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    #233759 09/14/16 01:11 PM
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    Can2K Offline OP
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    Please help me understand these scores - and where do we go from here?
    [Please don't quote scores - I'll be removing them later. Thx]

    DS8.5 recently had a psychoeducational assessment
    Background - he was identified 'gifted' by the school board in SK (WISC IV GAI was 99%)
    Later on we had an OT assessment and he was diagnosed with DCD
    Also a vision assessment uncovered convergence insufficiency - he's had vision therapy for almost a year - almost ready to be graduated from that.

    We did the assessment at the recommendation of his teachers last year who reported some behaviour problems in class (wandering around the room, singing, distracting others), as well as incomplete work, and organization problems. We worked with them on accommodations including allowing him to take more breaks, use ear muffs, reduce writing demands, and some use of AT.



    They also had us and teachers fill out Conner's questionnaire - they are diagnosing ADHD based on Conner's and the Tower of London test, as well as how he behaved during testing (had trouble staying in his seat, fidgeted and fiddled with things, dropped his pencil numerous times).

    Questions - how unusual is this profile? I keep reading that ADHD kids have poor working memory!

    What changes should we ask for in his IEP (he has one already with 'gifted' and DCD listed as exceptionalities)? The psych report lists a bunch of recommendations for ADHD, but says nothing about his strengths - I'm having a hard time figuring out what are they, and how do we support/differentiate? He
    is very sensitive - I'd like for him to feel he's good at something and not that he just has 'needs' to work on.

    Last edited by Can2K; 09/16/16 11:36 AM. Reason: scores removed
    Can2K #233760 09/14/16 01:41 PM
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    I'm no expert, but I can chime in with our experience with ADHD and working memory, but on the SB5. As far as I can tell DS has pretty severe ADHD and is now on a stimulant med that is working wonders for him. But when he took the test he was not yet diagnosed ADHD and did not have the med.

    The SB5 does not have any timed sections so no processing speed, but based on our observations he seems to think quite quickly once he focuses enough to actually do the thinking.

    On the SB5 he scored 98th %ile (132) overall on working memory with a 13 in non verbal working memory and am 18 in verbal working memory, or 84th and 99.6th percentiles respectively. I'm guessing he might do better now that he is medicated. The 13 was one of his lowest scores, but still above average. We were very surprised, especially since I have read so often about ADHD and poor working memory.

    Maybe it has to do with different types/causes of ADHD in an individual child? Maybe it's what allows some kids like ours to do well academically while other ADHD kids have trouble academically? I don't have any answers, but I too would love to know more.

    Can2K #233763 09/14/16 02:47 PM
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    Hm. I think it might be worthwhile considering whether NVLD or the existing DCD diagnosis fit better as possible alternative formulations. Many of those kids are characterized as ADHD early, but look less so as the years go by. Note: I'm not saying he doesn't have ADHD, but I'm not sure reaching for an additional diagnosis is totally justified by the data. The relevant points:

    1. VS much lower than VC or FR (both WISC and VMI), both motor and, to a lesser extent, motor-free. Though he did do nicely on the perception portion of the VMI, this does not involve spatial manipulations, even mentally, while both the WISC tasks do (one motor, and one motor-free).
    2. Visual memory much lower than verbal/auditory working memory. Can't tell if the WRAML visual memory was mostly owing to motor demands, since the recognition tasks weren't administered (minimal motor), but I'm suspecting it was, since he did fine with the VMI perception subtest.
    3. Preexisting Dx of DCD.

    As to the data they used to Dx ADHD, all of those could also be used to support NVLD &/or DCD Dx, including the EF deficits on the Tower test.

    His strengths: all of his motor-free language skills tested high. He even did well on spelling, probably because he only had to do one word at a time, and it's untimed. I'd be interested to see how his oral expressive language looked, in contrast to motor-involved written language. Similarly, his oral math skills, versus written. If you look at his achievement scores, you can almost line them up in reverse order of motor and motor speed demands.


    ...pronounced like the long vowel and first letter of the alphabet...
    Can2K #233774 09/15/16 12:57 AM
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    As aeh mentioned, the scores look like they are reflective of DCD. I wonder if it's also possible that his lower Visual Spatial score on the WISC, as well as some of his behaviors during testing, might be related to vision challenges. It sounds like Vision Therapy has helped, but he might still have some relative challenge attempting to keep his eyes focused. It's also possible that his DCD contributed to those behaviors.

    As aeh mentioned, DCD can look like ADHD, particularly in younger children. Our ds who has a DCD diagnosis had an ADHD diagnosis also when he was first diagnosed at 8. The ADHD diagnosis was based on his teachers rating scale and a computerized test of ef. The behaviors that his teacher saw in class looked very much like adhd, but they were really the result of DCD - either directly related to his DCD challenges or related to coping behaviors caused because he was unable to complete classroom tasks in the required amount of time due to his DCD. It's not easy to tease the two apart on a rating scale of observed behvavior. When ds was re-evaluated by the same neuropsych at the start of middle school, he lost the adhd diagnosis.

    Re what to add to his IEP - that really depends upon what his needs are at school. It sounds like he has typical accommodations for DCD, although those accommodations will most likely need to be tweaked a bit as he matures. What types of accommodations did the psych recommend for ADHD? Do you feel like they'll benefit your ds? Some accommodations are useful across diagnoses.

    I also really empathize with your desire to help focus him on his area of strengths - it's tough in early elementary when the 2nd e can require intense remediation and/or accommodation, often it seems like the chance to focus on a child's strengths is lost, and honestly, to a certain extent, it is - until the 2nd e has been remediated and appropriately accommodated. Try to remember that all the work you and he are doing to learn how to cope with his 2nd e - whether it's DCD or ADHD or both - is going to be key in allowing him to be where he needs to be in a few years, when his ability to build on his strengths will really kick in.

    Best wishes,

    polarbear

    ps - I'm just curious - did the psych who did the current testing say anything about his DCD? It's certainly reflected in his test scores.

    Last edited by polarbear; 09/15/16 12:58 AM.
    Can2K #233782 09/15/16 06:58 AM
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    Thanks aeh and Polarbear!

    I've looked at NVLD lists of symptoms - some things fit and others don't (same with ADHD). This is why I'm confused I guess.

    For example, he doesn't seem to have trouble understanding reading - he is slow at reading aloud, but when I can get him to do it (if I hold the book and move a ruler along under each line) - he reads with great expression. He knows how the words should sound and where the emphasis should be placed (he's quite picky about it and will re-read a line until it sounds right). He also makes comments that make it clear he understood the text.

    He does have trouble if I ask him questions about what we just read (e.g. why do you think this character did X? What will happen next?) - he gets mad when I do that. He seems to have trouble coming up with something to say - although he has improved over the year.

    He doesn't seem to have trouble socially - has a few good friends at school that he enjoys. They share common interests in Pokemon, Star Wars, Harry Potter, etc.
    His teachers reported no social issues, although they did comment that he misses non-verbal cues. (Perhaps this is visual or attention?)

    I've been paying more attention (ha ha) to possible ADHD symptoms lately - he does have quite a few inattentive symptoms (has trouble focusing on uninteresting tasks; gets distracted; appears not to listen when spoken to; has trouble organizing, planning; loses things) and a few of the 'H' symptoms - but these seem to be improving (fidgeting, trouble staying seated). Some of this seems to overlap with DCD, and some not.

    Having researched this a bit, ADHD and DCD co-exist 50% of the time - so I'm not discounting it. And as Polarbear noted - the list of accommodations for each are quite similar. I do feel that some of the additional accommodations the psychologist suggested would be helpful.

    I am just not sure what to tell DS about all this. He is already quite down on himself - says he is 'clumsy' a lot, etc. I hate to burden him with another negative label. I'd love for him to have something positive on his IEP, something to boost his confidence.

    I know he's smart - he makes these amazing conceptual connections in his mind, and he absorbs any oral learning quickly (eg if I read out loud to him, or he listens to the radio). I'm just not sure how to translate that to school.


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    Originally Posted by polarbear
    ps - I'm just curious - did the psych who did the current testing say anything about his DCD? It's certainly reflected in his test scores.


    The psych mentioned the DCD Dx in the report but didn't really do anything with it. They told me that his fine motor skills are 'average' based on the Beery and that the DCD was interesting 'historical' data. Possibly the VT has improved some of his fine motor skills enough to bring up his Beery score. They didn't test any gross motor skills and didn't really seem familiar with DCD symptoms. E.g the psych who tested him seemed surprised that he kept dropping his pencil and had trouble picking it up again.

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    That's interesting SaturnFan! So I guess a high WMI is not incompatible with ADHD?

    Honestly, his Digit span score blew me away - who knew he could remember up to 10 digits (forward)? Still trying to figure out what that's good for ...

    Can2K #233810 09/16/16 07:12 AM
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    Originally Posted by Can2K
    That's interesting SaturnFan! So I guess a high WMI is not incompatible with ADHD?
    I've got another one to add to the tally - DS has severely impaired attention, off the charts working memory (but slow processing speed). DH's whole family seems to have crazy good memories. It may be a less common combination, but it doesn't appear to be impossible.

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    Can2K Offline OP
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    Thanks Platypus - I guess it happens. Maybe that's why some of the ADHD profiles I read don't quite fit...

    I'm thinking that maybe the "H" part is more related to the DCD. He does have attention inconsistencies - was hyper-focused last night on his Pokemon cards, then told me (after he was in bed) that he just remembered some homework he was supposed to do (not written in his agenda, of course).


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