Just Received Assessment Results. Would Love Your Thoughts.

[Lots of boys]

Hi,

 

We just received the results of my youngest sons Neuropsych eval. A few years ago he was evaluated (about 4 years ago) and was given the diagnosis of ASD. He had also been assessed as having Apraxia of speech around age 3.

 

We sought this eval because he has REALLY struggled with learning to read and has made very slow progress over the last three years of homeschooling in this area.

 

Well, he was given the diagnosis of Dyslexia this time around - moderate to severe. Here are his overall results:

 

*removed*

Edited July 26, 2016 by Lots of boys

[PeterPan]

I'm not a whiz on the WISC.  They calculated an overall and then a GAI?  I always forget which way the discrepancy runs for NVLD.  Is the IQ they're kicking out about what you would have expected?  The IQ could be supressed by the effects of the SLDs.  I'd go by your gut sense there.

 

Did they run any language testing?  CELF or CASL?  It would be really helpful to see how much those are impacting his reading, writing, and just how they're progressing given the ASD.  

 

Did they run an APD screening tool?  I'm not saying I see anything there, just wondering if they did.  It would be another thing to eliminate when you're asking why the reading isn't coming together in spite of interventions.

 

Is he receiving interventions for his ASD?  Social thinking, yes, but also any effects on language, etc. 

 

Did they diagnose SLD writing as well?  I'm not saying they should have, just wondering if they did.

 

And then the elephant in the room, the reading.  What have you done for reading instruction so far, and how has it gone?  Have you done the Barton pre-test?  It's free.

 

Were the CTOPP scores this time higher than they were a previous time?  I was a little confused by your comment that he did reasonably well.  

 

You're wanting to know curriculum?  What have you done so far?  Does he work well with you or do you want to bring in tutors?  I think the first question is who you want to do the interventions.  Well you back up and make sure you have all the data, which you might not yet.  You have some good pieces here, but it would still be good to have updated language testing and maybe an APD screening.  If there are some language issues going on, they're definitely going to hold back his reading, no matter how much work on decoding you do.  And what I'm finding is that even OG-certified people who are supposedly dyslexia experts AREN'T really that versed once you say oh btw also ASD.  So I would gather all that info and consider the process a very AND kind of thing.  It's going to be dyslexia intervention AND language intervention AND...  kwim?  

 

If you do the Barton pre-test and he fails it, I can give you the dropbox link for my doc showing how I blended LIPS and Barton and PROMPT.  Are you still getting speech therapy or are you done?  PROMPT or a different technique?  My ds still gets PROMPT, so it was natural for me to blend it with LIPS.  Worked fabulously.  

 

Congrats on getting the eval.  Fwiw, my ds, who has a similar mix, is a pretty straightforward person on the dyslexia side.  What makes it hard is the combo of the apraxia and the dyslexia.  You have to get in there and physically let them feel and see the sounds and figure out how it all works.  But once we got that rolling, really not a big deal.  So that's where you put your big effort, your golden push.  

[Lots of boys]

Thanks OhElizabeth!

 

The Psych didn't give an overall I.Q. score. She said there was too large of a gap between percentages for an I.Q. to be meaningful. The three tests above were all she administered (over 5 individual sessions).

 

He had a year of intensive ASD intervention (everyday for 4 hours) from 5 - 6yrs. He hasn't had any since. He has had speech therapy from 2 - 6 twice a week but hasn't had any since. His speech is pretty good now but he still struggles with "r" and "l" sounds. Due to his Apraxia, he just likes to leave his tongue in the middle of his mouth for all sounds. He has a really hard time elevating his tongue tip to make sounds that require this type of movement. The problem is even more severe in real life speech (where he is trying to say an entire sentence at one time, often hurried or excited, verses single words with lots of time at a speech therapists). We have struggled a lot with him not being able to take what he learns in therapy and apply it to every day speech.

 

He didn't get any other SLD other than the reading. Writing is low too but I think now the scores have to be under the 5% to qualify for an official SLD. In the past, I think they could diagnose one based on the percentile spread.

 

This was our first time have the CTOPP done. My comments about him seemingly doing well on this test was because the Psych said that based on this test alone, he actually didn't really SHOW a dyslexia diagnosis. She said he did pretty well on that test but then the Woodcock Johnson showed much lower scores. We have been using Apples and Pears very slowly for two years, every day, mixed with a little ETC books so I wonder if he did better on the CTOPP because he has had SOOOOO much phonics work over the last two years. He can tell you what any morpheme says if you hold up a flash card, he just struggles to apply this knowledge to reading full words. He is still very much reading CVC or CCVC words only at this point and still sounding them out slowly each time despite the intensive reading/phonics instruction.

 

The only intervention the Psych recommended was getting him back in to Speech. I know we should, and I will, b ut he got so tired of it after going twice a week for 5 years. I felt like he wasn't making any more progress and all the activities they were doing seemed easy to replicate at home.

 

Anyway, I do really appreciate your response. I am feeling at a loss for how to move forward. I'm scared he may never read well and I am so disheartened by the extremely low reading scores despite how much time we have put into reading instruction. He is a good little worker - mostly cooperative as long as we work in short sessions. He really WANTS to read so I am so sad for him that it is such a struggle.

 

Thanks again.

Edited July 24, 2016 by Lots of boys

[OneStepAtATime]

While you work on the technical side of reading, are you pursuing other avenues for literature explore? How does he do with audio books? Have you tried whispersync? Could he use something like a Kindle with headsets and several book options loaded so he could pick which books he wants to listen to? It would at least give him exposure to more advanced reading material and would help his exposure to vocabulary and grammar and concepts while still giving him a sense of control.

[Terabith]

Have you looked into PROMPT for speech?  That's the gold standard for apraxia. 

[Tiramisu]

I also have a kiddo who could not be given an FSIQ or a GAI. She has visual and visual motor weaknesses which mess up a lot of the sub tests.

 

OhE, with NVLD the verbal reasoning will be higher than perceptual. Two standard deviations? My kids have that but other evidence ruled out NVLD and I think it's the visual processing causing that.

[Lots of boys]

While you work on the technical side of reading, are you pursuing other avenues for literature explore? How does he do with audio books? Have you tried whispersync? Could he use something like a Kindle with headsets and several book options loaded so he could pick which books he wants to listen to? It would at least give him exposure to more advanced reading material and would help his exposure to vocabulary and grammar and concepts while still giving him a sense of control.

We have regularly exposed him to audio books since birth. Our routine with school each day is for him to start with 30minutes of audio book time. It took him much longer to appreciate audio books than his brothers. He found it really hard to follow along without pictures until he was much older. We kept playing them and he coloured or played Lego while listening and eventually he started to like them a little more. We play books with a higher reading/interest level for him by audio like Dahl books, Wizard of Oz, anything by E.B. White etc. He has enjoyed them quite a bit this past year or so.

 

At night time we read to him from books that he is interested in but that he wouldn't be able to read to himself. Currently we are reading Miss Piggle-Wiggle.

 

He finds it hard to block out competing noises a lot. If he is talking to me and someone is talking, even quietly near us, he can't concentrate on what he wanted to say. This is the same when listening to audio books. It really needs to be silent for him to have any comprehension.

[PeterPan]

For the op, you really need to look into PROMPT.  It would readily solve your problem.  Yes, he's going to struggle to make that happen on his own.  He needs actual therapy that gets in and helps with the motor planning.  He'll probably only need PROMPT once a week.  When we're working very intensively and have the funding, my ds does 2 hours a week, one long session.  He takes a 10 minute break mid-way and I can talk with his SLP a bit then and then at the end for another 10 minutes.  

 

So even if you had to drive, like we do, you could probably do a double session and be done with it.  My ds really enjoys his therapy, so hopefully your ds would too.  :)

 

If you have trouble with the prompt institute provider location, pm me.  Or just keep putting in things lots of ways.  There are lots of people trained in it now, but for some reason their provider search is a PAIN.  So it's them, not you, and I'm happy to help if you get stuck.  It will be worth it.

 

My ds was diagnosed with scores like your ds', but it was based partly on discrepancy (gifted IQ, low scores).  I'm telling you this because I wouldn't want you to think oh it's not a legit diagnosis.  It IS!  It just means he's probably going to remediate a little more easily once you get really good methods.  Barton is NOT overkill for my ds.  

 

Now I will tell you my ds needs language work as well.  That's why I asked about your ds' language testing scores, because if that wasn't done it needs to be done.  Language will DEFINITELY affect his reading, so it's something you want tested.  The SLP can run the CASL or CELF when they do your intake eval.  You'd like to see the VMPAC for motor planning and then either the CASL or CELF.  I'd want the CASL, because it's more thorough.  But whatever you can get will do.

 

Yes he can learn to read!  That's the beauty of those scores.  He's just going to need all the components to come together.  He needs some more hands-on speech instruction (PROMPT), then phonological processing that carries over the PROMPT, then dyslexia--appropriate methodology, and language work to bring up any low language scores.

 

I LOVE the Grammar Processing Program books from Super Duper.  If you look at the samples and think oh that would be challenging for my ds! then I'd HIGHLY encourage you to get them.  They're SUPER easy to implement, and they raised my ds' language scores from very low to average even though we're not through the book.  We still have the other books in the series to go!  So when you pair those improved language scores PLUS the phonemic awareness work PLUS the decoding work in Barton, it all comes together.  It will come together in your ds too I think.  :)

[Lots of boys]

Have you looked into PROMPT for speech? That's the gold standard for apraxia.

I asked our SLP about this once and she said there wasn't any SLP PROMT specialists in our province (we are in Canada). I was shocked but we do live in a province with less people then most big cities. I find just locating an SLP somewhat familiar with Apraxia to be a real undertaking here.

 

I haven't asked in two years though so I will ask again and see if things have changed at all.

[PeterPan]

We have regularly exposed him to audio books since birth. Our routine with school each day is for him to start with 30minutes of audio book time. It took him much longer to appreciate audio books than his brothers. He found it really hard to follow along without pictures until he was much older. We kept playing them and he coloured or played Lego while listening and eventually he started to like them a little more. We play books with a higher reading/interest level for him by audio like Dahl books, Wizard of Oz, anything by E.B. White etc. He has enjoyed them quite a bit this past year or so.

 

At night time we read to him from books that he is interested in but that he wouldn't be able to read to himself. Currently we are reading Miss Piggle-Wiggle.

 

He finds it hard to block out competing noises a lot. If he is talking to me and someone is talking, even quietly near us, he can't concentrate on what he wanted to say. This is the same when listening to audio books. It really needs to be silent for him to have any comprehension.

Ok, so you need an APD screening and language testing.  That's what you just said.  If he has APD in the mix, you need to know.  He's finally old enough.  Our university will run the SCAN3 screening portion and do a basic audiology exam for $35.  Privately it would be $380 around here, but either way it's worth doing.

 

Did this psych diagnose ADHD as well?  And no APD screening and no language testing?  These things need to be done.

 

Reading is going to need all those skills to come together.  So keep going, get the rest of the testing.

 

You don't have to do anything PERFECTLY.  Seriously, your intervention doesn't have to be perfect.  If you can just find the areas (with a tad more testing) and do SOMETHING, you'll see how it fits together, see the progress, and keep going, and it will come together.

[PeterPan]

I asked our SLP about this once and she said there wasn't any SLP PROMT specialists in our province (we are in Canada). I was shocked but we do live in a province with less people then most big cities. I find just locating an SLP somewhat familiar with Apraxia to be a real undertaking here.

 

I haven't asked in two years though so I will ask again and see if things have changed at all.

 

You can go to the PROMPT Institute website and find out for yourself.  Things have changed a LOT in the last few years.  Availability has EXPLODED.  Off to see...

Edited July 24, 2016 by OhElizabeth

[PeterPan]

I'm popping up 36 in Canada who have completed Bridging or who are certified or instructors.

 

Advanced Member Search - The PROMPT Institute

 

Check instructor, certified, and bridging, then click continue.  On next page enter your location info, being kind of wide (like just canada) and see what you see.  I get 36.  

 

Certified or instructor would be idea.  Bridging if they're working on certification will do.  Or do your eval with a certified and then do therapy with someone closer.  

[OneStepAtATime]

We have regularly exposed him to audio books since birth. Our routine with school each day is for him to start with 30minutes of audio book time. It took him much longer to appreciate audio books than his brothers. He found it really hard to follow along without pictures until he was much older. We kept playing them and he coloured or played Lego while listening and eventually he started to like them a little more. We play books with a higher reading/interest level for him by audio like Dahl books, Wizard of Oz, anything by E.B. White etc. He has enjoyed them quite a bit this past year or so.

 

At night time we read to him from books that he is interested in but that he wouldn't be able to read to himself. Currently we are reading Miss Piggle-Wiggle.

 

He finds it hard to block out competing noises a lot. If he is talking to me and someone is talking, even quietly near us, he can't concentrate on what he wanted to say. This is the same when listening to audio books. It really needs to be silent for him to have any comprehension.

Have you tried headsets?  DS does better with noise canceling headsets for listening to audio books.  DH got him wireless ones so he can start his book and listen on his headsets while doing other things.  That way he is not tied to the Kindle.

[kbutton]

We have regularly exposed him to audio books since birth. Our routine with school each day is for him to start with 30minutes of audio book time. It took him much longer to appreciate audio books than his brothers. He found it really hard to follow along without pictures until he was much older. We kept playing them and he coloured or played Lego while listening and eventually he started to like them a little more. We play books with a higher reading/interest level for him by audio like Dahl books, Wizard of Oz, anything by E.B. White etc. He has enjoyed them quite a bit this past year or so.

 

At night time we read to him from books that he is interested in but that he wouldn't be able to read to himself. Currently we are reading Miss Piggle-Wiggle.

 

He finds it hard to block out competing noises a lot. If he is talking to me and someone is talking, even quietly near us, he can't concentrate on what he wanted to say. This is the same when listening to audio books. It really needs to be silent for him to have any comprehension.

 

i have one with ASD. I have one with auditory processing problems and apraxia.

 

The bolded stuff is strongly, strongly associated with auditory processing disorder (APD)--also called central auditory processing disorder (CAPD). It's often co-morbid with ASD. It may or may not be glitching up the reading. It certainly can, but so can the ASD. 

 

We don't have to be as low as 5% ile here to get intervention always, but it varies. If his verbal IQ is around 45th percentile, you'd expect anything verbal to be in that same general area.

 

You do know that 99% ile on the visual puzzles is gifted range, right? 

 

I would be getting an APD evaluation, a developmental vision screening, and some more language testing if possible (CELF or CASL). 

 

You said he knows all the phonemes. Can he build words with them? You said he has trouble using them in words--do you know if this is only in book text? What if you make it bigger, let him create the words and read them back, etc.? I am not a dyslexia expert, but if he can do those things with cards and larger text, it could be visual. Both of mine have had major visual issues and had therapy for them. In both cases, the vision issues didn't seem a big deal until the optometrist fatigued their eyes, found problems, and then started therapy. Then she said that she's surprised they learned to read prior to therapy because they were struggling so much. 

 

You find out about vision issues (beyond visual acuity) from a developmental optometrist (COVD). 

[Lots of boys]

 

You can go to the PROMPT Institute website and find out for yourself. Things have changed a LOT in the last few years. Availability has EXPLODED. Off to see...[/s

 

Thanks, I will do some more digging tonight and see if anyone comes up in our area. I would drive just about anywhere in our province if one was available.

 

You mention APD in another message. What are some of the symptoms? He has had a regular hearing test at the audiology department at our local hospital when he was first diagnosed with Apraxia. They put him in the sound proof booth etc. His hearing came back fine. I suspect the test for APD is slightly different but I'm not sure.

[Lots of boys]

i have one with ASD. I have one with auditory processing problems and apraxia.

 

The bolded stuff is strongly, strongly associated with auditory processing disorder (APD)--also called central auditory processing disorder (CAPD). It's often co-morbid with ASD. It may or may not be glitching up the reading. It certainly can, but so can the ASD.

 

We don't have to be as low as 5% ile here to get intervention always, but it varies. If his verbal IQ is around 45th percentile, you'd expect anything verbal to be in that same general area.

 

You do know that 99% ile on the visual puzzles is gifted range, right?

 

I would be getting an APD evaluation, a developmental vision screening, and some more language testing if possible (CELF or CASL).

 

You said he knows all the phonemes. Can he build words with them? You said he has trouble using them in words--do you know if this is only in book text? What if you make it bigger, let him create the words and read them back, etc.? I am not a dyslexia expert, but if he can do those things with cards and larger text, it could be visual. Both of mine have had major visual issues and had therapy for them. In both cases, the vision issues didn't seem a big deal until the optometrist fatigued their eyes, found problems, and then started therapy. Then she said that she's surprised they learned to read prior to therapy because they were struggling so much.

 

You find out about vision issues (beyond visual acuity) from a developmental optometrist (COVD).

Hi. Thanks for your message. Who would I ask about APD testing? I am going to make an appointment with a new SLP - one the Psych recommended was great with kiddos with ASD. I will ask the SLP for further language testing at that point.

 

He can't really build words very well with his knowledge of phonemes. He can read short words if I chunk the word up into the sound components but has trouble breaking a word into the phonemes by himself.

[kbutton]

Hi. Thanks for your message. Who would I ask about APD testing? I am going to make an appointment with a new SLP - one the Psych recommended was great with kiddos with ASD. I will ask the SLP for further language testing at that point.

 

He can't really build words very well with his knowledge of phonemes. He can read short words if I chunk the word up into the sound components but has trouble breaking a word into the phonemes by himself.

 

Audiology handles SPD, but there is an overlap with SLPs. A booth test is best, but the SCAN III can be run on a computer with fancy headphones by a psych if they have the credentials to do it. FWIW, our psych results were just as good as the audiology ones (heresy, I know!). I don't know if the psych can diagnose it though.

 

I would ask around for autism-specific strategies for reading in addition to looking at dyslexia resources. He may need a mash-up of both.

[PeterPan]

Just because the SLP sees a lot of ASD doesn't mean they've bothered to get trained in PROMPT.  It's a REAL pet peeve of mine.  Apraxia is present in 60% of the non-verbal ASD cases, and yet you have SLPs treating ASD who aren't trained in the most effective treatment.  Blows my mind.  One of the ASD charter schools in the big city near us got all 8 of the SLPs (yes, 8) trained in PROMPT.  It's THE method to look for.  If the SLP isn't trained in it, don't even bother with the intake appt.  Or do the PROMPT eval for the motor planning and also do the intake appt and focus on language (expressive/receptive) with the regular SLP.  There's more than enough language work to do double appts, mercy.  It's why I have done so much at home with my ds.  

 

The SCAN3 is the normal test for APD.  The first page is the screening portion.  You could call that audiology back and see if they have someone who specializes in APD who can do the SCAN3 for you.