Psychoeducational evaluation results

[akafred]

Whelp, Charlotte doesn't fit into a box. Shocking, I know. Her only dx out of this is ADHD (but duh). She didn't see anxiety but I def do. What she was able to get out of C in terms of testing shows no specific deficits. Unfortunately she was very uncooperative. She met with C twice in her office and then one more time at school, after having done an hour long observation of her at school.

The initial observation was done on a Wednesday late morning, aka after OT. She worked with a boy on math...and kind of dragged him behind her. (He is a year younger.) But the evaluator said she saw what looked like a very typical little girl working hard on math. She had a little squabble with the boy over who was going to put the work away, but showed no concern about that. In fact she said if I didn't know who I was supposed to observe, I couldn't have told you. No one stood out as really needing to be observed.

Her office was different. Char crawled under chairs, did gymnastics hanging from desks, moved constantly, and was very uncooperative. She came back the second day and really wasn't any better. She said if she (the evaluator) stood on her head she could sometimes get one more answer, but yeah. So she wanted to see if maybe she would be more settled at school, and had some improvement but not a whole lot.

Her basic conclusion is Charlotte is "neurodevelopmentally immature." Not a diagnosis obviously, just kind of a label she gives for kids who don't fit into neat little diagnostic criteria. She said most kids like this go on to mature. Behavior improves first, then they become more settled in general, then school work improves, and within 5 years she will probably be typical except for the ADHD. The kids who don't mature out of it are at risk of a mood disorder (by which she means anxiety or depression). She did go over the dx criteria of ODD and Disruptive Mood Dysregulation Disorder. She did not think she had either but those were closest. The DMDD might have fit 6 months ago when she was on stimulants and her anxiety was bad, but that doesn't really count.

As far as test results go, she tested at near average to above average on all areas. She was clear she thinks this is a floor, not a ceiling, and she is sure it is not indicative of ability. She just couldn't attend well enough to do better. At one point she convinced the evaluator she didn't know what a minus sign was. (!!!!Of course she knows minus!!!!) But it was enough to rule out any specific learning disabilities, especially dyslexia and dyscalculia. Her writing isn't as bad as I feared and she feels like it will come along. The one area of concern is spelling. This is probably a function of Montessori which stresses phonetic spelling longer than traditional school, but I will be watching and doing a little work outside of school on that as well as discussing with her teacher.

She did say that her school is the "perfect" environment for her. She was very impressed with the work the children were doing during her visits, and with the teacher and environment also. For her to say that no one stood out as needing an evaluation in a class where there are probably more kids with special needs than without is really impressive.

[Deleted]

This all sounds like pretty good news to me. What do you think of it all?

[akafred]

It's really good info, and I am super glad to know that we are doing the right things in terms of which school she attends and that kind of thing, and of course it is a relief to know that she isn't showing any signs of any specific learning disabilities. And it was reassuring to hear that she has seen kids like Charlotte who show this kind of non-diagnosable but definitely present neurodevelopmental disorganization, immaturity, whatever you want to call it, and to hear that in her experience the kids almost always outgrow it. So all of that is very very good. It's just a little underwhelming that we didn't get a very good picture of her actual strengths and weaknesses, actual ability level, and so on. She was really clear that she would not want us to share the report as is with a public school system or with anyone who might take that composite score and be like, "Well, that's it, that's this kid." I said the scores must be dreadful, and she said no, they are really not bad, they're average, it's just that she sees a big gap between actual performance, due to behavior and attention and outright refusal, and ability, capability, or potential. She said if we ever needed to submit it anywhere like that to let her know and she would rewrite the cover to be more vague and leave out actual scores. It was also a little disappointing that she didn't have specific strategies to help in the classroom, but it was good that the reason there were no specific strategies is that they are already getting it right. Which she said is usually not the case at all.

[macchiatto]

I can understand having some mixed feelings. Glad it seemed to be positive overall though. Hopefully she is able to outgrow it!

[mrsbuttinski]

No surprise there. I have yet meet a slide who slips neatly into a tidy box. It doesn't happen; there's always an unexpected deficit or superpower or a trait that is significant enough to bring challenges in some situation but not defined or global enough to rise to the level of a dx. And then there's always the moving target that is a developing child.

I'm sort of surprised Char wasn't more cooperative in the testing. She always comes off as a kid who rather enjoys 1:1 adult attention. Perhaps this was anxiety that the evaluator was writing off as non-compliance or defiance. It's not an uncommon MO for brighter anxious kids on spectrum. How was the experience framed for Char? We always put this kind of eval in the context of understanding ways to help DS rather than "judging him.

There seem to be 2 presentations around ADHD IME. Those for whom is does exist as a kind of emotional delay around self regulation and those for whom it is more of a life long set of deficits around executive function. I have had a couple of scouts who were the former- in these instances they were very bright GATE students who were consistently strong academically even when their impulsivity and hyperactivity were at their worst. And then there's my niece (a well-behaved GATE kid) who sailed easily through school, but who got an adult dx because she never fully got onto of the EF piece because she kind of didn't need to as other students might. She didn't get bit in the ass by EF deficits until grad school because she could phone it in. DS's ADHD is significantly better than it was but my mom is as bad as ever. There's hope, but not everyone outgrows it.

What sort of testing did they do? Most of the psychologists here would do psychoeducational to screen for further LD testing, but it isn't usually dxd or R/O based on the usual battery of scales used. Many places won't accept a dyslexia or dyscalculia dx unless it comes from a physician as a medical dx. DS's LD testing was administered by a specially trained teacher and vetted by a neurologist. It was separate from the WISC and achievements tests his regular psychologist did or the ones his school psych did. The WISC itself can be very suggestive of LD issues based on the pattern of PIQ/VIQ scores but it isn't infallible. My one niece has 3 std dev between her PIQ and VIQ which makes sense given her learning issues. DS's Aspergers impacts his WISC subsets in exactly the opposite way his dyslexia does- so his WISC scores look remarkable "normal"- his PIQ and VIQ have been with 2-10 points of each other which shouldn't happen given his dx. Medicated or unmedicated, remediated or non-literate, he tests pretty much in a narrow range. 

I hear you on the concept of floor. DS has always tested lower than evaluators expected given his verbal skills early on and his actual academic performance later

It's great that the evaluator confirmed the suitability of Char's school for her needs. That must've felt good to hear. But commenting on whether other kids were typical or not sort of bugs. It's unprofessional of her to comment to you on the other students outside of perhaps suggesting a learning community isn't an ideal fit. Sometimes such a comment is meant to be flattery and again I kind of side eye it. 

It's great that she'll be willing to tweak it should you need to share it with another school for some reason. Many schools won't accept a report that's more then 3 years old. We did an initial eval in mid-first and then had to repeat it at the end of third when we were considering a different indie school. In public schools, IDEA mandates every 3 years unless there are new concerns prior. 

[akafred]

Her comment about other kids was kind of an afterthought/reassurance. Like not only did Charlotte not stand out, no one else really did either. She commented that she was very impressed how hard all the children were working on their different tasks etc.

Yes, I think Char felt anxiety that drove some behaviors. I couched it all exactly like the psych said to, which is to say that she will ask her to do a variety of tasks, and they are for a wide range of ages so some of them will seem very easy and some of them will seem very hard, and that is ok, just do your best and don't worry if you don't know all the right answers.

The evaluator hasn't sent the full report yet so I don't know all the tests performed yet. I know I saw WISC and we definitely did BASC2 and 3 (parent and teacher). And she mentioned that she did some extra subtests in a couple of areas where the results were unclear.

I think her wording was not so much "rule out" SLD but more "does not show early signs of..." Her reading was good and the only thing she didn't do well in there was the timed test of reading jibberish words. When she didn't time her she did fine. Anxiety again, probably.

My friend whose son has ASD (finally got the dx through the eval) also went through this process with the same evaluator and we got the same speech about the restlessness in her office. She says the "adaptive" behavior is to come into a new setting and be subdued as you check out the person and environment and make sure everything is safe, and the second time the child comes to her office they are usually a little bolder, do some whining and that kind of thing. The behaviors come out. But with "less neurotypical" kids, they display the opposite, being more disruptive at first until they kind of get a feel for how the situation is and adjust to it. She said sometimes they settle in more the second day but C didn't really do that. That is why she wanted to see her at school, because she had been very settled there, to see if she could get better results. And in one test she did significant improvement at school but the others she tried (of course she couldn't recreate 2 days of testing) she only got 1-2 more answers right before shutting down. She said at first C wasn't too thrilled to go with her at school, but then when it was over she didn't really want to go back and even said, "I don't want to go do all that work." Sigh.

I will say her office is just the kind of space where C does not do well for long periods of time. Small space (maybe 10x10), mismatched furniture, floor coloring doesn't match either, lots of built in bookshelves with books of all shapes, sizes, colors fairly haphazardly arranged with other items outside the books kind of all over. Too much visual information to look at (and not at all soothing) in too small a space. I don't really blame C for being distracted and unsettled. She probably would have done much better in a sparse classroom type setting.

Did I mention she convinced the evaluator that she didn't know what a minus sign was and kept calling it "equals"? She absolutely knows what minus is! She prefers plus, but can do minus. (She still has to count forward or backward in her head because she doesn't have all the math facts memorized.)