I'm lost...Can you give me directions?

[MaeFlowers]

Okay. We had an eval by a psychologist. We are scheduled for a speech eval on Wednesday and an audiologist next week. We are waiting for an OT for fine motor skills (they seem to be booked up at the moment.) I am wondering if there is anything else, any basics to cover. I was thinking an eye exam. I was also wondering about EF testing? There seem to be impairments there. I feel like I am going overboard but want to make sure I'm not missing anything.

 

On the upside, I am looking forward to the speech eval for kind of a silly reason. The place ds is going uses Hippo therapy with horses. That sounds so neat! It's extra for him to ride, but I might have to find the money so he could have that experience!

[PeterPan]

Your psychologist should have done an EF screening.  If he didn't, you might consider taking all the reports you get and all your information and going to a neuropsych for a 2nd opinion and extra testing if needed.

 

If you're going for an eye exam, go with a good developmental optometrist.  Just get the regular annual exam, but having the dev. optom. do it you can ask them to *screen* you for the extra things (convergence, focusing, tracking, etc. etc.).  COVD is where you find them.

[MaeFlowers]

The psychologist gave ds the conners continuous performance test. She said nothing about it and I am having trouble intepreting the scores. It gives the name of each test, the score and whether the score was typical, average, fast, etc. At the end, it simply says that there "chances are 60 out of 100 that a clinically signifigant problem with attention exists." :/ That's it.

I will look into covd and see what I can find.

[OneStepAtATime]

What specific tests were administered?  If you post the name of the tests (you don't have to post results if you are not comfortable doing so) others here might be able to help advise you on whether more testing through a neuropsych could help net more answers.

 

What specific troubles are you seeing in your child that caused you to seek evals in the first place (perhaps you posted these details before and I have forgotten...if so, apologies) ?  Also, what resources/books have you read?  

 

Big hugs.

[kbutton]

Is your psych going to pull all of this together into a longer report with comments at some point? That would help you know what the various scores mean. If not, I think you should take the results and get an interpretation.

[MaeFlowers]

The psychologist gave us a 15 page report. It just doesn't say much beyond scores. It is a very basic interpretation of the information, IMO, and as far as I know, all she plans on completing.

 

The tests we took are:

Bender Visual-Motor Gestalt...32nd percentile...I dont know what to think of this. It says average but I read somewhere that under 35th percentile is associated with visual processing issues.

WASI-II

WSJ-III ACH

Vineyard Adaptive Functioning Scales...Composite was moderate low due to communcation

Conners Rating Scale

Conners Contiuous Performance Test...I gave the overall score above and there are too many subtests to list unless it would help

Achenbach ASR

Conner Comprehensive Behavior Rating Scale

BYI

ASRS

CARS-2

 

I sought an eval because ds was having a few different issues: inattention, sustained attention, focus, basically ADD type issues. I also was concerned that there may be a language issue because he has trouble with writing (letters too large, unevenly spaced, inability to write on the line, lack of capitalization and punctuation, trouble lining up math problems, etc). Problems with memorizing math facts (he has done Xtramath soooooo many times and passed but it just does not stick). He also has trouble following directions both written and oral. I was suspecting dysgraphia or something alond those lines.

 

Reading: Ive read so much I can't even remember. Most of what I have read pertains to ADHD. (Books for teachers, psychologists, parents, etc. trying to understand how the brain works, treatments, etc.) I have read through some websites on LD as well.

 

I say I'm lost because I am. I'm not sure what to read or research because we still in the process of figuring out what is really going on. It's all new to me and I have so little time lately. Plus, I tend to get lost on the rabbit trails.

 

 

 

 

[OneStepAtATime]

Hopefully someone with more experience in those areas will chime in soon, but have you read the Mislabeled Child by Brock and Fernette Eide?

[PeterPan]

Well you're going to have more information hopefully once you get these other evals.  Deep breath.  Never fear, we can spend your money and suggest places to go.  :D  But seriously, take it one step at a time.  I'm sorry this psych was less than stellarly helpful.  Choosing a psych is very hard to me, because it's like you're trying to choose a specialist for your problem before you know what the problem IS, kwim?  So maybe breath, let these other evals happen, see what they turn up, and then decide.  

 

Just so you know, ADHD *is* the catch-all when they haven't got a clue.  Another psych still might not give you a more helpful label than that, sigh.  But you could use the extra info from these other evals and someone who can pull it all together and read the tea leaves.  For my mystifying son I'm using a neuropsych who specializes in dyslexia.  The neuropsych assures me he's seen a lot of motor planning issues (part of my ds' problem) and of course he has down the dyslexia and developmental disorders.  So someone like that who is sort of a specialist in whatever your people turn up will be the most helpful in sorting it out.  

 

Executive Function (EF) is usually a big part of adhd.  At least for my dd, working on EF while *bringing in* the other things that were weak (speak, motor planning, etc.) got breakthroughs.  So you might shift and instead of thinking in terms of DSM labels (which are NOT satisfying sometimes), you might focus on looking up each test, figuring out what in the world it means, and then figuring out how you can work on it.  And when you can combine a couple things into one activity, that's even better.  So, for instance, if you do metronome work and you bring in something he's weak on and have him do it to the metronome, you're working on EF *and* another area and improving his ability to bring it all together.

[MaeFlowers]

Executive Function (EF) is usually a big part of adhd.  At least for my dd, working on EF while *bringing in* the other things that were weak (speak, motor planning, etc.) got breakthroughs.  So you might shift and instead of thinking in terms of DSM labels (which are NOT satisfying sometimes), you might focus on looking up each test, figuring out what in the world it means, and then figuring out how you can work on it.  And when you can combine a couple things into one activity, that's even better.  So, for instance, if you do metronome work and you bring in something he's weak on and have him do it to the metronome, you're working on EF *and* another area and improving his ability to bring it all together.

 

The bold part is why I was asking about EF testing. I dont really know that it is necessary. Reading Smart but Scattered was a real eye opener because the description of the little girl in the first chapter could have pretty much been written about ds. I don't care much about labels, I care more about what can help him. And I guess I've felt like I needed the labels to find the treatments? And it seems like there is more going on than ADHD.

 

I feel kind of stupid asking questions because I'm not even sure I am asking the right ones. I'm feeling not so smart and scattered lately. I think I just need to take a step back and get some perspective. (And stop being impatient. I would give ds these tests myself if I could. I'm a "do it myself" kind of person so waiting on doctors, therapists, etc. gets frustrating. )

 

I didn't quote but I have not read Mislabeled Child by the Eides. I keep seeing it recommended. I guess I need to go get that one.

 

 

 

[Tokyomarie]

The bold part is why I was asking about EF testing. I dont really know that it is necessary. Reading Smart but Scattered was a real eye opener because the description of the little girl in the first chapter could have pretty much been written about ds. I don't care much about labels, I care more about what can help him. And I guess I've felt like I needed the labels to find the treatments? And it seems like there is more going on than ADHD.

 

I feel kind of stupid asking questions because I'm not even sure I am asking the right ones. I'm feeling not so smart and scattered lately. I think I just need to take a step back and get some perspective. (And stop being impatient. I would give ds these tests myself if I could. I'm a "do it myself" kind of person so waiting on doctors, therapists, etc. gets frustrating. )

 

I didn't quote but I have not read Mislabeled Child by the Eides. I keep seeing it recommended. I guess I need to go get that one.

 

 

 

Do get The Mislabeled Child! It is a terrific book. I, unfortunately, had it on my shelf for a few years before I got around to reading it. I could have saved myself a lot of frustration in trying to understand my son had I just read this when I bought it! 

 

Don't worry about your "stupid" questions. No question is too stupid. As you keep asking questions and reading various websites and books, understanding will come. It just takes time. EF is a huge part of ADHD, but it is also a big part of autism spectrum disorders and can be a part of LDs. EF deficits are a major component of what makes so many of our children hard to parent and hard to teach. Learning how to help your child develop those missing skills will be a big part of helping your child with all of academics and life.

[PeterPan]

Mae, with EF they have an EF screening tool (which our new psych was actually a co-author of) and then they read the tea leaves in the other tests.  So for instance they'll run the full WISC and get the numbers for processing speed, working memory, etc. from that.  They'll run tests to *exclude* things like language processing disorders.  So you have the tests that show the symptoms and then the tests that exclude confounding factors.  Then that sort of leaves you with EF/ADHD causing your academic symptoms not say a language processing disorder.  I don't know if that makes sense, but that's the process our psych went through with us.

 

I personally don't know enough about the tests to tell you if you can find that data in what your psych did.  Maybe read it three times over till your eyes blur?  Our psych ran working memory tests several ways.  Then he could compare the results and show how it affected her ability to plan a project efficiently, or where she might have the digit spans (thanks to therapy work) but it was "effortful" or with extreme effort.  (difficulty of doing digit spans backwards vs. forward).  

 

It *might* be that Connors continuous performance test is like a TOVA for attention.  It's kind of curious that whatever score he got wasn't strong enough to persuade her to go ahead and diagnose.  Hopefully when you go through the SLP and audiologist evals you'll sort that out.

 

Ok, here's a question for you.  On the audiologist, did you make sure this person actually specializes in APD?  If you just go to some random audiologist, you're not necessarily going to sort this out.  Pick the name of a big city near you and google "city audiologist CAPD" and see what you get.  They have special isolated booths they use.  Doesn't have to be the most expensive guy in town either.  In the big city near us I've found big league phd audiologists and small fry single operators who both have the booths.  It's just what they decided to add to the specialties.  So make sure of that before you go.  And ask the SLP upfront if she'll be doing testing on language processing and the screening tool for auditory processing and phonemic awareness.  Don't go and then be disappointed.  

 

And I totally agree with Marie.  You SHOULD ask these kinds of questions and you should KEEP ASKING THEM till you get answers that make sense!  It's never a problem to ask questions on the board.  That's why it's here.  We're all just sorting stuff out, and it's a lot of work.  

[geodob]

As DS is 9, it would be difficult to test his Executive Functioning, as it doesn't exist at that age?

EF is something that occurs in the brains Frontal Lobes,  where it is essentially the overall manager and coordinator of all of the different regions of the brain.

 

But the way that the brain develops, is that it begins with a focus on developing the multitude of regions.

Then around puberty, a small connection to the frontal lobe and EF is made.

But this is a very basic connection, and just used for what is termed as the brains 'pruning process'?

A lot of 'junk connections' are formed in childhood.

So that EF is introduced, to help with the pruning.

 

But it is not until the late teens/ early adult, that a real connection to the frontal lobe is developed.

Which puts the brain's manager/ coordinator in place, to take care of Executive Functioning.

Though it then takes around 5 to 8 years to really develop Executive Functioning..

Which then manages adjustments to aging process.

 

So that with a child or teenager, their is actually no EF to test?

All that can be tested, are the brain regions/ functions that EF will eventually manage and coordinate.

[Tokyomarie]

As DS is 9, it would be difficult to test his Executive Functioning, as it doesn't exist at that age?

EF is something that occurs in the brains Frontal Lobes,  where it is essentially the overall manager and coordinator of all of the different regions of the brain.

 

But the way that the brain develops, is that it begins with a focus on developing the multitude of regions.

Then around puberty, a small connection to the frontal lobe and EF is made.

But this is a very basic connection, and just used for what is termed as the brains 'pruning process'?

A lot of 'junk connections' are formed in childhood.

So that EF is introduced, to help with the pruning.

 

But it is not until the late teens/ early adult, that a real connection to the frontal lobe is developed.

Which puts the brain's manager/ coordinator in place, to take care of Executive Functioning.

Though it then takes around 5 to 8 years to really develop Executive Functioning..

Which then manages adjustments to aging process.

 

So that with a child or teenager, their is actually no EF to test?

All that can be tested, are the brain regions/ functions that EF will eventually manage and coordinate.

 

Geodob, I believe that most researchers and writers on the topic of executive function, including George McCloskey, would disagree with your statements above on this topic. The common understanding of professionals working in this area is that the development of executive functions is a complex developmental process that begins in infancy and continues into the adult years. It is punctuated by periods of rapid development, such as the one you refer to that happens in puberty as connections between the frontal lobe and other parts of the brain are increasing rapidly in number.  Another time frame where there is tremendous growth is during the pre-school period.

 

There are assessment tools that can be used as early as pre-school age, though more are available once a child hits school age.

[kbutton]

You are clearly willing to work away at figuring things out, but it sounds like you're having a hard time hitting on the question that scratches the itch on the asking end. Is that the case? If not, feel free to ignore the rest of the post. If so, maybe this will help. I agree that there are no stupid questions, but I sense you are unsatisfied with your questions but need to start somewhere. Anyway, I have felt that way (and sometimes still do), and this is kind of how I approached it...

 

I think it's important to gather your own observations about your child, gather what the psych and testing data say, and see what else is missing--Literally matching the tests and data to symptoms and concerns a piece at a time. The psych should be doing this too. Then, you kind of see what gaps are left...did the psych and/or testing fail to explain this thing I am concerned about? Did the psych explain, but I need to do more reading? Do I need a second opinion? Do I need more testing? Do I need to stop and take something in that is swirling in my brain? Am I seeing similarities where I should see a distinction? etc. Am I just getting so much information at once that I can't take it all in?

 

I think this is what you are trying to do, but something still sounds like that satisfying question is just past your grasp when you are trying to ask. The Mislabeled Child might give you a reference point in which to place this whole process and some of the data you've found. Just a thought. 

 

I truly hope you are getting what you need from the discussion.

 

[MaeFlowers]

Do get The Mislabeled Child! It is a terrific book. I, unfortunately, had it on my shelf for a few years before I got around to reading it. I could have saved myself a lot of frustration in trying to understand my son had I just read this when I bought it! 

 

Don't worry about your "stupid" questions. No question is too stupid. As you keep asking questions and reading various websites and books, understanding will come. It just takes time. EF is a huge part of ADHD, but it is also a big part of autism spectrum disorders and can be a part of LDs. EF deficits are a major component of what makes so many of our children hard to parent and hard to teach. Learning how to help your child develop those missing skills will be a big part of helping your child with all of academics and life.

I went ahead and ordered The Mislabeled Child today.

 

Mae, with EF they have an EF screening tool (which our new psych was actually a co-author of) and then they read the tea leaves in the other tests.  So for instance they'll run the full WISC and get the numbers for processing speed, working memory, etc. from that.  They'll run tests to *exclude* things like language processing disorders.  So you have the tests that show the symptoms and then the tests that exclude confounding factors.  Then that sort of leaves you with EF/ADHD causing your academic symptoms not say a language processing disorder.  I don't know if that makes sense, but that's the process our psych went through with us.

 

I personally don't know enough about the tests to tell you if you can find that data in what your psych did.  Maybe read it three times over till your eyes blur?  Our psych ran working memory tests several ways.  Then he could compare the results and show how it affected her ability to plan a project efficiently, or where she might have the digit spans (thanks to therapy work) but it was "effortful" or with extreme effort.  (difficulty of doing digit spans backwards vs. forward).  

 

It *might* be that Connors continuous performance test is like a TOVA for attention.  It's kind of curious that whatever score he got wasn't strong enough to persuade her to go ahead and diagnose.  Hopefully when you go through the SLP and audiologist evals you'll sort that out.

 

Ok, here's a question for you.  On the audiologist, did you make sure this person actually specializes in APD?  If you just go to some random audiologist, you're not necessarily going to sort this out.  Pick the name of a big city near you and google "city audiologist CAPD" and see what you get.  They have special isolated booths they use.  Doesn't have to be the most expensive guy in town either.  In the big city near us I've found big league phd audiologists and small fry single operators who both have the booths.  It's just what they decided to add to the specialties.  So make sure of that before you go.  And ask the SLP upfront if she'll be doing testing on language processing and the screening tool for auditory processing and phonemic awareness.  Don't go and then be disappointed.  

 

And I totally agree with Marie.  You SHOULD ask these kinds of questions and you should KEEP ASKING THEM till you get answers that make sense!  It's never a problem to ask questions on the board.  That's why it's here.  We're all just sorting stuff out, and it's a lot of work.  

I took your advice and called the drs/therapists today. Thankfully, I was scheduled at the right places already. This is part of my issue...sometimes I don't know exactly what to ask them.

 

As DS is 9, it would be difficult to test his Executive Functioning, as it doesn't exist at that age?

EF is something that occurs in the brains Frontal Lobes,  where it is essentially the overall manager and coordinator of all of the different regions of the brain.

 

But the way that the brain develops, is that it begins with a focus on developing the multitude of regions.

Then around puberty, a small connection to the frontal lobe and EF is made.

But this is a very basic connection, and just used for what is termed as the brains 'pruning process'?

A lot of 'junk connections' are formed in childhood.

So that EF is introduced, to help with the pruning.

 

But it is not until the late teens/ early adult, that a real connection to the frontal lobe is developed.

Which puts the brain's manager/ coordinator in place, to take care of Executive Functioning.

Though it then takes around 5 to 8 years to really develop Executive Functioning..

Which then manages adjustments to aging process.

 

So that with a child or teenager, their is actually no EF to test?

All that can be tested, are the brain regions/ functions that EF will eventually manage and coordinate.

This is interesting. I think I need to go back and read about brain function in EF. I did so a while ago and I need to refresh my memory.

 

Thank you everybody for the support. I think I have just worn out some of the people in my life because I have a million questions and they are frustrated with me because they don't know either.

[MaeFlowers]

You are clearly willing to work away at figuring things out, but it sounds like you're having a hard time hitting on the question that scratches the itch on the asking end. Is that the case? If not, feel free to ignore the rest of the post. If so, maybe this will help. I agree that there are no stupid questions, but I sense you are unsatisfied with your questions but need to start somewhere. Anyway, I have felt that way (and sometimes still do), and this is kind of how I approached it...

 

I think it's important to gather your own observations about your child, gather what the psych and testing data say, and see what else is missing--Literally matching the tests and data to symptoms and concerns a piece at a time. The psych should be doing this too. Then, you kind of see what gaps are left...did the psych and/or testing fail to explain this thing I am concerned about? Did the psych explain, but I need to do more reading? Do I need a second opinion? Do I need more testing? Do I need to stop and take something in that is swirling in my brain? Am I seeing similarities where I should see a distinction? etc. Am I just getting so much information at once that I can't take it all in?

 

I think this is what you are trying to do, but something still sounds like that satisfying question is just past your grasp when you are trying to ask. The Mislabeled Child might give you a reference point in which to place this whole process and some of the data you've found. Just a thought. 

 

I truly hope you are getting what you need from the discussion.

i think this is exactly what has been going on. Everything is swirling around in my head and I cant seem to make sense of it. That's why I said I feel scattered. Your second paragraph is what I am thinking about doing. Sitting down and writing everything out where I can see it. I have not really done that yet. Maybe it will help the pieces fall into place. Now if I could just find some uninterrupted time...

[PeterPan]

Just had to laugh with you there.  Your sig says you have a 2 yo.  No wonder you feel a little crazy.  :)

 

It might be ok to wait, see what the new evals get you, then sit down and write out your new questions.  That's awesome that you're able to do this.  Hopefully you'll get some answers or rule some things out.  :)