We had DS6 tested for IQ and achievement by a private LEP when he was 4 and 5 years old. He is more "mathy", but actually is fairly well balanced Verbal and Non-Verbal according to SB5 and WPPSI-IV. Working memory very high, however, processing speed is relatively (although not dismally) low.

Last year I was thinking maybe dysgraphia because he was very avoidant of pencil-to-paper tasks, but his writing has improved a lot and he has never complained about pain when he's writing. Last year we had an OT eval done, but it was not particularly helpful - I filled out a questionnaire and basically the report was a regurgitation of what I had filled out. OT recommended doing listening therapy (haven't actually done this but may do it, although through a different provider) and providing DS with fidget toys.

The biggest issues are inattention, executive skills, and social skills. He's doing fine in terms of academic achievement because he was light years ahead when he started school, but he is getting into trouble every day for making noises, being off task and distracting others in class. We're pretty sure his teacher doesn't understand him, so we'll be meeting with her soon, but that's a different matter...

I would like to get him evaluated by a neuropsych, but DH thinks it's too early. In the meantime, we have scheduled an assessment for CAPD because he really does fit all the "signs". I'm also leaning towards doing another OT assessment for SPD with a provider that was recommended by the LEP.

Are we wasting our time (and money) by looking at things piecemeal and heading down these different roads? Should DS be doing a neuropsych eval before all these other evals, or is it better to wait until he is a little older? (DS turned 6 in July)

Isn't it also too early for a CAPD assessment? I thought they didn't like to do those until kids were 7 or 8 years old.

We did the piecemeal thing with our son and ended up getting lots of diagnoses that held pieces of the truth but didn't shed light on the whole problem in a unified way. We finally got what I consider the real unifying diagnosis when we went to the Eides after several years of mucking about.

I would definitely choose the neuropsych. An OT will undoubtedly identify sensory issues, but will not be able to tell you whether they are themselves a cause or an effect. Even if CAPD is identified, there's no evidence based treatment out there as far as I know. And you may only be working around the edges of a problem, rather than seeing the whole thing.

A neuropsych should be equipped to consider all the various issues and put the puzzle together for you.

I would also recommend the neuropsych first, so that you have some knowledge of what direction you need to be going before rushing into more of these assume-a-diagnosis type of assessments. What looks like a *sign* of CAPD *might* be a symptom of it - or it might be a symptom of something else - if you look around at various challenges you'll see that many symptoms overlap - plus it's difficult sometimes to actually see a symptom that's clear as a bell to a person who isn't spending every day with your child. I really *really* recommend starting with the comprehensive exam first and then branching off with other evaluations based on what the neuropsych recommends.

Best wishes,

polarbear

Comprehensive evaluation is generally the better way to go, as otherwise specialists only see their little part of the elephant.

And while I know some people have anecdotally-positive experiences with listening therapy, I would caution you that there is negligible research supporting its effectiveness, and some potential for damage to hearing. It tends to be recommended by OTs, who are, I have to mention, particularly prone to fad treatments, as a field.

Yes indeed. We were once told by a school OT that DS's behavior problems were not due to his conclusively diagnosed *autism*, they were due to his *sensory issues*. All trees, no forest.

Thanks everyone for your input. Yeah, I wanted the neuropsych first, but branched out more due to DH's reluctance.

So, is there such a thing as too young or not ready for neuropsych eval?

Anyone here have a neuropsych diagnosis (with a neuropsych experienced with gifted) that turned out to be wrong?

With that set of issues, I'd say that 6 is not at all too young.

I definitely got this feeling when I took DS to OTs. One of them put him on a spinning board for a few minutes each week, and then watched his eyes shaking back and forth. She couldn't seem to give me a logical explanation for why she was doing this. Then they wanted me to take him for vision therapy but couldn't really give me good reasons for that either. Metronome therapy was done on both my kids. It might have been somewhat helpful for DD but DS never seemed to improve. I thought that the activities meant to increase his fine motor skills were helpful, like how they made him cut with a scissors, or made him hold a pencil in his fingers rather than his fist, but otherwise I just had to roll my eyes at some of it. PT for gross motor was much more helpful, IMO.

I took DS to one follow up session with the OT that did the eval. It was about 30 minutes of her giving him different fidget toys to try out, a couple of slides down a short ramp on a board with wheels, 10 minutes of him lying on his stomach on a swinging platform throwing beanbags into a bucket, and discussion about whether I wanted to do listening therapy. I didn't get the sense that he got ANYTHING out of it. Admittedly only one session, but I am not inclined to spend $100/hr and take time off work to have him see someone in whom I felt little confidence.

Yay- I brought up the neuropsych again with DH and told him I really wanted to do it. He said "Go ahead". Then said something to the effect of "I guess you're not going give up on that". Perseverance pays off!

hmm, guess I'm on the other side of this - for us, OT made a big difference, there was an obvious change in DS's behaviour if he didn't go to his weekly session. Our OT let me sit in on every session and answered every question I had happily, and was able to answer all the "why are you doing this" type of questions. We went from shutdown & meltdown every week to "hey, when last did that happen?" And, no, I don't think it was maturity-related...

We did the listening program, and to me DS definitely talked more after doing it (before doing TLP he fit enough symptoms of Expressive Language Disorder that we were going to have him assessed), seems to hear more of what is said around him (vs losing it in background noise, and his pitch is way better (musically). His tolerance for the noises that used to really challenge him also improved.

Yes, this is anecdotal, but just wanted to state that there are people for whom this type of therapy works. I guess a lot of it would depend on your therapist and how good they are, how well they can apply what they learnt vs simply using their bag of tricks as dictated in the textbook for reasons unknown to them (because, yes, we saw one of THOSE OTs too, and that WAS a disaster). I guess it also depends on what's really going on - maybe it worked for use because sensory issues were as deep as it went, rather than just one layer of the onion.

Glad your DH agreed to the neuropsych!

When someone recommends a therapy for my child, I ask "what peer-reviewed research indicates that this is effective?"

It can also be useful to look at quackwatch.com or other sites.

There is a huge industry of snake-oil out there, preying on parents who are worried about their kids.

Anyhow-- Jkim, good for you-- I think you're doing the right thing by pursuing the neuropsych.

I would also recommend having DH spend lots of quality time with DS and other children, if he doesn't already, so that he actually has to manage these issues and sees them more clearly. That way it becomes a shared viewpoint, rather than just "your issue." Taking DS (2e/autism) to Scouts when he was young really helped DH see the challenges DS was facing.

OT worked for two of my kids too - but it worked best (long-term) when it was prescribed after a neuropsych exam where we knew specifically what issues our child was dealing with. Our other OT experience (different child) happened before we took dd to a neuropsych - she was young, 5 years old, and her OT consisted of listening theory, work on muscle tone in her trunk, and various OT strategies to help her feel calm. OT was *wonderful* for her - the listening therapy helped transform her from a child who could not sit still and pay attention in class, and who was highly distracted by background noise, to being a child who was still, calm and focused in class. The thing was though - for all that it worked, it just masked what dd's real challenge was - she wasn't unable to sit still etc due to sensory issues, she couldn't see. The issues with vision caused her huge anxiety, that resulted in behaviors that looked like they were just one big tangle of sensory challenges, sensory OT really did help give her strategies to cope rather than automatically moving into those behaviors that didn't work for her… but they didn't solve the root issue, so instead of a child who was all over the place wiggly not sitting etc (and not seeing), we had a child who was calm, well-behaved in class, seemed to be doing a-ok (who still could not see). So she was able to coast with those strategies for 2 more years before she just couldn't cope anymore, we took her to a neuropsych, and the testing there clearly showed she had some type of issue with visual tasks.

So, fwiw, I think there is something to the listening therapy. It really did help our dd, and it wasn't being promoted by quacks - it was part of therapy provided by a highly respected OT team at our local children's hospital. But any therapy, no matter how well researched etc - isn't going to be worthwhile or effective if it's not being pursued with a thorough understanding of the broad scope of the needs of the child.

Hope that makes sense!

polarbear

Left a message for neuropsychologist this morning - hopefully she gets back to me soon.

DH sees the issues I'm seeing in DS, he just feels it's more "normal" than I do and thinks that DS needs time to grow and figure things out. I think that DS getting into trouble at school every day and making us stressed out every morning and night just trying to get through simple tasks is not something we should wait to resolve.

Good to hear the personal experiences and different opinions about OT, etc. For me, it was mainly the practitioner that turned me off. I gave her another chance even after seeing the "fill-in-the-blank" report, but it was the 30 minutes spent on handing DS fidget toys that really made me feel like it was a waste of time. Him playing with fidget toys in her office was certainly not going to help him.

The audiology appt we booked is at Able Kids in Colorado. Maybe after talking to the neuropsych I will cancel or delay it, but there were several hearty recommendations online and in an email list I belong to. Kai - they didn't have a problem with his age, and actually said it's good to get to the kids before they become too frustrated and start shutting down.

Glad to hear DH is on board with neuropysch. appointment.
What is your school doing to accommodate him academically? Is he being accelerated at all? I just got behavior feedback from DD's teachers last year (1st and 2nd grade) and they reported no behavior problems at all, but noted she needed to be stimulated and engaged to avoid similar behaviors.

"they reported no behavior problems at all"

Ahhh - to dream the impossible dream. For us anyway ....

oh yes, we have our share too. She was in kinder at that time, and she got into trouble for speaking out pretty much every day, but had no complaints when she was sent to those other classrooms.

Fast forward to this year, she is in 1st grade and flips her behavior cards on a almost daily basis.

DS6 was full grade accelerated into 2nd grade this year. The class is also a 2/3 combination, so theoretically he could be working at 3rd grade level within the same classroom (although, that would take the teacher actually allowing him to do so...work in progress)