Tag

Assessment

What is Working Memory and How Can We Address It?

By | NESCA Notes 2019

By: Nancy Roosa, Psy.D.
Pediatric Neuropsychologist, NESCA

Melanie is a sweet, hard-working 11-year-old girl whose parents brought her to NESCA for an evaluation to try to understand why she was struggling in school. Melanie was a cheerful, vivacious girl who seemed intelligent, curious and articulate. But she was barely getting by in fifth grade, putting in hours on homework every night on assignments her teachers thought should take 30 minutes. Her parents were concerned about how she was going to manage middle school next year.

During the evaluation, Melanie did quite well on most tests. Her intelligence measured in the “Above Average” range, and her academic skills were solid. She worked hard and even did well on a test of sustained attention. So, it was clear she did not have a classic case of attentional dysregulation.

Upon further analysis, a few striking results emerged. Melanie had a good ability to remember information or work on structured tasks, but got confused on multistep tasks. One important result: she was able to remember and repeat back long strings of digits when repeating them verbatim, but she really struggled when she had to repeat them in reverse. The mental manipulations involved flummoxed her.

This is working memory: the ability to hold multiple bits of information in memory banks while there is another, distracting bit of information processing going on. Working memory is the “working” part of memory, as it holds information long enough for us to use it or store it away in longer-term memory banks. Analogies can be made to computer storage, where current information is held while processing occurs; or a mental chalkboard, where we jot down our ideas while working out a problem. For some children, like Melanie, that computer storage or chalkboard space is quite limited, causing difficulty with many aspects of learning. As a first grader, Melanie easily learned the sounds of letters, but it was harder for her to remember and apply that knowledge while reading words. Similarly, she easily learned math facts, but got stymied on multistep math problems. Finally, she had trouble with multistep directions. When her parents or teachers told her three things to do, her response was typically, “Wait, what?”.

Melanie’s parents were right to be concerned about middle school, since this is when students are presented with more complex assignments, such as lengthy reading and writing assignments, PowerPoint presentations and many other multistep projects, which were going to be hard for her.

Working memory deficits are related to other cognitive processes. Children with attentional regulation deficits or learning disabilities often – but not always – have working memory deficits. However, every child is unique, with an individual set of strengths and weaknesses. Therefore, a comprehensive and well-done evaluation is essential to clarify a child’s specific profile – a vital first step in crafting an appropriate plan for support and treatment.

Now that we identified Melanie’s difficulties as primarily due to working memory deficits, how do we help her?

My recommendations centered first on the types of accommodations Melanie would need in school to manage an uptick in demands.

  • Any complex or multistep assignment needed to be presented in writing so Melanie can refer back to the directions. She should be shown completed models and provided with scoring rubrics.
  • Melanie might need support from a learning specialist to manage complex tasks, by dividing them into component parts, then completing each part and integrating the whole.
  • Melanie should not be expected to take notes while simultaneously listening to a teacher’s instruction. She should be provided with notes or given an outline of the teacher’s talk that she could fill in.
  • Melanie’s pace of work was slow, given the need to frequently check back and remind herself what she was doing. Therefore, teachers should consider giving her shorter homework assignments that focus on quality not quantity, and extra time to complete tests and assignments.

We also discussed the strategies that Melanie would need to learn to compensate for working memory deficits. She was already using some important strategies, likely based on coaching from some talented teachers in her past. She knew she needed to write things down to remember them, so she had become good at creating outlines before she started writing and drawing pictures of math problems. However, as assignments got longer, Melanie was going to need additional strategies. For example, for lengthy reading assignments, Melanie might need to jot down sticky notes on pages or develop an ongoing “story board” to keep track of main character descriptions or plot points.

Once the family brought this information to Melanie’s educational team, they were able to meet and establish important accommodations, including time to work with a learning specialist several times weekly. The team also agreed to continue to monitor her ability to manage future challenges.

Beyond accommodating working memory deficits, there is ongoing research into programs that could actually improve an individual’s working memory. The hope is that by targeted practice, one could strengthen one’s working memory the way we strengthen muscles by working out at the gym. Despite a great deal of research, the preponderance of evidence does not indicate that these kinds of training programs are effective in improving working memory, except on the specific tasks used in the training program itself. At NESCA, we remain optimistic that further research and refinements will eventually yield more promising treatments.

Finally, one of the most important outcomes of the evaluation was a feedback session with Melanie herself, where I explained her learning profile to her in age-appropriate terms. My goal was to help her appreciate her many strengths and understand that her learning challenge was relatively small and specific. She might have to work harder in certain ways, but would be able to be successful in school and life.

At NESCA, we find that when a child is old enough to process this information about their profile, it is vital to provide it. We find that many children, even teenagers and young adults, tend to be black-and-white thinkers. When they struggle in school in any way, they conclude they are “stupid.” It is obviously vital to prevent this kind of global, negative self-concept from developing. Rather, we hope to give the child the self-awareness and confidence to develop and use compensatory strategies, no matter the area of weakness. We need Melanie and children like her to be confident enough to ask a teacher, college professor or even a job supervisor to provide written instructions to a task or go over directions more than once. Our goal is to arm her with enough self-awareness and confidence that she can go into any new situation, as a student or adult, and be successful while not letting her challenges define or limit her.

 

About the Author: 
Roosa

Dr. Roosa has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems. Her evaluations are particularly appropriate for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box. As part of this process, Dr. Roosa is frequently engaged in school visits, IEP Team Meetings, home observations and phone consultations with collateral providers. Dr. Roosa has also consulted with several area schools, either about individual children or about programmatic concerns. She speaks to parent or school groups, upon request.

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Blog Update: Increased Access to Publicly Funded Independent Educational Evaluations (IEEs)

By | NESCA Notes 2018

By: Nancy Roosa, Psy.D.
Pediatric Neuropsychologist, NESCA

In the last blog post about increased access to independent evaluations, we cited some provisions that were in the original bill, filed by State Senator Barbara L’Italien and State Representative Jim O’Day, which ultimately did not pass. The increase in rates for IEEs were made by a regulation from the agency, the Executive Office of Health and Human Services (EOHHS), not legislative action. A corrected version of the article is reprinted below. We remain excited about these changes and thankful for the hard work of our friends at MAC, the Ed Law Project, and the many advocates, parents, and psychologists who helped advocate for these changes.

As an independent group practice, not allied with any one school district, medical or advocacy group, neuropsychologists at NESCA are often called upon to perform independent evaluations for parents who are seeking an unbiased expert opinion related to their child’s developmental and educational needs. In some cases, this is the first evaluation a family is seeking for their child. In others, the family is in disagreement with the progression or conclusions of a school-based evaluation process. In Massachusetts, parents may seek private evaluation of their child at their own expense at any time and their educational team must meet to consider the results and recommendations of that evaluation. State and federal laws also provide parents with a procedure for requesting that a school district fund an Independent Educational Evaluation (IEE) if they believe that the school’s evaluation is not adequate or comprehensive enough. It is often helpful for parents who are interested in this important resource to consult with an educational advocate to see if they have a legitimate reason to request public funding for an IEE.

Unfortunately, in the past, the ability of families to access a publicly funded IEE has been limited by the low rates that school districts were required to pay to the independent evaluator, as set by state regulations. The maximum allowable rates were, until recently, $74.94 per hour with an allowed range of 8-12 hours, for a total of $899.28. Very few practicing evaluators are able or willing to accept less than $900 to perform what, by definition, needs to be a comprehensive evaluation in the context of what is often a complex situation centering on a disagreement between a family and a school district. These rates had not been raised since 2007, more than ten years ago. Thus, even when a school district agreed to fund an IEE, the school and family often had trouble finding an expert evaluator willing and able to perform it for the state rate.

This situation has changed, thanks in large part to the committed lobbying efforts of our friends at Mass Advocates for Children (MAC), a group of dedicated lawyers, advocates, parents and others who work tirelessly to ensure that all children in the state have equal access to educational and life opportunities. They focus particularly on those children who have disabilities, are low income and/or are racially, culturally, or linguistically diverse.  Thanks to MAC’s leadership in lobbying for this new change, the Executive Office of Health and Human Services (EOHHS) passed new regulations, effective April 1, 2018, which allow a maximum rate of $88.43 per hour, and the range of hours has increased to 9-20, bringing the maximum total rate to $1,768.60. This means more families, particularly those of limited means, should be able to access IEEs if they are needed.

We thank our friends at MAC for their dedicated work on this and other efforts that benefit the most vulnerable children in the Commonwealth. MAC also gives grateful credit to the Ed Law Project and other advocates, parents, and psychologists who helped advocate for this bill, as well as Lead Sponsors of the bill: State Senator Barbara L’Italien and State Representative Jim O’Day.

Please visit the MAC website to appreciate the scope of their many efforts.  https://massadvocates.org/

For more information about the Independent Educational Evaluation process in MA, check out these resources:

NESCA is proud to continue to provide evaluations funded both privately and publicly. While our rates are higher than the state’s standard rate, we are thankful that this increased funding is available to defray costs for families in need.

About the Author: 
Roosa

Dr. Roosa has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems. Her evaluations are particularly appropriate for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box. As part of this process, Dr. Roosa is frequently engaged in school visits, IEP Team Meetings, home observations and phone consultations with collateral providers. Dr. Roosa has also consulted with several area schools, either about individual children or about programmatic concerns. She speaks to parent or school groups, upon request.

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Increased Access to Publicly Funded Independent Educational Evaluations (IEEs)

By | NESCA Notes 2018

By: Nancy Roosa, Psy.D.
Pediatric Neuropsychologist, NESCA

As an independent group practice, not allied with any one school district, medical or advocacy group, neuropsychologists at NESCA are often called upon to perform independent evaluations for parents who are seeking an unbiased expert opinion related to their child’s developmental and educational needs. In some cases, this is the first evaluation a family is seeking for their child. In others, the family is in disagreement with the progression or conclusions of a school-based evaluation process. In Massachusetts, parents may seek private evaluation of their child at their own expense at any time and their educational team must meet to consider the results and recommendations of that evaluation. State and federal laws also provide parents with a procedure for requesting that a school district fund an Independent Educational Evaluation (IEE) if they believe that the school’s evaluation is not adequate or comprehensive enough. It is often helpful for parents who are interested in this important resource to consult with an educational advocate to see if they have a legitimate reason to request public funding for an IEE.

Unfortunately, in the past, the ability of families to access a publicly funded IEE has been limited by the low rates that school districts were required to pay to the independent evaluator, as set by state regulations. The maximum allowable rates were, until recently, $74.94 per hour with an allowed range of 8-12 hours, for a total of $899.28. Very few practicing evaluators are able or willing to accept less than $900 to perform what, by definition, needs to be a comprehensive evaluation in the context of what is often a complex situation centering on a disagreement between a family and a school district. These rates had not been raised since 2007, more than ten years ago. Thus, even when a school district agreed to fund an IEE, the school and family often had trouble finding an expert evaluator willing and able to perform it for the state rate.

This situation has changed, thanks in large part to the committed lobbying efforts of our friends at Mass Advocates for Children (MAC), a group of dedicated lawyers, advocates, parents and others who work tirelessly to ensure that all children in the state have equal access to educational and life opportunities. They focus particularly on those children who have disabilities, are low income and/or are racially, culturally, or linguistically diverse.  Thanks to MAC’s leadership in lobbying for this new change, the Executive Office of Health and Human Services (EOHHS) passed new regulations, effective April 1, 2018, which allow a maximum rate of $88.43 per hour, and the range of hours has increased to 9-20, bringing the maximum total rate to $1,768.60.  In addition, the Bureau of Special Education Appeals will be able to order a higher rate in extraordinary cases. Further, in the rare instances that parents prevail at a hearing and have paid expert fees, the parents would have the right to be reimbursed for these fees by the school district. This means more families, particularly those of limited means, should be able to access IEEs if they are needed.

We thank our friends at MAC for their dedicated work on this and other efforts that benefit the most vulnerable children in the Commonwealth. MAC also gives grateful credit to the Ed Law Project and other advocates, parents, and psychologists who helped advocate for this bill, as well as Lead Sponsors of the bill: State Senator Barbara L’Italien and State Representative Jim O’Day.

Please visit the MAC website to appreciate the scope of their many efforts.  https://massadvocates.org/

For more information about the Independent Educational Evaluation process in MA, check out these resources:

NESCA is proud to continue to provide evaluations funded both privately and publicly. While our rates are higher than the state’s standard rate, we are thankful that this increased funding is available to defray costs for families in need.

About the Author: 
Roosa

Dr. Roosa has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems. Her evaluations are particularly appropriate for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box. As part of this process, Dr. Roosa is frequently engaged in school visits, IEP Team Meetings, home observations and phone consultations with collateral providers. Dr. Roosa has also consulted with several area schools, either about individual children or about programmatic concerns. She speaks to parent or school groups, upon request.

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.