Doing what you are told

One day, in a state of complete exhaustion, I got up to complete my final routine before crawling into bed. In my head I planned to do as follows:
Put cheese in fridge
Put rice crackers in cupboard
Clean teeth
Crawl into bed

As I discovered when I next was looking for my favourite snack, what I actually did was:
Put cheese and rice crackers in fridge
Clean teeth
Crawl into bed

This is an example of cognitive planning going wrong… and an illustration of how executive function can be affected by fatigue. Children whose executive functioning has been affected by factors such as fatigue, anxiety, ADHD or other factors/disorders may find it hard to carry out a sequence of steps even if they do remember the main points of what they have been told.

Doing what you are told

To follow instructions we need to be able to identify the important items, plan and organise the information so we can follow-through with the instructions. Then, finally, we need to be able to concentrate and monitor our actions (ie. I should have realised that the rice crackers really didn’t belong in the fridge). All this is managed by something we call executive functioning (Hagemann, Hay and Levy, 2002).

Executive Function (Hagemann, Hay and Levy, 2002):

Executive function is part of the working memory system. It is a cognitive function that helps us helps us decide what to remember, and what to discard. It helps us put the information in the right order. And it helps us stay on track.

So if a teacher says, “Well, kids, now it’s time to pack up. I want you to put your pencils in your pencil-tin, your books in your tote tray and then come and sit on the floor ready to have a story.”

A student whose “executive function” is working well might have a thought process that goes something like this… “pencils away, book in tote, sit on the mat”. They will then do this in the required order, and be sitting quietly at the front of the room ready for the teacher.

A student whose executive functioning is not operating in the same way, you may find they carry their books and pencils with them to the mat, or they get out their tote tray and put it on their desk. Alternately, they could get distracted half way through and need multiple reminders to get back on track because they aren’t monitoring their own behaviour.

For other children it may just be that they take much longer to work through the process, having to work hard at remembering each step.

Executive functioning is identified as one of the key functions that is affected in children with attention deficit disorders like ADD and ADHD. This means that the children often act impulsively, without thinking about the instructions or consequences of their actions. It also contributes to the fact that they prioritise what’s going on outside the window rather than listening to the instructions you are giving (which, of course, links back to the difficulties with paying attention).

So this is just one more thing to consider when we give instructions….

Next time I am going to post a letter from a parent who has a child with ADD. It provides some great insight. If you want to contribute a similar letter, please email it to me at amandag7@optusnet.com.au

I hope this blog is helpful to you. If it is, make sure you vote on the poll on the left. I also look forward to your questions and suggestions for future topics.

If you want to find out more about me and what I am up to, you might want to visit www.learn2bebuddies.com.au


References

Hagemann, E., Hay, D.A., and Levy, F. (2002). Cognitive Aspects and Learning. In S. Sandberg (Ed), Hyperactivity and Attention Disorders of Childhood, p214-241. Cambridge University Press: Cambridge.

You might also want to visit:
http://www.ldinfo.com/executive_functioning.htm
http://www.ncld.org/content/view/1200/480
http://www.ldonline.org/article/Executive_Function_Fact_Sheet

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What did I just say?

Tom is standing in the supermarket. He has been asked by Sal to pick up a few things on his way home from work.

He knows he needs to get bread and milk because he remembers having nothing to eat for breakfast this morning. But he knows he was asked to buy something else.

Something for the bathroom.

Toilet paper? Toothpaste? Shampoo? Soap? Razor?

He knows he needs to buy one of these things because it has nearly run out.

He closed his eyes, tried to visualise or “hear” what Sal had said… but all he could hear was Sal saying, “Make sure you write it down so you don’t forget!”

And he had said, “I’ll remember… it’s only three things!”

But that was before he had fought peak hour traffic, met an old friend, taken two phone calls and fought with a fellow-shopper for a parking spot.

He got home with bread, milk and toilet paper (because he felt that was more important than the other toiletry items).

Sal called out, “Did you get my shampoo?”

Doh!


What makes us remember instructions?

When recalling things we have been told, we usually paraphrase or summarise the idea rather than repeating in our heads exactly what we have been told. That is because we usually only hold small snippets of information in our “working memory” for a short period of time.

Information in our working memory is easily accessed. Our working memory is where we put the information we are using. With our working memory we usually have to drag the information out of our long term memories so we can use it.

The capacity of our working memory

There are different theories about working memory, but Baddeley (2006) discusses this in depth. He states that working memory is for temporary storage of information. He also discusses that theorists suggest that it possibly involves four systems:
1- for processing sound and speech
2 -for processing visual information
3 – for helping us select what information we need to pay attention to
4 – to help us link what is in our working memory with our long-term memory.

While it seems that nobody is exactly sure of the capacity of each system, it is estimated that if we don’t link it to our long term memory in a few seconds, it can be lost. The only way we can save that information for later is if we file it carefully in a way that makes it easy to access later.

A good filing system

Repetition:
One way for us to have more success in storing instructions is through rehearsal. For example, if Tom had spent time chanting “Milk, bread, shampoo. Milk, bread, shampoo” to himself he could possibly have had more success in remembering what he needed. This is because the information would have been in his working memory for longer, with more time to process and link it to ideas and patterns in his long term memory.

Chunking:
Another way is to chunk information together. One good example is when we remember sets of three numbers in a nine digit phone number, instead of trying to remember the whole number at once. Again, this is because we are putting short chunks of information into our working memory, instead of overloading it with a large, unwieldy amount of information.

Linking with what we know:
But one of the most important ways of remembering what we have been told is by quickly making links between the instructions and what we already know, or what is important to us. That is why Tom remembered the milk and bread but not the shampoo.

Poor filing systems:

If you have trouble paying attention, controlling your thoughts, or have a small working memory capacity, then you will struggle to focus on information long enough to be able to retrieve all the information later. Their working memory may be overloaded (Hagermann, Hay and Levy, 2002; Gathercole, Lamont, & Alloway, 2006).

So that may be why you find a child with ADHD or ADD, when given instructions to get their books, sit at their desk and get out their pencil, wandering around the room with their book.

Anxiety can also cause difficulties with the working memory processes (Terry, 2006).

Children with developmental delays (intellectual disabilities), including children with Down Syndrome, will also have trouble with the processing systems of working memory. However, it is possible that most of their difficulties come with not being able to generalise or link new information with what they already know. They may also struggle to develop good memory strategies (Terry, 2006).

Again, this may mean that they cannot retrieve what they have been told… and this is in addition to possibly struggling with language patterns and vocabulary.

It is also important to remember that we all have different working memory capacities. Part of that is about the strategies we use, but there are many other reasons that we don’t fully understand (Terry, 2006).

So when you give some instructions, make sure you think about how you are catering to your child/children’s working memory.

Next time we will think about what it takes to act on instructions you have been given.

References:

Baddeley, A. (2006). Working Memory: An Overview. In S.Pickering (Ed) Working Memory and Education, p3-33. Academic Press: London.

Gathercole, S.E., Lamont, E., and Alloway, T.P. (2006). Working Memory in the Classroom. In S.Pickering (Ed) Working Memory and Education, 219-240. Academic Press: London.

Hagemann, E., Hay, D.A., and Levy, F. (2002). Cognitive Aspects and Learning. In S. Sandberg (Ed), Hyperactivity and Attention Disorders of Childhood, p214-241. Cambridge University Press: Cambridge.

Terry, W.S. (2006). Learing and Memory: Basic Principles, Processes and Procedures. Pearson Education: USA.

If you have any good websites that address this issue, please share them. I ran out of time to do some searching... maybe I will add some later.

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Do you understand what I'm saying?

Image from "Dave is Brave" www.learn2bebuddies.com.au . Copyright Amanda Gray and Daniel East.

Jenny has just arrived home from the gym feeling stiff and sore. Tom has just come inside as the coldness of the evening has made it too uncomfortable to work any longer in his garden.

Jenny rubs her lower back. “Uhhh! I feel old!”

“Brrr. I’m freezing, too! I’m going to have a shower.”

Jenny watches him go with a perplexed look on her face. “What?”
Image from

Interpreting

Even if we hear what a person is saying, and are paying attention, sometimes we don’t correctly interpret what they are saying.

To interpret or work out what a person is saying you have to be able to make sense of the sounds you hear. You need to change the isolated sounds into words, then put those words together based on their sequence and how they are said to get the full meaning of what you have been told (Anderson, 2000).

Minor misunderstandings like that between Jenny and Tom can occur because of trouble hearing. But they also often occur because we all bring our own ideas or context to communication.

Jenny’s context was that she was sore and tired. Tom’s was that he was cold. So he interpreted the word “old” to mean “cold”.


What makes it hard to interpret sounds?

The size of your vocabulary
You need to share the same vocabulary with the person to whom you are talking (Anderson, 2001). Children can have a smaller vocabulary for a wide range of reasons. Children with developmental delays such as that associated with Down Syndrome may take longer to learn words in a way that means they can “retrieve” them easily. This means that they may have a smaller vocabulary (Buckley, 1993; Chapman, 2006).

We pick up most of our vocabulary through experiences with language and conversations (Cross, 2001). Children who have difficulties hearing will have smaller vocabularies due to limitations placed on their language experiences. Children for whom English is their second language will also have a smaller vocabulary.

Some conditions like dyslexia can influence how we process sounds (Stein, 2001). So while children with these conditions may be able to hear the sounds, it might take them longer to work out what these mean. These children may also have a smaller vocabulary, or mix up sounds more often. They may also struggle to hear changes in tone of voice, which will be discussed below.

Children who have Autism Spectrum Disorders may also have a smaller vocabulary. This is mainly due their limitations in social and emotional reciprocity, or empathy (Scott, Clark, Brady, 2000). This means that the motivation for their communication will come from their own interests, not based on an understanding of how communication influences their relationships with others (Autism Association of South Australia, 2009).

For example, a child with Aspergers may have a special interest in Maths and logical problems. This child may then have a big vocabulary relating to this subject. But in the context of other subjects, including language related to everyday tasks and social interactions, their vocabulary might be quite small.

These difficulties can also lead to problems with the other things you need to know in order to correctly interpret what people are saying (discussed below).

Your knowledge of the patterns of language
To understand what people are saying you need to have a good knowledge of how words fit together in a sentence. You also need to know how tone of voice can change what they mean. As discussed in a previous post , this can be difficult if you have trouble paying attention to and interpreting others’ facial expressions and body language.

Your knowledge of the subject being discussed
As mentioned previously, knowing the context of a discussion is important in helping us interpret what is being said (Anderson, 2001). It helps us put the sounds together and chose the right words to fit the context. It also speeds up the process of changing the sounds into meaningful sentences.

So if you have a child who is tired, or bored, or struggling to pay attention they are more likely to misinterpret what you are telling them to do.


The process of interpreting sounds and words relies on our skills in remembering and retrieving information we have learnt (Hick, Botting & Conti-Ramsden, 2005). I will talk more about memory in the next post.


References:

Anderson, C. (2001). Pragmatic Communication Difficulties. In R. MacKay and C. Anderson (Eds), Teaching Children with Pragmatic Difficulties of Communication, p24-38. David Fulton Publishers: Hampshire.

Autism Association of South Australia. (2009). What is Autism? Retrieved 16th May, 2009 from:http://www.autismsa.org.au/html/disorders/autism.html


Buckley SJ. (1993) Language development in children with Down syndrome - Reasons for optimism. Down Syndrome Research and Practice,1(1), p3-9. Retrieved from http://www.down-syndrome.org/reviews/5/

Chapman RS. (2006). Language learning in Down syndrome: The speech and language profile compared to adolescents with cognitive impairment of unknown origin. Down Syndrome Research and Practice, 10(2), p61-66. Retrieved from http://www.down-syndrome.org/reports/306/

Cross, L. (2001). Early Communication Development. In M.S. Lue (Ed.) A Survey of Communication Disorders for the Classroom Teacher, p35-54. Allyn and Bacon: Boston.

Hick, R.F, Botting, N., and Conti-Ramsden, G. (2005) Short-term memory and vocabulary development in children with Down syndrome and children with specific language impairment. Developmental Medicine & Child Neurology, 47, p532–538. Retrieved http://journals.cambridge.org/download.php?file=%2FDMC%2FDMC47_08%2FS0012162205001040a.pdf&code=7abb5653813d8fc667d2aaa56a4c8e16

Scott, J., Clark, C., and Brady, M. (2000). Students with Autism: Characteristics and Instruction Programming. Singular Publishing Group: San Diego.




Stein, J. (2001). The Neurobiology of Reading Difficulties. In M. Wolf (Ed) Dyslexia, Fluency and the Brain, p 3-22. York Press: USA.

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Why aren’t you listening? Disobedient or Distracted?

Picture copyright Daniel East - from "Dave is Brave" www.learn2bebuddies.com.au

“I’ve told him what to do a dozen times, but it goes in one ear and out the other!”

Have you ever heard that said? Well, it might be very near the truth.

But, despite what you might feel, a “good kick up the backside” is not the solution. We need to understand why our words have not stuck with the child.

What is involved in doing what you are told?

When you are told to do something you have to be able to hear, listen, interpret, remember and act on the instructions. If you have difficulties doing any one of these things you can seem “disobedient”.

In this post I want to talk about hearing.

Hearing

I won’t give you a biology lesson on hearing here. You might want to visit the Mayo Clinic if you are interested in how the ear works. For now, I just want to point out some reasons why a child might not be able to hear you.

Conductive hearing loss (ASHA, 2009; Australian Hearing, 2009; Moore, 1997)

Children who have recurring ear infections such as Otitis media, or even a build up of wax in the ear will find it hard to hear clearly. For others the bone and cartilage structure may interfere with the movement of sound through the ear to the nervous system that processes the sounds.

Children with Down Syndrome are shown to be at increased risk of ear infections and conductive hearing loss because of their susceptibility to infections and the smaller ear canal (Moss, nd).

Indigenous Australians have also been shown to be at increased risk of conductive hearing loss (Coates et al).

For some children, the treatment might be through antibiotics or grommets (MyDr, 2008). For others, hearing aids may be used.

Sensorineural hearing loss (ASHA, 2009; Australian Hearing, 2009; Moore, 1997):

This is when the cochlea or the nerves that carry sound to the brain might be affected. The levels of hearing loss may differ, but generally sensorineural loss cannot be fully addressed even if the child is using hearing aids. For children whose cochlea is damaged, cochlea implants can be used. For others, communication will be through the use of sign language.


The levels of hearing loss are described as mild, moderate, severe and profound. If you want to know what a child might hear depending on the level of hearing loss they have been diagnosed with, visit ASHA and the Medical College of Wisconsin (they have a great picture that is easy to understand). The Warren Centre also has a good diagram of what sounds equate to different decibel levels (as seen in the ASHA description).

Disobedience or Distraction?

If a child has an ear infection such as Otitis Media they will struggle to hear you call their name in a noisy room or if their back is turned to you. So if they don’t respond, it is that they haven’t been able to pick out your voice from all the other noises going on around them.

If a child has a hearing aid or a cochlea implant, it doesn’t mean that they have perfect hearing. They will struggle to hear you in noisy rooms, or if there is something or someone making a noise closer to them than you.

You also need to remember that children with hearing impairments may have smaller vocabularies and may struggle with understanding how sentences are put together. This is because their learning of language is interrupted by what they can and can’t hear. This may mean they find it hard to pick out the important bits in your instruction.

For example, if you say "Julie, can you put your book away in your book tray, please?" the child
may know you have mentioned a book and a tray, but not make the connection between the two. So the child may be confused about what exactly you want them to do with the two objects.

Next Time

In the next post I will talk about the difference between listening and hearing. Later I will also talk about some strategies and things to think about when giving instructions to a child who has a hearing impairment.

References
Australian Hearing (2008) Types of Hearing Loss. Retrieved 10th May, 2009 from: http://www.hearing.com.au/types-of-hearing-loss

American Speech-Language-Hearing Association. (2009). Type, Degree and Configuration of Hearing Loss. Retrieved 10th May, 2009 from: http://www.asha.org/public/hearing/disorders/types.htm

Coates, H.L., Morris, P.S., Leach. A.J., and Couzos, S. (2002). Otitis media in Aboriginal children: tackling a major health problem. Medical Journal of Australia 177 (4): 177-178 Retrieved from: http://www.mja.com.au/public/issues/177_04_190802/coa10271_fm.html

Mayo Clinic (2009). How do we Hear? Retrieved 10th May, 2009 from: http://www.mayoclinic.org/hearing-disorders/how.html

Moore, B.C.J. (1997). An Introduction to the Psychology of Hearing. SanDiego: Academic Press.

Moss, K. (nd). Hearing and Vision Loss Associated with Down Syndrome. Retrieved 10th May, 2009 from: http://www.deafblind.com/downmoss.html

My Dr (2008). Otitis Media in Children. Retrieved 10th May, 2009 from: http://www.mydr.com.au/kids-teens-health/otitis-media-in-children

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