A few questions about the neuro-psych report.

[kRenee]

I received the neuro-psych report today. My 9.5 year old ds was tested using Wechsler Intelligence Scale for Children and the Beery Test of Visual-Motor Integration.

 

The neuro-psych recommends an evaluation with an OT, a physical therapist and for auditory processing. She recommended Earobics to "train for discrimination". No other treatment recommendations were included.

 

My ds's weakest area is in Processing Speed, which includes visual-motor coding /processing, visual scanning and visual discrimination. He is not strong in the Working Memory section either. This would include rote memory, working memory, sustained memory, verbal organization and sequencing.

 

I don't know exactly what the terms mean. If you have experience working with these areas, what program has helped your dc's?

 

Will the specific treatment recommendations come from the OT?

 

I spent a lot of money and didn't really learn anything helpful. Is this normal?

 

Karen

[Claire]

Actually, I think this report gives you quite a bit of information....but very few treatment recommendations, which is pretty typical.

 

The auditory processing, OT and physical therapy needs are likely all related. Auditory processing disorders can interfere with vestibular development, coordination, and processing speed in other areas. It can also interfere with vision.

 

You first want to address the sensory levels of development. It can be difficult to find an audiologist who specializes in evaluation of auditory processing, and the evaluation itself can be expensive. However, it's pretty easy to get an occupational therapy evaluation. That's where I'd start. (I don't have experience with physical therapy, but I would think an OT could recommend someone for that.)

 

If you can get an eval for APD, that's great. However, you can also opt to go directly into therapies. FastForWord is much more expensive than Earobics, but it is also highly likely to train auditory discrimination much better. FFW is a very intensive program done through a provider, but the actual training can take place at home on a computer. Cost is about $900 just for the software, plus purchase of any equipment you don't already have (quality computer soundboard and earphones), plus the provider's fees. Some providers offer a package deal, while others will charge on an hourly basis. Most children would require about an hour's worth of provider time a week (mostly for monitoring results and printing reports).

 

Basically, what you are looking at for sensory-level therapy, is bodywork (the OT and PT) and sound work (TLP and FFW). (TLP is an auditory conditioning program that can make it easier for a child with APD to get through FFW.)

 

Once that level of therapy is nearing completion, I would highly recommend getting a developmental vision evaluation. Your neuro-psych report mentions a lot of vision-related issues. Many of these may be resolved with OT, but others may not. Vision therapy is likely to remediate any remaining visual efficiency deficits.

 

The next step in terms of therapy would be cognitive skills training. Two provider-based programs are PACE and LearningRx (same company). This is the type of therapy that works on developing visual and auditory short-term memory, working memory, sequencing and directionality skills, pattern recognition, attention skills, auditory processing skills (segmenting, blending, phoneme manipulation), and quite a few others. Before starting this type of therapy, you want to try to reduce sensory-level deficits (vestibular/motor, auditory, visual) as much as possible because sensory-level deficits limit gains from cognitive skills training.

 

The very last step in remediation is academics. If you have done therapies in a bottom-up fashion (sensory therapies first, followed by cognitive skills training), then academics should remediate much faster.

[Kathy in MD]

assume that you should be looking for an OT (or the rare PT) certified or at least highly trained in SID - Sensory Integration Dysfunction (or the newer name SPD - Sensory Processing Disorder). The fact that the recommendation includes seeing an audiologist makes me think SID may be involved. If the OT does find a problem, she will do the needed therapy. In a large clinic, your ds's therapy would probably be assigned to an OT who is an employee.

 

SID often affects the inner ear, affecting both balance and language dev. I suggest you read The Out-of-Sync Child by Kranowitz to give you more insight into the symptoms of SID. If you do have an SID OT, check with her if she feels you still need a PT. Much of SID treatment always struck me as more like PT than OT. However sometimes your insurance company will have higher coverage limits for PT than OT.

 

I'm also assuming that you should be looking for an audiologist specializing in auditory processing problems. Years (25+) ago I went to an audiologist because I couldn't understand individual sounds. He tested my hearing and said I had great hearing. I now know that he didn't test for sound discrimination, which was my problem. Unfortunately APD specialists are hard to find. As far as I know, an audiologist will refer to a therapist or maybe some programs for treatment. My ds was diagnosed by a speech pathologist, who did the follow-up ST therapy.

 

Only after the possible underlying physical problems are resolved would I tackle intensive cognitive skills training. Coginitive skills include memory, processing speed (how fast the brain thinks), organization, logic and reasoning and many other higher level thinking skills. You may want to consider Earobics or Fast For Word after seeing the audiologist. After those programs are completed, I highly recommend Learning Rx or PACE for general cognitive skills.

 

Because SID both underlies most problems and the therapy has better results with younger children, I would push to have this evaluation done promptly. Therapy generally lasts a year or less and can be done concurrently with other therapy. Be aware that some OT clinics will treat as long as you are willing to pay. I have some recommendations if you find yourself in that situation.

 

Unfortunately you will find that often the neuro-psych or dev. pediatrician doesn't have specific programs to help. Instead they act more as a generalist, eliminating some possible sources of problems and identifying other probable causes. They often will send you to specialists who can make a definitive diagnosis in a narrow specialty and then treat the problem. The problem with seeing a specialist first is that many other problems may be missed. The "generalist" will act as your guide through the maze and help you find good specialists. As you go through the maze, you'll find you need the generalist less and less.

 

I do have a few questions for you. Did your neuro-psych only do those two tests? Did he do a physical or run blood tests for nutrient deficiencies or heavy metal poisoning? Did he do any observations of your child? Please note that not all symptoms require all these tests.

 

One last thought, much of the therapy may be covered by insurance. But never, ever use learning disabilities or education in any coorespondence with the insurance company

[kRenee]

Thank you both for your thoughtful responses. They do help quite a bit in organizing my thoughts and planning my next step.

 

In trying not to clutter my original email I failed to mention that ds is in vision therapy at the moment, and the psych did recommend a SPD OT. She only did those two tests. No physical or blood tests. And no observation beyond the administration of the tests.

 

So, I will persue an OT evaluation and an auditory processing eval and hopefully those professionals will be able to tell me which therapies or programs would be most helpful.

 

Karen

[Laurie4b]

When you say you received the neuropsychology report, do you mean that you got a copy in the mail? The person who did the testing should also sit down with you and explain the findings. That's often called a parent interpretive. It should be a standard part of the testing and included in the fee; otherwise, it's like a doctor sending you the results of bloodwork directly and not telling you what it means.

 

So, if you didn't get one, request one. Ask him or her every single question that you have. What does this mean? How will that affect my child in school? What could account for the difference in subtest scores? Did you only do these two tests? (That really surprises me, frankly. Generally, there would be more with a neuro-pysch. Nearly always, there is an achievement test like the Woodcock Johnson. If you had recently had that done, though, that might be why it wasn't done.) What were her clinical observations? (You should get more than scores; you should get the psychologist's observations while dc was taking that test.) You can ask the neuropsych in person why she recommends this or that.

 

The WISC-IV is divided into four parts: verbal, perceptual reasoning, working memory, and processing. A typical score would have all four areas fairly close in scores. If you have one or more areas that are significantly out of line with the others, that is where the best info will be in terms of what is going on. Working memory is the ability to hold info in your head while working on other info. The processing speed can be affected by different things: visual perceptual problems (probably not the issue if the perceptual reasoning is intact), visual motor difficulties (the VMI should correlate closely with the processing speed if the difficulties are visual motor), just plain fine motor skills, or difficulty with working memory (the two overlap a bit). An occupational therapist can work with the visual motor skills, fine motor skills, visual perception, etc. They wouldn't typically work with working memory. Vision therapy has some overlap with occupational therapy as well. They would typically work with exercises that help the eyes work well together.

 

I'm wondering why there is a recommendation for physical therapy? If you don't know, I would find out why that is being recommended.

 

We don't have experience with auditory processing.

[kRenee]

Yes, I did get a written report in the mail 6 weeks after we sat down to discuss the test results. And to be fair I should say that there were alot of opinions included in the report. So many were rather obvious if you've lived with this child for 9 years that I somewhat discounted them, but I suppose for an outside professional just beginning to work with my child they might be very useful.

 

The physical therapy was recommended because ds has poor posture/muscle tone.

He is already doing vision therapy.

 

So, doing OT and VT sounds like it will help in the processing area. What do I do to help his Working Memory (specifically identified as rote memory; working memory; and verbal organization and sequencing)?

[Claire]

So, doing OT and VT sounds like it will help in the processing area. What do I do to help his Working Memory (specifically identified as rote memory; working memory; and verbal organization and sequencing)?

 

Cognitive skills training works on short-term auditory and visual memory, working memory, attention skills, pattern recognition, sequencing, and a wide variety of other skills. That would be the next step after OT and VT. (You want to reduce deficits on the sensory level as much as possible before starting cognitive skills training, because sensory deficits lower the ceiling on gains from cognitive skills training.)

 

PACE or LearningRx are provider-based programs that are very good, but they are expensive. PACE is less expensive than LearningRx, which is basically the franchised version of PACE. Cognitive Calisthenics is a home program that is due out on the market sometime this year. It would be less expensive, but it's easier to do a provider-based program.

[Laurie4b]

OT's also work with poor posture/muscle tone. I recently read a book called Sensational Kids by the woman who runs the STAR clinic in Denver. It talks about the different subtypes of SPD and includes the postural problems.