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I know kids go for neuropsych evaluations to determine if they have ASD, and I know one who ended up with a diagnosis of OCD after such an evaluation. What else can a neuropsych diagnose? Also, what's the difference between an eval from a neuropsych and one from a developmental pediatrician?

Neuropsych (psychologist) can dx anything in the realm of the DSM (list of disorders related to mental health issues, disorders of cognition, ASDs, and learning disabilities). They rely heavily on a customized battery of standardized tests they administer. They will also conduct a thorough interview to asses dx level of functioning, significant history, and issues of concern. They will make up an evaluative report with results and recommendations.

A developmental ped is an MD who had a thorough understanding of both the DSM and the broader range of medical diagnoses, especially those effective a child developmentally and/or behaviorally. Their eval will usually consist of a thorough medical exam (possibly even bloodwork or genetic testing), review of medical history/records, a thorough patient/parent interview and possibly parent/teacher behavioral surveys. They would not usually perform standardized testing, but would refer a patient to a neuropsych if they saw a need to investigate a specific issue further.

There is no need for a neuropsych eval to determine things like depression, behavior disorders, mood issues, anxiety problems, and typical ADHD. However it can be invaluable to help untangle confounding or cocurrent problems such as ADHD vs. ASDs vs. expressive language delay (for example).

I should add that my DS who has an ASD saw both a dev ped and a neuropsych for his diagnosis. The team approach was especially useful for us.

DeeDee

Thanks for your replies.

Who would diagnose CAPD? What about SID?

Agreed that it's not necessary to have a neuropsych evaluation to diagnose any of these conditions, but we've found with two of our kids (both of whom have had extreme anxiety, one of whom was clinically depressed at one point in time) that a neuropsych evaluation teased out hidden challenges each child was dealing with. With both children, we had professionals ready and willing to treat/medicate the overlying anxiety/depression, but for each child the real issue that needed help was the underlying 2e diagnoses which weren't recognized by their pediatricians/counselors etc. Once we were aware of the 2e diagnoses (dysgraphia, expressive language disorder, associative memory challenge, etc) and remediated/accommodated for those, the anxiety/depression lessened significantly - to the degree treatment wasn't needed. Both kids have personalities that will probably always be prone to anxiety, but if we'd only looked at and treated the anxiety we would have missed a very important piece of the puzzle.

Please know I'm not suggesting anxiety/etc only exists as an outcome of underlying LD, but for a young child who's struggling in school and also showing signs of anxiety/etc, I would recommend a neuropsych eval.

Keet, I think CAPD is usually diagnosed by an audiologist who specializes or works with people who have CAPD. FWIW, we thought our middle dd might have CAPD at one point in time, but a neuropsych eval revealed she had an entirely different challenge (visual). It can be very tricky trying to understand what's up with young children simply because so many symptoms overlap between challenges. SID is usually diagnosed by an occupational therapist. It's not something you'd need a neuropsych eval to see - if you're seeing symptoms of SID, you can ask for a referral for an OT eval from your ped.

polarbear

Where I live and work, there is one person who can diagnose CAPD in the whole state school system. She basically said, "You know what? Whether or not CAPD actually exists is hugely controversial. These are the recommendations for students who have CAPD. Why don't you just try them, and skip the test?" The recommendations were very similar to what you would use for hearing impaired students, things like "avoid background noise".

I agree that trying recommendations if there is suspected CAPD is a good idea, because they can't hurt and they might help, whether or not it's CAPD. OTOH, I think it's important to test for a number of reasons. What if it's not CAPD but something else? It's not easy as a parent or teacher to sift through symptoms and know for sure what's up, but a neuropsych eval can point to very specific areas to look into as well as rule out challenges. If a child does have a challenge such as CAPD, they may have a teacher who is willing to give them accommodations without a diagnosis/testing/etc one year, but the next year end up with a teacher who doesn't believe the child has a challenge and won't accommodate. That's where having a diagnosis really helps, not with an individual teacher but with setting up a 504 plan and a record of accommodations that can follow a child through school. Although I don't have a child with CAPD, I have children with LDs and the other positive aspect to having an official diagnosis is understanding of why they are struggling (for parents and children).

polarbear

My son is on a wait list to be assessed for CAPD (through an audiologist at our local hospital). For us that particular diagnosis would answer SO many questions as well as qualify him for funding for an FM system (the teacher has a microphone and he wears earphones so he can hear her more clearly). Without the diagnosis I'd have to pay for this equipment myself. So while I agree that following recommendations for a diagnosis and skipping the test can sometimes work, other times a signature on a piece of paper from a diagnosing professional can sure help with $$$

My son is hearing impaired and also has CAPD. I've posted on this before. It is definitely a real diagnosis.
Some examples- in the classroom, the teacher said "who likes ice cream??!!" All of the kids jumped up and down and screamed, "I do, I do." Not my son - he was sitting in the front row with his excellent hearing aid on and working and the FM system working. It was like he didn't even "hear" her. But he had to have heard her due to all of the technology streaming into his brain at the time. It's like being deaf but you aren't really deaf.

How would you know if it's CAPD and not ADD?

ADD would present itself with non-auditory inattentive issues such as failure to focus on a difficult task (puzzle, worksheets, getting dressed-lol). You would usually also see difficulties with organization (school papers, closet, always losing things)beyond the typical child.

ADD can look like CAPD. However, if you get a good psychologist/audiologist, there are tests that can differentiate between the two. I forget now, but on the CAPD testing my son had as well as on the WISC, there parts of the test that required the ability to really concentrate, which he aced. Both the psychologist and the audiologist highlighted how these parts of the tests differentiated the two.
My son has excellent focus and concentration, esp. when it's quiet. In a classroom, he can sometimes get lost when it is noisy. Our audiologist said that she thinks his auditory processing disorder will catch up and normalize to that of other kids by the time he hits puberty. I hope so! We are doing weekly piano lessons (for two years) and he will also start viola with the school orchestra next year.

My son, meanwhile, has excellent focusing ability, and the more difficult a task is, the more he is able to concentrate (generally speaking - there's the odd exception).

He's an enigma - we've had many different pros disagree as to his diagnoses. Our psychologist has suggested ADHD combined type and Expressive and Receptive language disorder, which is from what I understand the linguistic component of CAPD. Meanwhile he's had four normal hearing tests which have ruled out any ear problems.

Our pediatrician meanwhile disagrees with the ADHD ("I've seen so many kids with ADHD and he's different."). I'm on the fence with the ADHD... some days, sure; others - not a chance. The language processing I believe completely (even with the fact that he reads above grade level in English )

Anyway.

ADD/ADHD and CAPD can be co-morbid/overlapping much the way that ASD and SPD can be (both of which school staff also thought my son has, but the docs said no way).

I read somewhere (Scientific American Mind, I think), that ADHD and CAPD can have identical symptoms and the diagnosis the child gets sometimes depends on the specialty of the diagnostician (i,e, psychologist Vs. audiologist).

Meanwhile our psychologist said "oh no, he doesn't have CAPD." (She's the one who diagnosed the ADHD). Then in the next breath she admitted that she didn't have all of the testing materials that an audiologist would have (well then how can you say with certainty that it's not CAPD?) Arrgh.

I don't have a problem with her work - I have a problem with testing & diagnosis in general: As my family doctor says, psychology is generally just the practitioner's opinion.

Surely science can do better - you'd think there would be actual medical tests available to pinpoint which brain region(s) is/are deficient. With my layperson's understanding that ADHD lives in the prefrontal cortex while language lives in the left hemisphere, & Broca's & Wernicke's areas, and the primary auditory cortex being located in the temporal lobe, I find the idea that disorders of these areas can be "interchanged by misdiagnosis" really frustrating.

Meanwhile we spend all these hours and dollars just to get someone's opinion...

(sigh)

CCN...I, too, wish there existed a specific test...especially being a clinician treating kids. The brain imaging evidence of ADHD is inconclusive, sometimes even demonstrating opposite findings. I was reading information from a psychiatrist (sorry forget name) who was discussing the proposed changes in the DSM5 that is due 2013. He specifically noted the difficulties in diagnosing ADHD and proposed that the diagnosis umbrellas a number of syndromes which could account for the brain image variability....yes, it is often a guess.

One thing I wanted to mention on this thread is the importance of medical rule-outs when ADHD/other behavioral issues are suspected. Simple tests of
lead levels, thyroid function, certain vitamin deficiancies, celiac or even PKU along with more complex genetic testing if warranted (fragile X,Klinefelter's ) are really minimally invasive. I can't tell you how many times I have to send a child back to their PCPs for a proper work-up.

Well, definitely, get an audiology exam for hearing before allowing anyone to prescribe medications for ADD/ADHD. Hearing loss is frequently missed in the screen at the doctor's office.

It amazes me that these tests aren't routine (I'm guessing it has to do with cost). My DS8 has been tested for celiac and gluten, at my request. I'm glad you mentioned the others - I'm writing those down The CAPD test this friday was also as a result of my insistence: I had to ask twice for it and provide examples of his speech oddities and language comprehension difficulties before we were referred.

I'm not anti-meds - not at all - I think some kids are saved by them. I just think they should be last on the list after all the medical rule-outs have been done. Thankfully my son seems to be fine without them so far. Mind you, I think he's easier than some (either that or I'm just used to him and my perception of what's "easy" is off, lol)

That would be awesome... I have my fingers crossed for you I've heard of this as well, that audio processing issues are sometimes just the result of a delay that eventually catches up.

We do piano lessons too. I think it's really, really good for them. My son loves performing at recitals. He's such a little ham, lol

Amen:)

I also forgot to mention blood glucose levels, especially for kids with a lot of mood lability - not to mention a thorough physical exam including simple neurological tests (in office). Sleep disorders are another hidden culprit. Also common meds such as Zyrtec, steroids inhalers, albuterol, and predinsone can be a source of troubles.

And often it's the convergence of medical issues exacerbating things like ADHD...but ignoring medical issues and only utilizing pyschotropic mess is an all too common practice with kids and adults alike (use of antidepressants in adults without exploring other causes of depression).

I'm glad you have gotten some helpful medical rule-outs.

My son is going for a neuropsych. His pediatrician said he appears highly gifted but must also be concerned about ASD or something else if he is sending my 2 year and and 8 month old son for that kind of exam.

Do children with ASD make eye contact? Are they emotionally sensitive at all? My son fits some of the characteristic but not others.

Hi Isaiah09,

The current diagnostic criteria for Asperger's Syndrome are here: https://www.firstsigns.org/screening/DSM4.htm#AS

I find Asperger's the most likely among the autism spectrum diagnoses to be considered by a neuropsych, because it sounds as though your DS didn't have significant language delays, and certainly not an IQ impairment. But there are links to diagnostic descriptions of all the various shades of ASDs from the top of that web page.

Good eye contact alone is not enough to rule out an autism spectrum disorder. They are looking for clusters of features that add up to a social disability: a failure to engage and relate to peers well, an inability to adequately understand the thoughts and feelings of others, impairments in social language, impairments in nonverbal communication, all these sorts of things can be part of the picture.

There is so much folklore about autism these days (i.e. "he can't have autism because he ... fill in the blank"), and a lot of it is not correct or not that useful for a family wondering how to proceed. Expert advice is much better.

Don't panic. See what the neuropsych says. Make sure they do a thorough range of testing. Ask them lots and lots of questions, and make sure you don't leave after the followup meeting until you understand exactly what THEY think you should do next (a new school that's a better fit, or special services, or whatever-- a clear path forward should be the goal.)

HTH,
DeeDee

It may be worth making sure you know that the term "Asperger's" is going away in DSM5, IIUC. There never has been a (universally agreed) distinction between "high functioning autism" and "Asperger's" anyway, but it's now important to realise that the condition isn't necessarily more disabling if it is labelled "autism". Same kids, different labels.

Right, Colinsmum.

The **proposed** but not formally adopted new criteria are here. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94 . They actually have a tab where you can compare them to the older language, so I should have just given you that link first.

Under the new criteria my DS9 will have "autism," not "Asperger's." (I have made sure he is comfortable with these category names so the switch won't mean much to him.) He will still be totally brilliant in my and some others' opinions, but eccentric in his interests compared to peers and still inclined to make grievous social errors. Hopefully less of the latter over time... we'll see how it goes.

The "high functioning" label never had any diagnostic validity; it was often used to indicate "undiminished IQ," but also as a way to tell parents "it's all okay, yours is doing better than most of the others we see" and get them out of the doctor's office. It's perfectly possible for a person to "function" at multiple "levels" at once (I've forgotten most of my calculus and can't run a mile without wheezing, I stub my toes often, but I can read in lots of languages: what's my functioning level as an adult? Likewise a kid who can do calculus but forgets to tie his shoes: what's his functioning level?) I'm not a big fan of that label, whatever the child's IQ.

DeeDee