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

Bumping for more input on CAPD if anyone here has it. An open-ended discussion with DD yielded the following info...she says she has trouble with:

--following a conversation when more than one person is talking at once
--remembering oral multi-step directions
--paying attention to a quieter voice when other voices are around her

She volunteered this info--I did not solicit it. That is pretty CAPD-ish, huh? She denies having trouble actually hearing, though of course, she may not know that she does, since she used to living in that body. She has a long history of serious middle ear infections in toddlerhood and had ear tubes.

The thing that doesn't fit is that she has no reading issues, no spelling issues, nada. So my question is whether that would be typical in a gifted kid with CAPD or whether that would pretty much always go along with it. I'll look into the screening for sure. She's going to start OT soon and they have audiology and so on on staff there so it should be easy. The testing looks nice and concrete.

She IS a "Huh?" kid. She's also a kid who looks bewildered a fair bit. Sort of a "Why is this confusing to you?" sort of character, since you know she's smart. It's always fairly easy to get her set straight, so it's never really that big a deal, but. She is also very literal and tends to miss some nuance in conversation at times, or to be slightly "behind."

The two things that are red flags to me in identifying clients who need screened for CAPD: 1) The Huh Kid (as you have described)...sometimes it feels as if I'm speaking a foreign language to them. I see them trying to figure out what I've said, but it doesn't compute. 2) Kids who mix up similar sounding words either speaking or hearing. I find this more often with brighter kids with a large vocabulary. "The Blank Look" is common...and the kids I've seen never complain about hearing issues....they just tell me they don't understand. Public schools have a simple CAPD screening tool they can give. But I usually suggest an audiologist who will give a very thorough hearing test initially to rule out normal hearing issues before giving the more advanced CAPD tests.

I have never noticed that she mixes up words at all. No issues with phonics. Self-taught reader. Flawless and fast. Very precocious verbally, in fact, as a toddler. So that part doesn't fit. But, although she has always talked a lot, she would still miss things. It wasn't that she wasn't reciprocal in conversation, but she does need to have things repeated, and always has. She gets called "spacey" by teachers and instructors. Other children complain that she doesn't seem to hear them or is in her own world. At home I'm afraid we tend to read this more as defiant/intentionally ignoring or oppositional, which it may be--or not. Her teacher brought up inattentive ADD as well (I guess I said this upthread) but we generally have no problems with completion of work. In fact, written work is almost always excellent.

Boy, she is a puzzle.

You know... A simple hearing test might be a good place to start. They're almost always covered by insurance. If you go to an audiology clinic, you'll have a foot in the door for CAPD testing if they recommend. I would bark up this tree before any ADHD talk.

DS14 has been diagnosed with CAPD. He cannot follow multiple people talking at once, needs to have things explained to him again in class, has real trouble understanding accents and has trouble hearing in gyms or swimming pools because the sound bounces around. He has that "Huh" look on his face in social situations because the talk flies by so fast. He had lots of ear infections when he was young.

In my opinion, people with CAPD often have anxiety because they get teased about being confused, and may look spectrummy even if they are not. Of course, you can have CAPD and be on the spectrum. My son has excellent theory of mind, but avoids social situations if he doesn't know the people. He has good give and take in conversation if he is comfortable with people.

He had his hearing tested by an audiologist with special training in auditory processing. He is on the 5th percentile for hearing in noise. The last few years he used an FM system (microphone for the teacher and earphones for him) to listen in class. This year, he hardly used them due to logistical problems in a large high school. Hopefully next year, it will be easier to get the FM system before class.

To me, your daughter sounds like she has some CAPD issues. My son also has dyslexia, so spelling is creative and phonics are still shaky, but he reads well (silently) and has excellenet comprehension. There are 4 types of CAPD, if you want to research it further.

Ultra, I know nothing about CAPD. But I will also say that you can often see this "huh" quality in people on the autism spectrum. They are so deep in what's in their own heads that they don't come out of that fast enough to listen to what you're saying (that is, a listening, not a hearing problem). We do spend a lot of time repeating/clarifying directions around here.

I hope you can sic your professionals on sorting this out.
DeeDee

My son has CAPD and is hearing impaired. Even with an excellent hearing aid, he still misses things in class or even at home. For example, in our house (which is quiet) with the hearing aid on, he was watching the Disney Channel. He said, "I can't believe they are saying bad words!" (What bad words?). He said, "They keep saying "hell, hell, hell."" Actually, they were saying "Help, help, help."
On the other hand, he reads 2-3 grade levels above, strong phonics (but we did 5 years of a phonics workbook series in 3 years), etc.
You can try to make sure she always sits in the front row (preferential seating). That is in my son's IEP. FM system can help. Ask teacher for their notes to photocopy or get a friend's notes, etc. There are ways to compensate.
I've just accepted that my son with hearing loss and CAPD will always miss spoken things, but my hope is that he is just so bright and can compensate in other ways that it will hopefully not ultimately matter.
How many teens miss things because they are spacey or are on their I-phone, etc? I always tell my son, you will have to work harder than the other kids just to keep up.

As I say, fortunately, this one should be an easy one to get tested through people we are already referred to (though not yet set up with).

Deedee, I got a chance to talk to her teacher about ASD concerns (we'd touched on it before but very briefly). I actually trust her almost as much as a professional, considering she has a number of years at a gifted magnet under her belt and has seen a number of gifted ASD kids. She also said that DD does not present as ASD in her opinion, in particular mentioning that she is socially well-liked--but she agrees that "something is there." She says, in fact, that she has spent the school year trying to figure out what it is, but still isn't sure what. In a way, it's comforting to know that this very experienced teacher (20+ years) finds DD as baffling as I do!

Update:

DD is in week 2 of 3rd grade. Here is a first: she has expressed to both me and her teacher that she is having difficulty hearing the teacher speak in the classroom. Her desk was towards the back and has been moved. (However, last year they moved desks all the time so it's not like this was just something that cropped up due to desk placement.) I don't know if this teacher has a soft voice or something. I also wonder if DD was simply not paying attention and said "I couldn't hear you" as an excuse, but I don't want to be too dismissive. Her teacher seemed to believe her; when I contacted her, she said she had already put a message through to the school to see about testing. As explained above, we also have wondered about CAPD--this has also been discussed with the teacher prior to school starting.

What should I be asking to have done?

Is it better to go through the school or our insurance?

ETA: this summer has clarified some things for me. DD had a very socially successful summer. She had an amazingly great time at sleepaway camp and made numerous new friends. She got a lot of calls for playdates and was very socially active; in fact, other kids seem to be seeking her out a lot. There's just no way you can say that this kid is having problems making friends or is socially isolated, though she also has a strong personality and is not always liked by other kids with strong personalities. So this really big piece of the puzzle for ASD just isn't there. We continue to see major emotional lability, though. I am more and more thinking that the depression diagnosis is the correct one.

We took my son to the audiologist for his regular exam right before school started. We had bought a new hearing aid in March, but she couldn't program it to the highest level since he said it was "too loud." This time, she was able to do that, which increased it by 20%.
He says he's hearing well in the classroom, even though there are 34 kids in the class. He's alot more focused also (although he's now in the full-time gifted program so maybe he's not as bored). We have opted not to use the FM system this year since our school also has a Surround Sound or overhead mike system.
The audiologists and psychologists we have seen said that the auditory part of the brain keeps developing throughout puberty. They think his CAPD will get better! He's in his third year of piano lessons and will start the string orchestra this year.
I definitely think music lessons help CAPD alot. That is something to think about if you think your daughter has CAPD.

What is the FM system? Do most schools have this? DD is just in elementary in a Title 1 school. Her class has only 18 kids, so is not too big.

Do you see a fancy audiologist or will just about any audiologist be able to diagnose this? DD has a history with an audiologist back from when she had ear tubes and hearing loss as a toddler. I could just call them up and get started with this, but it will cost us, since we have a high specialist deductible. Again, just wondering whether private doctors or school people are better here--maybe the school prefers "their" people? (Sheesh, I am so clueless about this 2E thing!)

We took our son to a specialized audiologist who had a PhD also to do detailed CAPD testing. It was in the soundproof room and it cost $1500. CAPD testing is difficult to do, and only a few specialized people are trained to do it (this is what I've learned). However, it was really worth it for us since my son is extremely verbal (WISC verbal IQ 144) but he has CAPD. It got him the IEP. The school did their testing for CAPD by reading him a story in a quiet carpeted room while the speech therapist clapped her hands! She said he didn't have CAPD.
An FM system is a device where the teacher wears a microphone and it transmits her voice wirelessly into my son's hearing aid. Or it can transmit to a small speaker on the child's desk. We get this free through the IEP. The school district buys it for him (it costs $1000 or so).
His school also has a Surround Sound in every room, unrelated to the IEP. The teacher wears a microphone and it transmits her voice a bit louder into an overhead speaker in each classroom.
For him, we finally figured out that the combination of the FM, hearing aid, and Surround Sound was too much amplication. He said sometimes the teacher wore her keys around her neck and he heard it clanking against the microphone!
I do think music lessons has helped retrain his brain- is that something you can try? He had lots and lots of ear infections as a baby, which is also how he became deaf in one ear (despite 4 surgeries to help all of that, grrrrr)

Oh yikes, $1500. Oh double yikes, "reading him a story in a quiet carpeted room while the speech therapist clapped her hands!" Yeah, DD's verbal IQ is around 140 or so.

UM, we aren't dealing with CAPD, but fwiw we have a friend who's dd has hearing loss and her teachers use the FM system in her classrooms. When you're advocating for your dd, if you have a documented need for something like an FM system, the school can't tell you they can't provide it because they don't have it at your dd's school - chances are good there is an FM system available in your school *district* and the school can get one and should be responsible for also training your dd's teachers how to use it.

The thing we've found is key in advocating for our 2e ds is being able to prove their is a need, and that the accommodation we're requesting is a typical accommodation for that special need (from what little I know about hearing, my understanding is the FM system is a typical accommodation). There are two routes to proving your child needs the accommodation - private professionals vs school testing. Sadly many of us have had the experience of school staff not offering up the correct set of tests, and also sometimes having a bias to show that kids don't need services or accommodations. That's why it's often helpful to have a private evaluation - the evaluation is almost always more thorough, you know the professional who is evaluating your child has the credentials that are needed depending on the child's challenges, and with a private professional you have a chance to ask questions that are relevant without worrying about bias influencing their answers. I apologize to any list members who are school staff who are reading this and think I am biased against school staff - I am not, really not. That's just been our very honest experience in our one school district, and it's an experience shared by friends of mine in other districts.

If you need to start with the school for an eval because you can't afford a private eval, absolutely start there. The school district is supposed to provide the evaluation, and you can request up front the type of testing your child needs. The school can state in return that your child doesn't need that testing, but they have to have a valid reason to disagree with your request.

One thing that really *really* helped us tremendously in advocating for our ds was having an advocate we could bounce questions off of - not just technical questions, but questions about our local school. For instance, if we were you, I could call up my advocate and ask for her honest opinion re would the school do an adequate series of tests, or would they try to get by with a bare minimum or try to fight our request for accommodations etc. Our advocate was able to advise on things like that, and then in turn give us the language we needed *locally* to make successful requests of the school.

Hang in there,

polarbear

Ultramarina, your daughter has enough symptoms of CAPD to make it worth investigating further. She is managing well--but what if life could be so much easier and less confusing?! Also, I agree with DMA that children with CAPD often have anxiety.

We just went through a CAPD diagnosis. The steps were:

1. See a local audiologist to rule out hearing loss. A standard hearing test should be covered by your insurance. Your local audiologist can give a regular hearing test (sorry, I don't remember if you said you'd done this recently). CAPD and hearing loss can present similarly in some ways, so it is important to rule out hearing loss. The Drs. Eide recommended this step (I think in the chapter "What? Huh? Auditory Problems in Children" in their book The Mislabeled Child). If the neighborhood audiologist rules out hearing loss, proceed to next step.

2. Get an assessment for Auditory Processing Disorder. This is a relatively new field and only some specialists will be able to do this testing. We paid about $600 for a comprehensive assessment. It was about 1.5 hours of testing (and then we met with the doctor for another 1-2 hours), so the whole thing took a morning. You may be lucky enough to live near such a specialist.

The results were incredibly helpful for us. There is a lot that can be done to make life less frustrating for the kid (and the whole family)!

One result of a CAPD diagnosis would be specific accommodations in school. These may include where your DD sits in the room, an FM system, and/or taking tests in a quiet environment.

Sorry, I don't know about school testing.

Good luck!

We have a large research university hospital near us that says they offer CAPD testing. Is there anything in particular I should be looking for?

They should do the CAPD testing in the soundproof room. For my son, they did things to look for a temporal processing disorder. So in the soundproof room, he wore headphones and they would present words or a series of clicks separate in time, and he had to respond to them. That was a small part of the test.
Shockingly to me, he did very poorly. He is both hearing impaired and has CAPD.
Hearing well is so vital for children. So far, this year has started off great for my son- maybe because his hearing aid is turned up louder and the extraneous noise (via the FM system) is quieter. He seems to be hearing better.
You would likely need to do private testing to see if your daughter has CAPD, to get those accommodations. Once we did that, we have easily gotten the IEP, and it's been a great experience/helpful for us.

You are lucky to have a local option!

I would want to find an audiologist with some experience with CAPD. Would you be seeing an audiologist with several years of experience, or someone in training/very new to the field?

I would also ask others in your area who have visited this center. Were they happy with their experience? Did the results make sense to them? Did they get a useful written report with recommendations for the parents and school?

Also, a list of audiologists diagnosing CAPD can be found at CAPD-US: http://www.capdsupport.org/Details/102.html Not familiar with this org but this may be one place to start. A few of the places we looked at were indeed on this list. Is the local audiologist listed here? Anyone else on this list local with whom you could compare the teaching hospital?

If you want to know where we went and why, you can PM me.

I talked some more with DD today about her experiences listening and hearing. She expressed that she did not want to take another hearing test (she recently passed one at the ped, but it was a weird experience with a confused nurse who said "This equipment is new and I don't know if it's working right"....DD also seemed confused). Whe I asked why, she said that it's "too hard" and that she can "never tell which sound the ear is in." I thought this was very interesting! Would that be a CAPD thing?

This is my son to a tee... except for the diagnosis.

We had a CAPD assessment at the audiology department of our local hospital. This after DS8 had FIVE normal hearing tests. The assessment was conducted in a soundproof room, took about 2.5 hours, done over two sessions. Because our pediatrician referred us, it was covered by our medical (we're in BC, Canada).

DS8 is SUCH a "huh?" kid... I was SHOCKED AND STUNNED when he passed each segment of the assessment (he was either at or above age level - one section he tested well above age level). He has all the behavior red flags for CAPD as well as having a diagnosis of a language processing disorder (the linguistic portion of CAPD). I'm still shaking my head.

The audiologist said that they can have audio processing delays, and he may be outgrowing his which is why he tested so well. Either that or somehow he's compensating (but how?). Don't know.

In our school district a formal diagnosis of CAPD gets funding to pay for an FM system (so much for that! sigh). Our school principal said that if DS8 didn't get the CAPD qualifying diagnosis that I could pay for the equipment myself if his teacher is willing to use it. I don't know who is grade 3 teacher will be yet and I haven't looked into the costs of the equipment, so that's not in the works at the moment.

jack'smom--no, not since she was about 3. At that age she did have conductive hearing loss as a result of repeated ear infections. I believe it was 40% in one ear at one point. However, after ear tube placement, she was retested and it was considered resolved. She was not retested after that other than this recent test at the ped's, which I really would consider a spoiled test. (How DD, who raised both hands multiple times--"raise the hand on the side where you hear the sound"--could pass is beyond me.)

OK, well that is considered the first important step. She could have hearing loss, which could be "fixed" by a hearing aid. You should get an audiology exam. She is 8 (I think you said), so she is definitely old enough to get an accurate exam. Don't be so sure the 40% loss resolved- at age 3, you really can't get a good hearing test.
I have mentioned before that my son has a 70 dB loss in his right ear (85 dB is "Helen Keller deaf), and that was completely missed 3 years in a row at the pediatrician's. And I'm a doctor.

Question--DD is functioning extremely well in school (all As last year). Does she have to have a proven impairment to get accommodations, or will a CAPD diagnosis be adequate?


Wow! I don't understand this. How are the tests so inaccurate?

We have always taken the approach that we want to get as much information as possible and then decide what to do. We chose to have an audiology exam and when the hearing loss was found, we got our son (who was 6 then) a hearing aid.
If you have a hearing loss, to me, you would want to know and would want to wear a hearing aid. With time, the "CAPD" would likely go away as your brain is retrained and you get better hearing.
Many parents are ashamed to have their kids wear hearing aids- I don't see why, frankly. My son is doing really, really well in school, and we are grateful he has and can wear a hearing aid.

Oh gosh--I would certainly have her wear the hearing aid if she needed one, at least to school! I can see that she might resist, but it seems like a no-brainer. If she has proven hearing loss, that is one thing. My question is more about the CAPD--if that turns out to be the issue (and there is no physical hearing loss), then I am not sure how the school would respond since she has no academic problems. I guess I need to read up on this stuff.

Legally, the CAPD diagnosis is absolutely enough. In practice, you may get pushback from the school, especially if you're asking for anything expensive. Wrightslaw is a good place to go for all the gory details on this.

I'm Googling...found this:


from http://www.lynchburg.edu/Documents/...20Accurate%20Diagnostic%20Procedures.pdf


from http://www.speechlanguagevoice.com/capd

also:

http://www.ldonline.org/xarbb/topic/5534

I realize I am way ahead of myself here...

Here's a nice blog post specifically on legal treatment of CAPD. Be sure to read the comments, too - there's some good BTDT advice.

Well, she passed the school's hearing test with flying colors, according to her. But "all the sounds were in one ear at a time" and "the nurse said I shoudl get a test from a real doctor." Haven't heard anything official from the school. In the meantime, she is really upset because her teacher keeps getting upset with her because she isn't "hearing" what the teacher says when she is absorbed in seatwork or reading. That is, she doesn't hear instructions to put her book away or stop working or move on to something else. She says she can physically hear her but the words just do not connect and she has to be told again or ask to have them repeated. Her teacher is not happy with her. Her work continues to be excellent, but she perceives that she is seen as a behavior problem and I fear she is right. I suspect the school is going to bark up the ADD tree again. I have an email in to the teacher but I guess it's time to go private now.

My Nephew has CAPD. My sister went through several audiologist that were not experienced enough to truely isolate his problem. I recommended that she go to a university which had a PHD program. They were wonderful. It only cost her less than the private practices for an extensive complete evaluation. Whereas, the private practice was more than double and did not provide good documentation. I referred a friend to the same university. Her son is now in a research program and his follow-ups are completely paid for by the university. The university professors have provided excellent support and advocacy for their child in relation to school issues.

As mentioned, you also should get a real hearing test from n audiologist in the sound proof room.

Okay, we're just waiting for the scheduling call from the university folks for CAPD and hearing testing.

DD's teacher says, "I feel that what I'm seeing in class is an attention issue."

It's not the first time it's been hinted at. But I look at inattentive ADD and I just don't see it. I mean, I see a few things, but this is not a child with trouble focusing. She also doesn't lose things much anymore (we had a brief problem with this at the beginning of last year but I can't recall our last lost item) and isn't particularly disorganized. She does, by her own admission, daydream in class, but I think this is her way of compensating for boredom. She has a very active inner fantasy life. I asked her if she ever feels like she has more trouble paying attention than other kids and she looked at me like I had two heads. IMO, she can definitely pay attention quite well. However, it's true that it can be hard to GET her attention if she is absorbed.

Hearing loss looks alot like ADD. If you can't hear what is going on, obviously you will tune out and create your own little fantasy world. My hearing impaired son always played alone and had a vivid fantasy/imaginary friend world in preschool. Gradually, after he got a hearing aid, he became more engaged with other children and school.
He always had a great attention span at home when it was quiet. He could sit for hours and build blocks, or legos, etc.
This year so far (knock wood!) has been great. We shut off his FM system, which linked the teacher's mike into his hearing aid. He said he likes not hearing her keys clinking- I guess sometimes teachers wear their keys around their neck, it would hit the mike,a nd amplify into his head!
They started fourth grade with the 5th grade mathbook, which has been easy for him, but alot of kids are struggling. He does basically all of the work in class but most kids have 30 minutes at home to do. Attention is a skill that can be improved with practice also. He's been doing weekly private piano lessons for 3 years, and that has helped alot too.

Couple of thoughts, Ultra--

1) Glad you are ruling out (or in) the hearing and CAPD issues.

2) ADD and ASD can be confounding. The "lost in own head" or "active fantasy life" elements can be characteristic of ASD; that failure to tune in, or "what?" kind of kid can just have such nice things going on the inner screen that they don't check in with the world. If the hearing/CAPD are ruled out, I would still say to take your DD to a neuropsych who has seen lots of girls with autism and get a really serious workup to figure out the attention and anxiety issues, and parse out what you're dealing with. Knowing can really help.

DeeDee

I'd be far more inclined to believe ASD than ADD, although honestly she is socially so well-liked these days that it doesn't seem a good fit either. Really, I know teachers see things I don't, and I know inattentive ADD is different from ADHD, but I don't see this as an ADD kid. In fact, other people's kids have always seemed unfocused and short on attention compared to her. It took me a while to realize she was the outlier. I mean, she's always been very able to sit and listen to people speaking, or sit and complete things. She sat through a lecture on water pollution issues with me recently that went over an hour--she was the only child present and listened with complete attention, asking me a lot of questions later (actually, she also cried about it later).

Sigh. I'd like to think we're going to get a CAPD dx and that it may help with some things, but even if so, it isn't going to solve everything with this kid.

Yes, if this doesn't turn anything up, we'll go on to more evals. She had a major school-related meltdown this afternoon. She is not meshing well with this teacher and I'd like to rule ADD OUT if we can, because the hinting about it is aggravating me.

Hi Ultra,

Yes, IMO teachers really have NO BUSINESS hinting around about ADD. They should fill out the diagnostic checklists that qualified evaluators ask of them, but they should not snidely tell anybody that their child "should be medicated" or anything of the sort. They are simply not equipped to make that kind of professional judgment; it is not in their training, and they should not take on that role.

I really do listen to teachers, because if they are telling me something is off, it invariably IS-- but the solution is not always what they think it is, and I really want my school team to listen to my private experts to learn about that, as well as deploying their own professional skills.

It may help to tell the hinty teacher in a serious tone, "We are working through these questions with our medical professionals." In a "this is the end of this conversation, thank you" kind of tone.

Long attention can indeed be related to ASD or ADD-- failure to transition from one thing to another. And it can be an asset, not just a liability. Very complex stuff.

Sorry about the school meltdown. I hope things get better soon.

DeeDee

Yes, I did send her an email that basically said something along those lines.

I know there is the "hyperfocus" thing with ADD, but it's not like she has hyperfocus on a few areas of interest. She's just focused. On whatever. Well, homework...homework can be a struggle. But classwork has always been completed on time, for instance. She isn't THE quickest to finish--but her work is superior.

Frankly, I think DD and her teacher are not hitting it off. It happens. DD can be prickly and can start off giving a bad impression, though she is not poorly behaved, per se. She isn't a cute pleaser, although she actually has a huge heart and means well. It sometimes takes adults a while to "get" her and understand how she ticks. Some adults immediately love her, but unfortunately they don't tend to be elementary school teachers. All her past teachers have eventually become fond of her, but this isn't our first rocky start, and with adults who only deal with her superficially, sometimes it never gets better.

Our experience has been that teachers may be quick to think that behavior they don't understand in class may be ADHD simply because there are quite a few kids in our school district who have (genuinely have) ADHD diagnoses so the teachers have seen ADHD before. Things like CAPD and some of the other challenges our 2e kids on this board have may have behaviors associated with them that look like ADHD, but the teachers aren't familiar with those challenges and also are not in palace to make a diagnosis. Our 2e ds' second grade teacher was quick to think ds had ADHD - and suggested it to us without using the term "ADHD".. but it was clear what she thought was up. DS does not have ADHD, but his 2nd grade teacher was absolutely correct in that *something* was up and he desperately needed help and support in the classroom.

I think it's also impossible for us as parents to fully tease out what's up with our kids when they are having challenges like this - we see the child we know at home, we read about intellectually gifted children and their associated quirks, we have knowledge from other parents and from reading and from our general impressions about things like ADHD but we're not trained experts who know who to diagnosis it any more than teachers are, and we find hints of things like CAPD by researching that may fit some of our children's symptoms so we check them out. Following our gut feeling and checking out things that seem to make sense is really important, and you're on the right track with that. The thing is, though, as you said, even if your dd has CAPD it's possible it isn't going to be "the" one thing that explains everything. I apologize for losing track of who's child has had what testing, but this is where I've found that a broad look by a private professional really really helps - either a neuropsych or in your dd's case possibly a developmental pediatrician familiar with ASD and ADHD.

Best wishes,

polarbear

I could have written this paragraph, Polar! Except that the teacher told us point blank that our kid had ADHD and should be medicated (teacher herself had a child with ADHD). In reality, DS did not have ADHD, he had ASD, which often includes unusual behaviors around attention (both long and short attention span).

Her adamance did help us get more support, so it was in the end worth something, however frustrating her misreading of DS's diagnostic situation was at the time. Ultra, I hope you can leverage your teacher's intuition into some support from the school that means something?

DeeDee

I'm sorry your dd is not having an easy fit with her new teacher. That stinks.

Something I have not seen mentioned on this board before is an easy little online 'test' you can do to help see if attention/brain flexibility are causing an issue with learning. Google "Stroop Test" and you will see a lot of versions online. The basic idea of the "Stroop Effect" is that our brain has to draw upon different areas to distinguish different information: words in one area, colors in a different area, OR visual locations or shapes in a different area.

You may get an idea of how well your dd does with this task which requires her to ignore cetain information (the printed color name) vs the requested information (the color of the PRINT of the word).

There are standardized versions of this test pyschologist's use...but when a layperson is trying to find a direction to look such as your dd who doesn't seem inattentive, you may find it's insightful.

Yes, I agree. DD had a workup for depression and anxiety. We also sort of covered ASD...it was a long session. She was not given any actual tests, though we filled out a lot of questionnaires. She was interviewed privately, as were we. They did give her an anxiety and depression dx. My feeling is that the anxiety one may not really be right but that the depression one is correct.

Interestingly, we have seen a lot less of the really distressing behavior at home recently. I have no idea why this would be, since school doesn't seem to be going too well. She has always been kind of on-again, off-again. We will have weeks at a time of relative peace and then things will go south and we see day after day of major problems. We have been doing a bit more behavior management/token economy stuff, which is always a mixed bag with her because she gets so upset when she "fails," but maybe it's helped.


Thanks! Times like this I do wish we had results from a longer IQ test. But I have a very strong suspicion that DD would have a strong processing subtest score, which doesn't seem consistent with ADD. I've mentioned here before that we have played around with online "brain games" that test digit span--she tests very, VERY high in that.

CAPD eval is scheduled for early October. Yay!

I'm paying more attention to ADD-like behaviors. One thing I do see is that DD needs a lot of reminders to stay on task with homework. The hard thing for me is that I don't help any other 8yos with their homework, so I don't know how typical this is, or if she does this in school. I do tend to find her in her room cleaning her fingernails with her pencil, staring into space, etc. (She does her HW in her room because she can NOT do it in the common area with her noisy 4yo brother bouncing around...she definitely needs quiet.) She is NOT hyperactive. She sits still and quiet. But she's not on task. She wastes a lot of time this way.

Well, DD had her CAPD evaluation today and it was very conclusive: no CAPD and no hearing problems. In fact, she blew through the assessment, by all accounts. Because I mentioned that her teacher has been bringing up attention-related concerns, they also administered an attention screener and were attentive (ha ha) to that issue during the 2-hour testing. They said they saw no attention problems at all and "did not have to refocus her even once."

So...well...huh. On to the next specialist, I guess. (sigh)

First, it's great news she doesn't have CAPD or attention issues. On the other hand, I totally commiserate with you on the disappointment of once again not having the answers.

Arggghhh.

She does have anxiey and depression diagnoses. So...she isn't diagnosis-free. (Um, yay?) It may be that we are barking up lots of wrong trees and looking for neurological answers where what we have is a kid whose dual exceptionality is simply and singly emotional.

Of course, they aren't ADD experts and they made that clear. But they were pretty clearly implying "ADD? Is her teacher nuts?" (I don't have a copy of the report yet, but I got the impression she blew the tests out of the water. TBH, it's not at all surprising to me that DD was easily able to concentrate on this novel task with a bunch of very sweet women giving her a lot of positive reinforcement. She said afterwards that it was fun.)

As it has been explained to me (I am not a psychologist), ADD is not the inability to focus, it's the inability to focus when it's not engaging. The inability to choose to do the right thing now to avoid problems later. The inability to choose to stay focused in the face of distraction. Just because my child can focus on reading a book or playing a computer game or tests well 1:1 in an ideal environment with an engaging tester does not mean they do not have ADD...

Ironically enough we have had the opposite problem with DD#2, we felt she had ADD, school thought she was fine. We had her diagnosed, started medication and saw a dramatic improvement in homelife (getting her attention, following instructions, completing tasks, general functioning, homework, ability to respond verbally to people). She herself was clear from the first day that medication made her life easier and she wanted to keep taking the medication and for it to work all day.... It was like a child with bad eyesight seeing clearly for the first time "Wow is this what the world is supposed to be like? Yes I want to wear glasses!". Handwriting improved, writing improved, reading improved. Overnight improvements, some of which disappear again off medication.

But school think we are nuts, because she's well behaved, sits nicely at mat time and looks like she is paying attention, and doing well in school. Not doing well relative to her IQ, but doing great relative to her classmates, particularly given her age and grade skip. All the problems like producing pretty much no work when alone at her desk, being unable to keep track of her possessions, return library books in library lessons (which are always right there in her bag), regularly failing to correct follow instructions the school has dismissed as "age appropriate". In a (very wriggly) boy heavy class she's an ideal specimen and we look crazy for thinking there was a problem.

We feel pretty anxious about putting a small child on serious medication, but I feel more anxious about the long term mental health problems I felt she was at risk of from NOT being able to perform as she was capable of. Depression, anxiety and other serious mental health issues are rife in the family and I could already see her going there.

I'm aware of this--however, while I see why DD would find this testing relatively rewarding, it isn't really THAT interesting. You have to sit there with headphones on and decipher text in one ear while nonsense is played in the other--that kind of thing. It was also 2 hours of sitting in a soundproof room mostly alone and following directions over a headset. I don't know what the attention screener was, but I assume there was some kind of distraction and she had to focus.

This is not to say that I am 100% sure that DD does not have ADD-inattentive. I see some things. I just don't see a LOT of things that match, and the things that do match seem like generalized "child having some problems" (or even "bored kid") issues.

I just want to chime in to say our ADHD-acting DD5 was tested and, in a quiet, focussed testing room without any other stimuli, and with lots of interesting, challenging tests to take, has laser focus. And we are laughed out of the testing office. When she went to the jungle-gym-looking, primary colored, fun house that was the occupational therapist's testing environment, she went berserk and took nearly three one hour sessions to be able to focus on a test that normally takes (other kids with sensory processing disorders) one hour to complete. I have no answers for you, just wanted to sympathize with regard to testing. :-/

Mum of Three - I appreciate your post - I'll think about that for our DD5.

Interesting. I did have to laugh a little when they were telling me how great DD's focus was as she spun back and forth on an office chair next to me. (She was pretty obviously SPD-ish when she was little--now you don't see it nearly as much, as she's learned to rein it in, but girlfriend still can't resist a spinny chair.)

ultramarina - my obviously 2E daughter (not the much more normal HG one mentioned above that has ADD) has a formal DX of CAPD, but only just. She scored 98% on most of the test. And 2% on two sections (the requirement to get a DX). I think even with the two scores at 2% they only diagnosed after I pointed out that she had a 4SD spread and that 2SDs was considered a problem for normal kids. IQ wise she's around the 98th, on a good day, on some subtests. All top or bottom, not much in between, but not an outlier at either end is how this one tests on every measure she's ever had applied to her. So her auditory performance matches her IQ performance, if that makes sense. If she was HG and we tried to get her assessed for CAPD I think we'd have failed because she barely scraped though to a diagnosis as it was and arguable if she's gifted at all, she's definitely got a problem but she's also able to compensate quite well, especially in a test environment. Not suggesting your DD has CAPD. Just suggesting that it's a bugger of a thing to test a gifted child for that mysterious "something" when the measure of a problem is made against normally developing kids.

Oh and the first time we had miss 2E's hearing tested they told us she had spectacular hearing and focus beyond her years and laughed us out of their office. No-one suggested that if she had such perfect hearing, but parents and teachers thought she might be deaf, then we should look at CAPD. Or ADD. Or something.

Hi Ultra,

So where do you go from here? Neuropsych?

I resonate with the previous posts (Mum3, seablue); my older DS (who has AS, not ADHD) can be a whiz at attending in testing environments. He turns it on because he's being assessed. Yet in a classroom, or at home while getting dressed, perhaps not so much.

My feeling is to let the CAPD testers test for CAPD, and turn to a different expert for the assessment for AS, ADHD, etc.

DeeDee

I guess my question is, if these kids can pay razor-sharp attention when being assessed in these environments, then how are we supposed to assess them for ADHD? Furthermore, if they can pay attention so well while being assessed, how serious can the ADHD actually be? Obviously, SOME kids (...many kids) are NOT able to focus while being assessed for ADHD.

My sense is that we have a bad teacher fit this year. It's somewhat surprising that it's taken this long for this to occur. DD is continuing to get good grades anyway, though not as consistent or high as in the past (no big deal; she was previously an A+ student and now she is more of an A- student). I am going to ask to have the school guidance counselor/social worker do a silent observation of her in class. I hear good things about her and I would like another adult's POV.

You can:
--arrange to have her observed at school by the testing professional
--use standardized questionnaires with a variety of adults who come into contact with her (i.e. not just the least-favorite teacher who complains) in a variety of different contexts
--use an expert professional who is used to diagnostic work with 2E kids


My DS doesn't have ADHD but has attention issues from his autism. His capacity for paying attention varies hugely depending on his stress level, his interest in the subject matter, his preoccupation with other things, and his belief that paying attention is worth his while in any given situation (rewards available or not, likely or improbable).

It has been a very serious issue for him, at school and at home, even though it appears intermittent.

DeeDee

This sounds far more like DD than what I read about ADHD.

I think having her observed would probably be essential if we continue with more diagnosis (we may need to give the checkbook a rest for a while).

Just remember, if you get on waiting list for the right professional now, it may still be 6-9 months before you have the actual evaluation. Or not-- it just depends.

DeeDee

Not sure, if this was covered already, but could it be that your DD is gifted? (j/k)

I'm curious if your DD measures way out there on her spatial reasoning (over and above other sub-tests?) Because I have most of the symptoms you've listed and that's the biggest hump on any test I've done. And I know my brain runs very system thinking/spatial. Combined with sensitivity here's how it plays out for me:

There is just too much information when you are hyper-sensitve and over-attenuate. Maybe the baseline stimulation is low, but part of the giftedness is the ability to self-regulate that mechanism and when interested it cranks up. It needs to regulate because "always on" is exhausting. If people are talking about meaningless stuff, then the brain is going to work on something else useful or take a breather. If someone is talking and I am interested, I am 100% paying attention and if stuff interferes that can fluster a bit.

If I'm working on something full on, you have to tap me or call my name a few times (and likely scare the pooh bear outta me.)

Oh yeah, you mentioned the phone, I have an awful time on the phone. There is no spatial context, I seem to need to have people in a place position to make sense. Speaker phone works ok (try that.)

It's possible there is some diagnosis that goes along with this combination, but I haven't felt a need to look for one.

Ha! Yes, it is indeed possible!

Unfortunately, we only have one very short IQ test on her (the RIAS) which really doesn't give very much info and didn't break it down in terms of spatial stuff or anything like that. However, she seems to be an abstract reasoning sort of kid more than anything, I'd say? Very philosophical. She has strong skills in math and reading both. She's also artistic and seems to have acting talent. But I wouldn't say she's super spatial, no. Like, she's not a major puzzle kid or incredibly into building (although she is GOOD at all those things...very well rounded).

Ultramarina - the hyperactive/impulsive ADHD kids are likely to stick out like a sore thumb even 1:1, even if they are still pretty well self-contained/behaved for THEM the tester is STILL likely to see enough to imagine what that kid must be like outside. But the primarily inattentive kids, I would add especially girls, are much harder to pick in a room without distractions, engaged by a person they have good rapport with doing something they find at least moderately engaging.

I don't know about your kids but my kids find IQ tests pretty fun, especially with an engaging tester. My more gifted child even more so, she has come out positively glowing from both her IQ tests.

Some kids with ADHD have patterns in their subtests that show it, not all do. Some kids it really does come down to history taking and observation in situ. I heard an expert talk on ADHD last year who talked about making a mistake early in his career with a girl who tested and interacted beautifully in his rooms, so he declared her to be perfectly fine despite parental concern. The parents/school begged him to come see her at school (a new idea for him back then). He went, and as he was walking down the hall talking to the principle they heard a commotion. When they got to the girl's class she was standing on her desk dancing and flinging her clothes around. This was quite a lightbulb moment for him in terms of believing the history of the parents and teachers that see the kid every day.... I am guessing your daughter is not dancing on tabletops in the classroom, but you get the idea. For some kids it won't be obvious under ideal circumstances, particularly if they are gifted and/or a girl and are purely inattentive not hyperactive or impulsive.

Yea, ultramarina, big picture abstract reasoning along with creative and divergent thinking all part of that arc.

One of things I've found for "paying attention in class" is if I set out to multi-task I can. If I'm cooking, can't have anyone in there too once I start, but if I am sharing the cooking isn't a problem. I used to sit in classes and read a novel or do other homework, but make 100% sure I followed everything the teacher said so I could answer questions and seem attentive.

So, even if it is some variant of ADD, there may be perfectly functional cognitive strategies that are long-term useful without having to have the expense of continued testing or drug therapy.

I am somewhat skeptical that we have true problems in the classroom going on here. We have seen some improvement in her timed work (DD tends to be somewhat slow--not extremely slow, just somewhat) after stressing that she really needs to work harder on finishing in the time allotted. She doesn't always fully read directions. It's usually on assignments that are easy. It's infrequent enough that it doesn't seem like a huge deal to me.

She is still getting all As. Her teacher is now complaining, however, about her "talking back and arguing." Yes, that would be my kid. *sigh* So while, if she does have ADD, it would certainly be the inattentive type, she is not a quiet wallflower. She is feisty. Stubborn. She will question you and call you out on everything, but she asks fabulous questions. Somewhere out there is a teacher who would love this kid, but we're still waiting.

Let me also say-- DD is an amazing kid....there is so much going on in there. She is going to be an incredible adult.

Ultramarina - all of your second para applies to my HG+ ADD girl. She's a bundle of contradictions fiesty, opinionated, stubborn (INSANELY stubborn), loud, verbal, great questions, amazing observations and yet also a pixie and sometimes almost mute. We NEVER would have even considered that she could have ADD were it not for my researching myself to death with regards to her much more overtly 2e older sister. I have no idea what's going on with your DD, poor teacher fit, boredom, nothing at all... Just saying that I have a child that almost no-one would peg as having ADD (well not yet anyway, it could have been coming) who is vastly better off on medication.

Having moved on from being horrified at the idea of an ADHD diagnosis when considering my elder child, it was surprisingly easy to look at this child and go "Well it's not overt, but the tell tale signs are all there, lets get a professional opinion before it trips her over".

I don't find myself horrified by the idea of her being ADD, but I read a lot about it for work and am wary of being part of what I perceive as a wave of overdiagnosing and overmedicating. We certainly do have issues with DD at home, and they are serious, but I have a hard time feeling like they are ADD issues. I am as yet unconvinced that her school issues, such as they are, are serious or ADD. If I was going to try a med for her I'd be more inclined to try anti-anxiety or anti-depressive meds...

I guess when it comes down to it--we absolutely have behavioral concerns about her, but "lack of focus" has never even been on the list. That makes it super hard for me to think ADD.

Ironically, I just got a message from her teacher saying that she doesn't feel we need a conference this quarter because DD has straight As and the teacher has no concerns about her academically or behaviorally. Eh? Maybe she is just prone to negative feedback and has bigger fish to fry?

Possibly!