CASL and CTOPP scores- help interpret?

[Terabith]

I don't have the report yet, because they want to wait for auditory processing eval to give recommendations. This is what she told me orally.

 

CASL

Antonyms - 130

Analogies (grammar) - 106

Sentence Comprehension - 113

Nonliteral Language - 123

Pragmatic 115

 

CTOPP

Said her memory for digits was only about 4 digits, that the standard score was 5, with 8-12 being average

Elision - standard score of 4 (8-12 average)

Blending - 14 (8-12 normal)

Rapid digit naming 8

Rapid letter naming - 9, but said it was obvious that was more difficult

 

So... On the one hand, she can definitely give the right answer to pragmatic situations. Maybe she just doesn't care to actually do it? (I tried to high five her the other day, and she licked my hand. And complained about how it tasted like soap. She's 11.)

 

This is the kid who completed the Peabody Picture Vocabulary Test at age 8. As in, they ran out of test items. Scored as 154 but said no idea what receptive vocabulary really was.

[Lecka]

I have read (iirc on the Social Thinking website) that there are kids who can score correctly on a test for pragmatics, but struggle to apply in real world situations. So I would not accept that pragmatic score excessively if it does not fit about what you know about her in real life.

 

I don't know if they then get observation forms???? I don't know. But I think there is something when the test score doesn't seem to reflect what you see.

 

Otherwise I don't know, just sharing I have read that before.

[PeterPan]

I sat in when my ds got the CASL pragmatics, so I've heard the whole thing.  Actually I think I was napping part of the time, lol.  It's long!  Anyways, there is data correlating results of the CASL pragmatics to the SLDT (social language development test), because SLD is a pretty common tool schools use.  They're very *different* tests, but the data correlates well statistically, meaning that a score on one will be predictive of a score on the other, blah blah.  But they ARE very different tests.  So I agree, in theory it IS conceivable that a dc could do well on one and not on the other.  However the data shows they correlate.  

 

The SLD has a bunch of subtest breakdowns, so you'll see Theory of Mind, etc.  That's actionable, useful info to have those categories.  I think inferences was on SLD.  Haven't looked at it in a while.  Maybe you needed CASL pragmatics plus one more from the CASL (I forget) to be perfectly correlated?  Wow, me and my brain.  Google and you'll turn it up.

 

The CASL pragmatics has the provider reading basic sentences and recording everything the child says.  So it will be something like "The phone rings and when you pick it up, it's your mom.  What will you say?"  It won't be exactly that, because I made that up.  But like that, with scenarios.  They're VERY real life, with no prompts, no multiple choice.  The provider writes down everything the dc says and scores later.  On the SLD, same gig, with them writing down everything.  It's a really detailed, time-consuming test to run!  

 

What intrigued me when my ds had the test was how much his theory of mind showed up even when he had the language.  So in theory he COULD have said the correct thing, but in his mind it was ok to say something off the wall or totally different.  And he does this a lot in real life too, kwim?  To me, the CASL (the only one I observed) was pretty typical of how he would have answered those things in real life.  There were lots of things that left me chuckling because those were DEFINITELY how he responds!

 

So here's your problem.  Say you say gifted IQ.  Like, hello, at 154 standard score on vocabulary is probably a gifted IQ at some point in the gifted range.  Then we go ok, pragmatics score is SS115.  That's NOT going to get you intervention and an IEP in the ps.  It's just not.  They don't care about discrepancy.  But as a PARENT you care about it.  Nobody diagnoses pragmatics based on discrepancy, but *I* say it matters.  It seems utterly illogical to me to say a dc with a gifted IQ is not going to need social skills and pragmatics to be able to keep up with her peers.  They will NOT say IQ and pragmatics should correlate, but *I* say that's illogical.  I think it could explain why her skills seem off/wrong/inappropriate, even if they are acceptable by the data.

 

So sure, ABSOLUTELY I would consider some mild intervention there.  Not like $10K bucks worth, but something, whatever you think is been necessary.  Social Skills only go up.  Like what is the harm?  We're not giving unneeded medication, just bumping her explicit understanding of social thinking a bit to allow her to participate appropriate in some things that maybe she'd enjoy because of her IQ.

 

I'm talking about a $20 book from Social Thinking.com, not some huge effort.  If you're not seeing an issue, don't bother.  If you are seeing things that bug you, then pursue it.

 

So what did they say about her reading?  That analogies is conspicuous.  Was NVLD on the table with her?  I can't remember.  Anyways, you could just do some stuff with analogies.  In TML (stuff for autism), we have a really practical, simplified way of working on analogies.  It may be that she has more complex ones in real life but doesn't get the simple ones needed to pass a test.  My ds was doing that, making wild, fantastic associations, but unable to do basic grouping and state basic reasons.  

 

That working memory is really low.

 

Licking can be the SPD.  My ds still licks, sigh.  Like way more than I'd like.  Have you tried giving her gum?  Spry has xylitol, so it's good for cavities too.

[Terabith]

She hates gum, but she still uses a pacifier. It's odd. I watched the CASL. It was interesting, because she could say the right things, but she doesn't do those things. Maybe she just doesn't care about other people. I dunno.

 

She has a lot of discrepancies with IQ, but memory and processing speed are really, really low.

 

The analogies test was more grammar than analogies like the SAT. One child is to many children, etc.

 

NVLD has been on the table, as has autism. She doesn't quite fit anything. Her nonverbal on the WISC was actually higher than verbal.

 

It was just interesting. She could tell what you do to introduce someone, but she never does it.

[Crimson Wife]

My class on language assessment just had a module on standardized testing psychometrics. It really frustrated me when the professor and textbook both said not to consider "mental age" from IQ testing but to purely look at whether the child fell below the 10th percentile (1.25 std. dev. below the mean) on the particular language test. I'm sorry, but if the kid has an IQ that is 2+ std. dev. above the mean and a score on some test that is exactly average, that's an indication that there is something going on.

 

I get that SLP's have to work within therapy qualification guidelines put out by insurance companies and state ed codes. But I think that the SLP has a professional obligation to recommend further testing when that kind of discrepancy is found.

[PeterPan]

The ps will not treat, but I don't think a *private* SLP has those restrictions.

 

Yes, there are kids who blow a pragmatics test out of the water and aren't applying it.  Is she on ADHD meds?  And has she had social thinking intervention?  Both can make a difference in making things apply and carry over.  And did you talk with the SLP about her doing *using* the skills/knowledge she demonstrated during the test?  That's something where they could do questionaires to show that happening.

 

Is she low muscle tone overall?  And is she getting OT for sensory?  That's some pretty serious sensory, when she's licking, seeking oral inputs, etc.  Did the SLP check her oral tone?  Did she offer any suggestions?  Abilitations sells a bunch of stuff.  You might see if you can get some help from the OT to calm down the overall and see if that chills the oral.  My dd uses christmas lights in her room, fluffy blankets, lots of pillows.  Her walls are to the HILT.  It's a real sensory thing.  The OT might also say brushing, joint compression, smells (candles, lavender cream), etc.  I was just telling my dd she should get a slam ball.  They also call them medicine balls.  You raise them overhead as far as you can and SLAM them down.  Crazy awesome.

 

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She sounds like one of those where it's always borderline, where her strengths counter her weaknesses and people want to say no way.  Sigh.  I think do what you think that fits the components you're seeing.  The things that you see that look like (pick labels, autism, spd, whatever) probably are kissing that and need intervention, even if the full profile hasn't become apparent or the stupid DSM isn't caught up with reality enough to help you. You've still got to deal with what you're finding.  A girl with serious discrepancies with a gifted IQ will still have problems and still benefit from interventions.  The worst that happens is the things turn out to be easy.

 

What are you trying to make happen with these evals?

 

[Terabith]

Sigh.  I wrote a long response and it got eaten by the interweb monster. 

 

She's not on ADHD meds.  She is on anxiety meds.  We experimented with ADHD meds, and there was a bump in processing speed, but drastic personality change and manic behavior that meant actually less was getting done.  It was rather creepy.  Since nobody is really sure she actually has ADHD, it didn't seem worthwhile.  She's been on anxiety meds since she was five and has done counseling.  The anxiety is pretty severe and has been lifelong.  She has had a few OT evals, but other than oral motor seeking behavior, she's come out fine.  Fine motor skills good, no low tone, no other sensory issues, gross motor skills fine.  Her sister had speech and OT as a toddler/ preschooler. 

 

She has these really, really, really high highs (vocabulary, reading comprehension and fluency, block design and visual matrices on the WISC, narrative memory) and really, really low lows (elision on the CTOPP, working memory, processing speed, memory for non-narrative things, spelling, and math fact fluency  are all in the under 70 range).  She has a lot of rigidity, lack of flexible thinking, social issues, although apparently these are due more to "not giving a da*n than lack of knowledge of what's appropriate.  She does weird things (pulling out hair and flossing teeth with it in public, for example).  She has no frustration tolerance whatsoever. 

 

She has a diagnosis of written language disability, due largely to her spelling.  Her handwriting is adequate.  We're working on typing, but she's not proficient yet.  Need to put more time into that, but she's so done by the time she gets out of school.  She actually has a medical diagnosis of autism, although she has always done well and passed the one-on-one ADOS.  Frankly, the older she gets, the more autistic she looks to me, however.  She's never been diagnosed with dyslexia, but the speech therapist was saying that with those CTOPP scores she was surprised about that.  Her reading comprehension is 98th percentile and decoding is average, however.  Her spelling has never gotten past the first grade level, and frankly, at this point, I'm not sure it will. 

 

The latest round of educational testing, they did the Test of Language Competence, which had some odd scores, that made us do this testing.  On the Test of Language Competence, she had a score off 88 on the "Expressing Intents" composite.  Her scaled score on Recreating Sentences was 5.  Making Inferences had a scaled score of 8, but she had a 16 on Figurative Language.   

[PeterPan]

Yeah, sounds like the ADHD meds weren't a good fit!   :scared: 

 

It definitely sounds like you're finding holes with your language testing.  

 

I think the not caring *is* the social thinking.  There are BCBAs who work with psychs.  Maybe move beyond the ADOS and get some autism-specific work going with a BCBA, someone who can get in her head...

[Tiramisu]

There's definitely a thing that happens with HFA, when they know what's appropriate and can articulate it in a one on one setting but don't or can't do it in a real social situation.

 

I think it can be the social thinking but I've also wondered if disordered processing plays a part, as in too many things going on in a real life scenario to coordinate appropriate behaviors and responses.

 

I have a kiddo who corrects the things I say and do in public, because it's not part of her mental script of how a social interaction is carried out. She has that script of what people do and say in social situations. But it's not like she can implement that perfect script when she has the chance.

[Tiramisu]

The other thing is that in very straightforward, simple social situations, you will often see good manners and behavior as long as the child is well rested, fed, feeling well, and not stuck on something.

 

But life is not often that way.

 

Then the teen years come and the complexity of social interactions can become even more overwhelming.