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Working Memory & Speech


HeidiD
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I've been reading the threads about Late Talkers and Dyslexia with great interest, since my son was recently evaluated and doesn't seem to fit neatly into any of the diagnostic "boxes".

 

It's interesting how much overlap there seems to be within the various "dys" conditions. Working memory seems to be a common denominator in ADHD, Dyslexia, & Aspergers and is classified as a processing problem under Executive Function.

 

His working memory is significantly impaired, and I'm wondering if this could be a cause of speech disfluency.

 

His speech is rapid and it's punctuated with "you-know" and "uh, uh", and he often repeats phrases two or three times in immediate succession before managing to articulate a complete thought. It happens when he's communicating relatively complex thoughts - not during ordinary, short, back and forth communication.

 

He recently had a thorough speech eval, and according to the SLP, there were "no red flags". I don't understand it, because this degree of disfluency seems like a significant problem.

 

He describes it as desperately struggling to get the words out before he forgets what he wants to say. I have no reason to doubt him since he's quite self-aware and analytical.

 

Is it possible that weak short-term memory is at the root of this problem?

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I don't know about the working memory issue, but one other thing that might affect your ds's ability to "think on his feet" is whether he is neurologically hardwired as an introvert. The book, The Introvert Advantage, explains how introverts actually have a longer neurological pathway for verbal responses. It's the thing that makes their brains work on a problem in their sleep, too. I can't paraphrase very well, but the book is a credible and interesting read about how introversion affects people's lives.

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I've been reading the threads about Late Talkers and Dyslexia with great interest, since my son was recently evaluated and doesn't seem to fit neatly into any of the diagnostic "boxes".

 

It's interesting how much overlap there seems to be within the various "dys" conditions. Working memory seems to be a common denominator in ADHD, Dyslexia, & Aspergers and is classified as a processing problem under Executive Function.

 

His working memory is significantly impaired, and I'm wondering if this could be a cause of speech disfluency.

 

His speech is rapid and it's punctuated with "you-know" and "uh, uh", and he often repeats phrases two or three times in immediate succession before managing to articulate a complete thought. It happens when he's communicating relatively complex thoughts - not during ordinary, short, back and forth communication.

 

He recently had a thorough speech eval, and according to the SLP, there were "no red flags". I don't understand it, because this degree of disfluency seems like a significant problem.

 

He describes it as desperately struggling to get the words out before he forgets what he wants to say. I have no reason to doubt him since he's quite self-aware and analytical.

 

Is it possible that weak short-term memory is at the root of this problem?

 

My dd9 also has working memory deficit and struggles with expressive language. She talks very fast, I assume because of her ADHD; but sometimes I can't make sense of what she's trying to tell me, so I have to slow her down and ask questions that help her organize her thoughts. She's fine with conversational back and forth banter, but struggles when she wants to tell us something that takes 3-4 or more sentences.

 

When she was evaluated for APD, she could not pass any part of the tests. The audiologist could not even administer some of the tests because my dd couldn't get through the screening/sample questions. A month or so later, she had an updated speech evaluation, and the SLP didn't see any signs of APD and didn't recommend therapy. A month or so after that, she had a comprehensive evaluation with an educational psychologist who could barely understand dd until she got used to dd's "unusual speech patterns." I waited 6 months until insurance would cover another evaluation, then took dd to a different SLP. DD had another year of therapy. They worked some on speech/articulation, but moreso on language concepts.

 

All that to say, if you disagree with the SLP's conclusions, find out how often your insurance company will pay for an evaluation and then go to someone else. It sounds like you need to find someone who will evaluate and focus on language concepts rather than just speech.

Edited by LizzyBee
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Interestig; I don't know. My most-delayed late talker (no words till 3, still getting speech therapy at 7 y.o.) has low processing speed but a particularly high working memory, according to his WISC scores. Oddly enough, working memory was his highest section - definitely not what I expected. (Just to complete the picture, he also has a history of sensory issues and still has fine motor issues, a complicated medical history that includes a tethered spinal cord, and some sort of attention issue that I haven't quite put my finger on yet, so somewhat possible ADD; and math is a huge strength for him.) He also has a language processing issue but it seems to differ from his sister's language processing problem, for which she is getting therapy. He is a very late bloomer. I also know others who had no speech difficulties who have lower working memory scores.

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Interestig; I don't know. My most-delayed late talker (no words till 3, still getting speech therapy at 7 y.o.) has low processing speed but a particularly high working memory, according to his WISC scores. Oddly enough, working memory was his highest section - definitely not what I expected. (Just to complete the picture, he also has a history of sensory issues and still has fine motor issues, a complicated medical history that includes a tethered spinal cord, and some sort of attention issue that I haven't quite put my finger on yet, so somewhat possible ADD; and math is a huge strength for him.) He also has a language processing issue but it seems to differ from his sister's language processing problem, for which she is getting therapy. He is a very late bloomer. I also know others who had no speech difficulties who have lower working memory scores.

 

I don't know that there is any particular correlation between working memory deficit and speech/language deficits. My kid just happens to have both, along with several other diagnoses.

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I don't know that there is any particular correlation between working memory deficit and speech/language deficits. My kid just happens to have both, along with several other diagnoses.

 

I was able to speak with the speech therapist yesterday, and it seems that my son totally concealed his speech problem from her. :ack2: This therapist has fantastic qualifications and met with him twice, so hiding it from her was quite a feat.

 

But she noticed he seemed to be trying to be quite "precise" in his speech. It never occurred to me to warn him not to conceal his typical speech patterns from a speech therapist! :ack2:

 

On the bright side, this proves that at least he CAN overcome this problem to some extent (by producing "an unusual intonation quality, with "precise, overemphasized" pronunciation). Is that better or worse? :tongue_smilie: This may have contributed to the neuropsych focusing on Aspergers, since nothing else about him really fits that description! :lol: I wish I could have been a fly on the wall....

 

The speech therapist did tell me that, theoretically, it's quite possible that weak working memory can result in disfluency. When someone is "insecure about their ability to remember", and speaks too rapidly, it can result in the type of speech problem he exhibits.

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Oh my, Heidi, our kids sound so similar. My ds has a similar pattern of speech, mostly when he is feeling questioned or "tested," as in when he feels that there is a particular "right answer" that he needs to retrieve and convey. Sometimes, he may also use fillers, rapid speech and repetition if he's excited, but more often if he's feeling pressured. Ds is not dyslexic, ADHD, nor anywhere on the spectrum. However, he does have impaired working memory issues, ocular-motor/vision processing issues, low-tone, poor motor planning, lousy fine motor skills. He has really good auditory processing, BUT very poor expressive language processing, so it's hard for him to convey what he understands, particularly under pressure. (Thank goodness we're homeschooling. A classroom would be crushing for him).

 

 

Yes, they sound very similar, and I suspect my son may also have auditory processing problems in addition to all the above. :tongue_smilie: His brother has CAPD, and there are so many similar behaviors ... :tongue_smilie: The SLP did tell me that he has weak auditory memory for de-contextualized data strings (his letter-number test was like 16th percentile, but his story memory was in the 60's and his sentence memory in the 90's).

 

 

In the two months that he's been going to ST, everyone has seen some improvement in his speech. Our SLP has very clear guidelines for her program, monitoring improvement, and determining his "graduation" from speech therapy. What's more, I totally love our SLP. She totally "gets" ds in a way that our wonderful OT and even neuropsychologist does not. She describes his mannerisms, speech patterns, patterns of frustration/shut-down, etc. to a tee. And while her expertise doesn't really include an understanding of how ds' vision and motor issues also affect his learning, she seems to have a better sense than anyone we've seen about his total picture.

 

She sounds very astute - you're so fortunate to have found such a great match. Our neuropsych seems to be "perseverating" on aspergers and dismissing visual and language processing problems as irrelevant, with her own subjective (inaccurate!) observations being given far more weight, particularly since his developmental profile is completely devoid of autism symptoms. :confused: In contrast, the SLP (with at least 20 years more experience than the youthful neuropsych) told me she noticed possible visual processing issues and that some of his other issues are red flags for CAPD! The SLP told me that his profile is that of a Big Picture Thinker (which matches years of our own observations) while the neuropsych insists he's the opposite. Who should I believe? :confused:

 

She recommended that I read Auditory Processes, even though ds' issues are expressive, simply because she felt that this older text gave some of the best explanations for language processing disorders and lots of strategies to accommodate/remediate for LPDs, knowing that we homeschool.

 

 

Thanks so much for recommending that - I've ordered it already. :)

 

Our SLP definitely connects some language processing disorders with working memory, and the few books that I've read about LPDs make a connection as well. (I'll try to post those titles later). I'm a little surprised that your SLP attributes such a weak link between the two, since so much of what I have learned suggest the opposite.

 

 

It just seems intuitive doesn't it? If you're having trouble holding a collection of thoughts, it would have to be difficult to produce coherent communication on top of it.

 

Anyway, please keep us posted. I'm really interested to hear how things are going with you guys.

 

(Sorry this post is so disjointed! I'm trying to type while cooking and clearing breakfast. Uh... my working memory definitely doesn't handle multiple tasks!)

 

Ah yes - same here. Burnt toast is my speciality. :lol:

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I was able to speak with the speech therapist yesterday, and it seems that my son totally concealed his speech problem from her. :ack2: This therapist has fantastic qualifications and met with him twice, so hiding it from her was quite a feat.

 

But she noticed he seemed to be trying to be quite "precise" in his speech. It never occurred to me to warn him not to conceal his typical speech patterns from a speech therapist! :ack2:

 

On the bright side, this proves that at least he CAN overcome this problem to some extent (by producing "an unusual intonation quality, with "precise, overemphasized" pronunciation). Is that better or worse? :tongue_smilie: This may have contributed to the neuropsych focusing on Aspergers, since nothing else about him really fits that description! :lol: I wish I could have been a fly on the wall....

 

The speech therapist did tell me that, theoretically, it's quite possible that weak working memory can result in disfluency. When someone is "insecure about their ability to remember", and speaks too rapidly, it can result in the type of speech problem he exhibits.

 

You know, sometimes my dd over-enunciates. In her case, I don't think it's because she's trying to hide her speech deficits; I think it's simply a result of 6 years of speech therapy. However, when she gets tired or rushed or uses big words, she totally drops or garbles sounds. It always strikes me as odd that the same child can have such good speech or such bad speech depending on the circumstances. She's 9 yo and I have trouble understanding her sometimes. And yet, other people can spend time with her and notice nothing odd at all. Her speech therapist even told me that if we send her to school, she will fall through the cracks because she's so personable. It's odd that her LDs are so severe and yet can be completely overlooked because she's social, smart, and tries hard.

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Heidi, do you think you could be seeing a word-finding issue? As I understand it, when a child uses "uh" frequently, that can point to such an issue. You might listen to see if he ever uses the wrong word for things, or pauses, as though he is trying to grope for the right word.

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I don't know about the working memory issue, but one other thing that might affect your ds's ability to "think on his feet" is whether he is neurologically hardwired as an introvert. The book, The Introvert Advantage, explains how introverts actually have a longer neurological pathway for verbal responses. It's the thing that makes their brains work on a problem in their sleep, too. I can't paraphrase very well, but the book is a credible and interesting read about how introversion affects people's lives.

 

Thanks for mentioning that. I have it somewhere in the house - will dig it out and re-read it. :)

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So while poor working memory is not the cause of language or auditory processing issues, it can certainly complicate those difficulties. Our SLP feels that ds' working memory issues clog up his retrieval of words, tangle the continuity of conversation, and create such a sense of overload that it disrupts speech fluency. Of course, there are other processes that going on here, but she's trying to address the working memory component, among other things.

 

Thank you - that definitely seems to apply here. I wish I could take him to your therapist. :) How does she address the working memory component?

 

It's awesome that your ds is so self-aware that he recognizes his inner process as he is trying to communicate, and you are so astute to recognize that these issues are connected.

 

It is helpful that he's so self-aware, particuarly since the speech therapist and neuropsych are giving contradictory reports. :tongue_smilie: And I've gotten so much useful information, and great book recommendations here at the Hive Mind. You guys are terrific! :)

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It always strikes me as odd that the same child can have such good speech or such bad speech depending on the circumstances. She's 9 yo and I have trouble understanding her sometimes. And yet, other people can spend time with her and notice nothing odd at all. Her speech therapist even told me that if we send her to school, she will fall through the cracks because she's so personable. It's odd that her LDs are so severe and yet can be completely overlooked because she's social, smart, and tries hard.

 

Does she have APD? My son (11 yo) developed some slurry speech patterns before we had him diagnosed. Now he goes back and forth. When I remind him to enunciate, he can speak clearly, but when he's mad or tired or whatever, he often slips back into the sloppy speech patterns. It's like an ingrained habit with him. We did LiPS a few years ago to get his reading off the ground, but it was so excruciatingly BORING that I transitioned him to Wilson as soon as I could. But now I think we'll go through LiPS again, this time with a focus on spelling and pronunciation.

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Just wanted to add - the word-finding could be a memory issue but could also be caused by a limited vocabulary. Sometimes icreasing vocabulary can significantly help the issue.

 

I think it must be a memory issue because his speech/language testing has him at 98 percentile for vocab. I can relate to the word retrieval problem myself. No one really notices it because I can usually quickly substitute another "big word", but when I'm stressed, it's not so easy. I wonder if it's hereditary? It's a really annoying condition. :tongue_smilie:

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Does she have APD? My son (11 yo) developed some slurry speech patterns before we had him diagnosed. Now he goes back and forth. When I remind him to enunciate, he can speak clearly, but when he's mad or tired or whatever, he often slips back into the sloppy speech patterns. It's like an ingrained habit with him. We did LiPS a few years ago to get his reading off the ground, but it was so excruciatingly BORING that I transitioned him to Wilson as soon as I could. But now I think we'll go through LiPS again, this time with a focus on spelling and pronunciation.

 

Yes, she has APD. She couldn't pass any part of the APD testing 2 years ago, and she's having a follow-up evaluation next week. At age 3, her articulation was below the 1st percentile for girls, and she also had some motor weakness that contributed to her speech issues. We did the first couple sections of LiPS, but we started using Barton as soon as she was able. Barton is so much easier to teach than LiPS!

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Yes, she has APD. She couldn't pass any part of the APD testing 2 years ago, and she's having a follow-up evaluation next week. At age 3, her articulation was below the 1st percentile for girls, and she also had some motor weakness that contributed to her speech issues. We did the first couple sections of LiPS, but we started using Barton as soon as she was able. Barton is so much easier to teach than LiPS!

 

Wow, sounds like she's come a long way, thanks to your hard work. :)

 

LiPS, Barton, Wilson...they all make me cringe. I think I'm allergic to structure and scripts! :tongue_smilie: Thank God there are people out there who have the patience to put together these wonderful programs for the rest of us! :)

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Wow. They are that far apart in their assessments? I'm a big believer in the diagnostic validity of "mommy gut." ;) If the neuro isn't jiving with your experience of ds, is it possible to get second opinion from a second neuro?

 

 

Oh yes! :rolleyes: I'm really disappointed in the neuropsych. I was under the impression that more science and less subjectivity was involved in this type of assessment. Now I wonder how many people are running around misdiagnosed.:tongue_smilie: Live and learn...

 

 

We just had another visit yesterday with the SLP, and there's been a cognitive shift happening for ds. Just two months ago, he could not easily repeat a string of three random numbers that he just heard without seriously attending to that task. At the session, he easily did five while continuing to play with toys. Before, if you asked him out of the blue to name two things that are red, he couldn't do it without a lot of fillers, repetitive words, stammering, pauses... Yesterday, he could produce three answers to a string of such questions without a hitch. Something is going on with his auditory processing and word retrieval systems. It's hard to pinpoint what exactly, since we are doing multiple therapies at the same time, but it's very clear that he is so much organized and relaxed about pulling words out of his head.

 

Anyway, our daily speech homework consists of doing random number strings, repeating back nonsense phrases using pictures, a matching game, and then asking ds to pick up two pictures at a time (a two-step request, basically). Every week, the tasks become incrementally more challenging. The nonsense phrases are less predictable. The number strings, initially just 3 random numbers, are now 5 numbers in an interrupted sequence (1-2-3-4-9 or 4-3-2-0-5). I'm supposed to let him play or do other tasks, if he wants, so he'll have to self-regulate his attention according to the amount of cognitive load he's experiencing. Soon, she'll be tapering us off the visual support, so that he needs to rely just on auditory input. Open-ended questions are coming later. It sounds ridiculously simple. The working memory tasks are so, so simple, but our SLP explained that she just wants to keep a certain part of his brain activated on a daily basis.

 

Anyway, the SLP feels that he's making a lot progress in a short time. She keeps careful notes, and her weekly measures are pretty quantitative. Many folks, not just me and SLP, have noticed a huge improvement in his speech. Conversations are more organized and easy to follow. He can remember names. His speech is more fluent.

 

 

That's very interesting. She clearly knows what she's doing - the results speak for themselves. :001_smile:

 

I'm of the mind that our other therapies (OT and vision) are contributing greatly to some of the gains that we are seeing in his language. I mean, clearly simply saying strings of numbers aren't going to be making all these shifts happen, ykim? But I do see that her therapy framework of "activating" working memory within a familiar context, then making the cognitive load more and more challenging for his language processing is helping. It will be interesting for me to see what his therapy is going to look like when he begins to have more "real life" language tasks to do

 

 

I'd like to look into vision therapy, but I've read so many mixed reviews. And the $$$ !!!! I wish now I had gone around the neuropsych and used the money for therapy. :tongue_smilie: DS clearly has some perceptual problems going on, but I didn't realize the seriousness of it because he generally scores high on achievement tests. Yesterday he thought his calculator was broken because he couldn't get the right answer to a trigonometry problem, but in reality, he was transposing a decimal point. This type of thing happens on a regular basis, but he seems to have developed various coping strategies so it's not glaringly obvious. :tongue_smilie: I did buy Kenneth Lane's book a year or two ago and worked with my other son on some of the ocular-motor exercises. There was noticeable improvement with him.

 

Thanks for sharing your experiences. You've been really helpful, and I'm glad you're seeing such positive results. :hurray:

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