Neuropsych results for DD7

[fourisenough]

Hi, everyone! This is my 'coming out' post on the LC board.  :lol: I feel like my first three (neuro-typical) girls were just a warm-up for parenting/educating my DD7! She's bright and wiggly and full of contradictions.  I'm here to share some of her diagnoses to ask for general thoughts, advice, commiseration, etc. Share away!

 

Working backwards, the summary and diagnoses of her 2/2017 full neuro-psych evaluation include:

General anxiety disorder with panic attacks; Adjustment disorder with depressed mood; ADHD, combined type (mild); and Specific learning disorder in written expression (mild).

 

We've known about the anxiety/panic attacks since age five. She is treating with a psych NP for meds and a therapist for CBT. Her anxiety is well-managed right now, but can swing wildly from the 'hardly noticeable' to the 'totally incapacitating'. I have decided to encourage myself to enjoy the good days/weeks and during the bad days/weeks to remind myself that this, too, shall pass.

 

The neuro-psych explained that she gave DD7 the Adjustment disorder with depressed mood diagnosis to reflect the fact that she is very bright and aware that her emotional struggles are demanding and put a strain on her family at times. DD reported feeling badly about this and worrying that her parents were upset with her because at times she wouldn't sleep in her own bed, separate easily, eat in restaurants, etc. This one sort of surprised me. Although, maybe it shouldn't have been a surprise. She is very in tune with what others are thinking and feeling. She reads people, especially me, very well. If I so much as sigh, she'll often drop what she's doing and ask me what's wrong, if I'm mad about something, etc. I will definitely take care to ensure she never feels like I'm upset with her for any of her struggles. This is an area that I can work on...

 

The ADHD combined type was not a surprise. She has to move a lot (literally climbs the walls), she needs frequent breaks while doing school work, she is uninhibited at times (though not dangerously so), and needs many, many snacks. Getting through a stack of school work is a battle (fought with much negotiating, incentives, and tap dancing on my part). She is 'bored' easily, hates to wait, and is mildly addicted to screen-time.

 

The SLD in Written Expression was also a little bit of a surprise. Her handwriting is beautiful (has lovely manuscript and cursive writing).The doctor wrote in her report that "(DD) is an exceptional reader, including her ability to read familiar and unfamiliar words, reading comprehension, and reading fluency," but "her scores in spelling and sentence composition were below what is expected from someone with (DD's) intelligence."  I agree with this. She is a surprisingly bad speller, given how well she reads. I was actually expecting her to be diagnosed with dyslexia, but perhaps this makes more sense.

 

Her IQ test was all over the place. Even within each subtest, she ranged from Superior to mild/moderate impairment. Because of this, the doctor noted that her full scale IQ score is not a true reflection of her overall intelligence and even her general ability index has significant discrepancies, making it "difficult to accurately depict her overall intelligence into one score." She felt that inattention, impulsivity, and anxiety present during testing also may have had a negative impact on her test scores. Is this what you all refer to as 2E or asynchronous?

 

Despite all of the above, DD7 is actually in a pretty good 'place' right now and has been for the last few months. I requested the testing appointment back in the fall when her anxiety had spiked. When she is anxious, her ADHD symptoms are much more apparent and she can barely do school work at all. 

 

All About Spelling has been going very well. We started about one year ago. We're currently in the middle of level 3. She has an excellent memory, so she can master the new phonograms and recite the rules like a pro. Applying them in her writing is another matter. I'm seeing progress, so I'm inclined to continue with it, but I'm open to other thoughts/suggestions. I've looked into Barton, but since she's such a strong reader, it doesn't really seem necessary. Or would it be better for her SLD-WE than AAS? She does very well with WWE2: her narrations are amazing, copywork is very good, and her dictation is fine as long as I spell most words for her. Is there something that might work better for writing than WWE or should I stick with it since it seems mostly fine for her?

 

I hate to mention all her struggles without also mentioning her strengths. She is super social, loves babies and old people, is an excellent athlete (gymnastics, tennis, ice skating, swim team, etc. - basically every sport she's ever tried). She is creative, self-reliant, has a freakishly huge vocabulary, and is very witty.

 

Thanks for letting me brain-dump here. I'd love to hear any of your experiences with this stuff and am open to suggestions for how to better meet her needs. 

 

 

 

 

[MerryAtHope]

 

The neuro-psych explained that she gave DD7 the Adjustment disorder with depressed mood diagnosis to reflect the fact that she is very bright and aware that her emotional struggles are demanding and put a strain on her family at times. DD reported feeling badly about this and worrying that her parents were upset with her because at times she wouldn't sleep in her own bed, separate easily, eat in restaurants, etc. This one sort of surprised me. Although, maybe it shouldn't have been a surprise. She is very in tune with what others are thinking and feeling. She reads people, especially me, very well. If I so much as sigh, she'll often drop what she's doing and ask me what's wrong, if I'm mad about something, etc. I will definitely take care to ensure she never feels like I'm upset with her for any of her struggles. This is an area that I can work on...

 

The ADHD combined type was not a surprise. She has to move a lot (literally climbs the walls), she needs frequent breaks while doing school work, she is uninhibited at times (though not dangerously so), and needs many, many snacks. Getting through a stack of school work is a battle (fought with much negotiating, incentives, and tap dancing on my part). She is 'bored' easily, hates to wait, and is mildly addicted to screen-time.

 

The SLD in Written Expression was also a little bit of a surprise. Her handwriting is beautiful (has lovely manuscript and cursive writing).The doctor wrote in her report that "(DD) is an exceptional reader, including her ability to read familiar and unfamiliar words, reading comprehension, and reading fluency," but "her scores in spelling and sentence composition were below what is expected from someone with (DD's) intelligence."  I agree with this. She is a surprisingly bad speller, given how well she reads. I was actually expecting her to be diagnosed with dyslexia, but perhaps this makes more sense.

 

Her IQ test was all over the place. Even within each subtest, she ranged from Superior to mild/moderate impairment. Because of this, the doctor noted that her full scale IQ score is not a true reflection of her overall intelligence and even her general ability index has significant discrepancies, making it "difficult to accurately depict her overall intelligence into one score." She felt that inattention, impulsivity, and anxiety present during testing also may have had a negative impact on her test scores. Is this what you all refer to as 2E or asynchronous?

 

She does sound 2E to me! Definitely a lot of areas of gifting in there. My oldest had a lot of similarities (very good at reading me or noticing subtle sounds/body language, and his scores were also so variable that they didn't think his overall IQ was accurately depicted).

 

 

 

All About Spelling has been going very well. We started about one year ago. We're currently in the middle of level 3. She has an excellent memory, so she can master the new phonograms and recite the rules like a pro. Applying them in her writing is another matter. I'm seeing progress, so I'm inclined to continue with it, but I'm open to other thoughts/suggestions. I've looked into Barton, but since she's such a strong reader, it doesn't really seem necessary. 

 

 

I'd keep going with AAS since that is working for her. This actually is somewhat common for students–check out this blog article on Automaticity in Reading and Spelling. When students are writing outside of spelling time, they have many more things to focus on–content, creativity, organization, punctuation, spelling, grammar, capitalization, what kind of audience they are addressing–it’s a lot to think about at once. In fact, even adult writers need to take time to rewrite and edit their work (and sometimes there are still mistakes!). Our students definitely need a separate editing time if the piece is going to be polished at all (which, honestly I wouldn't worry about in 2nd grade--for young, kids these skills often don't come together until much later). But you can take note of struggle words and do tile demonstrations during your next lesson time, to see if she knows the concepts easily when she only has to think about one word at a time. The activities in AAS help to scaffold from easier skills to harder skills in writing (individual words with tiles, then in writing, then shuffling the word cards to do mixed patterns, then dictations, then writing station activities...), so when you notice a struggle, back up to an easier skill level to practice it. I used dictations and writing stations to work on editing skills (rather than outside writing--I focused on content/ideas in outside writing until they were older).

 

Anyway, it sounds like you are doing a great job with her!

 

 

Edited March 11, 2017 by MerryAtHope

[PeterPan]

Congrats on coming out and welcome to LC!  :D

 

It sounds like you got really thorough evals, so that's awesome. Did you go through the subtests on the WISC to see the discrepancies? Sometimes there are patterns to them. If there are 2 standard deviations or more of discrepancy, that's significant. 

 

Yes, in general they'll say to assume they're as bright as they're highest scores and struggling as much as their weakest. So if her highest scores are in that gifted range, then sure call her 2E. If they're not, call her awesome. :)

 

It sounds like you're doing a lot of things really well. No on the Barton, yes on dictation and continuing AAS if you want. The issue is the ADHD. How was her working memory? Should be in the scores. Bumping her working memory *might* help. 

 

You could also check her visual memory with a developmental vision eval. My dd, sort of a similar position, turned out to have TERRIBLE visual memory. That's why the spelling wasn't sticking. ;) Seems kinda obvious when you say it that way. 

 

Has she been checked by an OT or PT or someone for retained reflexes? If she has not, I'd do that pronto. Like that would probably be my HIGHEST priority thing to get done. Working on retained reflexes would put her vision in a better place, might improve *some* of the motion needs, and may dramatically effect her emotional stability. There's some discussion that the rooting reflex is directly linked to dysgraphia diagnosis. Like you've got a lot of reasons to get that eval from someone who's really good at them.

 

If you can't find someone who is good with retained reflexes, I guess google and use youtube to try yourself. I'm not convinced anyone is GREAT at them. I've had my kids to 5 OTs who were all varying shades of inept with reflexes. Now we're using a PT who is better. She was trained by a neurologist at a university. Don't know why they don't get taught this stuff in school, but they don't. You really have to shop around. 

 

My ds has some particular reflexes that are very, very pesky and really do seem to affect his emotions. He also has that ADHD-combined label in his mix. Now he bumps over to ASD as well. Just saying I sympathize with you, sigh.

 

Like your dd, my ds thrives on sports. In the school year, we only do team gymnastics and swim team. In the summer, we dabble in lots more (speed skills, tennis, etc.) I totally agree with your cross-training approach. They really shouldn't do certain sports, like swimming, more than 2 days a week if they're training longer (1 hour classes), so doing multiple sports help them avoid repetitive motion injuries and burnout. 

 

What do you want to change/improve? She's on meds? I missed that and need to reread. Or your diagnosis is new and you're deciding? You've already done the CBT. Given how super bright she is, have you done any Social Thinking materials? I think she could bring this to bear with her behavior.

 

You seem kind of apologetic for your use of motivators, and I think you could work on that. With my ds, we use a lot of motivators. With his mix and what he understands, that meets him where he is. The motivators help him to do what he needs to do until he's mature enough to let the motivators fade and do it WITHOUT the motivators. That's a maturing process. There's typically some social delay with ADHD, even if it's not diagnosed or all the way to ASD or something. So it's something to ponder, whether there's a gap between the behavior you expect based on her *IQ and verbal abilities* and what she emotionally mature enough to make happen. She really could have a gap there. It might be that she needs some support strategies that are more typical to a younger child, even while she's doing academic work and having discussions that are typical of a much older child, kwim? Like you're going to have to allow her to be ALL that and have that spread.

 

You're doing the right thing advocating and learning! Welcome to the board!  :)

[fourisenough]

She does sound 2E to me! Definitely a lot of areas of gifting in there. My oldest had a lot of similarities (very good at reading me or noticing subtle sounds/body language, and his scores were also so variable that they didn't think his overall IQ was accurately depicted).

 

 

 

 

I'd keep going with AAS since that is working for her. This actually is somewhat common for students–check out this blog article on Automaticity in Reading and Spelling. When students are writing outside of spelling time, they have many more things to focus on–content, creativity, organization, punctuation, spelling, grammar, capitalization, what kind of audience they are addressing–it’s a lot to think about at once. In fact, even adult writers need to take time to rewrite and edit their work (and sometimes there are still mistakes!). Our students definitely need a separate editing time if the piece is going to be polished at all (which, honestly I wouldn't worry about in 2nd grade--for young, kids these skills often don't come together until much later). But you can take note of struggle words and do tile demonstrations during your next lesson time, to see if she knows the concepts easily when she only has to think about one word at a time. The activities in AAS help to scaffold from easier skills to harder skills in writing (individual words with tiles, then in writing, then shuffling the word cards to do mixed patterns, then dictations, then writing station activities...), so when you notice a struggle, back up to an easier skill level to practice it. I used dictations and writing stations to work on editing skills (rather than outside writing--I focused on content/ideas in outside writing until they were older).

 

Anyway, it sounds like you are doing a great job with her!

Merry, I was hoping you would see this and chime in! Thanks for your thoughts. I haven't clicked on your link, but will do that in a few minutes. What are writing station activities? Is that something that we begin at a higher level in AAS? Or is it not a part of the AAS curriculum?

[fourisenough]

Did you go through the subtests on the WISC to see the discrepancies? 

Yes, but I need to do it again to be sure I understood it. It was a lot of information to take in!

 

It sounds like you're doing a lot of things really well. No on the Barton, yes on dictation and continuing AAS if you want. The issue is the ADHD. How was her working memory? Should be in the scores. Bumping her working memory *might* help. 

Her working memory index score was 16th percentile (low average); but within Working Memory, her individual scores ranged from 5th to 75th percentile (25th, 63rd, 5th, 63rd, 75th, 16th). The doctor said she performed much better on the challenging tasks and much worse on the boring/repetitive tasks. Processing speed was a similar story. Her index score was 9th (mild impairment), but the scores ranged from 5th to 84th percentile. And again, she performed much better on the more challenging task. Doctor explained that this means she will do much better with novel, interesting work than with rote, monotonous activities. I think. She said so much in that 1.5 hour meeting that I might be mixing things up. Does this sound right to you?

 

You could also check her visual memory with a developmental vision eval. My dd, sort of a similar position, turned out to have TERRIBLE visual memory. That's why the spelling wasn't sticking. ;) Seems kinda obvious when you say it that way. 

I'm not sure I understand this. Are you talking about the "Visual Spatial" subtests? If so, she scored a 63rd percentile on one and 91st percentile on another. Or is visual memory not tested by a neuropsychologist? We see a COVD optometrist, but honestly, I don't think this DD has been in a few years. Time for an exam for sure.

 

Has she been checked by an OT or PT or someone for retained reflexes? If she has not, I'd do that pronto. Like that would probably be my HIGHEST priority thing to get done. Working on retained reflexes would put her vision in a better place, might improve *some* of the motion needs, and may dramatically effect her emotional stability. There's some discussion that the rooting reflex is directly linked to dysgraphia diagnosis. Like you've got a lot of reasons to get that eval from someone who's really good at them.

There is no way this child has dysgraphia. Is that what SLDWE means? If so, it's can't be an accurate diagnosis for her. She has amazing fine-motor (and gross motor) skills and beautiful handwriting. She doesn't struggle with the physical act of writing at all. She's just a bad speller.  

 

I didn't know anything about retained reflexes, so I looked it up. This is what I saw and it doesn't resonate. She is actually a physical specimen: very coordinated, athletic, toned, and strong. Am I missing something?

 

Symptoms include:

• Poor posture and/or stooping.
• Weak muscle tone.
• Stiff or jerky movements.
• Toe walking.
• Poor balance.
• Dislike of sports, physical education class, and running.
• Eye movement, visual perceptual, and spatial problems.
• Motion sickness.

 

My ds has some particular reflexes that are very, very pesky and really do seem to affect his emotions. He also has that ADHD-combined label in his mix. Now he bumps over to ASD as well. Just saying I sympathize with you, sigh.

Thanks for your sympathy. I feel like I live in the land of perfect children. We were nearly chased out of a co-op/homeschool enrichment program because my daughter refused to stay in class without me (this was before we began therapy/medication for anxiety); I left that place feeling terrible about my parenting skills and feeling so sad for my child.

 

Like your dd, my ds thrives on sports. In the school year, we only do team gymnastics and swim team. In the summer, we dabble in lots more (speed skills, tennis, etc.) I totally agree with your cross-training approach. They really shouldn't do certain sports, like swimming, more than 2 days a week if they're training longer (1 hour classes), so doing multiple sports help them avoid repetitive motion injuries and burnout. 

ITA! I have collegiate/high school swimmers and an aspiring pro-ballerina in the house; for this DD, I see much more benefit in trying many different sports both for the well-rounded exercise and exposure to many different peer/coach/social circles.

 

What do you want to change/improve? She's on meds? I missed that and need to reread. Or your diagnosis is new and you're deciding? You've already done the CBT. Given how super bright she is, have you done any Social Thinking materials? I think she could bring this to bear with her behavior.

Yes, she is on Zoloft for the anxiety. I did a 1-week trial of two different ADHD meds and they not only didn't make her any better, but gave her wacky side-effects (at turns crazy high-energy, exhausted, and irritable/angry).  Frankly, I'm a little gun-shy to try any more. I'm not sure we even need medication for the ADHD. I suspect we definitely would if she were in a classroom situation, but because she gets 1-on-1 instruction from me and I'm open to lots of breaks, snacks, short-work sessions, and incentive programs, we're making progress.

 

 

You seem kind of apologetic for your use of motivators, and I think you could work on that. With my ds, we use a lot of motivators. With his mix and what he understands, that meets him where he is. The motivators help him to do what he needs to do until he's mature enough to let the motivators fade and do it WITHOUT the motivators. That's a maturing process. There's typically some social delay with ADHD, even if it's not diagnosed or all the way to ASD or something. So it's something to ponder, whether there's a gap between the behavior you expect based on her *IQ and verbal abilities* and what she emotionally mature enough to make happen. She really could have a gap there. It might be that she needs some support strategies that are more typical to a younger child, even while she's doing academic work and having discussions that are typical of a much older child, kwim? Like you're going to have to allow her to be ALL that and have that spread.

I SOOOOO needed to hear this! Sometimes I feel like I'm coddling her too much. My older kids think she's allowed to get away with a lot of stuff that I would have never tolerated in them. And they're right; different kid, different strategies needed. Right now, we're working on a 3-month behavior/academic goal chart that is turning out to be very, very effective and much longer-term than anything I've done before. Getting to attend Disney on Ice is apparently what it takes to get her very focused on doing all her self-care, family chores, and school work with minimal fuss! 

 

You're doing the right thing advocating and learning! Welcome to the board!   :)

 

Thanks! My husband just asked what I was doing. I told him I'm getting valuable consulting from the pros! I do genuinely appreciate the chance to 'talk' all this over with you, dear Hive!

 ETA: change font color on comments

Edited March 11, 2017 by fourisenough

[PeterPan]

Whew, that was a lot! And I can't quote, because it was all in my quote, hehe. :)

 

No, don't go by that list you found on reflexes. My ds is a competitive gymnast. He just got multiple 2nd place medals and a large meet in a large area with private gyms, not Y gyms. My ds is RIPPED and looks athletic. He's also an amazing swimmer. And he as retained reflexes.

 

You don't go by vague lists like that, because it looks like a dyspraxia or autism symptom list instead of looking at specific symptoms of specific reflexes. You can actually test for each reflex. It's not voodoo. Google STNR or plantar reflex or rooting reflex. They're things you can see with specific tests for each one. No need to use vague symptom lists. Actually have someone do the tests.

 

Yes, you could update with your COVD doc. Personally, I would work on retained reflexes with a PT/OT *before* going back to the COVD doc. For reflexes, sometimes even a short time (1-2 months) can make a huge difference. So I'm not saying wait a long time, kwim? I'm just saying the retained reflexes are foundational, the bottom of the pyramid, and vision is moving up the pyramid.

 

SLDT=Social Language Development Test. I've forgotten where I was going with that, but I'm just saying for some kids it's really wise to do pragmatics testing and make sure you don't have holes. It's more reliable around 10-12+.

 

What a mess with the co-op. The thing to remember is these are things that are legally defined as disabilities. With that anxiety, she would literally get a $15K scholarship a year to access services in our state. Think about that. I'm advocating for my dd now, making sure that she gets Title III accommodations under the ADA. These are DISABILITIES, even if a particular group is too podunk or unknowledgeable to have a clue.

 

Ok, now your experience with meds is really fascinating to me. If you look into neurofeedback (which I did with both my kids, with sort of mixed results), you'll find discussions about ADHD-inattentive brain wave patterns vs. patterns for anxiety and ASD. The anxiety kids are just the opposite, with too MUCH of the alert brain waves. The ADHD-inattentive kids have too much of the foggy waves. So yes, putting kids with too much alert already on a stim med will INCREASE the irritability, anxiety, etc. We're really concerned about this with my ds. We'd love a magic pill, but we're not convinced that he needs a stimulant. He in fact gets MORE aroused, more hyper, more irritable, even with small amounts of chocolate, etc. We're scheduled to talk it through with the ped, so it's on my mind, sigh. Thanks for sharing.

 

Yes to your use of incentives. Good job!

 

Wow, she'll work for a goal that far out? That's very wow! Yes, it's the right thing to do. We have to meet kids where they are.

 

[MerryAtHope]

Merry, I was hoping you would see this and chime in! Thanks for your thoughts. I haven't clicked on your link, but will do that in a few minutes. What are writing station activities? Is that something that we begin at a higher level in AAS? Or is it not a part of the AAS curriculum?

 

You're welcome! The Writing Station starts in AAS 3, lesson 14, so since you're in the middle of AAS 3, you're probably almost to that point.

[fourisenough]

You're welcome! The Writing Station starts in AAS 3, lesson 14, so since you're in the middle of AAS 3, you're probably almost to that point.

We finished lesson 13 today, so I will look fwd to this in next lesson!