Integration Deficit: Deficiency in the ability to perform tasks that require intersensory or interhemispheric communication. Reflects delayed or abnormal interhemispheric communication. Deficiency in ability to coordinate multimodal inputs.
Keyword: They do not "synthesize". "It's too much".
Key CAF findings: excessive left ear suppression on dichotic listening tasks, can't label auditory patterns but can mimic them.
Key behaviors: trouble knowing "how to" do some task, tends to "watch and wait", poor starter, poor transitions, needs more time; lots of "I don't know", "I don't get it" or "I have no idea". Variable trouble in noise. Variable impact on communication. Academic effects in reading recognition, spelling, writing skills, other integrative tasks.
Other considerations: spelling- tend to spell phonetically not by the rules, the alphabet - can "sing" the alphabet but struggles to "say" it, digit span tests- tend to have more trouble with digits reversed, memory tests- difficulty with sentences - better on word memory
Key management strategies:
child may perform MORE poorly when visual information is added, they may need to look OR listen or look THEN listen
DO make sure that visual cues MATCH the auditory target and DON'T compete with it
DON'T EVER rephrase to a child with Integration Deficit, it will just confuse them
DO repeat the information with an associated visual cues, demonstration, or model
bothered by "noise" as a function of the TASK DEMANDS, not necessarily the level of noise, so change demands or remove child to quieter environment, especially for tests
require an experiential, structured, "hands-on" environment, lots of examples, multimodal inputs given one at a time
must know task demands up front
untimed tests
NO ALDs
consider Latin or Hebrew for foreign language requirement
use tape recorder, notetakers, books on tape, study guides, CliTs Notes
intervention focuses on academic and speech-language impact as needed and appropriate remedial programs include Orton, Lindamood-Bell, Wilson, and similar
"Bottom-up'-type activities that enhance development of interhemispheric skills include those that stimulate transfer of function, ability to extract key information, do "parts-to- whole" (synthesize). Examples: dance, music, juggling, karate, gymnastics, Bopit, Scrabble, Boggle, UpWords, Rummy and other card games, Rummy-Q, Top it, Brain Warp, Simon and Simon Says, Chess, Video games with pattern puzzles, "feely bag"
Pair OT-type activities with verbal tasks
and
Output-Organization Deficit: Deficiency in the ability to organize, sequence, plan, or recall appropriate responses. Difficulty on tasks requiring efficient motor path transmission/motor planning. May be behavioral manifestation of impaired efferent function or planninglexecutive function deficit.
Keyword: They can't "get it back out".
Key CAF results: poor performance in noise, target reversals, ordering problems, omission of target/substitution with previously heard word.
Key behaviors: disorganized, impulsive, poor planner. Deficits in expressive language, articulation, syntax. Educational problems: direction following, note-taking, remembering assignments.
Other considerations: free vs. directed recall tasks - tend to perform much better with free recall than with directed recall tasks
Key management strategies:
needs training and practice in the rules for organization
break info into smaller units, use tag words
use outlines, checklists, assignment notebooks, computers
use activities with specific order
teach verbal rehearsal, information chunking, use of mnemonics, metacognitive strategies, visual imagery and visualization.
may need speech-language intervention for expressive speech-language skills
may need academic TX for study, note-taking and test-taking strategies
consider ALD for attentiveness
use games that emphasize sequence, order, rules, planning: Alphabet games, drama, follow the leader, Bopit, Topit, Brain Warp, Freddie Fish, memory games, Scrabble, chess, Battleship, model building, cooking
and
Prosodic Deficit: Deficiency in ability to use prosodic features of target. Believed to reflect inefficient
right hemisphere function.
Keyword: Subtle problems. It's all "too fast". "blah, blah, blah, something".
Key CAF lindings: poor labelling AND mimicking of temporal patterns. Poor temporal integration. Reflects poor gestalt pattern recognition skills - unisensory in this case.
Key behaviors: pragmatic language problems including trouble with non-verbal cues, e.g., facial expressions, body language, gestures, sarcasm; heteronyms, expressive speech may be monotone, poor rhythm perception. Possible deficits in music. Variable academic impact. Part of the cohort of behaviors of nonverbal learning disability.
Other considerations: The Alphabet Song - song off-key or off-tempo music & musical cues - doesn't like music or can't "carry a tune"
multisyllabic production - "trips" over multisyllabic words or leaves syllables out
Key management strategies:
requires animated teacher with a melodic voice, lots of demonstration/examples, multisensory inputs and additional visual cues
change rate, pacing of speech, emphasis on key words
untimed tests
may require speech-language TX for pragmatic and nonverbal language, rhythm perception, prosody training
for academic intervention, consider Lindamood-Bell or Wilson
consider music TX and/or social work services (for social language)
use games/activities similar to those for poor integrator including singing, Math Rap, Schoolhouse Rock, Bopit, sing-along tapes/videos, books on tape, activities that work on pattern recognition (auditory, visual, or tactile) and symbolic language, listening to color, "soap" operas, dramatic arts.
Keep in mind: It's not just the perception of the timing cues for these children, it's what those cues MEAN.
Check for similar problems in other modalities - difficulty reading facial expressions or problems with tactile patterns
Check for NVLD
http://www.ocslha.com/Ferre.htm
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