Gifted Issues Discussion homepage Forums Twice Exceptional Updated again: no CAPD

(see last post for update)

I know--ridiculous, right?

Actually, I still think she's spectrumy! But now we have had THREE professionals dismiss this concern (one when she was three, two recently...but she's still never been formally assessed....I think I probably need to ask again, but they were so dimissive of the idea at our last appointment!) To many professionals, she apparently just does not "read" spectrumy.

Anyway, this ADHD/auditory thing not my suggestion/suspicion, but DD's teacher. Here are the concerns she mentioned:

--DD seems spaced out in class a lot (yet gets 100s on everything)
--After an assignment is explained to the class, DD will ask to have it explained again to her individually (yet when pressed she does actually seem to understand--I read this as anxiety/need for reassurance, not a listening problem)
--DD has difficulty following fast-paced large group situations (whether this is peers or an adult-led situation--something about it seems to fluster her)
--DD sometimes seems not to hear what others are saying to her or to be in her own world (but her teacher does not think this is actually a hearing issue)
--DD sometimes takes a long time to complete assignments, though this is largely because she is doing beyond-exemplary work

This is not the first time we have heard "spacey" about DD at school. Honestly, I have brushed it off because at home I would never describe her this way (and also because she always gets perfect grades, so who cares, YK? She's obviously listening "enough" and who can blame her if she's vacationing in her head a little?) Oppositional, yes. Not on-task, often. Spacey? Not so much. So maybe it's a noise issue? A boredom issue? Or maybe we are looking at an auditory thing or an attention thing? I looked at ADHD-inattentive again and I just don't see it. She completes her work, she has a great attention span (not just for things of interest) and she is pretty organized. She is and always has been the kid who is sitting there completing the craft project to perfection when all the rest of the kids have moved on.

There is some medical background. She had repeated ear infections, hearing loss, and ear tubes as a toddler. She had a hearing test lately at her ped. She passed, but it was odd. The nurse said the equipment was new and both she and DD seemed confused and bewildered. DD kept not being sure when to raise her hand. I wondered if DD was sort of tanking it and the nurse was writing it off to equipment.

ETA that IIRC, the hearing loss was considered resolved after ear tube placement. She was followed by an ENT for a while and eventually discharged. She did have professional hearing tests at that time...a number. Man, my memory is terrible.

It sounds like a proper hearing test is in order. Go to a real audiologist who understands the equipment!

When I had concerns for DS, I called the local Speech and Hearing center and got an appointment within the week. The audiologist was aware of auditory processing disorders and she was able to screen for that as well.

hmmmm...


"The National Institute on Deafness and Other Communication Disorders[55] state that children with Auditory Processing Disorder often:

have trouble paying attention to and remembering information presented orally, and may cope better with visually acquired information--I don't know; maybe?
have problems carrying out multi-step directions given orally; need to hear only one direction at a time--possibly; actually, maybe yes; this is a weak area
have poor listening skills--possibly
need more time to process information---possibly
have low academic performance---no
have behavior problems--in some situations
have language difficulties (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language)--definitely not
have difficulty with reading, comprehension, spelling, and vocabulary--absolutely not; areas of very high performance

"Using a telephone can be problematic for someone with auditory processing disorder, in comparison with someone with normal auditory processing, due to low quality audio, poor signal, intermittent sounds and the chopping of words"--YES. DD has a hard time on the phone. I have always wondered what the deal is with this.

What type of professionals have dismissed ASD? If the brush-offs are coming from people you need referrals from (like your pediatrician?) If you are having on-going concerns about this, I'd put together your list of concerns, as well as some info if you can find it addressing how ASD may present differently in girls than in boys (and how it may present differently in gifted children), and ask once again for a referral to a developmental pediatrician or a neuropscyhologist (I am not sure which type of professional you would see for an ASD diagnosis for a child your dd's age).


Each of the items on this list can also be a symptom of numerous other types of challenges... plus when a child has one type of challenge they usually don't fit a "yes" neatly on all the potential symptoms associated with that one challenge - hence making parent diagnosis from internet lists not terribly reliable

You've been looking for a reason to fit your dd, and doing a ton of research and thinking about it - but ultimately (jmo) I think a look by a professional is what you need to help put the pieces of the puzzle together in a meaningful way, rather than grasping at "it could be this" based on you trying to read as much as you can and make a stab at a diagnosis and then looking at a narrow evaluation just to rule out that diagnosis. I don't think your dd has been seen by a neuropsychologist yet (?) and if she hasn't, I'd seriously consider it (or the developmental ped).

A thorough exam by an audiologist who can assess for CAPD may also be worthwhile and can't hurt - but I would put a priority on a more comprehensive basic evaluation first.

polarbear

DD was evaluated by Early Intervention at 3, and they said no ASD, based on her having good social skills, good give and take in conversation. She was seen by two psychiatrists last week, ostensibly for an anxiety/depression work-up since they had no openings for an ASD eval till winter. However, they knew we had asked for an ASD eval, so they asked a number of questions related to that and also, I guess, gave their "impression." It was not as thorough for ASD as it could be, no. However, I asked them to cast a broad net, and it was a 3-hour appointment...pretty extensive.

BTW, this is a big and hotsy-totsy university psychiatric practice with a side specialty in ASD. I was specifically referred to this group by a local autism clearinghouse when I asked for someplace that would be good for gifted ASD girls. But I don't know if these particular psychs do ASD evals themselves--I should look that up. I feel like I am starting to look sort of like autism Munchausen parent at this point, which is weird because I don't get why other people don't see it, really. DH says I may have ASD-tinted glasses on and thus am seeing all anxiety and behavioral issues this way. One of the psychs also said this--"Sometimes these anxious kids can look sort of ASD in some ways, but professionally we see differences in the way the groups converse and interact." (Does that ring a bell for anyone? Basically, I think what she was trying to say was that anxious kids also may act odd/"off", but that there is a typicalness to anxious kids' social and interpersonal interactions that she discerned but that I might not be able to. But this seems to be relying on a sort of "gestalt" view of ASD and I know many here really dislike that kind of "diagnosis.")

Where we're at the three year old evaluation is done by the school district - my dd10 went through that evaluation, and just one experience in one place... but my gut feeling was that there was a large push on the part of the people doing the evaluation to *not* qualify children for services. It also is not an evaluation which would have led to a diagnosis, but instead to services for specific needs - i.e., if the child needed help with social skills and qualified, they would get that help, but they would not get a diagnosis of ASD or whatever from the evaluation (note - this may be very different in other areas!).

Neuropsychologist appointments have typically taken us around 6+ hours (for the child) as well as 1+ hour parent interviews before-hand and included testing beyond ability vs achievement. It's just my gut feeling that from the different issues you've pondered here on the boards that a complete neuropsych evaluation would be helpful in understanding what's up with your dd.

Gotta run - this may not make sense, my kids are talking to me at the same time I'm posting!

polarbear

I wouldn't let anybody rule ASD in/out without some live observation of her interaction with peers, especially not a gifted girl.

The school psychologist (who worked really hard not to find any issues) ruled out the need for the ADOS for DS8 because, one-on-one with her (an adult he wanted to please) he had good eye contact and was chatty (she asked him about his areas of interest!).

I periodically run through the DSM-IV criteria (and now the DSM-V), and I did long before DS8 was diagnosed. I never saw it in there, but my idea of what "normal" is... clearly isn't.

When evaluated by the private specialist we were in the middle of preparing for the science fair and working on one of his favorite subjects. He turned every single question she had back to that. Was it textbook ASD? She said so. Was it typical behavior? Not really, because he *usually* doesn't get *that* intense unless really encouraged. Was is significant? Probably.

Unlike you I went to the evaluation to get AS ruled out. Ah ah...

But the most damning evidence came from classroom observations.
Parent/teacher questionnaires will only take you so far (especially if the parent is me, who finds a 3 or even 5 point scale completely inadequate to judge anything and always tend to skew to the middle).

His... differences are much more obvious when thrown in the middle of a group of age peers. If he is at the center of adult attention, he shines. With peers... not so much, especially if the environment is unstructured. But if he was more shy and less eager to interact with other kids (or socialized to be more socially passive, as girls often are) a lot of his difficulties could be missed.

Hi Ultra,

The workup for hearing and auditory processing disorder is a very good idea.

If you want to rule ASD in/out, get someone (preferably someone with lots of experience with ASDs) to give the ADOS, the NEPSY, the PDDBI, and the Vineland.

I just posted this on another thread, but it may be handy for you to have it here. When my DS was diagnosed with AS at 5, these are the tests they used. I starred the ones that seem like they were important to us in understanding the AS.

Stanford Binet 5 (cognitive)
Woodcock Johnson III (academic achievement)
WIAT-II Word Fluency (academic achievement supplement)
Children's Memory Scale (memory)
VMI-V (visual-motor integration)
** NEPSY Social Perception (social awareness/understanding)
** ADOS (autism diagnostic observation schedule)
** Vineland (adaptive behavior - parent report)
** PDDBI (ASD characteristics - parent report)
**CBCL- TRF (general behavior - parent/teacher report)
** PLSI (pragmatic language - teacher report)

FWIW, my DS was dismissed as not possibly having ASD for some years after we first suspected. We had to find a real expert (autism clinic at a children's hospital) to get a dx. And he's a pretty classic case in many ways-- but giftedness does complicate the diagnostic picture.

HTH,
DeeDee