***Edited to make it slightly less agonizing to read through.

So here's what I've been told about DS 9.

(1) Definitely PG
(2) Possibly mildly AS
(3) Possibly NVLD
(4) Convergence Insufficiency

It has never been suggested, but I feel almost certain after reading and reviewing lists (like this one), that he has DYSCALCULIA. He's "positive" for almost all of the symptoms.

I've always thought that ds leaned toward the NVLD side, but imo,a dx of dyscalculia, and possibly CAPD, would explain much of what makes him look like he has AS.

When I read this page , I don't see how AS with dyscalculia is any different from plain old dyscalculia *in how it manifests*. What am I missing?

The things which make me doubt an AS dx are that he has never even come close to doing ritualized things, as far as I can tell. The only time he has ever had any kind of outburts or uncontrollable (or inconsolable) emotional displays was when he was a toddler. Loud noises (like fireworks) elicited screams of terror. He would climb our bodies to try to get away from the sound. He still startles at unexpected loud noises, including shouting.

He can be passionate and intense from time-to-time, but not so much so that he causes a scene. He's didn't regularly have tantrums even as a toddler --I can only remember one, and that was when asked to leave the library. LOL He's very compliant and follows rules --when he can remember them! There are no obsessive tendencies I can think of.

When looking at the DSM list, this is what I see in regard to my ds:

A. Qualitative impairment in social interaction

• Failure to use non-verbal social skills (i.e. eye contact, gestures, body posture, facial expressions)
  
  He does avert his gaze at times; his face can be quite expressive, but when he's not smiling, he does seem 'flat'; I can pick him out on the playground by how stiffly he runs and walks.

• Developmentally inappropriate peer relationships
  I don't think so, esp. when you take the PG into consideration.

• Lack of spontaneous sharing of enjoyment and interests with other people
  Not at all

• Lack of social and emotional reciprocity
  Not at all

B. Restricted, repetitive and stereotyped patterns of behavior, interests, and activities.

• Preoccupation that is overly intense and narrow
  Never

• Inflexible adherence to non-functional or peripheral routines
  Never
  

• Stereotyped or repetitive motor movements
  I've seen this only during one period of time when we were all under a great deal of stress.

• Persistent preoccupation with parts of objects
  Never. Not at all.

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It seems to me that he wouldn't even qualify for an AS dx at present. To me, dyscalculia and many aspects of CAPD fit him well and I'm leaning that direction instead of autism in regard to pulling together a plan to help him. I'm just wondering what you all think, based on what I've written and your own knowledge or experience of these things.

Is there anything I've written which would still make you still tend to lean toward AS or NVLD, with dyscalculia being comorbid?

Thanks for reading.

I am a novice here so I don't have much to share but your last bit about head knocks puts me in mind of the neuro-psychiatrist Dr. Daniel Amen and his work doing SPECT brain scans in his practice. I find his work fascinating and we sought out one of his clinics in investigating our son's issues with good results. I like how he SHOWS the diagnosis in the SPECT pics and doesn't simply rely on subjective checklists. His website is www.amenclinics.org.

Thank you. I actually called the neuropsych earlier in the week to see if he thought a scan was warranted. Though thinking about it now, I'm not sure that knowing that we had a TBI issue going on would really change much.

I think I may be getting down to the nitty-gritty of the issues on my own, so maybe we'll just have to go with what we presently know and see if we can find things to help him ourselves. It's just been so difficult getting to this place because of the self-education that's had to take place and the ever-changing, multifaceted nature of ds' issues. I think that I was hoping to find someone who really understood ds' struggles and could say 'yea' or 'nay' --you know, something concrete, and something accurate. I just don't like the idea of assuming it's one thing and wasting even more time, but... you do what you have to do, I suppose, and keep moving forward.

Mom2MRQ, what standardized testing has he had so far? Has he had a neuropsych workup before? How recently?

And what symptoms are you seeing that concern you? You've told us what you don't see- what do you see?


I'd say the best way to get sure about this is to get standardized test results that seem to you to be accurate-- that is, they reflect the assets and deficits you see in real life.

In the meantime, I would treat symptoms by going to professionals who help manage those things.

DeeDee

I'm curious if he is positive on dyscalculia traits relative to his overall intelligence profile or is he particularly impaired when reasoning with quantities?

Like is he showing a 160 Verbal IQ but a 70 in mathematics?
Or is it more a question of standard deviations, like 160 verbal and 115 in mathematics?

Or is it more about secondary symptoms like losing track of time or visualizing mechanical systems?
Can he glance at 8 pennies and tell it's 8 without actually counting them? What about with one eye closed?

It definitely seems that there can be a cascade of symptoms all branching from convergence insufficiencies and other impacts on core visual processing systems. We have seen a ton of turn-around after DS's patch therapy for his lazy eye, but overall his visual system is delayed but catching up.

Mom2MrQ - you know what missing for the DSM? "Neurologically odd - not otherwise specified"...

Looking at your OP I want to put out there that when our DD was diagnosed there were criteria that we didn't think she met, but when asked the right questions in fact she absolutely did, and other things we thought were very aspie that the professionals weren't at all interested in. It was an interesting experience. And different professionals were interested in different things. I have a particularly vivid memory of telling a story about my three kids , trying to convey a particular point about my DD who has Aspergers, the paed wasn't very interested in my point at all, but went into a lengthy spiel of his own about how something completely different he pulled out of the story was a brilliant indicator of her issues.

Ok coding 5! When all those scores are so high that is quite a big red flag! go find the old thread about the coding 5 club. I'm on my phone or I'd find it for you.

For his PSI to be 123 with coding 5 the other PSI subtest (symbol search?) must have been high, making coding his only weak point in the whole test (??). And I can't see how a child with major auditory processing issues could score 141 for WMI either. Could that auditory attention test have been spoiled some how?

I'd be looking for a visual motor issue myself... And introducing an iPod or similar for time and task management.

That auditory attention line in red must have a typo, 97 is not the 3rd percentile? But all those others that are low (in assuming you only shared the low stuff) seem more visual or visual/motor than auditory? I don't know that much about the WJ Cog though.

I was part of that thread when it got going --and am still trying to get to the bottom of things. One thing that I recall coming up on the thread which was quite interesting was the fact that so many of the Code 5 Club had convergence insufficiency.


Cancellation was substituted for coding --I just threw it out there because it was so low.

(Edited: numbers removed)


Yes, I agree that it seems like something along those lines would be the way to go. I tried a watch with a timer, but... err... he has to remember to set it and use it and all of that. When I get the energy to start training again, I guess that's what we'll deal with next.


I'm so glad you pointed that out. I knew that didn't look right, but I just didn't 'see' that. So, I wonder where it would fall.

I agree with you on the visual/motor issue. I've seen that since his first IQ battery. However, an auditory component seems to keep popping up when they try to narrow things down. The thing I see at home is that he sometimes confuses similar sounding words. This happens a lot more when he's not used to the person's speech, and when there is a lot of background noise.

Thanks for your input.

It seems like you have a ton of data. I personally wouldn't be satisfied without most of his symptoms pointing to one main diagnosis. The slow walk, bent arm, and palilalia sure sound like primary symptoms that would fit together in some distinct way.

From my side I was fishing to understand if his distinct set of gifts and challenges fit mine or possibly my son's (but they don't so much.) For visualizing mechanical systems, I was thinking along the lines of being able to describe the connections in a motor or to know that if one cog rotates one way, then another rotates another way. Basically internal mechanical aptitude contrasted to what vision or dexterity might limit outwardly.

Numerical awareness seems to have a specific area of the brain associated with it. In addition to it's contribution to math, a basic guage of it is the ability to sight compare quantities and judge quantities without counting. As my son is slowly building out his visual associated skills; things he had problems with visually like judging quantities are coming up to speed. Since his impact was with eye coordination, his functionality was significantly better with his good eye than with his bad eye or both eyes together.

Mom2MrQ - you mentioned that your ds fits many of the symptoms on the dyscaculia list you linked - but did you mention which specific items you're seeing? I'm sorry if I missed that in the replies, and don't mean to cause you extra work in all of this, but the reason I ask is two-fold: first, there are many symptoms that overlap between different types of diagnoses that are associated with impacts on academics (dyslexia, dysgraphia, dyscalculia in particular have many shared symptoms). My ds is dysgraphic and does not have dyscalculia, but I can check off quite a few symptoms from that list which I understand to be due to his dysgraphia (for instance, difficulty telling direction). Second - I tend to doubt your ds has dyscalculia based on his WJ-III math achievement scores. The only "low" score (and it's very relative) is the math fluency test - and that's a timed test, which you often see lower scores on for children who have low coding scores on the WISC (also timed). The issue causing both of these scores might be nothing more than slow handwriting speed.

The other thing I'll throw out there to totally confuse the issue with auditory attention - my dd who has vision challenges first *looked* like a child who had auditory challenges - she couldn't stand to be in a room with loud noises (not really all that loud - the tv at regular volume used to cause her to scream and we couldn't even *think* about turning on the vacuum cleaner while she was in the house), she freaked out in places where there were a lot of people and it was *loud*, and when she started in early elementary school she couldn't hear the teacher talk because the background noise in the room sounded so loud to her. She went through an auditory listening therapy program when she was in kindergarten, and that helped her learn how to filter out background noise and also helped her focus on her schoolwork. She continued to seem to have difficulty hearing though because she seemed to be unable to follow multi-step directions and didn't remember things we'd gone over with her etc and was still somewhat sensitive to noises none of the rest of us could hear. All of that went away when.... she had vision therapy... so I suspect at least a small part of what we were attributing to a hearing challenge was actually somehow related to her vision challenge.

Re the auditory attention score on the WJ-III - if the 97 score and the 3rd percentile is what's written on the report you have, I'd check back with the person who scored the test to be sure you have the right number for the 97 - I suspect that #s correct and that the 3rd percentile is the error, but you'll want to know for sure. If the 97 is correct, that's 3 points below 100, which is the mean for the WJ-III - so the score is just right about at the 50th percentile - which is still relatively low compared to the other scores. The other thing I'd do is to google a specific definition (or ask the tester) re what that subtest measures and how it's administered. That should give you a clue to what may be a relative weakness.

Best wishes,

polarbear

ps - the visual matching subtest on the WJ-III is very similar to coding on the WISC, so the relatively low scores there make sense... and both of those could definitely be vision-related.

pps - this may be tmi and hopefully won't sound disgusting and rude or whatever... but... my dd who had the listening therapy also has incredibly hard ear wax... it slowly builds up in way that we really can't see it and she's had to have it cleaned out at her ped's twice... cleaned out in a big way... and her hearing has improved dramatically both times Definitely not the full issue she was dealing with, but if you haven't had that checked and you're worried about hearing issues, it might be worth having your ped look at. I may come back and erase this so that my dd never knows I wrote it lol! But fwiw, her ear wax is different than my other kids' wax. Can't really figure out how to explain it, and I'm definitely *NOT* posting a picture.. but.. a picture would help to explain. YUCK... that's the last you'll hear on that subject from me

I agree, and those things can't be explained away as 'gifted quirkiness'. (Or can they? LOL)

I'm not sure how to answer that. If he knows how something works after having read about how it works, he can explain it well enough, but he's not great at walking up to something and figuring it out on the spot --at least I don't think so. Even when he builds and constructs things, which he likes to do, he doesn't use the best logic, imo. This is one area where I can clearly see that his mind works differently. It seems to me that he's more into the creative side of things than the functional side, though he does like to try to make things that work correctly. It just seems that he can't 'see' how to do that.

Heh, my youngest daughter needs to get her ears scraped out by the ENT every 4-6 months. Her speech noticeably devolves.

This symptom list is copied and pasted from http://www.dyscalculia.org/ I'm going to copy the things which apply to him, and strike those things I do not see. If it's a major issue for him --if it especially applies --, I'll put it in bold.

------

• Normal or accelerated language acquisition: verbal, reading, writing. Poetic ability. Good visual memory for the printed word. Good in the areas of science (until a level requiring higher math skills is reached), geometry (figures with logic not formulas), and creative arts.

• Mistaken recollection of names. Poor name/face retrieval. Substitute names beginning with same letter.

• Difficulty with the abstract concepts of time and direction. Inability to recall schedules, and sequences of past or future events. Unable to keep track of time. May be chronically late.

• Inconsistent results in addition, subtraction, multiplication and division. Poor mental math ability.[....] May have fear of money and cash transactions. May be unable to mentally figure change due back, the amounts to pay for tips, taxes, etc.
  Poor with money and credit. Cannot do financial planning or budgeting. Checkbooks not balanced. Short term, not long term financial thinking. Fails to see big financial picture. Note: Financial planning to the above degree isn't something he's been exposed to, so I'm nixing it based on lack of exposure.

• When writing, reading and recalling numbers, these common mistakes are made: number additions, substitutions, transpositions, omissions, and reversals.

• Inability to grasp and remember math concepts, rules, formulas, sequence (order of operations), and basic addition, subtraction, multiplication and division facts. Poor long term memory (retention & retrieval) of concept mastery- may be able to perform math operations one day, but draw a blank the next!
  
  May be able to do book work but fails all tests and quizzes.
  
  Note: He doesn't fail all tests, but it is rare that he gets all bookwork or quiz questions correct. His mistakes are almost always due to being off one number or reading the wrong sign. Sometimes, when we do oral math, he will blurt out an answer, then immediately catch himself and correct it --and usually he's correct with the correction, but not always. Then there are times when he knows it's wrong, but he can't quite 'get to' the answer. I stopped timing anything with him because he would have a complete meltdown and couldn't even think straight.

• May be unable to comprehend or "picture" mechanical processes. (Note: I addressed this in a previous post. I'm not sure if he's bad at this, or simply average.)
  
  Lack "big picture/ whole picture" thinking. Poor ability to "visualize or picture" the location of the numbers on the face of a clock, the geographical locations of states, countries, oceans, streets, etc.

• Poor memory for the "layout" of things. Gets lost or disoriented easily. May have a poor sense of direction, loose things often, and seem absent minded. (Remember the absent minded professor?)

• May have difficulty grasping concepts of formal music education. Difficulty sight-reading music, learning fingering to play an instrument, etc.

• May have poor athletic coordination, difficulty keeping up with rapidly changing physical directions like in aerobic, dance, and exercise classes. Difficulty remembering dance step sequences, rules for playing sports.

• Difficulty keeping score during games, or difficulty remembering how to keep score in games, like bowling, etc. Often looses track of whose turn it is during games, like cards and board games. Limited strategic planning ability for games, like chess.

Thanks again for your ideas and insight.

Quick thought, I could be wrong but it looks to me like his processing speed is declining relative to peers with age? All the processing speed tests trended down over the two year gap? The younger you are the less fast you have to be to look good against peers and cognitive ability being ahead would have given him a boost. The older kids get the more I wonder whether visual/motor speed is the bigger factor in doing well on PSI tests? Actually WMI was trending down too. Can you ask an expert about that?

That's something I was curious about, too. A frustration is that ds has been seen by different people in different settings each time. I wish I had more confidence in the results, but when I see the numbers changing so much, I don't know what to think. Last week I was toying with the idea of sending his records to A*end to review. He's good with the g and 2e issues, and he tested ds previously.

So have you gone through similar lists for dysgraphia and dyslexia and developmental co-ordination disorder? So many of these lists overlap. I am still going with "paediatrician didn't decide, neurologically odd son"... I'm not really suggesting PDD-NOS, but while I am no expert on dyscalculia I look at that list and I think all the stuff you've highlighted is too easily applicable to other conditions too. But pretty much all of it could be down to major visual problems weirdly overcome by a PG child - causing some quirks in other areas of development along the way as he tries to compensate.

Ideal auditory development is reliant on ideal development of the other senses too (surely?). I know blind people are supposed to be able to develop more acute hearing etc, but one wonders if whatever causes a visual processing difference (in the presence of "normal" vision) prevents a straightforward compensation via another sense.

My DD with CAPD, when tested at 7 by the OT for global sensory development had highly, highly developed visual skills in some areas (compensating for auditory weakness), most glaringly her visual speed was about 5 times her auditory speed (pressing a button in response to visual or auditory input), her visual was well above average, her auditory way below. So she definitely was stronger in some ways visually, compensating for the auditory deficit, BUT she also had some particular visual deficits, which I am guessing were either areas that needed better auditory skills to develop normally OR were impacted by the same root causes as the auditory issues... The OT got to the end of the visual tests and said "I can tell from these tests that she's amazing at Where's Wally and cant read."

Me again. Sorry to keep adding these random thoughts in dribs and drabs. My DD with CAPD is also dyslexic (and has AS). When we were first looking at the dyslexia something we were told was that dyslexia is now considered primarily an auditory problem (ie with hearing the sounds in words, phonemic awareness, phonetic awareness, and in my DDs case a major problem with the ability to sounds/concepts to symbols, but I read something yesterday that made me think this part was the AS at work). My DD did not particularly have problems with reversals etc, she simply did not comprehend the idea of symbols for sounds/concepts AT ALL, it was like the words weren't on the page. And she has major sequencing issues.

My DD has overt auditory processing issues, subtle visual issues and it adds up to dyslexia. I am intrigued that your son seems to possibly have a similar, yet kind of opposite pattern.

I see your son is 9, my DD mentioned above really started integrating and overcoming at about 9. She's improved dramatically 9-11. Which has been both miraculous and also illuminating in terms of the underlin issues that remain. My DH was a late bloomer, as was I, I can think of other friends too who were in remedial everything in lower primary and took of like a rocket somewhere around 5-7 grades. I wonder if this is a common 2e thing. The 2e is still there, but less crippling. Which leaves you to figure out - what does he need to know about himself to best support and maintain a happy and healthy adult life? It might not be the overt symptoms of his younger years. Though it may be related (same causes). That's not very diagnosic or practical I know. Just musing on his progress in areas you hadn't noticed (counting objects).

I'm glad that you posted this. I've heard others say this before, so I'm hoping we see it here too. I DO feel he has improved a lot in the past year.

Oh gosh, that's hard.