PAP 128

Identifying & Accommodating Slow Processing Speed

with Ellen Braaten, Ph.D.

Slow processing speed is common among individuals with ADHD. It can affect everything from responding when someone talks to you, to not getting classwork finished, to struggling in social interactions. A child can struggle with visual, motor or verbal processing, or any combination of the bunch. In this episode of the Parenting ADHD podcast, Dr. Ellen Braaten shares how to identify slow processing speed and how to accommodate for it through adjusted expectations, assistive technology, and a strengths-based approach. 

Resources in this Episode

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Ellen Braaten, PhD, is an experienced and prominent psychologist, researcher, speaker, and author. At Massachusetts General Hospital, where Dr. Braaten has been affiliated since 1998, she is the Executive Director of the Learning and Emotional Assessment Program (LEAP) and the Kessler Family Chair in Pediatric Neuropsychological Assessment. She also holds an appointment of Associate Professor at Harvard Medical School.

Dr. Braaten is widely recognized as an expert in the field of pediatric neuropsychological and psychological assessment, particularly in the areas of assessing learning disabilities and attentional disorders. She has received funding to conduct longitudinal research on child outpatient samples, and has published numerous peer-reviewed articles, book chapters, and reviews on psychological and neuropsychological assessment, intelligence, ADHD, learning disabilities, anxiety, depression, gender, psychotherapy, and motherhood. 

An accomplished and dynamic speaker, Dr. Braaten is a frequent media contributor, including NBC News, WCVB Boston, CBS Boston, and The New York Times. She’s also the co-author of the best-selling book, Bright Kids Who Can’t Keep Up, the first book of its kind to focus on information processing speed weaknesses in children. More recently, she published the second edition of The Child Clinician’s Report Writing Handbook, which has been called “the most comprehensive child assessment handbook available.” She is the author of How to Find Mental Health Care for Your Child and the co-author of Straight Talk about Psychological Testing for Kids.

Thanks for joining me!

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Ellen Braaten (00:03): Think about what life is like, alternatively, for these kids, all they ever hear is why can't you come up with something what's wrong with you? You know, I'm going to make the decision for you. If you couldn't make it in time. All of those things, their life can be overwhelming with those sorts of comments.

Intro (00:28): Welcome to the parenting ADHD podcast, where I share insights and strategies on raising kids with ADHD straight from the trenches. I'm your host, penny Williams. I'm a parenting coach, author ADHD, a highlight and mindset. Mama honored to guide you on the journey of raising your atypical kid. Let's get started. Welcome back to the parenting ADHD podcast. Today, I'm talking to Dr. Ellen Braaten about slow processing speed. And this is a topic that is really, really important for parents and educators to understand about many kids with ADHD. And this is a really common occurrence for them. Thank you for being here, Ellen. I so appreciate it. Will you start by introducing yourself? Let everybody know who you are and what you do.

Ellen Braaten (01:26): Thank you so much. Thank you for having me. I'm really excited to talk about this today. So I am a child psychologist who specializes in clinical neuropsychology. So that is the testing and the evaluation of kids with learning and emotional and attentional behavioral issues. So I do a lot of assessments in my clinical work of kids who have ADHD and learning disabilities. And then my other hat that I wear is as the executive director of the learning and emotional assessment program at Massachusetts general hospital, and also an associate professor of psychology at Harvard medical school. And I have done a lot of research in the areas of ADHD and particularly processing speed. I written a few books for parents, including a straight talk about psychological testing for kids and bright kids who can't keep up, which is a book all about processing speed, which we're going to be talking about today. So it's very much interest for me.

Penny Williams (02:26): I think it's so important to you. I love that it's smart kids who can't keep up. My own son is highly intelligent, but has a far, his slow at his processing speed is out of proportion to his intelligence, you know? And so that was really a big insight for us. So I wanted to talk about that a little bit. I think maybe to start is how do we task for slow processing speed? And what does it really mean?

Ellen Braaten (02:56): Great questions to start with? So in terms of how we test for processing speed, the simplest thing that I can give parents is that the best measure we have of processing speed, at least in my own research thus far, is the processing speed index from the Wechsler intelligence scale for children. So many kids who have had questions about their development or learning or attentional capacities have had a whisk at one point or another. So the most simple way to look at whether or not your child might have a processing speed weakness is to look at that index. And I'm sure that's what you're talking about too. When you said that your son has a big discrepancy and there are two ways of looking at this at this issue, one is, does your child just have slow processing speed? So when you look at the processing speed index on the whisk, is it below for example, the 25th percentile, we've also found that kids who have even somewhat normal processing speed, but very high abilities and other areas that those kids, because of that difference in processing speed from other areas, they can appear as if they have very, very weak processing speed.

Ellen Braaten (04:10): Even though it's only a relative weakness, I should go back just for a second and talk about what processing speed is in general. And in the simplest terms, it's how long it takes us to get something done in a given period of time. When we're talking about the Wechsler scales, for example, we're talking about measuring a person's performance on something that's very simple, either looking at two symbols and then determining very quickly whether the same they're the same or different, or it's being able to copy a code very quickly. Those kinds of tasks relate very well to other things that we see in the world that kids with processing speed tend to struggle with. And they can be anything from being able to form an answer to a question very quickly, or be able to hear what's going on in the environment here, a command that someone says, can you do this, this and this?

Ellen Braaten (05:06): And it takes them a long time to process that and have a motor response for it. And it's also being able to process things like social relationships quickly, or be able to do a test of simple math problems quickly. You brought up one other issue as well. And that is that, on IQ tests like the web wax, their scales processing speed is one of the indices, even though it really isn't by any one's definition, a measure of how smart we are, how well we can solve a problem. It's really just how quickly we can do those simple things in life. But in our culture, we sort of equate being able to do something fast as being smart. It's really not the case. There is somewhat of a, what we call an inverse between being intelligent on tests, like problem solving vocabulary, analytical reasoning skills, and being very quick in these simple sort of tasks. But again, we're asked to do a lot of those simple things quickly in our daily lives as adults and especially as kids in a classroom.

Penny Williams (06:18): Yeah, I did find it perplexing that the processing speed was part of the IQ test. Can you tell us why they're paired together?

Ellen Braaten (06:29): So it really, IQ is very much driven by what a culture considers important. The Wechsler scales in particular, their highest correlation overall is with how a child performs in school. And in our schools, you've gotta be able to quickly do things like copy notes from the board, being able to find the right page on the right, in the right textbook at the right time and do it very quickly. So that's why it's included. They also though admit that it's not the be all and end all. And so there are other ways of computing, a general ability index on the whisk that does not include processing speed. And also another aspect of the WISC, which is working memory, which a lot of other people would say, that's also not intelligence. I tend to think of processing speed and working memory is the things that support our intelligence.

Ellen Braaten (07:31): So if we're very smart, but it takes us a long time to get something done. It's good to know that, but that's not really part of intelligence. So it's, it's complicated, but the reason why they, why it's included on that is because we tend to value those things. And also those things tend to be important in school kinds of situations. So that's why it's jumbled into this, these other areas, although we can parse that out. And that's why it's good to look at where are the areas of strengths and strength and weakness in your child's profile. If some areas are very strong, but processing speed isn't you still have a very good idea of what their cognitive capacities are as well.

Penny Williams (08:19): Right? And for us, it was really important to know that processing speed was a part of that overall score on the whisk and be able to advocate for gifted inclusion for my own son, because with the processing speed factored in, he didn't meet that lower requirement of the IQ score for gifted. But if you took out that really disproportional speed, then he very much qualified, it, it really made a big difference for her, for his qualification there. So I always like to point that out to parents too, we, we can have smart kids who really struggle in school and, slow processing speed is just maybe one aspect of that. Can we talk a little bit about how do we accommodate for slow processing speed? How do we see evidence of it in our daily lives with our kids?

Ellen Braaten (09:16): Well, in your daily lives, you're going to see things that basically almost anything is going to be going to take longer to do. And it can range from being able to decide what your child wants for breakfast in the morning, because it takes these kids longer to process that again, simple information and to really know exactly what it is that they, that they want in terms of what you might see in academic settings, that also kind of trickle into the home setting. You're going to see problems with being able to have homework completed in a given period of time. You might even see problems with social relationships because a lot of social relationships are being able to process what's going on in a given time period. You might see a child who slow to get started on tasks too. So you might wonder like, Oh, well, that's, that's a double liability.

Ellen Braaten (10:21): So if you're, if you tend to be slower at being able to complete simple stuff, and then you're slower to get started on it now you're doubly behind find that it tends to be one of those things that kids who know, who, especially those were smart enough to know like, Oh, this I'm never going to get this done in time. So why even bother gets getting started. They might not even be able to articulate that, but they may very well know that they just feel already overwhelmed from the beginning. So those are the sorts of things you're going to see at home. Yeah.

Penny Williams (10:55): Slow to respond. I think too that was a big clue for me was that if I gave him more time than I thought was adequate, he would respond. It wasn't that he wasn't listening or trying to answer me. It was just that it was taking him longer than I expected. And I had to adjust that expectation.

Ellen Braaten (11:15): That is such a good point. That's half of the battle gear in terms of figuring out how to manage kids and how to help them is being able to adjust to their tempo. And one of the biggest questions I get and complaints, I get to totally understandable when I lecture on this as well, what do we do? Don't really have any magic pill or any magic sort of treatment approach. What we really need to start thinking about is being able to give these kids the time that they need in to be, and to show us their brilliance and, and all of the things that they want to say. And in another time period in a different era, it wouldn't be a problem. Life goes by, or life went by at a much slower pace, but when you're constantly bombarded with quickness and with keeping track of a million different things all at once, your system of being able to process is overloaded most of the time. So we've got to be able to give them that time to, to make a response, to have a response, to formulate it, because they've got a lot to say and not giving them that time is not only impacting them, but it's impacting us because we need to hear what they have to say.

Penny Williams (12:42): And we get frustrated because we think they're not listening. And then that just escalates the situation. So one thing I learned to do was to count to five very slowly in my head before I tried to elicit a response again, before I said something again, I gave him five full seconds to show that he was listening or responding before I went back to him again and trying to get his attention. And more often than not, he would answer within that time. But I just didn't have a good gauge, I guess, intuitively for how long, if someone talks to me I'm pretty good at answering right away. And that just isn't the case for him. And I had to learn that and be able to adjust so that we all felt better. He felt better because he was meeting expectations. He wasn't getting in trouble. And I wasn't frustrated because my expectations were in line with where he was and what he could do.

Ellen Braaten (13:45): I think these are such great points. And being able to make that switch as a parent or also as a teacher is a big, big deal, because think about what life is like, alternatively, for these kids, all they ever hear is why can't you come up with something what's wrong with you? You know, I'm going to make the decision for you because you couldn't make it in time. All of those things, their life can be overwhelming with those sorts of comments from parents, teachers, peers. So the more that you can do as a parent to bring that down, the more they're able to, to sort of develop those strategies for organizing their thoughts.

Penny Williams (14:33): Let's talk a little bit about school then. And so pressing same speed at school, because that obviously is where I think it can be the most challenging and kids who just work slower than their peers. Really. They're not getting their work done in the time that's expected. They're often spending way more time every night on homework, which I feel like is just punishing them for having a disability. What can we do? What, what kind of accommodations can we work with teachers and educators on to help them be able to succeed, but also feel good about themselves at the same time

Ellen Braaten (15:16): You bring up a few good points. And one is that the number one thing we can do is give them extra time to get things done. And that is absolutely one of the things we've got to do, but we can't just give them extra time and expect them to do the same amount of work necessarily because what happens is they're working all the time. So one of the things that I think we have to be is forceful about the workload, and we've got to think, oftentimes homework has just given and it's not thoughtfully given. So that's one of the things that teachers have to do. And sometimes they, they don't know about this issue and parents have to educate them. But I think the thing that really is difficult for kids with slower processing is busy work. And I think busy work needs to be deemphasized.

Ellen Braaten (16:11): They need to really think about how much a child needs to practice a skill so that they are competent and quick about them, about these skills without making it feel like they're being overwhelmed with it. So a teacher's got to be somewhat willing to adjust homework assignments to fit with that student's pace. And then also we've got to think a bit about technology. Sometimes technology can be overwhelming for kids with slow processing speed, but sometimes it can be really wonderful. So having some really good talks with your child's teacher or trying things out with technology, perhaps for some kids, it's easier for them to speak into a microphone and dictate a story that might be easier for them at other times, it might not be, and you might have to play around with that sort of thing. I think that things like lack of clutter less stress in the classroom and keeping things same place, same time, same sort of routine because every time kids have to readjust to something they're processing, whatever that simple thing is.

Ellen Braaten (17:26): And remember, these are kids who have trouble with the simple processing, not the complex. So when you're talking about big picture items, big, big ideas, sometimes they Excel because those are the sorts of conversations that happen. More slowly, they're the conversations that happen over time. And so what you, what you might find is that they Excel in those things, but when you just change the schedule up just a little bit or change how the homework is going to be graded. And so they've got changed, how they do it or change where the homework is supposed to be dropped off. All of those little things they're having to process. So the more you can keep it the same, the better that they are. And also things like recess. Oftentimes kids with slower processing speed are given extended time during recess need desperately to be able to reset their clock.

Ellen Braaten (18:25): They need to be outside and moving. So don't use recess as a time for them to catch up on their work. They need that recess time as much or better. And the one other thing that I would add is organizational skills are important because the more organized any of us are, the more we are able to do a task efficiently and efficiency is something to keep in mind. How can I make my child's world more efficient? And sometimes even speech and language therapy can be helpful, even in a very bright kid who has very good language skills. Sometimes their language system isn't organized very well. So having a speech and language therapist who, who has a specialty in the executive functioning of language can be a very important treatment approach to some kids with slower processing speed, because they're able to access the words that they're needing at that particular time.

Ellen Braaten (19:25): Again, they've got to, especially, I think sometimes with kids who have a huge vocabulary, they have much more to sort through. And so it takes them an even longer time to come up with a response. So those are some of the things that come to mind when I'm thinking about the sorts of accommodations and remedial work that can be done. And I should actually say one other thing we found in my research that kids with ADHD and also with slow processing speed, tend to have difficulty with time perception, meaning they don't really understand how long five minutes feels versus 15 minutes. And we ask them to manage their time when actually what we're finding is they have trouble with even the concept of time. So it's like asking a child to read words when they can't yet hear the sounds that make up those words.

Ellen Braaten (20:22): So one of the most important things you can do is to help your child learn a concept of time, teach them how to read an analog clock. Also do things like time, how long it does. It takes them to do simple things like brush their teeth in the morning or ride to school versus ride home from school. Now that we're all back in school for the most part, simple, not only time, how long did it take you to do your homework? Because that's oftentimes not the most fun activity of their day, but let's see. What does it feel like to, it takes you two minutes to brush your teeth. What does that feel like versus 20 minutes to ride to the gymnastics class? Those are the sorts of things that help them develop a sense of time, which then will help them manage that time. And that's especially important when you really have a problem with completing things in a given period of time.

Penny Williams (21:20): Time blindness can be a huge issue. And, and my own son has no concept of time. It five minutes or five hours. He just thinks everything takes forever in his terminology. And I learned to challenge that I learned to set timers and say, look, you can get this done in five minutes. Oh, no way. You know? And, and I would have to show him that, yes, he could get something done in five minutes and then that really helped him to start to build that concept of time. Right.

Ellen Braaten (21:51): And it's really something we've only become aware of in the last few years, as it relates to kids with ADHD and then also with slower processing speed. And what's so interesting is for years we've taught kids time management skills and it's not really worth it to teach them time management skills, if they don't really understand what it is that they're managing.

Penny Williams (22:14): Yeah. You know, how do you plan how long it's going to take you to do a project. If you have no concept of time, it's really hard.

Ellen Braaten (22:23): And I find either kid's fault, like your son in that camp, or they completely underestimate how long it's going to take. So they'll say, well, that's going to take me five minutes. I can do that later. And you know, a lot of kids do that to some extent, but kids with time blindness do it to the degree that it makes everyone frustrated. Every, you can say to them, no, think about it. It's going to take, how long you've got 10 sentences to write each sentence takes a minute. You're not going to finish this in five minutes. It's going to be at least 10 minutes. Like, it's that sort of thing that they need to understand the very nitty gritty of how long something really takes. Yeah.

Penny Williams (23:06): I've found a time timer really helpful for that too. It's a really good visual for exactly how much time is passing and how quickly it goes, been a favorite of mine for a long time, just because it makes it a more tangible, I think, more visual, which is so helpful. I wanted to ask you about can slow processing speed be asynchronous. And what I mean by that is like, my son is super verbally fluent and has a huge vocabulary. You know, his verbal fluency is way beyond his age and has been since he was very little, yet written output. And this is partly because he has dysgraphia as well, but written output, it was very, very slow or answering someone when talking to him is very slow. So can we have different speeds for different activities, maybe different parts of the brain.

Ellen Braaten (24:03): Absolutely. And I probably should have even mentioned that when I was first talking about processing speed is that there really are at least three big areas of processing speed. And when I was talking about the whisk that really measures two areas of processing speed that are very important in terms of overall processing speed, but that's visual processing where you're looking at something and taking that information in how quickly our eyes are perceiving information and then relaying it to the brain and then also motor processing motor speed. So that is the ability to have fine motor agility, how fast we can copy something or put pigs in a board. It's not really how fast we can run. We're not talking about, we're talking about motor processing speed. We're not talking about the gross sort of motor processing. How, how quickly you can run a mile.

Ellen Braaten (24:58): For example, we're talking about more specific kinds of speed. That's related more to cognition. So there's visual, there's motor. And then there's also verbal, as you mentioned. And there's a lot of overlap between these areas, but it's very important to get an evaluation, a comprehensive evaluation that looks at each one of these areas. You gave a perfect example of how some kids might be very slow at motor processing. That's going to affect their ability to take notes in class assignments from the board, do a drawing task. For example, oftentimes motor and visual can go together. So they're seeing something they're having to remember it for a split second, and then write it down. If both of those systems are somewhat slow, any kind of task where you're going to have to copy something or write something is going to be more difficult, but for a verbal, a verbal fluency, sometimes kids are extremely verbally fluent.

Ellen Braaten (25:59): And when it comes time though, to match that verbal fluency with the slow motor processing, what happens is a sort of like the least common denominator becomes primary, meaning that slow motor speed in terms of their ability to use a paper and pencil becomes the set speed and brings down that verbal processing. But it's very important to get a sense of within those three areas of processing speed, does your child have some strengths within one of those areas? Are they all weak or does your child, for some kids it's only verbal processing. They might be very quick with paper and pencil. They might visually process information, but they have trouble processing information. And then they might look similarly dysgraphic when it comes time to write something, not because their motor speed is slow, but because they're having trouble generating a verbal response. So all of these things are very important and yes, for most kids, it's, it's usually not just one of those areas for many, it's all three, but for a lot, it's sometimes two out of three and it's good to know what those are. So you can maximize the areas of strengths and support the areas of weakness. So maybe for your child, for example, doing something like generating a verbal narrative into a dictation program might be a better way to start a writing task rather than actually writing it.

Penny Williams (27:29): I remember in probably second, maybe third grade, he had a writing assignment and he didn't know where to start. He couldn't get started. And I said, well, why don't you just tell me he was supposed to write about what he did for spring break. I said, tell me about what we did for spring break. And he told the most amazing story and he had all of these really descriptive words. And then I said, okay, now you just have to write that down, write down what you just told me could not didn't know where to start. And, and, and I, that was a moment where I really realized a pretty significant disconnect there, but also that, that verbal fluency was his strength. And we could use that to sort of overcome some of the slow processing speed, the motor issues and things like that with the dysgraphia and other things. And, I think that's really what this is all about is how do we take strengths and use them to help with those weak and challenging areas to help them succeed, to help them feel competent and capable.

Ellen Braaten (28:39): Exactly. And just to give you a different point of view on that, if it was sort of the opposite where Todd was very quick motor wise, but very had had a lot of slowness in terms of verbally being able to produce a narrative where you'd want to start with is an outline that supports the verbal system. And they might actually do quite well writing something or typing something once they have a template, but they're not going to have that, that internal template that they're going to be able to verbally generate something. And so that's where this really needs to be very individualized depending on the child. It's not like processing speed is one size fits all. Well, just give them extra time. And it'll all work out. Extra time is important. And being aware of those smaller extra time things, like you said, that extra five seconds to generate a response can be a real gift to these kids, but it's not the only thing we can do. Yeah, exactly.

Penny Williams (29:42): And you know, this just reminds me of differentiated instruction. You know, this supports the fact that everyone learns differently and shows how they learn differently. And if we offer different options and opportunities to kids, then they can choose a way in which they can succeed to show you what they've learned and what they know. I, when my son was in high school, we had a lot more of that, a lot more assignments where you can choose to make a video or do a poster, different ways of showing what they knew and practicing and learning. And I learned earlier to advocate for that, for him to ask if he could not write an essay, but instead do a PowerPoint or something, more visual that he could really engage in better and also succeed at. And I think that's a really important thing for parents to know is that you can ask for these things you can ask for extended time, you can ask for reduced assignments, which was another big one for us because of that slow processing speed. He would have been doing homework every hour of every day, which he wouldn't have done. So, those reduced assignments were really important when necessary as well.

Ellen Braaten (30:56): Absolutely. It's really, it does take some times some advocating on the part of parents. And when I started this area of research about 12 years ago, it really doesn't even thought of as an important area at all of anything. Like nobody really was thinking 12 years ago about processing speed per se. And so I found that, a lot of times teachers had no awareness and that's still the case. I mean, this is a fairly new area of research and, and sort of exploration. And you might as a parent be the one who has to educate the teacher on it. It's not necessarily because the teacher doesn't know, teachers can't know everything, but hopefully they're open to you doing that. That's where the problem sometimes can come, but you might need to be the one to say, this is a real, this is a real issue. And there there's a lot out there like podcasts like this, that teachers can be referred to if they want more information.

Penny Williams (32:00): And so many resources and articles too. And I've just always found that taking the approach that this is what I've learned about my son. And these are the things that we found helpful. What do you think about implementing them in the classroom is as a pretty well-received way to approach it, including their opinion, but also really showing who your child is and, and advocating for them in that. And I think, that's really the crux of this whole conversation is really learning who your child is, what their strengths and weaknesses are, and then crafting a way forward that really honors who they are and what they need.

Ellen Braaten (32:45): You said it perfectly, that's, that's exactly the goal. And really it's exactly the goal for all parents too. In some ways it's a bit of a gift I find when you have a child who has some learning challenges, because you have the opportunity to teach them these skills that we all need to learn. Like we all need to advocate for ourselves at some point in our lives. Some of us don't ever have to do that until we get into our first job, or we get far into our career and find that we have to advocate for ourselves. So it's really an opportunity to teach some life skills and it might feel hard because it's, in some ways it's not fair to have to learn those skills early on, but in other ways there's really some research that shows that if you do learn these skills early on, it's associated with a lot of wonderful things as you move into adulthood. Hmm.

Penny Williams (33:40): I love that. I think it's a gift to have the sort of reason to dive deeper into who our kids are, to really, I know my son on a much, much deeper level than I ever would have dreamed of. And my daughter too, who is neuro-typical, but I've learned so many lessons from her brother that have really helped me in parenting her too as well. And, we always have to find the bright spots and the positive way forward, I think, and knowing our kids so well is how we do that. How we really are able to meet them where they are. Exactly. Well, thank you so much for sharing some of your wisdom and your time with us. That's been a really insightful and valuable conversation for everyone listening. Go check out the show notes at parentingadhdandautism.com/128, for episode 128, you will find links to Dr. Braaten's website and books there. And I would really encourage you to read more of her work and connect maybe, and really benefit from what she is doing for all of our kids, all of our kids with differences. Thank you again for being here. I really, really appreciate it.

Ellen Braaten (35:10): Thank you so much for having me. It was my profession.

Penny Williams (35:12): And with that, we'll end the episode. I will see everyone next time. Thanks for joining me on the parenting ADHD podcast. If you enjoyed this episode, please subscribe and share, and don't forget to check out my online courses, parent coaching and mama retreats at parentingadhdandautism.com.

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