Apologies for the length – the more assessments we get, the more confused I am about what’s going on and how to proceed.
DS7.5 tested HG+ at age 6 on the WISC (GAI 148, full scores
here) with a 41-percentile gap between VCI/PRI and processing speed. On the advice of polarbear and others here we followed up with the tester, who felt the gap was not significant, merely an effect of his tuning out at the end of the test. We kept an eye on DS and when last spring he became increasingly anxious, particularly at school despite a sweetheart teacher and low-demand curriculum, we began probing deeper as well as starting therapy for the anxiety.
We spoke to his sister’s neurologist, who ordered an EEG (normal) and an audiology screening (significant figure-ground and attentional difficulties) and diagnosed ADHD. Given his WISC scores and anxiety, she said we should on no account consider medication; rather start Fast ForWord for the auditory issues, start lifestyle interventions (Omega-3s, protein, martial arts, etc.), get him happier in school and see her in November. All of that has been on target; we are seeing good results from Fast ForWord, from the lifestyle changes, and from increasing structure and reducing stress in our home.
At about the same time, DS’s therapist recommended a full neuropsych screening with his partner. He initially felt that DS was exhibiting “ADHD-like behaviors fueled by anxiety” and mitigating the anxiety would reduce the behaviors. DS scored high for anxiety on the intake questionnaires, no other conditions.
Unfortunately, DS and the neuropsych disliked each other on sight; I literally felt him stiffen when she opened the door. The first half of the first session (the Woodcock-Johnson Test of Achievement) was nigh-disastrous, with (I learned later) his answers scornfully given while standing up surfing on her office chair, or leaping from her desk to her couch. When that didn’t irritate her enough he apparently started licking things in her office. While we still don’t have the report, he put up scores in the 83rd-98th percentiles; nothing that would let us apply for DYS, unfortunately. She brought him out after 45 minutes, I reset his attitude (one cheese stick, one run around the building), and they completed the rest of the session and the second session more successfully. She decided she did not need a third session or a repeat of intelligence testing to complete her assessment.
At our post-testing meeting, the neuropsych told us he was incredibly defiant, extremely oppositional, highly rigid and on the brink of school refusal, and that we should be prepared to meet with the district behavioralist in the next few days to work out a plan. (This has not happened; it has been a month and our single behavioral issue has been his muttering “that sucks” when the whiteboard broke down.) That he absolutely needs private school intellectually, but “they wouldn’t keep him a week.” That he is showing severe ADHD symptoms, this is unquestionably the umbrella issue and we should immediately see a psychiatrist about medication. That he also has a severe fine-motor deficiency and we should immediately consult the OT to whom she refers. His low WISC score was coding (8) which does seem to fit; she sees no other signs of a processing speed issue and says the fine motor deficit explains it fully. To my eye his writing is slow, awkward, and at the low end of normal among his peers, though he has repeatedly said it doesn’t hurt when questioned.
This week we saw her recommended OT -- who says he does not have a fine-motor deficiency at all, nor does he have ADHD, so we should certainly not medicate. She feels he has a visual-motor integration issue plus sensory-seeking behavior, and after 4-6 months of twice-weekly sessions to make him more comfortable in his own skin, the ADHD-like symptoms will be mitigated and they will release him to the developmental optometrist they work with for likely vision therapy. I am having a hard time understanding how this could so differ from the neuropsych’s assessment the previous month; on the other hand, the OT did achieve a much better rapport with DS. We are going ahead with OT next week, as well as finishing up Fast ForWord.
OT also suggested we begin the intake process with her sleep consultant and nutritional consultant. I cannot see bringing in yet more specialists at this point to muddy the waters. We’re already overflowing with diagnoses and recommendations, none of which agree.
Meanwhile, after several attempts to refocus the therapist, and several diagnosis-of-the-week guesses from him (ADHD! defiance! social skills! victim of bullying! needs prizes from the dollar store as an incentive!), we are ending our sessions with him. When I sat in last week at his request, it became clear that after four months, he has no respect from or authority with DS and many of the oppositional behaviors that so alarmed the neuropsych (especially leaping around on the furniture) were permitted or encouraged in their therapy sessions.
As we drag DS through all these assessments, we are lucky that his second-grade teacher is excellent (both rigorous and creative) and he is doing quite well, if not to the level his WISC scores might suggest. Above average, but not noteworthy. He skips out at the end of the day, is creating comic books “instead of writing” in Writer’s Workshop, and has several close friends and a large pack of buddies. When I volunteer in the school he seems happy and well-behaved, and the anxiety seems to be significantly reduced. Still, he complains that school is boring and there are some tears around homework. There is no gifted program or tracking before middle school so any accommodations will have to be individually negotiated. At home, he is happy, loving, and cheerful as long as not pushed outside his comfort zone. We still see unexpected explosions once or twice a week, but we seem to be on a clear upward trend.
While we are not opposed to medication, the gap between the professionals saying “on no account medicate” and “medicate immediately” is troubling; every expert seems to be sure their issue is the foundational one and must be addressed posthaste.
We are waiting for the full neuropsych report and then her letter to the school to initiate the 504 process. I would like to build in intellectual differentiation (she suggested math) as well as fine motor, auditory, and any other necessary accommodations. But it is feeling like there are too many potential issues to address simultaneously without driving the poor kid crazy. Where would you start?
