Gifted Issues Discussion homepage Forums Twice Exceptional How do I get an evaluation?

Hi, I'm new to this section of the board.

Any ideas on how to get and afford a neuropsych eval in the SF Bay Area?

Background:
DD10 had a terrible, terrible 3rd grade year. By the end we had a medical issue diagnosed that is under control now, and a 'specific disorder of written expression' from the district. (I hear the battery of tests they ran is a good, if general, set. I can list them if it matters.) Since everything was still awful, we moved to a private, free-form gifted school. Last year was better. They didn't demand any written output at all. They loved her, she was happy.

Now we are looking toward middle school and realizing she can't write. I'm slowly coming to terms with the idea I need a 2E evaluation. Polarbear, you are right and I should have done this first - it just took a while to sort out all the separate issues. Now that we have the medical problems and the gifted fit right, the second E is coming to the forefront. Her handwriting is fine, but her spelling is atrocious, composition takes forever and writing it down takes even longer. Her notes are all in the form of beautiful drawings. She has zero sense of time - no rhythm, and can't tell the difference between a few seconds and 20 minutes. She's ready for algebra but doesn't have fluency with math facts. Nothing she does runs on automatic: not tying her shoes, not putting on a seat belt when she sits in the car... She's happy to read but it feels slow to me, and she would much rather be read to. It sounds like stealth dyslexia/dysgraphia to me, as described by the Eides.

So, specific questions:

-How does one go about getting a neuropsych eval? I can't go through Kaiser, they don't cover educational evals. I can't go through the district, they have already done everything they will for us, especially since she can do multiple choice tests at grade level.

-Who should I go to for gifted + dyslexia in the Bay Area? Are they all equal? Do I need to know in advance which evaluations to ask for?
-Around how much will it cost? PM me if that is more comfortable to you.

-Is there really anything we can do for this, or is it just a matter of accepting she will never be able to do an in-class essay in her life, and finding an alternative high school and carefully selecting her college experience to accommodate her? Our district does not believe in 2E. Their idea of accommodating reduced output in high school is going to be for her to take the lowest level of every class they offer.

-Am I going at this the right way?

Thank you!

ljoy, There really *is* so much you can do for this - your dd is going to be fine, and she can learn how to write too! OK, I shouldn't be promising you any of that because I'm just a mom, but fwiw my ds has made *huge* progress and has finally in this past year really *really* for the first time I am starting to believe he's going to be able to write on his own and high school will be ok. Three years ago he couldn't spontaneously write enough words on his own to even have the TOWL graded (that means he was looking at a picture and couldn't come up with *20* words - really I think he didn't come up with any)... and now in 7th grade he is actually starting and making good progress on many of his writing assignments *in class*. He's still seeing a private SLP and we still provide a lot of support as needed at home, but it's gradually becoming less and less and over time you can really see tremendous strides. Sooo.. HANG IN THERE!!!!

I'm sorry I don't have time to write much right now (it's late and I am about to fall asleep lol!)... but fwiw, the way we got our neuropscyh covered by insurance was to be referred by our pediatrician, and it was charged to a medical code. The neuropsych's office administrator actually helped with the insurance coding to make sure it would be covered. I'm not in your area, so I don't have any referral advice, but we found our neuropsych through our pediatrician.

Aside from the neuropsych, it sounds like your dd could really benefit from accommodations (not just remediation/tutoring). Is she using any AT when she's writing at school? No matter what her testing ultimately shows, there are tons of things you could try right now with AT - if you have time to list what she has and hasn't tried, we can give you some additional suggestions.

And re high schools holding her back in lowest level of classes due to his challenges with writing - when my ds was 10 I would have predicted that easily happening to him. His private school accelerated him in math without worrying over math facts, and it was hugely successful. They've always expected him to do grade level work in LA and even though he was so writing-challenged for so long, it was absolutely the right thing to do - now that he's getting the hang of writing, he actually does much better when challenged with an intellectually-appropriate writing assignment than he does with something that's just not matching where his brain waves are at.

Re which evaluations to ask for - with my kids, I've found it most useful to describe the challenges you've observed and your concerns and then listen to what the evaluator says he/she would like to do. A typical neuropscyh eval will cover a wide swath of testing. Sometimes you'll be referred on for other more specific testing (such as OT or SLP) but in general, I find that it's been most useful to start with the broad look from the neuropsych first, because my gut instincts have absolutely been off re what the actual challenges were.

Best wishes,

polarbear

Thank you *so much* for the encouragement. The more I read the more scared I'm getting.

We are trying to get her to learn to type but she prefers to handwrite - at a glacial rate. Partly I think she wants to do the opposite of whatever we encourage... sigh. It's also a problem that her favorite typing game is for *speed* typing (Burning Cargo), and she is opposed to anything time based. She has just tried out Dragon Dictate on her iPod and gotten it to work when she reads a previously written passage, but hasn't tried composing on it yet. She just got a pair of noise blocking earmuffs to wear at school and loves them.

She's on her own for math. We have done some DOE EPGY - which, on reflection, is extremely dyslexic-friendly: they offer all the lectures as sound-and-text, and often even read the problems if they're word problems. Once we left public school and quit doing timed, 100%-required facts tests, she's been fine. Her new school is offering problem solving, but hasn't really advanced her math level; since she seems to be ready for algebra, they are going to make sure her pre-algebra has no gaps so she can move on next year.

For writing, she's in a mixed age classroom with 7-10 y/os. She is doing the same work as everyone else this year. Last year she got away with submitting comics instead of articles to the paper, and so on, but this year's teacher is actively preparing the oldest kids for middle school next year. She has chosen to sign up for a fiction writing club where the expectation is about 200 words/week and dictation is explicitly allowed. She's met the expectation about half the time, mostly by dictation. Her phrasing is beautiful. Spelling and speed, not so much.

I can try asking for a referral from our psych department. We already need to set up an appointment to deal with what her head of school describes as PTSD - post traumatic school disorder, the wild eyes and trying to run out the front door when I mention that homework exists. (I wish I were exaggerating.)

Thank you for any suggestions!

I started with my Insurance's behavioral health page and searched (for days!) until I found someone in my area who was a Neuropsych listed as being 'in-network'. Then I picked up the phone and called. I told them what was going on in school and with my son, and that we needed to get him tested to find out what all was going on (at that time I did not mentioned his being gifted, as we had a serious behavioral problem that seemed priority #1). We got an appt (6 months out) and finally got him assessed. Obviously she realized he was gifted once she met with him, but she was very experienced. I knew she was good when she talked about how smart he was, but not in a "oh goodness, your child is SOOO amazing and smart". She, instead, was like "clearly your child is very gifted and probably way ahead of his classmates, and he's also using his intelligence to manipulate those around him and to get out of work." It was amazing to have someone GET my child. And have good suggestions and next steps and recommendations for a 504.

Anyway, I got off-topic a bit there, lol. TL;DR - Try starting with your insurance company's behavioral health website.

I don't want to highjack this thread but, Amy, would you PM me the name of your neuropsych in N. Texas? Thanks.

And, back to the original ....

Sounds a LOT like dysgraphia/dyslexia as it exhibited in my son, now 12.

You've already received great advice, so I'll only add a couple of things. Make sure the neuropsych is experienced in testing 2E kids. We had a terrible experience over the summer, so finding one that will recognize what is Giftedness, what is LD, and accommodate testing methods to fit is going to be a huge benefit in creating useful results.

The second is that while some of these challenges will be lifelong, many are developmental delays. We've seen huge strides this year in quality of written output, speed of output. He still can't spell and doesn't have all of his math facts down but has gotten much faster at using the few he's memorized and counting up or down. So what you see as overwhelming now may not be so overwhelming in a few years.

Dan Peters at the Summit Center. I have heard him speak and he gets it about 2E.

Because it sounds so much like dysgraphia or stealth dyslexia (how is her reading?), you could also contact the Eides and ask for a referral in your area. You could also Google around for neuropsychs and then look to see if they quote the Eides or have links to their material on their web sites.

In terms of money, obviously this will vary by experience and by region, but our tester charged us $2500 for a detailed evaluation.

Good luck!

We had to give our ds time to get on board with typing. We started with letting him use the learn-to-type programs that he liked and also gently encouraging him to type his homework. He was really resistant to typing at school for a long time because he didn't want to open up a laptop in class and look different from the other students (even after he was in a class with two other kids using laptops!). It took several years but he's now using AT almost full time in middle school. The things that helped the most with transitioning to keyboarding were:

* Gradual pushes from parents to do it - there were a few places and times that we made him, because if we hadn't he never would have been brave enough on his own to open up his laptop at school when he was in class with the other students. Just opening it up and seeing that the other kids weren't going to treat him like he was from Mars helped him realize he could do it.

* Increase in workload - as the amount of homework increased with time we encouraged him to use his laptop at home and eventually the workload increased enough that he realized he needed to be typing in order to keep up.

* Increase in intellectual challenge at school - this helped indirectly in that he became motivated at school and wanted to do well

* Getting past other things at school that were making him uncomfortable (I'll post more on this later - have to leave for an appointment in a few minutes).

I'll be back with suggestions on the math and writing.

polarbear

Thanks! The Summit Center looks like a possibility. Unfortunately the Eides didn't have any suggestions for me (I emailed them last week). Her for-fun fiction reading is Harry Potter, Wrinkle in Time, Mysterious Benedict Society, etc. She is asking me to read her Godel, Escher, Bach aloud. These are vastly different levels. She can read Wikipedia articles for research, but avoids it, gets bogged down halfway down the page, and would rather find a Nova video on the same topic.


These might be relevant. Her compliance level, as you might guess, is near the bottom of her class - but her ability is probably near the top, especially if you discount the output problem. She has been rolling her eyes at assignments, and she's much more willing to do the higher output for her club than the lower output for her class. A chat with her about what would be a meaningful assignment and with her teacher about a good challenge level may be in order.

Also, some level of laptop ownership. At the moment she only owns her iPod, which of course doesn't come with a keyboard. All the kids are expected to type at school but she really needs the practice at home.