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Psychiatry
Children With Slow Processing Who Need Extra Time on Tests
How it helps to have cash—or technology.
Posted August 9, 2019
A recent New York Times article titled “Need Extra Time on Tests? It Helps To Have Cash” has ignited an explosive issue that has troubled psychologists for many years. Those of us who conduct neuropsychological evaluations are frequently asked to assess whether a child processes information slowly and, if so, whether he or she needs extra time on tests or other accommodations at school.
For the most part, unless the school has identified these concerns and conducted their own testing, students need a private, comprehensive evaluation with a psychiatric diagnosis to be considered for accommodations. Many children who may not meet the criteria for a DSM-5 diagnosis but who present with clear indications of slow processing speed would also benefit from these accommodations.
However, if their families do not have insurance that covers these services or cannot afford the cost of privately conducted evaluations, they are unlikely to get additional help. Without a formal psychiatric diagnosis, provided via a comprehensive neuropsychological evaluation, many children with slow processing speed who most directly are impacted by their neuropsychological functioning do not receive extra time or qualify for accommodations.
Accommodations usually come either in the form of an Individual Education Plan (IEP) or through a 504 plan. These accommodations are derived from federal legislation such as the Individual with Disabilities Education Act (for IEPs) or Section 504 of the Rehabilitation Act (for 504 plans). In Rhode Island, where I practice, 504 plans with accompanying accommodations are increasingly provided to students with ADHD, mild Learning Disabilities, or mental health issues such as anxiety and depression as opposed to IEPs, which are far more inclusive and expensive interventions. However, there are other costs to accommodations that are often borne by the families of children who need them.
The children who most need extra time for testing—those with clear neuropsychological signs of slow processing speed—often do not qualify for extra time. They may display poor reading fluency, slow clerical motor skills, sluggish reaction times, and snail-like visual scanning on neuropsychological testing, along with many real-world signs of slow information processing. But these children do not necessarily present with classic attention, learning, or psychiatric disorders. Unless the school is concerned, they often do not get evaluated and do not receive accommodations.
Many children with slow processing speed who truly need extra time for tests and are able to receive a complete neuropsychological evaluation eventually end up with a diagnosis of ADHD, Predominantly Inattentive Type. While this is frequently not their primary difficulty, it is the best rationale for obtaining extra time. This may seem like a roundabout way to get the accommodations they need, but it often achieves the desired outcome.
The New York Times article suggests that rich families are able to afford evaluations and psychiatric diagnoses that support the need for extra time on tests. In order to level the playing field at school and in high stakes testing, extra time for tests should be supported by impairments on tests assessing slow processing speed. However, many children with a psychiatric diagnosis of ADHD, LD, or Anxiety/Depression do not display direct neuropsychological testing data demonstrating slow processing speed.
Does this mean that parents are paying for accommodations? Mostly, no. Some of these students have executive-functioning difficulties with organization, planning, and task initiation while others may be anxious and emotionally overwhelmed by the demands of test-taking.
Students who are considered 2E (Twice Exceptional) may have average scores on measures of processing speed but exceptional scores on many other measures. A unifying characteristic of children who truly need extra time on tests is that they “can’t show what they know” in time-limited testing. Unfortunately, without the data derived from neuropsychological testing to reveal these difficulties, financial discrepancies often determine which students benefit from accommodations.
Neuropsychological testing provides the necessary data for justifying accommodations such as extra time on tests. However, parent, teacher, and self-reports of plodding behavior in other settings tend to be highly consistent with the testing. At home, slow processing speed is seen in the amount of time it takes to complete homework or get ready for school in the morning. In the classroom, difficulty completing classroom assignments or writing down homework before class dismissal is common. The inability to keep up with peers in the classroom or in fast-moving communication is part of the daily experience for these children, particularly when they get beyond third or fourth grade.
Since accommodations generally do not cost anything, 504 plans in the school setting are fairly common. They are the best first step for most children, as they implicitly tell them that they are capable of performing well if they have enough time. Many of these accommodations are kept in place through high school for high-stakes testing.
But what if we could also improve slow processing speed through skill development and the use of technologies? This would cost more but might facilitate learning, improved self-esteem, and independence. It could also be applied to all children, regardless of the financial status of their family. While the research is in its infancy, there is compelling evidence that a combination of skill training and targeted use of technology can result in moderate improvements in slow processing speed.
Here are a few strategies where technology might be used to improve slow processing speed:
1. Playing action-based video games.
Studies conducted by C. Shawn Green and Daphne Bavelier revealed that decision making and reaction times can be improved by playing action-based video games. While the effects are modest, they are promising. Playing esports has opened the door to improving reaction times and, in turn, the speed of processing. New tools are being developed by neuroscientists to help with peak performance in athletes. Other studies have shown that playing video games such as Rayman Raving Rabbids can increase fluency (speed) of reading.
2. Use virtual reality as a tool for skill development.
Making something automatic makes it faster. Think about children who have mastered the multiplication tables who require less time for processing of information while doing math calculations. More efficient processing can be achieved by using VR repeatedly to practice an activity.
3. Talk, don’t write.
Many children with slow processing speed who need extra time to take tests would benefit from speaking their answers rather than writing them. Applying dictation skills for traditional writing assignments or being able to dictate short responses to a test would be helpful for many of these children.
4. Type, don’t write.
Developing expertise in typing is a no-brainer for many children who write slowly. However, these students need to recognize that typing is a skill that requires training and repeated practice to become experts.
