Nonverbal Problem Solving Research Articles

Communication and Emotional Vocabulary; Relevance for Mental Health Among School-Age Youths.

BackgroundThe association between language and mental health may be connected to several aspects of language. Based on the known associations, emotional vocabulary could be an important contribution to mental health and act as a risk, protective or resilience factor for mental health in general. As a preliminary test of this hypothesis, an assessment of emotional vocabulary was constructed and used among youths in school age. Cross-sectional associations and prediction models with parent-reported youth mental health as outcome were examined for emotional vocabulary as well as general vocabulary, non-verbal problem solving and social communication, controlled for age, gender and subsamples.ResultsEmotional vocabulary, general vocabulary and non-verbal problem solving were directly associated with each other and similarly associated with age and gender. However, they were not significantly associated with social communication skills or mental health in the expected direction. Only social communication skills showed significant negative associations with behavioral mental health problems, suggesting these skills to be potential resources related to mental health.ImplicationFuture research should investigate whether behavioral problems may be prevented or improved by developing better social communication skills among community school-age youths. However, our results suggest that merely expanding emotional vocabulary is not likely to produce such effects unless this is integrated with improving social communication.

A-053 Importance of Neuropsychological Assessment in a Patient with DiGeorge Syndrome

Abstract Objective 22q11.2 Deletion Syndrome, (DiGeorge Syndrome), is a genetic disorder which commonly causes heart defects, a submucosal cleft palate, and other health conditions, in addition to developmental delays. Individuals with DiGeorge Syndrome are more likely to have Attention-Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), with research also supporting a high risk for developing schizophrenia in adulthood. Method In this case study, a 22-year-old woman presented with DiGeorge Syndrome and trunkus arteriosus at the Department of Human Services (DHS) for employment services. Additionally, the patient’s parents reported concerns about behavioral outbursts and emotional regulation difficulties for the last three years. The patient completed a full neuropsychological, cognitive, and emotional assessment battery to help understand any neurocognitive and psychological limitations in obtaining and maintaining employment. Results On neurocognitive testing, she performed in the Severely Impaired range on measures of attention, processing speed, working memory, verbal memory, visual memory, visuospatial ability, motor functioning, and nonverbal problem solving. While performing in the Moderately Impaired range for tactile memory, verbal fluency, and cognitive flexibility. However, the patient exhibited a personal strength on the Verbal Comprehension Index of the Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV). On emotional functioning testing, she did not display early signs of schizophrenia nor psychosis. However, the patient did express emotional and behavioral signs of ADHD and ASD. Conclusion This case study emphasizes the need for neuropsychological testing and ongoing psychological monitoring for individuals with DiGeorge Syndrome, as it relates to treatment recommendations and planning.

Enhancing visuospatial skills in second graders: An exploratory follow‐up study

AbstractThis study was intended to assess the effect of a psychoeducational computer‐assisted and paper‐and‐pencil training designed to empower visuospatial skills in students attending the second grade of the primary school. At pretest, posttest and at the subsequent 3‐months follow‐up, 44 Italian second graders were presented with a battery of tests assessing nonverbal problem solving, imagery, speed of processing, visuomotor coordination, and verbal working memory. After pretest, 22 pupils were trained by the psychoeducational intervention for 15 weekly sessions (Fastame & Antonini (2011). RECUPERO IN… abilità visuo‐spaziali [Recovery in… visuo‐spatial abilities]. Trento, Italy: Edizioni Erickson). Posttest scores and a follow‐up assessment conducted after 3 months by the end of the training documented the positive effect of the psychoeducational intervention in enhancing visuospatial functions of the experimental group. These outcomes were also replicated when a questionnaire assessing visuospatial efficacy was proposed to the teachers of the participants.

Demographic, psychological, behavioral, and cognitive correlates of BMI in youth: Findings from the Adolescent Brain Cognitive Development (ABCD) study.

Previous research has implicated demographic, psychological, behavioral, and cognitive variables in the onset and maintenance of pediatric overweight/obesity. No adequately-powered study has simultaneously modeled these variables to assess their relative associations with body mass index (BMI; kg/m2) in a nationally representative sample of youth. Multiple machine learning regression approaches were employed to estimate the relative importance of 43 demographic, psychological, behavioral, and cognitive variables previously associated with BMI in youth to elucidate the associations of both fixed (e.g. demographics) and potentially modifiable (e.g. psychological/behavioral) variables with BMI in a diverse representative sample of youth. The primary analyses consisted of 9-10 year olds divided into a training (n = 2724) and test (n = 1123) sets. Secondary analyses were conducted by sex, ethnicity, and race. The full sample model captured 12% of the variance in both the training and test sets, suggesting good generalizability. Stimulant medications and demographic factors were most strongly associated with BMI. Lower attention problems and matrix reasoning (i.e. nonverbal abstract problem solving and inductive reasoning) and higher social problems and screen time were robust positive correlates in the primary analyses and in analyses separated by sex. Beyond demographics and stimulant use, this study highlights abstract reasoning as an important cognitive variable and reaffirms social problems and screen time as significant correlates of BMI and as modifiable therapeutic targets. Prospective data are needed to understand the predictive power of these variables for BMI gain.

Parent-reported executive functioning in young children treated for cancer

ABSTRACTIt is well known that children treated for cancer are at risk for cognitive and functional impairments. Such research is largely based on studies of late effects in school-aged or older children. However, far less is known about executive function weaknesses in preschool-aged children treated for cancer. Thus, the aim of this study was to examine executive functioning in a clinically referred sample of young oncology patients, and its association with broader domains of functioning. Data from 61 young children with cancer, who were referred for clinical cognitive evaluations, were abstracted and included in this study. Patients were 5.00 years of age (SD = 0.72) at assessment, 54.1% male, and two-thirds (63.9%) had been treated for brain tumors. Most executive functions were significantly discrepant from the mean, with 47.5% of preschoolers having parent-reported working memory concerns within the clinically significant range. There were no differences in executive functioning based on diagnosis or treatment status. Parent-reported executive functioning was strongly correlated with global intelligence and adaptive functioning, with some indices also associated with nonverbal problem solving and pre-academic skills. Ultimately, results indicate the presence of emerging weaknesses in executive functioning in young children with cancer, and add to a growing body of literature highlighting the potential cognitive and behavioral risks associated with a cancer diagnosis in early childhood.

Poststroke Post-Traumatic Stress Disorder: A Review.

Despite a recent decline in mortality,1 cerebrovascular disease (stroke) remains the fifth leading cause of death in the United States and the leading preventable cause of disability.2 Furthermore, quality of life (QOL) after stroke depends on more than retention of physical functioning and ability.3 Psychological health and well-being are known to associate with QOL outcomes,4 for example, an estimated 30% of stroke survivors develop depression.5 Although poststroke depression (PSD) is a well-researched and established phenomenon,6–8 far less is known about the development of poststroke post-traumatic stress disorder (PTSD).9 Researchers have hypothesized that acute medical conditions such as asthma attack10 and myocardial infarction11 can precipitate PTSD, but PTSD specifically after a stroke has only been formally conceptualized for <2 decades.12 Despite the relative paucity of research on post-stroke PTSD, this article attempts to consolidate what is currently known: elaborating on the construct of poststroke PTSD, weighing the conflicting prevalence reports in the literature, exploring identified or hypothesized pre-morbid and post-morbid predicting factors, and summarizing promising future directions for research. Identifying gaps or conflicting findings may facilitate future studies to identify risk factors for poststroke PTSD and establish a more efficacious management strategy. Stroke is one of the leading causes of disability in adults.2 With estimated prevalence rates of 20% to 65%, depression is a pervasive consequence of stroke that has been linked to cognitive deficits including memory, nonverbal problem solving, attention, and psychomotor speed.13 Likewise, depressive symptoms experienced up to 12 months after hospitalization for subarachnoid hemorrhage (SAH) are tightly associated with QOL, more so than both demographic variables and hemorrhage severity.14 But PSD is not the only mental health outcome that may follow stroke; poststroke PTSD has similarly been shown to impact mental health and …

Examining Durability and Generalization Following Lexical Retrieval Treatment in an Individual with Semantic Variant of Primary Progressive Aphasia

Event Abstract Back to Event Examining Durability and Generalization Following Lexical Retrieval Treatment in an Individual with Semantic Variant of Primary Progressive Aphasia Kindle Rising1* and Pelagie M. Beeson1 1 University of Arizona, Speech, Language and Hearing Sciences, United States Introduction: The Semantic Variant of Primary Progressive Aphasia (PPAsv) is characterized by marked anomia, even in the earliest stages of the disease1. Despite the progressive nature of the disorder, there is evidence that lexical retrieval may improve following behavioral treatment2-4. Most approaches focus on stimulation treatment targeting specific lexical items (e.g., verbal repetition paired with written words), but outcomes are typically item specific with limited generalization, and maintenance has not been well characterized2-4. Treatment approaches that attempt to engage relatively spared cognitive processes (phonology, orthography, episodic memory) in addition to maximizing residual semantic abilities may contribute to better generalization and durability2-5. Henry and colleagues (2013)5 described one such approach, which contributed to positive treatment outcomes and generalization in an individual with PPAsv. Additional treatment was conducted with this individual two years after the first course of therapy. Here we report response to treatment at each time point, and describe performance following various intervals without treatment. Method: SV was a 60-year-old man who described increased word finding difficulties over a 1.5-year period. Comprehensive assessment revealed relatively isolated language impairment characterized by severely impaired lexical retrieval. Performance on semantic tasks was significantly below the normal range. An MRI revealed notable atrophy of the left anterior temporal lobe, consistent with PPAsv. SV participated in a two-phase lexical retrieval treatment: The Arizona Lexical Retrieval Cascade and Generative Naming Treatment5. Treatment included self-cueing for naming by engaging residual cognitive processes and further training these strategies in the context of generative naming for semantic categories (e.g., tools, animals). Direct treatment effects and generalization to untrained tasks were documented immediately following each phase, at one and four months following the initial treatment, and again two years later. At that time, SV received a second “dose” of the two-phase lexical retrieval treatment. Outcomes were documented immediately following this second round of treatment and 6-months later. Results: As depicted in Figure 1a & b, SV demonstrated notable gains following the first course of treatment, and maintained performance on treatment tasks for four months. Two years later, performance on trained tasks declined, but did not fall below baseline. SV’s response to the second course of treatment was equally robust, but performance declined slightly after six months. After each round of treatment, SV showed generalized improvement on untrained lexical retrieval tasks, and maintenance up to at least four months. Measures of non-verbal problem solving and general cognition remained relatively unchanged over time (Figure 1c). Conclusions: These findings suggest that ongoing rehabilitation for PPAsv can be beneficial, even as the disease progresses. The optimal length of time between treatment periods is not clear, but SV’s performance indicates that an interval between 6-months and two years should be considered. This case adds to the growing literature suggesting that lexical retrieval treatment capitalizing on strategic use of residual cognitive processes may contribute to generalization, and items trained using this approach may be relatively durable in the face of progressive language decline. Figure 1 Acknowledgements This work was supported by NIH/NIDCD grant R01DC007646.

The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders

ObjectiveTo determine the relationship of motor skills and adaptive behavior skills in young children with autism. DesignA multiple regression analysis tested the relationship of motor skills on the adaptive behavior composite, daily living, adaptive social and adaptive communicative skills holding constant age, non-verbal problem solving, and calibrated autism severity. SettingMajority of the data collected took place in an autism clinic. ParticipantsA cohort of 233 young children with ASD (n=172), PDD-NOS (n=22) and non-ASD (developmental delay, n=39) between the ages of 14–49 months were recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of scores indicted through calibrated autism severity. InterventionsNot applicable. Main outcome measuresThe primary outcome measures in this study were adaptive behavior skills. ResultsFine motor skills significantly predicted all adaptive behavior skills (p<0.01). Gross motor skills were predictive of daily living skills (p<0.05). Children with weaker motor skills displayed greater deficits in adaptive behavior skills. ConclusionsThe fine and gross motor skills are significantly related to adaptive behavior skills in young children with autism spectrum disorder. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.

A Virtual Reality Test for the Identification of Memory Strengths of Dyslexic Students in Higher Education

Research suggests that Virtual Reality has a key role in the development of new diagnostic tools in neuropsychology and shows great rehabilitative potentials for individuals with specific neurological, intellectual and cognitive disabilities. In the case of dyslexia, a neurodevelopmental reading disorder, the use of Virtual Reality technologies has only been recently documented in a handful of studies. The main focus of these studies has been the identification of visuospatial strengths, the exploration of nonverbal problem solving treatment and the increase of awareness in educators and parents with children with dyslexia. Even fewer are the studies of Virtual Reality and the lifelong memory difficulties of adult individuals with dyslexia. With a more clinical, rather than technological, perspective the goal of this paper was to design specialized tasks in virtual environments to be part of a screening process/assessment of characteristic memory difficulties for undergraduate students diagnosed with dyslexia. Results showed that there were no statistically significant differences in the performance of students with dyslexia and students without dyslexia, a finding which highlights the development and successful use of compensatory memory strategies by the participants with dyslexia. Taking into consideration the real life representations, the multisensory approach, the increased sense of presence, the well-designed tasks and the recorded positive attitude of all participants, the study concludes that the use of Virtual Reality in neurological and neurodevelopmental memory disorders will be innovative and suggests that hands on Virtual Reality applications, become an indispensable part of these deficits' cognitive assessment and rehabilitation.

Enzyme Replacement is Associated with Better Cognitive Outcomes after Transplant in Hurler Syndrome

To investigate whether intravenous enzyme replacement therapy (ERT) benefits cognitive function in patients with mucopolysaccharidosis type IH (Hurler syndrome) undergoing hematopoietic cell transplantation (HCT). Data were obtained for 9 children treated with HCT + ERT (ERT group) and 10 children treated with HCT only (no-ERT group) from neuropsychologic evaluations before HCT and at 1-year and 2-year post-HCT follow-up. At 2 years after HCT, children in the ERT group lost 9.19 fewer IQ points per year compared with children in the no-ERT group (P = .031). Furthermore, the ERT group improved in nonverbal problem solving and processing, whereas the no-ERT group declined, resulting in a difference of 9.44 points per year between the 2 groups (P < .001). ERT in association with HCT enhances cognitive outcomes, providing new evidence that ERT is a valuable addition to the standard transplantation protocol. Although the mechanism responsible for this improved outcome is unknown, both direct benefits and indirect effects must be considered.

Nitric-Oxide Supplementation for Treatment of Long-Term Complications in Argininosuccinic Aciduria

Argininosuccinate lyase (ASL) is required for the synthesis and channeling of L-arginine to nitric oxide synthase (NOS) for nitric oxide (NO) production. Congenital ASL deficiency causes argininosuccinic aciduria (ASA), the second most common urea-cycle disorder, and leads to deficiency of both ureagenesis and NO production. Subjects with ASA have been reported to develop long-term complications such as hypertension and neurocognitive deficits despite early initiation of therapy and the absence of documented hyperammonemia. In order to distinguish the relative contributions of the hepatic urea-cycle defect from those of the NO deficiency to the phenotype, we performed liver-directed gene therapy in a mouse model of ASA. Whereas the gene therapy corrected the ureagenesis defect, the systemic hypertension in mice could be corrected by treatment with an exogenous NO source. In an ASA subject with severe hypertension refractory to antihypertensive medications, monotherapy with NO supplements resulted in the long-term control of hypertension and a decrease in cardiac hypertrophy. In addition, the NO therapy was associated with an improvement in some neuropsychological parameters pertaining to verbal memory and nonverbal problem solving. Our data show that ASA, in addition to being a classical urea-cycle disorder, is also a model of congenital human NO deficiency and that ASA subjects could potentially benefit from NO supplementation. Hence, NO supplementation should be investigated for the long-term treatment of this condition.

Cognitive and developmental influences in visual-motor integration skills in young children.

Measures of visual-motor integration skills continue to be widely used in psychological assessments with children. However, the construct validity of many visual-motor integration measures remains unclear. In this study, we investigated the relative contributions of maturation and cognitive skills to the development of visual-motor integration skills in young children (N = 856). We used a block regression analysis to determine the contribution of maturation, as indicated by age, followed by broad cognitive factors (Study 1) and subsequently by individual subtests in verbal and nonverbal domains subsumed under each factor (Study 2) in explaining score variance of the Bender Visual-Motor Gestalt Test (2nd ed.; BG-II; Brannigan & Decker, 2003) Copy and Recall scores in children between the ages of 4 and 7 years. Results confirm that maturation accounted for a large proportion of variance in both BG-II Copy and Recall performance, above which Stanford-Binet Intelligence Scale (5th ed.; SB-5; Roid, 2003) Quantitative Reasoning and Fluid Reasoning factors significantly contributed to visual-motor integration performance for the Copy phase, and SB-5 Quantitative Reasoning and Visual-Spatial factors accounted for a significant amount of variance for the Recall phase. Additionally, nonverbal domains were more related to visual-motor performance than verbal domains. Results from this study are interpreted to suggest nonverbal reasoning and visual-spatial attention are important contributing factors to visual-motor integration, as measured by the BG-II. Developmental implications of visual-motor integration skills, nonverbal problem solving, and mathematical competence are discussed.

Implementing a Brief Exam to Identify Frontotemporal disease-associated Deficits in ALS Patients

Flaherty-Craig completed her doctorate in clinical neuropsychology with thesis research focused on executive functioning in temporal lobe epilepsy at the Union Institute and University in 1998. After her clinical fellowship in Neurorehabilitation at the Penn State University Hospital Rehabilitation Center as a post doctorate, she joined the faculty of Neurology in 2003, where she continues to pursue a multifaceted across-the-lifespan research program including pediatric oncology, developmental disorders and frontotemporal disease (FTD). Her dementia studies have resulted in the development of a published brief exam (2006) for detection of the FTD prodrome. A refinement of this approach, published in 2009, allowed for the identification of the three subtypes of the FTD prodrome upon completion of a 20 min brief exam. This exam is now being applied to a multi-center study involving 14 ALS Multidisciplinary Clinics across the United States. Recently published (2011) validation studies have related the FTD cognitive prodrome to difficulties with both verbal and nonverbal problem solving, accompanied by loss of insight. It is expected that this work will lead to the development of innovative remediation approaches to compensate for deterioration in judgment capacities in a broad spectrum of conditions that affect the frontal lobe, from developmental disorders to emerging FTD. Areas of impact are expected to include treatment compliance, safety and quality of life with respect to both the affected individual and caregivers.

Motor skills of toddlers with autism spectrum disorders.

With increased interest in the early diagnosis and treatment of children with autism spectrum disorders (ASD), more attention has been called to the motor skills of very young children with ASD. This study describes the gross and fine motor skills of a cross-sectional group of 162 children with ASD between the ages of 12 and 36 months, as well as a subset of 58 children followed longitudinally. Gross motor and fine motor age equivalent scores were obtained for all children. A 'motor difference' variable was calculated for each child's gross and fine motor skills by taking the absolute difference of the children's age equivalent motor score and their respective chronological age. In Study 1 (the cross-sectional analysis), ANCOVA (co-varied for nonverbal problem solving) revealed significant group differences in the gross motor and fine motor age difference variables. Post-hoc analysis revealed that gross motor and fine motor differences became significantly greater with each 6-month period of chronological age. In Study 2, 58 children were measured twice, an average of 12 months apart. Results indicate that the gross motor and fine motor difference scores significantly increased between the first and second measurements. The importance of addressing motor development in early intervention treatments is discussed.

The Cognitive and Academic Profiles of Reading and Mathematics Learning Disabilities

The purpose of this study was to examine the cognitive and academic profiles associated with learning disability (LD) in reading comprehension, word reading, applied problems, and calculations. The goal was to assess the specificity hypothesis, in which unexpected underachievement associated with LD is represented in terms of distinctive patterns of cognitive and academic strengths and weaknesses. At the start of 3rd grade, the authors assessed 684 students on five cognitive dimensions (nonverbal problem solving, processing speed, concept formation, language, and working memory), and across Grades 3 through 5, the authors assessed performance in each academic area three to four times. Based on final intercept, the authors classified students as LD or not LD in each of the four academic areas. For each of these four LD variables, they conducted multivariate cognitive profile analysis and academic profile analysis. Results, which generally supported the specificity hypothesis, are discussed in terms of the potential connections between reading and mathematics LD.

Cognitive Correlates of Inadequate Response to Reading Intervention

.The cognitive attributes of Grade 1 students who responded adequately and inadequately to a Tier 2 reading intervention were evaluated. The groups included inadequate responders based on decoding and fluency criteria (n = 29), only fluency criteria (n = 75), adequate responders (n = 85), and typically achieving students (n = 69). The cognitive measures included assessments of phonological awareness, rapid letter naming, oral language skills, processing speed, vocabulary, and nonverbal problem solving. Comparisons of all four groups identified phonological awareness as the most significant contributor to group differentiation. Measures of rapid letter naming, syntactic comprehension/working memory, and vocabulary also contributed uniquely to some comparisons of adequate and inadequate responders. In a series of regression analyses designed to evaluate the contributions of responder status to cognitive skills independently of variability in reading skills, only the model for rapid letter naming achieved statistical significance, accounting for a small (1%) increment in explained variance beyond that explained by models based only on reading levels. Altogether, these results do not suggest qualitative differences among the groups, but are consistent with a continuum of severity associated with the level of reading skills across the four groups.

Do different types of school mathematics development depend on different constellations of numerical versus general cognitive abilities?

The purpose of this study was to examine the interplay between basic numerical cognition and domain-general abilities (such as working memory) in explaining school mathematics learning. First graders (N = 280; mean age = 5.77 years) were assessed on 2 types of basic numerical cognition, 8 domain-general abilities, procedural calculations, and word problems in fall and then reassessed on procedural calculations and word problems in spring. Development was indexed by latent change scores, and the interplay between numerical and domain-general abilities was analyzed by multiple regression. Results suggest that the development of different types of formal school mathematics depends on different constellations of numerical versus general cognitive abilities. When controlling for 8 domain-general abilities, both aspects of basic numerical cognition were uniquely predictive of procedural calculations and word problems development. Yet, for procedural calculations development, the additional amount of variance explained by the set of domain-general abilities was not significant, and only counting span was uniquely predictive. By contrast, for word problems development, the set of domain-general abilities did provide additional explanatory value, accounting for about the same amount of variance as the basic numerical cognition variables. Language, attentive behavior, nonverbal problem solving, and listening span were uniquely predictive.

Neuropsychological Outcome of Ventral Capsular/Ventral Striatal Gamma Capsulotomy for Refractory Obsessive-Compulsive Disorder: A Pilot Study

Neuropsychological Outcome of Ventral Capsular/Ventral Striatal Gamma Capsulotomy for Refractory Obsessive-Compulsive Disorder: A Pilot Study

Neuropsychological functioning following craniopharyngioma removal

The neuropsychological functioning of patients who had undergone surgical removal of craniopharyngiomas was compared to that of an endocrine control group composed of patients with nontumor hypopituitarism, an obese control group, and a normal control group. Neuropsychological assessments consisting of measures of intelligence, memory, attention, and executive functioning were carried out. The craniopharyngioma group had lower Performance IQ than did the normal control group, but their Performance IQ was comparable to that of the hypopituitarism and obese control groups. The craniopharyngioma patients did not differ in Verbal or Full Scale IQs from the remaining groups. There were no group differences on measures of verbal or nonverbal memory, ability to sustain attention, or executive functioning including measures of verbal or figural fluency, nonverbal problem solving, ability to copy a complex geometric figure, and visual motor and visual sequencing skills. The group mean scores on the measures of intelligence and neuropsychological abilities for the craniopharyngioma patients were in the low-average to average range. While craniopharyngioma patients can have significant morbidity including endocrine and visual deficits as well as obesity resulting from hyperphagia, neuropsychological deficits are not always present. Their neuropsychological outcome is more benign than some previous studies have suggested.

Tier 3 specialized writing instruction for students with dyslexia

Two instructional experiments used randomized, controlled designs to evaluate the effectiveness of writing instruction for students with carefully diagnosed dyslexia, which is both an oral reading and writing disorder, characterized by impaired word decoding, reading, and spelling. In Study 1 (4th to 6th grade sample and 7th to 9th grade sample), students were randomly assigned to orthographic or morphological spelling treatment but all students were taught strategies for planning, writing, and reviewing/revising narrative and expository texts. Both treatments resulted in improvement on three measures of spelling and one measure of composition. Morphological treatment resulted in better improvement in spelling pseudowords, whereas orthographic treatment resulted in better improvement in rate of reading pseudowords. In Study 2 (4th to 6th grade sample), students were randomly assigned to explicit language treatment (phonological working memory + phonological-orthographic spelling + science report writing training) or nonverbal problem solving treatment (virtual reality-based computer simulation, drawing maps, and building clay models). Both treatments used science content material and resulted in significant improvement in spelling and reading pseudowords (accuracy and rate). The surprising finding was that hands-on, engaging science problem solving led to more improvement in phonological working memory than did specialized phonological instruction. Only when spelling instruction emphasized orthography or morphology (Study 1) did real word spelling improve.