How hard can it be?

9 September 2007 at 16:50 (ADD/ADHD, Auditory Processing Disorder, Autism/Asperger's, Communication, Deaf / Hard of Hearing, Dyscalculia, Dyslexia, Invisible disabilities, Learning Disabilities, Prosopagnosia, Teaching/Tutoring, Tinnitus, Tourette's / tics)

A few years ago I had the pleasure of providing the annual Inservice training session for a university’s tutoring department. One of the themes I explored in brief was how tutees, especially those with various learning disabilities, may have processing difficulties. We have to take information in, make sense of it, retrieve information, and then be able to relay information back. Various kinds of learning disabilities interfere with steps in this process, and the interference can happen at more than one step, especially when a person has more than one kind of difficulty. (Learning disabilities and other physiological issues are often co-occurring, technically known by the dreadful-sounding term of “comorbid”.)

The upshot of all this is that any “speed-bumps” or “road-blocks” in the processing will result in slow processing (it takes longer to do things), or uneven processing (some days it’s more difficult to do things, not always for apparent reasons), or intermittent or chronic inabilities to do things (being able to do things on some days or in some hours, but not others, can be more frustrating than never being able to do them).

There are a variety of disabilities out there, but instead of describing how each one can affect a person’s ability to respond in educational efforts, I’m going to describe how processing works in general, and at which steps some disabilities become apparent.

Whenever we interact with the world, there is a whole series of steps that has to happen. Let’s take the subject of, “Answering a question asked of you”. Most people assume that this is really simple, and thus, easy. Hah!

1. Hear the question. This is sensory processing done by the ears, which can be affected by hearing loss, middle ear infections et cetera. In the case of visual sensory processing, we have refractive, receptive or muscle disorders that reduce the ability to see things.

(Somewhere between steps 1 and 2 is the damn annoyance of tinnitus getting in the way. The noise doesn’t really exist, but is created in some unclear manner within the sensory and perceptual route.)

2. Understand the words. This is perceptual processing, or what the brain does with the signals that the sense organs transmit. We have to: (A) realise that someone is talking; (B) that they are talking to us; (C) be able to follow the person’s speech within background noise; (D) be able to stay focused on what they’re talking about; (E) interpret the sounds. This is the part where the (Central) Auditory Processing Disorder messes things up. Things like AD/HD, Tourette’s or brief absence seizures can also interfere with the focusing part of the process. Decoding printed words can be impeded by dyslexia, likewise decoding printed numbers and calculations by dyscalculia.

3. Think about what the words mean. Assigning meaning requires not only understanding the meanings of individual words, but also the words put together into a gestalt, the greater abstract significance. Sometimes we run into confusion because of non-literal language uses, such as puns, slang, idioms, inferred (unspoken) meanings, and nonverbal communication. It’s frustrating when people “don’t mean what they say and don’t say what they mean”! Also, questions nearly always require the listener to access and construct background information that creates the context for the question. (Doubtless you’ve had the experience of walking down a hallway and a colleague asked you a question that was unrelated to what you were doing or what was happening immediately around you, but without some kind of “headline” to alert you to the topic of their question, you either needed a moment to figure out what they were talking about, or you had to ask them.)

The words must also be put into the proper sequential order. English grammar relies upon word sequencing for some kinds of meanings. Directions or commands require time-sequencing to make sense. Everything involving numbers requires sequencing (e.g. the place-value that creates the difference between 29 and 92, or the steps in calculations), and sequencing can be another part of dyscalculia. Dyslexia can also show up at this stage, especially with those common, short words that don’t bring up an associated mental picture (you can picture what “green” or a “cat” is, but not a “the” or an “is”; many of these are on the Dolch list of common “sight” words).

4. Retrieve information from memory. Memory that you are using for doing immediate things is known as working memory. Short-term memory is information that you retain for a little while, but isn’t committed to long-term memory. So holding onto part of the sentence you have heard & understood, while puzzling out the part that you didn’t understand, and then making sense of all that together, uses working memory. Being able to remember what people said a little while later is short-term memory. Working and short-term memory issues feature in a great many kinds of learning disabilities.

It’s a common issue that the information we need to understand and answer the question is “in there … somewhere”, but it’s hard to find or slow to find when someone else (randomly) demands it, rather than the person spontaneously pulling it up for their own lines of thought. Information on demand by someone else, and information spontaneously accessed by one’s self, use different kinds of retrieval processes. We all hate the “I know it, but I don’t know it” problem because it makes us feel stupid. Knowledge retrieval can also be difficult if someone knows the material in another language, so has to go through input and finding and output translations. And sometimes we have to do a similar kind of translation from abstract thinking to visual thinking to expressing thoughts in words, which leads us to:

5. Put the answer into words. Oft times we know what we want to say, but we have to figure out how best to express it. Maybe we get the answer all planned out, and then realise that we’re struggling to recall a particular word. Sometimes we’re actively contemplating what the other person does or does not know, so therefore how much background information we need to give them.

(Personally, I’m prone to answering questions by giving the background supporting evidence, and then finishing up with the thesis statement. Apparently the rest of the world just wants the thesis statement, and doesn’t care how I arrived at it. You know, the whole loquacious & pedantic bit.)

6. Speak the answer, or use another means of manual or texted communication, as the case may be. I’m a highly verbal person myself, but there have been times when I felt disembodied, like I was waiting for my mouth to speak, as though I was standing at a subway stop waiting for the train to come by. Sometimes one gets through some of the sentence, but then part of it seems to have fallen out of the working memory buffer. Sometimes I stutter, or have enunciation problems, but I have learned to just work through those, as I do a lot of public speaking. Things like Tourette’s, dyspraxia, or speech problems make this more difficult, so even having more-or-less successfully gotten through steps 1 through 5, we’re still trying to get the answer out.

These kinds of problems are neurological, and not the result of being “lazy, stupid or crazy”. This is why we need to give students a lot more time to answer questions, without interrupting them with further prompts to answer, or adding to their stress levels with impatience or ridicule. It also helps the interactive question and answer process of teaching and tutoring if we break down the questions into smaller, sequential pieces, and also backtrack and “recap” or summarise what we have gone over to put it into the larger context.

But wait, there’s more!

A lot of the issues we have in education, at work, and in daily life are also related to the realm of “executive function”, which is the whole sticky ball of organisation, planning, self-awareness & self-monitoring, and execution of various efforts. Organisation problems can be spatial (keeping track of where things are), temporal (keeping track of when things happen, the order in which they happen, AND how much time has passed), and what I think of as “hierarchical” (how important various tasks are to do at any one time). Executive function problems are common in autism/Asperger’s, AD/HD, NVLD (Non-Verbal Learning Disorder), and are frequently seen in people with Tourette’s and Bipolar problems. Depression, PTSD, traumatic brain injury, and a host of illnesses can make mental operations sluggish or skittish as well. “Ain’t we got fun.”

So let’s say you’re attending to some business of your own at work, or are out shopping or in your neighborhood, and someone comes up to you en passant and asks you a question. Now, if you also have prosopagnosia (faceblindness), you’re trying to figure out:

* who is this person?
* do I know them?
* what’s their name?
* what are they talking about? (if I could remember who they were, that would help)
* what do I know about this?
* what am I supposed to do about this?
* how do I answer this?

Of course, if you’re still stuck on that first step of, “who is this person?” then the amount of working memory you have for processing all that other stuff is severely reduced. Once you get past the identification issue, then there’s the auditory processing issue. Once you get past that …

::blink, blink:: “What did you say?”

For more information, this page describes (in a fairly non-technical manner) how the input-integration-memory-output process works, or doesn’t, as the case may be.