Attention & ASD

[Handywoman]

As part of evidence gathering for dd2's assessment for ASD, her school teachers (she has two - job share) have filled in a Social Communication Questionnaire.

Her teachers acknowledge there are difficulties in certain areas that affect her 'quite a lot' at school. At the top under 'Main Concerns' it says: difficulty following instructions without the need for extra instruction or to be re focused. Attention drifts from the task and anxiety when under pressure'

This is addition to 'limited facial expression, does not show age appropriate creativity in problem solving, struggles to pick up / forgets new routines, cries when put under pressure / on periphery of interaction / slow to respond to name / conversations can go off on a tangent/ reading problems and other things.

She was originally referred back to Paeds by me for ADD but the Paed discounted this. Her working memory is good (assessed by SaLT) and dd2 has demonstrated the ability to control and maintain the focus of attention for long periods when required. Her SaLT report reveals huge discrepancy between normal/advanced general language skills (previously severely delayed) and understanding of non literal language (1st centile).

My question is: can problems of attention and need for extra instruction be part of the deficit of social communication/interaction? Or are these problems not normally seen as part of ASD?

Any insight here gratefully received (scrabbling around in the dark as usual)!!

Handy woman x

Slt did a WISC test? Or which test did she do?

You live and learn.

I'd be pushing for an actual full psycho-ed evaluation tbh.

Loads of kids have dual asd and add dx of sorts. I'm fascinated that the slt assessed for add...

I should add - there are loads of crossovers with this sort of dx. I don't think you are going to get a full picture from slt though.

Loads of kids with add have hyper-focus. It's completely accepted. Bit baffled by the paed's dismissal...

Thanks. The SaLT assessed working memory and auditory processing (she did not assess for ADD). Both came out normal. An Ed Psych assessment has been requested by the Paed but progress is glacial (am actually surprised school even agreed to it given that her academic achievement is normal.)

HW x

Re hyper focus: I would say dd definitely has the ability to do this. And it can look the same as impaired social interaction or repetitive rather than imaginative play. 'twas ever thus. She will be 8 in march.

Her previous Connors rating scales scored highly from class teacher but low from TA. I think this contributed to the Paed's dismissal and focus on the 'social communication' aspect. There are definite issues with reciprocal interaction, lack of cognitive empathy and inflexible thinking. Yet for her new teachers the attention problems are massively more noticeable. But maybe this is because the ASD traits are so much more subtle in girls and more noticeable in an unstructured environment?!

Such a minefield!!!! Driving myself mad........

Ds1 is officially t'other way round. Add with asd traits, a few optional extras, and gifted. The gifted bit means that no one particularly cares how much he is struggling, as long as he occasionally manages to hand in a piece of work.

He got to 10 before his teacher insisted on a full assessment. Every other teacher and school (and paed to be honest) had just sucked their teeth, and then decided to do nothing, as they knew he 'could' do the work... in theory. Everyone agreed that there was a 'something', but couldn't really decide what, so no one assessed for anything.

Self fulfilling prophecy appears to be how they wanted to test until y5 put her foot down.

Good luck with the EP.

Yy re hyperfocus, too. Ds is the same. We had one paed say 'definitely asd' and refer on, as that day he 'looked' social communication disorder personified. It really does depend what you are looking for as to what you see, if you have a particular specialisation.

I see a lot of things in ds1.

At 7 or 8, the 'differences' between kids and their peer groups get more noticeable, too. I would definitely keep pushing, at least until you've got a complete profile. Don't let the EP just do the same tests over, either. Insist on a full battery!

Thanks, madwoman. That helps hugely

.....sorry, madwoman, wanted to ask did your ds1 end up getting full evaluation from Ed Psych......? and was his profile of educational skills 'spikey'?

I ask becuase dd2's Comm Paed has requested an Ed Psych assessment on the basis that she suspects her profile is indeed spikey. So far we have the working memory (but assessed with numbers only, by SaLT) and auditory processing but no global, verbal or non verbal IQ. OT assessed visual-motor integration which was 'well above average'. Despite fabulous decoding skills, her reading comprehension is utter pants!

And if the Ed Psych assessment reveals a spikey profile does this support a diagnosis of ASD.... or ADD.... and is there any point in distinguishing the two when they can look so blinking similar? Or is a 'spikey' profile more likely to indicate an isolated SpLD?

HW x

Well spiky.

There is a full 50 centile difference in two out of four areas that literally cuts the results in half. he still comes out as gifted overall, which is kinda scary, without the results that are compromised by the 'whatever it is but we're calling it add with a few extras' his profile would be eyebrow raising. The psychs get v excited by the spikiness, and it really does go a long way to explain how he can be so theoretically (and occasionally) bright, but find life so, um, difficult.

Interpretation of the results is quite an art form (I use art deliberately in place of science ) and I get the impression is hugely coloured by the results of additional testing (I'm guessing dd has done Beery VMI, Conners, etc?) as an aid to interpretation.

It's definitely why I would suggest they do a full testing battery instead of 'just' using wechsler testing. It will give you a fuller picture and can throw light on the results of the 'main' test. Any point in distinguishing? Ummmmmmm, the jury is still out in my head on that one - I find it useful to have actual results in front of me and then to try to work out causation (as that will often give you a bigger clue in finding a coping mechanism or support for the child) but I don't think it's essential. I guess I think that if you have the results and you know that the child struggles with x, you can try different supports for that until you find out what works. So any dx that allows people the time and funding to try alternative supports is great...

It's a bit chicken and egg, but for kids with difficulties of any kind, I'm a huge fan of getting as full a picture as possible. Sometimes things fall into place.

I suspect that for SpLD, more specific additional testing would be required to explain the wechsler results...

All three of mine have had full assessments done (long story) at different times, and for different things. They all 'make sense' and explain different things about the kids, (and sometimes throw up a few surprises that only make sense in hindsight, lol).

It's good that comm paed is pro testing. I would definitely ask if she has specified particular tests, or just a basic wechsler...

Thanks, madwoman! Comm Paed has not been specific, has just requested 'assessment by ed psych'. SENCO is trying to find out what is wanted. Yes we have done Beery VMI, Conners x 2 and Strengths&Difficulties x 2.

It is frustrating. I am at my wits end this week as to why a bright child with good language skills cannot grasp the fact that there are different types of rock formation (y3 homework), despite explanations, animated web pages and YouTube over a whole week. She is STILL clueless about the concept!

Aaaarrrrrrggggghhhh.......