Preschool IQ test - uneven scores?

[Southern Ivy]

Any test score gurus who can help me make heads or tails of these scores? 

The neuropsych said that dd has unevently-developed cognitive skills. Her Full Scale IQ was 78, which is below average but the NP also stated that it's not a good descriptor of her actual abilities. But, I'm really trying to understand how to use these scores to address my daughter's needs. 

 

This was for the WPPSI-IV: 

(The child's general cognitive ability, as measured by one or more standardized, comprehensive intelligence test) 

[Percentile scores: mean/average performance = 50th; average range = 16th through 84th]
 

Scale                             Standard Score    Percentile            Subscale        

 

Block Design                       10                        50                 Visual Spatial 

Information                           9                         37               Verbal Comprehension

Matrix Reasoning                 6                         09                 Fluid Reasoning

Bug Search                          8                         25                  Processing Speed

Picture Memory                    8                         25                 Short Term Memory

Similarities                           7                          16                 Verbal Comprehension

Picture Concepts                  4                         02                  Fluid Reasoning

Cancellation                         9                          37                 Processing Speed

Object Assembly                 12                        75                  Visual Spatial                          

 

 

SubScale                                        Standard Score    Percentile 

Verbal Comprehension                      88                        21

Visual Spatial                                     106                      66

Fluid Reasoning                                 72                        03

Processing Speed                              90                        25

 

Full Scale:                                            78                       07

 

 

 

 

 

 

Edited June 24, 2017 by Southern Ivy

[Lecka]

Well, it isn't a good descriptor of her abilities.

 

I have this with my younger son.....

 

You have a few things...

 

One, maybe this is a great benchmark for the future.

 

Two, maybe this is a sign of how well she can take a test.

 

Improvement she makes before she tests again will be a combination of actual improvement in what is tested, and improvement in her ability to perform on the test.

 

Really -- ability to perform on the test is huge and it is hard sometimes to tell (just from a test like this and looking at scores) which thing improvement is coming from.

 

So I think the main use of the test at this point now is to understand "okay I need to address her ability to participate in the test in such a way that she can receive an accurate score" -- and try to do that if it is also makes sense with what you are seeing in everyday life.

 

I am afraid when the comment is that it's not an accurate representation -- you are looking for comments that show the tester's impressions and opinions.

 

Because literally ---- this is how it is with my son ---- they have to mark things wrong. Things he could answer in another situation. They have to count it wrong because they have to follow the rules of the test for it to be standardized, for them to be able to compare current scores to past and future scores.

 

They literally mark things wrong that she could have gotten right if x, y, z

 

Like sometimes they are allowed to give one prompt, sometimes two prompts. Like -- "tell me more" once. Sometimes they are allowed to repeat a question only once, or only twice.

 

If she could have answered correctly with them saying "tell me more" one more time and repeating the question one more time ----- well that is not reflecting her ability, but they are counting it wrong.

 

But it reflects her ability to participate in the test isn't what is expected for her age and that is its own important piece of information even if it isn't a score on paper.

[Lecka]

When you get a test back where the comments are that the tester believes the scores accurately reflect ability -- well, then you can look at scores.

 

I mean -- it is not the best but this is how it goes when you get a note that the scores aren't believed to be accurate.

Edited June 24, 2017 by Lecka

[PeterPan]

Poor fluid reasoning goes with disabilities. Do you know how to google site search? type the terms plus site:welltrainedmind.com in your google bar. So google site search "fluid reasoning" and find the threads from the past on it. Then you can rabbit trail those kids and see what super low scores in that are associated with.

 

You've got a lot of room to go up there. Verbal is not fixed. Even if there's APD going on or something, it's still not a fixed thing. With meds plus intervention, I'll bet that goes up. Your visual/spatial stuff is SO much higher. That's why she's telling you that 78 score is NOT going to be accurate. Even on a bad day her visual/spatial scores are in the average range. If they're going up, they'll go up into the bright/gifted range. Then she'll be performing more like you were expecting, seems like.

 

One way to think of it is that she's as BRIGHT as her highest scores imply and is STRUGGLING as much as her lowest scores imply. She's all of those things, all at once.

 

But I'd be shocked if even the top scores don't go up a bit. It sounds like that's what the psych is expecting. And some people do have just really dissatisfying scores, sigh. Some kids never are just all tidy and neat and obvious. So you go back to the mantra. She's at least as bright as her highest scores imply, maybe brighter. Maybe MUCH brighter. And the verbal stuff is clearly glitching up. Clearly want to do evals there. And the behavior. And motor planning.

 

Not to sound to perky, but that processing speed could be worse. Like it's low, probably low for where she's going, but it could be worse. Single digits would be way worse. That is the OH MY lands realm. My dd's is around yours for processing speed, and it's frustrating, fatiguing, needs compensation, but it's livable. If people just give her time to think, it's livable. And meds bump processing speed! Super bonus for meds there. 

 

Processing speed was the big surprise for me when I had dd eval'd. I was living with stuff, but I really thought it was character, like she just didn't want to or wasn't trying to. Then I got the scores and was like OH. So it's something you can look at with her, like how much more can you do to give her time to process, to realize that she's probably fatiguing with her work, etc.

 

[Lecka]

Hopefully someone can have a better comment! I have been where it is like -- when they say they can't get an accurate score -- then they flat out can't get an accurate score.

 

But it is still a benchmark for how she did that day, you can still compare scores -- how she takes the test is a good thing to work on.

 

But it isn't like "oh, now I have so many answers."

[Lecka]

Oh, if you do get speech or OT, and get a low score they think is accurate (sigh) -- then some scores there may give context for some of these scores.

 

Maybe a test required expressive language and on speech testing that is a lower score.

 

Maybe listening.

 

Things like this can be part of the picture too.

 

Did he recommend speech or OT evals?

 

(My kids are the kind where the comment would be "they need speech and OT evals.")

Edited June 24, 2017 by Lecka

[Daria]

I'm a special educator, and I used to work with young kids.  Tests this age are notoriously unreliable.  Kids can do poorly for so many reasons, and teasing the reason out is almost impossible.  This is particularly true for kids whose disabilities impact communication, interactions with others, or attention and impulse control. 

 

It was not uncommon for me to read a report on a kid when they came into my class that said one thing, and then when the triennial came when they were 6 or 7, see scores that painted a very different picture.  I've seen IQ's jump by 40 points, or profiles of strength and weaknesses that got turned on their head.  Generally, I found that my own impressions as a teacher, based on what I saw the child do in the classroom, were a better predictor of later scores and later achievement than preschool test scores.

 

One thing that doesn't happen, however, is that kids don't do things on the test that they can't do in real life.  So, if a child scores within the average range on a subtest, then we can assume that their true abilities in that area are at least average.  

 

Given all that, I'd take the following things away from this.

 

-- There is unevenness, relative to kids her age, in her ability to do certain abstract tasks under standardized conditions.  Many kids her age are able to be more consistent than she is, but it's difficult to say whether that's because of the nature of the tasks (e.g. some where harder) or variable attention (e.g. they gave some tests later in the session when she was tired, or earlier in the session when she didn't have a relationship with the examiner, and therefore she did worse).  

 

-- She has age appropriate skills in many areas.  Her visual spatial skills were great, her verbal comprehension skills and processing speed scores were solidly in the average range.  Based on this, I would assume that one should have high expectations for success in a curriculum designed for children her age, and if she isn't successful, I'd assume it's because she isn't being well accommodated, rather than due to a lack of potential.

 

-- It's possible that there is a weakness in fluid reasoning, which would mean that she's better with problem solving tasks that are familiar, and that she knows something about, and right now, as a young child, she has more trouble applying her skills to tasks that are new and don't let her draw on what she knows.  It's not definite that she's weak here, it could be a coincidence that the two lowest scores are in this area.  I also wouldn't assume that this means that fluid reasoning will be weak in the future.  But right now it's something to look out for.  Especially if that matches with what you see from her.  

 

-- Testing in a few years will give you a much better picture. 

[PeterPan]

Yeah, what I was looking at was whether the subscales were consistent for types of things. So was fluid reasoning similarly low in each subscale, etc. And to me it's noteworthy that she REALLY ENGAGED with that object assembly. Look at that. That's a serious score! She really went to town there, and yet it requires some self-regulation (often low with ADHD), attention, sticking to the task, etc. That's really interesting to me. And then look how the fluid reasoning tests are all consistently in the dumps and go wow, what was SO much harder about that, that when push comes to shove, even on a bad day, even with her disabilities at her worst, she can pull it out for object assembly but NOT for fluid reasoning...

 

That's the stuff I was pondering. But I'm not a guru, just a hack. :D

 

Everything else was kind of consistently low and affected by verbal, which I think everyone agrees is clearly affected.

[PeterPan]

Just to follow up with what Daria is saying about how it's NORMAL to have a spread at her age, look at the verbal comprehension. Standard score 88, percentile 21. So you could get all freaky about the percentile, but you shouldn't. You look at the standard score and the standard deviations. Until you're hitting 1.5-2SD, you're really not at significant. So that standard deviation thing is what tells you that even though the percentile is 21 (was that a typo?), she's within the SPREAD of what is common for the age. 

 

So definitely bone up on standard deviations so you don't get rattled.

Edited June 24, 2017 by OhElizabeth

[Lecka]

Here is an example of a question my son missed.

 

"Tell me about a forest."

 

He said -- there can be a cave in a forest.

 

First prompt: what else can you tell me about a forest?

 

He named some forest animals.

 

Second prompt.

 

He named some more forest animals.

 

So -- two prompts were allowed.

 

He was counted wrong because he didn't say "trees." To be counted correct all you had to say was trees.

 

Now -- its true he didn't tell the main characteristic of a forest -- but he also showed he has an idea of what a forest is like.

 

But this is just counted wrong.

 

He got a low score on this and the speech therapist said he was really close like this on a lot of them, if she could have talked to him about it more or something he probably could have gotten some of them.

 

But that isn't the way it works on a standardized test.

Edited June 24, 2017 by Lecka

[Daria]

Just to follow up with what Daria is saying about how it's NORMAL to have a spread at her age, look at the verbal comprehension. Standard score 88, percentile 21. So you could get all freaky about the percentile, but you shouldn't. You look at the standard score and the standard deviations. Until you're hitting 1.5-2SD, you're really not at significant. So that standard deviation thing is what tells you that even though the percentile is 21 (was that a typo?), she's within the SPREAD of what is common for the age. 

 

So definitely bone up on standard deviations so you don't get rattled.

 

Actually a 21st percentile is not a score to freaky about.

 

It's important to remember that IQ scores and subscores, and almost every other kind of score, are clustered around the middle.  I often use height as an example of this.  Imagine that you're in school and they tell you to line up by height.  There are a few kids where everyone knows to send them to the front or the back of the line, because they stand out.  They're the "tall" kids or the "short" kids.

 

Then you have a much larger group of kids where there's going to be lots of shuffling and measuring and disagreement, because the difference are small enough that people haven't really noticed.  

 

IQ is the same way.  There are small numbers of kids at either end who stand out, and need something very different.  But then there are large number of kids whose abilities are very similar.  21st percentile is well within that range.  

 

So, even if that score turns out to be stable long term (and I'm skeptical about all preschool scores, but particularly the scores of kids who do have identified needs in other areas), 21st percentile is a decent score.

[Lecka]

The thing is -- in practical terms I think a test like this at this age is mostly just going to qualify for services or result in a referral or recommendation for this or that.

 

There is usually some reason kids get the testing and then you get pointed towards some kind of service, some kind of therapy, some kind of referral, etc.

 

It isn't maybe taken super-seriously as being, well, really meaningful in any long-term way.

 

Plus it is probably going to be viewed by many people like "well we will see what happens when there has been a period of therapy," or the person the referral is to will get to know the child and know more from getting to know them.

 

That is just kind-of what the purpose is a lot of the time.

[PeterPan]

20th percentile scores (on a variety of tests) get gifted kids diagnosed with SLDs and delays, so they *can* be significant. The standard deviations will show the significance of the percentiles and how far outlying the scores really are. It's the bell curve and clustering Daria is talking about. 

 

A lot of what happens is what Lecka is sort of driving at, that you qualify, you get in the door with SOMEONE and then they add goals and uncover more. 

 

You're probably going to have some hindsight, when you put this data together with data a year or two from now and go ok, here's the pattern of what interventions we did and what is improving. That will be really interesting, perhaps even more than if you had only done the later snapshot. 

[Crimson Wife]

I would be very curious to see how your child did on a completely non-verbal IQ test like the Leiter or the CTONI. My DD scored exactly average on the "non-verbal" portion of the WPPSI but in the gifted range on the Leiter. The lowest subtest score on the Leiter was higher than the highest subtest score on the WPPSI.

 

Matrix Reasoning on my DD's WPPSI was much lower than Block Design, Object Assembly, and Bug Search just like your child. What the NP who ran the Leiter told me is that she thinks my DD did not understand the instructions for the Matrix Reasoning task due to the receptive language delay.

 

Picture Concepts tests the child's ability to categorize and I would recommend finding a Speech & Language Pathologist to run the Bracken Basic Concepts Scale. I would also want to see a comprehensive language test done such as the CASL or the CELF to see if there is one or more areas of receptive language weakness that can be identified. The Information subtest on the WPPSI is solidly within the normal range but the Similarities is borderline-low. With the other subtest scores, I'd say it is a "red flag" for a possible language issue partially compensated for by an above-average underlying IQ.

 

Disclaimer: I am not a certified SLP or psychologist, just a mom with a bachelor's in Communicative Disorders and a bachelor's in psychology plus life experience with language-based learning disabilities.

[Southern Ivy]

I would be very curious to see how your child did on a completely non-verbal IQ test like the Leiter or the CTONI. My DD scored exactly average on the "non-verbal" portion of the WPPSI but in the gifted range on the Leiter. The lowest subtest score on the Leiter was higher than the highest subtest score on the WPPSI.

 

Matrix Reasoning on my DD's WPPSI was much lower than Block Design, Object Assembly, and Bug Search just like your child. What the NP who ran the Leiter told me is that she thinks my DD did not understand the instructions for the Matrix Reasoning task due to the receptive language delay.

 

Picture Concepts tests the child's ability to categorize and I would recommend finding a Speech & Language Pathologist to run the Bracken Basic Concepts Scale. I would also want to see a comprehensive language test done such as the CASL or the CELF to see if there is one or more areas of receptive language weakness that can be identified. The Information subtest on the WPPSI is solidly within the normal range but the Similarities is borderline-low. With the other subtest scores, I'd say it is a "red flag" for a possible language issue partially compensated for by an above-average underlying IQ.

 

Disclaimer: I am not a certified SLP or psychologist, just a mom with a bachelor's in Communicative Disorders and a bachelor's in psychology plus life experience with language-based learning disabilities.

Thank you. I will make sure to ask for those tests to be run when I call around for a new SLP. (Ours moved back to St. Louis. We went for a year for initial g/k sounds.) 

 

I'm very interested in these scores now, too. 

[Southern Ivy]

I'm a special educator, and I used to work with young kids.  Tests this age are notoriously unreliable.  Kids can do poorly for so many reasons, and teasing the reason out is almost impossible.  This is particularly true for kids whose disabilities impact communication, interactions with others, or attention and impulse control. 

 

It was not uncommon for me to read a report on a kid when they came into my class that said one thing, and then when the triennial came when they were 6 or 7, see scores that painted a very different picture.  I've seen IQ's jump by 40 points, or profiles of strength and weaknesses that got turned on their head.  Generally, I found that my own impressions as a teacher, based on what I saw the child do in the classroom, were a better predictor of later scores and later achievement than preschool test scores.

 

One thing that doesn't happen, however, is that kids don't do things on the test that they can't do in real life.  So, if a child scores within the average range on a subtest, then we can assume that their true abilities in that area are at least average.  

 

Given all that, I'd take the following things away from this.

 

-- There is unevenness, relative to kids her age, in her ability to do certain abstract tasks under standardized conditions.  Many kids her age are able to be more consistent than she is, but it's difficult to say whether that's because of the nature of the tasks (e.g. some where harder) or variable attention (e.g. they gave some tests later in the session when she was tired, or earlier in the session when she didn't have a relationship with the examiner, and therefore she did worse).  

 

-- She has age appropriate skills in many areas.  Her visual spatial skills were great, her verbal comprehension skills and processing speed scores were solidly in the average range.  Based on this, I would assume that one should have high expectations for success in a curriculum designed for children her age, and if she isn't successful, I'd assume it's because she isn't being well accommodated, rather than due to a lack of potential.

 

-- It's possible that there is a weakness in fluid reasoning, which would mean that she's better with problem solving tasks that are familiar, and that she knows something about, and right now, as a young child, she has more trouble applying her skills to tasks that are new and don't let her draw on what she knows.  It's not definite that she's weak here, it could be a coincidence that the two lowest scores are in this area.  I also wouldn't assume that this means that fluid reasoning will be weak in the future.  But right now it's something to look out for.  Especially if that matches with what you see from her.  

 

-- Testing in a few years will give you a much better picture. 

Thanks! The NP said to test her again in a year after she's on meds for her ADHD (she was very hyper during this test. It was incredibly difficult for her.) 

Thank you for explaining the fluid reasoning. That makes sense and given her personality to just give up and not try if she's confused/frustrated, I can see how she failed that. 

[PeterPan]

Thank you. I will make sure to ask for those tests to be run when I call around for a new SLP. (Ours moved back to St. Louis. We went for a year for initial g/k sounds.) 

 

I'm very interested in these scores now, too. 

 

Ok, I'm going to rabbit trail that for one second, just because I'm me. That seems excessive to me that it took a year to get g/k. They're the same motion, just voiced/voiceless. I just wonder if there's actually motor planning behind this and not just a fuzz of delay. You already know you have flags for OT from some other screening you did that I forget.

 

And the reason I'm mentioning this is because the *particular* type of therapy you would be looking for IF there is motor planning involved would be PROMPT. Not prompting, just PROMPT. You would go to the PROMPT Institute website and go through their cumbersome, never properly updated, really annoying provider locator map and look till your eyes bleed. And if you find some people within say a 3 hour radius, call, talk with them. They'll see a LOT of people like you. 

 

A therapist who is well-trained in PROMPT can elicit the motor planning patterns and tell you definitively if it's praxis (motor planning) or not. 

[PeterPan]

Thanks! The NP said to test her again in a year after she's on meds for her ADHD (she was very hyper during this test. It was incredibly difficult for her.) 

Thank you for explaining the fluid reasoning. That makes sense and given her personality to just give up and not try if she's confused/frustrated, I can see how she failed that. 

 

Personality is an interesting thing. I'm not sure "gives up when it's overwhelming" is personality when you have a disability. Ability to stay calm, regulate your emotions, form a strategy, make a multi-step plan, that's all executive function. That's the stuff she has a disability in, because EF is at the core of ADHD.

 

So, like with my ds, EVERYTHING is hard. Every. single. thing. in the whole entire world. Because he has all three SLDs and motor planning and social issues. If one thing isn't getting him, the next is. And every time it's hard, we have to stop, use strategies to stay calm, formulate a strategy for how to tackle the problem, stay calm and use the steps and work the plan. So I have him doing these really adorable story sequencing strips where there are 7 strips of text to sequence to make a familiar story. He has to read them (ugh) and put them in order, but his tendency is to flip out. So we break it into steps together. At first I gave him the steps, now I just remind him to use his strategy. (What was our strategy, what do we do first, etc...)

 

They don't get to do that on IQ testing and standardized testing, which is what Lecka was telling you, that stuff can't come out because of the disabilities, because the tester isn't allowed to support that. Otherwise it wouldn't be standardized. But for tasks, we're going to bring in strategies.

 

So not personality. Disability that needs support. And maybe personality, but really I try to believe good things about my ds for personality and leave the bad things to disability. :)

SaveSave

Edited June 25, 2017 by OhElizabeth

[Southern Ivy]

Personality is an interesting thing. I'm not sure "gives up when it's overwhelming" is personality when you have a disability. Ability to stay calm, regulate your emotions, form a strategy, make a multi-step plan, that's all executive function. That's the stuff she has a disability in, because EF is at the core of ADHD.

 

You are very right. Until all of this came to light, we just thought it was her personality, thus why I said that. More of an old habit than not recognizing it's her disability. I need to recondition my mind to think of that behavior differently. 

 

Ok, I'm going to rabbit trail that for one second, just because I'm me. That seems excessive to me that it took a year to get g/k. They're the same motion, just voiced/voiceless. I just wonder if there's actually motor planning behind this and not just a fuzz of delay. You already know you have flags for OT from some other screening you did that I forget.

 

And the reason I'm mentioning this is because the *particular* type of therapy you would be looking for IF there is motor planning involved would be PROMPT. Not prompting, just PROMPT. You would go to the PROMPT Institute website and go through their cumbersome, never properly updated, really annoying provider locator map and look till your eyes bleed. And if you find some people within say a 3 hour radius, call, talk with them. They'll see a LOT of people like you. 

 

A therapist who is well-trained in PROMPT can elicit the motor planning patterns and tell you definitively if it's praxis (motor planning) or not. 

I'm not sure. It took a bit for her to get the g/k without lots of prompting (we also had quite a few useless lessons because of a stubborn little girl - wanted the rewards without the work and basically just gave the SLP the toddler finger), but once she got it, she did really well. The SLP didn't express any concern, though she did consult with some other SLPs for other ideas. So, who knows, there might be more there. I have a notebook with notes from all these conversations. PROMPT is going in. I'll check it out. 

(Your description of the website cracked me up.)

[Lecka]

G/k is one of the minimal pairs that sounds extrememly similar.

 

It was extremely hard for my older son.

 

K was maybe his very hardest sound, but they targeted k first because they thought once he learned k he would be able to learn g.

 

Then when he got to g he regressed on k -- which they said was a normal (but frustrating) process because he had to figure out when to use which sound.

 

For phonological auditory processing -- there are some consonants that make a shorter sound and are the hardest to tell apart, and I know g and k are two of them. I know g, k, d, and t are ones because those were all speech sounds for my older son.

 

But at the same time -- she can do it now!!!!! If she can do it now, she can do it now ---- she is doing it.

 

But at the same time -- when you have gotten comments she is hard to understand -- I think if these are your relatives and you are considering a speech eval -- ask them if they hear her mix up or muddle sounds, that you may be used to. Or does she talk fast. Or does she not quite make sense -- not say things in a way that really makes sense. Is she hard to follow.

 

I really barely knew anything about speech therapy -- I thought it was only speech sounds. Well, they do also work with kids who are hard to follow.

 

So I think -- ask what they mean and tell a speech therapist that is an area of concern. Now -- the problem is are your relatives used to talking to 5-year-old girls?

 

I think a lot of this *could* be better with ADHD medication. Like -- it really could be. It is hard to know until you try it (or an alternative).

 

But if she is hard to follow, more than it being articulation, then it could be helped.

 

What happens is you get an overall impression "she is hard to understand sometimes" and then it is the speech therapist who can say "well it is partly articulation and partly she is hard to follow."

 

I don't know any of the terms for when kids are hard to follow, but they do help kids to organize their thoughts more clearly.

 

But to me -- it makes me wonder if in "reading" maybe she can start with phonemic awareness and not need LIPS/FIS/phonological awareness.

 

She is absolutely in the right age group for it. Iirc Phonemic Awareness in Young Children starts with identifying words in a sentence, and identifying syllables.

 

Then for part C -- maybe she can remember more with ADHD medication (I think that remains to be seen). She could tell the sounds apart -- that is good. As far as the concept of the tiles -- I think that is hard for a 5-year-old. She is in the youngest age group and not in Kindergarten -- so on that I think she could just be young.

 

But for my son -- it was all auditory discrimination, his auditory memory was fine. But there is stuff out there for auditory memory. But I don't know much about it.

 

But I do think it sounds like she could start with something like Phonemic Awareness in Young Children, and you see how that is and hopefully (I don't remember!) they will say when they want to start introducing letters in the process.

 

Advice that works for my younger son -- only start with a few letters, maybe 3 or 5. Don't pick ones that are easily confused at first. Then it will be less confusing and she can have time to get good at them before you add more in. And you can bring in multisensory ways to work on them. Or games. Or a combination. Some kids do better with the "it's kind of like an art project" stuff and some kids do better with the more active games where you jump to a letter or bounce a ball onto a letter, or put the letters on the wall and throw crumpled paper at them. Whatever is engaging and seems to click.

[Lecka]

Also -- I don't think you just had a stubborn little girl at speech. I think you had a speech teacher who took a little bit of time to find the right technique to work with her.

 

It is a combination of both. And it isn't bad on either side. It is just a process.

 

I would interpret a lot of my older son's behavior at speech therapy as willful and frankly deeply embarrassing to me, and I got feedback like ---- one, they see it and it is part of their job to bring in techniques and help things go well.... two, this is how younger kids act when they are frustrated and can't do what they are asked.

 

So it is not like ---- she wasn't at fault at all, but it's also not like she was just doing it on purpose.

 

Edit: what I mean is -- your speech therapist got advice, tried something different, and then your daughter did better -- so it seems like what she was trying first may have been frustrating your daughter because it was too hard.

Edited June 25, 2017 by Lecka

[Heathermomster]

The best way to use these scores is to tuck them away. They are helpful as a base test. You know she has ADHD and very likely CAPD.

 

Maybe find a good child psych and get the ball moving on the attention issues. Seek an OT evaluation for pincer grasp, reflexes, motor planning, perceptual vision, core strength, vestibular, and possible sensory issues. Work with an SLP. If you can locate a PROMPT SLP as OhE suggested, that would be awesome.

 

I don't know whether you have considered this. Take the coursework and get the OG certification. You teach for a living. I know several moms that became OG certifed for their own kiddos, and then went on to tutor other students.

[PeterPan]

Around here excellent OG is $65-80 an hour, making Heather's advice excellent, as usual. 😀

[Southern Ivy]

Also -- I don't think you just had a stubborn little girl at speech. I think you had a speech teacher who took a little bit of time to find the right technique to work with her.

 

It is a combination of both. And it isn't bad on either side. It is just a process.

 

I would interpret a lot of my older son's behavior at speech therapy as willful and frankly deeply embarrassing to me, and I got feedback like ---- one, they see it and it is part of their job to bring in techniques and help things go well.... two, this is how younger kids act when they are frustrated and can't do what they are asked.

 

So it is not like ---- she wasn't at fault at all, but it's also not like she was just doing it on purpose.

 

Edit: what I mean is -- your speech therapist got advice, tried something different, and then your daughter did better -- so it seems like what she was trying first may have been frustrating your daughter because it was too hard.

Oh, no. Trust me, it was pure stubbornness that day. lol It wasn't speech production that was the issue that day. If it was her balking over the work, I wouldn't think it was stubbornness, but frustration.

I don't even remember what the whole incident entailed, but Kelsey (the SLP) called her bluff that day. We sat for 30 minutes - dd kept trying to negotiate and Kelsey kept telling her the expectations. We left that day having done absolutely no speech work, but Kelsey earned dd's respect. After that, lessons were a dream and they had a fantastic rapport. 

I'm not looking forward to finding a new SLP. We loved Kelsey a lot. 

[Southern Ivy]

The closest PROMPT SLP is 1.5 hours away and I think she's only had the introduction to PROMPT. The others are beyond what I can realistically drive for a therapy session. 

Edited June 25, 2017 by Southern Ivy

[Southern Ivy]

The best way to use these scores is to tuck them away. They are helpful as a base test. You know she has ADHD and very likely CAPD.

 

Maybe find a good child psych and get the ball moving on the attention issues. Seek an OT evaluation for pincer grasp, reflexes, motor planning, perceptual vision, core strength, vestibular, and possible sensory issues. Work with an SLP. If you can locate a PROMPT SLP as OhE suggested, that would be awesome.

 

I don't know whether you have considered this. Take the coursework and get the OG certification. You teach for a living. I know several moms that became OG certifed for their own kiddos, and then went on to tutor other students.

What do you mean? Meds or behavioral therapy or ??

[Guest]

The SLP is in a children's center that has OT and PT, though. So, man, if we could get both scheduled down there....

Southern Ivy, check their website for therapist profiles. It can show you what they have to bring to the table. At this point, you don't even know if you are dealing with motor planning issues. Did the neuropsych mention having any problems with understanding what your girl was saying? Not trying to step on any toes here but not all kids' articulation issues automatically equal apraxia!

Edited June 25, 2017 by Guest

[Lecka]

Child psychs can do CBT (cognitive behavioral therapy) -- it can be good for ADHD.

 

I am glad it was just one day at speech! I think that is pretty common -- and it sounds like the speech therapist handled it well :) I hope you have a good experience with everyone you might work with in the future, too!

 

Edit: I'm not sure -- I just read that and thought "CBT."

 

It is good stuff :)

Edited June 25, 2017 by Lecka

[Guest]

Agree with this:

 

Child psychs can do CBT (cognitive behavioral therapy) -- it can be good for ADHD.

 

I am glad it was just one day at speech! I think that is pretty common -- and it sounds like the speech therapist handled it well :) I hope you have a good experience with everyone you might work with in the future, too!

[Crimson Wife]

  Not trying to step on any toes here but not all kids' articulation issues automatically equal apraxia!

 

My DD's articulation and many (though not all) of the attention issues turned out to be due to partial hearing loss. So if your child has not had full audiology booth testing within the past year, I would strongly recommend it. The standard hearing screening at the pediatrician's office did not catch it because it only tests a few frequencies and not the ones where my DD was profoundly deaf at.

[Lecka]

I also think people mean different things when they say behavioral therapy -- I would say it and mean "ABA" which is mainly for autism.

 

But in a lot of contexts I think it would mean CBT.

 

It is -- talking through and practicing mental strategies, developing coping mechanisms, stuff like that I think.

[Heathermomster]

What do you mean? Meds or behavioral therapy or ??

CBT and/or meds. The child psych will sort that and if they are worth a hoot, will send your child to OT.

[Lecka]

Oh, the audiology screening is a good idea.

 

Also -- in practice for me, I would be asking the pediatrician for a referral for whatever is recommended for ADHD, and that might mean a child psych -- and then see what that person says.

[PeterPan]

What do you mean? Meds or behavioral therapy or ??

 

 

CBT and/or meds. The child psych will sort that and if they are worth a hoot, will send your child to OT.

And just to clarify, are you saying child pdoc or psychologist? I'm really asking so the op will sort it through. I've seen both doing CBT in our area.

[PeterPan]

The closest PROMPT SLP is 1.5 hours away and I think she's only had the introduction to PROMPT. The others are beyond what I can realistically drive for a therapy session. 

 

Well I drive farther than that, have for 6 years now. :) Really, I'm hoping it was a negative. I totally, totally agree with you on not bothering with someone with only Intro. However, however, however, I will tell you that provider map is NOT up to date. So what you might want to do is call/email them and actually ask what their current training level is in PROMPT. It's VERY possible the map is not accurate, because I know people for whom it's not.

 

And then, when you have them on the phone, simply talk through it. They can ask you questions and just sort it out, like whether it's even worth the effort, whether there's even a probability of turning up something. I will say though that the dots that I was connecting were that you've been referred for OT for motor planning issues, that you continue to have articulation and intelligibility issues (intelligibility is HUGE with praxis), and that getting one sound (g/k) took a year. And just talk it through, kwim? Talking it through costs nothing. They might blow your mind and be really helpful. They might tell you no. I'm just saying it would be a *reasonable* question, a reasonable thing just to make sure you put on the table and sorted out and eliminated, just like you eliminate autism and go to the dentist and the eye doctor and everything else.

 

And yes, there are people with APD who also have apraxia. When it rains, it pours. You wouldn't be the first and you'd rather it were diagnosed than not. It's super easy to elicit and demonstrate the motor planning problems.

 

As far as the distance, my personal advice is first to see, with that phone call, whether it's even warranted to eval for motor planning. They can ask you enough questions to predict. Then, if it IS warranted to eval, see if they do the VMPAC or what testing they use. The VMPAC is *the* test from PROMPT and it's quite detailed. Will blow your mind. If it's praxis, it will be obvious and you'll have data to show it. If it's not, same gig. 

 

Anyways, I would solve the problem of what kind of therapy you need after you actually know what the problem is, kwim? And if the SLP thinks there are enough flags that it would even be warranted to test her motor planning (which I'm not saying it is, but I'm saying you could answer with a phone call), then you could do the testing, see the results, then decide. 

 

Your best evals are going to be from someone who is certified, obviously, and you'd like to hear they're using the VMPAC. Unless there's a replacement I don't know about. They recently did something on us a different way, so there may be a replacement, hmm. But the VMPAC was really good.

 

Whatever, I was only saying it as a thing to eliminate. It's a low probability explanation, kwim? Phone calls are cheap/free. Me, I call people all the time. I call and ask lots of questions. I play dumb really well, and I learn a lot that way, kwim? People are really nice and they'll actually try to HELP you if you ask. You could even just say there's this obnoxious mom online who mentioned this and you just want to make sure there's nothing to it. :D

[Southern Ivy]

But at the same time -- when you have gotten comments she is hard to understand -- I think if these are your relatives and you are considering a speech eval -- ask them if they hear her mix up or muddle sounds, that you may be used to. Or does she talk fast. Or does she not quite make sense -- not say things in a way that really makes sense. Is she hard to follow.

 

I really barely knew anything about speech therapy -- I thought it was only speech sounds. Well, they do also work with kids who are hard to follow.

 

So I think -- ask what they mean and tell a speech therapist that is an area of concern. Now -- the problem is are your relatives used to talking to 5-year-old girls?

 

I think a lot of this *could* be better with ADHD medication. Like -- it really could be. It is hard to know until you try it (or an alternative).

 

But if she is hard to follow, more than it being articulation, then it could be helped.

 

What happens is you get an overall impression "she is hard to understand sometimes" and then it is the speech therapist who can say "well it is partly articulation and partly she is hard to follow."

 

 

Oh yes, my friend who said she was hard to understand (after I asked) has a 5 year old girl (my daughters best friend) and has taught K and 1st. 

My mom has taught Pre-K up to 6th for 30+ years and is an elementary administrator. She's quite frequently with littles. 

My sister teaches Sunday school for this age group as well, plus her friends all have kids around the same age. 

 

So, yeah, they're used to 5 year old girls. 

 

Dd talks pretty fast, but she also muddles her sounds. There are still some speech issues, but those are developmentally appropriate. However, I'm kind of feeling there's a lapse in some pronunciations that I'm hearing, but that aren't registering. She does say some wrong words - like today she said "These shoes keep snapping my feet." I had to ask a few questions before she confirmed that she mean 'pinching' 

 

 

 

 

My mom came up today and took dd for the next few days for VBS at their church. While she was here, we talked over what I've been learning over the last few days with you all and the 3 posts I've made. She definitely agrees with the OT and she's strongly suggesting LIPS as well. We talked a lot about what "school" needs to look like this year. It was a good talk. :) Helped me talk about some things and solidify what I was thinking and to sort through all the info on this thread and the others. 

[PeterPan]

Ok, please, y'all keep razzing me on this, but intelligibility, talking really fast, this can be a red flag for motor planning problems. Kids can do it to cover up their poor motor control.

 

I tell you, we're talking a phone call. Just a phone call. Worst case scenario is you drive three hours, do the VMPAC, get told no it's just something us. 

 

Even worse case scenario is you DON'T call, DON'T get the VMPAC, and you go to some untrained, flashcard wielding (note my nasty tone here) SLP who doesn't diagnose the praxis or diagnoses it and has only IMITATION and flashcards and little wands in the mouth. Wow I'm nasty. Worst case scenario is ineffective therapy. 

 

You'd rather drive that far once a month, once a week, once every other week, and have therapy that WORKS than to have super frequent therapy that doesn't work. And solving intelligibility problems with praxis is nasty. They have to go all the way back, because what has happened is that someone plowed forward with more advanced skills in the heirarchy without building a FOUNDATION of motor control. That's why she's unintelligible.

 

Yes, there's a school of thought that less effective methods, done in sufficient quantity, can still get kids where they need to be. I'm all for success and wish everyone well, so more power to 'em, wish 'em well. For the kids for whom it wasn't enough, well that's where you get kinda pissy and wonder why the SLPs treating it wouldn't get trained in a KNOWN EFFECTIVE METHODOLOGY. Grr.

 

Then there are the lovelies trained at level 1 who tell people it doesn't work. Yeah, I'm on a rant. 

Edited June 25, 2017 by OhElizabeth

[PeterPan]

The other brilliant thing about PROMPT, if there happens to be motor planning going on, is that you can harness it to bring multi-sensory to your LIPS, etc. That's what we did, and it was SUPER POWERFUL.

 

To me, personally, I don't get why they aren't using PROMPT for EVERY child. Why should kids with more typical delays not get it? There's no harm to it, and it gives you the ability to instantly cut to the chase and get the dc there. So much trouble could be saved. Oh, that wouldn't make them money if it took less time to do the therapy. Hmm. 

 

Oh yeah, Liz here is never cynical.

[Southern Ivy]

Southern Ivy, check their website for therapist profiles. It can show you what they have to bring to the table. At this point, you don't even know if you are dealing with motor planning issues. Did the neuropsych mention having any problems with understanding what your girl was saying? Not trying to step on any toes here but not all kids' articulation issues automatically equal apraxia!

She could understand her, but had to really concentrate at times or had to have dd tell her again. 

 

My DD's articulation and many (though not all) of the attention issues turned out to be due to partial hearing loss. So if your child has not had full audiology booth testing within the past year, I would strongly recommend it. The standard hearing screening at the pediatrician's office did not catch it because it only tests a few frequencies and not the ones where my DD was profoundly deaf at.

She had an audiology test done at 3.5, so about 1.5 years ago. The audiologist came in and said that we would definitely try, but that at her age, she might not give an accurate reading. But, dd did really well. The audiologist was actually surprised. 

Of course, things can change in a year...

 

CBT and/or meds. The child psych will sort that and if they are worth a hoot, will send your child to OT.

Ok, and SOOOO many things coming in at me at once...can you refresh my memory on the WHY for the CBT? Just want to make sure I'm understanding correctly. 

 

 

I know you all probably feel like you're beating a dead horse with me. Thanks for sticking with it!

[Southern Ivy]

The other brilliant thing about PROMPT, if there happens to be motor planning going on, is that you can harness it to bring multi-sensory to your LIPS, etc. That's what we did, and it was SUPER POWERFUL.

 

To me, personally, I don't get why they aren't using PROMPT for EVERY child. Why should kids with more typical delays not get it? There's no harm to it, and it gives you the ability to instantly cut to the chase and get the dc there. So much trouble could be saved. Oh, that wouldn't make them money if it took less time to do the therapy. Hmm. 

 

Oh yeah, Liz here is never cynical.

My mom was mentioning finding an OT that was familiar with LIPS. She seems to think that one of the kids at her school was with an OT who utilized LIPS. 

(But, sometimes, my mom confuses herself. lol So, I'm wondering if that's really a thing.)

[PeterPan]

CBT and Social Thinking will be roughly equivalent and serve similar purposes. They're a meta-cognitive approach, helping the dc to engage and become active in his understanding and choices. It's the difference between you passively telling her everything to do and her learning to understand herself, understand how others thing, and begin through how to make better choices.

 

Trying to remember here, but basically a 5 yo should be 100% intelligible, irrespective of letters missing. It's something we have watched for years on my ds, and it's *exceptionally* concerning that you're getting it flagged so much. Don't blow that off.

 

The audiology testing can change, but that's interesting that you had it done at 3.5. What prompted it then? Was she not responding?

[PeterPan]

My mom was mentioning finding an OT that was familiar with LIPS. She seems to think that one of the kids at her school was with an OT who utilized LIPS. 

(But, sometimes, my mom confuses herself. lol So, I'm wondering if that's really a thing.)

 

Uh no. OTs might do Zones of Regulation. SLPs might do LIPS. Personally, I think you're going to need to do LIPS yourself. I think you want the SLP eval first, including the VMPAC, CELF/CASL, things for vocabulary, the TOPS if they have it normed for that age, and a CTOPP if someone has it. Then begin LIPS. The other benefit to doing that testing first, besides giving you thorough baselines, is it gives her a bit more time to mature. Honestly, even with my ds' IQ, he really benefited from some extra months. If you do all that testing and she's closer to 6 when you actually begin LIPS, it would be good enough. Not saying you can't do it earlier, just saying my ds did better with a bit more time under his belt. You could also get that OT eval, begin meds, etc., before beginning LIPS.

[PeterPan]

The reason to do LIPS yourself is because you're going to have to own the full gravy train on this problem. Whoever teaches her needs to be able to continue that methodology into Barton 1 and 2. If she *does* have motor planning issues, the person will have to blend in PROMPT. If the SLP wants to do it, fine. I'm just saying it's a process and somebody has to follow it through. 

 

OG tutors aren't typically able to handle significant behavior challenges, and they'll have no experience with the hands-on inputs of PROMPT. Now I personally think it would be super fab awesome if PROMPT made a training course so they COULD. Like that would be really stellar! 

 

Let it unfold, see what happens. Maybe it won't be that complex. Just saying that's how I ended up *not* using tutors for stuff, because I realized too many puzzle pieces needed to come together.

[PeterPan]

What are her strengths? What is she awesome at? What does she REALLY LIKE to do? Whatever she's really into is probably what you're going to do more of and call it school. :)

[Southern Ivy]

CBT and Social Thinking will be roughly equivalent and serve similar purposes. They're a meta-cognitive approach, helping the dc to engage and become active in his understanding and choices. It's the difference between you passively telling her everything to do and her learning to understand herself, understand how others thing, and begin through how to make better choices.

 

Trying to remember here, but basically a 5 yo should be 100% intelligible, irrespective of letters missing. It's something we have watched for years on my ds, and it's *exceptionally* concerning that you're getting it flagged so much. Don't blow that off.

 

The audiology testing can change, but that's interesting that you had it done at 3.5. What prompted it then? Was she not responding?

I requested it due to not responding or having to call her several times. I wanted to make sure we didn't have a hearing issue going on. 

She passed very easily, though. So, I just assumed it was typical preschool zoning out. :) 

[PeterPan]

I requested it due to not responding or having to call her several times. I wanted to make sure we didn't have a hearing issue going on. 

She passed very easily, though. So, I just assumed it was typical preschool zoning out. :)

 

Uh, no, that's why we took my ds in, and shortly after that he got his autism diagnosis. Not responding is definitely noteworthy.

 

Does she still do that? Is there any pattern to it, like it happens more in noisy environments? With my ds, it was kind of odd. Like if you were *behind* him he was less likely to respond. He turned out to have proprioception issues for anything *behind* him. So you might notice patterns to it or whether you're now compensating.

[PeterPan]

By compensating, I mean maybe you have the habit now of always really getting eye contact and getting on her level before you talk to her. That kind of thing. 

 

There's such a range, sure. But if it's happening that she's not responding, you'd like to notice the situation (background noise, what she's doing, where the person calling her was at, etc.), and see if there are patterns. 

[Heathermomster]

She could understand her, but had to really concentrate at times or had to have dd tell her again.

 

She had an audiology test done at 3.5, so about 1.5 years ago. The audiologist came in and said that we would definitely try, but that at her age, she might not give an accurate reading. But, dd did really well. The audiologist was actually surprised.

Of course, things can change in a year...

 

Ok, and SOOOO many things coming in at me at once...can you refresh my memory on the WHY for the CBT? Just want to make sure I'm understanding correctly.

 

 

I know you all probably feel like you're beating a dead horse with me. Thanks for sticking with it!

I prefer a child psychiatrist for ADHD treatment because they can test and prescribe meds. There are studies that state a combo of therapy and meds have the best outcomes WRT ADHD. Therapies involve both the parents and the child.

 

Eta: A CBT and child psychiatrist may work together to support the treatments. My local child psych works in the office with a team of professionals, counselors, and testers.

Edited June 25, 2017 by Heathermomster

[Southern Ivy]

What are her strengths? What is she awesome at? What does she REALLY LIKE to do? Whatever she's really into is probably what you're going to do more of and call it school. :)

The girl loves nature and art. She loves climbing her tree and hanging off anything - she's got some wicked arm strength. Her imagination is one of a kind. I really just need to have her tell me stories and write them down. We could get them published and make tons of money. haha

 

Mom and I talked about continuing with math, doing science experiments and watching Magic School Bus, reading Bible stories and living books for history, and hitting OT and speech hard. 

[Southern Ivy]

Uh, no, that's why we took my ds in, and shortly after that he got his autism diagnosis. Not responding is definitely noteworthy.

 

Does she still do that? Is there any pattern to it, like it happens more in noisy environments? With my ds, it was kind of odd. Like if you were *behind* him he was less likely to respond. He turned out to have proprioception issues for anything *behind* him. So you might notice patterns to it or whether you're now compensating.

It's typically only if she's watching TV (like, really in the zone) or if it's noisy.