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When to try a new program?

Leslie Chalmers Gravel

September 01, 2011 23:07

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My client is not making good progress with Lexercise. He takes weeks to graduate to the next level, and I barely graduate him, and always with modifications of short game time and reduced word bank. And then he struggles, scores hovering around 50%. We work together usually 2x per week, and he has flashcards and I send assignments and email regularly with the mom. He is very ADHD, and I wonder if he doesn't get that under control if he'll really benefit from Lexercise. Help! I don't want to keep stringing the parents along. I'm starting to lose faith in his abiltiy to make adequate progress. Very much looking forward to feedback. Sandie?????

 

Thanks, Leslie

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11 comments

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  Sandie Barrie-Blackley September 02, 2011 12:47

  Leslie~

  Before computer-assisted software like Lexercise that produce a graph of the child's accuracy it might have been easier to just keep seeing the child for weeks on end with very little progress. But when you are confronted with a"flat" graph week after week that slaps you with evidence that the child is not progressing, it is (or should be!) hard to ignore!  (...to say nothing of painful!)  I am interested to read your post because I have been struggling with a client just like this myself this summer. (All summer we have covered just two Levels! >:)  

  I think when you have  a problem like this you FIRST have to figure out the reason for the problem.  If the problem is basic attention regulation that will have to be addressed head-on before any "program" will be of much benefit. (Attention is necessary for ALL skilled learning.) Of course, the good thing is, if he is struggling with attention regulation and you are able to identify it and get him help, it could make a HUGE difference to his whole life. I don't know if this is the case with your client, but it does sound possible.  Since I don't know enough about your client to say what might be causing his failure to respond, I am going to describe what has happened with my client in hopes it will give you some ideas.

  I focused on the game Isolator with my client, partly because that task is essential for skilled reading and spelling and partly because it requires less working memory than the MatchStar games. I gave him some MatchStar Games but I used Isolator as my primary indicator.

  First, I tried using 3 very, very short (2 min.) Isolator games instead of one longer game and challenged my client to beat his previous score on each subsequent game. (I made three, 3 min. Isolator games  instead of one 9 min. Isolator game.) [NOTE: The report averages all the iterations of the same game so you can't see the separate performance on each Isolator game.] This did not help. The accuracy graphs remained flat.

  Next, I did a lot of practice with him "off the computer" in the office to see if I could figure out the trouble. I wanted to be sure he could  isolate speech sounds in 3 sound words.  He was pretty impulsive, and I found I needed to slow him down to get him to think and not guess. I realized that I was cuing him a lot and helping him focus. Working with nonsense words (vs. real words) seemed to slow him down, so I tried a week of using noting but 3 sound nonsense words . This did not help. The accuracy graphs remained flat.

  About this time my client's mom (who had been observing all this) told me a story that gave me some insight:  She said that when this child (who is now in 3rd grade) was in 1st grade he was missing his play time at school every day because he was not finishing his morning work.  Apparently, the teacher's practice was to require any child who had not completed his morning work to "walk laps" in the gym rather then participate in play time.  This boy never finished his morning work and had to "walk laps" every day. His mom finally told him to "just finish" the work by just randomly filling in answers so that he "complete" the work no matter what. He did that, and he didn't have to "walk laps" any more!  He did this all year apparently. Mom said, "I think he has learned to guess." Hummm.  Now, this boy's language processing is really impaired. (He has a "double deficit" pattern on the CTOPP and his word reading scores are all <10th %ile. He has a significant history of dyslexia in his family.  So, his processing problems ARE significant.  He probably could not have ever completed that morning work (accurately) in the same time that all the other kids were completing it. So, guessing his way through was maybe all he could do!  In any case, after I heard that story I decided I needed help!  The school still had not done a psycho-educational evaluation and were resisting doing that, so I referred this boy to a private psychologist, and I asked him to look especially at attention and response habits.  His results confirmed a diagnosis of ADHD, and also he found (using a, "easy" math activity) that if this boy made even one error he became so dis-regulated than he missed the next item no matter the difficulty of the items!  Essentially, he was unable to tolerate ANY error without melting down and turning to a guessing strategy. Soooo.....with this psychologist's help, we have designed a program that I hope is going to help.

  I made a one minute Isolator game using only 2 sound words (e.g., am, if, at, af, ill, etc.).  I worked with him on this game (in the office) to help him build his confidence. Then I asked him to do the 2 sound game at home. He was able to do that with >80%. (He was thrilled!)  I have him working for geodes now (which he LOVES):  2 consecutive days >80% earns him a geode. I have not yet bumped him back up to 3 sound words so I'm not sure how that will go, but I'm going to move very carefully!

  What I learned from this client is the importance of backing up to the point where you do can get consistent accuracy (e.g., >80% for 2 days in a row). At least for my client, that was 2 sound words!  (I have only ever had 2 elementary school age children for whom I have had to back that far up!)

  We are also referring this boy to a psychiatrist to get a medical dx of ADHD and to consider (at least short term) medication to help take the edge off the stress cascade he has in response to an error. I can see this is going to take a lot of patience from everyone, but I do feel like we are taking some little steps in the right direction at last!

   I wonder if you might need some help (from a psychologist or a developmental pediatrician or child psychiatrist) to look with you at this boy's Lexercise accuracy graphs and figure out how to help this child respond (to anything) with consistent accuracy?  If your client has a formal diagnosis of ADHD I wonder if you could get the physician who is working with him to collaborate with you (prescribe or adjust his attention-regulating meds. using the accuracy graphs as an indication of his attention regulation.)  If you do that , I suggest beginning by establishing a accuracy baseline (i.e., the Lexercise Level at which the child can achieve >80% accuracy for 2 consecutive days).  Be absolutely sure the listening environment is optimized when he is doing Lexercise (no TV on, no phones ringing, he is using headphones, etc.)so that's not derailing him.

  I hope you'll give is a progress update!

  Sandie

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  Leslie Chalmers Gravel September 02, 2011 13:15

  Sandie,

  Thank you for your very helpful and thorough comment. I certainly appreciate your time and expertise. That's a great idea about 3 very short Isolator games. I didn't know I could do that. How can I find out how to creat 3 Isolator games on the same practice plan?

   

  You've given me a lot to think about. I will write more later. But if you wouldn't mind telling me how you create 3 Isolator games in the same plan, that would be terrific.

   

  Thank you again, Leslie 

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  Yen Walter September 02, 2011 13:46

  I wanted to add some personal observations I have made of similar clients whom I work with who have ADHD and reading impairments. I did something similar to Sandie of sticking only to 2 phonemes and slowly added a third but progress was pretty slow seeing the child 2x/wk. Then both of the families I was treating decided to do a summer reading intensive program 5 days a week for a month at our local reading centers using OG instructional methods. They took a month off speech therapy and 1 other family of an extremely severe kid did it for 3 months. I have to say I saw a significant difference in their phonological processing abilities/working memory skills for retaining the sequential order of sounds and general attending and listening skills. But this was 3 hours a day, 5 days a week! Yes they are both still in that moderate severe range linguistically overall but it allowed those kids to move a step forward that did not stagnate their therapy with me when they returned and actually made my job easier because the kids seemed to be registering the cues much easier processing wise. It also made artic therapy more successful as they were able to better adjust their place of production by auditory input alone which i was pleasantly surprised by in that 1 month of intensive listening and attending practice which was very hard for them to do before. The point is, some of these severe kids really do need more intensity to make effective brain changes. It might be worth training a family member to build in more intensity of practice face to face to save some costs of only having a professional do it in between your sessions. I know Fast forward has shown progress in processing abilities and part of it I think in the intensity that the program provides to create those changes in mental timings somewhere in the brain of repetition and practice to improve the attention/listening abilities in a broad sense.

   

  Yen Walter

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  Leslie Chalmers Gravel September 02, 2011 14:12

  Thanks for the input Yen. I will respond later more in-depth, as I'm in the midst of trying to figure out how to create a specialized program.

  CHAD and SANDIE:

  Here's what I want to do:

  Two Isolator games in one practice plans, but each Isolator game with a different word bank.

  He is at Level 6 working on "ks" and "kw" phoneme pairs. This is what I want to do. He has more difficulty segmenting "ks", so, my desried plan:

  Isolator game 1: base words: three graphemes, four phonemes: wax, fix, etc., for 2 minutes.

  Isolator game 2: "ks" words with suffixes only: using all the base words from the Isolator game 1 word bank, but with suffixes (e.g., waxing, fixes, etc.)

  But when I try to do this in Ima Tester, it only keeps one word bank (and I spent time going through and selecting the word bank for each Isolator game. It only used the 2nd one entered, so I ended up with 2 Isolator games that were exactly the same.

  I'd be grateful for some guidance on this. Can it be done? If not, it would be a good thing to be able to do. I want to try this plan so I can isolate and closely and easily monitor progress (I find that reading the errors don't always tell me what's going on, as errors can be made for a number of reasons.) Does this make sense?

  Thanks so much for your attention.

  --Leslie

  p.s. I was not able to log out. There was nothing to click on at the bottom. I had to shut down my computer to get out.

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  Leslie Chalmers Gravel September 02, 2011 14:24

  Yen,

  Just more attentively read your comment. Very interesting. The familyI'm working with looked into Cog-Med. I did meet with the folks in our area that offer Cog-Med (are you familiar with it? It has gotten good reviews/results for ADHD, but is very expensive and there is no face-to-face therapy involved). Anyway, I advised the mother to stick with Lex and our program for now. I think this child would benefit from at least short-term medication (and I'm not a pusher of that, but he is losing so much and requires lots of one-on-one. He goes to a prestigious private school with very small class sizes).

  I wonder about going to the school and working with him maybe 4 days per week instead of his reading teacher so we have consistency, and doing an OG program with him. People around here like Wilson, so I've thought about getting OG certified (so expensive). I need to double my client base, so money is tight (the ol' Catch 22). I'm also considering taking the online course through the Dyslexia Training Institute. Any thoughts?

  Thanks, Leslie

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  Chad Myers September 02, 2011 14:57

  Hi Leslie,

  I thought you would like to know that Sandie will soon (in the next month) offer a two-part, online course covering the structure of English and how to deliver Orton-Gillingham treatment. It will be all online, so you don't have to travel for it. It can be completed at your own pace, and it's much less expensive than other comparable courses.

  If you are on our Clinician-focused newsletter list (you can join at this link), you will get the notification about it, which will go out next week.

  Best regards,
  
  Chad
   

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  Sandie Barrie-Blackley September 02, 2011 15:18

  Leslie~

  The phonology at this level (Level 6) is one of the most challenging of the entire O-G Scope & Sequence.  Even adults have trouble with the concept that <-x> represents two phonemes (/k/ + /s/) and <qu-> represents two phonemes (/k/ + /w/).   So before you decide that the problem is the child's attention  I'd ask if this child is able to demonstrate accuracy (>80%) on previous, easier levels (e.g., Level 4 words with no suffixes).  For example, maybe it isn't attention but difficulty processing consonant blends.

  Adding a suffix (e.g., /s/) will create a consonant blend at the end of the word:  bat --> bats.

  And adding suffixes to the Level 6 words will be especially challenging. While the base words may have 4 sound (e.g., quit) , the suffixed words may have 5 (quits) or even a 6 sounds  (quizzes) ! 

  So, I suggest creating a practice plan with only base words (no suffixes) to find the level at which the child can be accurate (>80%).

   

  You can't create Practice Plans with different Word Banks.  The software is designed so that it pulls the words from the current Word Bank in to all the games. It is designed that way to be in compliance with Orton-Gillingham (O-G) principles.  The O-G approach requires a tight focus on a small set of linguistic elements: If you worked on more than one Level at a time it would serve to erode this focus.  

  Assuming the child has shown he can be accurate with Level 4 and 5 words, here is what I suggest (and you may want to print these steps off so you can follow them step x step):

  1) Go to your Clients' Page and select Edit (for that client).  Then "Add a Practice Plan."

  2) Choose  Level 6.

  3) SAVE AND CONTINUE.

  4)  Add the 1st Isolator Game:

        In Station 1:  Select a game--> Click on Isolator --> ADD GAME.

         Edit Game Settings ---> Select 2 min.---> Save Game Settings

  5)  Add the 2nd Isolator Game

         In Station 1 :  Select a game--> Click on Isolator --> ADD GAME.

         Edit Game Settings ---> Select 2 min.---> Save Game Settings

  (If you have done this correctly you'll see two thumbnail pictures of the  Isolator Game, one under the other.)

  Now, click on "SETTINGS" on the left tool bar.

      Click on Word Bank.

      On Filters, click on "Suffix". 

      De-select (unclick) all 8 suffixes. 

      Now click on "Syllables"

      De-select 2 and 3 (so you'll just get 1 syllable words.)

      Look at the resulting words in the Word Bank and unclick any words that you think may be inappropriate (e.g., < quid> is a word the child doesn't know so you might not want to use that word.)

     Look under the "SAVE" button at the top right and e sure you have at least 20 words. 

    Click SAVE.

    Click PREVIEW and you can see how this Practice Plan will look and the Word Bank you have chosen will be printed at the bottom for your reference.

  Try that and see if that improves his accuracy.

  Sandie

   

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  Yen Walter September 02, 2011 15:21

  Leslie,

  I did take the course from the Dyslexia Institute last year which helped deepen my understanding of OG teaching methods as a quick overview. Sandie also recommended some reading texts for me to try and get up to speed a little as I am not specifically trained in any of the reading programs like Wilson, Project Read or LMBell which are popular in my area. I would love to take Sandie's course online when it comes up. Yes I have heard of cog med, one of the neurologists in my area has set up a practice specializing in it. Due to the costs involved, many of my clients really can't afford it. I have thought about doing it in my office but my plate is really too full at the moment to take on yet another thing. My situation is a little different as most of my clients already have reading tutors and so I am seeing them moreso for the speech /language issues than reading specifically but it has helped for me learn what they are doing so that I can use the same 'language' to help the child generalize what they already know to our work. My clientele is primarily with the autism population so reading comprehension is more the issue with many of them rather than decoding though some have concomitant dx if ADHD, CAPD etc The families that finished their intensive programs now have reading tutors continue the work this fall in their homes 3 times a week. I sometimes feel that we should think about doing short intensive boosts here and there to jumpstart a system and then take a step back and review.

  Yen

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  Leslie Chalmers Gravel September 05, 2011 19:43

  Hello Yen:

   

  I agree with your statement: I sometimes feel that we should think about doing short intensive boosts here and there to jumpstart a system and then take a step back and review.  This is something I do in my practice in session with the child--cycling back to earlier practice plans. I'm also using SPELL-LINKs, focusing on the same things that I'm focusing on in Lexercise.

   

  I am looking forward to taking Sandie's online class, as well.

   

  Thanks for your thoughtful comments.

  --Leslie

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  Leslie Chalmers Gravel September 20, 2011 11:39

  The puzzle has been solved as to what works to make this child perform more consistently.  I asked him what he thought would help, and he said he thought that if his mother sat with him would do better. Ever since she has been doing so, his accuracy scores have been between 74-82%. The power of witness.

   

  --Leslie

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  Sandie Barrie-Blackley September 20, 2011 15:15

  Yes.....and WHAT a great idea: Ask the child !   Thanks for letting us know how it was solved!  Sandie