Neuropsych eval.

[Mom2Five]

I am waiting on a call back from my dd6s drs office to find out if they are going to give a referral for her to have a neuropsych eval and an eval with an audiologist. I know that she needs these things (severe language/communication issues). She has already been evaluated for autism and they felt that she didn't fall under that diagnosis even with all those issues.

I understand the audiologist more than the neuropsych. Can someone explain what kind of testing is done and what things you can find out from it. I strongly suspect processing disorders.

[PeterPan]

Who did the autism diagnosis/screening?  If it was EI, that could change.  That's one of the things you'd definitely expect the np to look at again.

 

The psych will run a WISC (IQ), achievement testing (to look for discrepancies and SLDs), a CTOPP (phonological processing, dyslexia), the CELF or something similar (for language), attention, EF, and ASD screenings.  At least that's pretty much what our np did with ds, similar age.  There were more tests, but that's the idea.  For the audiology, I took my ds to a university that has the full booth set-up to do APD testing.  He was too young to test (they want 7), but they could do part of the screening and discuss.  I totally agree a good audiology exam is worthwhile when you're having language and communication issues.  My ds wasn't responding and it seemed inexplicable.  The audiologist got to see that happen and make sure there wasn't an audiology explanation for it.

 

[kbutton]

You should ask for some adaptive behavior testing if they do that at her age. A similar option for CELF that is often used for kids with auditory processing issues is CASL. A lot of processing in a neuropsych evaluation relies at least partly on motor skills. If she has iffy motor skills, I would want to know more about the motor domain, and I would want to try to find out if there are tests to show how that motor stuff influences the processing. Basically, you want to get as clear a picture as you can whether the processing is auditory, motor, or just a slower cognitive throughput. It's probably going to be a combination of more than one of those.

 

I would get a developmental vision exam from a COVD optometrist as well.

[Mom2Five]

A behavior group in town did the testing. I will have to check the sheet again to see what the persons qualifications were. I remember some initials after the name, haha.

This is so overwhelming. All these abbreviations and tests and doctors and im so ignorant with all of them.

We are in a big university town and I did find out they have a clinic that does testing for speech/language/hearing. I made a call to them this morning and im waiting to hear back about how long for an appointment.

[Storygirl]

Does your insurance require a referral from the pediatrician? We never had a referral but just called the NP and made the appointment ourselves. You can check to see if your insurance will cover NP testing. It seems that most people have to pay out of pocket. We had to pay the full amount for one of our children, but insurance covered most of the cost of the other child's testing (different issues and different NPs).

 

If insurance won't pay, and the cost is prohibitive, you can also ask your local school to evaluate her. Federal law requires them to evaluate students in their district who are suspected to have learning disabilities, even if they are homeschooled (there is a process you have to go through for this to happen). The schools can run many or maybe all of the tests mentioned by OhElizabeth, and they will do it for free.

 

You may get a different level of service and a different amount of information going through the schools. It's just a different process than doing it privately (we have done it both ways). But you can get some testing done and may get some of your questions answered.

[PeterPan]

If autism is the question, the school is not the place to get that answered.  Remember, the school isn't asking the same question you are.  You're asking what is going on (medical diagnosis).  The school is asking what things are present in such a degree or in such a way that they affect his ability to receive an education.  If he can receive his education and you can't show it affects that, you won't get the diagnosis.  

 

So when the question is autism, you have to go private.  

[Storygirl]

That's true about the autism. She was asking about processing issues in her first post, though.

 

OP, if you do decide to get a screening for autism, I'd personally go to a full autism specialty clinic instead of an NP. Our own next step for one child is to do that. First he had a NP evaluation, but we think the NP may have missed the signs of autism (though they were excellent on diagnosing all other issues). Then he had a school evaluation, but they didn't care to look for autism, though we kept asking. So I'd vote for going to a clinic if you want that piece looked at again.

 

 

Edited February 25, 2016 by Storygirl

[Mom2Five]

Ok, im a little slow but I finally checked the diagnosis and the person who did the...what I would call observing has lmhc and bcba after her name. This was a private group who to my knowledge deal primarily with autism.

I would not be surprised if she does eventually get a diagnosis that includes asd, but it could not be that as well and I wouldn't be shocked.

I know there is something going on though. A processing disorder of some sort. Motor skills were mentioned. The thing I have seen with her is that she still does a full fist grasp of her pencil or when coloring..holding any writing instrument.

I did get a hold of the local college and they do hearing tests, but said they do not do tests for processing and other issues. It is the same with speech.

 Our insurance does require referrals. I am still waiting on the drs office. I think I may have missed their call yesterday and just called and left a message.

Besides the school, anyone else do these testings? Another department at the college maybe?

Her main issue is conversation and responding appropriately to questions. I can ask her things and its like asking a 2 or 3 year old. As far as toddlers crying...what happened? She wont tell me. Did you do that on accident or on purpose? Same thing. She cant answer questions like what she had for breakfast. Someone will ask her something and she will just tell them how she wants a pet bunny and it has nothing to do with what they just said.

[Tiramisu]

You should ask for some adaptive behavior testing if they do that at her age. A similar option for CELF that is often used for kids with auditory processing issues is CASL. A lot of processing in a neuropsych evaluation relies at least partly on motor skills. If she has iffy motor skills, I would want to know more about the motor domain, and I would want to try to find out if there are tests to show how that motor stuff influences the processing. Basically, you want to get as clear a picture as you can whether the processing is auditory, motor, or just a slower cognitive throughput. It's probably going to be a combination of more than one of those.

 

I would get a developmental vision exam from a COVD optometrist as well.

 

Something I read recently (and I can't remember where) indicated how important adaptive behavior is in figuring it out if it's ASD. I think EF was also very significant. (These were the most problematic areas in the questionnaires we had to complete.)

 

I have almost wondered if these are of particular significance for girls, especially since I read the article that someone linked here about how the brain scans of girls with ASD are comparable to NT boys in the lighting up of social areas.

[PeterPan]

Ok, here's what I'm going to say.  When was her last speech eval?  Where is she getting her speech therapy?  I think you're going to need a complete set of evals, maybe at an autism clinic, to sort this out.  Go through the DSM5 criteria for ASD yourself.  If she's there, then ask for the referral to an autism clinic and get a more thorough eval.  You also need audiology to make sure there's not another explanation there.  Some places will even run part of the SCAN3 (screening for APD) at that age, so go to a good audiology place that has the booth setup for APD.

 

Right now you could have any number of things or combination of things going on.  You need thorough evals to sort it out.  You can go neuropsych plus all those evals OR you can go to an autism clinic and often get all the evals under one roof.  

 

As far as the BCBA doing the observations, how old was she at the time?  The BCBA should have had some tools like the ADI-R, the Gilliam/GARS, the Vineland (an adaptive living scale to differentiate ID and ASD), etc.  If the BCBA did not do any tools, I would not consider that a complete exploration.  

 

I hope you can get complete evals and get it sorted out.  Evals are not a fun process, but they're necessary so you can have information to make a good game plan.  No matter what happens, the boards will be here for you.   :)

Edited February 26, 2016 by OhElizabeth

[Mom2Five]

Thank you very much. The BCBA did not do anything really. I'm not familiar with what is usually done and this was my only experience. She basically asked me a series of questions about her while she played in the room (This was last August she was 6). She asked my dd maybe two or three questions, to which she had odd ball answers. I think the main reason she concluded that she couldn't diagnose for ASD at that time was that my dd made eye contact, played nicely and cleaned up the toys when asked. So yes, that wasn't a good eval.

Her last speech eval was when she was 4.  She was in speech for a while, but then our insurance dropped us, we lost our time slot (I was taking 3 kids to speech at the time so it was hard to coordinate their schedules).

This year has been crazy for us. We moved to a new city in May and we are about to move back home either in a few weeks or for sure by April. I am trying to get all the testing done before we move back, so I at least have that ready for the new ped and can say this is what she's been diagnosed with so far and this is what she needs.

I had a horrible ped before we moved here who refused to give referrals which is why im still trying to get this sorted out. We wont be going back to that office, but because of their insurance (Medicaid) the options are pretty slim.

Off to make more phone calls...