My son's (interesting) evaluation results

[Storygirl]

Yesterday we finally received the NP's report. The report began with a long summary describing what they saw in my son and the accommodations that they thought would help him, and an overview of his results, but I'm interested in understanding more about each test, so I googled them and made my own little cheat sheet. I'd be happy for any insights that you may have.

 

Interestingly, there were several of the additional tests that showed severe impairment, where he is in the 1st percentile or LESS (most of these are less).  These included

 

* grooved pegboard test

* NEPS-II Arrows 

* D-KEFS Trail Making Test number-letter switching subtest

* D-KEFS Tower Test

* Rey Complex Figure (both the copy and recall subtests)

* WISC-IV coding subtest

 

He also could not do the WIAT-III essay composition subtest. They indicate that verbal prompts were provided, but he still did not produce enough words to produce a valid score. This is interesting to me, because he actually enjoys writing and often makes up stories, especially when he types them. However, we have not done as much formal academic writing, so I'm wondering if he was thrown off by the format or did not understand what they wanted him to do because it was different from the writing he is used to. Not sure??

 

Over all of the testing, his scored deviated widely. For example, he is in the 80 and 90th percentiles on some verbal and memory subtests, including a 99th percentile in the Word Pairs, Long Delay subtest of the Children's Memory Scale. Mostly, however, his scores are in the average to low average range for most testing categories.

 

They gave him a diagnosis of Nonverbal Learning Disorder, and I can kind of see why, even though the initial reading that I've done shows that he doesn't fit this diagnosis exactly. They did call him in for additional testing after they initially thought they were done, because they needed some more information to figure him out.

 

In part of the summary, they wrote that he scored in the borderline-to-impaired range in

* fine motor coordination

* theory of mind

* visual-spatial construction skills

* visual perception (motor and non-motor)

* attention switching

* bilateral fine motor dexterity

* copy and memory for a complex geometric design

* visuospatial processing

* motor planning

* organizational skills

 

I'll post additional test results after awhile, but I only have time to do a bit now, so I'll list the WISC-IV

VCI = 102 (55th percentile)       PRI = 77 (6th percentile)    WMI = 91 (27th percentile)   PSI = 68 (2nd percentile)

FSIQ = 82 (12th percentile)       GAI = 91 (27th percentile)

 

Similarities =  63rd

Vocabulary = 50th

Comprehension = 63rd

Block Design = 9th

Picture Concepts = 25th

Matrix Reasoning = 5th

Digit Span = 75th

Letter-Number Seq. = 5th

Coding = 1st

Symbol Search = 9th

 

His IQ seems low to me. They said that it was not accurate, due to the spread in his scoring, but that they believe he has a low average IQ. If I think of IQ mainly as a measure of school performance, I can see that he will struggle compared to his peers academically, but he is so bright and witty and funny and clever with word play that I have always thought of him as being kind of smart. He doesn't care for schoolwork and doesn't like to read and struggles terribly with executive function issues and attention, and has anxiety so that all inhibits his ability to perform on tests like these, I think.

 

They did not mention any concern with vision issues, but the OT yesterday suggested that I have his eyes checked, because when going through some evaluation checklists with her, she noted some things that can be caused by vision problems (she didn't give me a report yet, so I don't know exactly what she was referring to). Shouldn't the NP have noticed a need for vision help during all of this testing? I'm not really questioning the OT; I just think it's interesting that she mentioned it and the NP did not.

[Crimson Wife]

Has he had an evaluation by a developmental optometrist? With the red flags raised on visual tasks, I think it would probably be worth having the eval.

[OneStepAtATime]

I cannot emphasize enough that test scores may mean nothing in the long run, depending, although for many practical reasons it DOES help to have those answers, however inaccurate some of them might be.  But test scores, testing and success with school work only goes so far.  Whatever else you do, help him attain mastery wherever he can in life skills and help him get internships/apprenticeships in fields of interest before he leaves high school.  Having practical experience, really solid life skills, and contacts in fields of interest before he even heads into the work force or to college can go a LOOOONG way to securing a better future, regardless of test scores or grades. 

[kbutton]

They gave him a diagnosis of Nonverbal Learning Disorder, and I can kind of see why, even though the initial reading that I've done shows that he doesn't fit this diagnosis exactly. It's rare to have all the symptoms fit a particular child. If you have big areas of concern about this, I would discuss it with the evaluator. We had a surprised diagnosis--it wasn't really on anyone's radar, but it does fit. For example, you have to think out of the box a bit--our son with Asperger's stims all the time, but he doesn't do a lot of the kind of stimming that people associate with ASD. His stims are mostly verbal, and until the last year or two, they were the kinds of things that all noisy boys did. It's just that he did them more, in a larger variety of settings, didn't outgrow the quirkiest ones, etc. They did call him in for additional testing after they initially thought they were done, because they needed some more information to figure him out.

 

My understanding of NVLD is slim. I learned about it when researching ASD, and I immediately thought, "this is my MIL." When others post on the board about their kids with NVLD, it's like they are writing about her. If she does indeed have NVLD, all of what you listed below is strongly consistent with what she is like.

In part of the summary, they wrote that he scored in the borderline-to-impaired range in

* fine motor coordination

* theory of mind

* visual-spatial construction skills

* visual perception (motor and non-motor)

* attention switching

* bilateral fine motor dexterity

* copy and memory for a complex geometric design

* visuospatial processing

* motor planning

* organizational skills

 

His IQ seems low to me. They said that it was not accurate, due to the spread in his scoring, but that they believe he has a low average IQ. If I think of IQ mainly as a measure of school performance, I can see that he will struggle compared to his peers academically, but he is so bright and witty and funny and clever with word play that I have always thought of him as being kind of smart. He doesn't care for schoolwork and doesn't like to read and struggles terribly with executive function issues and attention, and has anxiety so that all inhibits his ability to perform on tests like these, I think. My MIL has never been remediated at all for her struggles, and she has been known to get kind of passive aggressive about her quirks. She has "bragged" about her very low normal IQ, and she is very intelligent. I won't say what it she tested as, but it's very in line with your child's WISC scores. She graduated from HS and did some college work (she got married and didn't continue). She was a good student through being very conscientious. She doesn't like to read, and I suspect it's because she can't hold onto plots very well (gets very hung up on details). She rarely watches a movie, but if she does, she doesn't follow it well and then kind of obsesses about details that confuse her. She doesn't understand why others like these things (theory of mind). Honestly, getting stuck on details is a huge thing that underlies many of her issues--socially, with reading, communication in general.

 

They did not mention any concern with vision issues, but the OT yesterday suggested that I have his eyes checked, because when going through some evaluation checklists with her, she noted some things that can be caused by vision problems (she didn't give me a report yet, so I don't know exactly what she was referring to). Shouldn't the NP have noticed a need for vision help during all of this testing? I'm not really questioning the OT; I just think it's interesting that she mentioned it and the NP did not. My son is currently doing VT, and I'm surprised at the overlap between VT tasks, what I've heard happens in OT, "brain training" exercises, etc. Our vision therapist says this is because a lot of what goes wrong with developmental vision stuff is brain related and uses similar pathways. So, any kid with some degree of quirky motor problems is probably more at-risk for vision issues as well (either co-morbid or one leading directly to the other). Our son is "almost normal" in many areas of motor development, from ahead of the curve to behind it on a skill by skill basis, but when you add those issues up, they overlap a number of areas that seem unrelated (schoolwork, swimming, small and large motor issues, vision, catching a ball).  Typical screening questions for OT or dyspraxia don't catch those quirks because they often ask about milestones, not individual skills. My son hit his normal milestones at a frighteningly fast pace, but it's little weird domain-specific stuff that didn't develop correctly.

 

[Storygirl]

Has he had an evaluation by a developmental optometrist? With the red flags raised on visual tasks, I think it would probably be worth having the eval.

 

We haven't had him screened (although we did have my daughter screened a couple of years ago, due to reading difficulties). I'm going to see what the OT suggests the issue is in her report, and we'll consider making an appointment -- probably for both of them. Here's the thing about his vision. I have never once considered that he might have an issue with his eyes. Not once. He had no trouble learning to read, doesn't squint or hold his head to the side while reading or adjust the distance between his eyes or his paper, had a fairly easy time learning handwriting (although it can be sloppy, due to poor fine motor skills), has no trouble with reading his work in his workbooks or on flashcards, and has never once complained about anything concerning sight.

 

That doesn't mean that he doesn't have an issue that I haven't discerned. When reading aloud, he can sound choppy, although if I remind him to read smoothly, he corrects that and can read with expression. He also does not read for pleasure. He likes to look at books with photographs and sometimes will take a chapter book to his room with him, but as far as I know, he has never made it through a book on his own. He loses interest. Reading is not what he likes to do. I've always chalked this up to his attention issues (pretty severe ADHD combined type), but it could be due to eye issues, I guess.

 

But wouldn't the NP have commented if she had seen one single thing that suggested that his eyes were an issue? The fact that she spent so many hours with him and did not observe that at all is telling to me. I'm not discounting the OT's opinion, but she has only spent two hours with my son, and much of that was talking to me, not him. The NP was with him for eight hours in very lengthy sessions of one-on-one time. Is vision not something a NP would notice? They wouldn't diagnose, of course, but I would expect them to suggest a screening if they thought it was warranted. They definitely seemed to think his low visual perception scores were neurological somehow and a disability instead of a vision issue.

 

I'm not opposed to having him screened. We might as well. But I'm skeptical.

[Storygirl]

I cannot emphasize enough that test scores may mean nothing in the long run, depending, although for many practical reasons it DOES help to have those answers, however inaccurate some of them might be.  But test scores, testing and success with school work only goes so far.  Whatever else you do, help him attain mastery wherever he can in life skills and help him get internships/apprenticeships in fields of interest before he leaves high school.  Having practical experience, really solid life skills, and contacts in fields of interest before he even heads into the work force or to college can go a LOOOONG way to securing a better future, regardless of test scores or grades. 

 

I think you are right. I've always thought he would do better at something physical, like being a chef or a sound engineer type (he likes food and plays around with recording music). His limitations are likely to keep him from being able to do pursue many traditional career choices, so we'll consider that for sure. And life skills are a big one. Some of his other test scores show a severe executive function deficit, which is absolutely no surprise!! He's going to need a lot of training and guidance to succeed with independent living, and that will be a necessity, because he is not the kind of kid who will want to live with mom and dad for an extended time when he is a young adult. He'll want to spread his wings, so we'll need to prepare him well. That's going to be a challenge.

[kbutton]

We haven't had him screened (although we did have my daughter screened a couple of years ago, due to reading difficulties). I'm going to see what the OT suggests the issue is in her report, and we'll consider making an appointment -- probably for both of them. Here's the thing about his vision. I have never once considered that he might have an issue with his eyes. Not once. He had no trouble learning to read, doesn't squint or hold his head to the side while reading or adjust the distance between his eyes or his paper, had a fairly easy time learning handwriting (although it can be sloppy, due to poor fine motor skills), has no trouble with reading his work in his workbooks or on flashcards, and has never once complained about anything concerning sight.

 

That doesn't mean that he doesn't have an issue that I haven't discerned. When reading aloud, he can sound choppy, although if I remind him to read smoothly, he corrects that and can read with expression. He also does not read for pleasure. He likes to look at books with photographs and sometimes will take a chapter book to his room with him, but as far as I know, he has never made it through a book on his own. He loses interest. Reading is not what he likes to do. I've always chalked this up to his attention issues (pretty severe ADHD combined type), but it could be due to eye issues, I guess.

 

But wouldn't the NP have commented if she had seen one single thing that suggested that his eyes were an issue? The fact that she spent so many hours with him and did not observe that at all is telling to me. I'm not discounting the OT's opinion, but she has only spent two hours with my son, and much of that was talking to me, not him. The NP was with him for eight hours in very lengthy sessions of one-on-one time. Is vision not something a NP would notice? They wouldn't diagnose, of course, but I would expect them to suggest a screening if they thought it was warranted. They definitely seemed to think his low visual perception scores were neurological somehow and a disability instead of a vision issue.

 

I'm not opposed to having him screened. We might as well. But I'm skeptical.

 

Not liking to read may be unrelated to vision. Some people just don't like to read.

 

Our COVD doc can't believe that my son was asymptomatic with his vision issues for so long. He has 20/20 vision and no adaptations to how  he does schoolwork (straining, etc.), and he reads for hours and hours sometimes. Our old optometrist identified and completely dismissed an intermittent wandering eye (which is why we see a COVD now), and that was our first inkling something was up. I read up a little and managed to discern some of those symptoms myself (he couldn't cross his eyes at all). Upon exam, the COVD doc said he "should" be experiencing symptoms. She gave him some words for symptoms, artificially made him exhibit some so that he could feel what they were like, etc. (Aspies apparently tend to underreport symptoms and assume what they experience is normal unless told otherwise.) She gave him a couple of exercises for the not crossing eyes thing. She suspected he just adapted well and would show up with symptoms when he started reading smaller print on more crowded pages. Bingo--8 or so months later, he's having issues, and we're doing VT. He still has 20/20 vision.

 

My other little guy has been able to hit a moving ball with hands, feet, or an object almost since he could walk. We didn't think he had vision issues either, and when he was screened at 4, we found out that he will never ever be able to go without glasses. He has a very strong astigmatism and can't see a thing. He exhibited very few symptoms, and those symptoms were subtle and not definitive for vision issues.

[Mukmuk]

Echoig what previous posters gave mentioned- many of the tests that you listed where your ds has weaker scores have a direct link to viual spatial skills. I don't know about the rest, but a covd can help rule out issues here. That would be my first stop.

[Storygirl]

Interesting! You guys are giving me food for thought. Tell me this. If I had not mentioned in my post that the OT suggested he needed a vision screening, would you have seen a need in his scores alone? I'm still wondering why the NP wouldn't have suggested it, if it such an obvious thing to check.

[PeterPan]

Story, care is TOTALLY PIGEONHOLED with these people.  You're lucky you even have an OT who catches eye stuff and refers off.  

 

Glad you got a thorough, helpful eval.  So are they recommending anything for you?

[Mukmuk]

We've approached this a little differently.

 

We had already tested ds for vision and auditory processing before his NP evaluation at 9yo. So when the results came out, I googled to see if the subtests where he scored lower relied on auditory and visual processing. Bingo. They did.

 

For example, your son scored really well in digit span. This is a test of working memory as well as auditory processing. My son bombed this relative to his other scores. The implication is that your son has the adequate auditory processing function to process the information and the working memory to score better than 75% of his cohort.

 

If it were only one or two visual processing reliant subtests that your son scored lower in, he may not have visual processing issues. But he seems to be scoring lower across the board every time visual processing skills (visual spatial construction, motor, processing, block design, picture concepts, matrix reasoning, coding) are called for.

 

It's worth a check to rule it out.

[Storygirl]

Story, care is TOTALLY PIGEONHOLED with these people.  You're lucky you even have an OT who catches eye stuff and refers off.  

 

Glad you got a thorough, helpful eval.  So are they recommending anything for you?

 

1) OT for the dyspraxia (fine motor and dexterity specifically, although the OT is doing her own full evaluation) and SPD. They included a list of recommended programs for the OT and/or school to consider using.

 

2) They offered suggestions for writing instruction to improve skills lacking in both handwriting and thought expression (including graphic helpers such as graphic organizers, outlines, checklists, etc.). They diagnosed dysgraphia.

 

3) If we enroll in school, we should request an IEP -- "his cognitive deficits and learning disabilities make it difficult for him to thrive in a general setting for all subjects"

 

4) "To assist with executive weaknesses, teach him specific strategies in context and encourage him to use them in multiple subject areas and settings to promote generalization."  I have to look up the links they provide to see if they include more specific ideas about this.

 

5) A bunch of ideas for helping with dysgraphia and dyspraxia during schoolwork.

 

6) A list of activities to promote fine motor skill development.

 

7) A few suggestions for dyscalculia (use graph paper and a highlighter) and some websites to check.

 

8) A list of reading strategies

 

9) An entire page of suggested classroom accommodations (sit near the front; take tests in a quiet room with no time limit, etc)

 

10) Lots of suggested resources (books and websites) for ADHD and executive function issues.

 

11) Continuing treatment/counseling for anxiety and learning behavioral strategies we can use, such as positive reinforcement and token economy, to improve compliance at home and school.

 

Nothing about VT!!!

 

They really seem to read his issues as a lifetime disability that will need to be accommodated but that will not be overcome (which goes with the NVLD diagnosis). I think this is because he has social skills issues seen with ASD, though they ruled out ASD. They saw a composite of symptoms, not just the visual processing things alone. They commented in our in-person briefing several weeks ago that they found him to be an unusual puzzle to figure out (which is what we've always felt). So they see the "deficits with nonverbal functions including visual spatial processing, visual-construction, visual perception, and perceptual planning. This cognitive profile is consistent with a nonverbal learning disability profile." They continue on to describe the kind of social difficulties that go along with NVLD (which do describe DS's challenges) including that he has impairment in "theory of mind," which tests ability to predict others' actions and take another person's perspective. So they see the impairments with visual processing to be a symptom of the NVLD, not a symptom of vision issues.

 

We'll probably call and ask them about their opinion of vision screening and see if they have a recommended provider anyway. I mean, if these things can be improved with vision therapy, it would be well worth it. On the other hand, if his difficulties are neurological, not with vision, the VT would not work, right? We need to be sure we get a very trusted VT, because we have so many things to work on that we can't waste time and money on something that will not help him. I know that not all VT are equal.

 

So confusing. Why don't these children come with an owner's manual?

 

By the way, I also have the test results for 18 additional screening tests (plus all the subtests within those) that they conducted. They really tried to investigate him thoroughly.

[Crimson Wife]

From my understanding, the VT exercises will actually help the brain re-wire itself if the individual is young enough. Kids' brains are plastic so it's definitely not too late for your DS. I found out as an adult that my eyes don't team together well but while VT would likely help a bit even now, the improvement likely wouldn't be worth the cost of me doing it. But if I'd had the opportunity to do VT as a kid (not sure if it even existed back then), the cost/potential benefit ratio would've been much higher.

[PeterPan]

We've approached this a little differently.

 

We had already tested ds for vision and auditory processing before his NP evaluation at 9yo. So when the results came out, I googled to see if the subtests where he scored lower relied on auditory and visual processing. Bingo. They did.

 

For example, your son scored really well in digit span. This is a test of working memory as well as auditory processing. My son bombed this relative to his other scores. The implication is that your son has the adequate auditory processing function to process the information and the working memory to score better than 75% of his cohort.

 

If it were only one or two visual processing reliant subtest that your son scored lower in, he may not have visual processing issues. But he seems to be scoring lower across the board every time visual processing skills (visual spatial construction, motor, processing, block design, picture concepts, matrix reasoning, coding) are called for.

 

It's worth a check to rule it out.

My dd said something to this effect too, that she knew she was doing well in certain sections of the tests because she could harness her visualization skills (which had been improved by VT).  In her case it was the stuff where she couldn't use visualization where she scored lower.  

[PeterPan]

From my understanding, the VT exercises will actually help the brain re-wire itself if the individual is young enough. Kids' brains are plastic so it's definitely not too late for your DS. I found out as an adult that my eyes don't team together well but while VT would likely help a bit even now, the improvement likely wouldn't be worth the cost of me doing it. But if I'd had the opportunity to do VT as a kid (not sure if it even existed back then), the cost/potential benefit ratio would've been much higher.

I don't know.  I've done some of the exercises myself and gotten some progress.  If you have access to the homework your dc did, it might be worth the effort.  Or go for a session ONCE or like once a month and just let them get you started.  You can still make headway as an adult.

[PeterPan]

1) OT for the dyspraxia (fine motor and dexterity specifically, although the OT is doing her own full evaluation) and SPD. They included a list of recommended programs for the OT and/or school to consider using.

 

2) They offered suggestions for writing instruction to improve skills lacking in both handwriting and thought expression (including graphic helpers such as graphic organizers, outlines, checklists, etc.). They diagnosed dysgraphia.

 

3) If we enroll in school, we should request an IEP -- "his cognitive deficits and learning disabilities make it difficult for him to thrive in a general setting for all subjects"

 

4) "To assist with executive weaknesses, teach him specific strategies in context and encourage him to use them in multiple subject areas and settings to promote generalization."  I have to look up the links they provide to see if they include more specific ideas about this.

 

5) A bunch of ideas for helping with dysgraphia and dyspraxia during schoolwork.

 

6) A list of activities to promote fine motor skill development.

 

7) A few suggestions for dyscalculia (use graph paper and a highlighter) and some websites to check.

 

8) A list of reading strategies

 

9) An entire page of suggested classroom accommodations (sit near the front; take tests in a quiet room with no time limit, etc)

 

10) Lots of suggested resources (books and websites) for ADHD and executive function issues.

 

11) Continuing treatment/counseling for anxiety and learning behavioral strategies we can use, such as positive reinforcement and token economy, to improve compliance at home and school.

 

Nothing about VT!!!

 

They really seem to read his issues as a lifetime disability that will need to be accommodated but that will not be overcome (which goes with the NVLD diagnosis). I think this is because he has social skills issues seen with ASD, though they ruled out ASD. They saw a composite of symptoms, not just the visual processing things alone. They commented in our in-person briefing several weeks ago that they found him to be an unusual puzzle to figure out (which is what we've always felt). So they see the "deficits with nonverbal functions including visual spatial processing, visual-construction, visual perception, and perceptual planning. This cognitive profile is consistent with a nonverbal learning disability profile." They continue on to describe the kind of social difficulties that go along with NVLD (which do describe DS's challenges) including that he has impairment in "theory of mind," which tests ability to predict others' actions and take another person's perspective. So they see the impairments with visual processing to be a symptom of the NVLD, not a symptom of vision issues.

 

We'll probably call and ask them about their opinion of vision screening and see if they have a recommended provider anyway. I mean, if these things can be improved with vision therapy, it would be well worth it. On the other hand, if his difficulties are neurological, not with vision, the VT would not work, right? We need to be sure we get a very trusted VT, because we have so many things to work on that we can't waste time and money on something that will not help him. I know that not all VT are equal.

 

So confusing. Why don't these children come with an owner's manual?

 

By the way, I also have the test results for 18 additional screening tests (plus all the subtests within those) that they conducted. They really tried to investigate him thoroughly.

Sounds like you got a great eval!!  Ok, here's the bummer.  Does his NVLD label get you access to the Ohio Autism Scholarship?  

 

It's not the job of a np to conclude vision problems any more than it's his job to label auditory problems.  If they have some savvy with it and experience they might notice something and refer off.  They're not eye docs.  You go to a developmental optometrist to get your vision questions answered.  Your dev. optom will have experience with autism, adhd, and NVLD.  Maybe it would be equally good to ask the optom. to diagnose your psych issues, since of course she has seen these kids and ought to recognize it and tell you?  ;)  (you know that's not the case)

 

You're going to wait on the eye doc till you move.  There's a killer eye doc practice where you're moving to.  I suggest you free the question from your mind and deal with it later, in a couple months, when things settle down.  

[Julie of KY]

Like others have said, go see a developmental optometrist.

 

While you can ask your NP his opinion on vision therapy, I wouldn't necessarily trust his answers. Our NP was in the middle of testing our third child when I mentioned to her that I thought I had figured out a way to help my daughter's reading (and my son's writing). I told her that I was convinced that vision therapy would help. She told me that she had heard of VT, but didn't really think I needed to spend any money on it as "there's an app for that". Oh, was she wrong. Vision therapy has had amazing results.

[Lecka]

I took my son to a VT screening after having an OT recommend it.  

 

For him ----- the screening did not come back saying DO VT.  It came back saying -- yes, I do see what the OT is seeing, and no, I don't think that VT has got something for him that OT does not have.  

 

They both (OT and VT) said that sometimes for a specific child, one or the other of them might have more success with their methods.  But, they did not say they could predict that ahead of time.  

 

For quite a few reasons, but all more personal/logistical and not from research into "what is better," we did OT.  

 

After about 2-3 months, the OT spoke to me and said she was not seeing progress in an area, she thought I should know, I should consider VT.  Then -- I made an appointment.  Then -- before the appointment, he did make progress in OT in that area.  Then I cancelled the appointment for VT.  

 

My son's crossing the mid-line, bilateral coordination, and eye tracking  all improved immensely with OT.  For this kind of thing -- he did do the "helping the two sides of the brain work together" stuff.  I think he might have gotten the benefit from any number of programs/professionals who do this kind of thing.  But I really liked his OT ;)  It was great, worth it, etc.  

 

The visual perceptual skills ------ higher, but still low.  School OT told me he had some areas below 10th percentile but his average was above. Private OT told me she thought he was above the 10th percentile in everything, with low scores between 15-20th percentile.  

 

He has exited OT with them saying -- this is where they can get him.  

 

I have not pursued VT again to see if they could get those scores higher.  When I saw the VT he did not seem to promise anything in these areas.  He was most concerned with the tracking and saying he could treat the tracking, but he thought OT was a good option for my son, he did not say "I can get you a result the OT can't."  He said more, that if he didn't make progress on tracking with OT that VT would be a good option then, or I could start with VT if I preferred.  

 

Overall though -- my experience with the OT saying to consider it, was more, that the OT could not "rule out" vision issues that could be treated by VT.  They had seen kids who presented the same way as my son on some testing, who did go to a developmental optometrist and turn out to have issues that could be treated very well with VT.  So -- the OTs knew, "if I see this, I know VT may help, but my training and background does not let me know if VT will help or not.... the VT is the one who will do their testing and then know."  

 

The OTs were not surprised that I heard from what I did from the VT (that he could help tracking but not so much other things).  But they have had other kids where with the same things going on, VT has helped them, b/c it turned out the child had something else.  

 

I am in a smaller town and I think it is different here with some things.  For me -- i felt like the tracking issue they told me about was kind of bizarre, but after two OTs and a COVD independently all told me they saw the same thing, then that made me feel confident it was valid.  Then when it improved -- the school and private OT both told me they saw improvement at the same times, and I could also see it for myself in his reading.  

 

Personally -- I think I would try to find out, "did the neuropsych definitely rule out vision-related causes."  I might try to ask his office.  I might try to ask the OT "do you think the neuropsych eval could have ruled out vision-related causes."  If I got answers like "the OT can't rule it out but the neuropsych can" then I  would be satisfied with the neuropsych eval.  If I got answers like "the neuropsych did not address this even though the exam was so long, and the OT thinks it warrants a screening" then I think I would do a screening.  

 

I went to the COVD in my town, and I was pleased with him as far as -- he did not push VT, he did not think VT would be needed for my son just b/c that is the service he provides.  His eval seemed thorough.  I did not think his practice was set up for my age of child, and it was on a street with difficult parking, and the waiting area would have been extremely difficult for me with my two younger kids.  And, insurance would not have paid, but insurance did pay for OT.  The OT had a swing in her office, lots of toys and games for his age, and a Wii.  

 

But at a certain point -- if you decide the VT screening is worthwhile, you just have to go to the screening and see what you are told.  I would look for someone who doesn't seem like they recommend VT for every person who walks in their door.  That was not my experience but I did worry about that.  

 

But if you go to the screening, then you can find out if there is something VT can do that OT doesn't address, if that is the case.  If it is not the case, you have found that out.  

 

I think that for my son that convergence insufficiency was what the OT thought was possible.  But she is not a VT, she cannot say if he has it or not.  She can just say -- why don't you see what the VT says, and sometimes kids turn out to have CI and sometimes they don't.   

 

Edit:  I am remembering that the school psychologist was also at the meeting where this was discussed.  He agreed that a VT screening was worthwhile, but he made it clear that he saw kids with similar issues that VT did not help.  But, he was positive about getting the screening and seeing what the VT said.  But -- I think he thought the OT might be getting my hopes up too much, so he was just saying more, don't get your hopes up about it, b/c he did not think "this is guaranteed to help."  The OT wasn't saying that either, but she did say that some kids turned out to have an underlying issue that turned things around dramatically when VT was done.  

 

But at the end of the day -- I took my son and the VT said he wasn't seeing any underlying things like that.  But I was glad to find out, and have  a Plan B for when we weren't sure if OT was going to help his tracking or not.  

 

That is just from the people in our town.... I have not pursued it at a higher level.  I feel satisfied, but I can see that I am not far from feeling like "I think I should get a second opinion from another COVD."  

[geodob]

Story, I would suggest that you would be wasting your time and money with vision screening?

As with NVLD it is important to understand that the underlying issue is with Spatial processing.

Where Spatial processing works in combination with Auditory and Visual processing.

 

But the effect that a Spatial disorder has on Auditory and Visual processing?

Should not be confused with an intrinsic Auditory or Visual processing disorder.

Rather it limits what can be done with each of them.

While Visual processing forms a visual image.

It is Spatial processing that enables us to manipulate the image.

Also importantly to identify relationships between elements within the image.

Which is related to pattern recognition and sequential thinking, and 'mind mapping'.

 

So that what really needs to focused on, is Spatial processing.

 

 

 

 

[Lecka]

I wasted my time and money in the sense that we did the eval but no VT.  But I was glad to rule it out.  

 

I also think, it is possible someone could have NVLD and also have vision issues treatable with VT.  I don't think that means VT would address the core deficits or whatever, but someone might have both things separately.  

 

But with that said, I think it is very possible it is going to be a waste of time and money, in the sense that I think it is very possible to be told there is not an issue treatable by VT.  

 

But I think it may or may not be possible to rule that out without going to a specific eval.  (But is there, then, even any reason to think an eval is warranted?  I don't know.... my son did have tracking issues too, he didn't only have low scores in the visual-perceptual areas.  He also had signs of convergence insufficiency when he was younger that he outgrew, but I did want to make sure that was no longer an issue.)  

 

Another thing -------- the meeting I went to was a little "here is a lot of downer news."  I think sometimes people (like an OT) feel like "I don't want to just give all this downer news, when really there is a tiny chance that VT could help, and then I can have a chance to say something positive and uplifting to this depressed-looking parent whose child I think is a great kid."  

 

I think there was a little (or a lot) of that with the OT I saw.  But you know what -- I was happy to hear something positive on that day.  So I feel like, that is okay with me.

 

If it seemed more like -- just a total and complete rabbit trail distracting me from what I should really be doing, I would disapprove of the "let's say something nice" thing more.  But I think it was okay with me this time.

 

With my younger son I have seen more things like this, and it is more frustrating.  Like -- the guesses are more just hopeful guesses, to try to say something positive to me.  

 

I think you might be able to feel out the OT this way, too, possibly.  You might be able to see if she thinks it is a really, really small chance, or if she thinks it is unlikely but possible, or possible.  Or, if they just feel like they can't rule it out and a screening is called for in that circumstance.  Like -- is it just a "check the block that it is ruled out" thing, but no one really thinks it is likely.  Like -- when they said I should rule out a seizure disorder instead of autism for my younger son.  No one has ever thought he had a seizure disorder, but they say it anyway b/c they are supposed to say it, b/c sometimes it will turn out that a child has a seizure disorder.  And they could have a seizure disorder and autism, or a seizure disorder and no autism, with the autism symptoms disappearing when the seizure disorder is treated.  You just have to see, I think.  

[Julie of KY]

I don't think it is a waste of time to get an opinion from another professional. Even if you don't pursue anything vision related, it may relieve any doubts in the back of your head about could VT help?

[wapiti]

FWIW, we have ruled out vision issues for my boys with the full developmental vision eval with no regrets.

 

I would try to find a COVD with a practice that also addresses down-stream vision processing stuff, as not all of them do, IIRC.  Choose wisely.

 

I would also talk more with the OT about what OT may be able to accomplish toward this end.  For my dd, OT really helped the VT.

[kbutton]

 

I also think, it is possible someone could have NVLD and also have vision issues treatable with VT.  I don't think that means VT would address the core deficits or whatever, but someone might have both things separately.  

 

But with that said, I think it is very possible it is going to be a waste of time and money, in the sense that I think it is very possible to be told there is not an issue treatable by VT.  

 

But I think it may or may not be possible to rule that out without going to a specific eval.  (But is there, then, even any reason to think an eval is warranted?  I don't know.... my son did have tracking issues too, he didn't only have low scores in the visual-perceptual areas.  He also had signs of convergence insufficiency when he was younger that he outgrew, but I did want to make sure that was no longer an issue.)  

 

This.

 

Geodob mentioned that NVLD brings spatial glitches. Definitely. It also brings motor control glitches that may (or may not) affect developmental vision, which VT may or may not help, depending on what the actual problem is. The overlap between motor issues and developmental issues appears to be significant based on what our vision therapist (not the COVD doc, but an assistant trained to do therapy) has been telling us. She usually has just a few kids starting VT at the same time, but right now, she has 14 kids all starting within about 3 weeks of each other. She said that being able to compare them this way has been really eye-opening. She has a child or two flying through therapy, and she has some that are a hot mess. The ones that are a mess have motor control issues across the board. The ones flying through have some motor areas that don't work quite right, but apparently just need a nudge in the right direction and a little practice (this is my son).

 

A COVD screening is pocket change, and it might be covered by a vision plan and/or medical plan. VT usually is not covered. My COVD doc found things with my kids that should have been caught by a regular optometrist and were NOT. In addition, she caught things specific to her expertise.

 

I do recommend to nearly everyone that they have their child screened by a COVD doc because it's made a big difference in our family. We are 4 weeks into VT, so I haven't swallowed the Kool-Aid--we benefitted from the COVD expertise immediately with vision issues she detected in my child who doesn't need VT (at least not yet). In our case, it's the difference between needing to patch my son's eye and not having to patch it--the optometrist made one mistake (hugely wrong Rx because he didn't dilate my son's eyes), the lab that made the glasses made a second mistake, and the office failed to check the glasses when they came in (third mistake). Those mistakes took my son from at risk for lazy eye to a lazy eye. Thankfully, the COVD doc found both errors, and getting new glasses corrected the mistake (she had us follow up two months later to see if his brain/eye responded).

[kbutton]

They really seem to read his issues as a lifetime disability that will need to be accommodated but that will not be overcome (which goes with the NVLD diagnosis). I think this is because he has social skills issues seen with ASD, though they ruled out ASD.

 

It is a lifetime disability, but it's not only because of the social issues. However, anything that rises to the level of diagnosis and affects learning has some lifelong implications. My husband's family is full of people with exceptionalities (probably all ADHD, one with dyslexia and maybe CAPD and SPD, one with possible NVLD, maybe some ASD in the extended family--most are probably gifted as well). When they need a group photo taken, and the photographer says, "look a little more to the right," half of them will look left, and half of them will look right. When the photographer tries to remedy the situation, they'll all look the other way. Some of them will do so because the don't know left or right (doing the hokey pokey is interesting). Some will not be sure if they need to look to the photographer's right or their own. It's really an interesting experiment, and it happens EVERY TIME as if they've never had pictures taken or that they could ask a question to clarify. The dyslexia may be remediated, the executive functions may be slipping into place in their 30's and 40's, but this kind of stuff will continue to happen, particularly if you put several people with exceptionalities together--they play off of each other. These are features, not bugs (as they say in the software industry). It's built into the operating system. Learning strategies for photo shoots, such as telling the photographer to say something like, "look toward the wall" instead of using a direction or asking a question when you don't understand are workarounds that substitute for knowing left from right or being able to follow conventions that other people know. They don't make the underlying exceptionality go away, but they do help the person reach their potential (and help the photographer know how to respond!).

 

What you want to know, and what therapies will help you do, is to mitigate negative things and build on the positive things to help your child reach his full potential, whatever that potential ends up being. 

 

[Crimson Wife]

 

Story, I would suggest that you would be wasting your time and money with vision screening?

As with NVLD it is important to understand that the underlying issue is with Spatial processing.

Where Spatial processing works in combination with Auditory and Visual processing.

 

Unless you are a developmental optometrist who has evaluated the OP's child, I don't think you or any of us are in a position to tell the OP whether or not she'd be wasting her time & money with VT. The OP's child could have BOTH a visual issue AND a spatial processing issue.

 

The only way to tease apart whether it's one vs. the other vs. both is to have multiple evals by different practitioners. The NP can run certain tests, but he/she is not an OT nor a developmental optometrist.

[Plink]

I'm shocked that your neuropsych was willing to do testing without a report from a pediatric opthalmologist. Ours wouldn't schedule us without proof of an appointment, and they were booking a year out.

 

My DD's report was similar to your son's. I found that I needed a good long time to accept, grieve, and fully understand why she received the diagnoses that she did. ((Hugs))

[Storygirl]

I just wanted to let you know that I'm reading and thinking about all of your comments (thank you so much!). Keep 'em coming!  I don't have much time to respond, because we decided last night that our house will go on the market on Monday (gulp!  -- this is a week earlier than I imagined), so I'm frantically cleaning out closets, etc. I'll chime in as I can and will definitely have more to say after the weekend when I have slightly more time.

[PeterPan]

 

Story, I would suggest that you would be wasting your time and money with vision screening?

As with NVLD it is important to understand that the underlying issue is with Spatial processing.

Where Spatial processing works in combination with Auditory and Visual processing.

 

But the effect that a Spatial disorder has on Auditory and Visual processing?

Should not be confused with an intrinsic Auditory or Visual processing disorder.

Rather it limits what can be done with each of them.

While Visual processing forms a visual image.

It is Spatial processing that enables us to manipulate the image.

Also importantly to identify relationships between elements within the image.

Which is related to pattern recognition and sequential thinking, and 'mind mapping'.

 

So that what really needs to focused on, is Spatial processing.

 

Are you seeing something that makes you *exclude* vision as a cause of some of her symptoms??  It's not like people can't have BOTH.  I know someone whose dc did.

[FairProspects]

Isn't the assumption just that if VT or an eval was warranted, the NP would have referred that out in the report? I know that was the case for us. If the diagnosis was NVLD, that is a separate issue from eyes, just as dyslexia is the flip side of NVLD separate from eyes. As someone who was burned by VT (and ds was one of those hot mess kids mentioned above who got little to no benefit from lots of VT), I wish someone would have told me that if the issue is dyslexia, all the VT in the world isn't going to address the problem. That may be the case for NVLD too, in which case the VT would be a waste because it is not the primary processing issue - the NVLD is.

[Heathermomster]

 

Story, I would suggest that you would be wasting your time and money with vision screening?

As with NVLD it is important to understand that the underlying issue is with Spatial processing.

Where Spatial processing works in combination with Auditory and Visual processing.

 

But the effect that a Spatial disorder has on Auditory and Visual processing?

Should not be confused with an intrinsic Auditory or Visual processing disorder.

Rather it limits what can be done with each of them.

While Visual processing forms a visual image.

It is Spatial processing that enables us to manipulate the image.

Also importantly to identify relationships between elements within the image.

Which is related to pattern recognition and sequential thinking, and 'mind mapping'.

 

So that what really needs to focused on, is Spatial processing.

 

So, how do you remediate spatial processing issues?  

[kbutton]

I read geodob as saying that remediating visual and auditory stuff won't necessarily cure NVLD (though maybe geodob is also not a fan of VT).

 

I am curious about how to remediate spatial stuff--good question.

[Heathermomster]

I read geodob as saying that remediating visual and auditory stuff won't necessarily cure NVLD (though maybe geodob is also not a fan of VT).

 

I am curious about how to remediate spatial stuff--good question.

If I were to guess, I would say that he supports VT where it is warranted.

 

Geodob, correct me please.  I read that NVLD is caused by intrinsic spatial processing issues, so the best auditory/visual processing remediation in the world is pointless without correcting/addressing spatial processing first.  

[PeterPan]

Heather, from my big whopping pool of 1, I'll say the person I know whose dc has nvld (diagnosed) had severe sensory integration, to the point where the body was just totally misreading sides, etc.  In that case regular VT didn't work, even though the dc had developmental vision problems.  They ended up with an unusually good sports vision therapist who used the dc's whole body and worked on the sensory as well.  

 

By the time you get this much going on, it's not simple answers.

[geodob]

I'm a strong supporter of VT by fully accredited therapists.

Though from everything that Story has written, their is no suggestion of any vision issue.

Yet their is no reason why a vision assessment shouldn't be done.

But this would be separate from the NVLD diagnosis.

Where the NVLD needs to focused on.

 

Though in regard to remediating spacial processing issues?

It begins with tests that go through the stages of development of spacial processing from birth.

So that the stage where a delay has occurred can be identified.

Then having identified the delay, recommencing develop can be explored.

Which may or may not be able to be developed?

Though spacial processing involves a network of brain regions.

So that delay with different regions will different difficulties.

[Heathermomster]

I'm a strong supporter of VT by fully accredited therapists.

Though from everything that Story has written, their is no suggestion of any vision issue.

Yet their is no reason why a vision assessment shouldn't be done.

But this would be separate from the NVLD diagnosis.

Where the NVLD needs to focused on.

 

Though in regard to remediating spacial processing issues?

It begins with tests that go through the stages of development of spacial processing from birth.

So that the stage where a delay has occurred can be identified.

Then having identified the delay, recommencing develop can be explored.

Which may or may not be able to be developed?

Though spacial processing involves a network of brain regions.

So that delay with different regions will different difficulties.

Awesome!

 

So, what kind of specialist performs these tests?  Is there a specific test name?  Would you recommend any books or research materials to help us understand spatial processing?

[PeterPan]

I wouldn't have said vision problems when my dd was that age, because I didn't realize things we were seeing were attributable to them.  (We assumed other explanations.)  I repeat, I know a dc who has an NVLD label *and* needed VT.  If you've had ANY reason to think vision, you're wise at least to get a screening by doing a regular annual exam with a really good developmental optometrist.  Given that she's only just now doing an OT eval (right? I've lost track) she has no clue what all is going on there and how extensive the glitches are.

[Storygirl]

Okay. I'm back. Sorry to disappear just after starting my thread, but I've been crazy busy getting my house on the market :willy_nilly: . And after a few days..... no showings yet :thumbdown: . But we're hoping for some activity over the weekend.

 

Anyway, I'm going to go back through this thread over the next day or two and may pull out some of your comments to respond to, since I haven't had time to do that yet. In the meantime, I have some more information. We received the evaluation report from the OT yesterday, and it is interesting as well. Many sensory issues at play (no surprise, except for the fact that it is a loooong list of issues to address).

 

Here is what is fascinating to me, though I'm not sure of its significance yet. Both the OT and the NP ran the Beery-Bukentica Visual-Motor Integration test. NP scored him at 75 (age equivalent 6 yr, 3 mo.) borderline impaired. OT scored him at 69 (2nd percentile, 6 yrs, 3 mo.). Similar results. As a reminder, DS is 10.

 

BUT the OT also ran the Motor Coordination subtest, which scores motor alone, without visual perception included, and DS scored in the 4th percentile (6.4 yrs). But, and here is the interesting part, she ran the Visual Perception test, which evaluates visual abilities without motor skills integrated, and he scored in the 65th percentile (equivalent to 11.8 years).

 

I didn't have a chance to talk to the OT yet about what she thinks this means. By next week, she will have read the NP report as well, so I'm going to ask her more questions then. She did comment to me that that visual perception score was very interesting.

 

I'm listing some more visual scores in my next post.

 

ETA:  I mentioned before that the OT suggested a visual screening. In the report, she mentioned that DS self-reported that he reads his book with his head down on the desk and his eyes close to the page. I said at that time that I didn't notice him doing that particularly (he doesn't really read much, anyway, and likes to sprawl out on the floor when he does, so he's not typically in an upright reading at the desk position). She took his word for it. That is the only thing she mentioned in her report for her suggestion of vision screening, other than that vision can have an impact on many things and should be evaluated.

[Storygirl]

The NP report does list results for the TVPS-3, which evaluates visual perception strengths and weaknesses. I don't know if any of you are familiar with this test, but just in case, I will list his results. The NP used a scaled score as follows -- I won't list the whole scale, but just the parts that show how DS scored.

8-11 Average

6-7  Low Average

5     Low, borderline impaired

4     Impaired

3     Very impaired (including anything below 3)

 

DS scored as follows

 

Visual discrimination    3

Visual memory             8

Spatial relations           8

Form constancy           4

Sequential memory      7

Figure ground              6

Visual closure              4

 

I'm not sure of the significance of these scores, except that they are low. Which is interesting, because the OT scored him higher on her visual perception test.

 

I do realize that we should have his vision fully evaluated, because there are questions raised here.

 

I also realize that if the NVLD diagnosis is correct, that helping his vision will not change that diagnosis, even if it helps him improve in some areas. 

 

If the NVLD diagnosis is not correct, vision therapy could make a huge difference. 

 

I'm sure they gave him the NVLD diagnosis based on a combination of factors, including his visual-spatial problems, but also his social issues. I'm inclined to believe the NVLD, because it helps explain him. On the other hand, he doesn't fit exactly in that box, and some of his behaviors may be caused by his SPD and ADHD instead of NVLD, which could cast doubt on that diagnosis. So I'm not buying it completely. DS is complicated, with a lot going on.

 

 

 

[Storygirl]

And the OT also agreed with the Developmental Coordination Disorder (dyspraxia).

 

This is also so very interesting, because DS is a competitive gymnast. His gross motor skills are good, but his fine motor skills are abysmal. I can see how his gross motor gymnastics skills lack refinement (which is why he scores lower at the meets) and that OT will be valuable for him. But I think it interesting that someone with dyspraxia can do multiple back handsprings, etc., and routines high up in the air on the rings and high bar.

 

It makes me feel a little sad for him. If he didn't have the dyspraxia, I suspect he would be an excellent gymnast, but he has so many personal obstacles to overcome that it holds him back from doing as well as his peers.

 

I also have the mom guilt. I've always known his fine motor skills were poor, and he was diagnosed at age 2 with SPD, so I've always known that as well. But we didn't find the early intervention OT to be overly helpful for him, so we stopped it when he out-aged Help Me Grow at age three and didn't pursue private therapy until now. We should have done something for him earlier. Maybe he wouldn't be struggling so now :sad: .

[Storygirl]

Pondering things a little more this morning, I'm inclined to think that the NP's evaluation of DS's visual perception is more likely to be accurate, since they ran multiple tests, and the OT ran one. His good performance on that one test may have been an outlier.

[Terabith]

As someone who has horrible, horrible, REALLY horrible spatial skills, how do you improve those? 

[wapiti]

To me, intuitively it sounds odd that a competitive gymnast would struggle with some sort of spatial processing, though it's likely that I am misunderstanding something. Maybe I am confusing spatial processing with proprioception? or might near-vision spatial processing (if there is such a thing?) be different?

[Storygirl]

To me, intuitively it sounds odd that a competitive gymnast would struggle with some sort of spatial processing, though it's likely that I am misunderstanding something. Maybe I am confusing spatial processing with proprioception? or might near-vision spatial processing (if there is such a thing?) be different?

 

I think it's odd, too. When we mentioned that DS is a gymnast, the NP asked how he does. We mentioned that he placed dead last in his age and level category at the state competition this year. They just nodded as if that is what they would expect. DS has skills, but he seems unable to pull everything together at one time well enough to progress or succeed as well as his peers. It also takes him longer to learn everything. And he has performance anxiety.

 

I'm not sure if gymnastics uses the same kind of spatial processing that he had trouble with on the tests. According to the OT, he definitely has trouble with prioproception. I agree that it is curious. At the same time, we see that gymnastics is excellent for him, because it works on his weaknesses at the same time that it allows him to use his strengths. And as a sensory seeking risk taker, it satisfies a lot of those desires.

[PeterPan]

Don't guilt yourself on not getting the OT evals for that 2nd go-round until 10, mercy.  My dd didn't even get them the FIRST time till 12.  

 

What you might find, as you dig through this, is contradictions you're not expecting.  He might be VSL with a developmental vision problem.  So you might see some scores on the vision testing bumped by VSL strengths and others down because of the DCD/motor control problems.  It's sort of the "God closes a door and opens a window" thing.

 

Yes, working on proprioception (sense of self in space) would in theory help his gymnastics.  It's ok for him not to be the best at the gymnastics if he's having a good time and getting SOME benefit.  It has taken me a long time to realize that about sports and I may need to eat more crow and deal with that before I'm done.  

 

On the NVLD vs. whatever thing, may I humbly suggest just riding on it, letting whatever they said stand, and figuring it will all pan out over the next few years?  You'll probably do another eval before college, so you'll have another chance to sort this out with more age and more things becoming obvious.

[Storygirl]

Thanks, Elizabeth! I've had to come to terms with his lower performance in gymnastics over the last couple of years, as we have seen his potential being undermined by his limitations. It's been hard. And it is an expensive sport to commit to when you are not excelling. However, we see so many benefits for him that it is worth it. We're hoping that he will be willing to continue after we move. Changing gyms will be a big deal for him. I've been thinking recently about what to tell his coaches about his struggles. I don't want them to think that he is not trying or not listening or not worth their time when they don't see the improvements that they expect. I don't want them to give up on him. They haven't so far, but if they think that he is not giving his full effort, it will inevitably have an impact on what they think of him.

[PeterPan]

I can't say how every coach handles it, but at least around here with ice skating it seems like they *know* kids are going to come in with a variety of ability levels and that the point is to enjoy yourself and grow as a human, not to go to the Olympics.  There are lots of other reasons to do sports besides progressing and winning.  

 

You've motivated me to work on getting him an OT eval.  I hadn't thought seriously through what all might *not* get worked on with the gymnastics sessions.  He's getting so much stronger, it's fabulous.  However you're right it might not be helping his fine motor at all.  So, sigh, that's now on my hit list.  Just trying to decide who to use.  I could go locally and get someone not stellar but convenient.  I could drive further and get my pick of plenty of good (even great!) ones but have a longer drive that demotivates me.  I just have handwriting on my mind, sigh.  He's approaching the start of formal K5 and I'm gun-shy.  In reality, that's the thing I *most* want help with and I hadn't put that into words till just now.

 

Sorry to side-track you, hehe.  I just find your situation fascinatingly similar.  :)