Is it Time for a Neuropsych Eval?

[scbusf]

DD just turned 7 in June. She has a repaired cleft lip and palate and was adopted from China at age 18 months.

 

She is very energetic - like seriously, the girl never stops moving. She is also LOUD. She talks loud, walks loud, the girl is just loud.

 

She can follow directions. She frequently asks me to repeat things. she is very advanced in math and science.

 

She is still not reading. We have tried Reading Eggs, Progressive Phonics, Phonics Pathways, and I feel like there was one other. Part of the problem is that she can't sit still for 10 seconds. I'm really not sure that's the only thing we are dealing with, though.

 

She has had meltdowns due to frustration - I thought they were due to anxiety issues. She has been taking a low dose of Prozac and it has helped the meltdowns. I was hoping that if the meltdowns stopped, then we could focus on the other issues. The other stuff hasn't improved.

 

I don't know - maybe we are dealing with ADHD and some sort of processing issue or something?

 

Any thoughts?

[PeterPan]

There's usually a wait to get into a good psych. It's definitely not too early, but I think what you could do is go ahead and talk with your ped, get the ADHD diagnosed, start some meds for that, and see if that helps her calm down and attend to the reading lessons. That would fill the 1-3 months or more while you're waiting for a psych eval. 

 

If you can find someone to run a CTOPP sooner, like a reading tutor, that would be helpful. She also sounds like she desperately needs an OT eval.

 

To what do you attribute her asking you to repeat things? What happens when she is in noisy places? Can she hear you then or does she seem not to hear and discriminate your voice in noisy places? 

 

How is her phonological processing? Can she rhyme? Does she play word games readily?

 

Really, you could be dealing with anything. Sometimes evals reveal things over time, but sure it's ok to want some evals now. Clearly stuff is going on, and since you don't have her bio history you don't even know what. I had my ds evaled at newly 6, so clearly I'm in the sooner is better than later camp on evals. :)

[OneStepAtATime]

There could be many things going on.  She could have APD, ADHD, Dyslexia, low processing speed, low working memory, brain development issues caused by something during the birth process, even food allergies.  Evals should help sort out at least some of it.  Even if she has ADHD and meds are not something you want to look at having that answer helps you know what additional resources to look for, what additional supports you might need to put in place, etc.  And if it isn't ADHD then you know something else is going on and can try to dig deeper.  As OhE said it can take time to get in with a neuropsych so I would schedule that now since you may be waiting for the appointment for months.  You can always cancel later.  

 

How is her rhyming?   Phonological processing?  

 

Have you had any sort of eye exam, by the way?  Not just a cursory screening through a pediatrician?

 

Meltdowns could be anxiety.  Could be coupled with extreme frustration.

[Davysmom]

Now is a great time for an evaluation. There is no reason to wait (other than waiting to get seen!)

 

Don't let your pediatrician dx ADHD. I have a lot of background working with ADHD children. My dh and dd are ADHD.

We have an adopted child who presented like classic ADHD. He was not reading at 7 either.

 

The neuropsych evaluation turned up things I never expected. He is not ADHD. I was so ready to just start meds. Our pediatrician had already dx ADHD and had given the referral to the neuropsychologist. But when I called the dr to set up appointments they asked us not to do meds until after the evaluation if they were needed. They said 3 or 4 out of 10 kids they see dx with ADHD by a pediatrician actually have it.

 

Our kid is a different kid now. It is amazing. We were able to get to the root of some issues and we are still working through others.

 

Take your time and find a good dr. It makes such a difference.

Edited August 16, 2017 by Davysmom

[Dmmetler]

In general,if you're asking the question, yes, it's time. The more information, the better.

[PeterPan]

Some peds run testing like the Quotient before they do meds. I personally wouldn't do meds based solely on the stupid EF questionnaires, totally agree. Ironically, our ped disagrees with our $$$ neuropsych and says there's NOT ADHD going on with ds. Think about that one, lol. So there are presumptive jerk neuropsychs out there too who don't listen very well and overdiagnose their pet things. I really like data, and I like the Quotient.

 

My personal line on meds at this age is danger to self or others. There's probably a lot going on with this dc the mom isn't saying if the mom already put her on prozac, kwim? There's more than enough warrant to get the kid into evals and pronto. Even basics like OT eval and looking at food allergies and things. You've got so much dysregulation going on there, and that's something OT is specifically able to work on, when you get the right OT. 

 

The bummer is the wait and figuring out how significant these behaviors are and what she can do while waiting to get into the psych. In some areas that can be a 3-6 month wait. If she's got a long wait, she needs some options. That's where a Quotient and meds, a trial of caffeine (super low, no sugar added), some OT, she needs some options. 

[Stibalfamily]

We had a neuropsychologist test our son. It was very overwhelming and depressing to hear the results. So be prepared emotionally when you go in. We also requested the school psychologist at our local school do a full evaluation on our son (they do this even if you are not going to the school). This was a bit more helpful as it gave us more educational info like poor working memory and specific learning disorders.

Edited August 16, 2017 by Stibalfamily

[Crimson Wife]

Children with cleft palate are at greater risk for hearing loss (it has to do with the craniofacial structural abnormalities) and some of the symptoms mentioned would be consistent with a milder or partial hearing loss. Even if she passed hearing tests in the past, I would encourage you to get full audiology booth testing (not the screening test at the pediatrician's office). If you can find an audiologist that screens for central auditory processing disorder, that would be even better.

 

When my DD received treatment for her hearing loss it didn't fully resolve the attention issues (she definitely still has ADHD in addition to the hearing impairment) but we did see a significant improvement.

[scbusf]

To answer a couple of questions:

 

Her rhyming is great!

 

Vision - she has had an exam by an Optometrist. The doctor said DD's vision was a bit under where it should be, but she didn't want to over-correct it at this point. She said we could come back at any time if she is squinting or anything. Maybe we will do that and see if glasses help.

 

Hearing - She has had a couple of Audiograms in her life and all have been normal. Off the top of my head, I don't recall when the most recent one was. I will look it up and ask our ENT if she should do another one.

 

And of course, this week, it's like her reading has turned the corner. We'll see if it continues. But she's been reading things and I keep asking her if she's really reading it, or if it's something she has memorized.