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    #246377 - 11/29/19 07:10 AM A Bit Overwhelmed - Just Starting Out
    sciona Offline
    New Member

    Registered: 11/09/19
    Posts: 1
    Hi! I'm going to try and cram all the necessary details into this post as possible without running too long...so please feel free to ask any follow up questions.

    In short, I have an 8 year old that would be in 3rd grade and I think it is likely he is gifted. We are just now embarking on this journey to find out what exactly is happening. If I had to guess, I would think he is 2e (ADHD and dysgraphia).

    We had struggles in preschool and I initially thought he was a bit behind the curve and I was going to hold him back from Kindergarten a year. It turned out to be the opposite. There was little to no support in our area so we decided to homeschool.

    So I started to accept that he was probably a bit advanced at that age but also reasoned that it was likely just that he memorized information faster. I had been warned by others that around 2nd grade or so, it 'switches' over from just memorizing and parroting information to actual processing and that's why our local gifted programs don't start until 3rd grade.

    Fast forward to this school year. He has shown an affinity for certain subjects but his struggles have become even more apparent (mostly the dysgraphia). I attempted a week or two of accommodation just to see what would happen (I scribed for him, we did verbal tests instead of written, etc) and his performance GREATLY improved! All of a sudden I could see his reasoning skills so much more clearly coupled with his memory.

    Up until this point, we didn't see a need to do any testing since we homeschooled. Now, however, I feel that I need to know exactly what he is struggling with so I can be sure I'm accommodating properly and not enabling or encouraging poor habits.

    Because of our personal backgrounds, my husband and I are wanting to approach this cautiously but thoroughly. We are planning the first step, which will just be a CogAT. In preparation of that, I pulled out my records to see if I ever took a similar test. It turns out that I did. I took the OLSAT at the end of 2nd grade and my non-verbal score was a perfect 150 but my verbal was something like 116. I had been recommended for gifted programs but never enrolled. A little background - I had switched schools something like 11 or 12 times in my childhood and typically due to traumatic events, including being in foster care. I know without a shadow of a doubt that my husband is also very intelligent but he struggled with ADHD and was told he was lazy and unfocused in school and also had his own drama filled childhood.

    So, basically, we feel like we're flying blindfolded half the time. We are trying to do the best we can with what we know but we don't necessarily know what the best things are to move forward.

    We know that we would need to consider an educational psychologist at some point for additional testing. How do you pick one? If I'm right about the ADHD and dysgraphia struggles, from my understanding, we would need to find one that specializes in 2e testing, correct?

    Are there any other professionals that can administer that kind of testing? Is there a website that easily breaks down the differences between each kind of test so we know what might be best?

    Any other thoughts would also be appreciated as well! Thanks for reading. :-)

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    #246433 - 12/07/19 04:09 PM Re: A Bit Overwhelmed - Just Starting Out [Re: sciona]
    aeh Offline
    Member

    Registered: 04/26/14
    Posts: 3506
    Welcome!

    Before I respond to any of your actual questions, I need to say that you and your spouse have already demonstrated a tremendous amount of success and resiliency, both personally and as parents.

    Specifically with regard to parenting, your experiment with accommodations was both thoughtful and intuitively perceptive. I think you can trust yourself a bit more.

    In terms of making healthy choices for accommodations, my general approach has been to think carefully about the learning objective for any given task, and accommodate anything that interferes with accurate assessment of performance level in the target skill, and then to work on focused skill remediation of any deficit areas separately. For example, one of mine also has dysgraphic qualities, but is strong in math. In homeschooling, I scribed all math all the way through algebra I, and even (on particularly stressful or enervating days) sporadically in geometry and algebra II. History and science were nearly 100% oral and activity-based until middle school. In parallel, we worked on each of handwriting, spelling, and written expression. Each of, in that spelling and written expression were, at various times, addressed without using handwriting. I think of this as decoupling the various aspects of academic tasks into their component skills. It allowed for instruction to match the degree of asynchrony experienced by our child, so that, in any given year, instruction might easily range from two years behind in spelling, to one year behind in writing, to on grade level in history, to a year ahead in science, to four years ahead in math.

    As to evaluation: Yes, ideally you would want someone skilled in twice exceptionality. In reality, there may not be such a person accessible to you in your area. You have several options for acquiring some basic evaluative data.

    1. Request an evaluation for special education eligibility from your local public school district. Despite his above-grade level performance in some areas, you do have evidence of a suspected disability, which obligates the district under federal child-find provisions to at least consider an evaluation at district expense. This evaluator would likely be a CAGS or EdS-level or doctoral-level school psychologist.

    The pros are that this would cost you nothing financially beyond your current tax burden, and, should you ever choose to reenter the district schools, they would be more likely to accept and respond to any findings from the evaluation. You also might find that the district in which you reside has interpreted their FAPE obligations to include offering some level of special education support even to private- or home- schooled students.

    The cons are that their recommendations and orientation are likely to be more narrowly focused on the public school, classroom-based setting, including the profile and services available in the district. The quality and clinical skill of the evaluator may also be somewhat unpredictable. Families on this forum have had experiences running the entire range of quality with school-based evaluations. (To be fair, this can be the case even with clinic-based doctoral-level evaluations. I have certainly seen some pretty shoddy work from board-certified neuropsychologists. Of course, as frequenters of this forum know, I have a little bit of personal bias toward school-based clinicians!)

    2. Request a referral for a clinic-based evaluation through your primary care health care provider. If approved, your insurance will probably pay for at least part of the cognitive, emotional, and executive functioning aspects of the eval, and, rarely, very light academic screening, but not an in-depth academic achievement evaluation. This evaluator would likely be nominally a doctoral-level clinical, counseling or school psychologist (with or without board-certification in neuropsychology), however, in a hospital-based eval, while a doctoral-level psych will sign off on the evaluation report, the actual examiner will almost certainly be a master's level or predoctoral clinician working under their supervision.

    The pros are that clinic-based evals tend to be better coordinated with other medical providers, in the event that there are additional medical evaluations or questions in play. You also have more control over the focus of the evaluation, since you are the client, which can include asking specifically about implications for how you homeschool, as well as impacts of his profile on other important life functions outside of schooling. Hospitals generally have access to the widest range (read, most expensive) of assessment instruments out of the various evaluation options, including some of the computer-based direct assessments of ADHD-related symptoms. With the number of other professionals looking over their shoulders, quality tends to be most consistent here. Depending on your insurance, you may pay anywhere between nothing (or nominal co-pay), and a hefty percentage of co-insurance.

    Cons are that (depending on your insurance) there will almost certainly be no quality quantitative data on his actual academic achievement; everything discussed educationally will be speculative. Which is not to say useless, but just not based on actual performance.

    3. Private pay for an evaluation. As in a hospital, the evaluator will be a doctoral-level clinical, counseling or school psychologist, with or without board-certification in neuropsychology. Unlike in a hospital-based eval, the undersigned evaluator will most likely be the actual examiner. It is not unheard of for insurance to pay for part of this, but most likely, you will be spending somewhere between $2000 and $7000 out-of-pocket (depending on your market).

    Pros: this is probably the most likely avenue to a 2e specialist (although highly-skilled evaluators with 2e expertise exist in the other two settings too). You have complete control over the direction and focus of the evaluation, and can choose who has access to the resulting data.

    Cons: quality and resources can be highly variable across private practice professionals. Some of the best evals of the thousands I've read or written have come from this category, but some of the worst have too (including using very outdated instruments, mis-scoring or misinterpretation, and basing sweeping diagnostic findings and recommendations on deeply flawed assessment data). As with finding vendors for so many other services, you'll want to do your research, and ask for references and recommendations from more experienced members of the parenting and educational community.

    You probably shouldn't need to walk into an intake session with your evaluation professional with a list of specific instruments. If you have a good clinician, they'll know what to do, and will have their own ideas about the best approach to answering your referral question. If they actually need your list, then you should walk right back out again, and find someone else. But if what you're asking is what kinds of tests you might expect in your DC's case, then:

    a. cognitive/intellectual assessment: for your DC's age group, this will probably be a WISC-V, KABC-II NU, DAS-II, or SB5. These are all solid cognitive assessment (aka IQ) instruments. You only need one of them. The WISC has one of the most current (which usually equals best) norms, with the KABC-II having been recently re-normed (hence NU, for normative update), but not revised in content. Some evals will use the WJIV COG, which is also current, but that is almost exclusively offered only in schools. This aspect of the assessment should give some sense of learning preferences and the kind of learning style diversity represented by your own early OLSAT data.

    b. executive function: likely including sustained attention, inhibition/impulsivity, cognitive shift (switching), self-regulation (emotional, behavioral, cognitive), planning/organization. This is where the suspected ADHD is most likely to show itself. Or where you may find that criteria for ADHD are not met, but some EF deficits still are identified. There are quite a few possible instruments in this category, many of them depending on whether you go the hospital, clinic, or school route. But it will probably include indirect measures, such as rating scales (BASC, BRIEF, CBCL, Conners, ASEBA/Achenbach), and direct measures (DKEFS, NEPSY, RCFT, WRAML, CVLT, WCST, TOVA, IVA, CCPT). A hospital-based evaluator is most likely to have access to all or most of the direct measures, although some private practice and school-based practitioners will have a subset of them. Evaluators will select a few as the base battery, and likely add as it seems called for.

    c. academic achievement: norm-referenced assessment of reading, writing, math, and possibly oral language skills, in comparison to age peers. Typical instruments include the WIAT-III, KTEA-3, WJIV ACH, which are comprehensive batteries, and then supplementals, like the KeyMath3, TOWL-4 (writing, age 9+)), GORT-5 (reading), or TORC-4 (reading). Measures of phonological processing (relevant especially for suspected dyslexia/dysgraphia) can be placed in this category, too (although they fit in others as well), including the CTOPP-2 and FAR. For dysgraphia, I like the PAL-II, despite its age.

    d. depending on the referral questions and intake interview, social-emotional or social communication assessments: These would be relevant if an emotional (e.g., anxiety, depression) concern or developmental social disorder (e.g., autism, social communication disorder) were suspected. I can detail these if you find them to be relevant. So far, you haven't indicated so.

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    #246435 - 12/07/19 06:09 PM Re: A Bit Overwhelmed - Just Starting Out [Re: sciona]
    Portia Offline
    Member

    Registered: 03/17/13
    Posts: 1776
    Welcome!

    You are doing a great job! You are asking the right questions. Aeh gave excellent advice (as he is prone to do). I sent you a PM which can be found by clicking on the blinking envelop next to "My Stuff" on the toolbar.

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