Archive Page 2

09
Feb
12

A Wandering mind

In my last post, I wrote about Vince.  I suspected dysnomia, which turned out to be the topic of that post.

It also turned out that he was no more dysnomic than a rhetorician. He simply couldn’t recall that one name (Charles Dickens). Otherwise, he was fluent and linguistically sophisticated.

But he did turn out to be what I have come to call the “unconventional thinker”. I will be writing about this sort of learner in future posts quite often because they are very interesting and very much misunderstood. I alluded to this sort of mind in a previous post.

Suffice it to say at this juncture that Vince could generate multiple plausible responses to any test stimuli that permitted some degree of response latitude. So, while the answer to “What is two plus two?” is highly constrained, the answer to the question , “In what way is first and last alike?” is not. There are a number of correct responses to this question (e.g.  they’re both “extremes” or they’re both “ends”.)

But what Vince could do effortlessly was conjure a range of plausible (or possible) responses to items that seemed to have a very limited range of appropriate answers. This capacity to think discursively (non-linearly) appeared most strikingly in his efforts to assemble a series of pictures (presented in mixed-up order) into a “sensible story”.

The IQ subtest used, called Picture Arrangement, has been deleted from the most recent IQ battery; nonetheless I use it to assess just this type of thinking. Imagine, then,  a five-panel cartoon strip, without words, that has been cut up into individual panels and then presented in a disarranged sequence . The examinee, in this case, Vince, is told to “put the pictures as fast as you can into an order that tells  a sensible story.”

Vince spent a great deal of time with these items, shifting and repositioning the panels until he settled on one that he considered correct. But in nearly every case, his facial expressions and body language emanated uncertainty even as he said, “Done.“… as if he wouldn’t be surprised to learn that he was wrong.

I talked to Vince about his delays and uncertainties, asked him what it was about this task that seemed to confuse him. After a moment’s reflection, he said, “ I just could see so many different ways to put the pictures together.” Asked to give an example, he selected one of the card sequences he’d already done. Then he set about explaining how the features of each panel could mean something slightly different…depending on the assumptions made about the rest of the pictures.

He subsequently demonstrated no less than five different ways in which the pictures could be sequenced and explained how each was plausible, even if some were unlikely. “I sorta’ guessed which sequence was right because really they all could have been right.”

Vince turned out to have an IQ at the 98th%ile; his Verbal powers were no less than gifted. In effect, then, it was the very “generativity” of his intelligence, his enormous powers of perception, inferential reasoning, fund of information and abstracting capacities that he deployed in extraordinary idea proliferation.

Consider the simple sentence,”Mr Jones sold his house by the beach.” Consider then a multiple choice question like ,”Where was Mr. Jones’ house located ?” 1) in the city 2) out of town 3) by the beach 4) in the suburbs.

If you picked #3, you’d probably be right. But it could also be any of the others. Why? Because it may have been the case that Mr. Jones was standing by the beach when he sold his house that was #1, #2 or #4. That is, Mr. Jones’s house was nowhere near the beach though  he did contract to sell it as he stood on the beach.

Needless to say, Vince “hates” multiple choice tests. “I see more than one answer,” he says. He also dislikes essay writing: “I come up with so many ideas, good ones. But I can’t decide how to organize them.  I don’t know what the teacher expects. My teachers say I ramble, include too many details and the connections between my ideas aren’t clear to them.”

Vince dislikes the authoritarianism of text books, of grammar rules, of the idea that are absolute scientific “truths”. He’ll dislike formal education until he gets to Graduate School… maybe.

But he’ll be an innovator, a discoverer…unless education defeats him.

I’ll be writing about this type of person, this wandering mind,  often.

02
Feb
12

“It’s Right on The Tip of My Tongue”

Just yesterday, Vince, a 17-year-old from a prestigious private school, came for an Evaluation.  Soft-spoken, a bit self-conscious but wholly committed to doing his best, Vince demonstrated very sophisticated verbal aptitudes – faculties nearly essential in the particular school he attended where so many peers possessed superior abilities.

But Vince was struggling in school and seemed unable to overcome his diffuse but substantial achievement problems.

Though no pattern of deficits or even weaknesses emerged in the first of two test sessions, one interesting moment arose when I asked (as part of the IQ Battery’s “Information” subtest), “Who wrote ‘Great Expectations’?”

Vince shot up straight, clapped his hands together, snapped his fingers once and exclaimed, “Wait, I know this!  I KNOW I know it! Gimme a sec!”  But after some 40 seconds passed, after much grimacing and sighing and seat-shifting, he seemed to sag in his chair, as if he were deflating.  “I can’t think of his name.  I know it!  I know it!”  A moment later, he sighed deeply and groaned “Aw, I don’t know.”

At that point, I took out a piece of paper and asked him to guess how many letters were in the author’s last name.  At first, he looked amused, but after some encouragement, he said, “Uh, eight!”.  I said, “No, there are seven” and drew seven short dashes on the paper (like the kids’ game, “Hangman”)  The dialogue continued:

Me:  “How many letters are in his first name? “

 Vince:  “I’ll say seven”.  

ME:  “Right”  And I drew seven short dashes to represent the seven letters that Vince guessed were in the author’s first name.  Now, he was looking at two groups of seven dashes:

ME:  “What’s the first letter that comes to mind when you think of this writer?  Just guess.”

Vince:  “Okay, um…’I’?”

I put the letter “I” in the second dash of the last name group of seven

_ _ _ _ _ _ _  –  _I_ _ _ _ _.

ME: “Guess again.”

 Vince: “I dunno – ‘C”?

 I put the “C” in two spaces: C _ _ _ _ _ _  –  _IC_ _ _ _.

Me: “Next?”

Vince: “E”.

I put the two “E’s” in.  Now he was looking at:

C_ _ _ _E_  –  _ _ I C _ E_ _.

ME: “Any guess as to his name?”

Vince:  “No, not at all”.  

ME:  “Guess again”.

Vince:  “I keep thinkin’ “S'”.

ME:  “Right”  And I added the “S’s”

C_ _ _ _ES – _ IC_E_S.

ME: “Next?”

For the sake of brevity in this post, I continued to ask Vince to guess letters one by one,  and as he guessed a correct one, I inserted the letter in the appropriate space.  In order, he “guessed” the following letters, “D”, “K”,”A”, “N” and “R”.  He was now looking at:  C_ARLES DICKENS.

He’d guessed all the letters in the name without error, the number of letters in the name (OK, he guessed one extra space) . But he couldn’t recall the name !! How is it that he could take ALL those absolutely correct guesses ( and he was genuinely guessing as far as I could determine and he was concerned) and NOT KNOW THE NAME?

He looked again, threw his hands up in the air, smiled broadly but in some embarrassment, and nearly shouted, “Oh God! Charles Dickens, of course!”  Until that moment, he could not recall the name.

What Vince had been experiencing was what is popularly known as a mental block.  When this “block” occurs frequently in a person’s speech efforts, it is called “Dysnomia”  Often described as a “word-finding” difficulty, it entails spontaneous, inexplicable failures to recall names, dates, even math facts or word pronunciations on demand.  This disposition to “draw blanks” is not a manifestation of anxiety or an intellectual deficit.  It disrupts speech spontaneously and unpredictably in circumstances in which the speaker has to recall a name to answer a question or specify a particular object or person in a sentence he wants to communicate.

While it is fairly common for true Dysnomics to be able to recall individual letters or sounds of the desired name and while they often can specify facts associated with the desired name (e.g. Vince knew Dickens was an “English” writer of the 19th Century”), they all too commonly fail to “find”  names.  But later on, perhaps driving home or sitting in a chair watching TV, Dysnomics will spontaneously recall the name:  “It just popped into my mind!”

In future posts, I will describe how exasperating and  how frequently Dysnomia can impede academic achievement.  At the same time, I’ll review what I ultimately learned about Vince.  I don’t think he’s truly Dysnomic but…I’ve been wrong before. We’ll see.

31
Jan
12

Attention Disorder? Felicitous Flaw

Steve was not a kid. He was a middle-aged Professor in some arcane scientific field, a member of the National Academy of Sciences, an international scholar. He was getting depressed because he couldn’t master some coursework in mathematical computations he had been trying to learn.

Steve’s IQ turned up at the 150 mark, higher than 99.9% of the adult population, far into the exceptional range. But measures of attention were peculiarly lower, not dismal, just too low for such an otherwise gifted person.  No history of psychiatric disorder or  recent trauma could account for these low scores.

But in discussion with him, he recounted how hard he had to work in school, how he spent so much time on homework, especially with foreign language work (“I hated French!  Math was hard too, until I got to calculus and statistics.  They were easy.  I don’t why,” ).  He told me how he had to double- even triple-check his work and still find mistakes, how he had to re-read everything. He said he got good grades because he worked much harder than his classmates. He figured he was just average but did well because he just spent all his time with schoolwork.

I reported to him the results of my testing, his exceptional scores, his singular intelligence. He stared at me as I reported these facts to him. Then he began to cry, just for a short period, quite against his will. He was embarrassed: “I’m sorry. But this is a real shock!  All my life, I just thought I was, you know, sort of slow and certainly not smart.”

Steve had been laboring, all those years, under the adverse effects of a rather severe Attention Deficit. He had been young when he could handle all the re-reading and double-checking that his deficit demanded of him. But now, in this current coursework which required strict attention, he was unable to generate the extra energy and effort  necessary to learn the material.  And it was demoralizing and depressing him.

We discussed the benefits and liabilities of medication, among other treatment options. In a subsequent conversation, he reported that he had tried the medication – on an as-needed basis – and had found it “incredibly helpful”. “I could concentrate!”, he exclaimed.

But then something really odd happened.

For when I said, “It’s a shame this medication wasn’t available to you when you were younger”.  He replied: “I’m glad it wasn’t.” A bit stunned, I asked why. “Well,” he said, “over the years, I learned to learn in different ways, ways that made the job easier though it  never became really easy.  But these “different” ways led me to think about things from original or unconventional points of view.  And that’s what won me all the accolades and honors I’ve enjoyed over my professional career, my ‘unusual’ ways of looking at things and all the discoveries and insights those ‘ways’ generated.  IF I’D TAKEN MEDICATION I WOULD NOT HAVE LEARNED THESE WAYS AND I DEFINITELY WOULD NOT BE WHERE I AM TODAY!” 

Steve made me think, hard and long.  And I realize now, as I’ll report in future posts, that there are real advantages to having an Attention Deficit, that strengths of enormous amplitudes can spring from that “deficit”.  He taught me a deep respect for the legitimacy and dignity of all learning types and styles . . . . if I would only take the time to look for them. Needless to say, I have.  Thanks to Steve.

28
Jan
12

He’ll catch on; he’s such a nice boy

Kyle’s 8 years old now. But he’s just beginning second grade; he was “held back” in kindergarten because his teachers thought he was immature. Kyle’s Verbal abilities reached into the Superior range at 124, better than 94 % of the kids his age. Put another way, he had the “mental age” of a child two or more years older than he. That is, he answered test items that the typical 10 or 11-year-old would answer. Of course, that age group is in the 4th/5th grade NOT the first month of 2nd grade.

Kyle was told to write about his dream house. He dutifully positioned his lined paper on his desk and began to scrawl, gripping he pencil tightly as if at any moment it would squirt from his fingers and clatter on the classroom floor and invite a warning from his teacher, Miss Warmsly.

He thought of a lot of things, actually pictured his dream house in his mind’s eye, colorful and detailed in ways only children can imagine. His house would be near the ocean; it would be a house boat so he could watch the fish go by and swim any time he wanted.

Below you can see what he wrote.  He spent ten minutes on it. When his teacher strolled by his desk, she cooed, “Good job, Kyle. Why not add some more?”

But Kyle knew that the tangle of lines and curves he’d just engraved on his paper were garbage. They made no sense to him. As a matter of fact, he wasn’t sure whether they were wrong or right because when he went to write, he couldn’t think of how the letters should look, “How do you make a ‘y’?” he’d asked himself when he started to write the word “you”. Just a vague knot of lines floated momentarily in his head. He prayed (he was a good Christian boy) he wouldn’t have to read his description to the class because he  had no idea of what his markings “said” or even when  one word ended and the next began. How did the other kids do it, he wondered and make it look so easy and even add illustartions.

Kyle was very bright. And so knew he was an abject failure; kids had laughed at his work before. Anger and tears competed just below the surface as Kyle stared at his paper.  Miss Warmsly was sooooo nice and he wanted so much to please her. But he knew her coos and smiles and kind gaze were basically those of sympathy and pity and well-disguised disappointment. He knew these things because  her coos and all were replaced by genuine sounds of praise and pleasure when she looked at the other kids’ papers… and because he was sharp, insightful.

Kyle dreaded the possibility that anyone would see his “writing”. He dreaded it so much that nausea began to get  jumbled in with his anger and tears. So, he put his head down on his desk and wouldn’t look up, put his arms and head over his paper so his shame would be hidden.

Later, a “learning specialist” tested Kyle’s writing skills and concluded that they were in the “average” range and that he should try harder because she and all his teachers “knew he could do it”. The specialist did note that “Kyle’s spelling errors and sentence structure made it difficult to gain meaning from his writing” but that “overall, Kyles’ writing skills were in the avegrage range.”

Two months later, Kyle became obstinate,”oppositional”, even “defiant”. He was sent to the principal’s office several times. His parents were called in. They were told he had an emotional problem, that he needed help and, of course, that he was “coming along” in his writing.

Three months later, Kyle was in my office so I could see how he was doing. He was sullen, defensive. He did not smile at all…only once when he talked about a science fair he went to with his Dad. He was severely limited in both reading and writing. Indeed, he was a long way from literacy, a very long way.

Kyle’s dream house remained invisible to everyone, friends, family, teachers. It stayed in his head, this elegant floating boat house on a sapphire sea, beautiful fish leaping at the bow, the sun so warm on his face. He swore to himself he’d never, ever, ever again put his heart on paper where it would be ridiculed and trampled in the laughter of his classmates.

At a meeting I attended, one where his teachers and specialists and parents gathered to discuss Kyle’s  “issues”, I asked if any one  of them would be so kind as to read Kyle’s “dream house” paper  aloud (I’d made copies for all). They politely declined. “He’s such a nice little boy!” his teacher cooed.

Kyle will be in therapy soon, superior intelligence and all.

The humiliation of a dyslexic

25
Jan
12

I heard what you said; I just forgot

An Attention Disorder is manifested in numerous ways because, quite simply, attention is involved in nearly every activity, even the generation of thoughts.

One common feature of an Attention Deficit is rapid forgetting of what one has just read or heard.  Consider Liz, whom I described in my 1/22/2012 posting.  Essentially, she couldn’t reliably register and maintain incoming information for a period of time sufficient to interpret or manipulate it in some way.  This process of data-maintenance is a function of Working Memory.  But Working Memory must be extremely reliable if one is to respond correctly to whatever the incoming information requires. And its processing powers are formidable.

If someone says the word “grand”, for instance, you will not be able to understand it until you register all the sounds of that word in Working Memory.  “Grand” consists of five sounds, /g/, /r/, /short a/, /n/, and /d/.  So each of these five sounds must be identified precisely.  If any one is inaccurately identified, you will not be able to identify the word.  Or you will misidentify the word (e.g. as “grand” or “grunt” or even “”can’t”).  In fact, you may not be able to tell whether what you heard is a word or not. When you listen to a young child speak, a person with a foreign accent, a drunken slur  or one with an unfamiliar dialect, you find yourself concentrating very hard. You narrow your eyes, watch their lips and facial expressions, focus intently on the sounds they’re producing and often enough ask them to repeat.  All you are trying to do is identify  sounds  so that you can assemble those sounds into a word you recognize.

Meanwhile, you are “holding” the sounds you do hear in Working Memory, sustaining them there until you finish your analysis or give up. I’ve been amazed with young mothers whose toddlers seem to be saying “Ahwanceal” and the mother instantly responds,“No it’s lunch time; cereal is only for breakfast.”  You might notice here that even determining how many words were said can be daunting because you can’t tell where one word ends and the next one begins (locally, the spoken unit “Jeweet?” is easily segmented into “Did you eat?” by a listener familiar with the local dialect patterns.).  Indeed, our ability to recognize slang, “accent” and dialect variations depends on precise identification of aberrant sounds as acceptable variants of standard sounds (the unit “Yall” is nonsense since there is no such word, yet few have difficulty assigning it the meaning of “You all”.)

Recognize that the time it takes to say “grand” amounts to a small fraction of a second. Recognize further that you effortlessly identify all its sounds in that sliver of time. The sentence, “I’ll be reading Dickens this afternoon” contains 25 sounds, yet all of them are easily identified in about 1.5 – 2.0 seconds. That’s over ten sounds a second.  And all this “Auditory Processing” takes place in Working Memory.

So, Working Memory  has to be extremely efficient and reliable.  But suppose it is NOT.  Suppose information (sounds) entering this system are very rapidly corrupted (deleted, mis-sequenced, garbled).  Or suppose that something heard exceeds the limits of Working Memory because it’s too long. Then, the information is lost or misinterpreted.  So, what was happening to Liz was that her Working Memory could not reliably and correctly “hold onto” language data (sounds, mainly).  So, before she could interpret what she heard, the data themselves were being corrupted…or erased.  And then, she suffered the consequences: misunderstanding in some cases, in others, instant and wholly INvoluntary forgetting.  In circumstances where she couldn’t request a repetition, she was defeated.  For her, forgetting what people said to her, forgetting what she’d just read were all too common experiences.  And when her job depended on efficient auditory processing, where the consequences of mis-hearing or mis-reading a direction, dosage amount, drug or patient name could be lethal, she despaired.  Because she couldn’t stop forgetting.

25
Jan
12

Right Church, Wrong Pew

Liz wanted to be a nurse. And so she went to college, got her degree, then earned a Masters degree in Nursing at a prestigious university.  She graduated with a 3.95 GPA, with honors and everyone’s applause.

Finding immediate employment at a world-renowned hospital, she soon started to become depressed and anxious, disenchanted with the job though she loved working with other professionals and the patients. But the demoralization continued  and she sought therapy. The therapist referred her to me for evaluation. “Something doesn’t make sense,” the therapist said. “Liz is very bright, she’s  had a stable upbringing, has lots of friends, no trauma, no evidence of familial disposition to mood disorders. But she keeps complaining about the work, how nervous she gets. Maybe you can help clear up this matter.  She’s on medication, an antidepressant, but that’s not making much of a difference.  I’m at a loss.”

And so, a few days later, Liz entered my office.  Congenial, cheery, sophisticated and very mature in her ways, despite her youthfulness (she was 24), Liz seemed the epitome of all that makes up a competent and sensitive human being.  And she was hard-working, intent on doing her best on each task I presented her.  Her IQ reached into the 90th%ile+,  superior.  It would have been higher had she not obtained two remarkably lower scores. One was on a subtest called Digit Span, another on a subtest called “Arithmetic” .

Both are very sensitive to attention span. The possibility that an Attention Disorder was related to her depression soon occurred to me.  But more evidence was needed. So I asked some questions like the following;

1. Do you ever have to re-read something you’ve just read.

“All the time, even in high school and always in college.  I’d spend hours on homework!  I mean, I could read just one paragraph and then realize at the end of it that I was thinking of something else.  And then I’d have to re-read.  But that was OK. I never minded working hard.  I’m not really very smart if you want to know the truth.  I just work hard.”

2.  Do you make little mistakes, like forgetting to write some words in a sentence or miscalculate in math?

“Well, yeah. But they were never really a problem because  I’d double-check my work.  But I always hated math because no matter how many times I checked, an error would show up anyway, always a careless error, dumb, stupid. “

3.  How about lecture note-takng in college?

“I was OK if the professor didn’t talk real fast.  And I became a really FAST writer. I never participated in class because I was so focused on getting the notes that I couldn’t concentrate on WHAT the teacher was talking about.  Same thing with foreign language; I had to try really hard to remember what was said in French so I could translate it.  But I’d keep forgetting, and so my translations sucked.  I HATED French!”

I asked her about her nursing job.  I LOVE nursing, but… I…it’s getting to me, getting me down.”

And then the tears began, pained sorts, robbing her of the dignity and  self-possession she’d worked so hard to project.

” I have to give out all these medications, different dosages, sometimes three or more for some patients.  And I’d keep forgetting who got what.  And I’d study and study the dosage charts and names and still catch myself making dumb mistakes,  forgetting this or that. I’d spend hours reading and re-reading the charts.  But I was taking too much time, and the supervisors were getting on me because I was not giving enough attention to my patients.”

I was afraid I was going to hurt  somebody! “

Liz did have an Attention Disorder, quite severe.  It corrupted her ability to remember “little”  things, data, details, numbers and the like.  It compromised her efforts to monitor her work for “dumb” mistakes because those errors came so quickly, she didn’t know she’d made them; they were INvoluntary and so she could not know where her mistakes were.

Liz, at my encouragement, sought another position in Nursing, one that required far less charting and record-keeping, one where she had time to do her job well and with pride and satisfaction. Her depression lifted; it has not returned. She has become the very competent, sensitive and compassionate nurse she always wanted to be, that in truth she always had been.  In a Psychiatric position, she excels in her understanding of the human condition, of struggle and suffering, and her great empathy for her patients.  She found her calling.

21
Jan
12

Gifted and Learning Disabled?

Asymmetric Intelligence (note the scores above are derived from an older version of the Wechsler scales, It is displayed here to simplify the issues discussed in this posting. Later versions of the Wechsler scales, which I will address in subsequent posts, include "Index" scores that needlessly complicate the explication of the central issue in this posting: The differences between Verbal and Non-verbal Intelligence measures.

This set of IQ scores, including subtest scores, was obtained by a young man in his teens. He was angry, depressed , very sophisticated and confused. And he was brilliant and mediocre at the same time.

You should look at the difference between his  Verbal Score and his Performance Score. The former, Verbal, was of a magnitude shared by LESS  than FIVE in every THOUSAND kids his age; he was clearly gifted verbally.  His score far exceeded the mean even in his fast-paced private school setting, where the “average” was the 90th percentile. Even in this competitive milieu, he distinguished himself. His ideas were abstract, insightful, far beyond his years. He effortlessly generated fluent, grammatically complex and stunningly insightful comments and test responses, embedding in them vocabulary items both precise and scholarly. He read voraciously, debated issues with his teachers and refused to agree with things just because some authority said so. He loved TRUTH. He was respected, even awed by some of his teachers; he intimidated some with his astute reasoning and flawless logic.

But he was getting poor grades. He hated Science and Math. His writing was a scribbled tangle of lines and curves. He said he hated to write. His parents complained that he was disorganized, lazy, argumentative . But they loved him. “He’s a sweet boy,” his mother said. His father often discussed…and argued about…politics, the economy and especially morality, right and wrong. “He just seems frustrated all the time,” his father observed, just a hint of sadness in his voice. “He seems confused.”

Eric had good reason to be confused ! Look at his Performance score. About 50 of every 100 kids his age would score lower. BUT 50 would score higher. And so, in his high-powered, academically rigorous independent-school classrooms, he was well BELOW the average for that population. So, mathematical concepts like “square root” or “acute angle” didn’t make much sense to him. He could memorize formulas and procedures. But he couldn’t apply what he was learning. He couldn’t reason well at all when such concepts were involved.

When I asked him how far it was from New York to Los Angeles, he said “About 30,000 miles.” When I asked him to show me how big a “foot” was by holding his hands apart, the space he produced between hands was a good three feet. On an outline map of the U.S., he drew the Mississippi River horizontally from Texas to California. He “lost” things, he said. “I can never remember where I put something.” And though he was close to getting his driver’s license, his parents worried because he got lost so easily and couldn’t read maps at all.

Because what the Performance subtests measure, the ones called  Block Design, Object Assembly , Coding, etc .(see above), is NON-VERBAL abilities.  Notions of abstract space, proportion, orientation, direction, even time participate in these Performance functions. And so, when weaknesses and deficits occur in them, concepts like “The day after tomorrow” or “bilateral symmetry” or “atomic shells’ , even  left-right , the order of months in the year, ratios and congruency become nearly impenetrable mysteries because they cannot be “pictured”, because the word and terms connect with NOTHING or only the most nebulous of mental representations. Handwriting is sloppy, planning efforts are perfunctory and athletic competition is minimized.

Eric could, I guess, be called gifted-learning disabled. He was rare, rarer than many a gifted child, but common enough for me to have seen quite a few over the years. In later posts I’ll discuss what becomes of such individuals, what can be done to support them, what they can do themselves.

I explained a lot of this to Eric in a conference after testing. His parents asked me to. He had a thousand questions. He smiled a lot.