Got our written neuropsych report last Thursday...

[jujsky]

Well that's what I thought, then I saw her positive response in the other thread. If there were indications of problems and the doc wasn't able to help them, then maybe the eye problems are still there? Maybe think about finding another doc? It's not like *all* docs flop. I'm just observing that the things she is describing could very well be eyes.

 

Not meaning to rub a sore point, just saying what I see.

 

I think the only VT in our area is the guy we saw. He rotates at a few practices he either owns or is affiliated with, and therefore covers most of the area that is within driving distance for me. I don't even believe or trust in the man to give my son a vision screening at this point. Don't get me wrong -- I DO think VT can work, but I don't think it's necessarily a cure-all for every child, and I see a lot of people pushing it on this board. I also think there are many bad doctors out there who either don't know how to implement VT or don't appropriately train their staff to do VT. Our case was a horror story. It can work. I believe in the philosophy behind it, and I'm happy for those that have had successful outcomes from VT. In our case it either didn't work because of the way it was done or he didn't need it in the first place and the doctor was scamming us for money.

 

I will post later with DS's scores and weaknesses more in depth to see if any of you wise ladies can help me piece together some ideas/curriculum suggestions that will work for him. In good news, I spoke with a behavior therapist last night that our fabulous pediatrician recommended, and we have an appointment with him tomorrow (he's working this Sunday to make up for the snow day earlier this week). I asked him all the important questions, including how he feels about homeschooling. He had no problem with it and was sort of confused why I asked him. When I explained many counselors are staunchly against it, he was shocked. He thinks it's great! He focuses on training the parents to work with the child instead of counseling the child as the guy we used (and didn't like) when DS was 4. I'm cautiously optimistic that this man will be able to help us.

[Tokyomarie]

I will post later with DS's scores and weaknesses more in depth to see if any of you wise ladies can help me piece together some ideas/curriculum suggestions that will work for him. In good news, I spoke with a behavior therapist last night that our fabulous pediatrician recommended, and we have an appointment with him tomorrow (he's working this Sunday to make up for the snow day earlier this week). I asked him all the important questions, including how he feels about homeschooling. He had no problem with it and was sort of confused why I asked him. When I explained many counselors are staunchly against it, he was shocked. He thinks it's great! He focuses on training the parents to work with the child instead of counseling the child as the guy we used (and didn't like) when DS was 4. I'm cautiously optimistic that this man will be able to help us.

 

This behavior specialist sounds promising. Obviously, it is a plus that he is pro-homeschooling. As for anyone who will assist with behavior and emotional issues in a young child, I personally prefer someone who spends as much or more time educating parents as he/she spends with the child, because it is the parents who will be working with the child all those hours of the day/week that professionals are not available. Listen for the buzz words of his philosophy and ask what books or other references he often recommends. Then before settling on working with this person, do some reading about the particular approach he takes to see if it is a good fit.

[PeterPan]

Well sure, post what the man gave you, tell us if what he said jives with what you saw in the appointment or see happening, and let's see if Yllek or someone can read the tea leaves. That's a frustrating position to be in. I'll make one suggestion though. In my own slight experience, I think someone who does *not* have the problems will either be fine with the VT exercises or will nail them extremely quickly (hard the first time, and then boom has it, that sort of thing).

 

I'd love to hear more about your experiences to see if we could help you through it. I don't know. See the other question I have, just backing way up here, is did he check for retained primitive reflexes and sensory integration problems? Has your ds done any OT for sensory? I'm totally mixing things up probably, but have you said he has a diagnosis somewhere on the spectrum? See once you start talking that, you're talking about kids who can have *extreme* sensory integration problems, stuff that would make your hair curl and that you might not even *realize*. Have you read KarenAnne's stories here on the boards about VT with her dd? Diagnosis NVLD I think. Jist is she got VT through someplace, paper only, and it just did NOT take, not at all. Still had problems, knew part of it had to be eyes, sputtered and floundered, finally coming across this AMAZING doc who trains Olympic athletes. The guy got a hold of her dd, started doing testing, and found sensory integration problems that would blow your mind. Like put her on the floor tummy down, touch her right leg, and she would lift her left! Would there's no way in the WORLD a child like that can coordinate eyes and get things working right! All the signals were jumbled!

 

So those docs that treated her at first might have been fine for most kids, but some kids need more, the VIP treatment, the really hands-on, on the floor, rewiring the brain. And so when you're saying nothing they did worked and it was the most horrible experience ever (sorry to paraphrase), that can be part of it.

 

I only mention all that, because, well because you do have options then if you can figure out what went wrong. Like if it was just that doc and he was just a bum, a bad apple, a runt pig, well then you can get that $30 book on amazon and do it yourself. But if there are neurological things going on, that's something that's probably affecting lots of his life, not just his vision. And in a case like that you're wanting an OT eval. We've even had people post about PTs who were quite skilled with vision stuff. More than one way to shake a stick!

 

So it's not a cathartic thing or proving somebody right or wrong on the boards; it's just about seeing if there are any options there or hidden clues.

 

And yes, what a blessing to get someone counseling you who will help on the *you* end of knowing what to do!!! :)

[jujsky]

DS had an OT evaluation when he was almost 4, and went to OT for a year and a half. It helped him tremendously, but the OT did warn us that she sees a lot of kids back there when they turn 8-10 because they outgrown their sensory plans. He had a partial OT evaluation through the school in December, and he had most of the same issues, only more mild than they were when he was 4. He's on a waiting list to get into an OT program affiliated with our local hospital. I should be hearing from them within a month or so. DS is a seeker and has weak trunk muscles and a weak tripod grasp. There are some gross-motor and fine-motor things going on. He can do flips and somersaults like a pro, and he took to ice skating fairly well. When it comes to catching a ball, tying his shoes, or riding a bike, he struggles.

 

When he went for his neuropsych they did consider he might be on the spectrum, but ruled that out. He has a lot of social problems, uses a very mature vocabulary, and gets fixated on topics sometimes, but I was told he was too social to be on the spectrum and communicates too well. They feel that ADHD accounts for the majority of his social issues. I've done online parent assessments for autism/Aspergers before, and they always come up as not on the spectrum, or slightly on the spectrum. I don't know how accurate those are.

 

As to some of his scores, I can list those below:

 

IQ

Verbal Comp: 124 (Superior)

(Similarities: 15, Vocab: 15, Comp: 12)

 

Perceptual Reasoning: 100 (Average)

(Block design:8, Picture Concepts: 11, Matrix Reasoning:11)

 

Working Memory: 94 (Average)

(Digit Span:8, Sequencing: 10)

 

Processing Speed: 91 (Average)

(Coding: 7, Symbol Search: 10)

 

It states that the average scaled scores (the sub-tests for each section) are 8-12, while the average standard scores are 90-109. He barely makes Average on Processing Speed, and although on THIS test it doesn't look like Working Memory is too horrible, check out his Working Memory score on the BRIEF below.

 

On the BRIEF, he demonstrated problems with Inhibit (96%, T=71), Shift (98%, T=74), Initiate (93%, T=66), Working Memory (98%, T=74), Plan/Organize (91%, T=65), Organization of Materials (99%, T=71), and Monitor (98%, T=69).

 

Woodcock-Johnson (90-110 is considered average) He did well on the Woodcock-Johnson, even in math. His math scores in this test do not reflect what I see at home, and it is noted that he was unable to do any multiplication or division problems. It was also noted that he cannot easily recall math facts and was using his fingers to count.

 

Letter-Word Id= 120

Reading Fluency= 116

Passage Comprehension= 115

Story Recall = 109

Understanding Directions= 108

Calculation= 101

Math Fluency = 83

Applied Problems = 104

Spelling= 95

Writing Fluency= 107

BROAD READING= 120

BROAD MATHEMATICS= 100

BROAD WRITTEN LANGUAGES= 102

MATH CALCULATION SKILLS= 97

WRITTEN EXPRESSION= 112

ACADEMIC FLUENCY= 110

ORAL LANGUAGES= 110

 

OT Eval using the BOT-2 test):

Fine Motor Precision: 9, Below Average

Fine Motor Integration: 10, Below Average

Manual Dexterity: 9, Below Average

Upper-Limb Coordination: 9, Below Average

Bilateral Coordination: 12, Average

 

Another OT evaluation, the DTVP-2:

Position in Space: 16%, Below Average

Figure Ground: 63%, Average

Visual Closure: 84%, Average

Form Constancy: 50%, Average

Composite Scroes:

Motor Reduced Visual Perceptions

Percentile: 55%

Quotient: 102 (Average)

 

It is stated that he scored on the average to below average range on all of the subtests, and his composite scores place him in the average range for motor-reduced visual perception.

 

Those are just the tests the school administered. I'll try to post the neuropsych tests he did later today. I have to fill out the forms the behavioral therapist sent us before our meeting today.

[chiguirre]

My concern with MUS (if it's the program I'm thinking about) is it covers one thing a year. Doesn't it cover addition one year, subtraction the next -- that sort of thing?

 

MUS covers addition and subtraction through 20 in Alpha as well as a few other more minor topics, does carrying/borrowing and skip counting in Beta and introduces multiplication in Gamma. It's not that far off standard scope and sequence imho, although it's not Singapore Math either. The real sticking point is memorizing the math facts in Alpha. If you hit a big stumbling block you'll have to use an outside resource to work specifically on developing retention. That's when I used Semple Math.

 

You could go to the MUS website and download practice sheets from Alpha, Beta and Gamma to see where your ds is successful and where he needs more work.

 

If you find he's strong on some topics and needs to shore up others, Math Mammoth's Blue series offers topical workbooks that might suit your purpose. They move faster than MUS and require that a student have more number sense than Geezle possesses, but they are really well written. If Trinqueta didn't love the cartoons in SM, we'd use MM.

[jujsky]

MUS covers addition and subtraction through 20 in Alpha as well as a few other more minor topics, does carrying/borrowing and skip counting in Beta and introduces multiplication in Gamma. It's not that far off standard scope and sequence imho, although it's not Singapore Math either. The real sticking point is memorizing the math facts in Alpha. If you hit a big stumbling block you'll have to use an outside resource to work specifically on developing retention. That's when I used Semple Math.

 

You could go to the MUS website and download practice sheets from Alpha, Beta and Gamma to see where your ds is successful and where he needs more work.

 

If you find he's strong on some topics and needs to shore up others, Math Mammoth's Blue series offers topical workbooks that might suit your purpose. They move faster than MUS and require that a student have more number sense than Geezle possesses, but they are really well written. If Trinqueta didn't love the cartoons in SM, we'd use MM.

 

I supplemented with MM Blue last year, and that didn't seem to help him much. We also did 9 months at the Kumon Center which included going to the center 2X/week, and homework 7 days/week. I thought the kill-and-drill approach would cement those facts in place. It didn't help in the slightest. I haven't heard of Semple. I'll look at that.

[MomatHWTK]

My son's therapist told me to accomodate his processing problems by letting him use a calculator. We are moving forward with math concepts and no longer worrying about memorization of math facts. Some days he remembers them all "easy" and other days he can't pull them up for anything. :confused:

[LittleIzumi]

I supplemented with MM Blue last year, and that didn't seem to help him much. We also did 9 months at the Kumon Center which included going to the center 2X/week, and homework 7 days/week. I thought the kill-and-drill approach would cement those facts in place. It didn't help in the slightest. I haven't heard of Semple. I'll look at that.

 

We've been working on math facts for the last year, and we found some things she enjoyed (like Math Bingo) but it didn't seem to be helping her facts at all. I figured it would just take a long time. Then I found something that really grabbed her interest/current attention focus of horses, MathRider, and within two weeks she has made incredible leaps. Using her current focus has also let me introduce daily writing and reading and history tied to that focus with no fights where previously she was very resistant to all three subjects. The hyperfocus is maddening sometimes but this time I'm using it to help.

[PeterPan]

I'm not too keen on symptom assessments for ADHD. I've done them a few different times for my dd, and I can tell you the results can vary WIDELY depending on where you're at in life. So it will be interesting to see the neuropsych results when you post them.

 

The position in space score for the visual perception was way off from the others. Check out this link http://books.google.com/books?id=aHPKrwmFM3EC&pg=PA225&lpg=PA225&dq=dtvp-2+position+in+space+depth+perception&source=bl&ots=NY_99JgT38&sig=xCMV6-_NWMYdeql4u8KMvgSgN9U&hl=en&sa=X&ei=SrtTT6iDHsLw0gG3w-TaDQ&ved=0CCAQ6AEwAA#v=onepage&q=dtvp-2%20position%20in%20space%20depth%20perception&f=false Seems like it fits what you're saying, that he loses his columns, etc.

 

Did the OT check sensory integration, retained primitive reflexes, tone (not strength, tone), etc?

[Nancy in NH]

Yes, that's the place--same doctor. We did not use them, despite all the months I spend getting our insurance to authorize and agree to pay. He wouldn't bill, and the insurance required the physician submit the bill. I called to plead my case with them though he was never available. I emailed Dr. C before giving up. He did not even bother to respond. Believe me, I am so glad now (after learning more about VT and my son's particular problem) that it worked out the way it did.

 

Nancy in NH

 

You didn't happen to seek out VT in Merrimack, did you? The name of the place escapes me, but it's a big, yellow building. That's where we went. I won't post the doctor's name, but it began with a C. I'm curious if it's the same place. There aren't many in this area. He also wouldn't direct-bill insurance. Did you end up using them or not because you couldn't get insurance to pay? If you didn't use them and it's the same place, you dodged a HUGE bullet!!!!!

[Laurie4b]

Sorry that you got a report that is not helpful to you. If it's any consolation, having a long paper trail is helpful in getting accommodations for tests like the SAT or ACT, so it will turn out to be useful for something. Bad news is that you do need to repeat testing about every 3 years to maintain the paper trail, but you could go somewhere else.

 

It does sound like they have a pre-prepared report for kids with ADHD. However, it is bizarre to me that they would recommend their rewards system. It worked because it was novel. Duh. That's why people with ADD kids have to change behavior systems every few weeks. It gets wearisome!

 

I loved our neuropsych and we got excellent practical suggestions. She does not homeschool, but is supportive of it in most cases. Our ds's issues overlap yours to some degree, but not all . He also had an LD-NOS because it just doesn't fit any box. It was the appropriate dx for him.

[jujsky]

 

Did the OT check sensory integration, retained primitive reflexes, tone (not strength, tone), etc?

 

I'm not sure if this OT checked those things. I know he has low tone because of the OT evaluations he had when he was 4 and 5. I was told he can increase strength, but will always have low tone.

 

Okay, neuropsych results:

 

He took the Differential Ability Scales (DAS-2) that measures "verbal, nonverbal, spatial, working memory, and processing speeds."

 

Verbal: 125 (95%, high) It's noted here that he " also exhibited strong skills on a task requiring verbal abstract and conceptual reasoning abilities, as his skills fell a the 12-year, 3 month level."

 

Nonverbal Reasoning (measures nonverbal and visual perceptual reasoning): 105 (63%, average). It was noted that while on-par with children of his age, this skill set is "significantly lower than his verbal abilities."

 

Processing Speed: 96 (39%, average) "Consistent with same-age peers."

 

Working Memory: 85 (16%, below average) "Challenges in working memory are often noted in those with executive functioning difficulties, as difficulty sustaining attention and resisting distractions negatively impacts the ability to store and use information."

 

They assessed his memory with the Developmental Neuropsychological Assessment (NEPSY-II) It says, "On the Narrative Memory subtest, a task measuring language processing and short-term memory for verbally presented information, he was read a short story then encouraged to recall as much as he could remember. He recalled several parts of the story, and his score fell at the expected level. He had more difficulty on a cued recall task in which he answered open-ended questions about the story, and his score fell in the borderline range. He demonstrated sills at expected level when asked multiple choice questions." I can post the scores if you need them. They don't make a lot of sense to me, so I'm assuming the above blurb is the gist of it.

 

They mention the NEPSY-II again, and say that they used select tests to measure his Executive Functioning.

Inhibition test: (9%, borderline range) indicates slow processing speed and rapid naming. He made errors when naming shapes (6%-10%, below expected level), and did not correct errors, resulting in an uncorrected errors score that fell below expected level (2%-5%). On an inhibition task where he had to name the opposite shape, he fell at expected level. On a switching task he fell at expected level. "Overall, his scores improved across tasks, particularly when the attentional and executive function demands increased. While this profile is less common, it indicates that his attention was actually improved when the task became more demanding. Some children with attention and executive function challenges exhibit such a profile and it is hypothesized that he increased difficulty of the task allows for improved ability to hold attention." So what they're saying is, the results in this area make no sense and they can't tell me why :glare:

 

He also did selected subtests from the Wechsler Individual Achievement Test (WIAT-III) to measure his academic functioning. It looks like they did spelling and arithmetic. It's noted that in regards to spelling, he used a "weak, right tripod grasp of a pencil that afforded him relatively poor control while writing. His handwriting was legible; however, the size of his print was large given his age.

 

Spelling: SS=90, 25%(average, 2nd grade level) It's noted that he misspelled more difficult words, but wrote them phonetically.

 

Math Reasoning:

Orally presented word problems: SS=82, 12% (2nd grade, low average)

Numerical Operations: SS=89, 35% (2nd grade, low average) It's noted that he made careless mistakes, added when subtraction and multiplication was required, and didn't pay close attention to detail. "His impulsivity and inattention may have negatively impacted these areas."

 

They did the Autism Diagnostic Observation Schedule (ADOS) Module 3, which I guess is the module given to children with fluent speech. The results indicate that it is "unlikely he meets the criteria for a diagnosis of autism spectrum."

 

There were other measurement tools used, but many of those were the check-list type things we filled out -- the CBCL, BRIEF, and SRS.

 

Some things to note in the conclusion of the report that lead me to believe he has NVLD, even thought they didn't call it that: "He exhibited a significant difference between his higher verbal reasoning skills and average nonverbal, working memory, and processing speed skills."

 

Math difficulties noted: "Although his score appeared to be impacted by his challenges with attention, current results are commensurate with the prior academic testing as assessed with the Woodcock Johnson, suggesting difficulties with mathematics that may not be fully explained by lack of effort or attention during mathematics testing."

 

ADHD: "Per observation and parental report, he is experiencing clinically significant behaviors consistent with ADHD as well as conduct problems that are negatively impacting his functioning." "Direct observations of History Kid's behaviors indicated challenges regulating his behaviors, as he was easily distracted, inattentive, and impulsive."

 

Not entirely sure what to make of some results, especially the bolded part. We have met twice with a behavior therapist, and his style/views mesh with ours and our pediatrician's, so I think we're going to have a very positive working relationship. He's totally on board with homeschooling and wishes more parents with children who have issues would do it to spare their self-esteem. We're trying a couple of modifications out, and meeting with him again in 2 weeks to throw out what isn't working and start fresh, or tweak what is working.

[jujsky]

Yes, that's the place--same doctor. We did not use them, despite all the months I spend getting our insurance to authorize and agree to pay. He wouldn't bill, and the insurance required the physician submit the bill. I called to plead my case with them though he was never available. I emailed Dr. C before giving up. He did not even bother to respond. Believe me, I am so glad now (after learning more about VT and my son's particular problem) that it worked out the way it did.

 

Nancy in NH

 

Count your lucky stars, Nancy! Seriously! That man is out for money and nothing else.

[PeterPan]

Julie, I would encourage you to start this as a new thread so you can get feedback from plenty of people, not just me. Just cut and paste. As far as my take, well I don't see where you're getting NVLD from this. They said he doesn't test as on the spectrum. He has test scores and symptoms consistent with ADHD. Did they put a subtype in the diagnosis? There should have been a DSM code. Find it in your paperwork. That's you're label. They're not saying he's NVLD. You're misinterpreting the thing on the difference between his verbal and other scores. That just means his working memory and ADHD affected them, pulling them down. '

 

On the plus side, his processing speed is low but not as low as my dd's. ;) Not that that's any consolation, but there you go.

 

You're looking too much at details and missing the big picture. Find the DSM code they used. Everything I'm seeing there is ADHD. Did they recommend meds? Sorry, I totally forgot the whole tenor of your thread. Personally, I would just embrace the label. If at some point you think he crosses the line over to the spectrum, it may show up next time you do the testing in a few years. Obviously at that point you'll use someone else. But really, you have a ton of info here. Info ABOUNDS on this board about what to read and what to do with ADHD, low processing speed kids. Just look up the book threads and start reading.

 

The best advice I got before our neuropsych eval was not to argue with the diagnosis, just to accept it and work with it. I understand you think there could be more going on, but at this point if you just take their label and start working with it, you have a lot you can get done. There's tons of good info on how to modify for ADHD. Get the Linguisystems workbooks. Get some stuff to work on his working memory. Raid your library for the popular books here on it. There's a lot you can do.

 

It would be nice if at some point you could find a more scrupulous helpful developmental optometrist. Because the eyes are run by muscles, it seems like these kids with low tone are the ones most likely to have issues. If you ever found someone better, it would be something to pursue. And sure, read about auditory processing too. But you have a really good start with that neuropsych report. I mean they said bold as brass what they think (ADHD, low processing speed, executive function and working memory issues). They see no evidence right now of spectrum. It's a screwy line any, trying to parse these kids. But you have your label. I'd just go with it.

[peacefully]

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[rafiki]

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[jujsky]

I don't really need to grieve -- I expected an ADHD diagnosis, and I'm fine with that. I also agree that he has this Developmental Coordination Disorder. I'm frustrated with the report -- not with the diagnoses. My biggest complaints are the lack of helpful suggestions (Sit him by the teacher? Really? I paid how much for that nugget of wisdom?) and the LD-NOS diagnosis. They need to be more specific with me as to what that means. It sounds like NVLD, but they refuse to be specific with me. NOS is doctor-speak for, "We don't know what's wrong with your kid, but there's something there." Awesome. I could have told them that, and I don't have a medical degree. I have very little tolerance and patience for unknowns, and that is largely what an NOS diagnosis is. To me it felt like a lot of money and time to reconfirm what I already figured out on my own by reading, researching, and making observations (ADHD and NVLD, or what I'm going to assume is NVLD). I was expecting them to offer more concrete steps to take besides all the ones I've already taken and ones designed for kids in PS. I felt after reading the report that I was back where I started on trying to help him, and was frustrated that after all that time, money, and effort they didn't offer me decent advice. I'd heard from so many people that the resources and advice offered in the report made such a difference and made the whole experience worth it, but because I didn't find that to be the case, I was disappointed. In short, I didn't receive what I expected.

 

Again, we're on our own trying to find help. It's frustrating, but I feel like we're starting to make progress in finding the right people. I found a wonderful behavior therapist who is helping us, and I got the call today from the OT office that they have an opening for an eval. He's going in for an OT evaluation on the 21st. Insurance covers a generous 60 visits/year, so we should be more than set there. I'm also reading tons of books on ADHD and trying to sort out the nuggets of useful information and suggestions that may work.

[PeterPan]

I think in reality they give these bland, non-descript labels because they don't REALLY understand what's going on. They're trying, but what they're doing is subsectioning up into a ton of labels things that are very, very similar. They find ways to parse it, but it's just all screwy. Take the current reading disorder label that will in a couple years again be called dyslexia. So if it's a label you can have and lose, it's a symptom, not a permanent brain condition. And yet we know it reflects permanent brain structure. I read a really dry, nasty book by a dude Fletcher where he said that x number of years ago ALL these problems were lumped under one glorious name: minimal brain dysfunction. Even more descriptive, eh? But they lumped ADHD, EF, dyslexia, all of it together.

 

At least you're working through it. That's really awesome that you're getting an OT eval. That should be helpful.

 

Yllek, sometimes they don't use one label because the other label they put on includes it.

[peacefully]

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[rafiki]

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