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Higher education and cognitive disability: adaptive strategies.

Abstract

Graduate level studies have academic demands which are multiple and varied. A student with a cognitive disability may be especially challenged due to the abstract and theoretical subjects inherent to higher education. Material presented includes a description of student needs, possible approaches for faculty, and adaptive strategies (task analysis, pre-arrangement, planned performance and appraisal). Through carefully applied planning, discipline, and use of resources, a graduate student with a cognitive disability may successfully complete a master's degree or doctorate.

Introduction

Graduate level studies are by definition complex, abstract, and highly theoretical. Can a student with a cognitive disability realistically pursue a master's degree or doctorate? This commentary will support the belief that through adaptive strategies and faculty support, advanced academic work is possible. Topics include description of student needs and specific techniques for instructors to utilize or recommend. The perspective reflects the author's personal experiences with completion of a doctorate after sustaining a head injury in a motor vehicle accident.

Awareness of Student Needs

A graduate student may have been challenged by a learning disability throughout schooling, or may have recently been evaluated and diagnosed. If a cognitive disability is more recent in determination or occurrence, the student would require much more intervention with introduction to varied compensatory techniques. When experiencing a non-apparent or "invisible" disability, self-disclosure to faculty is important. The student may describe holistic issues in addition to cognitive challenges, which affect performance, including sensori-motor symptoms (visual or auditory, mobility), or psycho-social (isolation, depression, communication). Focusing on cognitive issues, the executive functions required in scholarly tasks are especially challenged. These skills include: memory, judgment, planning, problem solving, concentration, decision-making and attention to simultaneous demands. (Wilson, 2001; Edgar, 1978). Considering the many activities of a student such as attending class, listening, taking notes, lab participation, writing, study and research, these are significant difficulties. Limitations in those skills areas may affect the student's abilities for attending class, listening, note taking, lab participation, writing, study and research. Special help is likely to be needed to accomplish the activities of learning, independent study, and research. It is important for the student to establish working relationships with professors which will promote the design and use of creative adaptive strategies.

Approaches by Faculty

With larger classrooms and demanding schedules, professors may wonder how it would be possible to address the specialized learning needs of each individual student. Time for advisement and additional review is limited. Suggestions, which follow, are intended as possibilities for faculty to use when approached by a student who has identified his or her special needs. Suggestions are offered not with the intention of substituting for Special Education type needs. The ideas may be especially helpful to full or part time faculty who do not have training or experience in providing for special needs. The graduate student is expected to take initiative for arranging meetings and to be responsible for implementation of plans. In the course of a semester, the professor might initially meet with the student to review needs, establish a plan (perhaps short bimonthly meetings to determine progress and revised strategies) and finally assess achievement. They may jointly define specific problem areas, goals, and approaches. The faculty member's role is to promote autonomy by facilitating problem solving and to recommend techniques which increase structure and adapted ability.

Adaptive Strategies

The strategies described occur within a four-step process, including task analysis, pre-arrangement, planned performance and appraisal. The more routine and predictable, the greater chance of high performance levels and decreased confusion or fatigue (Cole, 1998). Through practice and repetition, new habits may be developed which increase academic performance (Macdonald, 2000). Any behavior or action has a large cognitive component (Macdonald, 1998). The approaches are presented within the context of enabling the student throughout the spectrum of student occupations. Examples will be provided from course registration through thesis preparation and defense. The interventions are designed as part of a conscious and deliberate system to establish methods and means for success. The suggestions are ways to structure self and organize objects through compensatory techniques.

Task Analysis

Task analysis is a system of evaluating the variables within a person, activity, and environment which may enhance or inhibit actual performance (Watson, 1997). Assessing student strengths and weaknesses are a dominant feature of planning approaches. This includes recognizing personal functional challenges and how they relate to the social and structural environment. For example, if class registration in person or via telephone menu is overwhelming due to difficulty in processing information quickly or in a noisy environment, the student may request a brief personal meeting for assistance in the Registrar's office. Evaluating all aspects of an activity includes determination of the components of activity performance, materials required, and interpersonal requirements (Macdonald 2001, CA). For instance, prior to classes beginning, the student may prepare early at the bookstore with all non-text needs, so that when texts are assigned a portion of purchases has already been completed, in a quieter setting.

Consideration of the physical environment is also important. As an example, physically getting to campus can be cognitively demanding. To access my own university I needed to drive, take a train and subway, and then walk. After establishing a topographical map and procedure to follow step-by-step, careful rests were scheduled. This prevented arriving fatigued and unfocused for a meeting with a faculty member. Developing a familiar map should include noting location of rest areas, rest rooms, and pay telephones. Planning, pacing, and prioritizing are key elements to enhancing ability. Establishing a system for task analysis involves breaking down a task into segments, understanding sequences of steps, and short versus long term aspects. By seeing a project as a series of discrete steps, each piece appears simplified and more manageable. Note taking, for example, requires preparation of materials, careful attention, processing and synthesis, and writing. Follow-up may include re-organizing through outlines, comparison with peers, and highlighting areas for early preparation for study.

Recognizing short and long term aspects of semester requirements is important. The student would benefit from early establishment of the grand scheme for each class and how they interface with other courses. For instance, early in the semester, the student may initiate the design of a filing and organizing system to separate all materials and devise simple access. This may be through separate notebooks and tote bags or via computer methods. For hard copies, color-coding may be helpful, such as all materials for Statistics are in red.

Skills required for studying require careful evaluation of needs. Devising a special study space is essential. Ideally, the place for studying would be distraction free, comfortable, and easy to access. In practice this would mean limited visual or auditory distraction, and a location where one may easily start at work without elaborate preparation. Time required for all aspects of a student's role needs to be carefully assessed. Temporal considerations are many, including juggling all aspects of usual daily living activities with coursework, study and writing, balancing assignments and all other responsibilities that occur on a daily, weekly, and monthly basis. This needs to consider personal highs and lows of ability at different times of the day. Realistic planning is required, for example, time needs to be scheduled on a daily basis to organize and file materials completed from that day and then prepare materials for anticipated needs the next day.

Holistic considerations are important to facilitate maximum cognitive skills. This includes ergonomic issues to reduce physical strain, such as attention to seating, writing devices, and positioning at a computer. Sensory issues are important in the actual classroom setting. For example, to best listen to the professor, ideal seating may be in the front row, away from an open door in order to reduce distraction. Relaxation techniques may be helpful to reduce stress and extend overall daily ability. This may include meditation, stretching exercises, or short rest periods. Task analysis is a conscious process of looking at aspects of the student experience and breaking it down into component parts. The parts are then considered in relation to the learner's cognitive challenges. This serves as a foundation of preparation and then is applied throughout actual activity performance.

Pre-Arrangement

The second step of any actual performance is pre-arrangement. This addresses aspects to consider to promote preparation prior to action. This establishes a framework for more deliberate and prepared "doing." Discussion will include aspects of self-awareness, organizing behaviors, and coordinating assistance. Self-awareness is required for management of cognitive challenges. Self-management is complex and requires ongoing discipline and determination. Cognitive symptoms may vary, reflective of types of activity, time of day, or other influences. Maximizing ability relates to symptom recognition, prevention, and intervention.

Controlling cognitive symptoms may be based on recognizing triggers to "overloading" and decompensation. If fatigued by maximum demands, difficulties with forgetfulness, awareness, focusing, learning, and judgment may occur. These limitations can then further impede attempts at applying known successful strategies. Prevention then, is an important piece of promoting ability. For example, if note taking is a draining activity and interferes with ability for class participation or lab work, a tape recorder may be a helpful substitute. Later, in a quiet environment, and at a more tolerated pace, the student may transcribe.

Establishing a plan for balance is a pre-requisite to ability and activity (Macdonald, 2001 NY). Through this process of anticipating needs for alternative approaches, skills may increase. Pacing is an important means to balance time and energy. By budgeting when activities occur and their frequency and duration, intense cognitive demands are avoided. For example, for written assignments, scheduling should be established so that papers for several courses are not in process concurrently. Because so many strategies are required to enable performance, that process in and of itself may be draining. Motivation may fluctuate. "Backsliding" may occur as a consequence of fatigue, over-confidence when techniques are successful, or as a symptom of forgetfulness or impulsivity. Self-cueing reminders may be helpful to promote the very conscious and deliberate steps of pre-arrangement. This may include reminders by note, "Post-it" tabs, or in a personal organizer to follow necessary steps.

Some time management techniques have been alluded to earlier. Additional strategies include methods to convert any "mental checklists" to visual cues. This serves as a memory prompt and to predict amounts of time needed for activity completion. Schedules and "to do" lists may be divided into daily checklists on a calendar which reflect both routine and special tasks. Other innovations may include devising checklists or charts and tables to map out elements of a project over time. This helps to orient the student to aspects completed, in process, and "still to do." Timelines assist in planning and prioritizing, and are aids in preventing many overlapping activities. With systems to reserve spaces of time, stressful rushing or simultaneous demands may be avoided. Anticipating future time needs also prevents difficult "spur of the moment" actions, which may pose dilemmas.

Project management approaches also help to modify cognitive limitations. These tips are especially useful during library research and written assignments. Concrete suggestions include working in priority sequences and progressing from most to least complex. For the most complicated procedures, a written protocol for "How To" is helpful. With that cue, the student does not need to recall or repeat problem solving for a process such as a specific system of note taking for extensive references. Forms may be devised to track the many responsibilities of a student, including communication with faculty. Repplier (2001) recommends writing "presets", a short script for anticipated activity, which would include description of rationale and specific behaviors. Concrete approaches for organizing includes careful record keeping systems. Because so much material may accumulate during thesis development, easy access is essential. Clear labeling systems with a table of contents with "chunking" of categories is helpful. Alphabetical order or topical categorization may be used. Applied consistently, the student will not waste valuable energy in lengthy "scan and search" time. Task analysis and pre-arrangement are important steps of preparation to promote performance. With much repetition, these preliminary steps become more automatic and over time require less conscious effort. When consistently applied, those compensatory techniques enhance ability for the next step of planned performance.

Planned Performance

Planned performance is the actual involvement in student occupations, including class participation, study, test taking, and research. Performances are deliberate and focused and follow established adaptive sequences and schedules. This includes attention to the needs of each activity, including set-up, performance, and clean up and follow-up.

Attending lecture, for instance, is a single activity reflecting an extensive process. It involves timely personal preparation, travel, and arrival using principles of energy conservation. During lecture, some professors prefer that questions or comments be held until a designated time. To compensate for memory challenges, the student may then keep a separate post-it pad to jot down a question. If placed in the context of the notes, the questions on the post-it notes would also serve as a reminder during later study. Other suggestions during study include promoting predictability through the set up of supplies, and devising protocols for proceeding. Ideally, a space could be left with materials in place from the previous time. A separate file drawer or plastic crate/box may be helpful to designate and store current priority projects. Underlining and highlighting are helpful, with careful discrimination of the major themes and priority supportive explanations.

Organizing study and research time may be best accomplished by fully completing one subject or task before beginning the next. Avoiding multi-tasking may not be altogether possible, but best results are possible when separating content of activity. This helps to focus on manageable portions of projects and eliminates the sense of being flooded with the magnitude of a whole semester. Addressing any tendencies toward procrastination is also important. Tasks left unfinished one day must be added to another day, which may cause a problematic stacking of required duties.

Because of the need to do one thing, one step at a time, extreme care must be taken to manage and preserve ability. A person without a cognitive disability may be able to juggle several tasks simultaneously, such as doing laundry or cooking a meal while involved in preparation for an exam. With a cognitive disability, this may prove too distracting, resulting in an inability to focus. Because of the elaborate pre-thinking steps in place, the student would not need to start each work session with "What do I do now?" When completing a session, a note may be left as a reminder of where activity was ended and what needs to be done next. Beyond checklists and calendars, a dry-erase board may be posted near the work area that clearly states the next priority or special "don't forget" reminders. Carrying a small notepad and keeping one at bedside may be helpful to record "brainstorms" for later use.

Managing symptoms is an important component of actual doing. Because so much reading is required, adaptive equipment may be helpful to promote ability. A variety of magnifiers are available, and excellent lighting is helpful. Using a bookmark or other screening item to isolate for reading one line at a time may prevent challenges with figure ground perception. Earphones or earplugs may reduce extraneous noise.

A final aspect of planned performance involves practice. Before attempting some activities, preparation through writing or actual rehearsals may be helpful. This step helps the student to organize, experience "dry runs," respond to feedback, and increase familiarity with what may occur. For example, preparation for proposal or orals defense may involve outlining of materials to present. Actual rehearsal with peers, family or friends may provide helpful suggestions for improving format or means of delivery. These approaches may also reduce anxiety by increasing awareness of what to expect and providing the opportunity to improve performance before the formal event. Planned performance allows for more capable involvement in all aspects of graduate study. Through the use of self-cueing, visual aids and reminders, organizational techniques, and balancing activities with rest and rehearsal, overall skills may be increased.

Appraisal

The remaining section in the four-step process is appraisal, an assessment of the actual performance. It is a way to objectively critique quality and methods, and to develop revisions while anticipating future needs. What is working effectively? Any needs for change or substitutions? Is extra assistance necessary, or additional skills needed to use available technology? This important step offers the opportunity to creatively modify techniques in use, or to identify problem areas. For example, on especially taxing days, how can symptoms be reduced? Perhaps going to a familiar place for lunch would be indicated to avoid the mental stimulation of a new setting and menu. Are there any outstanding challenges? Is there a balance of scheduling, energy use and rest? Are organizational strategies successful? What new approach may be attempted to decrease any difficulties or increase consistency of success experiences?

Appraisal is an important final step to evaluate the applied adaptive strategies. Through ongoing cycles of identifying need areas, attempting approaches, and creating revisions, the graduate student establishes methods to competently manage all aspects of academic responsibilities.

Summary

Through carefully designed and consistently applied techniques, the graduate student with a cognitive impairment may increase academic performance. Methods include adaptive strategies and faculty assistance and support. Examples of compensatory techniques were provided to match many aspects of the student roles and responsibilities, ranging from note taking to orals defense. Developed as a tool for faculty use, the approaches presented are intended to promote awareness of means to reduce barriers and increase opportunities for graduate students with a cognitive disability.

Acknowledgements

I wish to thank Laurie Wallace, OTR/L and Lois Longwell, LCSW for their expertise in devising strategies to promote function. Appreciation is also extended to Paula Passero, for her assistance in the preparation of this manuscript.

References

Cole, M.B. (1998). Time mastery in business and occupational therapy. Work: A Journal of Prevention, Assessment & Rehabilitation. 10, 119-127

Edgar, E.B. (1978). Learning Disabilities. In R. M. Goldenson, J.R. Dunham, & C.S. Dunham (Eds.), Disability and Rehabilitation Handbook. New York: McGraw-Hill.

Macdonald, K.C. (2001, February). Balancing the demands of personal and professional lives. Paper presented at the Women in Science meeting of the New York Academy of Science on Women in Science: Balancing Acts, New York, NY.

Macdonald, K.C. (2001, February). How do you make a habit of making habit happen? Poster session presented at Understanding Habits in Context Conference for the American Occupational Therapy foundation, Pacific Grove, CA.

Macdonald, K.C. (2000). Experiences of five women adapting to physical disability. The Israel Journal of Occupational Therapy, 9 (2-31), 39-62.

Macdonald, K.C. (1998). Adaptation to physical disability: The experiences of five women aged fifty to sixty. Unpublished doctoral dissertation, New York University.

Repplier, A.D. (2001). Cognitive--Behavior psychotherapy: Intervention approaches for mild brain injury. TBI Challenge, 4 (6), 8-10.

Watson, D.E. (1997). Task analysis: An occupational performance approach. Bethesda, MD: American Occupational Therapy Association.

Wilson, J.U. (2001). Addressing executive functions following TBI. OT Practice, 6 (3), 10-13.

Macdonald is a lecturer at Housatonic Community College. She received a doctorate in Occupational Therapy from New York University, where she studies adaptation to adult onset of physical disability. While continuing to recover from traumatic brain injury, she is involved in writing and lecturing.
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Author:Macdonald, Karen Crane
Publication:Academic Exchange Quarterly
Geographic Code:1USA
Date:Jun 22, 2002
Words:3213
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