Met with the Neuropsych this morning and got a report from her and got to talk with her for a while. Her diagnosis is ADHD, PDD-NOS and GAD with depressive tendencies. She had a lot of good recommendations in the report and also recommended a speech pathologist, to help with his communication skills, and a counselor she likes. She also spelled out the accommodations she feels he could use in a 504.

As for his test results, she said they may be an underestimate of his overall capabilities, but are 'likely an accurate reflection of his current functional level.'

(They are going to send me the full test results, this is what we in the report)

WISC-IV
VCI = 100
PRI = 145
WMI = 107
PSI = 109
FSIQ= 118

WIAT-III
Total SS = 115
Oral language SS = 113
Listening comprehension SS = 117
Oral Expression SS = 106
Reading proficiency SS = 122
Reading comprehension SS = 102
Average word reading SS = 118
Pseudoword decoding SS = 113
Written expression SS = 114
Alphabet fluency SS = 120
Sentence composition SS = 108
Spelling SS = 104
math SS = 110
Math problem solving SS = 124
Numerical operations SS = 93
Math fluency SS = 114
Addition SS = 112
Subtraction SS = 114


I haven't read much about the WIAT, so I'll have to look into that. She did list out what grade level each of the scores equated to, so that was helpful. I was surprised by how low his numerical operations score was. Not sure why that's so much lower.

I wasn't surprised his verbal WISC score was lower than his non-verbal, but WOW, that's a big difference. And I'm surprised the other scores are all so much lower as well.

I'll add more later on if I get a chance, but I just wanted to share. You guys have been so helpful and without you guys I don't know if we would have gotten all this info at this point!

Hi Amy,

Glad you got information you feel confident about. That's a wonderful step.

Why a 504 instead of an IEP? Usually people with this range of disabilities will benefit from special education services at school.

Did she give you treatment/therapy suggestions? We have seen great improvement with DS through targeted therapies.

FWIW we were told by a neuropsych that as you remediate deficiencies, test scores can change a lot, typically becoming both higher and less spiky.

Kudos to you for seeking good information to help your DS!

DeeDee

Wow, that has got to be quite a challenge with HG++ PRI scores and average VCI & others. Poor kiddo must be dealing with some major roadblocks. FWIW, my one dd with ADD tested much lower on WMI and PSI as well but I'm not sure if they are truly low so much as impacted by ADD. She's seriously fast, but she makes so many mistakes that PSI probably came out low due to mistakes not actual speed.

DeeDee - I would imagine because she knows the school district he's in and assumed he wouldn't qualify for an IEP due to not being behind in any subjects. I will follow-up with her though, since he won't be returning to that school. The charter school might be more open to an IEP in this situation.

Cricket - Well, DS is on Tenex, for his impulsiveness, so I'm sure that helped in those areas, but the Dr did say she didn't feel that part was being helped enough. She basically implied she felt his Tenex should be at a higher dose, IMO. She is sending a copy of the report to his psychiatrist, and we see him like next week, so we'll find out what he wants to do with all this then.

Glad you have some more info. Do you feel like this is on target?

Do you feel like the PDD-NOS is right? I know you were looking at Asperger's before. I found myself wondering about PDD-NOS the other day. I'd sort of forgotten about its existence. Is it going to go away with the new DSM, too?

We were told that IEPs were only available for children who were performing below grade level which virtually rules out 2e kids. 504 is pretty much our only option here and the funny thing is that my non-2e child has one while my 2e kid doesn't b/c we haven't been able to find any accommodations to write into a 504 that would actually help with her issues.

ulramarina - I believe it is all being lumped into the Autism diagnosis in the next DSM, yes. I do think PDD-NOS is probably a better fit than Asperger's, but, as always, the most important part is really getting him the right services, which I hope her report will help us with.

I feel like his WISC scores are lower than I expected (out side of the VCI and WMI... but even she said these could be under-representative. I think his PRI qualifies him for DYS.. so maybe I'll look at applying and see if we can't get even more help.

Wow this is soooo close to my son's profile. It would explain a lot. His VCI was very low compared to PRI and he is ADHD, GAD, borderline for Asperger's. It confirms a lot for me.

My (inexpert) understanding is that with gifted children - Aspergers you should see a high VCI and poorer PRI, Autism the high PRI and low VCI (or this would be PDD if the child does not meet all the criteria for Autism).

My daughter borderline for Aspergers but I actually think HFA is a better fit from my reading....

It's not that simple, unfortunately. People on the spectrum tend to have their own patterns of cognitive weaknesses and strengths, particular to the individual.

The main thing separating an HFA diagnosis from an Asperger's one is the presence or absence of a significant language delay in childhood.

I believe that marker will be downplayed in the new DSM; the proposed new definition focuses on social skills problems and patterns of repetitive interest and rigidity, which as I understand it should still easily encompass most people currently diagnosable with ASDs, including the gifted.

DeeDee

The problem with the new DSM definition is that it requires a repetitive motion or tic along with the other requirements (previously only required for a Autism diagnosis, not Aspergers or PDD). Now, any child who doesn't also have repetitive motion problems won't meet the criteria... I'm just focused on one year at a time...

Amy, it doesn't actually require tics-- a repetitive interest would qualify.

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94

DeeDee

Is that now the complete DSM for ASD? That is, that's it now, in total? All previous criteria are thrown out? Interesting. I wonder how practitioners are going to react to this change on the ground?

It's interesting that restricted interests are no longer considered necessary. My DD has never had this and it's always been a point of hesitation for me, since it's generally considered such a major feature of ASDs. She does really like birdwatching, but she would never talk about birds to people who are not interested in them--in fact, she deliberately conceals the hobby at school because she's aware it's a little odd. She also goes days without talking about them or birdwatching.

I have read some stuff saying girls with ASDs are different and that things like "reading" or "art" may be their obsessive interest...but come on. I just don't know that we could consider a gifted girl who loves to read to have an obsessive interest in reading that counts as an ASD trait.

Ultramarina, I agree. I kind of think that's why we got a suggested diagnosis of Asperger's this year--that DD8 loves to read and will sit for hours reading all kinds of stuff. Also at school she was resisting her teachers' efforts to have her 'advance' in math by doing 2-digit multiplication and division, and then 3-digit, and then 4-digit...she was bored silly with it and kept going back to her fraction work. I guess that qualified for the B criteria, because I've never seen any of the current "B" criteria from her, although she does have social issues. If they do change the criteria to encompass kids who like to read, I would expect the "rate" of Asperger's to go way up. Hooray, more diagnoses--diagnoses all around!

I think both my daughter and myself more clearly meet the new criteria oddly enough. Maybe she'll move from borderline to diagnosed when it comes in.

DeeDee - I do realise my few sentence was simplistic, but it does follow that that a language delay is likely to lead to a lower VCI, unless there has been significant remediation or progress before testing. And Aspergers, in my understanding, is supposed to include co-ordination issues which would potentially impact PRI. Though I realise we are all unique there is an expected pattern. Though how relevant that will be anyway as the DSM5 comes in I am not sure.

I would just like a clearer answer than "maybe" on my own daughter.

No, the DSM-5 is not finally approved yet. What I posted was the draft. It's still being argued about, for example here: http://thinkingautismguide.blogspot.com/2012/06/how-dsm-5-dsm-5-draft-autism-criteria.html


It would depend on how she's using the interest. If it's the major means with which she can get herself under control when she's upset, or if it is so compelling for her that she avoids social interactions that are fun for other kids, it can be a trait.

My DS's special interests at an early age were math and science. If he was upset, working with numbers was very soothing for him. He would add large columns of numbers repeatedly if he needed to calm himself down. He also happens to have it as a serious academic interest, but its use made it definable as a special interest.

I don't think this leads to "diagnoses all around"-- but it does help call attention to the trait of autistic people to use objects (and sometimes the people around them) in unusual ways.

DeeDee

I think the new criteria will capture a few more of a certain kind of person, while not excluding people who were diagnosable under the new criteria. I hope that the particular case of girls is clarified better in the new DSM.


Not necessarily. My DS didn't talk much at all till he was 2, but came in at that point with his ABCs and sentences. You can't assume linear growth/progress.


The coordination problem does not affect all people with AS and is not considered diagnostic. Syndromes are like family resemblances, where nobody has the full collection of features.


I hear you! The maybe is really hard to deal with.

DeeDee

Thanks DeeDee.

I know for DS he never had a language delay, and still doesn't have any problems with language, per se, but with communication. He knows his vocabulary words, can spell, etc. However, he has a lot of difficulty with certain areas of communication, especially decoding other people's intents/feeling and properly expressing his own.

I didn't think to ask the Neuro at the time, but I am curious to know, what the deciding factor was for DS to be PDD-NOS vs ASD. Or if, by meeting the criteria for PDD-NOS that excludes ASD? I still don't entirely understand how that works.

The big thing for me is that having a diagnosis of PDD-NOS means that DS now qualifies for a whole list of special services that only apply to kids on the spectrum. (I forget the names, but there's basically a special state law related to IEPs for kids on the spectrum, due to the fact that they often don't have academic delays, but still need special help.)

I can't wait to meet with the new school! I'm making myself wait until after we come back from our trip to the beach in July. (I did shoot an email to the principal, but am not really expecting a reply any time soon, as I know how end-of-year tends to be.)

This is very interesting, my DD received the exact same diagnoses (ADHD, PDD-NOS, Anxiety, and situational depression) her WISC scores were very similar except reversed on VCI/PRI - she spiked in VCI with the PR being the lower one.


I would love to know more about what services they provide, it's too late for my DD but I am curious what we would have received if we had gotten the diagnosis earlier. I am still trying to figure out what supports would be helpful to ask for in college.

I am not sure about the ASD/PDD-NOS question either, I was told they don't give the ASD diagnosis anymore so I assumed it was just the new term for HFA but my DD keeps telling me she does not have ASD, just PDD-NOS so I guess it's spelled out somewhere.

Nik - From age 3-8 they can qualify for treatment services through a few different places, one being the Child Study Center in Ft Worth (that place has like a 1yr waiting list, and it costs a fortune if you are trying to get in w/o going through the state.) Here are the links for the school stuff - http://www.texasprojectfirst.org/AutismStrategies.html if you click on the link for the Commissioner's Rules on IEP development for students with autism, it will open up a pdf with the 11 strategies they are meant to consider for any student with a spectrum diagnosis when forming the IEP. If you've ever gone through an ARD process, there's a few check boxes at the end of it that relate to being either accepted or rejected, and there are 2 boxes for accepted - one says something like 'the child meets the requirements of a learning disability or emotional disturbance which is currently effecting the students learning blah blah blah' and the other one basically says 'the ARD committee finds the student has autism and is entitled to services'. Obviously not worded like that, but that's the basic idea anyway, hah.

The state also offer special services related to finding employment, independent living and mental health counseling.

Ooh.. I found the name - Texas Project FIRST. Could not remember that for the life of me!

Here's another list of state entitlements - http://www.dads.state.tx.us/tarrc/services/communityservices.html

PDD-NOS is one kind of autism spectrum disorder (ASD). ASD is the umbrella designation for what are now considered a variety of disorders (Asperger's syndrome, autism, and PDD-NOS).

The designation "high-functioning autism" doesn't have any real diagnostic validity. "High functioning" means that IQ is unimpaired; but it has nothing to do with the severity of the autism. A person can have a high IQ and really significant impairments from autism.

HTH,
DeeDee

I am bad about using ASD = Asperger's even though I know it's meant for the whole spectrum disorder.

Me too, I think its because I have trouble spelling Aspergers.

Thanks for the links, too much info for my (probably adhd) brain right now but I'll review this weekend :-)