates the concepts being taught. Examples
    are pictures, charts, graphs, semantic maps,
    etc.

34
Cognitive ProcessesExecutive Functions
  • Executive Functioning can be conceptualized into
    two broad areas cognitive and behavioral/emotiona
    l control. The cognitive aspects of executive
    functioning include concept generation and
    problem solving. The behavioral/emotional aspects
    of executive functioning relate to the inhibitory
    controls of behavior (e.g., impulsivity,
    regulation of emotional tone, etc.)

35
Executive FunctionsSpecific Skills Measured
  • Cognitive Flexibility (Set Shifting) measures
    the students ability to stop focusing on one
    activity and start focusing on another activity
  • Concept Recognition and Generation measures the
    students abilities to recognize or generate
    multiple ways of classifying or categorizing
    objects, pictures, or words
  • Problem Solving, Fluid Reasoning Planning
    measures the students ability to solve problems,
    apply reasoning skills, and use planning
    strategies

36
  • Response Inhibition (Impulse Control) measures
    the students ability to learn and demonstrate a
    new response to a stimuli instead of producing a
    typical response
  • Behavioral/Emotional Regulation measures the
    students ability to shift cognitive set and
    modulate emotions and behavior via appropriate
    inhibitory control. Additionally, it looks at
    the students ability to cognitively self-manage
    tasks and to monitor his/her performance

37
What it might look like in the classroom
  • Behavioral Implications for Cognitive
    Flexibility
  • May be concrete and have rigid thinking
  • May demonstrate difficulties with transitions
  • May perseverate
  • May have difficulty taking feedback
  • May be stubborn and argumentative
  • May not like to try new things
  • May demonstrate difficulties making friends
  • May lack empathy

38
  • Academic Implications
  • May have difficulties with abstract thinking
  • May have difficulties deviating from the
    classroom schedule
  • May have difficulties coming up with more than
    one solution to a problem
  • May have difficulty switching gears
  • May not do what has been asked of him appears
    to be noncompliant
  • May not learn from his/her mistakes
  • May not think well on his/her feet

39
Suggested Classroom Accommodations
  • Develop routines for the student to follow
  • Plan for situations that will require the use of
    cognitive flexibility
  • Teach coping strategies
  • Reduce novelty by pre-teaching or allowing the
    student to preview the materials to be presented
    providing cuing in advance of transitions (e.g.,
    you have 5 minutes left, etc.) providing gradual
    exposure to new situations

40
  • Modify tasks by breaking them down into their
    component parts providing the student with
    templates or rubrics to follow decreasing the
    complexity of information presented
  • Increasing the level of support around tasks by
    offering frequent reassurance or reinforcement
    providing step-by-step assistance in working
    through difficult problems being nearby during
    transition times

41
What it might look like in the classroom
  • Behavioral Implications for Problem Solving,
    Fluid Reasoning Planning
  • May make poor behavioral and social choices
  • May not follow through with requests to complete
    tasks
  • Lacks common sense
  • Doesnt think well on his/her feet
  • May be stubborn and/or oppositional
  • May demonstrate poor social judgment

42
  • May act without thinking of the consequences
  • May appear to be depressed
  • May not make plans with friends
  • May have difficulties problem-solving
  • Demonstrates rigid thinking
  • Academic Implications
  • May not get the broader concepts (but should be
    able to do rote learning)
  • May demonstrate difficulties with math
    problem-solving

43
  • May have difficulties responding to essay
    questions
  • May do better on multiple choice tests
  • May not generalize information appropriately
  • May lack insight
  • May not get the big picture
  • May experience difficulties with comprehension
    (e.g., reading, math written expression)
  • May have difficulties brainstorming
  • May be late for class and come unprepared
  • May demonstrate difficulties with time management
  • May have difficulties with sequential tasks

44
Suggested Classroom Accommodations
  • Avoid the use of sarcasm
  • Use multiple choice instead of essay test formats
  • Use scaffolding
  • Anticipate transitions
  • Provide frequent cues/reminders to keep working
  • Provide graphic organizers for writing
  • Break larger assignments into smaller, more
    manageable parts

45
What it might look like in the classroom
  • Behavioral Implications for Response Inhibition
    (Impulse Control)
  • May say or do things the he/she quickly regrets
  • May say or do things that cause embarrassment to
    others
  • May deny his/her behavior even when caught in
    the act
  • May have difficulty explaining why he/she chose
    to do something

46
  • Academic Implications
  • May call out frequently in class
  • In reading, may have a tendency to guess
    impulsively at words based on the first letter or
    may have the tendency to insert words that are
    not actually in the text
  • May have a tendency to respond quickly to
    questions and/or problems without stopping to
    think or problem solve

47
Suggested Classroom Accommodations
  • Increase external controls by restricting access
    to settings or situations in which the student
    can get into trouble
  • Increase supervision
  • Reduce the opportunity for the student to act
    impulsively by limiting decision making
  • Provide the student with clear, simply stated
    explanations, instructions, and directions so
    that he/she knows exactly what is expected

48
  • Do not leave a lot of unstructured time for the
    student
  • Teach the student decision-making steps (a)
    think about how other persons may be influenced,
    (b) think about the consequences, (c) carefully
    consider the unique situation, (d) think of
    different courses of action which are possible,
    and (e) think about what is ultimately best for
    him/her
  • Teach the student to think before acting (e.g.,
    ask him/herself What is happening? What am I
    doing? What should I do? What is best for
    me?)

49
What it might look like in the classroom
  • Behavioral Implications for Behavioral/Emotional
    Regulation
  • May over/under react to situations
  • May experience difficulties with anger management
  • May present as being emotionally labile
  • May appear lazy, unmotivated, or spacey
  • May be able to tell you what they are supposed to
    be doing, but cannot get started
  • May require constant cuing

50
  • May get overlooked because they are not causing
    problems within the classroom
  • May appear to be aloof or disinterested in peers
  • May lose things easily
  • May be disorganized
  • May be easily frustrated
  • Academic Implications
  • May have difficulties with group learning
  • May have trouble focusing
  • May experience emotional difficulties that
    interfere with academics

51
  • May not complete homework or classwork
  • May appear to be passive/resistant
  • May have difficulties starting schoolwork
  • May turn in poor quality work
  • May have difficulties managing long-range
    projects
  • May not turn in homework
  • May be forgetful
  • Work may be messy

52
Suggested Classroom Accommodations
  • Provide assistance to the student with getting
    started on his/her work
  • Provide more frequent check-ins to ensure that
    he/she is completing assignments
  • Provide a written/visual cue to assist him/her
    with beginning work
  • Teach/support organization skills/systems (e.g.,
    folders, planners, etc.)
  • Provide student with step-by-step instructions

53
  • Home and school should work together to implement
    an organization system that works for the student
  • Color code subjects
  • Provide a space within the classroom that the
    student can go to if they need to calm down
  • Anticipating problem situations and preparing the
    student for them
  • Teaching coping strategies
  • Structuring the environment in order to avoid
    problem situations or to allow you to intervene
    early
  • Allowing for breaks if tasks appear to be
    frustrating

54
Facilitators/Inhibitors Allocating and
Maintaining Attention
  • Attention is a complex and multifaceted construct
    used when an individual must focus on certain
    stimuli for information processing. In order to
    regulate thinking and to complete tasks of daily
    living such as schoolwork, it is necessary to be
    able to attend to both auditory and visual
    stimuli in the environment. Attention can be
    viewed as the foundation of all other
    higher-order processing. In other words, if
    attention is compromised it can

55
  • adversely affect other cognitive processes of
    language, memory, visuospatial skills, etc.
    Attention can be divided into three subareas
    selective/focused attention, sustained attention,
    and attentional capacity.

56
Allocating and Maintaining AttentionSpecific
Skills Measured
  • Selective/Focused Attention refers to the ability
    to pay attention to relevant information while
    ignoring irrelevant information. An example of
    selective/focused attention would be the childs
    ability to pay attention to only the classroom
    teacher when there is the noise and the visual
    distracters of the classroom to ignore.
  • Sustained Attention refers to the ability to
    maintain an attention span over a prolonged
    period of time.

57
  • Attentional Capacity refers to the childs
    ability to recall information ranging from small
    chunks (e.g., a string of numbers or letters), to
    larger chunks of information (e.g., list of
    unrelated words or sentences of increasing length
    and complexity), and to even larger semantically
    complex chunks of information (e.g., memory for
    stories).

58
What it might look like in the classroom
  • Behavioral Implications of Attentional
    Difficulties
  • May have difficulties sustaining attention to
    non-preferred tasks
  • May be easily distracted by external and/or
    internal stimuli
  • May have a low frustration/tolerance level
  • May lose things necessary for tasks
  • May seem spacey or forgetful

59
  • Academic Implications
  • Fluency may be negatively impacted as students
    mind wanders
  • Quality of work may be impacted by careless
    errors
  • May have difficulties following directions
  • May not follow through with directions/instruction
    s and tasks
  • May not complete assignments
  • May appear to have memory issues

60
Suggested Classroom Accommodations
  • Providing the student with opportunities to move
    to a quiet place in the classroom any time the
    auditory and visual stimuli interfere with
    his/her ability to function successfully
  • Providing the student with shorter tasks that do
    not require extended attention in order to be
    successful. Gradually increasing the length of
    the tasks as he/she demonstrates success
  • Providing the student with a predetermined signal
    (e.g., hand signal, verbal cue, etc.) when he/she
    begins to display off-task behavior

61
  • Modeling appropriate behavior in the presence of
    auditory and visual stimuli (e.g., continuing to
    work, asking for quiet, moving to quieter part of
    the classroom, etc.)
  • Providing the student with a timer to be used to
    increase the amount of time during which he/she
    maintains attention (e.g., have the student work
    on the activity until the timer goes off)
  • Following a less desirable task with a more
    desirable task making the completion of the
    first necessary to perform the second

62
Facilitators/Inhibitors Working Memory
  • Working Memory is the ability to hold on to
    information while performing complex tasks for
    example, solving a mental math problem

63
What it might look like in the classroom
  • Behavioral Implications Refer to earlier section
    on Learning and Memory
  • Academic Implications
  • May forget or be unable to follow multi-step
    directions
  • May forget what he/she was talking about
  • May forget the details of reading (while still
    reading)
  • May forget what he/she is looking for

64
  • May be able to answer factual questions, but has
    difficulties with recalling complex details,
    making predictions, or making inferences (e.g.,
    can see the individual trees, but not be able to
    see the forest)
  • May forget ideas or sequences of thoughts after a
    writing task has been started

65
Suggested Classroom Accommodations
  • Keep oral directions short and simple and
    supplement with visual cues when possible.
  • Provide intensive repetition, practice, and
    review in learning activities. To promote
    retention, provide activities to reinforce the
    skills or content at frequent and regular
    intervals, gradually increasing the intervals to
    less frequent and intermittent.

66
  • When introducing new skills, provide the student
    with concrete pictures to look at, hands-on
    activities, or other ways to visualize and form
    associations regarding what is being learned.
  • Given the students limitations with working
    memory, he/she may benefit from verbal rehearsal
    strategies (i.e., talking cues) to keep
    information in memory for a longer time.
    Teaching him/her to talk his/her way through
    multi-step or multi-sequential tasks, such as
    division, might be helpful as well

67
Facilitators/Inhibitors Speed, Fluency, and
Efficiency of Processing
  • The facilitators/inhibitors of speed, fluency,
    and efficiency of processing are conceptualized
    to be composed of four second sub-classifications
    performance fluency, retrieval fluency, acquired
    knowledge fluency, and fluency and accuracy.

68
Speed, Fluency Efficiency of Processing
Specific Skills Measured
  • Performance Fluency Measures the students
    ability to quickly perform simple repetitive
    tasks
  • Retrieval Fluency Measures the students ability
    to quickly assess information from long-term
    memory
  • Acquired Knowledge Fluency Measures the degree
    to which reading, writing, and math is fairly
    automatic for a student

69
  • Assessing Fluency with Accuracy Measures the
    interaction between completion time on a task and
    accuracy. Some students slow down on tasks to be
    more accurate. Other students are very fast but
    make many errors. Ideally, students have average
    completion times with good accuracy

70
What it might look like in the classroom
  • Behavioral Implications
  • May become easily frustrated
  • May get tired easily
  • May appear to be inattentive
  • May act like he/she doesnt understand
  • May experience delays in responding

71
  • Academic Implications
  • Delays in responding to questions
  • May be slow at doing work
  • May have difficulties taking time tests
  • May not be able to complete assignments during
    class time
  • May have difficulties following a lecture
  • May have difficulties multi-tasking
  • May get poor grades despite high levels of effort
  • Does not appear to remember information (forgets
    the question while attempting to process the
    information)

72
Suggested Classroom Accommodations
  • Repeat instructions
  • Student may want to tape lectures
  • Give instructions one at a time
  • Be brief and concise
  • Allow for a delay in the students response
  • Give the student extra time
  • Replace timed tests with alternative assessment
    procedures

73
Additional Areas Assessed
  • Cognitive Processes Auditory/Phonological
  • Sound Discrimination and Auditory/Phonological
    Processes Measures the students ability to
    discriminate differences in sounds and speech and
    to apply basic auditory and phonological
    processing skills
  • Acquired Knowledge Acculturation Knowledge
  • Semantic Memory Measures the students knowledge
    of basic information retrieved from memory.

74
  • Acquired Knowledge Language Abilities
  • The language domain is categorized into oral
    expression and listening comprehension (receptive
    language)
  • Acquired Knowledge Reading Achievement
  • Acquired Knowledge Written Language Achievement
  • Acquired Knowledge Mathematics Achievement
  • Social-Emotional Functioning and Adaptive
    Behaviors

75
Sources
  • www.cdc.gov/concussion
  • http//www.cdc.gov/concussion/HeadsUp/schools.html
  • www.cokidswithbraininjury.com
  • Brain Injury A Manual for Educators, Colorado
    Department of Education
  • Executive Function in the Classroom Practical
    Strategies for Improving Performance and
    Enhancing Skills for All Students Christopher
    Kaufman, Ph.D

76
  • Executive Skills in Children and Adolescents A
    Practical Guide to Assessment and Intervention
    Peg Dawson Richard Guare
  • Helping Students Remember Exercises and
    Strategies to Strengthen Memory Milton J. Dehn
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