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any Ed Psychs about? (or similarly super-knoweldgeable types) LONG SORRY!

(15 Posts)
Handywoman Tue 29-Jan-13 16:58:06

Just back from a (fairly lengthy) meeting at school with SENCO and CT. SENCO has spent the afternoon assessing dd2.

She is 7yrs 10months (Y3) has a history of severe language delay and behavioural/social communication problems, non-literal language on 1st centile - assessed by excellent private SaLT - and is awaiting assessment for ASD.

School wise her decoding skills are excellent but her reading comprehension has stalled and she now hates reading BUT is now having quite a bit of intervention (yey!) to help her move on. So far so good..... (intevention-wise).

So my question is: SENCO assessed her processing speed (suspected to be slow, dd is über-easily distracted and needs extra time to process instructions and gets her knickers in a twist keeping up in class spelling tests, although her spelling is good). At home she will go ballistic if someone interrupts her thoughts or her talking. She often needs re-focussing back to a task and does not keep up with group reading sessions, because of ?processing ?attention ?distractibility.

This assessment today was a timed exercise in naming things seen or read from a piece of paper. There were two types of naming tested. One was the naming of streams (rows) of numbers. The other was naming pictures of house/hat/ball in different combinations in rows.

The outcome of assessment was: numbers was excellent and speedy. Pictures was very slow and almost at the level qualifying for extra time in SATs. It was a massive discrepancy.

Trying to get the bottom of the reading issues (and of dd2 in general) does anyone know what this discrepancy might reveal? SENCO is going to speak to the Ed Psych when she comes next week and will report back.

Does anyone here have any experience of this and what it might indicate? Is it a specific phonological processing problem? In which case why is she so good at decoding words?

Clutching at straws, in the dark as usual........ be really really grateful for some help or input, similar experiences or just Honks would do <sigh>

ilikemysleep Tue 29-Jan-13 23:39:36

Lots of issues here...

Kids with attention issues / adhd type problems often have very high processing speeds, I wouldn't necessarily expect slow's like a wheel that spins too fast and bits fly off inefficiently, rather than a slowly spinning wheel...

Could ask why SENCo is assessing when she doesn't really seem to understand what she is asssessing or what the tests are measuring, specifically. I would guess there will be some kind of manual with the test kit that goes into more detail about what each subtest measures specifically and what a low score on tests mean. However, without knowing the test she has used and not recognising the description of the tests, my guess would be:

Reading numbers - once number symbols are overlearned and especially assuming we are talking single integers- very small amount of possibilities (Just 0 through 9), basically a verbal fluency task. The only things that could slow you down would be not knowing the number names, stuttering / stammering, or very slow visual decoding which is pretty unlikely with something as simple as a previosuly learned number shape (but imagine they were Roman numerals, they take longer for us to process as we have to 'work each one out', that's the sort of process I'm talking about).

Naming pictures - completely different task. Requires more visual analysis (probably not a huge amount assuming pics are simple), requires matching of picture to verbal label, requires efficient 'finding' of verbal label. She could have her verbal labels inefficiently stored, may struggle to retrieve them. So could be a stoarge or retrieval problem. She could also need auditory signalling and not be good at visual analysis (is it a pineapple or a hand grenade?) . Could be a verbal fluency issue too, there are more possibilities to get it wrong (is it a duck or a chicken? or a sink or a tap? or a monster or monstrous?)

My guess would be, her processing of language isn't slow because her processing speed is slow. Her processing of language is slow because her language storage and or retrieval is inefficient and her language overall is delayed and / or disordered as you say. What they have probably demonstrated is that in the absence of heavier language demands, her processing speed is very good, but that she needs a simplified language environment and more time for responding verbally because of her language needs. (Which, TBH, they probably knew already from the SALT report?!...!)

Let me know what the school EP says smile

Handywoman Thu 31-Jan-13 10:22:03

ilikemysleep thank you thank you thank you thank you!!!! I massively appreciate your reply.

I was thinking, like you, that these two sorts of naming are pretty different beasts. So thank you for that.

But the strange thing is that dd2 does not have any problems with word finding. There is no 'er.... um... thingumybob' to her expressive language. However, her expressive output can be on the slow side and sound as though she might be needing time to process her thoughts. Our excellent SaLT has actually noted this in her report on dd2 when she aged 5. The main feature of her expressive language in her SaLT assessment (Sept 2012 aged 7;6) was poor conversational skills (not realizing when someone is confused by what you say, going off topic, on tangents, poor expectations of what somebody needs to know e.g. when someone asks you to describe a cat).

So up til this point it seems somewhat plausible, this slow naming task, that there is a verbal processing issue or language issue. Until you factor in that dd2's broad language skills tested by SaLT in Sept: vocabulary (including retrieval) use of grammar etc. are age-appropriate and are no longer delayed (caught up with 9 months of intensive 1:1 SaLT weekly with support +++ at home with language and listening skills e.g. getting her in the habit of using eye contact). They are normal save for 1st centile for non-literal language/poor conversational skills.

Add to the mix that last night she went back to Oxford Reading Tree (Allstars) after school agreed to provide dd2 with a tailored selection of books. In contrast to most of her KS2 texts (more direct speech, requiring more inference) dd2 rattled this ORT book off in one fell swoop, reading speedily and fluently, with understanding and enjoyment. It was 41 pages long. She read it in 20 minutes.

The difference between the texts is only the amount of higher-level-language, but the difference in dd2's ability to access the text is stark. It is like night and day. To me this would suggest her problems are caused by ASD rather than SpLD and are more line with the SaLT assessment.

I am indeed angry with the SENCo for administering the test and not knowing what the result means. I couldn't say this because our relationship is fragile (this SENCo demonstrates zero self awareness and has still not apologised for telling me that my dd1's maths difficulty is caused by me transferring my own anxiety on to dd1, rather than her moderate Dyslexia). BUT this assessment has nonetheless caused me to wonder where we are going next.... perhaps some sort of auditory processing issue or SpLD not ASD. SENCo had the gall to recommend Johansson Sound Therapy on the basis that she did it for her kids! The fact that she is making recommendations based on tests she does not fully understand rather irritates me. I suppose I am lucky in the sense that the teachers recognize that there are definite problems with dd2 and curriculum. If that were not the case then lord knows where we would be...... she believes her SENCO-ness means she is the expert at fricking everything and without the teachers my opinion would count for zip cause she is rubbish at truly listening to parents. She felt no embarrassment at administering a test which left us all sitting around going 'ummmmm'. I was not impressed.

Dd2's developmental Paed asked school to have dd2 assessed by an Ed Psych back in June but this never happened (Ed Psych was reluctant to see a child who achieved 2b across her Y2 SATs.....pesky SATs!!). But now, based on this '?discrepant' result(is it?) Ed Psych assessment is back on the cards but will not happen before our next appt with Developmental Paed: therefore 8 month delay and not going to form part of our planned Paed review.

I am pretty depressed and stressed out at the moment with dd2's issues (its's not obvious is it hahahahaha) and feel that since 15 months old I knew something was different about this girl of mine. Now that educationally a rather noticeable gap has appeared, I am desperate for something more concrete than never-ending cycle of appointments, questionnaires and assessments. This is our second time under Developmental Paed! I felt that we were one step closer to getting an ASD diagnosis but now I am not sure. I've been considering a private Ed Psych to do an ADI-R/ADOS because I want to fully understand the context of dd2's social and educational issues (NHS MDT assessment not due til Aug/Sept). Am now wondering whether this Ed Psych should do a WISC or ASC assessment rather than an ADI-R/ADOS.

Should I ignore this annoying (if well meaning SENCo) and just crack on with ADI-R/ADOS with private Ed Psych? If you got this far then

1. please do feel free to tell me what a fine example I am of someone with kids with SEN driving themselves barking mad and

2. thank you so much..... <slopes off in search of valium>

Handywoman Thu 31-Jan-13 10:54:50

ps ilikemysleep I will let you know what the feedback is from school's Ed Psych (but am not holding my breath, since these tests are not necessarily discrepant).

<continues in search for valium>

Handywoman Thu 07-Feb-13 00:38:45

So ilikemysleep Ed Psych say yes slow processing, presumably related to language load. But this was not the main emphasis. Ed Psych seems to have identified anxiety as the cause of her being so distracted/easily bothered by sound/getting upset in class. i think she is spot on.

Ed Psych has suggested a raft of interventions most notably ear defenders, visual prompts for expressing emotions and for planning and executing written work.

Basically I think Ed Psych has pointed school along the lines of community Paed ie potentially ASD.

I hoping we can re commence with private SALT and therefore feel our way forward with dd2's language....

KeepOnKeepingOn1 Thu 07-Feb-13 12:21:25

Handy - did the EP do WISC-V or the nferNelson Insight Primary self esteem measure or MALS (myself as a learner)?

pinkorkid Thu 07-Feb-13 12:34:01

I was just going to suggest the wisc -v, as keepon did. It makes much more sense to have a comprehensive overview of all skills and deficits rather than senco just picking one area and then not being sure how to interpret it.

Miggsie Thu 07-Feb-13 12:46:27

Hi, my friend's child is like this - very fluent reading but struggles to make sentences (he is also ASD).

The difference seems to be decoding the words - you need to know about word sounds and letters - and the formation of sentences. Once a word is known I suspect your DD will know it always - as she will have a very good retention memory, but she cannot then use them to form sentences.

The skill of reading a set of written words, and the skill of spontaneously forming words you know into a coherent sentence is a massive leap. If you think that we have words and we all know them, but any sentence we speak is unique - never heard before- sentence that we have formed from those basic words and grammar rules. We take semantic meaning and then put it into a sentence. This ability is extremely complex, but because most people acquire language, both receptive and expressive simultaneously we don't actually appreciate how complex it is. So I think the issue here is expressive language (how we speak to others) - it appears to be way behind receptive language (how we recieve speech and writing from others).

My friend's child struggles with any form of conversational speech. He has learned a set of phrases which he needs for everyday life such as "please can you open this for me?" or "please would you pass me..." which he has learned by heart and can say very well. He struggles to form any spontaneous sentence - particularly in response to "why?" questions. If given a list of options he is able to pick one without any problems.

Sadly, he has not had enough speech therapy to make a difference to his condition, the school seems to think "it will get better on its own", which it patently isn't.

I do know that children whose receptive language is fine but expressive language is very poor respond well to music and forms of music therapy.

I would get a good speech therapist - not just to assess but to actually do some language formation practice. I suspect your DD will need lessons in expressive language in English the same way we would learn Spanish or Japanese.

KeepOnKeepingOn1 Thu 07-Feb-13 12:59:09

Have you considered auditory processing difficulties? DS1 has APD and SpLD as well as ASD.

I would make sure that the EP is thinking ASD related anxiety (secondary) rather than primary anxiety. Nice and cheap. We wasted several years in that particular cul-de-sac.

Handywoman Thu 07-Feb-13 13:04:46

pink and keepon you are absolutely right, no these were not done and it is crap.

I do get irritated by this SENCo. We had a run in this year over her comments blaming me for Dyslexic dd1's maths difficulties and I complained to the governors. These issues were apologised for 'clarified' with HT and Govs but she has never commented - she acts as though these comments were never said although she doesn't deny them either. We carry on as though it never happened.....(!)

Last June dd2's Paed explicitly asked for an 'assessment of dd2's skills profile across the curriculum' (suspecting a 'spiky profile'). Comprehensive assessment via school's Ed Psych was, however, rejected (officially by Ed Psych, but school were clearly not that enthusiastic in the first place about spending £££ to assess a child who achieved level 2 in all Y2 SATs).

What seems to have happened following this was that SENCo was informed by the CT that processing was 'suspected to be slow', and this test was plucked out of the air/Google/book as a standalone test without being fully understood, which is clearly poor practice in terms of 1) being done in isolation, therefore being of limited value and 2) being administered in a rather amateur fashion and not really being qualified to interpret the results.

But the SENCo has already demonstrated herself to be lacking a 'self awareness gene' and thinks this is all really valuable stuff. Personally it raised more questions than it answered, but you would have a hard time convincing this SENCo. That said, SENCo is nothing if not keen to help (hence trying to pretend to be an Ed Psych for the afternoon).

What school have done is 'have a lengthy discussion with' Ed Psych. Quite different from a proper assessment like WISC or ASC. Loads of interventions seem to have come out of this discussion. I think Ed Psych seems to have seen dd2's SEN through the prism of 'suspected ASD' and advised school on that basis. The elephant in the room remains the missing Ed Psych assessment.

If these interventions do not show any demonstrable improvement in output or behaviour I am going to have to ask something to be done but don't know whether ADOS or WISC is the best thing to do next.

Confused? You bet.......!

Handywoman Thu 07-Feb-13 13:15:52

Miggsie you raise really important points about language. Thank you. dd2 had a severe issue with both receptive and expressive language. Aged 4 she had the receptive language of an 18 month old.

She was recently assessed by our amazing and talented SLT (the one who brought about a massive catchup in language skills in dd2 aged between 4 and 5) and her general language skills are thought to have further developed and be within the normal range. Except for non-literal and conversational skills.

I have no idea how auditory processing would be diagnosed, with or without an ASD diagnosis - keepon how did you get this tested? I would be interested to know.

I really think the quickest thing to do would be to see if dd2 is on the spectrum. Because this would shed light on much of what is going on, potentially. She really has no scheme to identify emotions at all. Simply will not talk emotions. Happy and sad is all she can identify. She is almost 8 years old. She has very limited understanding about the motivations of others. She has massive meltdowns where she can lose control and put herself in physical danger.

I personally think that we probably need to

1) find out if she's on the spectrum
2) have a WISC done to understand where her cognitive strengths and weaknesses lie
3) consider APD (?based on the results of WISC).

Anyone with me on this?

KeepOnKeepingOn1 Thu 07-Feb-13 13:22:00

Was DD seen by SALT at school? There are more SALT assessments that can be done (or private if necessary). Has she had ACE, TAPS 3, CELF-4 including pragmatics profile, narrative assessment etc? DS2(6) had these done by the SALT through school. The results of these assessments have led to referral to EP (whole day assessment next week) and the comm paed.

Handywoman Thu 07-Feb-13 13:28:46

We have not been offered NHS SaLT. We were discharged from them age 5 and I was glad to see the back of them. NHS was an actual joke. Our SaLT assessment was by private SaLT over 90 mins using ACE and TAPS 3 including narrative assessment and non-literal language (a sort of pragmatics profile I guess?) so I think her language assessment was in-depth enough (what do you think, keepOn?). SaLT report was sent to school in Sept last year. SENCo said it was a 'nice report' but seems to have had little affect on school's view of dd2's issues, although I hope that when we go back to comm Paed in three weeks she will be able to make use of them.

Handywoman Thu 07-Feb-13 13:30:39

I should add that only a bit of TAPS 3 was done due to trying to keep costs down. Is there part of TAPS 3 that includes language processing tests? I think dd2 was only assessed using numbers (and therefore her auditory processing was thought to be fine). Do you think TAPS 3 is worth revisiting for a fuller assessment?

KeepOnKeepingOn1 Thu 07-Feb-13 13:51:58

The CELF-4 subtest (Understanding Spoken Paragraphs) confirmed severe APD in DS1 - below 1st percentile. In depth assessment is carried out at the APD audiology clinic at GOSH. For this you need a tertiary referral - paed or audiologist usually. Visit the APDUK website and see if anything stands out. When she is interrupted does she have to go back to beginning again?

ime ASD was the last thing that was considered and we had to pay for private dx. Behaviours are similar and the conditions often overlap or co-occur. DS1 acquired other dxs rather than ruling them out but tbh nobody really knows if, for example, he has stand-alone ADD or is inattentive due to the ASD/APD/SPD/dyslexia/dyspraxia/anxiety etc.

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