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    Joined: Oct 2017
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    EPL Offline OP
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    Hello,
    I am new here and looking for help understanding my DS8. We recently took him for a full neuropsych evaluation because of increasing problems with emotional outbursts, perfectionism, anxiety, and intensity. His older brother is highly gifted/ADHD.

    The results are confusing. He was diagnosed with Generalised Anxiety Disorder and possible DCD which we don't see at all. He's an amazing artist and very coordinated athlete. His achievement scores are way higher than his IQ scores. His IQ scores are gifted verbal but high average in the rest.

    His achievement scores are below. Wondering how much anxiety impacted testing since he clearly does not have a fine motor issue even though the NEPSY testing indicates he does.

    Basic Reading 129 97th
    Math Fluency 157 > 99th
    Word Reading 129 97th
    Pseudo word Decoding 120 91
    Spelling 148 >99th
    Math Problem Solving 141 > 99th
    Math Fluency: Addition 151 > 99th
    Math Fluency: Subtraction 160 >99th

    Is it unusual to see such a discrepancy between achievement and IQ? And should we also dismiss the fine motor findings since we don't see this at all in his daily life? Finally, he also scored low on the social perception tests and attention tests. Could he also be ADHD?

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    Welcome to the forums, EPL. You'll find a wealth of information here smile

    I'm a parent, not a professional, so keep that in mind while reading my advice wink

    My high school senior has DCD. He was first diagnosed at 8 through a neurospcyh exam, which we'd turned to because his teacher was convinced he had ADHD and we didn't see anything other than a highly intelligent kid who seemed to be a perfectionist and who was most likely very bored at school. He was also extremely anxious at that point in his life - so anxious he were really concerned, seemed totally out of proportion for anything that was happening in his life at the time.

    The DCD diagnosis was a *complete* surprise to me - I couldn't quite believe it at first, but DCD is complicated.I don't know if the diagnosis is correct for your ds or not, but I wouldn't throw the concerns out the window without first reading up a bit on DCD and then taking a look at the global picture of your ds' work and developmental history. DCD impacts each individual in varying, extremely individual, ways. For instance, my ds is also an amazing artist - his drawings when he was younger were so detailed and accurate that adults would see them and be amazed that a child had created them. (He's still great at drawing but it's not really his "thing" anymore wink ) Like you, I didn't understand how a person who could create complicated drawings could also have a fine motor disability, but the roof of DCD is a disconnect between brain and muscle group which impacts the development of automaticity. The art of drawing, for instance, is very different than the art of handwriting. The way you hold your pencil is different than handwriting, once you start drawing your pencil rarely leaves the paper therefore you aren't picking up, finding your place, putting it back down, starting over again like you do when writing. You also aren't having to repeat what you've learned previously, you're creating something new each time you draw.

    I'd suggest putting together a list of questions for the neuropsych re her report, think through a few things re your ds' history and present functioning before finalizing your list, and then ask for a follow-up appointment where you can ask your questions. I found this to be *very* helpful in understanding my ds' neurospcyh report and diagnosis.

    The things I'd consider re your ds:
    1) Did he meet developmental milestones like crawling/walking/etc basically on time or late?
    2) When did he start speaking?
    3) What does his handwriting look like?
    4) Does he seem shy when he talks to people he doesn't know well?
    5) How is school going for him? Is he doing well on his academics or is he seeming to underachieve vs what you think he should be capable of doing?
    6) How is school going socially? Is he having a hard time making friends?

    This (above) may seem like a random list... and it is a bit of a random list. but fwiw, each of these things has been an issue for my ds (not in any obvious glaring was at age 8, but the signs were there once I knew what to look for). Each could be related to many things, but for my sample of one, each is directly related to his DCD.

    When you put together your list of questions for the neuropsych,

    1) Did she feel any of his development history indicated the possibility of DCD (Im guessing she asked for a development history as part of the neuropsych eval).
    2) Did she observe your ds as being especially anxious or tired during the ability testing? What order did the testing take place (achievement or ability first)?
    3) Your ds has extremely high scores in the fluency achievement tests, how is that explained if he has DCD?
    4) What test scores and observations went into the DCD diagnosis?
    5) How does the nueropsych feel DCD will impact your ds?

    Last thought for now - if I were to introduce my ds to you today, in high school, or even many years ago in 2nd grade, he wouldn't "look" like a kid with DCD. One of the most difficult things about advocating for a student with DCD (as well as parenting a kid with DCD) is that it's truly "hidden" - and it's so easy to mistake signs of it as other things, such as perfectionism etc. The reason my ds had such high anxiety in 2nd grade was that he was struggling and none of the adults in his life saw it. Once we understood the issue, were able to explain to him why he was struggling, and were able to get accommodations in place at school his anxiety evaporated.

    I hope you'll find the answers you're looking for - hang in there!

    polarbear

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    Welcome!

    These are very strong achievement scores across the board. I do notice, however, that there were no written expression subtests at the sentence or passage level (depending on whether he is in 2nd or above grades), and no reading comprehension. With the exception of math problem solving, most of these scores are in basic skills, which, at this early grade level, are easier to top out (score very high in) than reasoning and comprehension tasks are.

    A few factors should be considered in thinking about whether the difference and direction of difference in the academic and cognitive testing are significant.

    1. Is this difference within the standard error? Generally speaking, if the cognitive test was the WISC-V, the correlation is between about 0.5 and 0.8 between the two tests. From that standpoint, the difference between, say, a 130 cognitive score and a 140 achievement score, is not that significant.

    2. Are there differences between how comfortable he might have been with academic vs cognitive testing? It is possible that the achievement testing felt more familiar, which allowed him to demonstrate more of his range, while the cognitive tasks, which are intentionally novel, for the most part, may have been less comfortable. Including the social perception and attention results, the verbal high/nonverbal low cognition, and the anxiety, brings in the possibility of other diagnoses as well. For example, these data are sometimes consistent with an NVLD or high-functioning ASD profile, both of whom generally are more challenged by novel situations.

    So in answer to your questions:
    1. Unusual discrepancy: not necessarily. But it may still be meaningful, since there is a fair amount of information missing. If you have other data that you are comfortable sharing, we may be able to provide additional feedback. Or if you prefer to pm me, feel free to do so.

    2. Fine motor: again, not necessarily. NEPSY fine motor testing is not only about pure fine motor coordination. It can be affected by other factors as well. Also, it depends a bit on which task or tasks were actually low.

    3. Social perception/attention: possibly, but there are several other diagnostic considerations as well, including NVLD and ASD. Really, lots of things affect face reading and executive functions.

    This isn't, perhaps, as helpful as you may have been hoping! There really are just too many possibilities to say anything definitive based on the limited data available. One hopes that the neuropsych had good reasons for making the formulation given you.


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