Expert: Dr. Sharon A. Mitchell - 1/20/2009

Question
QUESTION: Hi,

I am mom to four children on the spectrum. All of them have average to superior test scores on their WISC-IV. The two I am concerned about also have CAPD. Their expressive/receptive language scores are also in the high average to superior range. Neither of them can read at grade level. They are showing avoidant behaviors related to school. These behaviors include not wanting to go to school, being late for school and doing whatever they can to get out of class while at school. While these behaviors are troublesome I feel that they are the result of inadequate support; maybe another LD not yet diagnosed? The school,however, feels that the attendance issue is the cause of poor progress or no progress. I have had some independent evals done and there is suspicion of dyslexia. My question is: Is this a common profile for a child on the spectrum and are there any strategies I can present to the school to relieve some of the school stress and anxiety?

ANSWER: Four children on the spectrum! My hat is off to you. What a busy life you must lead.

I'm not sure I understand the situation of the two who have CAPD. You say that both their expressive and receptive language scores are high. That sounds unusual for kids who have central auditory processing disorder. I can see that they might score very well on the expressive parts of language tests, but would expect lower scores or scattered scores on the receptive subtests. To have a diagnosis of CAPD an audiologist's assessment would have to show that the child has difficulty processing what is heard, resulting in low receptive scores.

The other thing that confuses me is that having an autism spectrum disorder generally rules out having CAPD (also known as APD – auditory processing disorder).  Here's a quote from the American Speech-Language-Hearing Association:
"APD is an auditory disorder that is not the result of higher-order, more global deficit such as autism, mental retardation, attention deficits, or similar impairments." (http://www.asha.org/public/hearing/disorders/understand-apd-child.htm)

Here is some information on CAPD:

http://kidshealth.org/parent/medical/ears/central_auditory.html

http://www.iser.com/caparticle.html

http://www.ldrc.ca/contents/conditions/capd.php

http://www.asha.org/public/hearing/disorders/understand-apd-child.htm

CAPD, like autism spectrum disorders, is not something that will go away if only the school would do the right things. And reading difficulties could explain some of the school avoidance behaviors you're noticing.

Having auditory processing difficulty could be behind why your children are having difficulty with reading, despite obviously being very bright.

It would help if I had an idea of the age of these students. In the first few years of school, much time is spent on the process of learning how to read. Since it's not easy to memorize the host of words we encounter, children are exposed to a variety of methods of decoding words. Phonics is one of those methods - not the only one but a very useful tool. Kids with auditory processing difficulties may find it hard to hear the slight differences between sounds such as the short /i/ and /e/. They may not hear easily the differences between /sh/ and /ch/. For a bright child, it can be discouraging to look around and see that other kids are "getting it" when you don't. That's a drawback of being bright but there are also plusses. Kids like yours can learn other ways to learn and apply skills that come more readily to them.

Kids with autism tend to become rigid. They find one way of doing something and continue to use that approach even when it does not work for them. They can then become frustrated. That may be happening to your children when they read and come to a word they don't know. They may be relying on just on or two strategies and when they don’t solve the problem, then they have no alternatives to fall back on.

For kids in higher grades, while they may be able to decode words all right, they may fall behind their classmates on the comprehension side of reading. Children with autism are often concrete, black and white thinkers. Such kids greatly prefer non-fiction books to novels.

Beginning around grade 4 but especially in the middle years grades, far less attention is paid to HOW to read, but more on reading for meaning. Comprehension questions change from basic who did what, when to look more at predicting what might happen if..., inferring things that were not directly stated, interpreting character feelings and motivations - all things that do not come easy for anyone on the spectrum. That does not in any way mean that these are not activities they should engage in. In fact they most definitely should. They will learn a lot of social skills and life skills from becoming better at this. It's just that these will be harder concepts for them.

I’ve written more about helping ASD kids with reading comprehension at this link:

http://www.autismsite.ca/html/reading_comprehension.html. You may find more school-related articles that could help at : http://www.autismsite.ca/html/answers.html

Many kids with ASD's (autism spectrum disorders) share characteristics with people diagnosed with CAPD - they have difficulty processing information they hear. This difficulty is more pronounced in noisy and/or unfamiliar situations or when feeling anxious. It's not a matter of being unable to hear but being able to attend to, interpret and respond correctly to what is heard.
There are lots of things that can be done to help; some at school and many ways you can help at home.

The first thing I would suggest is talk to the audiologist who diagnosed your children with CAPD. What strategies does she recommend based on the profile of responses your kids made during the assessments? Did she communicate her findings and recommendations to the school? To you? To your children if they are old enough to understand? Was there any follow-up where the school could ask further questions?

Some kids with CAPD (and many kids with ASD) find it easier to garner information in a classroom where the teacher's voice is amplified over some type of FM system. There are many brands/types of these sound field systems. Some are built-in; others are portable. Some require the student to wear a receiver; others are broadcast to the entire class. I prefer the latter because so many kids benefit and on one child in particular stands out.

Here is just one example of a sound field system:

http://www.phonicear.dk/eprise/main/PhonicEar/DK_gb/SEC_ALS/SoundFieldSystems/_i

If technology is not available, here are a few simple environmental things that can help your children listen more effectively:
- Allow the student to seek out a quieter place to work, at the back of the classroom or even in another room if they need extra quiet to do their seat work

- Seat them where they can best hear the teacher

- Seat them away from noisy, distracting areas such as the pencil sharpener, the door, traffic by the teacher’s desk, etc.

- Have  a designated spot on the board where assignments are always posted. That way if the child did not catch the directions, she can read them from the board

- Post around the room examples of finished products as samples

- Post around the room examples of how to do problems

- Give the child a checklist to follow of suggestions when she’s stuck such as check back in her book to see how it was done last time, ask a fellow student, check for examples posted around the room, skip that problem for now and go on to the next one until she can ask the teacher for help

- Teach the child to tune in to key phrases such as “for example”, “open your books to page”, “for homework”…


- Some kids find foam earplugs helpful in tuning out excess background noise

Kids with autism are generally better at taking in information through their eyes than with their eyes. You can capitalize on their visual strengths and their sense of logic. When reading, rather than concentrating on sounding out each individual word, have your child instead think about the content. Does the sentence make sense? If not, stop and read it again. Don’t just rely on phonics, but think about what word would make sense in that context. Now that he’s come up with a word that could fit, do the letters match the sounds he’s saying? If not, try for another word. Go back to the beginning of that line or the beginning of the sentence and try again. There’s a good chance that the right word will come if he’s concentrating on meaning rather on each separate word. Take a look at any pictures on the page. That’s not cheating – the pictures are there to give clues.

It’s no fun practicing reading when it’s a non-stop struggle. When your child practices, make the book easy for him. To decide if a book is too hard, use the five finger rule. Have him start reading. As soon as he comes to a word he does not know, hold up one finger. If he holds up all five fingers before he’s finished that one page, then the book is too difficult to practice on.

Reading fluency affects comprehension. If a child stops and struggles with too many words, then he loses the overall meaning of the passage. In order to have improved reading comprehension, a child needs to increase his reading fluency, the rate at which he reads. To work on fluency, start with easy books and gradually build up as the child gains speed and confidence.

Here’s the link to a free online handbook that will give you lots of tips for practicing with your kids at home:

http://www.education.gov.sk.ca/adx/aspx/adxGetMedia.aspx?DocID=190,211,107,81,1,

While there are lots of books written on reading, this is the one is most often recommend to parents for its sound practices, easy readability (and it’s price): Reading Reflex. Take a peek at it at http://tinyurl.com/892s54. And, you’ll be please to know that this book addresses auditory processing difficulties.

You ask if the pattern you describe is common with kids on the spectrum. Yes, it is. And the anxiety and school avoidance are also common. There are many, many things that can cause kids with autism to be anxious and reading difficulties are only one possible reason.
Have things changed in your children’s classrooms? Is there a new teacher? Has the routine been disrupted? Getting back to school after a vacation can be difficult.

Are there sensory issues at school that seem overwhelming to the children? Can you work with you school on this?

Many kids on the spectrum are true individuals. They may prefer solitary pursuits and to do things their own way. Unfortunately, school logistically does not often work that way. The regimented do-this-at-certain-times, change-subjects-now, do-this-even-if-you-don’t-feel-like-it requirements may not suit the preferences of a bright child with autism. School, like life, is a group affair. While this can be hard at the time, think of where you want your child to be ten, fifteen, twenty years down the road. What sorts of skills will he need to do what he wants to do? It’s worth continuing to work with your school so that your child can gain the tools he needs.

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca


---------- FOLLOW-UP ----------

QUESTION: Hi,

The children ages are a 14yo boy and a 10 yo girl. Most have experienced a traumatic event at school. My son's school called the police to have him arrested for assault because he was sword fighting with a pencil and his pencil broke the skin of the child and my daughter's teacher told her if she continued to be late he was going to call the truant officer on her and have them come to her house and arrest her and take her to school. She hasn't slept in her own room since.When I say their expressive /receptive language is high ...they are.. but there is a significant split between the two 100/112 for my son and 109/129 for my daughter. They both have a hard time getting to school on time,I'm often called about an illness or they just don't want to go. I am concerned that the above events have triggered these behaviors and they are escalating. I am trying to get the school to understand that my children do not feel safe or supported and all they tell me is that there is little to no progress because they are often late and or absent. While I agree that the kids need to be there, I also feel that these issues are a result of what happened and are a contributing factor. Neither of them can read or spell at grade level despite having average to above average IQ scores..they are 3 to 4 grade levels below. I will check into the CAPD ...maybe it is just a tangent of the autism like you stated.

Answer
I'm not sure I'd worry that much about their spelling weaknesses. In this era of computers, spelling difficulties are more readily corrected by built-in spell checkers.

Their reading skills are more of a concern, but again, there are ways to get around this. I know of several people with dyslexia and very weak reading who were success at university by using various forms of technology.

There are comprehensive software programs like Wynn Reader and Kurzweil that will read text (that has been scanned in) or text from sites you've found in an internet search.

You can read about these programs on these sites:

Wynn http://www.freedomscientific.com/LSG/products/WYNN.asp

Kurzweil http://www.kurzweiledu.com/

If putting thoughts to paper is also a problem, starting with relatively inexpensive methods, are the voice-to-text possibilities where you speak into a microphone and your words are turned into text on a computer. Then you can edit the work and print it out. Microsoft Office 2003 has this feature automatically built in. You can also buy specific programs to do this, such as Dragon Speak Naturally. Wynn and Kurzweil also have these features.

Here's some other software that's free or not too expensive that you might find helpful:

BrowseAloud is a free tool that will read websites out loud to you http://www.browsealoud.com/page.asp?pg_id=80004

WordTalk is a free plug-in developed for use with all versions of Microsoft Word (from Word 97 upwards), which can help people with reading difficulties use Microsoft Word more effectively. http://www.oatsoft.org/Software/wordtalk.

ReadPlease 2003 reads any text you see on your screen. It is all-purpose text-to-speech software—available in free and plus versions. www.readplease.com

Natural Reader is also available in both Free and Professional versions,  Natural Reader reads any selected text and reads &  highlights in its own window (Free version) while the Professional Version provides a toolbar for all Office products and converts synthetic speech to MP3 Audio files. http://www.naturalreaders.com/download.htm
         
Mozilla Firefox with ClickSpeak is a version of Mozilla web browser. The free ClickSpeak extension provides text-to-speech support on all web pages. http://clickspeak.clcworld.net/  

The E-Text Reader is designed to be a reading tool. You can use it for opening up and reading existing documents in your computer or you can cut and paste from any program on your computer.http://www.premier-programming.com/elib/etext_reader.htm

You'll find more possibilities here http://www.greatschools.net/cgi-bin/showarticle/3071

I'm sorry that your children have had some bad experiences at school. That's troublesome for all concerned.

But your kids need an education and it sounds like the school wants them to be in their classrooms. So, you both have the same goal in mind.

What I'd suggest is that you keep talking with the teachers. Could you suggest a fresh start? When defensiveness builds up on both sides, it's hard to listen to the other's point of view and to come up with a plan together. And when kids see an opportunity to expand on a rift between the adults in their lives, they will often exploit that division.

Could you start with clear expectations that you and the teachers would come up with an enforce jointly. First on the list would be attendance. But once your children are at school, then there needs to be plans in place for what to do when things don't go as hoped. Is there a "go-to" person for each kid, someone they can go talk with when upset or when they don't understand something. Often kids with ASD will misinterpret a situation, getting off on the wrong foot and things escalate from there. They need a strategy for what to do when they're unsure.

If they feel overwhelmed, whether by volume of work, sensory or social issues, is there a safe place they can go? Someone to speak with? Something sensory that will help them calm themselves? (Bean bag or rocking chairs can sometimes work well).

Social stories may be helpful in teaching the kids what to do when upset and in going through a checklist of strategies they can employ.

Is there a visual schedule at home and at school that tells each child exactly how his/her day will look? Even with highly verbal, bright kids, a visual schedule is the first thing I recommend because I've seen it work so well.

School is sort of like life. For kids, school is their work. As adults, we go to work whether or not we may feel like it because there are certain expectations of us. If your kids are bright, they will have the opportunity to attend post-secondary school if that's their wish and to hold down rewarding jobs. In those settings they'll encounter people they don't like and have some experiences that are not pleasant. They'll need training and practice in how to handle themselves when things don't go well. The skills they learn in the next half dozen years in school will hold them in good stead in their adult lives. I know that today you're focussed on the "now" and just trying to get through. But with kids with ASD's it pays to continually think five, ten and fifteen years down the road to where you think they might be and the skills they'll need in order to be successful there.

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca