If you had a kid who was struggling with schoolwork (and more), and you had the opportunity to take them for an eval...

[ILiveInFlipFlops]

What kind of eval would you be looking for? (Please don't quote, as I'll delete some of this later on. Thank you!)

 

One of my kids is struggling and has been for awhile. She has a hard time completing work in a timely manner. I can assign her a math review with maybe 30 problems, and it will take her days to get it done because she just can't seem to buckle down and focus on it. If I tell her she has X amount of time and to sit there until it gets done, she ends up in tears of despair. We have the same problem with writing assignments, and reading assignments take forever. She doesn't read for fun anymore--even books that she does enjoy take her forever, and she often doesn't finish them. 

 

I know there's a significant anxiety component, and we're addressing that. But in the meantime, I have an opportunity to bring her to a well-regarded psych center at the local university. They do a multitude of psychoeducational evaluations, but it sounds like I need to tell them which ones I want them to do. 

 

Where should we start with this? Am I looking for an ADHD eval here? I could see this being the inattentive type of ADHD (there's definitely no hyperactivity component), but that's my own armchair analysis (FWIW, I also think of myself as having inattentive-type ADHD based on all the reading I've done over the years). 

 

For additional information, she's also been somewhat depressed. She's always been a reserved kid, and now she's a VERY reserved teen. She doesn't come out of her shell much, though that has improved since we started a supplement regimen that helped me when I was struggling years ago. She's an extremely bright kid but has never, ever wanted to do schoolwork of any kind. She has no outside interests other than reading Tumblr and surfing Pinterest. 

 

She has very good intentions and can see what she NEEDS to do--she just doesn't seem to be able to accomplish the steps it takes to achieve those goals. She saw a therapist briefly (I ended up needing surgery and we got off her limited schedule and couldn't get back on), and the therapist would give her weekly "homework," and she would leave the office all prepared and with a plan to do what the therapist assigned her, but as the week would go on, she just couldn't/wouldn't be able to do what she was told and would go back the following week having to report that she hadn't done any of it, which of course would make her more depressed and frustrated with herself. And so on. She wants to go to college, she wants to do big things in life, she talks about traveling and taking photographs etc. But when offered opportunities to take steps toward those things (e.g., take a teen photography class), she won't do it. If we start to talk about what she'll need to do to get into the college she wants to go to (grades, SAT, etc.), she gets very depressed and hides away.

 

She's had all the standard bloodwork, and with the exception of her D being slightly low, it was all normal. We're exercising more, but she's not willing to try any food-related experiments. She does take the supplements I give her, and those do help quite a lot in terms of her mood, but nothing we've tried has helped with the motivation/ability to focus issues. 

 

So given all of the background info, what kind of evals would you start with? Does it sound like ADHD is a good starting point? Something else? I honestly don't know where else to go with her at this point, and we've used up all our "spare" time in terms of school. High school starts next year, and more important than that, I need to start preparing her to be a functioning adult, but I have no idea how to help her. 

 

Ugh, thanks for listening. I'm open to any advice you may have. And thanks again for not quoting. I want to be able to provide context and history here, but I really don't want to leave most of this for all to see forever!

Edited November 6, 2016 by ILiveInFlipFlops

[Arcadia]

I have a friend who was treated for anxiety as a teen. Until her anxiety level was closer to teen peers norm, she could present as ADD/passive. My younger boy has mild social anxiety and it does show up when he was evaluated for ADHD and autism. His cautiousness has a slight flight element while my oldest social cautiousness has a fight element.

 

I don't know whether ADD testing would be accurate right now while anxiety is being addressed. For the psychologists that evaluated my kids, I did let them know that my kids are the "guarded" kind and would not response immediately to small talk. Some strangers thought my oldest was ESL/non-verbal because he won't talk as my oldest is very picky about who he will talk to.

 

As for traveling and taking photographs, my hubby bought me a DSLR. My younger boy who is keen on photography made use of it on our vacation and any field trips we did. He shoots nature and architecture. He is turning 11 and has no interest in a formal class. We put a 128gb sd card in so he can shoot the same object with different camera settings and see what works best for what. Like he took many photos of Hard Rock Cafe's facade under different settings to see which looks better to him. When I was a kid, we were using rolls of film so I could not shoot so many and I read up photography magazines and ask the camera film developers for tips.

 

ETA:

IQ test can be affected by anxiety. The psych had to sub a test for my "non-verbal" kid. Some testers are great with calming the child down/putting the child at ease, some are not.

Edited November 6, 2016 by Arcadia

[Jean in Newcastle]

They don't provide a general screening and then decide on more specific tests from that?  That's what our neuropsych did. 

[sassenach]

I think it's a little weird that they want you to choose a diagnosis before the evaluation! Isn't that what they are supposed to do? Tell you what's going on?

 

IME, depression can pretty much feed all of the other issues you mentioned. It also could be add or working memory or something else. I guess I would ask for a neuro psyc evaluation for learning disorders, if they'll allow you to be that vague.

[scholastica]

They don't provide a general screening and then decide on more specific tests from that?  That's what our neuropsych did.

 

  

I think it's a little weird that they want you to choose a diagnosis before the evaluation! Isn't that what they are supposed to do? Tell you what's going on?

IME, depression can pretty much feed all of the other issues you mentioned. It also could be add or working memory or something else. I guess I would ask for a neuro psyc evaluation for learning disorders, if they'll allow you to be that vague.

If it's at a university, it is likely that the grad students will be doing the testing to get experience. In that situation, you have to tell them what tests you want done or what you are looking for specifically.

 

You should probably have an IQ test done, as well as ADHD testing and tests for EF and learning issues. The IQ can tell them where she would be expected to be performing and the other tests can tell them where she is actually performing and what may be interfering if there is a gap. Good luck.

[gardenmom5]

I'd do an eval in a heartbeat.

 

what are you doing for her low d?  (and define "low".   minimum is 50, but some drs still go by 30 as a minimum.)

 

just on a hunch (becasue i had similar issues, and this was part of what it was tied to).  a 24 hr saliva cortisol test.  (the blood test is worthless.  also, what most drs use.)  it should start high, and go low through the day. - poor adrenal function can cause brain fog and scattered thoughts.  and hormones (which would change with puberty) affects them.

 

[Crimson Wife]

I'd recommend finding an educational therapist who specializes in Executive Functioning issues. I don't know that getting a psych eval at a university is going to give you as much "bang for your buck" as working with an ed therapist on improving her EF skills.

[ILiveInFlipFlops]

I have a friend who was treated for anxiety as a teen. Until her anxiety level was closer to teen peers norm, she could present as ADD/passive. My younger boy has mild social anxiety and it does show up when he was evaluated for ADHD and autism. His cautiousness has a slight flight element while my oldest social cautiousness has a fight element.

 

I don't know whether ADD testing would be accurate right now while anxiety is being addressed. For the psychologists that evaluated my kids, I did let them know that my kids are the "guarded" kind and would not response immediately to small talk. Some strangers thought my oldest was ESL/non-verbal because he won't talk as my oldest is very picky about who he will talk to.

 

As for traveling and taking photographs, my hubby bought me a DSLR. My younger boy who is keen on photography made use of it on our vacation and any field trips we did. He shoots nature and architecture. He is turning 11 and has no interest in a formal class. We put a 128gb sd card in so he can shoot the same object with different camera settings and see what works best for what. Like he took many photos of Hard Rock Cafe's facade under different settings to see which looks better to him. When I was a kid, we were using rolls of film so I could not shoot so many and I read up photography magazines and ask the camera film developers for tips.

 

Thank you, that's helpful experience.

 

They don't provide a general screening and then decide on more specific tests from that?  That's what our neuropsych did. 

 

I think it's a little weird that they want you to choose a diagnosis before the evaluation! Isn't that what they are supposed to do? Tell you what's going on?

 

IME, depression can pretty much feed all of the other issues you mentioned. It also could be add or working memory or something else. I guess I would ask for a neuro psyc evaluation for learning disorders, if they'll allow you to be that vague.

 

Thank you, this is what I thought too. I was just going to go into the appt on Friday and discuss that and see what they said, but I have a sneaking suspicion that I'm going to walk in there and find out we're all set up for an ADHD test since I wondered aloud if that was a possibility on the initial phone call!

 

  

If it's at a university, it is likely that the grad students will be doing the testing to get experience. In that situation, you have to tell them what tests you want done or what you are looking for specifically.

 

You should probably have an IQ test done, as well as ADHD testing and tests for EF and learning issues. The IQ can tell them where she would be expected to be performing and the other tests can tell them where she is actually performing and what may be interfering if there is a gap. Good luck.

 

Excellent, thank you so much. Yes, that's exactly the kind of clinic environment that it is. It has a very good reputation around here, and it's what we can afford, but I guess in exchange we'll need to be more specific with what our concerns are.

 

I'd do an eval in a heartbeat.

 

what are you doing for her low d?  (and define "low".   minimum is 50, but some drs still go by 30 as a minimum.)

 

just on a hunch (becasue i had similar issues, and this was part of what it was tied to).  a 24 hr saliva cortisol test.  (the blood test is worthless.  also, what most drs use.)  it should start high, and go low through the day. - poor adrenal function can cause brain fog and scattered thoughts.  and hormones (which would change with puberty) affects them.

 

Ha! I can't even get a doctor to take me seriously about this, let alone consider it for my teen. How does one do the 24-hour saliva test? I assume it's something I can order and manage myself, since there's no blood involved? I have her taking 5-htp, tyrosine, and a good omega complex, and it makes a world of difference in her outlook, but she's still not where I'd like to see her. 

 

I'd recommend finding an educational therapist who specializes in Executive Functioning issues. I don't know that getting a psych eval at a university is going to give you as much "bang for your buck" as working with an ed therapist on improving her EF skills.

 

The problem is that we have very little "buck." The reason we're going to the university is because it's what we can afford. Our insurance doesn't cover any of this. And how does one find an educational therapist? I've been searching for a good therapist for months now, and the few that I've been able to find are never on our insurance (and we have no OON coverage). 

[Janeway]

She sounds like my son. I would start with a standard psychological evaluation.

[hornblower]

I would borrow money if necessary for this.

You need a standard psycho-educational evaluation.  They run about $1500 around here. YOu need to look up your registered psychologists & find one that is specially trained in educational assessment. 

The other people who do these are neuropsychologist but in my area they tend to be more expensive. Otoh, I hear you get even deeper test results to depending on issues, it may be worth seeking out & sorting out in case insurance covers one or the other). 

 They give a battery of tests& if you just describe some symptoms (as you did above) they will look for certain things that could explain it.  Our assessment was I think 15hours (broken up in a bunch of sessions) and in the last session, the psychologist administered a bunch of tests to get further clarity based on earlier results.  ie, skilled therapists will tease out issues and figure out if the issues are memory, executive function, ADD, ASD etc. 

Depending on results, the student may get an official disability designation which would allow for accommodations at college (more time during exams, ability to record lectures etc etc). 

fwiw, I've btdt with a child with learning disability + mood disorder. Addressing both was key though I will say that once mood is handled (pharmaceutically) ability to cope with the LDs improved greatly. 
 

[kbutton]

I would also get a vision check with a COVD since she's not enjoying reading for fun anymore. 

[ILiveInFlipFlops]

fwiw, I've btdt with a child with learning disability + mood disorder. Addressing both was key though I will say that once mood is handled (pharmaceutically) ability to cope with the LDs improved greatly. 

 

Thank you. If we could find that kind of assessment around here for $1500 I would seriously jump on it. The lowest I've heard around here is $3000, and up from there. I'm going to call the university on Monday and see what they say about all of this. 

 

As a side note, how does one go about handling the pharmaceutical aspect? Can you just go to a psychiatrist and explain what's going on? Do you need some kind of precursor appointments before you get to psychiatrist? I didn't want pharma to be my first steps, but I've been working this from different angles for about a year now, and there's been only mild to moderate improvement, and in some areas, no improvement at all. 

[hornblower]

i'm going to pm you 

[Jean in Newcastle]

In addition to the psych testing, you might consider a screening test for depression and/or anxiety. Our pediatrician does that here and then refers to a child psychologist if it seems like medications or other therapy might be warranted.

 

 

Sent from my iPhone using Tapatalk

[ILiveInFlipFlops]

I would also get a vision check with a COVD since she's not enjoying reading for fun anymore. 

 

I've thought about that. I think I'll make that call tomorrow. My strong suspicion is that mental focus is the issue, since I've watched her while she reads, and really her brain just wanders off and she sits staring into space while she daydreams. One day I told her to spend some time reading the lit book I assigned her (which she is enjoying, as much as she enjoys any book these days). I came upstairs an hour and half later, and she'd read about 10 pages. I asked what she'd been doing all that time and she said that she started thinking about what she would do if she were the last person left on earth and spun out a whole long story for me about that. In the meantime, we've been working on the same book for two months now  :banghead:

[ktgrok]

ADHD, working memory, and getting her vision checked would be big steps, as well as depression being treated. Depression can decrease working memory, but ADHD and frustration with life can trigger depression, etc etc. It may be a matter of which came first, you know? Or treating the biggest issue first. 

[ktgrok]

I'd also want her screened for dyslexia because of the reading issue. But again, that could be depression....depression can manifest as not enjoying the thing you used to enjoy as well as brain fog. 

[ILiveInFlipFlops]

In addition to the psych testing, you might consider a screening test for depression and/or anxiety. Our pediatrician does that here and then refers to a child psychologist if it seems like medications or other therapy might be warranted.

 

 

Sent from my iPhone using Tapatalk

 

Do I need this screening if I already know she's depressed and anxious? We don't need referrals (and when I called the ped to ask who they refer to, of course they don't accept any insurance at all). 

[ILiveInFlipFlops]

I'd also want her screened for dyslexia because of the reading issue. But again, that could be depression....depression can manifest as not enjoying the thing you used to enjoy as well as brain fog. 

 

 

I kind of wrote off dyslexia because she was an early reader (learned pretty much on her own at 3-4) who read fairly voraciously when she was younger. Do you think that could still be possible? I hate to say it, but when screens in various forms started to become more available to her was when the reading really dropped off. Now the majority of what she reads is very short form, KWIM? Memes and Tumblr-length web posts, etc. Which brings me back around to thinking about attention span...

Edited November 6, 2016 by ILiveInFlipFlops

[ktgrok]

I kind of wrote off dyslexia because she was an early reader (learned pretty much on her own at 3-4) who read fairly voraciously when she was younger. Do you think that could still be possible? I hate to say it, but when screens in various forms started to become more available to her was when the reading really dropped off. Now the majority of what she reads is very short form, KWIM? Memes and Tumblr-length web posts, etc. Which brings me back around to thinking about attention span...

 

I honestly don't know. Could you have her read aloud to you so you can see how well she's actually reading?

 

And yes, attention span could be the problem, or depression could be causing short attention span. Hard to know which came first. When we started addressing my son's ADHD and Aspergers his depression got better. But it can go the other way around. 

[ILiveInFlipFlops]

I honestly don't know. Could you have her read aloud to you so you can see how well she's actually reading?

 

And yes, attention span could be the problem, or depression could be causing short attention span. Hard to know which came first. When we started addressing my son's ADHD and Aspergers his depression got better. But it can go the other way around. 

 

Hm, that's a good idea. I did finally figure out that the depression/anxiety goes hand in hand with the learning stuff. For a long time it looked like a laziness/motivation issue. But when she got old enough to really start wanting to take schoolwork seriously and I could see she was really trying and struggling and watching how that affected her depression, I finally started thinking something else is definitely going on. I feel like I'm in the eye of a hurricane trying to get help though!

[Jaybee]

I still wouldn't completely dismiss dyslexia. Her issues may not be related to a learning disability at all. However, I have a ds who can read quite well (if you read aloud with him you might not notice a notable problem), but his comprehension is quite spotty, and reading is a lot of work for him. He was in a school for K and 1st, and I kept asking them because I thought something was wrong. They always assured me he was doing well. Toward the end of 1st, he really started falling through the cracks. He was first tested after 2nd grade, and does have an "expressive language disorder" diagnosis now. Working with him every day, I still feel that his tests rank him a little higher than his ability actually falls. It affects his work in every subject. 

[kbutton]

He was first tested after 2nd grade, and does have an "expressive language disorder" diagnosis now. Working with him every day, I still feel that his tests rank him a little higher than his ability actually falls. It affects his work in every subject. 

 

Language testing is a mixed bag with psychs, but I agree with this poster that an expressive (or receptive) language disorder can really influence schoolwork. My son has relatively mild issues in this regard (not really tested by a psych, but by an SLP), and it's pervasive across the board. In his case, it's likely stemming from auditory processing issues. 

[Rosie_0801]

Whatever else might be going on, she sounds like she's suffering from powerlessness, which is common enough in the teen years.