Can we talk APD screening?

[PeterPan]

You knew that was coming, right?  LOL  I'm not totally laughing here, just acknowledging that people here have written me privately and suggested it.  Anyways, we ran the tool with the SLP today, and he bombed it in various shades.  I knew he would and she didn't, so she was surprised.  She's stopped the whole "homeschooling is so great because you just teach them where they are and it takes care of it!" thing.  I'm not Wonder Woman.  I think the 13th percentile scores jolted her.  They weren't all that bad, but I haven't seen them all yet. 50th%ile on word recognition (same or different), 37th on segmenting and 13th percentile on blending.  There are 5 more sections (I think?) and I don't have those scores yet.  I know the inferences he bombed, because she said so afterward to me (with him obviously NOT in the room).  

 

We're going to try to get an acuity test pronto to make sure that's not part of the mix.  Obviously they won't do an actual APD booth eval till he's 7.

 

What are the other possible explanations of those auditory processing screening test scores?  See to me, the inferences stuff was spectrum, not APD.  The not coming into your world was spectrum, not acuity.  The phonemic awareness was dyslexia, not APD.  And I suppose all of that could have a totally different explanation, like NVLD?  We don't think ID/low IQ.  We just don't.  Could be, but we don't.  He doesn't seem particularly to have slow processing speed.  But I've been wrong before, sigh.

 

I'm not depressed here.  I'm so tired from the long day, I can't even wrangle with which of those possibilities I'm most afraid of, kwim?  I'm glad I finally have numbers showing what I've been saying, that something is wrong.  (The whole: He'll outgrow it, Homeschooling cures it, blah blah thing was getting really old.)  But is APD the ONLY possibility with the poor results on that test??  That just doesn't make sense to me.  

 

Oh, to be clear, we're running a bunch of tests with the SLP so we can hand them to the psych in three weeks as a pile of data to let him synthesize into his verdict.  That's where we're at.

[Guest]

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[geodob]

With the segmenting and blending tests?

Did the SLP also do these tests with headphones, and just testing one ear, and then the other ear?

As with one sub-type of APD, one ear processes sound slightly slower than the other ear.

Where perhaps you can imagine how this effects hearing?

As it sort of 'blurs' sound?

So that with segmenting sound, the segments heard on each ear, don't match up ?

 

Though this can be identified by testing each ear in isolation, with headphones.

Where their will be a significant improvement, without a competing ear.

 

[PeterPan]

With the segmenting and blending tests?

Did the SLP also do these tests with headphones, and just testing one ear, and then the other ear?

As with one sub-type of APD, one ear processes sound slightly slower than the other ear.

Where perhaps you can imagine how this effects hearing?

As it sort of 'blurs' sound?

So that with segmenting sound, the segments heard on each ear, don't match up ?

 

Though this can be identified by testing each ear in isolation, with headphones.

Where their will be a significant improvement, without a competing ear.

Interesting question!  An SLP doesn't do anything with headphones, isolating ears, etc.  That all falls to the audiologist.  An audiologist won't run that type of booth screening till the dc is 7.  

 

I guess what I'm wondering is whether ALL kids with spectrum or dyslexia would test the same way on that test?  That's what is confusing to me, that the test is looking at the same things a CTOPP would look at, I would think.  I haven't seen the CTOPP.  Of course this was all auditory, not written.  Even so, wouldn't a dyslexic have scored similarly on this??  

[PeterPan]

Kbutton found this article:

 

Auditory Processing Disorders in Children: Beyond the Audiogram Gail M. Whitelaw Auditory Processing Disorders (CAP/APD) 11184

[PeterPan]

A link I don't want to lose.  Has a least of suggested treatments for CAPD  http://www.tacanow.org/family-resources/auditory-processing-and-autism/

[Lecka]

http://www.amazon.com/Teaching-Your-Child-Love-Skill-ebook/dp/B008PQ5C5Y/ref=sr_1_2?ie=UTF8&qid=1411230855&sr=8-2&keywords=joyce+autism

 

This is a link to a book that is in my local library.  It has a two page or so list of various issues with visual processing and auditory processing, that can go along with autism.  It is the best book in our library for explaining auditory/visual processing in an autism context.   

 

I have seen things where people are described as having autism and then specific auditory or visual processing issues are mentioned.  I have seen things where people are mentioned as having autism and apd . 

 

I honestly think -- it is one of those things where they can be a little circular, and you address both sides.  Like -- is it attending (more autism) or distinguishing the sounds (more apd).  Well -- they go together.  If you are attending better, you can distinguish the sounds better.  If you are distinguishing the sounds better, you will have an easier time with attending.  Or it could be more one or more the other.

 

With this book -- the woman's son has got all kinds of issues, and she talks about how she breaks it down to target different things, and what things will be more difficult for him b/c of one thing or another.  

 

It is not a book I have gotten a lot of "okay now do this" information from, but I have liked reading it.  

 

But in case you did not know -- auditory and visual processing issues are pretty common in kids with autism.  It is not like it is only autism, or everyone with autism will have an auditory or visual processing issue, but it is on the common side I think.  

 

I also think -- your son is young, and a lot of these things are skills that can improve.    It is not like an IQ test where the results are supposed to be the same from every year.  These are things where you can have a before test, and then some remediation or therapy, and then an after test, and a lot of scores go up.  This is stuff where speech therapy/Lips/Orton Gillingham etc. does result in scores going up for many kids.  

 

I might be able to find my older son's stuff, I know he had scores in areas like this that did improve.  

 

Separately, I think there is overlap between different things.  I don't think that everyone with autism or with dyslexia would score a certain way.  But, some with autism and some with dyslexia could score a certain way.  

 

I think that when the Eides say that "you can't have dyslexia and autism" ----- this is not what they mean. They mean, like the totality of dyslexia, with their own definition (that I think is great), that they use and that is in their book.  But they do not own the definition of dyslexia, I think maybe no one does, it is not in DSM V.  But I do think -- kids with either diagnosis can have the same underlying things sometimes and need the same multisensory reading approaches.  But that is not what the Eides mean when they talk about dyslexia.  But it is what a lot of people mean.  A lot of people say dyslexia and mean "this child would benefit from multisensory,sequential reading instruction, and from accommodations such as books on tape and dictation software."  Then there are other people who mean -- what the Eides say in their book.  

 

Anyway -- that is my own explanation for the whole "you can't have autism and dyslexia" thing.  You can both have some auditory processing challenge, though.  

 

Oh, I also have seen, with writing about autism, people who lump what could be called "auditory processing" into "sensory processing."  But then they could be talking about the same thing with different terms.   

[PeterPan]

Thanks Lecka, that hits a lot of it.  Your contrasts make sense.  This is killing me, because CAPD/APD hadn't really been on my radar.  And it doesn't feel like we traded OUT a label for another one.  It seems like all we're doing is adding labels onto the list.  It's sort of killing me.  That's all.

 

And yes, if you miss enough (APD) eventually you'd stop trying and withdraw, I would think.  I don't know.

 

Today he went to visit his aunt, who gave him treats and snacks.  I told him his aunt loves him.  Then I said your aunt gave you treats.  Then I asked WHY his aunt gave him treats.  His reply?  "I'm quick and have good ideas."  This is the type of testing (inferences) the APD screening had, but I wanted *dh* to see it.  He has totally thought ds's oddities were this passing thing, something he'd outgrow, and it's becoming very obvious now he's NOT going to outgrow it.  Editing to add: The APD screening didn't use anything requiring empathy or perspective-taking, I don't think.  It was more like: it's raining outside.  Suzy put on boots.  Why did Suzy put on boots?

 

Weird thing is, I'm realizing that same break in the logical thought processes has been there with puzzles, with how he solves problems in his life, etc.  I've been SAYING all the signs and I didn't see them, didn't see how they connected.  

 

So I'm even more stunned.

 

I wondered about that, whether the therapies and interventions would move the scores.  They definitely can, because I think some of the scores we saw on the screening reflected the work I've been doing with him.  The ones that *seemed* ok were the ones where we've been working with therapy materials on those specific skills.  The ones that were drunken sailor low were the ones we haven't tried to intervene on yet.  So at some point does intervention make it hard to identify but still leave the problems?  Or they're still always behind their peers, just not AS far?  I don't know.  I've become convinced that the whole "do therapy and it disappears" thing isn't true.  One manifestation disappears, and another lurks in the corner or just around the best.  There's always some other aspect you didn't hit or the way it reappears when they have a growth spurt and need more help.

 

I'll go look at your link.  Thanks.   :)

[PeterPan]

Lecka, while we're here, can I ask one more thing?  How do they distinguish OCD from spectrum, and how common is it to let the ASD label include the OCD or to separate them out?

[Lecka]

I don't know.  

 

I can tell you what counted as repetitive actions (or whatever?) when my son was diagnosed with autistic disorder.

 

He had places where he liked to pace in our backyard.  He liked to walk back and forth along a path of stepping stones.  He also, at the time, was having a phase of saying "I knocked down a building."  It is about the only time he has ever said echolalic anything, but he was saying that around the time we went for his diagnosis.  He was observed to play with some toys repetitively -- this meant fiddling with them instead of more playing with them.  Like -- moving a part back and forth, on a toy phone.  (And it was one month before he turned 4 -- so legitimate for them to expect more than fiddling when playing with a toy car and toy phone.)  (He would do much better now!  But still does some repetitive things, for sure, here and there.)

 

That was it.  It was like -- he had enough to qualify for that section, but he is not a hugely repetitive kid.  

 

So I don't know much about it -- it is not something I have ever looked into much.

 

http://www.tonyattwood.com.au/index.php/component/djcatalog2/item/31-children/183-obsessions-in-children-with-autism-or-asperger-s-syndrome-content-analysis-in-terms-of-core-domains-of-cognition  This is a link I saw searching "Tony Attwood OCD" I have a vague memory like he mentions it in a book I have read by him?  I think when I have seen it mentioned it has been more with Aspergers or HFA, but I really don't know, I haven't paid attention.  

 

Edit: my son enjoys repetitive pacing, but he does not have a problem with stopping to do something else he also enjoys, and if we are doing different stuff and he doesn't have a chance to go and pace, it is okay.  I think it is a good break for him, though, at various times.  I don't think it seems anything like OCD -- he does not mind if he doesn't get to do it, or think he has to do it, or anything.  It is pretty repetitive, though.  I have never asked about it -- just my impression, that for him it seems like it just fits "autism."    

[texasmama]

Lecka, while we're here, can I ask one more thing?  How do they distinguish OCD from spectrum, and how common is it to let the ASD label include the OCD or to separate them out?

I'm not Lecka, but I have my professional two cents to add on this one.

 

ASD (as you know) is very often comorbid with ADHD and/or an Anxiety Disorder.  OCD is a specific anxiety disorder.  If a child meets criteria for ASD AND OCD or an Anxiety D/O according to the DSM, then in my experience (and I agree with this), both diagnoses should be given.  I think it is usually pretty clear (at least with kids on the higher end of the ASD) when the repetitive behavior is due to ASD and when it is due to anxiety.  With kids who have classic autism, I would imagine it to be more difficult to tease them out.  With the now defunct Aspergers or HFA, it is more clear, IME.

 

P.S.  I am addicted to parenthetical statements.... (and ellipses...)

[PeterPan]

I'm not Lecka, but I have my professional two cents to add on this one.

 

ASD (as you know) is very often comorbid with ADHD and/or an Anxiety Disorder.  OCD is a specific anxiety disorder.  If a child meets criteria for ASD AND OCD or an Anxiety D/O according to the DSM, then in my experience (and I agree with this), both diagnoses should be given.  I think it is usually pretty clear (at least with kids on the higher end of the ASD) when the repetitive behavior is due to ASD and when it is due to anxiety.  With kids who have classic autism, I would imagine it to be more difficult to tease them out.  With the now defunct Aspergers or HFA, it is more clear, IME.

 

P.S.  I am addicted to parenthetical statements.... (and ellipses...)

Ok, thanks for explaining this.  It actually sets my mind at ease.  I just started reading things and thought man, what if they look at the things my ds does that are repetitive and say it's OCD...  And then that was one more thing on my mind, and then I was a mess.  But you're right, if there needs to be clinical anxiety, he doesn't have it.  (at least as far as I know)  I spent some time with a boy who was diagnosed OCD, and indeed with that brief encounter the anxiety was dominant and driving things.  

 

Well thanks, you've lowered my anxiety.  :)

[Lecka]

I think a certain amount of my son's former repetitive actions have been replaced with "productive" actions, just because he has learned more.  

 

Now if there is a toy to play with, he knows how to play with it better.  In the backyard, now he knows how to kick a ball around.  

 

He still does some repetitive things here and there, but seeing how he has replaced some old repetitive actions with new actions, I don't think he was playing that way in the past, from anxiety.  I think he just liked it, and also did not know a different way or ways.  When he is taught -- he often likes to play the new way, but sometimes still likes to play the old way.  

 

When he plays more "typically," he still does not bring in a lot of "novel elements" or make up a lot of stuff.  He still plays more simply.  I think this is just where he is on his developmental timeline.  His play is more advanced than it used to be, though.  He can also play with new toys and copy other kids or just know in general how to play with a kind of toy.  

 

For example -- I took him to a church event at a member's home, and kids were playing in a playroom.  There was a Fisher Price garage type thing, and my son sat and played with some cars, and had them drive up into the garage, and made car noises... and it was a new set of toys he had never seen before.  That is something that is very good for him, he used to not be able to do that.  Then -- if he didn't have a sense of how he was supposed to play with stuff, he might just fiddle with it or mess with, opening and shutting a door or spinning the wheels on the car, or whatever.  

 

I do think that a lot of his resistance to doing new things may be related to anxiety, though.  But, so often, the first time there is a new thing he does extremely bad, the second time he does a little bad, and the third time he does great, and then does great from then on.  I think it is anxiety from not being able to predict what is going to happen, where my daughter (frex) can fill in a lot of blanks and have an idea of what is going on, that is a lot harder for him. 

[PeterPan]

I don't know.  

 

I can tell you what counted as repetitive actions (or whatever?) when my son was diagnosed with autistic disorder.

 

He had places where he liked to pace in our backyard.  He liked to walk back and forth along a path of stepping stones.  He also, at the time, was having a phase of saying "I knocked down a building."  It is about the only time he has ever said echolalic anything, but he was saying that around the time we went for his diagnosis.  He was observed to play with some toys repetitively -- this meant fiddling with them instead of more playing with them.  Like -- moving a part back and forth, on a toy phone.  (And it was one month before he turned 4 -- so legitimate for them to expect more than fiddling when playing with a toy car and toy phone.)  (He would do much better now!  But still does some repetitive things, for sure, here and there.)

 

That was it.  It was like -- he had enough to qualify for that section, but he is not a hugely repetitive kid.  

 

So I don't know much about it -- it is not something I have ever looked into much.

 

http://www.tonyattwood.com.au/index.php/component/djcatalog2/item/31-children/183-obsessions-in-children-with-autism-or-asperger-s-syndrome-content-analysis-in-terms-of-core-domains-of-cognition  This is a link I saw searching "Tony Attwood OCD" I have a vague memory like he mentions it in a book I have read by him?  I think when I have seen it mentioned it has been more with Aspergers or HFA, but I really don't know, I haven't paid attention.  

 

Edit: my son enjoys repetitive pacing, but he does not have a problem with stopping to do something else he also enjoys, and if we are doing different stuff and he doesn't have a chance to go and pace, it is okay.  I think it is a good break for him, though, at various times.  I don't think it seems anything like OCD -- he does not mind if he doesn't get to do it, or think he has to do it, or anything.  It is pretty repetitive, though.  I have never asked about it -- just my impression, that for him it seems like it just fits "autism."    

Lecka, that's fascinating.  Thanks for sharing.  

[PeterPan]

Lecka, I'll just ask, since that seems to be what you're walking up to.  Are you saying the autism diagnosis was made on so little evidence that it surprised you?

[Lecka]

No -- I was sure he had autism.  He had a real lack in joint attention and very poor language skills.  He totally, completely fits the "lack of joint attention, lack of manding" model that is a model for early autism intervention.  Manding means requesting -- he did not know how to request.  He could know the name for something (tacting) but not how to ask for it.

 

I was worried he would not have enough repetitive actions to qualify for diagnosis.  They said he did not have a lot -- but enough to qualify.  

 

(There is a model of early intervention for children with very poor language/communication skills, called Verbal Behavior, where a word is not just a word, it is a word and how it is being used, like -- to ask for something, to label something, to answer a question, or to repeat the word.  That is how he was -- he could learn the name of something, but not be able to ask for it.)  

 

I was worried he would not qualify in every area, though, some things are on the spotty side for him.  

 

He also had extremely low imitation skills, which at the time I didn't realize, but once he started learning imitation skills, I realized that he hadn't had any before -- for him, a very "autism" thing.  

 

But he is not super repetitive or super sensory.  I wondered if he would not be diagnosed for those reasons.  It surprised me they seemed like "oh, sure, we can count that for repetitive action."  Not in a bad way, though, more like I didn't know if they would or not?  

 

I kind-of new he needed help of some kind and that he needed to get diagnosed to get it -- so I kind-of hoped they would diagnose him, but I also worried he would not qualify.  I was pretty shocked he qualified with "autistic disorder" but -- it has been nice to have it down on paper, I think, I think it has made things easier.  

 

So, I went in, wanting him to be diagnosed, but honestly afraid I would be told there was nothing wrong.  But also -- if there was nothing wrong, that would be nice to hear, too.  I was not sure what to expect, and I did expect autism, but I was not sure.  

 

Edit:  I think, too, they also totally thought he had autism, and that contributed to the "check the block, sure, that can count for repetitive actions" thing.  It was not like "hmmm, it is on the bubble, let's really look at the repetitive actions thing."  It was more like "he totally has got autism based on the language and joint attention stuff, so let's easily check the box for repetitive actions."  Or -- that is how it came across to me.  

 

Edit again:  I was surprised that it didn't seem to take much at all for repetitive actions.  That is true -- I was surprised.  

 

Another edit:  when I look at VB-MAPP and ABLLS and what they are covering -- there is no doubt to me my son has autism.  When I read The Verbal Behavior Approach, there is no doubt my son has autism. When I read An Early Start for Your Child with Autism, I have no doubt my son has autism.  Those are checklists and treatment approaches that totally fit him -- they are just what he is like (or was like).  

 

But -- he really does not have a lot of repetitive actions.  And it is not just me -- people comment on it, also on his lack of echolalia.  A lot of kids similar to him do have more repetitive actions and more echolalia -- he just happens not to.  He is also really good at pronouns, and has high social motivation.  It is all -- his own profile.  There are a lot of areas and a range for each area.  Some areas are spotty for him, and then others are more "ding ding ding." 

 

 

[kbutton]

Lecka, this is all very interesting, particularly the manding and the repetitve behaviors. My son was late diagnosed with PDD-NOS (9) is and 2e, but it's interesting to hear your explanations on the communication side. My son made it abundantly clear that he wanted something, but he didn't ask. If someone asked me when he was little if he could ask for things, I thought, of course he can. He had a very specific noise he would make, and then he'd gesture to what he wanted. He could explain things with both words and gestures--complicated stuff, like the process for lighting a fire in our wood stove! But he didn't ask for stuff really, and I thought he was just being picky about talking--he was kind of perfectionistic about using language, and now that you are describing this manding thing, I think maybe he just hadn't put it all together (he did get better about that later if he wanted to know "why" and such), but he still doesn't adequately know how to request help or evaluate if he needs it.

 

When he does stuff that feels good to him like you are saying your son does, he doesn't have anxiety when he can't do it either (but he does have general anxiety at times). We've had people think possible OCD around those behaviors, but again, they don't drive him--they are nice add-ons that he enjoys as often as he can. They relax him, not tie him up or hold him hostage. 

 

He doesn't have a lot of repetitive behaviors. He has a few things he does when he's not at ease (face rubbing, etc.), but most of his repetitive behaviors are repetitive vocal stims, not echolalia. 

 

The way you explain things is so very interesting--you put practicality to the lingo and jargon in a way that makes it seem more real and applicable. Thanks!