Gifted Issues Discussion homepage Forums Twice Exceptional CAPD and ADHD - is there a distinction ?

I was wondering if there is a distinction between CAPD and ADHD. For kids with CAPD, do they tend to focus on pencil/paper tasks better (assuming no dysgraphia etc)? Does CAPD affect processing speed ?

I have been observing my child in the classroom (I volunteer as much as I can). There seems to be a minute lag between other kids following and him following -- so, if the teacher says (for example), let us stand up and sing the Jingle bells song, my child stands up (literally) a minute after the other kids stand up and then starts singing. He seems to be compensating somewhat by following what the other kids are doing, but does not seem to do it automatically. This happens (the minute lag) for every instruction given verbally. In a one-on-one environment or in a very small group, I don't notice this.

If you have had a CAPD evaluation, did you first do the ADHD eval or both or in some other order ? Thanks to Polarbear's advice, we do have a neuropsych appointment scheduled. On a related note, his motor skills seem to be improving, but he has been really working at it every day (including holidays/breaks etc). If he misses a day, it shows up. I am not very hopeful of getting a dysgraphia diagnosis based on how much he has been working at it. However, more than 4 sentences tires him as well - this could be developmental; his teacher assures me it is, but I am still worried because he spends so much of effort producing output. Before the appointment though, I want to be sure that I am asking the right questions. Any advice would be greatly appreciated.

Thanks in advance

My son has CAPD and no signs of ADHD. He is much better orally and visually than with paper and pen tasks. His processing speed is fairly high average but probably lowered because of his dysgraphia not CAPD. He had a year of speech therapy and seems to have improved tremendously and is now average or above average in all areas.

When we did the CAPD evaluation, the audiologist did some testing that can tease out ADHD traits from CAPD. My son had no signs of ADHD with his testing.

Hi mom2one,

I think your ds is in first grade this year? Or kindergarten? I have a few thoughts for you - sort of in backward order from your post, so hopefully that won't be too confusing!


You're doing a great job of researching as well as observing your ds and thinking through what seem to be challenges for him, correlating it with what you are learning about potential challenges. You're probably already 90% ahead of where most parents are when their child goes in for a neuropsych eval I think it might help a bit to know that you don't have to know all the right questions to ask or have an idea of what's up before the neuropsych eval - a neurospych eval looks at overall functioning (academics and home), includes a parent interview in which you give a detailed developmental history as well as your current concerns and observations etc. You would tell the neuropsych about how your ds seems to lag behind by a minute as you've described above, but it's ok if you don't know whether or not that's potentially CAPD or ADHD - that's what the neuropsych eval is designed to tease out. The eval starts with a standard set of ability vs achievement tests as well as (usually) behavior surveys and the parent interview, and then the neuropsych chooses additional tests and asks additional questions based on what he/she sees in the testing and from the surveys and parent interview. So many challenges and behavioral symptoms overlap in between diagnoses that it's really difficult and challenging as a parent to know which diagnosis is present. The neuropsych is trained specifically to tease out symptoms and correlate what the total set most likely means - then you are given referrals for follow-up with the professionals who deal with specific diagnoses.


Evals for CAPD and ADHD are very different in the details and who does the actual eval... but a neurospych can give an ADHD diagnosis as well as refer your child for a CAPD eval if they see a potential red flag for CAPD during their eval. Because evals cost $ and time, my gut feeling has always been it's easier to start as broad as you can and then follow-up with specific evals once you have a professional who feels the eval should be done. In our area we also have to have referrals from professionals to get private evals (or a referral through the school) - and those referrals (where we live) have to start with your ped. Our ped has always recommended going through the neuropsych eval first, then we've had the neurospych referral (and ped will also then refer) for things like follow-up evals or therapies based on the neuropsych's recommendations.

One of my dds has had a CAPD eval (following a recommendation from a psych eval). She didn't have CAPD, but the same psych (at the same time) also recommended sensory OT which led to her going through a listening therapy program which helped with many of the symptoms I'd thought might be CAPD. She's also my dd who has been suspected of having ADHD. I wondered about both of them when my dd was your ds' age, but ultimately we found out she was having severe vision issues - and it wasn't until we'd been through neuropsych testing that anyone saw enough of her broad functioning picture to realize it was a vision-related issue. I wasn't thinking vision, so I was only seeing the bits and pieces of symptoms that matched things I'd read about or heard about from other parents.

I'm guessing that you're probably thinking what the heck after reading about all the confusion over what was up with my dd - but the reality is that it can be very tough to work through all the complicated puzzle pieces to find what's really going on. Of all the different paths we've taken and evals etc - it was the neuropsych that helped the most as a good starting point simply because it is such a broad overview that takes in "everything".


My first thought here is that there are so many potential things that could be causing what you are seeing with the lag time. My dyspraxic dysgraphic ds who has challenges with expressive language does this. He says that it just takes him longer to move, and that's a key part of dyspraxia. In conversations when we see the lag, he says it's because it takes him a minute to put his thoughts together - that's most likely due to his expressive language disorder. He also tells us he thinks through what other people want to hear in a response before he responds - that's personality. So there are three things going on in just one kid that result in something similar to what you're seeing. There are so many other things it could be too - including not hearing well in general, not hearing well against background noise or not being able to process what is being heard. ADHD would not be something I'd suspect in that particular situation - but huge disclaimer - I'm not a professional so don't take anything I say as meaning anything other than one parent's conjectures

Best wishes as you move forward - you are doing a great job thinking this through and asking a lot of questions!

polarbear

ps -


It's possible that this is developmental or due to a different challenge, but this also sounds like it could be dysgraphia (the tiring after more than 4 sentences and the having to really work at it to improve). One thing you might want to take to your neuropsych interview are examples of his handwriting - other clues to dysgraphia are inconsistent spacing and letter size, reversals, mixing up caps and lower case, backward letters, lack of consistency in how the same letter is formed, crumpled up/messy/torn up paper etc. I wouldn't worry that dysgraphia (if that's what it is) won't be diagnosed because your ds has worked on fine motor skills and his handwriting has improved - dysgraphia is diagnosed in a neuropsych eval by a combination of evidence - our ds has a very distinct pattern in his ability testing and achievement testing that is reflective of dysgraphia plus the neuropsych included follow-up tests that showed clearly the type of dysgraphia he has (fine motor). His neuropsych also looked at his handwriting examples both from school and the work he did during the eval and things she noted about it included the speed (slow), she observed how he held his pencil and his wrist and posture while writing, she observed that he didn't form letters consistently and it was her opinion that his level of handwriting output (form, spelling, consistency etc) was significantly below expected level based on education and grade. A teacher sees a lot of broad spectrum of kids using handwriting and will be used to seeing some kids who "get it" quickly and others who are on the lower end of the "getting it" spectrum - same thing with reading in the early grades. The teacher is naturally looking at it from a teacher's perspective - not all children develop beautiful handwriting early on. The neuropysch is going to be looking at your ds' samples from the perspective of being a professional trained in looking for issues who also has most likely seen a wide variety of handwriting samples from young children. He/she is going to be more able to identify an issue with handwriting (if it exists) simply because she's looking for potential issues, and because she has the training in what to look for, as well as having extra input to guide her that the teacher doesn't have.

polarbear

Polarbear and qxp - thanks very much.


This would describe my son as well, though initial processing speed results showed he was weaker when compared to various other subsections of the test


He is in first grade. Thanks for all your thoughts. It made sense to me. By the way, I was really not thinking what the heck :-), but I do agree with you - it takes some effort to tease out exactly what is going on


The lag thing worries me a lot. He does follow along after a minute's lag, but it is for "everything" in a classroom environment. He is also not into team sports - especially, anything that involves a lot of hand-eye co-ordination (baseball comes to mind). He loves the sport as long as other people are playing it, but he seems to know he is not good at it, and does not even want to try. That worries me too.



He seems to have stopped with letter/number reversals (except for p's and 9's), but the spacing, and the sizing of the letters are still not good. I have samples from preschool onward, and while, yes, you can see an improvement, writing takes an inordinate amount of time. I'll definitely act on this suggestion -- very, very helpful


Very well explained. This makes total sense to me.

Also, school-wise, I am not sure what to ask -- his teachers seem to know of his math/verbal/lang arts abilities, and his reading level is met somewhat (atleast they seem to be sending books with level O and beyond), though he can read pretty much anything (as long as content is appropriate). He does seem happier, so I am hoping he is being challenged in some way or he is just liking the friendly atmosphere.