Confused/Suprised by evaluation results

[MaeFlowers]

Today we received the results of our ds' evaluation with a psychologist. There were some things I was not suprised by while others things kind of threw me. I was hoping you could chime in and give me some advice.

1. He was diagnosed with ADHD combined type. I was expecting the inattentiveness but not the diagnosis for hyperactivity. I consider ds a pretty mellow kid...all of his friends, cousins, etc. Are far more energetic. She said it was because he was restless in his seat through evaluations. I mean, this IS a 9 yo boy we are talking about. He is not fast talking or constantly moving, just a little squirmy in the seat.

2. The WJ-III...the scores were odd. His iq test...not what we expected. For example, he scored high were he has consistently scored low on all other tests (i.e., spelling) while scoring poorly in things he normally does well on. However, this is one of the reasons we sent him in...his inconsistent testing results. She had no input on this because she said it was hard to tell because he is home schooled.

I just don't know what to think. I felt we just got a list of scores and no answers. I feel like maybe she didn't have any answers. So, I am asking you lovely ladies...what could be causing such erratic test scores? Do you think the scores today could simply be wrong?

 

I wanted to add that ds had language delays as a todder but now tests average to above average pretty consistently except for spelling (consistently low) and comprehension (erratic). She also noted some fine motor skills issues and recommended ot.

[OneStepAtATime]

Gosh that's frustrating.  I wouldn't go so far as to say that everything in the report is wrong, but perhaps the doctor really doesn't know what to do with the scores and is not homeschool friendly in her internal assessments.  In other words, she may be secretly chalking up descrepancies to homeschooling.  And I agree, a 9 year old boy just wiggling around a bit in a chair does not scream ADHD hyperactivity version to me.  I have a 10 year old boy.  He wiggles a lot.  I have a brother.  He was pretty wiggly, too.  So was I for that matter.

 

Hugs....hopefully someone else with more experience will chime in here soon....

[PeterPan]

This was a school psychologist or private?  Psych or neuropsych?  A neuropsych, in general, would have run more tests.  I think the regular psychs just spend less time overall and run less tests, meaning they have less to parse.

 

My dd got some wackiness on the WJIII for the spelling section, but during it there was someone CHOPPING WOOD right outside the window.  Like yeah, how's that for limited distraction environment!  So you could have contributing factors like that.  The WJIII is largely done orally, so if his 'language delay" as a kid was actually say something involving word retrieval or praxis or a language processing disorder, then you could be seeing that create a discrepancy between what you get with all written testing and what you get with a more oral test like the WJIII.  

 

When was his last SLP eval for that language issue?  

 

Labels are rough.   :grouphug:   I guess just give it time.  People told me to accept it and give it time, and that did help.  It took a lot of time, but eventually it made sense to me.  If the lady is right, it might all come together.  It might be with time she'll turn out to be right, or she could turn out to be wrong.  You'll do fresh testing in 3-4 years and that will help you confirm it anyway.

 

So are you going to do the OT eval?  That's great that you're finding this stuff.  

[MaeFlowers]

It was a private psychologist. I looked for a neuropsych but kept running into dead ends. I did find one but could not afford him. I was hoping the psychologist could give me some insight. She didn't seem to have any answers to my questions...and she couldn't recommend therapists because that was something that would normally be handled by the school system (her words). She didn't seem to have a negative opinion of home schooling but maybe just more experience with working with schools.

As for spelling, I don't really know what is going on. His phonics are strong. I know this isn't the issue. Specifically, if given an oral spelling test, he leaves out the vowels. So, for instance, he would spell vowel as vwl or vowl. Writing is wackier spellings that do not make sense. However, he will more often than not, ace his spelling quiz. In fact, he does most things better orally. One of the reasons we took him for evals was because I suspected dysgraphia. She didn't address this at all (maybe that is why she recommended ot?).

He has never had an slp. Maybe he should have. When he was 2, he only knew maybe 20 words and he had lost some. I remember the appt well because that seemed to trigger the dr and she asked me quite a few questions to rule out autism (which they did.) He was slow in talking but quick to read.

I don't know. The more I think about it and write about it, the more I get confused. I feel like there is a missing piece to this puzzle. Maybe the ot will help? I am planning on calling them tomorrow.

 

Please forgive any errors, I'm on my tablet and editing is a pain.

[PeterPan]

Did the psych run a CTOPP?  A CTOPP is the test of phonological processing.  He might be doing everything visually and not hearing the sounds in the words. He sounds very bright, so he might do that, spelling and learning to read entirely visually. What you might do on the spelling is get something like WRTR from the library, make/buy the flashcards with the phonograms, and see if your ds can hear them, whether he can identify the component sounds in words, etc.  (Or you could give him the Barton screening test, for that matter.)  You're just looking to figure out is this a phonemic awareness issue, a needing more practice issue, a working memory issue (knows but forgets as he starts to say), etc.  

 

Dropping words is what my ds did, and he had apraxia.  You might research it.  What you're describing would be an outcome with mild, untreated apraxia.  It might explain things for you.  Apraxia can occur with autism, yes, but that's not the only scenario.

 

Yes, the OT is going to have good thoughts on dysgraphia and praxis.  You might talk with your prospective OT and see what she'll test, how long she'll spend, etc. They definitely vary.  

 

 

[MaeFlowers]

She did not do a CTOPP. He took an IQ test (WASI-II), the WJ-III ACH, the Bender-Gestalt, the Conners Continuous Performance test and then we answered quite a few scales to rule out autism.

Here's the thing. He rarely spoke at 2 years and what he said was only really understood by myself and dh. I thought it was my fault. Dh worked crazy hours and it was always just myself and ds. I am not much of a talker. I talk when I need to mostly. And, I always knew what ds needed without him talking. He was like clockwork as a baby and toddler. People started asking questions. You know, "Should we send him to speech therapy?" kinds of questions. His teacher at his preschool didnt seem concerned and I thought it would work itself out. By three he was talking more but was still difficult to understand for most people. I dont know when he learned to read. I know this sounds odd, but I think he was 4. Sometime around late 3, early 4, he began asking to read to me. He wasnt reading, though. He had memorized his books (early chapter books). Not too much later (maybe a month or two), he came to me asking what an electric company was. He was reading the mail on the desk. He has never sounded out words, he just reads them. I see those videos of kids learning to read and sounding out words and letter sounds. He never did this. He spent first grade at public school using his reading time to teach the other kids in the class how to read. I gave him the Let's Go Learn DORA test for reading a few weeks ago. His phonological awareness was at 12th grade level (it was a recording of words and he had to choose the right written word). His spelling...first grade.

Hopefully the OT can be of some help. I feel like all the information is in there, he is just having trouble getting it out.

[PeterPan]

So when it's in print, he recognizes everything?  When he has to hear the word and evaluate the sounds, how is he?  

 

http://www.bartonreading.com/students_long.html#screen  This is the Barton screening test.  It's not as thorough as a CTOPP.  

 

Again, what you're describing *could* be verbal apraxia.  They're much more aggressive now with interventions than they were even 9-10 years ago, because they have better therapies.  Literally, you could have taken him to a traditional therapist and gotten no change anyway because apraxia is motor planning and word retrieval, not a developmental delay.  For a long time, the best they had was working on overall communication (sign, etc.) and flashcards.  Now there's a newer therapy (PROMPT) that can work on the motor planning, but it has only been around less than 15 years.  It's only in the last two years that I could find a person properly trained in it without driving 2 1/2 hours.  In a populous state with several large cities!  

 

So now, yes, they would have sent you for interventions and a speech eval before he was 2 even.  But they couldn't do that 10 years ago because the evals and the methodology weren't there.  Even the first SLP (speech language pathologist) we visited when my ds was turning 2 said they'd do nothing and just sort of work on "communication."  She wasn't trained in the technique, so basically their tack was wait, see what happens, and when the kid has trouble speaking at 3,4,5 finally diagnose it as the untreatable problem. Thanks.  

 

Also, apraxia can be genetic.  It's not only genetic, but it certainly can be.

 

An SLP can run tests for auditory processing and phonemic awareness.  Your concerns are valid, and the issues with spelling and ability to hear the sounds may be occurring only when he's speaking, not when he's using his (obviously very good!) visual memory.  That's not really an OT thing.  The psych could have run the CTOPP and dug in there, but not all regular psychologists do.  I know one we first started with wasn't going to, and I just couldn't get over that hump that I HAVE to have that info.

 

If you want free info, click on that Barton screening test.  It's free and a start.  If he fails that, well then you have insta-info.  If he does well on that, dig some more.  Try the same techniques with longer words.  How was his working memory?  Is there a difference between his auditory working memory and his visual?  You can dig in there and try to sort out whether he's not hearing the sounds, not correlating sound to written, dropping sounds because of poor working memory, or what.  The psych report will have working memory.  

 

An SLP is for more than articulation.  They look at all aspects of language and can do testing to screen for auditory processing problems, phonemic awareness, word retrieval, language processing, etc. etc. 

 

Just so you know, our SLP, who is an apraxia specialist, puts ALL the kids through Earobics, phonemic awareness software.  It's not the only way to do it.  I've got it and like it, but I'm also doing LIPS with my ds.  He couldn't hear or discriminate the vowels at all.  So to him /a/, /e/, /i/, /o/, /u/ were just not something where he could touch a tile when you said touch this tile when I say /a/ and touch this tile when I say /u/.  We worked on it, some miracle occurred, and now he seems to be able to hear them.  However he still can't hear all the individual sounds in words. Actually he struggles to hear any individual sounds in words.  First sound he can sometimes get.  Rhyming he sometimes gets.  Final consonant or middle (or tell me the two sounds in "at"), forget about it.

 

Sometimes when a dc is missing sounds, it corresponds to a particular sound level (I speak as a fool) and the SLP will notice a pattern and refer you for auditory processing screening.  I don't know enough to say more than that, but that definitely is something we've talked about for my ds.  If you just *call* a good speech therapist and describe your concerns, they'll tell you what they can do.  I don't know if it's just our area of the country, but everybody I call has been very nice and helpful.  When in doubt, just call and ask could they help, what tests would they run, etc. 

 

If you read about apraxia and think that could be what was going on, you might find it helpful to consider calling a PROMPT-trained therapist.  They'd be more in the loop on apraxia and the consequences and things that go with it.  There are levels of severity (mild, moderate, severe), so you have a range of outcomes.  

 

http://promptinstitute.com/index.php?page=find-a-prompt-slp  This is the PROMPT provider locator page.

 

PS. I'm not an SLP and don't play one on tv.  I'm just telling you some questions to ask.  I've learned a ton by calling around and talking with people and flat up asking them if they can help me and how.  That's what I recommend doing.  Also, you could consider going through the ps for their evals.  They will have an SLP who can run these tests for free for you and they can do the OT eval. That's what I'm working on right now for my ds. I need the pooled help, so I'm asking for it.  

[kbutton]

I can't speak authoritatively to your situation, but I can tell you that my son had great spelling scores on the Woodcock Johnson, and he can't spell. He would get perfect or nearly perfect scores on tests nearly every week he had them when he was in school. He reads several grade levels above. He used phonics, but not extensively. And he can't spell very well in real time. 

[MaeFlowers]

I've made some calls today and have him scheduled to see a doctor in regards to the adhd and am working on getting him in for speech and fine motor skills therapy. (They have to contact our ins company first.) He already had an appointment scheduled with an audiologist. Maybe we will get some answers soon.

 

To be honest, spelling is the least of my worries right now. I am more concerned about how he processes information and some of his other behaviors. For example, why can he not follow directions? Yesterday he did a page in his vocabulary workbook the wrong way. The instructions said to write a sentence with each of the vocabulary words. It said that if you did not know the meaning of the word, you could look it up in the dictionary. Instead of writing sentences, he wrote down the definitions. Dh talked to him about the directions, he seemed to understand...then proceeded to erase his work and then write the definitions from the dictionary instead of the sentences. Today I gave him a sheet that said answer questions 2-5 on page 21 of said book. He came to me with the book saying, "What am I supposed to do with this?" I give very specific written directions. I just don't know. I can't make it any clearer than I do. I am so exhausted from it all and really just want to cry right now.

[PeterPan]

Did you say a SLP eval is on that list?  They can look into how he processes and understands language.  He may literally not be understanding like you think he is.

[MaeFlowers]

Did you say a SLP eval is on that list? They can look into how he processes and understands language. He may literally not be understanding like you think he is.

It was recommended. I have to call the therapist back tommorow to find out more. They called this evening but I missed the call!

[PeterPan]

It was recommended. I have to call the therapist back tommorow to find out more. They called this evening but I missed the call!

Good!  They may be able to help you quite a bit.  I'd love to hear how it goes, since I'm always looking ahead to what kinds of things to watch for in my ds.  :)

[kbutton]

I scanned through again and didn't see CAPD earlier in the thread. What you described with directions sounds like my son who bombed a CAPD screening (he's too young for the real test). He now knows that he doesn't hear things correctly and asks lots of questions to clarify, but he's not good at following directions--he has to see something done or be walked through it a time or two. He probably has some borderline ADHD stuff too, but the direction following is very frustrating (not as severe as in your case). He also has VERY SLOW processing speed--his processing is in line with someone who has about half his IQ. I wouldn't be surprised if your son is on slow processing side because of or in addition to the other issues.

 

I think the screening was called the SCAN III, and it tests broadly for auditory processing and speech problems. 

[Erin]

 

 

I wanted to add that ds had language delays as a todder but now tests average to above average pretty consistently except for spelling (consistently low) and comprehension (erratic). She also noted some fine motor skills issues and recommended ot.

Coupled with the inattentiveness, this all sounds like dyslexia to me...  

[MaeFlowers]

I scanned through again and didn't see CAPD earlier in the thread. What you described with directions sounds like my son who bombed a CAPD screening (he's too young for the real test). He now knows that he doesn't hear things correctly and asks lots of questions to clarify, but he's not good at following directions--he has to see something done or be walked through it a time or two. He probably has some borderline ADHD stuff too, but the direction following is very frustrating (not as severe as in your case). He also has VERY SLOW processing speed--his processing is in line with someone who has about half his IQ. I wouldn't be surprised if your son is on slow processing side because of or in addition to the other issues.

 

 

I think the screening was called the SCAN III, and it tests broadly for auditory processing and speech problems.

 

  

Coupled with the inattentiveness, this all sounds like dyslexia to me...  [/size]

I just looked at the symptoms of capd. It sounds exactly like ds. (Except for the word problems) I actually suspected dyslexia for a while. I think dysgraphia fits him better. I am wondering how capd and slow processing speeds might affect an iq test. I didn't expect the test to come back with exceptional numbers but I really didn't expect his score to be as low as it is. Of course as his Mom I think he's a smart kid but many people (teachers, other parents, etc) have referred to him as gifted so something just doesn't seem to jive.

[kbutton]

  

I just looked at the symptoms of capd. It sounds exactly like ds. (Except for the word problems) I actually suspected dyslexia for a while. I think dysgraphia fits him better. I am wondering how capd and slow processing speeds might affect an iq test. I didn't expect the test to come back with exceptional numbers but I really didn't expect his score to be as low as it is. Of course as his Mom I think he's a smart kid but many people (teachers, other parents, etc) have referred to him as gifted so something just doesn't seem to jive.

 

I get the impression that CAPD and dyslexia are quite related, and you can have both or just one or the other. 

 

Slow processing really drags down an IQ test. My son's entire IQ test was a bit weird, but the psychologist was able to use the General Abilities Index (GAI) to calculate his IQ. (WISC is the test she used.) The GAI leaves out working memory and processing speed under certain circumstances. She thinks he's still probably smarter than what his GAI allows (besides being a really quick learner, he asks very perceptive, deep questions). Low enough scores on certain sections of the WISC processing stuff qualifies kids for extra time on tests and such (including SATs, etc.).

 

My older son has dysgraphia/disorder of written expression--he has major issues with getting all the pieces of writing together (thinking, physical act of writing, word choice, spelling, etc.). My younger one (the one who bombed the CAPD screening) has some big flags for dyslexia, but we'll see how it goes. He catches himself, so he's slowly learning to correct reversals and whatnot. I think he's going to be okay, just slow to develop writing skills. Physical handwriting is coming along okay (he is motivated), but I strongly suspect that handwriting will never be automatic for him. (This is a strong family trait on DH's side--several of them feel like handwriting is basically drawing letters, not an automatic process.)

[MerryAtHope]

I've made some calls today and have him scheduled to see a doctor in regards to the adhd and am working on getting him in for speech and fine motor skills therapy. (They have to contact our ins company first.) He already had an appointment scheduled with an audiologist. Maybe we will get some answers soon.

 

To be honest, spelling is the least of my worries right now. I am more concerned about how he processes information and some of his other behaviors. For example, why can he not follow directions? Yesterday he did a page in his vocabulary workbook the wrong way. The instructions said to write a sentence with each of the vocabulary words. It said that if you did not know the meaning of the word, you could look it up in the dictionary. Instead of writing sentences, he wrote down the definitions. Dh talked to him about the directions, he seemed to understand...then proceeded to erase his work and then write the definitions from the dictionary instead of the sentences. Today I gave him a sheet that said answer questions 2-5 on page 21 of said book. He came to me with the book saying, "What am I supposed to do with this?" I give very specific written directions. I just don't know. I can't make it any clearer than I do. I am so exhausted from it all and really just want to cry right now.

 

When my kids were this age, I had them:

 

1-read the directions out loud to me.

 

2-underline key words that tell them what to do.

 

3-put a number inside a circle above each step (so if a set of instructions said to do 3 things, they numbered the things 1, 2, and 3--so that they didn't just do 1 or 2 of the things!)

 

4-they explained the instructions back to me in their own words, so that I could correct any misunderstandings.

 

This can be time-consuming...but necessary and helpful for some kids! 

[MerryAtHope]

  

I just looked at the symptoms of capd. It sounds exactly like ds. (Except for the word problems) I actually suspected dyslexia for a while. I think dysgraphia fits him better. I am wondering how capd and slow processing speeds might affect an iq test. I didn't expect the test to come back with exceptional numbers but I really didn't expect his score to be as low as it is. Of course as his Mom I think he's a smart kid but many people (teachers, other parents, etc) have referred to him as gifted so something just doesn't seem to jive.

 

Both could definitely affect the test. With the slow processing speeds, there is a scale that they are supposed to use that corrects for this and gives you a more accurate score....GAI, General Ability Index.

[MaeFlowers]

I looked into the GAI. Ds only took the wasi, the short form of the wisc, and from what I could find you need all the tests of the wisc to calculate gai. Our insurance won't cover the wisc right now. I am thinking that if we want a better sense of iq, it might be better to wait a while and see what comes of his appointments with the psychiatrist, speech therapist, etc. I don't have the money for it right now anyway.

 

Thank you, MerryAtHope. I will try those steps with ds next week. Maybe I can catch some of his misunderstandings before he gets started.

[MerryAtHope]

I looked into the GAI. Ds only took the wasi, the short form of the wisc, and from what I could find you need all the tests of the wisc to calculate gai. Our insurance won't cover the wisc right now. I am thinking that if we want a better sense of iq, it might be better to wait a while and see what comes of his appointments with the psychiatrist, speech therapist, etc. I don't have the money for it right now anyway.

 

 

I know it's all so expensive! We wanted to do some things much earlier than we were able to (my son did vision therapy at age 12-13, and I so wish we could have done it at age 8!) We all do what we can do. I agree though, that you don't have the most accurate picture of his IQ right now, and wouldn't let the numbers upset you. Either way, they only show one small picture of who our kids are.