Not being able to recall instructions - any ideas why? (ASD)

[bialystockandbloom]

DS (HFA, 5yo) in year one - on the whole is getting on really well but has big problems in recalling the instructions the teacher gives. To the extent that from sitting on the carpet to going to his table, he has no idea what to do.

He said today that he does listen, but that if he says he doesn't know what to do, his teacher will tell him off for not listening. (Don't think that's true, teacher knows there's more to it than 'not listening'.)

No-one can work out whether it's because he's a) not listening (see above), b) he doesn't understand, or c) he has a brain like a sieve and the words just float in and out again. His TA & ABA shadow have been reinforcing with ipad tokens when he recalls something, but I'm not sure it's behavioural anyway so don't think this will make any difference.

Is this common with ASD/AS? He is like this at home - eg puts something down and a second later would not be able to tell you where he's put it. But has fantastic memory in so many other areas.

Any ideas what is behind this, and what to do about it?

Has he been seen by an OT?

I have no experience of the above but DS1 had an OT assessment last month and some of the key words mentioned with regards to him not being able to process information were Motor planning issues and auditory proceessing difficulties. We have a program in place to tackle them now.

I think this is classic ASD. My son has these difficulties recorded on his statement. I think processing problems are very common as are problems with working memory.

Working memory is different to long-term memory, it is like the brain's calculator - you have to store info and do something with it.

Has he had working memory tested?

Agree with inAE, it's a very typical problem with ASD, instructions need to be broken down into a few one or 2 part instructions, with a new instruction once the first bit has been completed.

Oh blimey yes! ds (15asd) has always been like this!
He has learnt things along the way to help himself as he has got older. He writes notes to himself now... makes notes ... or wears a band on his wrist as a reminder if there is something he needs to remember .His short-term or working memory is awful. His long term memory however is amazing! He can remember things in detail from when he was under 2.
Consequently organisational skills were poor too.
I think for ds the problem has always been one of trying to filter out stuff ( noise /distracting sights/ smells/ feelings etc and sort out the things that were important to process and act on. Also sometimes... He's still processing the thing from before so he misses stuff. Also ( lol) he's thinking about something that is really interesting and can't stop.

He also had a very poor concept of time. He could tell the time at aged 4 but at 10 I realised he had no concept of what time felt like. This took a lot of work. It was like he thought he could just stretch it . Stuff that you realise nt children are just born with ( like guessing it was evening time for instance) just didn't seem to be there.I had to do lots of time tasks with him. He's still not great... But again.. He now recognises that he has a problem with it ... So watches it.

Thanks all. Yes we are breaking things down into step-by-step instructions.

Interesting, I hadn't ever thought about the processing aspect. Of course it's this

Trout you are absolutely right, ds has dreadful organisation too (and he's only flipping 5yo, it's gonna get worse isn't it!). And the time obsession - ds is constantly either asking how long till xyz, or telling me how long it takes for xyz. I have realised just this week that it's probably because he's trying to make sense of how his day is constructed, and trying to make it as meaningful and less abstract as he can.

Lots of food for thought, glad i posted this.

Ds1 is the same and he does the counting down and telling me how long it takes to do things as well. The EP who worked with him explained it relates to TOM and Executive Function.

This article explains the connection between theory of mind, central coherence and executive function and really helped me to get a handle on why ds is good at numbers and science, but hits a brick wall with long, multi-stage problems and is unable to follow a basic set of instructions.

This one's worth a read as well, although a bit heavier, iykwim.

Thanks for those...Useful reading.
Lol...Those articles would have been really handy 10 years ago ! ( When i was banging my head against a brick wall with him). Good to see it written down and to know he's typical in some ways iykwim.

Ooh thank you moose really interesting.

And one of the authors of the second paper is an Ellen Bialystok No relation, of course!

I have only read the first page but it looks really interesting.

Dd3 really struggles with instructions, she nearly always needs them more than once and I tend to get her to repeat them back to me.

At school she is now able to ask for instructions to be repeated but I am going to forward that article to the SENCO because I think she would be very interested in it.

Thanks moose.

bialy, your Ds is probably going to need his instructions given in a different way . The teacher will need to moderate her langauge and get rid of all wooliness.

I have become a sargeant major, most of my instructions have only 2 words eg, shoes on, brush teeth, eat breakfast. Not exactly polite but it works

Thanks so much for that Moose, never heard of central coherance theory before but it makes so much sense. I can understand why symbols etc might be so useful for simplifying info, planning sequences etc. Unfortunately my ds is obsessed with signs so gets very distracted by visual timetable stickers and wants to play with them rather than pay attention to what they're meant to represent...

LOL Ineedalife, I bark so many simple instructions that my DSs often reply 'Yes Sir' - even when I correct them and say 'Yes, Ma'am'
My DS1 doesn't have ASD, but dyspraxia and SPD. There is a lot of crossover.
Just off to read moose articles.

have a look at the A4 recording whiteboards available from the TTS website. DS2 uses one all the time as he has extremely poor working memory & processing.
It allows people to record instructions for him & also for him to recall a thought or idea without having the added preassure of trying to remember it in a class or while out.
Has helped ease his frustration no end.
Sorry cant do links but they are a handy little tool & cheap!

actually i think they are called Talk-time cards

Hope nobody minds me posting, Ds is not asd but his short term memory is poor however his long term memory is great he can remember what we had to eat and done on a certain day when he was 2, hes nearly 7 now. I hadnt heard of working memory before just googled it and looked at some digit recall things on 6 numbers ds couldnt even get the first one, should this be a concern? and should i try him with less numbers or does this not count?

DS1 (11) has Auditory Processing Disorder as well as ASD. There is a clinic at GOSH that needs referral from paed/audiologist. Has he had any assessments done - WISC by an EP, CELF, ACE by SALT? These are not diagnostic but might give you a pointer. DS2 (6) has had these done because of problems following instructions. DS1 scored below the 1st percentile for one test whilst DS2 was on the 91st percentile. So DS1 doesn't follow instructions due to APD and working memory (0.03 percentile) rather than ASD whereas DS2 doesn't follow instructions for different reasons - he is under investigation but I suspect they are related more specifically to ASD. Different causes and different interventions required. I can tell the difference between them - DS2 appears more severe (oblivious at times) but is less consistent as he can also listen well. DS1 consistently has the same issues - appears more chronically forgetful and is only able to listen/hear in ideal circumstances.

It is quite common for children with APD to insist that they do listen but they don't understand. They also hide it well (compensate by lip reading, make excuses) and teaching staff are terrible at recognising a listening impaired child. DS1 hid his disability for 6 years in primary.

bialy DS2 is like this as well. Frighteningly good memory for facts and such, but appalling for everything else. He can memorise songs well - after hearing it once or twice, he can sing it through. (I'm still trying to decide if this is a good thing or a bad thing ) But picking up his room or toys in the living room requires a zillion separate instructions given one by one. Each and every time.

The obsessive asking (impatient "is it time for ... yet?") over and over is constant as well. We have resorted to sand timers in an attempt to slow it down and get him to learn to wait. We have 3, 5, 10, and 15 minute timers which we use for various things. I'll often tell him "okay, we're having a snack in 15 minutes" and then put the timer on, telling him "watch the timer and let me know when it's done, and THEN we'll have snack." It does seem to help a little, although there are always bad days.

The odd thing with ds1 is that he scored high average for working memory on his WISC IV test (his lowest score was for processing speed). He actually scored unusually high on the reverse digit span test (scored at adult level), which totally confused the EP at the time and meant she had to consult on the results.

He has an incredible memory for facts and things that happened a long time ago. He can sit in a class and 'listen' whilst reading a paperback and still be able to recount all the main facts of the lesson, but if you give him an instruction, he is unable to plan, organise and co-ordinate his thoughts and actions well enough to do it. For me the executive function thing makes more sense for him.

If I quote the first paper I linked to:

"If we break down the skills or functions into sub functions, we might say that executive functions tap into the following abilities or skills: goal, plan, sequence, prioritize, organize, initiate, inhibit, pace, shift, self-monitor, emotional control and completing."

... and think of someone who can't do the things it lists, I have basically just described ds1.

I also find this:

"Executive functioning does not have one definition agreed on by researchers,
however, it is generally considered to describe the set of skills an executive would need to stay on top of his or her job; planning, organizing, prioritizing, multi-tasking.

Executive dysfunction may make it difficult to maintain a topic in a conversation as the student with ASD has difficulty maintaining a sense of order in his spoken messages often producing tangential responses, he or she may also have difficulty with the organization of written expression or independently planning to complete class assignments."

Sums him up really well, in relation to schoolwork and conversational skills. He can talk your ears off when it's a list of facts or an obsessional topic he's learned by rote, but he can't relate an event that's happened in the right order and he really struggles with the organisational planning and structuring that's required to complete schoolwork or say, going upstairs and getting himself properly dressed and ready to go out.

Imo, working memory issues will look the same/cause similar problems, but as you can see from ds's results it's not always the case, so simply working on working memory skills won't necessarily improve things. In the absence of testing such as the WISC or Ravens tests, it's definitely worth trying some WM exercises in the first instance though.

I have a feeling ds did so well on the digit span because he loves numbers and is good at retaining facts, particularly when they relate to patterns or series. If the test had been about recalling the right actions to do something as simple as make a cup of tea (fill kettle, close lid, plug in, switch on, etc) I have no doubt he would have scored extremely low. So, I'm not 100% convinced that the WISC WM tests are a good indicator of WM skills, but that's purely based on my/our own experience and I could be way off the mark.

Triggles (tis you isn't it?) your ds2 sounds remarkably similar.

It is strange. If you play the "I went to the shop and I bought a..." he is spot-on.

Hadn't really considered the auditory processing angle, or that the classroom may have too many sensory stimuli. Having done two years of behavioural therapy I've probably become a bit entrenched in thinking that almost everything is a behavioural issue or can be solved through behavioural teaching.

Doesn't exactly explain the fact that he needs frogmarching repeated asking to tidy up though

keeponkeepingon yes he has had CELF assessment, will have to dig it out and have a look.

Thanks everyone, this is all really useful and interesting.

bialy yes, it's me. Due to some email and name issues, I've had to alter my account, so will no longer be Triggles. I will choose a new name after the holidays. (I hate choosing names so am putting it off)