No writing!

I woke A-One an hour earlier this morning and let him know the time for brain training.  I mentioned that I wanted him to try some alternative problem solving games, those that did not involve arithmetic, so that we could see how his problem solving goes when it's not about maths.

He brought up the login page at my request. After he worked through the games, grumbling that whoever wrote them is mentally challenged, we looked at his results. No PBs today; in fact he went down in 3 of the games.  However his speed is now over the 50th percentile at 52.6!  Overall he is at the 16.5th percentile.

When he completed the set games, I asked him to choose one of the non-maths problem solving games.  He had a choice between shapes and words, both of which required him to discern the hidden rule. He chose the shapes.

He read the rules of the game and saying it still didn't make sense he proceeded to play anyway.  The game requires the player to guess whether a shape fits the rule or not, so the first couple of tries is trail and error to discern the rule.  However when he got a 'X' on subsequent guesses, he consistently wanted to go back to the start.

Mum: You don't need to go back to the start each time you get one wrong.

A-One: I can't get any wrong.

Mum: It doesn't matter whether you get it wrong, because that's how you find out what the rule is.

A-One: No, I can't get any wrong.

Nevertheless, he seemed to be getting the hang of it, but wouldn't play it again.  I'll be very interested to see how he goes over the next week, as long as he's willing to add the game to his daily list.

We then took up the clocks exercise to a familiar refrain. 'This is a waste of time.  I have better things to do,' as he sat down at the table.  He was willing to try 2 clocks only, taking a while to work them out and making several errors.

Mum: Where did you get the 47 (minutes) from?

A-One: It's correct!  That's what I say it is!

Mum: Let's count them up.

A-One (sighing): OK. It's 52.

After the clocks, we took the first couple of paragraphs from the Inquirer section of last weekend's The Weekend Australian.

A-One: I'm only reading as far as I want to.

...

Mum: Where did you read to?

A-One (without waiting for me to read): There.  It's saying that the government and people are spending as if nothing bad is going to happen to the economy, and the Prime Minister is saying Australia has a good economy.

Mum: OK. Now I want you to write that down.

A-One, quite vociferously: No! No! No! I'm not going to write it down!

Mum: OK.  I'm just letting you know that writing it down in your own words will be one of our future exercises.

 

 

 

Well do I remember the challenges A-One felt at writing his assignments when at school.  I recall one of his teachers wrote one of his assignments while he dictated.  She knew he knew the work and could see that writing it down was a barrier to his succeeding. This year's neuropsychologist's report also recommended something like Dragon Dictate if he needed to write assignments.

 

However, that's the compensatory approach. The Arrowsmith approach is to exercise, exercise, exercise the weak cognitive function.  I just need to find the right level of challenge so that he doesn't refuse.



3 PBs!

A-One fitted in his Lumosity training around computer games today.

He gained 3 PBs, one being the vowels game now that he knows what vowels are: 



Speed

Speed: 47.9th percentile!
Memory: > 20th percentile
Attention: ~20th percentile
Flexibility: 15.5th percentile
Problem Solving: <2nd percentile

We looked at his result trend for each category.
He 'I know Mum''d me when I started to comment that his attention seems to be plateauing.

His problem solving had been improving, but of late it's taken a dive.

Clocks exercise?  Not a chance.  The sage declared:  'I don't need to do it every day to get the results I want.'

Like last Wednesday, he received a phone call to come into work earlier than usual.  He hadn't remembered what time he left, or what bus he had to catch.  So he went through the exercise again - successfully.

5-handed clocks

With A-One being turned off the clocks exercise, I re-read Norman Doidge's summary of the Arrowsmith school approach. A-One had been zooming through the 3-handed clocks, and had elected to go straight to Legendary level for his latest X-Box game, so I thought he might respond more positively to a greater challenge.

I decided to create a page of 5-handed clocks with the hands already on them.  That meant that A-One had to read the times rather than write the times.  Where the Arrowsmith school uses 1/60th second for the 4th hand, I instead used milliseconds and microseconds on two 'sub-' clocks within the main clock, because milliseconds and microseconds have practical application. I showed them to A-One after I had printed them out, and he once again stated emphatically that he wasn't going to do them.

I let that go so that A-One could do his Lumosity training first.  I noticed that he's starting to use the 'pause' button on some of the games. Even though the image disappears during a pause, it gives him time to think.  Also for one of the games, whenever he made a mistake, instead of continuing on with the game he went back to the start each time.  So it seems to me that he is becoming 'hooked' on achieving good scores.

He's now over the 15th percentile overall, and his speed is over the 45th percentile. Memory and attention are around the 20th percentile, and flexibility a bit lower than that.  Today he went down in problem solving, to less than the 2nd percentile.  I've told him he needs to relearn his tables and number facts to improve on this one. 

When he and his sisters were young, I used to play songs of tables in the car to school every day, and once upon a time he knew them all. At school the children weren't drilled on their tables like we were when I was at school, and I don't think any of my children would have learnt their tables but for those songs. For them it seems to have been use it or lose it.





I raised the new clocks exercise again:

A-One: No! I don't need to do them! I'm not going to do them! Two hands are all you need to read a clock ... I'm going to the toilet.

Fifteen minutes later (I measured it this time), he came back to resume his computer game.

Mum: Can I just show you how these clocks work, without you doing the exercises?

A-One: Alright.

I explained a millisecond, and a microsecond.

A-One: What do you need those for?

Mum: They are usually used in science, in laboratories, and sometimes to measure how long it takes to access data on computer discs.

Using the first clock as the training example, he made an error reading the hour hand but was able to correct himself when I pointed it out.  He was willing to read the time on the second clock too.

Mum: How about the next one?

A-One: No! No more today!

Mum: How many milliseconds in a second?

A-One: 1000

Mum: How many microseconds in a millisecond?

A-One: 1000

Mum: Fantastic! You know, you're not slow in picking this up. Do you remember when you first started this only a couple of weeks ago that you didn't even know how to read the half hour? And look what you can do now! All you need is practice so that you can do it quickly. Like swimmers - most people know how to swim, but it's those who train and train who swim really fast.

By that stage I was talking to one ear - the other was already under the headset.

Clocks are only for telling the time!

A-One duly completed his Lumosity training this morning.  He gained a new personal best for the flexibility game which requires him to recognise shapes, but continues to plateau (down actually) on memory and problem solving.  His speed is now over the 40th percentile, memory and attention up around the 20th percentile, but problem solving remains doggedly around the 2nd percentile. Overall he is over the 14th percentile for his age group.

When I mentioned moving on to the clocks and reading comprehension:

A-One: No! I know the clocks! I don't need to do any more clocks!

Mum: The next stage is to add a 4th hand.

A-One: No! I'm not doing any more clocks!

Mum: You realise it's about training that part of your brain that is good not just for reading clocks, but for other things too?

A-One: No! I don't need to do that!

Mum: OK. Well let's move on to some reading.

A-One: No! I don't need to do that either!

Mum: The reading this morning is different from last week's.  (I had planned to use the first paragraph from the Inquirer section of The Weekend Australian.)

A-One: No! My reading's OK.

Mum: Do you realise why we're doing this?  To improve your chances of getting a job so that you can keep yourself - especially after we're gone? What will you do then?

A-One: I don't know. I don't want to talk about it anymore!  Stop trying to make me do it!

A-One immediately brought up RuneScape and started telling me more about a feature that he'd pointed out to me yesterday.

So what's the problem?

No brain training yesterday.  I woke up late, had some other things to attend to, and then A-One received a phone call from his work to come in earlier.  He handled the phone call very well, saying that he needed to look up the bus information to work out how to get there by that time. He couldn't remember the address of where he worked, so I suggested he look at Google Maps to see if he can recognise it from the map, which he did.  I saw him call up the transport website ('I know, Mum') and enter the 'to' address (checking with me), and figured out which bus he had to catch and when.

A year ago, he hadn't able to do that, or perhaps had been unwilling to.

This morning he resumed his Lumosity training - resplendent in his PJs (I didn't have time to argue the point today).  Again he showed the same steady improvement since he started, gaining a couple of PBs and dropping his score a little in others.  He is now in the 12.7th percentile for his age group, and is almost at the 30th percentile for speed!  So how does that correlate to his feedback that he was too slow at work the other night?

His lowest area is still problem solving, at 2.6th percentile, while all the others are over the 10th percentile.  The problem solving game is all mental arithmetic, and for a generation used to using calculators, I'm not sure that this really tests out problem solving ability in real life. 

I do the Lumosity training too and my problem solving score is much higher, but I think that's because when I was at primary school we were drilled and drilled in our times tables and number facts, so I'm not 'working it out'; instead remembered facts simply pop into my mind.

The neuropsychologist suggested we try mind mapping with him. Is that a compensatory strategy, or does it exercise the problem solving part of the brain?


He zoomed through another page of 3-handed clocks, but would not do another page. 'Only one page a day, that's all!'  He was about to leave, when:

Mum: Wait a minute.  There's something else today.  I want you to read this paragraph and tell me what you think the central point of it is; what it's about.

A-One: This isn't necessary.

Mum: How about we see that?

Perhaps he was too keen to get on to other things too, because he didn't argue the point much either, and proceeded to read the paragraph.  He took longer than I did (reading it upside down) and reached the end of the page which was mid-sentence, showing all the signs of having finished.

Mum: It goes over the page. The paragraph ends here, see?

A-One: I'm reading to the end of the sentence, not the paragraph.  That's all!

Being obvious that he would proceed no further, I asked him what he thought it was about.  He was able to tell me very well, and when I asked a specific question, he answered that very well too.

I'm starting to wonder whether his impairments are more to do with attitude and motivation.  My next thought is to have him sit with me while we peruse accommodation advertisements and household bills, so that he gains some sense of what independent living requires.  We're not trying to turf him out, but we won't be around forever either.

A random act of kindness

A-One's laptop died today.  He did his brain training in the study, drawing my attention to the cafe (memory) game where he's surging forward.  Only two PBs today, but his overall BPI is now almost at the 10th percentile for his age group, which is a good advance on when he started.

Mum: Did you have music going?

A-One: Yes, but I'm not paying attention to it.

Mum: Did the music have lyrics?

A-One: Yes.


As he was sitting at the computer, he mentioned that he gave some money to a couple yesterday near his work.

They were asking people on the street for money. From Toowoomba, they had a sick baby and were just back from the hospital. Having borrowed a car which had run out of petrol, they couldn't raise the owner. A-One gave them $10.

A-One: That was kinda like a random act of kindness wasn't it Mum?

Mum: Yes, it was, and very good of you.  Do you think they were genuine?

A-One: I don't think they were playing me, Mum.  She looked really worried. The baby was in a pram, although I didn't quite see the baby.

...

Before we started the clocks exercise we talked about a daily routine for his brain training.  He is still unwilling to agree to a set time even though he follows a pretty consistent routine from 2pm onwards: shower, pack his bag for work, eat, spare time, clean teeth, head off to the bus.

Mum: So what about setting a time for brain training?

A-One: Well, clearly it needs to be before 2pm.  But I can't say a time, because there are other things I want to do too.

Mum: How much time do you want to allow for the other things, so that we can work backwards to figure out when you need to wake up?

A-One:  I don't want to talk about this - it's wasting time.  Let's just get this over and done with so I can do other things.

He whizzed through one page and would go no further.

Forging new neural pathways requires significantly more than 20-30 minutes per day.  At this stage, if I mention the 3-4 hours per day that is spent at Arrowsmith schools, I expect I'd see the heels dig in big time.

Patience!

My regular physical exercise includes cardio and weight/resistance work.  I wonder if negotiating with A-One also gives my mind a mental workout.  My father-in-law commented once after A-One spent some holidays with them, "A-One is such a blessing. He really teaches you patience!"

After feeling despondent on Friday, I stepped back a little for A-One to choose his own time for brain training over the weekend (only Lumosity, no clocks).  In the context of WOW, we had some discussions about agreeing with others to do things at or by a certain time.  A-One understands the concept, ably articulating the courtesies about time commitments when playing WOW with others.

So how do we help him translate that to real life! I am endeavouring to incorporate some sense of timing/planning in our work together.  That is probably the most disabling of his cognitive impairments when it comes to his employability.

Anyway, he completed his brain training on his own for both days, again improving his overall Brain Performance Index (BPI).

This morning, he arose, completed his morning jobs and went straight to his brain training - again on his own.  I was on the treadmill when he came out beaming, "I've just unlocked the next level in the cafe game!"  We looked at his results, and his BPI chart rose more steeply today - yay!

Before we took up the clocks again:

Mum: I'll be finished my exercise in about 20 minutes, then we can get on to the clocks again.  This time we'll add a second hand.

A-One: Why do I need to do that?  Second hands aren't important to telling the time!

Mum: Mostly, that's true.  The clocks exercise isn't just about telling the time.  It's about exercising that part of your brain so that you can understand concepts and ideas better.  When you read something, you can read it very well, but you don't always understand what you are reading.  This exercise will help you understand what you read better.


I'm basing this on Barbara Arrowsmith-Young's experience where, after 3 months of doing increasingly complex clock exercises, she was able to read philosophy and understand it!

I had added seconds to the same exercises that he had done with just 2 hands, but kept the old exercises out of sight.  We started by looking at the second hand of a clock, so that he could count the 60 seconds around the clock for a minute.  Once he got the hang of that, he managed the first page of clocks pretty well.  I observed that for every clock he counted in fives around the clock for the second hand.

A-One: That's all I'm doing today!

What A-One doesn't know yet is that I plan to incorporate some comprehension testing into our program.  I may use a book of short stories, and start with a single paragraph, asking him what he thinks the key point is and what the story may be about.

When it suits me!

With the grudging withdrawal of the music, A-One's level of co-operation has not been so high today.  When it was time to move onto the clocks exercise:

A-One: No! I'm not doing it!  I'll do it later!

Mum: I need to finish this work with you today so that I get on to other things.

A-One: I'll do it when it suits me! Not when it suits you!

Mum: I need time to write it up, and if we do it later I'll run out of time.

A-One: Why do you need to write it up?

Mum: So that we have a record of what works and what doesn't work for you. 

A-One: I'm not doing it now!

Mum, feeling rising frustration and disappointment: Please, can we do it now? Don't you want to work in with me on this?

A-One: Yes, but we can do it later.

Mum: Do you not want to do it now because you want to go back to watching the movie?

A-One, unable to stop a chuckle rising: I'll only watch 15 minutes; I won't watch the whole movie.

Mum, knowing A-One's '15 minutes': It'll probably only take about 5 minutes to work on the clocks.

A-One: How many pages?

Mum: Only one today.  Next week we'll add in second hands. Then there's millisecond hands, microsecond hands.

A-One: Second hands move all the time! How can you do that?

Mum: It's not so much about learning how to tell the time; it's about exercising that part of your brain that understands relationships between things.

A-One: I don't need to exercise that part of my brain!

Mum: Can we do it now?  The other things I need to do will mean I'm out of the house later on.

... A-One moved to the table with the clocks exercise.

Again he got the first one wrong, applying the same principle to the big hand as to the little hand i.e. between 2 numbers rather than using the whole 60 minutes.  After reminding him to count in 5s around the clock, he zoomed confidently through the page.  I noticed at times that he touched his finger to the numbers as he counted in 5s around the clock.

I'm now reminding myself to tell him only what's planned for the next session, not for later sessions - it's too much for him to contemplate, especially when he's not being co-operative.

He's now watching the movie!

It's about when you don't know how to do something

After I came home I woke A-One for today's brain training. 'Just a minute!' he said.  That's his favourite phrase when he's called for dinner too; we often finish before he arrives.

First we attended to some banking - we recently set up his internet banking and he's getting the hang of it quite well.  He remembered a call centre operative's instructions from the other day and could identify each recent transaction in his statement.


His online training went well again today.  He gained 4 personal bests out of 5 games, and his chart is still showing improved scores.  Even when he made a mistake, he seemed to know it before the game alerted him. Only one of his recorded cognitive competencies is still in the 1st percentile, and his memory and speed are still his best scores.

No protest from him when we resumed the analogue clocks work. I suggested he review the work we did yesterday, and he spent several seconds (sometimes up to 6 or 7 seconds) looking at each clock face where he had drawn the hands yesterday.  I asked him some review questions and talked about 'to' and 'past' the hour. 

For today's clocks, 10/20 to- and past- the hour, and 5/25 to- and past- the hour, counting in 5s would be an advantage, so I checked that he could do that, which he had no trouble doing.

On looking at the 10/20 page:

A-One: You've 'mixed up' the 10s and 20s times. It would be better if you had put all the 10s together and all the 20s together.

Mum: I could have, but that sounds too easy.  I wanted to challenge you.

A-One: Why do I need to be challenged?

Mum: Because it's only when you have to work at it that you are learning. When you don't know how to do something, that's a really precious time.  It's the very best learning time because it's only then that you can forge new neural pathways.  Once you know something, you're not changing your brain.

A-One:  Silence.

No protests, so I thank god for small mercies.

After drawing the big hand in the wrong place on the first clock, I explained the one complete rotation in 60 minutes again, and asked him to count by 5s up to 60 while tracing his finger through each of the numbers.  He was then able to self correct the first clock. 

He completed the page, sometimes copying the placement of the big hand from an earlier one.  He did them all so well that I told him it's now time for a 30 second celebration dance. He just looked at me, but I did a sitting dance anyway!

A-One: That's all I'm doing today.

Mum: How about just trying the first one on the next page?

He did ... and completed the whole page!

Tomorrow, none of the minutes end in '5'.

Analogue clocks

We added a change of scene today to start work on analogue clocks. That's how Barbara Arrowsmith-Young got started on her own exercises, and from the Principal's pack I received from the Arrowsmith school, the description of the brain function improved by this exercise seems to fit A-One.

From what I have read, Barbara put hands on her clocks and drilled herself to tell the time.  Her goal was to improve that part of her brain that understands cause and effect and mathematical relationships.

I'm starting the other way around. I have created pages containing 12 clocks without hands, each with a time underneath represented digitally (A-One knows digital times). The exercise I'm asking A-One to do is to write the hands on the clocks.  In time, we can try it the other way round too i.e. having him read the times represented by the hands.

Page 1: 6 x on-the-hour times, followed by 6 x half-hour times
Page 2: 6 x quarter times, followed by 6 three-quarter hour times
Page 3: 6 x (10 or 20) past-the-hour times, followed by 6 x (10 or 20) to-the-hour times
Page 4: 6 x (5 or 25) past-the-hour times, followed by 6 x (5 or 25) to-the-hour times
Page 5: 6 x (any other number) past-the-hour times mixed with 6 x (any other number) to-the-hour times



A-One was fine with the 6 x o'clock (on-the-hour) times. When we got to the first half-hour time, he was stumped.

I drew diagrams of the large hand travelling round the clock once an hour, and the small hand travelling between two 'numbers' each hour. With assistance he was able to draw the first half-hour time, but his comment was 'Even though it's right, it doesn't seem right.'

By this time, he was slouching in his chair.

Mum: Take three deep breaths - oxygen to your brain helps you stay alert.

A-One: I don't need to do that.

Mum: OK. Stand up and shaaaaaaake yourself about.

A-One: No! I don't need to do that.


Nevertheless, he sat up straighter in his chair. That enabled him to declare that he was doing only as many as he was comfortable with!

As we tried a few more, he would refer back to my diagrams, and ask how many pages there were to go. A couple of times he drew the little hand between the wrong two numbers, but insisted it was between the correct two numbers. I used a ruler to show him where he'd drawn his hands in relation to the numbers, and his retort was 'Even though it looks wrong, it's right!'

We got to the end of the second page ...