Retrieval of Visual Episodic Memory as a Skill Goal: Part 4

Previously we have discussed Literacy and the connection or disconnection to speech in part 1.
In Part 2 we discussed Communication and Education with RPM and the letter board.
In Part 3 we discussed generalizing skills to other modalities than the letter board itself. 
In Part 4 we discuss retrieval of episodic memory.

I would like to thanks Sue Finnes for helping to edit and give advice on this blog post. Thanks for your time, talent and insight Sue! You can see some of her and the rest of the Unlocking Voices Team's work and help here.

What is Episodic Memory?

This is our memory of ‘episodes’ or events.
In a typical RPM session we avoid questions about episodic memory because it often tends not to be reliable. In chapter 8 of ("the green book") "Developing Communication for Autism Using Rapid Prompting Method: Guide for Effective Language" Soma discusses how memory is formed and what topics are reliable in RPM to discuss. You can obtain your own copy of it here or here.
 
As a parent or teacher you want to know reliably what has happened to your child when you weren't around. Each child will be different in what they are able to express about the past. Some are very accurate and some are completely inaccurate. When students spell inaccurate things for parents or teachers (where the person holding the board has no knowledge of the situation) people will question if the student is the one spelling, and if RPM is valid. 

Why do our students have difficulty with episodic memory?

​The student may have retrieval difficulties or an alternate way of processing the world around them. Soma has written in her books about the altered sensory development – meaning that our students may see things differently, may hear things differently, may feel things differently, may smell and taste things differently— all these factors will affect how they remember an event. A great example of this is when Soma took Tito to a place where the room was dominated by a grand piano – yet when she asked him about it afterwards he could not recollect seeing it – she asked what he did see and he replied that he could only see the smell of strong onions. As a school teacher,  my student would tell me something that happened at home (an event) and, when appropriate to check, I found out they were right often, but I also realized that some of what they said wasn't right--sometimes connected to an emotion and sometimes plain incorrect. 
 
When you do RPM, typically you are there with the student learning and teaching together. If the students starts going off track you bring them back, but when you are not there experiencing together, no one is there to bring back the focus or catch the student getting off track - this leads to different encoding and mental mapping. (You can read about mental mapping in chapter 8 of “Understanding Autism Through Rapid Prompting Method).

Picture Example: A student may look at a picture ‘globally’  without really seeing any detail or look at it ‘selectively’ taking in only one aspect and discarding the rest. If he or she felt pressure, it is possible will make something up and the selective student may not have even seen the whole picture. 

Example- Transferring to devices, handwriting or speech: Another example of this difficulty is shown when you have your student transfer letter board skills to handwriting, the keyboard, or speech. Your child will touch say 't' then 'h.' Then you remove the letter board. Your student initially may only write the 'h' or only write the 't.' You are able to 'see' the information 'drop.' When you represent the letter board to refresh the mind the student is easily able to go and select each letter again. In this case you have a visual (letter board) and kinesthetic reminder (student' movement) and sometimes auditory (teacher says the letters after the student touches the letter) that assist with retrieval. With time the student develops confidence and the retrieval skills necessary to be able to write, type or speak without the use of the letter board. 

Why can my student tell me things accurately when I know about them?

My thought is a) you were part of the environment so you were encoded into the situation--therefore you trigger the retrieval. b) You are competent in the topic as well and we all do better when people are competent in what we are talking about...in Autism it is more extreme.---For example a doctor is usually more helpful if he can see you have studied up on the health issue. This isn't necessarily he or she trying to be rude, but just that we have a hard time discussing certain issues if someone is not familiar with them. c) If you were in the situation you may have helped your child to focus on different aspects. d) Influence is possible if the board work was poor, but frequently is not the reason.
 
You will notice as time goes on and as you discuss things that your child sees the world differently and therefore retrieves differently. Many parents have reported their child interpreting events differently because of this issue.

Why is it important NOT to 'push' for information?

​I have found that if my student brings something else of their own accord the information is much more often accurate information. But if you fish for specifics and details--then the information is less accurate. So don't pressure things out. If the child says, "I don't know." Take it. If the child says, "no" to if something hurts, take it. Don't pressure, because what can your child do but make up an answer. 
If you put the student on the spot and they get anxious they are more likely to look for cues from you. In those cases if your board work is poor or you are gesturing during open ended communication, then influence is possible. 

How to work on this as a skill

​ DO NOT TEST YOUR CHILD. Retrieval is a skill goal--NOT a way for your child to PROVE themselves. We are dealing with a population that has more anxiety than the typical population. We are also dealing with a sensitive matter.
Let's perspective take. Imagine that everything you say is questioned. Imagine people not thinking you have the mental capacity to understand and reason except at a low level. Now imagine people running a test to see if you really are smart and really are the one communicating. Now imagine this with anxiety and alternate processing with a pendulum of emotions swinging back and forth. Now imagine that if you don't pass these tests people will cut off the learning, the communication, the progress. For some this would be UTTERLY HORRIFYING.
So work on these skills only when your child or student is proficient at spelling with you in open ended communication, with the child's permission, a clear explanation of what you are doing and why and BELIEF- belief that your child or student will progress here...
 
 
There are many ways to work on episodic memory retrieval. Here are some ideas:

• You can snap photographs wherever you go and then discuss them with your child after the event. You can review these photographs
• You can go into a room together and teach your child to scan it. Then leave the room and compare notes on what you saw.
• You can send your child to a place with someone in your family. When they come back ask them what they saw and heard. If you have any questions, I suggest that you go back to the location (so pick a location that you can do that) and check for details you may have missed but your child didn't
• You can discuss what happened while you were gone. (I would not involve the school or people that would doubt your child if they said something ‘wrong’)
• Soma mentioned to me that she would put numbers upside down on the floor for Tito to pick up, look at, place down without Soma seeing and then write the number. Numbers were easiest. So you might start there.
• I suggest making a game out of it. See the above, were a bit formal. This isn't wrong, but making a game can be a great way to learn. Try different things is the idea.

 
 
In RPM we are teachers so we TEACH while also respecting the student’s alternate perspective. Alternate doesn't mean 'fail'. We may see the world differently, the teachers view is not better than the students, but we can teach the student how the majority of the world might focus.

Visual scanning and retrieval skills – working with Matteo

​The notes which follow show how I have worked on visual scanning and retrieval skills using pictures with Matteo and more ideas for different learners. Please note that Matteo took very fast to open ended communication from day one and he has good skills in all areas. Matteo's home is very believing and accepting...there is hardly a better environment for success then there. If you TEACH in a home environment to retrieve, particularly one in which there is belief, then you can make progress. Matteo made great gains as he was TAUGHT and as he practiced. He had to encode different information and generalize previous skills learned to new situations.  
 I really appreciate his willingness to help and to be filmed...he is putting himself out there.
Each child has a ‘letterboard clock,’ meaning each child will come at his or her own rate -we can call the time take to master this skill a ‘retrieval skills clock.’
 
You will need to teach :
  
 1. HOW to and WHAT to scan
 
2. HOW to and WHAT to retrieve (so description is accurate to others)
 
You will see from some of the videos that I was developing how to teach this as I went. I didn't know all the ways to do it, so I learned. I hope you will benefit from seeing my mistakes and what I should have done better.

​1. How and what to scan
 
Some of your children are very auditory and do not visually scan well at all...okay so your child will take more work to help them to scan. Begin by working on this as a skill by doing picture reading lessons - You can learn more about picture lessons from chapter 6 of "the green book."
 
I suggest the following both doing it together and doing these activities when you are not looking at the same thing. That helps you see the progress your child is making when you are not aware of what he or she is seeing.
 
Ways to teach scanning:
            -start by looking are pictures with little in them to build up the visual and scanning tolerance (start with just showing a number and ask your child to spell out what number it is, or a playing card and ask for the color, number and suite. You might have your child look at the card, put the card down, ask for the number, then have the child look at the card again, put it face down and ask for the color, etc-- this way you build up the tolerance, success and memory for the ask--critical for auditory learners)**(SEE ADDENDUM FOR MORE SUCCESS)
            -teach your child to use his/her finger to help the student visually track and scan the picture. (Some will get caught looking at the finger so help the student look past the finger to the picture.)
            -Some students you will have to encourage to look by gently helping them bend their head or holding the pictures up, using gestures (pointing towards areas of the picture) and auditory prompts (look up in the corner, now look across the picture, now in the right corner, what do you see there, now let’s look at the center of the picture. See that figure over there? What is he doing? Look at the lines on his face) kinesthetic/visual prompts (shake the picture to bring the student’s attention to the picture.)
            -help the child look for colors (use the prompts above)
            -look for main objects (use the prompts above)
            -main idea of the picture (use the prompts above)
 
If you are not sure how your child scans, on your first run you can check that out, by simply having your child look at the picture and then asking what is in it.
Another way (we will discuss more in future post) is playing a game of “I spy.” In this game you will not know what your child is describing  until you or another guesses it right and it is a natural way to work on scanning. But if you play long enough you will start to see where your student’s eyes tend to be and more specifically what he or she selects and discards. (This will be discussed in a blog post on social skills or activities).
 
After your child has scanned a picture and tells you what he or she has seen then you can highlight to the student what you saw in the picture to help him or her understand what to look at.
 
2. How and what to retrieve
 
We retrieve by scanning well and comprehending what we scan. You can ask the main idea of the picture, what it was about, what colors were seen (Matteo’s family found that helpful), what shapes. Then when your student is finished telling you, again you go back and teach what is most important to retrieve. Sometimes labeling pictures with written words as you scan can help with retrieval as well. This could be particularly important if the child is non-verbal and can’t verbally prompt themselves with the words they can say.
 
Relate the picture to the student. Discuss the picture. Ask the student opinions and what emotions does the picture produce in the student. Have the student reason about the picture and apply the picture to his or her own life.
 
Important to note is that pictures are static visual images.  Static images are easier to handle then the 3D moving environment as it is smaller and easier to go back to remember. Taking pictures of places you go to and events, and then talking with your child about them when you get home, can help fill in the gasps. This is what Soma did with Tito to work on retrieval and fill in the holes about past events.

Assessing current visual retrieval skill level

 
I show Matteo a photo in a magazine that I haven't seen. I explain to him that this task is hard for everyone. I have him look at it – to scan the while picture - and then I ask him to tell me what he saw. He spells IT HAS A MAN IN IT. Then I let him look at it again. (Remember this is his first time. I don't want to overwhelm.) He spells ‘IN THE DIRT HE IS’. I looked at the picture and saw that there was a man, some dirt but more grass. So his facts are correct, but there are many key elements not mentioned.

Helping him to understand how other people may see a picture

I look at the picture with him and talk about all the things I can see – so he begins to understand the level of detail required. His mother tells him that he should ‘paint a picture’ for someone who hasn't seen it.
 
We do two more where I ask him what he saw.  If I felt he was getting anxious I let him look at the picture – I don’t want him to become frustrated.
 
His mom suggested we do it with face (playing) cards. I held it up and then put it down and asked. He had to name the number, suite, and color. He did the same whether I saw the card or not...usually 2 out of the 3 were correct.
 
The following videos are taken 2 months later after he had been practicing with his Mom and his helpers. 

Video 1 – joint scanning and retrieval

In this first picture Matteo and I scan it together. We have a joint experience. I make sure he scans the whole thing, using his finger. He labels the different things he sees verbally. He has been working on the skill of ‘how and what to scan’.
Then I turn it over and ask him to tell me everything he saw in the picture (the retrieval skill).
 
IT HAD GRASS IN THE BACKGROUND. THE HORSE WAS BROWN. THE CARRIAGE BLACK. ON THE GROUND WAS STREET. 
Then I ask him what was happening in the picture: THE HORSE WAS NOT MOVING BUT STANDING-- IN THE FRONT ATTACHED.
Lenae’s memory : I remembered the horse moving and a man in the carriage. I also remembered the horse had a harness.
At the end I have him look at the man in the back to help him attend to more details and point out he is moving.

Video 2: Scanning without assistance and retrieval – where I have seen the picture

In this video we look at the picture together but I do not help him scan it. When we turn it over so he can't see it, he spells:
IT IS A GLOB OF BALLOONS. IN THE CENTER IS WHITE WITH NOTHING ON IT. THERE IS GREEN, BLUE, PURPLE AND WHITE. IT HAD 'HAPPY BIRTHDAY' ON IT.
Lenae’s memory : That the center was green not white, that there was also red, yellow, and orange balloon.
As you see we have a different perspective. I see a different center than he does. I don't know why he skipped the warm colors other than perhaps they were the last things he said and this is likely getting tedious. Notice that I correct that the bottom is white and not the center. I believe I could have done better and said, ‘oh, I see green as the center. We have a different viewpoint.’

Video 3: Scanning without assistance and retrieval – where I have not seen the picture

In this one I didn't see the picture before he looked at it. I saw it after he wrote everything. However, as I admit in the video I thought I might have seen the rings (what he didn't really mention) reflecting in the two way mirror...all I saw was there were vaguely the Olympic rings and possibly a blue background. 
Listen to him as he scans. He verbalizes. He says "white cow"...notice that 'cow' and 'cloud' are similar sounding. He spells: IT WAS OF WHITE COWS AND GREEN LEAVES. THE WHITE CLOUDS AND BLUE SKY ARE NOT THAT NICE. I ENJOYED IT. Anything else? NO JUST COLORS LIKE RED, YELLOW AND BLUE
 
Notice that his visual focus is the background...My focus would be the Olympic rings. He was correct. Had I been observing and scanning with him, 'cow' likely would not have come out and the rings may have been mentioned as I would have brought his attention to it.
 
I was a bit shocked as you can see...to see no cows in the picture, I would have done better to include him in the follow up conversation sooner as I view myself as a bit rude here,  to ask him to show me the cows and acknowledge to him that yes the cloud may look like a cow. In this instance, in hindsight, in order to help him in the future with description writing, and to avoid confusion to others, I would suggest that he could have said ‘clouds which look like cows’. I may have also explored what he meant by ‘are not that nice’ – ask him to expand on that. I am learning that I need to help him with the skill of accurately describing what he sees so that others will agree – so it’s necessary to separate his opinion about the picture from what the picture actually shows.   

Video 4: Scanning without assistance and retrieval – where I have not seen the picture – but student is getting tired

By now he is tired. I decided to show you because this video teaches a lot. When we are tired we encode differently and in his case his accuracy goes down. He still gets some things right but again because I am not aware of what he is doing then I am not able to help him focus and he is a bit visually exhausted so he isn't scanning as much.
At first he spells IT IS OF THE WHITE SKY – NOT SURE I GET IT. So I let him look at the picture again, encouraging him to lift his finger up to scan the picture, he spells: IT IS OF A DRAWER THAT IS WHITE. IT HAS A BLUE LAMP. IT IS A ROUND TABLE AND GREEN ON IT. I AM SURE IT IS NICE. I CAN'T REMEMBER MUCH.
So you can see that he mixes a few colors up. When I asked about the green table which he also mentioned verbally but which you can see isn't there he pointed to the knobs on the drawers...so possibly the knobs triggered a memory and then the colors and verbal words and tiredness produced those results. He knows what a table is. Most likely his verbal got the better of him. 
 
As you can see the JOINT ATTENTION on the TASK AT HAND is critical in RPM. In a typical RPM session the teacher should look at the work with the student. Here we are practicing a skill so it is different, but as you can see it is easy to articulate incorrect facts-that is not just for him but for all of us. Clearly he is processing and spelling. Clearly he is getting better at the visual retrieval skill, but it takes practice.

Summary: key points for teaching scanning and retrieval skills ​

1. Start with very simple pictures- particularly for auditory learners. Teach the child how to scan. Have the student look at the picture, place the picture upside down and ask for one piece of information. Bring the picture back to view. Then place flat and ask for one more piece of information.

2. Teach the scanning skill – by looking at things jointly. Begin in RPM sessions looking at pictures – tell me 3 things you see in the picture. Take the students finger and guide it round the picture – if non-verbal pause and ask him to point on the letterboard after each item , then gradually increase the amount of time looking and discussing pictures. Lay the picture flat inside down and ask for recall.
 
3.  Discuss the content of the picture. Ask for opinions, emotions, and reasoning. Bring out your own point of view in the process for the student to see and understand as well.
 
4.  Do these task both when you are looking jointly at a picture and when you are not.
 
 Of course episodic memory involves more than just what you see – also what you hear, feel, smell, do, etc. Again these are skills we can work on – I’ll post more ideas in my next post.

ADDENDUM:
When starting you may need to give choices. So for example you might write down two choices (say 3 and 6) then on a separate piece of paper write 3 and 6. Randomly select the number you want to show the child (don't look at it after the first few runs, but at first go ahead to help bridge the gap between independent scanning and joint scanning. Then ask the student which number they are looking at. Slowly build up to 3 choices, then 4 and then all numbers 0 to 9 showing. You can do the same with showing a color. So basically you are going back to beginning steps of RPM to help the child encode how to independently retrieve and scan when there is not joint attention.
The other idea is go directly to showing a full picture and asking for anything they see whether it be colors, objects etc. You might show a whole picture with all colors on it and ask the student to tell you one color. This way the student starts with immediate success and becomes confident leading to a better experience.
Some students get anxious very very easily and it isn't encouraging to 'fail.' So at first, particularly with very auditory students, you need to scaffold the retrieval and scanning very well to build the confidence as many student will be retrieving correctly but be so anxious (yes, even in a believing environment) that they miss things they actually are seeing and know. I have had this happen with students who spelled to me a paragraph of information I had no idea about and it was true.