Running Head: THOMPSON - INTERVENTIONS FOR MEMORY DEFICITS

Interventions for Students with Memory Deficits Shauna Thompson ID 10017221 University of Calgary APSY 693.71 L20, Spring Session 2009

Thompson - Interventions for Memory Deficits

A learning disorder is diagnosed when a students achievement on standardized tests is below what is expected for their age, grade, and level of intelligence, and it is not found to be linked to any other nonacademic causes. In most cases, deficits in academic skill areas significantly impact a students academic and interpersonal success. According to the American Psychiatric Association (APA, 2000), abnormalities in cognitive processing, such as deficits in visual perception, linguistic processes, attention, or memory, often precede or are associated with learning disorders. In evaluating a student who is struggling academically, it is important that achievement and intelligence testing is complemented with an evaluation of these less-obvious areas of cognitive functioning. This paper will present information which outlines the cognitive processes involved in memory, with a focus on interventions to target memory deficits in the classroom. The intervention information will be provided within a best practices framework put forward by Upah and Tilly (2002). Memory is a complex and involved process that supports all aspects of learning, and provides the foundation for acquiring complex skills in school. Memory includes the ability to take in information, process it, store it, and retrieve it when needed. Students with deficits in memory functioning are at high risk for failure across academic and interpersonal domains in their lives (Alloway, Gathercole, Adams, & Willis, 2005; Baddeley, 2003; Bull, Espy, & Wiebe, 2008; Gathercole, Alloway, Willis, & Adams, 2005; Schuchardt, Maehler & Hasselhorn, 2008). The big-picture concept of memory encompasses short-term and long-term memory events and processes. Given that deficits in short-term working memory (hereafter referred to as working memory) are more predominant in childhood when compared to the prevalence of deficits in long-term memory, this paper will focus on working memory. The available evidence indicates that working memory is an important part of the cognitive basis of intelligence (Case, 1992; Schweitzer & Koch, 2002, as cited in Swanson, 2008). Alan Baddeley and Graham Hitch (1974) developed a multicomponent model of working memory that will be used as a framework for the discussion of memory within this paper. The model was developed from experimental work with normal adults and children, from

Thompson - Interventions for Memory Deficits

studies of individuals who suffered brain damage, from computational modeling, and from work using brain imaging techniques (Logie, 1999), has been elaborated on as we learn more about memory, neuroanatomy, and neuropsychology (Baddeley, 1986; 2000), and is the most widely accepted model in searches of current and past research on memory. Baddeley and Hitch (1974) use the term working memory to describe the short-term memory system involved in the temporary processing and storage of information, and their model details a collection of specialized cognitive functions that comprise working memory. One group of functions enables temporary storage of the visual appearance and representation of objects (the visuo-spatial sketchpad), a second group enables temporary storage of verbal material and information in terms of its phonology (the phonological loop), while a third offers a coordinating executive function which enables the conscious manipulation of information (the central executive). New and old information come together in the working memory. All three components make use of prior knowledge stored in long term memory, and the products of moment-tomoment sensory perceptions that are interpreted through prior knowledge. Information is stored temporarily in working memory to allow information to be updated in-the-moment, and to avoid having our minds filled with useless information. Verbal and visual information from the environment, as well as other sensoryperceptual information is received in the working memory. Robert Logie (1999) calls working memory the desktop of the brain (p.174), where we keep track of what we are doing and where we are in the moment. As its name implies, working memory is an active system that enables its contents to be combined with stored knowledge and manipulated, interpreted, and combined again to develop new knowledge, assist in learning, form short-term and long-term goals, and support interactions with the physical environment. Working memory has a limited capacity for information storage and processing that is dependent on the particular demands of tasks. These demands are exacerbated for younger children because fewer of their mental strategies and processes are automatic (e.g. phonics, numeracy skills, fine-motor skills). As a result, their working memory requires more concentrated and

Thompson - Interventions for Memory Deficits

purposeful attention and focus (as discussed in our course presentations). It is important to note that this effect lessens over time as children become more practiced and skilled, and more knowledge becomes crystallized. Processes like reading, adding and subtracting, reasoning and problem solving, thinking about the meaning of what you hear or read, or carrying out a sequence of operations like getting dressed in the morning all involve carrying out operations on information while it is currently held in working memory. As mentioned, tasks that require the use of the working memory require varying degrees of attention and mental effort. Without repetition, rehearsal and processing, the contents of working memory are vulnerable to distraction, seemingly evaporating from the mind if focus is interrupted (Logie & Baddeley, 1987). Anyone who has been distracted or interrupted in the middle of doing a mathematical equation, reading a complex paragraph, or dialing a telephone number has experienced the true vulnerability of working memory information, likely returning to the beginning of the task to start again. Younger children are more susceptible to interference and distraction than older children (Swanson, 2008), likely due to their inability to ignore irrelevant information and prevent it from entering the working memory. This also improves with age for most children as they learn to apply different levels of focus and attention when it is required. Working memory functions are not localized in one specific area of the brain. Baddeley (2000) reports extensive attempts to associate different memory processes with specific anatomical regions of the brain with conflicting results. This has particular relevance when working with children who have a brain injury, but will not be further explored within this paper. Even in children who do not evidence a measureable memory deficit, memory function can be affected by a number of different environmental and interpersonal factors, including stress, anxiety, hunger, inattention, trauma, injury, distraction, disinterest, and the presence of a learning disability. Consistent findings in the literature show a close relationship between childrens academic achievement and their working memory skills (see Gathercole et al., 2006, for a review). Working memory underlies the foundational skills needed for reading (Gathercole et al., 2006), writing (Gathercole et al., 2006), mathematics (Bull et al., 2008; Gathercole et al., 2006), and language

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development (Baddeley, 2003). If children do not receive early intervention, memory deficits cannot be improved over time and will continue to impede the childs chances to be successful in school and other areas of their lives. When assessing a child who is struggling in school, we are often looking for qualifiers for diagnostic labels, such as those found in the DSM-IV-TR (APA, 2000). Diagnostic labels are useful for providing a snapshot of the key components of a childs learning disorder, and for helping a school and student achieve funding for special education services. However, establishing a diagnosis is by no means where assessment and intervention ends. More important than a diagnostic label, a specific and individualized intervention must be designed to target a students unique learning strengths and needs, helping the student develop the skills to reduce their deficits, enhance their strengths, and reach their highest potential. Kristi Upah and David Tilly (2002) present a four-stage behavioural consultation model in which the school psychologist leads the intervention team (IT) through four stages of behavioural consultation, beginning with problem identification and moving through problem analysis, plan implementation, and program evaluation. Each stage has a number of quality indicators that guide the IT in designing, implementing, and evaluating quality interventions for every student. The remainder of this paper will be devoted to the review and implementation of this process as it applies to the assessment and intervention of memory deficits. The behaviour Sarah, a fictional 8-year old, will be examined as we move through the model to demonstrate how each step can be applied to the assessment and intervention of memory problems. In a real assessment situation, the process would be applied to each of the behaviours targeted by the IT, though in this example only one problem is identified. The first stage in creating an effective intervention is to clearly and accurately identify the problem. A problem is often identified at school when theres a clear difference between what is expected of a student and their actual behaviour or performance in the classroom. The three steps within this stage help the team to describe, validate, and determine the magnitude of the problem (Upah & Tilly (2002), p.484). In the first

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step, the IT must develop a behavioural definition of the problem that is objective, clear, and complete. The definition must describes characteristics of targeted behaviour that are observable, including examples and non-examples of the behaviour so it is easy to recognize when it does and does not occur. The definition must be simple, clear, and easy to understand so that it can be read, repeated, and paraphrased by anyone working with the student. This will ensure that all team members to have a good understanding of when the behaviour is occurring. It is common for students with a poor working memory to have difficulty following instructions and to appear inattentive. Here is an operational definition for Sarahs behaviour that follows the example provided in the Upah and Tilly article (2002): Ignoring classroom instructions means that Sarah does not obey instructions given by the teacher. Examples of ignoring classroom instructions include (1) remaining in her seat when asked to go to circle time, (2) leaving books and papers on her desk at the end of a class when asked to clean up, and (3) remaining in the circle time area when asked to return to her chair. Non-examples of ignoring classroom instructions include (1) incomplete spaces on worksheets due to lack of understanding, (2) low contribution to group activities while in a group setting, and (3) failure to provide a correct answer when called upon in class. The second step in this stage is to collect baseline data on Sarahs problem behaviour in the classroom, before any kind of intervention is attempted. The IT must determine which behavioural dimensions are relevant, how they could be systematically measured, and how the data could be collected. For our student Sarah, the relevant dimensions include frequency, latency (time between the presentation of an instruction and Sarahs compliance or non-compliance), intensity (whether Sarah is non-compliant some of the time, most of the time, or all of the time), topography (what Sarah does when she does not follow directions), accuracy (how often Sarah is compliant), and duration (length of time before Sarah follows a given instruction). Data will be collected in the

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classroom using a simple score sheet where the recorder will note brief details of instructions given in the classroom (including time, teacher, type of instruction (e.g. written/verbal/group/individual), and the time and form of Sarahs response. Behavioural dimensions will be scored at the end of each session and charted graphically each afternoon by the school psychologist. The teachers aide, the school psychologist, and the learning centre teacher will observe in the classroom in pairs for a onehour block each morning and afternoon for a minimum of one week. One person will record data for Sarahs behaviours, the other for her classmates, until a steady range of Sarahs behaviours is established. The baseline data will be used to evaluate the existence of problem behaviour, the effectiveness of interventions, and Sarahs progress through the intervention process. The third step in this stage is problem validation. The baseline data for Sarahs behaviour will be compared to the data collected for classmate performance. To validate the problem, the data collected must show a discrepancy between Sarahs performance and that of her classmates, and the IT must deem it large enough to warrant an intervention. If it happens either that there is no discrepancy, or it is not large enough to necessitate an intervention, the IT must re-examine the existence and/or severity of the problem, returning to earlier steps in the model. If both elements are confirmed, the problem is validated, and further assessment is needed to develop an intervention strategy. The second stage in creating an effective quality intervention is to analyze the problem. Upah and Tilly (2002, p.489) describe this stage as the most complex and critical to the selection of appropriate interventions. The five steps within this stage help to determine what is known about the problem, and what information is still needed to understand the underlying causes for why the problem is occurring. The first and second step in this stage require collecting information, both known and unknown, in the areas of instruction (teaching methods and interventions used), curriculum (current learning requirements), environment (classroom size, organization, energy), and the student. First, the students cumulative record, previous assessments, and samples of current

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classroom work should be reviewed, and interviews should be conducted with the student, teachers, and parents. The use of rating scales for teachers, parents, and students, such as those provided in the

Behavior Assessment System for Children (BASC-2; Reynolds, C.R & Kamphaus, R.W, 2004), along with personal interviews can be very helping in collecting a lot of relevant information across several domains in a short span of time. This is important in the assessment of memory problems because the problems these students experience are often difficult to distinguish from issues such as attention and learning on the surface. Once all known information is collected, the second step is to use observation and testing to obtain information about the students current academic, intellectual, and cognitive strengths and weaknesses. For Sarah, the Wechsler Intelligence Scale for Children (WISC-IV) could be administered to assess her strengths and weaknesses in the areas of learning, executive functioning, attention, and general intelligence; The Wechsler Individual Achievement Test (WIAT-II; The Psychological Corporation, 2002) could be administered to evaluate her academic achievement; the Childrens Memory Scale (CMS;
Cohen, 1997) could be administered to evaluate her attention and memory across domains. Scores from these tests can be linked to infer correlation between functional domains. An abilityachievement discrepancy analysis can be conducted with the WISC-IV and the WIAT-II, and an ability-memory discrepancy analysis can be conducted with scores from the WISC-IV and the CMS (Drozdick, Holdnack, Rolfhus, & Weiss, 2008) to provide a fuller picture of Sarahs strengths and needs, particularly to identify the underlying cause of her memory deficits. The third step in this stage is the generation of informed statements about why the problem occurs. As a hypothesis statement, Sarah does not follow verbal classroom instructions because when she is given a large amount of verbal information she becomes overwhelmed and disengages due to her deficits in phonological processing and her inability to hold a large amount of information in her working memory. A prediction statement creates a direct and logical link between

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information gained in the assessment and actions for intervention. In this case, If Sarah is presented with short, clear, instructions that are broken down into small steps, this problem will be decrease. The fourth step in this stage involves validating the hypothesis and prediction statements by either implementing the intervention, or systematically manipulating the environment (teaching strategies used with Sarah, as suggested by the prediction statement above) and observing the effect on Sarahs performance. When the statements are validated by lessening of the problem, the goal of the process then becomes intervention design and implementation. The second stage in creating an effective quality intervention is to develop and implement a plan. The four steps in this stage guide the development and carrying out of an intervention plan in order to resolve the identified problem. The first step in this stage is to develop a goal statement that states the extent to which the target behaviour is expected to change. It should include the time frame, condition under which the behaviour is expected to occur, a behavioural description of the task to be performed, anda standard for how the behaviour should be performed. For example, In two months, when Sarah is given instructions in class, she will complete the task as requested and ask for clarification if she does not understand. The second and third steps involve developing an intervention plan and measurement strategy. The intervention plan identifies who will do what, as well as when, where, and how it will be done. Instructions should be simple and clear, providing a clear description of the procedures to be used to ensure that the intervention is applied consistently by all involved parties. This will also help involved adults implement the intervention as intended, increasing the treatment integrity and likelihood of successful outcomes. The measurement strategy follows the same path as that in baseline data collection, but may be modified as needed. Overall, the method and materials used to collect the data should remain the same to allow for accurate comparisons between baseline and post-intervention behaviour. The same behavioural checklist used in the first stage could be used to monitor Sarahs progress, with a modified observation schedule.

Thompson - Interventions for Memory Deficits

The fourth step in this stage is to determine how the treatment decisions will be made. Key information to be determined by the IT includes a projected duration and frequency of data collection sessions, strategies for summarizing data to be evaluated, and a guideline that states what will happen when a certain pattern of data occur. In Sarahs case, observations will be scheduled three times per week for one month, with the results entered graphically and reviewed during weekly IT meetings. After one month Sarahs progress will be evaluated. If she is following simple and clear classroom instructions 100% of the time the intervention will be discontinued. If she is following classroom instructions less than 100% of the time, observation will be extended two weeks at a time. The fourth stage in creating an effective quality intervention is to evaluate the intervention. The four steps in this stage work to determine how well the intervention plan is working, as well as whether any aspects of the plan need to be changed. In the first step, student performance needs to be assessed frequently so interventions can be modified as needed to provide the highest level of support. Data should be collected several times per week and plotted for review by the IT. The Consistency of measurement across time allows the IT to be sure that changes in the data are a result of student performance, rather than changes in measurement procedures. The second step of this stage is to complete a formative evaluation of the intervention during its implementation so that it can be changed as needed, increasing the potential for student success. The students average rate of performance, level of performance, trend in performance over time, and change in latency postintervention should be compared and tracked on a regular schedule, comparing baseline date with the students current performance. The score sheet data that was entered graphically for Sarahs behaviour tracking is intended to provide these results in graphic form so that these areas are clearly visible to the IT. If data is continually above the goal-line, the IT may wish to raise expectations for the students behaviour. If the data is continually falling below the goal line, they will need to change the interventions strategies so that performance improves. If data are highly variable over time, the

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student may require additional motivation to perform the required behaviours consistently so the data accurately reflect the students abilities. This progress monitoring will be continued with Sarah for one month post-intervention, to determine whether her progress is maintained once observation is not occurring frequently in the classroom. The third step in this stage requires that the treatment integrity is assessed to determine whether or not the intervention is being implemented as planned, allowing accurate conclusions to be made about the effectiveness of the intervention. In Sarahs case, direct observation of classroom interactions and teacher behaviour will be conducted once per week to assess whether she is successfully delivering information to Sarah in chunks that are small, simple, and manageable, and that she is alert to signs that Sarah may not have understood an instruction and requires additional support or explanation. The fourth and final step of this stage, the completion of a summative evaluation, is performed once the intervention is completed. The IT uses information based on the decision-making plan from stage three, and the difference between the students baseline performance and the post-intervention performance. If the outcomes were positive, then the IT can plan for maintenance and generalization. If it was not positive, the IT will want to consider making changes to the intervention or reanalyzing the problem by revisiting earlier stages of this model.

In wrapping up, it is important to note that while the model has been presented in a neat, linear, stages and steps fashion, intervention often occurs in a very non-linear fashion. Progress may occur in some areas but not others, requiring the IT to go backward through the steps and stages until they discover the location of the hole in the proverbial bucket. However, using this type of problem-solving approach to intervention remains the best research-based approach for improving individual student outcomes, (Upah & Tilly, 2002, p.495).

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