Do I really need evaluations?

[kalusignan]

My dd8 (2nd grade) has obviously had some learning differences and quirks that I've noticed for quite some time. She has not had any evaluations, but I'm fairly convinced of slow processing. This is something that I've been working through with her on a daily basis. This manifests mostly during our math time, but obviously she has issues throughout her daily activities. For instance: knowing what needs to be done before we leave the house, forgetting to put her shoes on, forgetting her violin when we're going to violin lessons, daydreaming, needing explicit instructions for EVERYTHING (many times, step by step instructions, said multiple times), needing to be told to buckle her seat belt EVERY time we get in the car, etc.

 

I also suspect possibly ADD and/or mild dyscalculia/dyslexia. ?? This also manifests mostly during math. She has a hard time getting started, knowing what to do next, getting distracted, making silly mistakes, writing letters and number backwards, confusing 03 with 30, etc. We are now using RightStart, which we've been using for the last year. It's helping tremendously, but it still takes a lot of work and patience and hand-holding. She's not even close to being able to work independently, although she expresses that she would like to.

 

She does fairly well in reading. Although, learning to read was not an easy process for her, she's now reading at or above grade level. Spelling is a challenge, but still at a place that would be considered normal for her age. Same with writing and grammar, and ironically loves writing and doesn't have a problem thinking of words, sentences to write down. Her memory and reading and listening comprehension is very good, excellent even.

 

So, here's my question: Obviously, I could bring her in and run the full gamut and expense of neuropysch testing and evaluations, but I'm wondering what it would really tell me. I already know what her struggles are, and we are working through it daily. She's working mostly at grade level, and I don't have any intentions of enrolling her in public school. How would evaluations and possible diagnosis help me? I haven't ruled it out, but I'm curious if there's a reason I haven't thought of.

[Crimson Wife]

Sometimes symptoms that appear to be one thing actually turn out to be due to something completely different. BTDT and I wish that we'd known then what we know now because my DD could've gotten the proper interventions sooner. 

 

Also, depending on what the ultimate diagnosis or diagnoses are, building a "paper trail" from early on may be important.

[PeterPan]

You're not saying anything in there that screams dyslexia/dyscalculia, only ADHD.  Is there more going on to make you think SLDs?  If there are no SLDs, no dysgraphia, no developmental problems, then you can just go with a clinical psych.  They won't run as much, but really you don't need as much with just ADHD.  In our area a clinical psych eval is $800 and a neuropsych is $2200.  So yes, clinical psych will be totally adequate, at least for what you're describing.

 

Use the extra money and get an OT eval and a vision eval by a developmental optometrist.  She may turn out to have some retained reflexes, midline issues, or developmental vision problems going on to explain those reversals.  Reversals are not dyslexia.    So yes on the OT eval.  For the vision, go to COVD, find a developmental optometrist, call around to al your options, and when you've chosen one just start with the normal basic exam (you know, the $60-100 kind).  That way they can *screen* and tell you if there's a reason to do the full developmental vision exam.  

 

You want to do the psych eval, because the IQ testing will give you some breakdowns to help you target some things you can actually improve.  I didn't when I had questions with my dd (right around the age yours is right now), and it was one of my BIGGEST MISTAKES.  We didn't eval till she was turning 11 (VT and OT) and 12 (psych).  Huge mistake waiting so long.  There was lots of water under the bridge by that point.  So yes to the psych eval, because it will let you target some things better and work together better.  If you want, do the OT and VT evals *first*.  Sometimes either or both will improve executive function (EF) issues.  A LOT of what you're describing is EF.

 

How is she in background noise?  Does she ever seem not to respond?  Rigidity or anxiety when things are unknown?  Any differences in play or social response?  Shared imaginative play?

[PeterPan]

If you want to start reading on ADHD, do a google search of the boards and look for our previous threads on ADHD books.  Also look for threads where we've discussed EF.  Both will help you.  :)

 

To do a site search, use your terms and site:welltrainedmind.com 

[kbutton]

I think a basic clinical psych eval and OT, COVD exam is a great place to start. The clinical psych can let you know if there are suspicions of other stuff.

 

A lot of my son's ADHD issues are fading into the background after having fixed some vision issues. It's probably still there, but things are so dramatically better that I think part of the deal is that visual issues plus physical coordination issues (both kinds of things due to retained reflexes), auditory processing issues, speech motor issues, oral motor issues, etc. were totally draining his executive functioning resources. We're watching things sort out over time. The lynchpin was really fixing the reflexes, which worked on vision, core stability, etc. He had a tremendous need to thump, fidget, move, etc. because his body was not happy with itself. OT didn't help that. Vision therapy that worked on reflexes did--bonus, he can see things better too. His hands and eyes work together. His body recognizes he has core muscles.

 

You could have straight ADHD going on, but the COVD exam is inexpensive and worth every penny. If you feel funny asking for an evaluation when ADHD is likely behind it, mention any school symptoms, and tell the COVD that you are mentioning them because you know people whose ADHD symptoms ended up being tied to vision, and you don't want them to overlook anything. :-) It makes me feel better walking into an evaluation if I can articulate why I feel it's necessary (some practitioners seem baffled when people walk in their door--I can never figure out exactly why. They're getting paid, lol!).

[kalusignan]

 

How is she in background noise?  Does she ever seem not to respond?  Rigidity or anxiety when things are unknown?  Any differences in play or social response?  Shared imaginative play?

 

She doesn't do well with a lot of distraction, which is partly why my younger dd is going to preschool once a week and will continue twice a week next year. My dd8 actually prefers to do her school work when her little sister isn't running around, making noise, interrupting, etc. which I totally understand and give my dd8 a lot of credit for understanding about herself.

 

She usually responds to me...I haven't noticed anything really atrocious in that regard. For awhile I was getting frustrated with her not responding, but realized that she just needed more time. That's why I was thinking slow processing. Especially with math, after I ask a question, I wait a seemingly long time for an answer, and most times she will answer correctly. When I ask for her to explain how she figured the answer, her reasoning is spot on. It's just takes her more time than normal (I think) to get to the right answer.

 

She does have some anxiety about some things. This is going to sound weird, but mainly food-related. She's a very picky eater and is always asking what we're having for the next meal, worrying if she'll like it. I went so far as coming up with a weekly menu with pictures, placed on the fridge, so I wouldn't have to explain what the next meal was going to be constantly. We recently went out to a restaurant (fairly rare for us), and she could not pick something from the menu. I suggested mac and cheese since that's something she likes, but since she didn't know if it would be a kind that she likes, she expressed that she would rather not order ANYTHING than try the mac and cheese. I ordered the mac and cheese and she ate 2 bites...

 

She plays VERY well with other kids including her sister, has close neighborhood friends, adapts well to new environments, enjoys imaginative play, and is overall EXTREMELY creative. She's very bright and often surprises me at her creative, out-of-the-box thinking.

[PeterPan]

Yes, you know that's just about eliminating things.  You're definitely describing sensory issues, anxiety, ADHD.  The question about background noise was because that can indicate APD.  You're saying when it's distracting, and that's ADHD.  So then if she's in a noisy place and has trouble hearing you, a serious degree of that would make you say hey get to audiology.  But when it's just when it's distracting, that's the ADHD, yes.  It sounds like you're dealing with that the best you know how. Fwiw, you can *improve* that somewhat by working on sensory, working memory, etc.  But honestly, I gave up and finally gave my dd an office of her own.  You'll talk with people who have opinions like that and maybe say that isolating them makes it WORSE.  I could actually buy that.  Part of cognitive therapies and VT will include improving their ability to work with distractions.  You're actually going to want to work on that.  In our case, dd has some mild (borderline for bumping over to APD) issues that just, when combined with the sensory and the ADHD, make it too much.  But just as a general statement, yes that's something you could work on therapeutically.  For instance in vision therapy they'll turn on a radio or have other clients also working in the room, because they want to build that person's ability to use the skill AND handle distraction.  

 

It sounds like she has a lot of strengths and a great personality!  She's very self-aware, which is interesting.  

 

A good OT eval for sensory would give you some options, and you have options for how you want to handle the anxiety.  Personally, I don't suggest just waiting on it, hoping it will improve/go away.  It's really not necessary to do that.  Not only are there CBT and medications (the things people normally think of), but there are materials you can implement yourself.  SocialThinking.com sells some, but also we've had other threads where people have mentioned books.  So when you read those books and work on it with her, you're giving her a way to use strategies rather than just letting her be a victim of it.  That's what our behaviorist emphasizes with ds, that he can have strategies and make a good choice.  So I'd definitely urge you to pursue options for the sensory and anxiety, because both of those are things you could intervene on with good effect.

 

Fwiw, girls have so many strengths that sometimes they are masking the weaknesses.  I think it results in this discrimination and under-identification in girls.  The problems don't manifest with the violence or physical severity, necessarily, of boys, so we say see, it's a nothing, do I even need to bother...  But I guarantee you it's NOT pretty when your girl is 10, 12, 14, 16 and STILL struggling with these issues.  They're not going to just go away.  So yes I would eval for them, get some options for them.  We have lots of good options now.

 

Retained reflexes *should* be a topic a good OT is trained in.  Reality is, OTs don't learn all this stuff in grad school.  They take courses afterward and get trained in things.  So you actually have to ask upfront whether they eval for retained reflexes, what approach they use to integrating them, etc.  You will sometimes find OTs who are trained in Zones of Regulation.  Zones might be something that would help your dd.  It would pull together the sensory, the anxiety, and the self-regulation.  It's stuff you can ask about as you consider OTs.  You can also get Zones yourself.  5 Point Scale is another you might like.  And there are anxiety-specific books.  We're doing 5-point stuff with my ds right now, so it helps to quantify HOW BIG a problem this is and whether we can be flexible in our response or whether we REALLY have to be that anxious about the thing.  

 

Does she seem to fatigue when eating?  

 

 

Edited May 5, 2016 by OhElizabeth

[kalusignan]

Thank you all for your responses! You've given me a lot to think about, talk with my husband about, and research, since much of this I don't know anything about.

 

Unfortunately I'm VERY aware of what EF problems look like since my husband has a Traumatic Brain Injury which has affected him a lot in that area. But that's looking at how a grown adult deals with EF problems, not a child. He also went through years of vision therapy, OT, and much more, so I can at least draw on that knowledge and experience.

 

I'm sure after I look into this more, I will have more questions. lol

 

Thanks again!