Gifted Issues Discussion homepage Forums Twice Exceptional Competing diagnoses - help prioritizing

elsie - it's really tough when you have multiple evaulations and professionals all weighing in with different opinions. FWIW, my belief is that the way to trudge through all of this is to always listen to your own gut instinct as a parent - I believe that most of the time parents' instincts are right on target - we're the people who know our child the best, who've spent the most time with them, and who have their best interests at heart. It gets complicated because as parents we don't have all the knowledge that the experts do, but as time goes by and you collect the data, you filter the data you receive with your instincts about the evaluation itself or the person who did the evaluation, or the circumstances of the evaluation etc - and then move forward with your instinct as a parent re which direction to choose and which advice is most meaningful.

Just curious - could you post your ds' NEPSY scores? Those scores might be telling re whether or not there is either a fine motor or executive functioning challenge going on.

polarbear

Elsie, the thing I found most helpful when trying to figure out what on earth was going on with my 2E child was reading the books:

"Disorganised Children: A guide for parents and proffessionals" http://www.amazon.co.uk/Disorganised-Children-Guide-Parents-Professionals/dp/1843101483

And also the Misdiagnosis and Dual diagnosis book. The first book was the most useful as it was fully of issues that my DD clearly did NOT have and gave me some confidence in myself, that no, I did NOT imagine my child had every condition I read about. Conversely the details provided about a number of issues which she at least leans towards provided information that I had not read previously (which turned out to be major clues) and also came together as a pattern. When I latter talked to a local psychologist who is a specialist in girls with Aspergers and mentioned to her about the chapters I HAD marked in this book as "maybe an issue", as compared to those I had not, the expert response was "Well those are ALL co-morbidities with ASD, or they are what an OT might call the aspects of ASD that they deal with, everything you have identified I expect to see in, or am not surprised to see, in a child with Aspergers. You aren't seeing xyz different conditions, you are seeing multiple aspects of a global neurological difference".

I guess how it seemed to me was that with a very high functioning girl on the spectrum that each professional came in and saw a slightly odd or borderline presentation of whatever they most commonly looked for. Very few were looking as globally as I was, and there are no girls experts in my own city. Without the research I did myself I would not have ended up figuring out what it all meant...

My point being that with very bright children who clearly do have problems but have different presentations with different people/environments or have atypical presentations of their issues YOU will be the one that has to figure out which aspects are "real" (not transitory behaviour like jumping on and licking couches because it's been encouraged by a third party), which are most important and what forms a pattern that makes sense. And then maybe try to find one (or more) experts you trust to actually know whether you are or are not on the right track there.

This sounds oh, so similar. We have the Misdiagnosis and Dual Diagnosis book and I will look for the other.

polarbear - yes, we finally have the written report with scores. Diagnoses are ADHD and Developmental Coordination Disorder. The latter sounded very odd to me (and surprising as it did not come up in our meeting). The neuropsych says she codes fine motor deficits this way to increase the chance services will be covered.

Last year's WISC, with a tester he liked, showed VCI at 99.9th percentile, PRI at 99.7th, WM 91st, PS 58th.

NEPSY scaled scores, percentiles, classifications:

ATTENTION AND EXECUTIVE FUNCTIONING

Animal Sorting Total Correct Sorts
7, 16% (borderline)

Animal Sorting Total Novel Sort Errors
--, 26-50% (at expected level)

Auditory Attention Total Correct
12, 75% (at expected level)

Auditory Attention Combined Scaled Score
11, 63% (at expected level)

Auditory Attention Total Omission Errors
--, >75% (above expected level)

Auditory Attention Total Commission Errors
--, 11-25% (borderline)

Response Set Total Correct
15, 95% (above expected level)

Response Set Combined Scaled Score
10, 50% (at expected level)

Response Set Total Omission Errors
--, >75% (above expected level)

Response Set Total Commission Errors
--, 26-50% (at expected level)

AA vs RS Contrast Scaled Score
10, 50% (at expected level)

Clocks Total Score
11, 63% (at expected level)

Design Fluency Total Score
8, 25% (at expected level)

Design Fluency - Structured Array Score
11-25% (borderline)

Design Fluency - Random Array Score
26-75% (at expected level

LANGUAGE

Comprehension of Instructions Total Score
11, 63% (at expected level)

Phonological Processing Total Score
12, 75% (at expected level)

Speeded Naming Total Correct
11-25% (borderline)

Speeded Naming Total Self-Corrected Errors
6-10% (below expected level)

Word Generation-Semantic Total Score
17, 99% (above expected level)

Word Generation-Initial Letter Total Score
15, 95% (above expected level)

WG Semantic vs Initial Letter Contrast Scale Score
12, 75% (at expected level)

MEMORY AND LEARNING

Memory for Designs Total Score
16, 98% (above expected level)

Memory for Designs Content Score
17, 99% (above expected level)

Memory for Designs Spatial Score
16, 98% (above expected level)

MD Content vs. Spatial Contrast Scaled Score
14, 91% (above expected level)

Memory for Designs Delayed Total Score
17, 99% (above expected level)

Memory for Designs Delayed Content Score
15, 95% (above expected level)

Memory for Designs Delayed Spatial Score
15, 95% (above expected level)

MDD Content vs. Spatial Contrast Scaled Score
14, 91% (above expected level)

MD vs. MDD Contrast Scaled Score
13, 84% (above expected level)

Memory for Faces Total Score
9, 37% (at expected level)

Memory for Faces Delayed Total Score
9, 37% (at expected level)

MF vs. MFD Contrast Scaled Score
10, 50% (at expected level)

Memory for Names Total Score
11, 63% (at expected level)

Memory for Names Delayed Total Score
10, 50% (at expected level)

Memory for Names and Memory for Names Delayed Total Score
11, 63% (at expected level)

Narrative Memory Free and Cued Recall Total Score
10, 50% (at expected level)

Narrative Memory Free Recall Total Score
9, 37% (at expected level)

Narrative Memory Recognition Total Score
51-75% (at expected level)

NM Free and Cued Recall vs. Recognition Contrast Scaled Score
10, 50% (at expected level)

SENSORIMOTOR

Fingertip Tapping-Dominant Hand Repetitions Completion Time
2-5% (below expected level)

Fingertip Tapping-Dominant Hand Sequences Completion Time
51-75% (at expected level)

Fingertip Tapping-Nondominant Hand Repetitions Completion Time
2-5% (below expected level)

Fingertip Tapping-Nondominant Hand Sequences Completion Time
11-25% (borderline)

Fingertip Tapping-Dominant Hand Combined Scaled Score
6, 9% (borderline)

Fingertip Tapping-Nondominant Hand Combined Scaled Score
4, 2% (below expected level)

Fingertip Tapping-Repetitions Combined Scaled Score
3, 1% (well below expected level)

Fingertip Tapping-Sequences Combined Scaled Score
9, 37% (at expected level)

FT Dominant Hand vs. Nondominant Hand Contrast Scaled Score
4, 2% (below expected level)

FT Repetitions vs. Sequences Contrast Scaled Score
12, 75% (at expected level)

Imitating Hand Position - Total Score
10, 50% (at expected level)

Imitating Hand Positions - Dominant Hand Score
26-75% (at expected level)

Imitating Hand Positions - Nondominant Hand Score
26-75% (at expected level)

Visuomotor Precision Total Completion Time
14, 91% (above expected level)

Visuomotor Precision Total Errors
11-25% (borderline)

Visuomotor Precision Combined Scaled Score
8, 25% (at expected level)

SOCIAL PERCEPTION

Affect Recognition Total Score
10, 50% (at expected level)

Theory of Mind Total Score
>75% (above expected level)

Theory of Mind Verbal Score
>75% (above expected level)

VISUOSPATIAL PROCESSING

Arrows Total Score
12, 75% (at expected level)

Design Copying General Total Score
>75% (above expected level)

Other assessments:

BASC - clinically significant for hyperactivity, anxiety, withdrawal, adaptability

Conners' Rating Scale - significant for Inattention and Hyperactivity/Impulsivity

Gilliam Asperger's Disorder Scale
Overall <1%
Social interaction <1%
Restricted patterns of behavior <1%
Pragmatic language skills <1%
Rigid cognitive patterns 5%

Woodcock-Johnson III Tests of Achievement, normed for grade 2.0, grade equivalent/percentile:

Brief Achievement 3.8, 97%

Broad Reading 4.7, 97%
Broad Math 3.3, 96%
Brief Reading 4.5, 96%
Basic Reading Skills 4.4, 94%
Brief Math 3.4, 96%
Math Calc Skills 2.9, 90%
Brief Writing 2.6, 76%

Academic Skills 3.5, 96%
Academic Apps 3.6, 95%

Letter-Word Identification 4.9, 97%
Reading Fluency 5.4, 98%
Calculation 2.9, 92%
Math Fluency 2.9, 85%
Spelling 2.5, 74%
Passage Comprehension 3.8, 91%
Applied Problems 3.8, 97%
Writing Samples 2.9, 77%
Word Attack 3.7, 83%

He was extremely uncooperative during the Woodcock-Johnson - some of the specifics are funny if I'm in the right mood. Somewhat more cooperative during the other assessments.

Thanks for posting the scores elsie - I don't have time to look at them right now but will take a look tonight. My ds also has the "Developmental Coordination Disorder" diagnosis and fine motor deficits related to it. DCD is also frequently referred to as "Dyspraxia" so if you are interested, you can google Dyspraxia + Symptoms etc and possibly see if any of it sounds like your ds. Be forewarned - dysgpraxia (DCD) impacts people in *many* different ways and in a wide variety of degrees - so you'll most likely find long check-lists and will only be checking off a few symptoms. It has been interesting for us, however, to watch that list of DCD symptoms over the years, because there were things going on with our ds related to DCD that weren't obvious until he matured a bit. Other things got better over time too.

I also wanted to say - those are awesome WJ-III Achievement scores for a kid who was supposedly jumping all over the couches and not relating to the neuropsych!

More later,

polarbear