Speech evals next week

[Sdel]

I've been waiting 4 months for DD's eval and 2 months for GS eval.  They are 8 and almost 3.  Finally got the scheduling call today and we'll be doing the evals next week, back to back.  Is there anything I need to be aware of to ask about/bring?

 

I'm honestly not too concerned about GS's eval.  I only asked for the referral because while I was at DD's ADHD appt with the pedi my gut was screaming at me to do so.  We are currently in the middle of a custody issue and his speech came up (How is that for intuition?).  He really is fine though, maybe on the late bloomer side of things, but since I've put in the referral he's picked up by leaps and bounds.  He finally started saying the long e sound just last week.

 

DD is my main concern.  She has lots of trouble with spelling.  She reads/comprehends well, but doesn't seem to really grasp the phonograms.  She'll sound out the words correctly but put down the wrong letters when writing.  She likes things loud and she talks loud.  She'll mix up hearing blends.  She has a hard time making/hearing some of the sounds, especially r.  I was told to bring her WISC scores for them to look at.  I'm hoping I can get some answers for the spelling difficulty and if not a better idea of where to go from here than the pedi can give me.

 

Stefanie

 

[PeterPan]

Have you gotten a hearing eval?  What you're describing in your dd could also be explained by hearing.  If she has only had the ped screening, you could consider going to an actual audiologist.  Sometimes the SLP will pick up on it too, with patterns in what sounds are being missed.  She could also be dyslexic or have a combination of things going.  

 

So for the phonological processing, you're hoping for a CTOPP, the comprehensive test of phonological processing.  The SLP may have some kind of APD screening tool. Really though, those evals take significant time.  If it's a quick eval (1 hour or 1/2 hour), you're going to just do basic things.  Just depends on what jumps out to the SLP.  I think you definitely have reason to want evals.  It's just the issue of the person having enough time to do all the testing.  Around here an SLP is 1/2 the price (or less) of a psych, so anything the SLP can do is nice to get done with them.  Our SLP has tests for all kinds of stuff.  There's detailed language testing they can do, etc.  It might be they'll do some, get a sense, and then maybe suggest you come back for more.  The results on one thing will point them to what's needed next.  

 

For your gs, hmm.  I'm all in favor of early identification.  They have charts and will quantify his speech and make sure he's on track.  It's easy and fun.  He'll probably have a good time!  He'll be bored stiff while your dd is eval'd, and you may or may not be in the room with her.  If you want to be in the room while she's eval'd (not essential, optional), then taking a 2 yo doesn't seem very practical.  Or maybe he's super quiet?  Just something to think through.  

 

I think I would want an audiology eval, no matter what, to explain why your dd is wanting everything so loud.  That seems really conspicuous to me.  Around here I can get an eval and the SCAN3 (APD screening) at the university for $35.  It's a lot more privately ($380), but I'm just saying if you can find it at $35 I would definitely recommend it.  If you have to pay more, well see what the SLP says.  I'm just noticing a lot of your symptoms seem to go back that.  Any issues with ear infections, silent ear infections, that kind of thing?  Ever been to an ENT?

Edited April 15, 2016 by OhElizabeth

[Storygirl]

I agree with checking hearing with an audiologist. I thought I'd point out that the spelling issues and loudness could be due to dyslexia plus ADHD, which are often co-morbid.

 

I wouldn't rule out the idea of dyslexia, even though she reads well. DD10 reads at grade level and scored in the 99th percentile for reading comprehension, but has a fairly severe phonological disability and can't spell. She has dyslexia. I'd definitely ask for the CTOPP, which tests phonological skills.

 

Also ADHD has several types and often appears differently in girls than in boys and thus goes undiagnosed more often.

 

Are your evaluations through the school or a private provider? The SLP is not going to diagnose dyslexia, but if they can run the CTOPP, those scores will be revealing.

Edited April 16, 2016 by Storygirl

[Sdel]

OhE - we'll have a full 2 hours per kid to eval (4 total hrs with the SLP). As for the GS, he's an easy keeper. He also needs to go second because I don't want his parents tainting the SLP if they show up before she has a chance to do my daughters eval. They've made it a court issue so I'm sure they'll show up and make asses of themselves.

 

Story girl - it is a private eval. My husband is a hospital employee so it is through his employer's outpatient rehab services. She is also so ADHD you can't miss it.....extreme hyperactivity in addition to nonstop talking and inattention.

 

I spent 45 minutes with a screener discussing my concerns when we made the appointments and she said she was taking notes for the SLP to review and formulate a tentative plan prior to the actual eval.

 

I do want to get an audiologist screen, but nothing sticks out on our insurance listings. Our pedi is great, but he is new to the area so he hasn't quite gotten a full reference list for some of these evals. I'm hoping the SLP may be able to direct me somewhere since they are closer to that field.

 

Stefanie

[Crimson Wife]

SLP's have the training to do a basic audiology screen (like the kind a pediatrician will do). Some clinics require their SLP's to run a hearing screen on all new patients. If I were to get my master's where I'm doing my 2nd bachelor's, their university clinic does that. However, I would still have an audiologist run full booth testing because the hearing screen may not pick up a loss that only affects certain frequencies. My child is profoundly deaf in the high frequencies but it didn't get flagged by the pediatrician's screen.

 

My DD never acted like she had trouble hearing because she apparently figured out how to lip-read to fill in the gaps as her hearing deteriorated. The symptoms that she did have- "spacing out" in noisy environments, talking loudly, not always responding to someone calling to her on the first try, etc. all got chalked up to her previously diagnosed autism and ADHD (which she does have in addition to the hearing loss). When she started mixing up consonant pairs, everybody thought dyslexia and/or auditory processing disorder.

 

Hearing loss was not on anybody's radar screen except her school speech therapist thought that there might possibly be a mild one because some of the consonant pairs DD mixes up are not the typical ones for a phonological disorder. I went into the audiology booth testing thinking it was a "check the box" thing prior to the school psych doing the dyslexia testing. It's a good thing that I was pushy on dyslexia testing in K because who knows how much longer it would've been before we noticed the hearing loss (it's gotten worse so maybe by now, but that's 14 months longer without hearing aids).

[Sdel]

Okay, I could just cry.  We just told my GS parents about the eval because we are court ordered to.  And the first reaction from his mom was to look over at the GS and say, "I hope you have a bad speaking day that day."  I know that she is going to come in and try to tank this eval to make it a court issue because it's the only thing they have that they think they can make a stink over to paint us as unfit parents.

 

He really is *fine*.  They just can't understand him because they don't spend any time with him, and the little time they do spend they don't focus on him.  I just hope the SLP doesn't get swayed by their BS.

 

Stefanie

Edited April 17, 2016 by Sdel

[PeterPan]

Oh my, did you get that on tape?  What a horrifically traumatizing, confusing thing to say to a child!!!  You need to tell the SLP that, that he has been getting conflicting messages.  It would be important to know in case the child has strange behaviors or refuses to participate.

 

Now, I really don't know what you have going on, but it sounds complex.  So the bio parents are saying you're unfit and should not get custody because they claim he has intelligibility issues?  If he IS having intelligibility issues, it's not your FAULT, mercy.  But it's really not reasonable to say that their intelligibility concerns have no validity.  You would understand him more because you hear him more.  This is COMMON.  In fact, when we had my ds do fresh evals before his IEP, we had him seen by two SLPs who had never worked with him.  Just working with someone for a long time, even as a professional SLP, will get you so used to their speech that you don't hear it the same way as someone who isn't used to the pattern of his errors.

 

So I don't see how intelligibility has ANY BEARING on the case, because the point is you ARE taking him for evals and ARE pursuing interventions.  This child is only 2??  Your goal for intellgibility is super low there, something like 50%.  I forget, but you can google it.  By age 5/6, sure they should be 100% intelligible.  Yup, just googled, if he's under 3 it's not normal/common to be completely, 100% intelligible.  There are charts that show intelligibility with strangers vs. intelligibility to parents, because it will go down with strangers.  http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=29:admin&catid=11:admin&Itemid=117

 

I would encourage you to lower your defensiveness and just let this work out.  It's common for a dc to need speech therapy, so I don't see why that would affect custody when you're WILLING to do that.  Doesn't make sense.  Now for a mother to say abusive things that imply that the dc shouldn't speak that day if he loves her, THAT is horrific.  And the dc may do that.  Some kids absolutely would be cognizant of a dynamic like that.  So you've got an issue, but it isn't whether he's intelligible or not.  I don't know if you're getting legal counsel on this, but I don't see how you have anything to "prove" just by the intelligibility.  Doesn't make sense to me.  My ds wasn't 100% intelligible at age 6 and nobody said I was an unfit parent.  

Edited April 17, 2016 by OhElizabeth

[Noreen Claire]

DD is my main concern.  She has lots of trouble with spelling.  She reads/comprehends well, but doesn't seem to really grasp the phonograms.  She'll sound out the words correctly but put down the wrong letters when writing.  

 

Does she have trouble writing other things, or is it just spelling? This sounds a lot like my oldest, who could read and comprehend at/above grade level but couldn't do pretty much anything written anywhere near correctly/at grade level. Turns out, he had a non-verbal learning disability. Ask him a question and he knew the answer; ask him to write it down and it got lost between his brain and his hand.

 

Just a thought.

[Sdel]

OhE,

 

It is long an complicated....and I'll be brief.  GS was removed by CPS at 1 month of age for mental health/drug issues in both parents (mom's being severe and ongoing since she is trying to get on disability).  You know that post partum depression checklist that you look at and question who in their right mind says these kinds of things even if you might think them sometimes....well, yeah.....

 

The parents are essentially strangers in his life.  His first 3 months with completely open ended visitation, they spent less than 6 hours a week with him.  In the last year and a half they've spent on average only 12 hours per two weeks with him.....He will be 3 next month, 3 1/2 by the time we actually get around to seeing the judge.  The problem is they have unrealistic expectations of his speech.  One particularly heartbreaking visit, he threw a ball over his baby gate to get their attention.  He said, 'mom ball and a slurred please' and pointed over the gate at the ball.  For 20 minutes she refused to go get the ball until he said to her "Mom, go get the ball please."  She expected that exact sentence and directly stated she wouldn't go get it until he said it.

 

Court is essentially to remove the language that defines a plan working towards returning the child.  This is not the make or break issue for our case.  There is a long standing history of neglect/abuse.  The speech issue actually is pretty negligible.   I just didn't want his eval to turn into this.  I wanted it to be honest, not smeared with lies for the sake of court.

 

Stefanie

Edited April 18, 2016 by Sdel

[Sdel]

Does she have trouble writing other things, or is it just spelling? This sounds a lot like my oldest, who could read and comprehend at/above grade level but couldn't do pretty much anything written anywhere near correctly/at grade level. Turns out, he had a non-verbal learning disability. Ask him a question and he knew the answer; ask him to write it down and it got lost between his brain and his hand.

 

Just a thought.

 

Her WISC-IV scores indicate a non-verbal profile.  But while she reads/comprehends well, but she breaks down at the phonogram level there as well.  Her reading scores on the WISC were all over the map honestly.

 

There are issues with her hearing words correctly and saying words too.  If I say brownie, she may inquire about if I said grownie.  She'll often add sounds as well.

 

Stefanie

[Crimson Wife]

 

There are issues with her hearing words correctly and saying words too.  If I say brownie, she may inquire about if I said grownie.  She'll often add sounds as well.

 

Take this with a grain of salt because I'm only a mom with life experience and a half-way complete bachelor's in Communicative Disorders, but this sounds like either a physical hearing issue or an auditory processing issue, or both.

 

My daughter with the hearing loss makes similar mistakes because she physically cannot distinguish between certain sounds. Getting her digital hearing aids helped, as did starting Lindamood-Bell LiPS at home plus auditory-verbal therapy with a SLP at the clinic for the deaf & hard-of-hearing. Her hearing is continuing to deteriorate, however, so she'll be having cochlear implant surgery next month.

[Sdel]

Take this with a grain of salt because I'm only a mom with life experience and a half-way complete bachelor's in Communicative Disorders, but this sounds like either a physical hearing issue or an auditory processing issue, or both.

 

 

 

My gut is leaning toward APD issues because of family history.  We have no family history of hearing issues, but on dad's side she has two cousins with autism and related issues.  APD is common with autism, correct?  So, most likely its APD related than hearing loss related.  But, well see what the SLP says.

 

Stefanie

[Crimson Wife]

My gut is leaning toward APD issues because of family history.  We have no family history of hearing issues, but on dad's side she has two cousins with autism and related issues.  APD is common with autism, correct?  So, most likely its APD related than hearing loss related.  But, well see what the SLP says.

 

Stefanie

 

APD is frequently co-morbid with autism.

 

I do have to warn you that half of all hearing loss is genetic, and it is more common for that to be recessive than dominant. We had no idea that DH and I were both carrying rare mutations in the same gene until the genetic testing results came back last summer. There had not been any history on either side of childhood-onset HL as far back as anyone could remember. 

[Sdel]

Okay, so evals done.

 

On the GS, the parents did show. Turned out exactly as I expected......low end of normal and just watch for the next 6 mo - 1 year to make sure he continues to progress.

 

For DD, she did a CTOPP. She didn't even run the supplements, just the core, because she saw enough frustration to tell there was enough for treatment. Says the problems were all over the place with no real pattern. R's were a problem but she said there were a ton of ways to make the R sound and DD made some of them and not others. Plan is to work on things for a couple of months and get to know DD and reassess for exploration in other areas (audiology/dyslexia diagnosis). The bonus, they do multidisciplinary meetings about each child in treatment so she's going to talk to the OT/PT about possible referral for eval or at least some specific exercises to work on at home.

 

Stefanie

[PeterPan]

Since psychs use the CTOPP to diagnose dyslexia, I wouldn't do therapy level interventions before you get a proper eval.  If she's 8 and failing the CTOPP, get the dyslexia diagnosed.

 

Sounds like it went as well with your GS as it could, so that's good.

Edited April 23, 2016 by OhElizabeth

[Sdel]

She still has a speech articulation issue that needs an SLP. I also got a lead today for someone who is a former ps person who will be able to do officially recognized dyslexia diagnoses. It seemed the speech uses the CTOPP differently than to treat dyslexia (?)because I asked about it even though I know they don't diagnose it. She felt the same as I do, just doesn't quite see dyslexia. Once I see the actual scores and the report I'll know more.

 

Stefanie

[Crimson Wife]

Literacy disorders actually do fall within the scope of practice for SLP's according to the American Speech-Language-Hearing Association, which is the professional organization certifying SLP's.

 

Whether the individual state licensing permits SLP's to officially diagnose dyslexia or restricts that to psychologists is another story. I've been trying to find out the answer for California since getting trained in dyslexia diagnosis isn't cheap. I know that as a SLP, I'd be permitted to screen for dyslexia the way I'd be permitted to screen for Central Auditory Processing Disorder.