Where to start with evals

[holdinon]

Sorry in advance for the long, rambling post.

 

I have had my head in the sand too long now, and really need to do something besides wonder what is going on with ds10.

 

For background, ds14 was diagnosed last year with dyslexia.  He's received dyslexia therapy and he does fairly well with school and quite well with "life" in general.

 

Ds10, I believe also to have dyslexia, but I think there's more to it.  For one thing, his dyslexia issues, such as phonemic awareness, and phonics/reading in general seem to be not as severe as ds14's.  However, there are other issues, that I can't determine whether they stem from dyslexia or are something else, that make him have a harder time that his older brother.

 

I have wondered about auditory processing, but when I read the symptoms, so many of them do not seem to be the case.  But there is definitely something "wrong" with his understanding.  He has me repeat things all the time.  He cannot follow (and in comprehend) directions that seem age appropriate.  He gets confused and has to clarify. 

 

But, beyond the hearing aspect, he also doesn't "get" other things as well......for example:  We pulled in the driveway yesterday after a windy storm.  A full trash bag (that had been by the garage waiting to go to the street tonight) had blown in front of the garage entry.  I asked him to get out and move the trash bag.  He got out, picked up the trash bag and walked into the garage, towards the door with it.  I tapped the horn to get his attention, he turned around, and I pointed in the direction of the other trash bags.  He looked at me, looked at where I was pointing, and then back at me.  He had no idea that I was meaning for him to put the bag back with the others.  (I have no idea if I'm painting this scene well enough, but trust me that a typical 10 year old would have understood what to do in the context).  And, this was not a one time thing.  Stuff like that all the time.

 

He has started playing football, and it is clear that he is always one step behind everyone else after getting the coaching instructions/plays.  He knows how to play football, and he knows the plays, etc.  But he seems to have to look around at everyone else before he comprehends what the coach has just told them. 

 

Also, his vocabulary is no where near that of any of my other kids.  I have always read aloud to him, and we talk about everything.....all the things you're "supposed to do".  But he still seems "slow" (I hate even saying that, but I don't know how else to describe it).

 

For a long time, I have thought it's just because he's the baby of 6 kids, and he was just late blooming, but I'm seeing that is simply not the case.

 

So.  I'm sorry this has been long and drawn out.  I wanted to try and give a decent picture of what's going.  

 

We are going to definitely do the dyslexia evals soon, but that is at a specific dyslexia center.  I know they don't "do" things like APD issues.  We live in an area that does not offer a lot in the area of evaluations---or at least I don't know of much.    What questions do I need to be asking around and/or what type of doctor/therapist should I be looking for?  I'm just clueless at the moment with anything beyond the dyslexia.

 

(This has taken longer to write up that I thought, and I've got to run.  Please ask anything that may be pertinent, and I'll be back later)

TIA!!

 

 

[Tiramisu]

Hi! I'm a mom of a grown girl with APD. I also have younger one without APD but with some significant visual processing weaknesses. They would both be the same as your son in the garbage bad situation. Reading that made me laugh. They are both rather bright but the confusion in day to day stuff is confounding.

 

Now, there are different kinds of APD. Usually, kids will have problems with speech and spelling. My DD never had those problems, and she's a musician. But she will mishear things, especially if anything else is going on around her. And takes her time to process what she hears.

 

Our story is long and I don't want to bore you, but the most important thing I can tell you is getting an APD eval at a children's hospital where they understood APD was one of the best things we did for her and our relationship. And it was covered by insurance.

 

The other kiddo went through the same AP testing, and doesn't have it. And this sounds bad but she doesn't seem quite as clueless in situations...even if she wouldn't know what to do with the trash bag either. Maybe it would be, first, being stuck in her own thoughts. And, second, maybe the visual glitch would keep her from understanding what the gesture meant.

 

My feeling is a neuropsychological eval is probably going to be the most helpful. Lots of people recommend that here, and I'm sure you'll get that. Not everyone needs one, particularly if the issues are limited to schooling. But why I think it might be advisable to you is because those daily life things are so confusing and frustrating. And, in my experience, they get more confusing and frustrating with age, as we expect them to be responsible for more on their own life. It really helps to know what that disconnect is, and a good np will give you that if anyone can.

 

Sometimes you can get insurance to cover an np eval but not if it's seen as a learning issue. We're supposed to have ours covered due to a past concussion but the wheels are grinding very slowly. Our np asked us some basic questions to try to figure out if it could qualify for insurance coverage.

 

If you've ever suspected visual problems, you could also start with an evaluation with an optometrist certified through covd.org. Ours was $200 and the optometrist confirmed visual issues but did not recommend therapy for them.

 

I hope this helps in some way. Hugs!

Edited August 19, 2016 by Tiramisu

[Tiramisu]

Also, a pediatrician should be able to check his ears for fluid and do a hearing screening.

[Storygirl]

I agree that a NP evaluation may be helpful to tease out what might be going on. One of my children has trouble with auditory information and general processing, and we are working to figure out his issues. We've seen struggles both at home and at school.

 

We started with a hearing exam, which I highly recommend. Mild hearing loss can go undiscovered but cause auditory troubles. I won't go into our whole story, but DS11 has been evaluated by an audiologist in a full hearing booth and also screened for auditory processing issues. He was then referred to an ENT, who didn't think he had hearing loss or APD. The ENT had a team of evaluators that worked with him, one of whom was a SLP. The SLP ran some receptive and expressive language testing.

 

We are glad that we have checked through all of these areas. It's been good to rule some things out, even though we have not landed on the answer yet. The ENT team also referred us to the neuropsychologist to do more in-depth testing. We got on that waiting list in March and will (finally) have our first appointment with the NP in September.

 

That's all to say that it can be tricky to put a finger on what is causing these kinds of problems, and it may take seeing more than one specialist. I would start with a hearing exam. You can find a private audiologist, or check with any nearby research university. We were able to have our hearing screening done at the university, free of charge.

 

After all this time, I can tell you what I suspect we may hear for DS11 (he does not have dyslexia). I think he may have a combination of ADHD inattention type and slow processing speed, exacerbated by anxiety.

 

I think ADHD inattention can interfere with the individual attending to what is being said or explained. ADHD and dyslexia often are co-morbid. Working memory can also play havoc, when there are multiple things for the person to process at one time. A NP can help figure much of this out, but having an audiology screening is a good idea.

 

 

 

 

[PeterPan]

Where you start is going to depend on the audiologist.  Not every audiologist has the full booth setup to do a good APD eval.  What *I* would do is get a basic audiology exam and SCREENING (SCAN3 screening portion) from the audiologist you would want to use if there is APD.  That way you can hit just your basic, obvious things like is there an audiological explanation for this.  I would also get an SLP eval, because it sounds like his language is affected.  The SLP, hopefully, will do the CASL or CELF or something similar.  Now if you go to a neuropsych, they'll usually be able to run that language testing as well.

 

You're at a good age to make some moves on this, so it's really just what you have access to, what it's going to cost you, etc.  You could literally do the audiology and the SLP and the np and not have it be overkill.  I've done that with my more complex ds.  But I had access to a university that would do the audiology and screening for $35.  Easy for me to recommend at that price, kwim?  

 

So you're going to have to start somewhere, with what you can afford, with what you can make happen.  I like an SLP eval as part of the mix, because the more detailed testing they do (more detailed than the np) will give you information to make actionable plans.  You'll be able to take those scores, go to SuperDuperInc, buy some stuff, get some stuff going.  The audiology is going to give you explanation for *why* the glitches are happening possible or at least eliminate it as an explanation.  And the psych is what is going to take to sort it out ultimately, because you need to know if there's ID, processing speed, whatever going on.  

 

With the audiologist, you've got that basic exam and the screening, then you have the full APD eval.  Private audiologists around here will sometimes want to see a recent psych exam AND the SLP eval before they'll even see you for APD.  That's why I'm saying it's not overkill.  I think they're also trying to stop people from wasting their time if audiology isn't going to be the explanation, lol.  

 

So that's why I'm saying you start somewhere, take a step, then take the next one.  Some places are faster to get into than others.  Like if audiology is 1-2 weeks and the SLP is a month and the psych is 3-4 months, well there you go.  

 

Adding: You're doing the right thing getting the evals!  It doesn't hurt people to have evals and know the right words for their challenges.  What hurts is having the problems and NOT knowing why or using the WRONG words, like dumb, slow, etc.  Well slow is just reality, lol.  But I'm saying once his self-awareness kicks in, he'll notice and have feelings about this.  Better to eval, know, and know how to handle it.  He's still gonna have a good life and be an enjoyable person to be with!  :)

Edited August 19, 2016 by OhElizabeth

[kbutton]

I have wondered about auditory processing, but when I read the symptoms, so many of them do not seem to be the case.  

 

APD is a weird thing because while you want *more* symptoms to be really sure about things like ADHD or dyslexia, with APD, you can have one symptom and get a diagnosis if the issue in question is severe enough. 

 

Otherwise, just repeating what others have said. You might need a psychological testing (IQ, achievement, basic functioning) before you get an APD evaluation.

 

Just as you can (sometimes) get language testing from a psych instead of from a speech person, you can get a computerized SCAN III screening for APD from some psychs if booth testing is expensive, unavailable, etc. It's a bit less reliable, but we got meaningful results from ours that were then repeated on a booth test a couple of years later. There are many ways to skin a cat, and how you skin yours depends on what is available to you in your situation. 

 

APD sounds quite likely, but so does receptive language problems or memory problems. It could be all of the above. 

[Crimson Wife]

Also, a pediatrician should be able to check his ears for fluid and do a hearing screening.

 

Honestly, I would skip this and go for booth testing with an audiologist. The hearing screening only tests certain frequencies and my child had profound losses in others that were not flagged. 

[holdinon]

Thanks everyone! 

 

I don't know about neuropsychologists in my area.  I will have to look around.  He has a regular check up coming up soon, and I will ask his pediatrician.  But we really don't have a good relationship with him.  (There haven't been any issues really, just have never really "clicked" and we only go for checkups once every few years and ds has only been to dr for illness maybe once in last 5 years). 

 

Regarding the SLP.......He did have speech therapy for several years.  I forgot to mention that earlier.  So theoretically, they did the vision/hearing/etc during that initial visit to get set up for that.  It was through the public school, and it did not take very long at all (less than an hour for everything they did which included large and small motor skills assessments).  He was preschool age at the time.  He received the therapy for speech only (normal childhood speech delay type issues).  Once he could speak where others could understand him, they of course released him.  Should I take him to a private place for re-evaluation?

 

Audiologist.....My older ds went to an ENT place for hearing evals prior to the dyslexia screening he did, and that will be required before I take dd10 for the dyslexia testing also.  So I will find out how extensive that testing is, and if it is detailed enough to get the information referred to above.  I think it may be what we need. I honestly didn't know too much about what they were doing with older dd, because we just needed to "check that box" before they would do the dyslexia testing.  But he told me that he was put in a soundproof box, so I'm hoping that means that is what we need as far as the audiological part--especially since that only cost 25 bucks!

 

But this is definitely good info to get me started in the right direction.  Someone above mentioned "receptive language" problems, and that is a term I have not heard, so I'm going to look into that as well.

 

Thanks for this!!

 

 

 

 

[kbutton]

Regarding the SLP.......He did have speech therapy for several years.  I forgot to mention that earlier.  So theoretically, they did the vision/hearing/etc during that initial visit to get set up for that.  It was through the public school, and it did not take very long at all (less than an hour for everything they did which included large and small motor skills assessments).  He was preschool age at the time.  He received the therapy for speech only (normal childhood speech delay type issues).  Once he could speak where others could understand him, they of course released him.  Should I take him to a private place for re-evaluation? Public school testing thresholds for hearing and vision are usually only going to catch the worst issues. As mentioned, they do not test all frequencies and such. They will not necessarily test of APD or for ocular motor issues.

 

Audiologist.....My older ds went to an ENT place for hearing evals prior to the dyslexia screening he did, and that will be required before I take dd10 for the dyslexia testing also.  So I will find out how extensive that testing is, and if it is detailed enough to get the information referred to above.  I think it may be what we need. I honestly didn't know too much about what they were doing with older dd, because we just needed to "check that box" before they would do the dyslexia testing.  But he told me that he was put in a soundproof box, so I'm hoping that means that is what we need as far as the audiological part--especially since that only cost 25 bucks! Not all places that do audiology do APD testing or screening. You need to ask about those parts too.

 

 

 

[holdinon]

Ok....so in looking closer....and trying to understand not only who does what, but also what they need to do exactly......

 

I need to ask the audiologist or whoever we end up getting the hearing testing done with if they do the "Scan 3".   And I need to ask a speech and language pathologist if they do a " CELF or a CASL".  Is this right?

 

Also, I'm looking back at the info from older ds's dyslexia testing and they did the following things with him (and will do the same with ds10).  With these tests, would our direction be more clear with results with any of these?

RAIS--2

"informal alphabet assessment"

CTOPP-2

WRMT-III

WIAT-III

TWS-5

OWLS-II

CELF-5ST

 

 

And, I just noticed as I was typing those that the CELF mentioned above will be done with dyslexia testing, but it is denoted that it was a "screening test".  So I'm guessing the SLP would do the "real" one.   Does that mean that the if he were to "pass" this at the dyslexia place, then I wouldn't need to pursue this with the SLP? 

 

Sorry for all the clearly ignorant questions.    I feel so lost.  But y'all are making it better;-)

 

[kbutton]

I can speak to only part of this...not familiar with all of the tests (I don't have any kids with dyslexia).

Ok....so in looking closer....and trying to understand not only who does what, but also what they need to do exactly......

 

I need to ask the audiologist or whoever we end up getting the hearing testing done with if they do the "Scan 3".   And I need to ask a speech and language pathologist if they do a " CELF or a CASL".  Is this right? Yes.

 

And, I just noticed as I was typing those that the CELF mentioned above will be done with dyslexia testing, but it is denoted that it was a "screening test".  So I'm guessing the SLP would do the "real" one.   Does that mean that the if he were to "pass" this at the dyslexia place, then I wouldn't need to pursue this with the SLP? I would want the full test regardless, but I assume that the idea is that a screening will catch kids at risk. I would not fool around with the screening.

 

Sorry for all the clearly ignorant questions.    I feel so lost.  But y'all are making it better;-)

 

[Crimson Wife]

The CELF is a very comprehensive assessment with many subtests (15? can't remember off the top of my head) that takes quite a long time if all of them are run. The dyslexia screening presumably only ran certain subtests and the full battery might turn up additional issues.

 

If the child hasn't had hearing testing since preschool and is now 10, I would definitely go get updated testing. My child went from totally normal hearing to profound in the high frequencies in 4 years but because she's a good lip reader she never acted like she had any trouble hearing.

[holdinon]

For some reason, I'm unable to quote today....sorry about that.....

but thanks for confirming!

 

That's crazy about the hearing loss.  I'm going to call the ENT's office that did older ds's hearing to see if they do the complete tests.  I know I can get in there in just a couple weeks or so.  If they don't do it, I'll start asking around to see where to go.  I know insurance will pay for the hearing (after small copay) so we are going to start with that, and go from there.  In the meantime, I'm going to need to ask around and see about a SLP and the NP.  I think the SLP will be fairly easy to locate.  I'm a little worried about finding NP, but we'll see.

[kbutton]

Crimson, I thought the CELF had like 7 or 9 tests, and the CASL was the long one? 

[PeterPan]

CELF doesn't have as many subtests as the CASL and I don't think takes as long to administer.  There's no way it takes as long to administer, lol.  We spent hours and hours with our SLP doing CASL subtests and didn't even do them all.  Our np did the CELF.

 

The most polite way to ask the audiologist about it would be to ask if they do APD testing or if they refer out.  And then if they test, just kinda say in passing oh do they use the TAPS or the SCAN3 or something else?  The person on the phone won't know, but that will flag them to ask the audiologist.  Then the audiologist will call you back and talk it through with you to let you decide for yourself.  At least that's a way to handle it.  Your place sounds good, so hopefully they do it!   :)

 

Yes, if it has been that long and he had problems, it may be that you've got some language issues. The private SLP may look at articulation, yes, but they have extensive LANGUAGE testing they can do.  The stuff you're describing is language, and if you get somebody who really enjoys digging in on that, they could help you immensely.  There are a lot of good materials out there.  They're open and go, so even if lots of therapy isn't in reach, you'll be able to use the detailed testing to target your efforts.  My favorite haunts right now for materials are SuperDuperInc and Linguisystems.  Also, Teachers Pay Teachers has some speech therapy stuff I see people using.  So it's definitely something you can bring into your day to work on quite easily if you can just get the information on what you need to target.  Or you can work with the SLP.   :)

Edited August 20, 2016 by OhElizabeth

[holdinon]

Still can't quote, but OHElizabeth---thank you, thank you, thank you!  That is very helpful (because I definitely would not have been able to put the questioning together like that!

 

 

 

And, thanks again to everyone who commented---I still sort of feel like I'm going to battle, but now, at least I know how to use some of the armor  :laugh: 

[Crimson Wife]

Crimson, I thought the CELF had like 7 or 9 tests, and the CASL was the long one? 

 

I'm seeing:

 

Observational Rating Form (teacher fills this out)

Sentence Comprehension

Linguistic Concepts

Word Structure

Word Classes

Following Directions

Formulated Sentences

Recalling Sentences

Understanding Spoken Paragraphs

Word Definitions

Sentence Assembly

Semantic Relationships

Reading Comprehension

Structured Writing

Pragmatics Profile

Pragmatics Activities Checklist

 

Depending on what other testing the SLP is doing, he/she might skip some of these. For example, I don't see the "word definitions" subtest on my DD's most recent CELF testing but the SLP did the Peabody vocab test so that's presumably why.

[kbutton]

Thanks for clarifying, Crimson. I didn't realize they sometimes skipped parts. 

 

And yes, the CASL can be really long, particularly if you have a kid that answer right just often enough to keep that subtest going and going! They have to strike out a certain number of answers in a row, and my kiddo put a whole new spin on how to stretch that out!

[PeterPan]

‎images.pearsonclinical.com/images/pa/pdfs/casl5.pdf

 

Just for your fun, here's the CASL subtest list.  The pragmatics on the CELF is not well-regarded.  The pragmatics on the CASL yields scores that correspond well to scores on the Social Language Development test.  

 

I like the individual breakdowns on things like antonyms, inferences, idioms, etc. on the CASL.  The pragmatics is pretty fascinating too.  It doesn't give you the breakdowns of the SLD (which is a more detailed test), but the tester writes everything down.  Doing that we were able to see patterns to ds' speech that we hadn't realized.  

Edited August 20, 2016 by OhElizabeth

[PeterPan]

Sorry, op, some of us are test junkies.   :lol:

[EKS]

Agreeing with the others about getting his hearing tested.

 

But I just wanted to say that the behavior you're describing is similar to how my dyslexic son (the 20yo) behaved at that age.  He has several diagnoses besides dyslexia--APD, ADHD, Asperger's (this one was most likely a misdiagnosis), and vision problems that were mostly fixed with VT.  All of his issues have improved greatly in the past few years, which has been wonderful to watch.

[holdinon]

Sorry, op, some of us are test junkies.   :lol:

 

Yes, my eyes were crossing there for a minute. :laugh:

Oh, and look....I can quote now!

 

[holdinon]

Agreeing with the others about getting his hearing tested.

 

But I just wanted to say that the behavior you're describing is similar to how my dyslexic son (the 20yo) behaved at that age.  He has several diagnoses besides dyslexia--APD, ADHD, Asperger's (this one was most likely a misdiagnosis), and vision problems that were mostly fixed with VT.  All of his issues have improved greatly in the past few years, which has been wonderful to watch.

 

Speaking of the vision therapy...that was mentioned upthread too and I overlooked it.  I do know one person who is taking her son for vision therapy.  It's a couple of hours away from here.  I may need to get more information from her.  Apparently, from what she was saying, it's controversial around here.  I don't know enough about it to know why, but there are no doctors near here that do that.

 

The dyslexia, SLP, and audiologist, though, should be fairly easy to get locally.  The dyslexia and at least an initial visit with the ENT doesn't take that long to get into.  I'm not sure how long of a wait if we need to go somewhere else for audiology.  And I'm hoping the SLP won't be too long of a wait either.  I'm guessing though that the neuropsych though is a different story.  But at least we have a starting place.

[EKS]

Speaking of the vision therapy...that was mentioned upthread too and I overlooked it.  I do know one person who is taking her son for vision therapy.  It's a couple of hours away from here.  I may need to get more information from her.  Apparently, from what she was saying, it's controversial around here.  I don't know enough about it to know why, but there are no doctors near here that do that.

 

The dyslexia, SLP, and audiologist, though, should be fairly easy to get locally.  The dyslexia and at least an initial visit with the ENT doesn't take that long to get into.  I'm not sure how long of a wait if we need to go somewhere else for audiology.  And I'm hoping the SLP won't be too long of a wait either.  I'm guessing though that the neuropsych though is a different story.  But at least we have a starting place.

 

It's controversial around everywhere. 

 

I'd start with what you can obtain locally.  Honestly, there is only so much you can do--when my son was diagnosed with APD, we were already saturated with therapies that seemed to be doing some good, so we ended up foregoing APD therapy (or whatever it's called).

[PeterPan]

Well VT is a complex topic.  Are you having vision symptoms?  A lot of what you were describing sounds like some kind of language disability, processing issue, etc.  But sure, it's always good to get vision checked.  You can look at COVD to see who is available in your area.  The *strength* of VT is working on convergence.  There's lots of evidence behind VT's effectiveness for convergence.  My dd did VT to great benefit.  

 

I usually suggest people just sort of, as a normal course of things, get their eyes checked and screened.  Not some expensive thing, just an annual visit thing and asking them to screen.  Then you could decide what you need to pursue further.  I agree that when a dc has a complex situation, triaging is an issue!  You're literally going to go what is holding him up the MOST right now.  In your case, sounds like language is.  But sometimes vision is.  

 

Just work through your evals, see what you find out.  We'll be here as you get evals and want to talk things out.  :)

[Crimson Wife]

Sorry, op, some of us are test junkies.   :lol:

 

I'm paying good money to my university to take courses like "Language Assessment in Children" so it's a good thing I am :tongue_smilie: