How to talk about your kid's learning disorder: Part 2
"Processing"
Lots of parents come to me concerned that their kids have a “processing disorder.” Honestly, I never know what they mean, and it is impossible for me to know how to intervene unless I get more information about the true nature of the cognitive difficulties. Implicating “processing” is vague at best and misleading at worst.
Let’s start by talking about the neuroanatomy of sensory processing and integration.
Sensory information is first received and perceived by the brain in the primary sensory areas. Secondary association areas lie near the primary sensory areas, and that’s where sensory perceptions are recognized. Tertiary association areas are where different sensory modalities are combined and used in higher-order cognitive functions like language, attention, organization, and planning.
Generally, I assume that most healthy kids are able to perceive and recognize sensory information, so when I think of the type of processing that might go wrong in school, I’m not usually implicating the primary and secondary association areas; I’m thinking about the stuff that happens in the tertiary association areas--when information being integrated and used in higher-order cognitive functions.
The types of breakdowns in higher-order cognitive processes are diverse, so let’s work though a few common examples.
Auditory Processing
Many parents are told that their kids have Auditory Processing Disorder. Auditory Processing Disorder is such a commonly-used label even though it’s not an official clinical entity: it’s not included as a diagnosis in the DSM, and it’s not a recognized part of educational classifications. To be honest, if you consider the framework of the brain that I described, it doesn’t totally make sense. The term ‘auditory processing’ implies that the kids have issues with secondary association (i.e. they have auditory deficits that make it difficult to discriminate sounds), but that doesn’t really fit; like I said, most healthy kids can accurately identify sounds, and interventions that claim to treat dysfunction in the secondary association areas, like FM systems and auditory training programs, have limited utility. Instead, it’s a tertiary association issue. The vast majority of these kids either have trouble comprehending spoken language or paying attention in loud, distracting classrooms. Interventions that target those higher-order cognitive functions, like speech-language therapy and interventions to increase attention, are much more likely to be effective.
Visual Processing
Visual processing is also an interesting one. I don’t hear many people claiming to have “visual processing disorder,” but there are misconceptions about the ways in which visual processing deficits contribute to learning disorders. The main misconception is the supposed link between visual processing and reading. Some people think that the core deficit in their reading disorder is the inability to accurately perceive letters: they somehow see letters differently, so they fail to recognize them. If this ever happens then it’s very, very rare—I certainly have never seen it in my practice. Instead, more often than not, people with reading disorder struggle to manipulate the sounds of language and to match sounds to letters, which, again, are higher-order cognitive skills that take place in tertiary association rather than secondary association areas. And, again, it’s important to treat the actual problem; it’s a shame when people waste time and money on vision therapy when they would be much better served with structured, phonics-based reading instruction.
Visual processing issues can, however, come into play in two major ways. First, some kids with reading disorder do struggle to read when the text is small and the page looks crowded. It’s as if the cognitive load is just too high to simultaneously manage the language and visual-spatial demands that reading requires. In those cases, it can be helpful to blow up the font and increase spacing between letters.
Second, visual processing contributes to visual-spatial and visual-motor integration. Those higher-order cognitive deficits make it tough to organize writing on a page, which makes math really difficult. These kids tend to have trouble drawing graphs, lining up numbers for arithmetic, writing equations so sloppily they can’t read their own handwriting… you get the idea. And since writing out their work is such a challenge, they rely on mental math, which is imperfect. These kids can benefit from OT and assistive technology. I also like telling them to write out their work for one math problem per sheet of unlined computer paper. It’s a really simple intervention, but it’s really effective.
Processing Speed
If anyone has ever taken an IQ test, it probably measured verbal and non-verbal reasoning skills, as well as working memory and processing speed. It’s a little confusing because the first two domains are quite different from the latter two. Verbal and non-verbal reasoning skills are what I generally consider “real” intelligence, since they are the ability to use different types of information in abstract reasoning and problem solving. The other two—working memory and processing speed—are measures of cognitive efficiency. Working memory is the ability to hold information in mind and manipulate it. Processing speed is the speed at which information flows through primary and secondary areas to tertiary areas where it can be used in reasoning and problem solving. People with slow processing speed take a long time to think, but the quality of their thoughts can be very good. But since so much of school (and life) involves time pressure, people with processing speed deficits are at a true disadvantage. They need accommodations like extra time on tests to produce high-quality work.
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I know this isn’t really a Broadway video, but Nick Jonas was in Les Miz, so it counts, right?