dueling therapists

Why can’t this both be a factor? My son who has a word retrevial problem,also has great difficulty with motor planning. He will be doing fast forword this summer,but doing Interactive metronome first.

I agree with Socks, it’s probably entirely possible that both are correct (or at least somewhat correct).

When in doubt, go to a higher authority, someone more qualified than both of them like a neuropsych who specializes in identifying ld in kids. Let the person most qualified line out the overall issues and then the specialists can handle their end of the program without skewing things one way or the other.

You ask what is a parent to do? Follow your gut instincts and don’t believe anyone just because they told you so. Explore, seek, research, ask questions and don’t stop until you are comfortable with the caliber and quality of the explanations you receive. At this time, I think it is safe to say you still have questions.

Good luck.

Andy

My son has both problems too. I will tell you that we did FFW last summer and saw no improvements in word retreival. We saw major improvements in memory, and receptive language. We now are doing Neuronet therapy which is addressing the motor end of it, among other things. She thinks his word retreival problems are more of a motor problem than anything else. So maybe it is a matter of what therapy to do first.

REalize also that all these experts see it from their own perspective. You are in the end a case manager.

http://www.neuroacoustics

I would recommend that you read some of the very interesting material on the NeuroNet website (http://www.neuroacoustics.com). It sounds as if your son may have CAPD problems that have affected vestibular and motor development. Also, word retrieval problems are a characteristic of certain subtypes of CAPD. NeuroNet is the only therapy I know of that can sometimes address word retrieval issues. (FastForWord does not address word retrieval problems, although it can be very helpful in other ways.)

If you can’t do NeuroNet, I would at least get a CAPD evaluation by a qualified audiologist. See http://pages.cthome.net/cbristol/ for a search engine to locate qualified audiologists in your area (regular audiologists do not have the necessary training).

I’d have to say that both your specialists have interesting theories, but neither is seeing the complete picture. The underlying problem is likely to be auditory processing issues which may or may not be responsive to specific therapeutic approaches. It would pay to find out before investing a lot of your child’s time in something that may not be optimal for him.

Mary

I do think I will get him a CAPD eval. Unfortunately, many therapies, such as NeuroNet, can not be found in our state. I’m skeptical about Fast Forward for him because he has excellent phonemic sense and above age level receptive language scores; it just seems that there is some sort of odd disconnect happening somewhere. He just can’t generate appropriate responses in a timely manner, if at all (see the examples in the earlier message). Any other advice about programs to help him generate ideas and speed up the process would be greatly appreciated.

I’m a person who’s skeptical about “packaged programs” even though I know many people have had positive experiences with them. I think the package programs like Fast Forward or any of the others should come with the traditional “let the buyer beware” label. These programs are costly and sometimes faddish. They come and go but as they do they take a great deal of money from caring parents.

If money is no issue, what does one have to lose? If though, as with most of us, paying for these programs is a certain challenge, then I’d be skeptical of this program and the others.

Word retrieval issues can impact on a child’s academic and social life although I know successful adults with word retrieval issues. I also know that as I age I develop, as do most people, word retrieval issues. Yet I manage.

If this were my son, rather than any expensive packaged program, I’d take the old fashioned approach and read out loud to him. Play tapes in the car. Have patient conversations with him allowing him to speak his thoughts at the pace he’s comfortable at. The “connection” between his smart brain and his ability to retrieve the words and speak them will improve in your son as it does it most children.

If I had to choose between a therapist helping to improve oral motor movements or a packaged program, I’d take the therapist every time. The therapist might also offer remediation for his word retrieval issues if he has them.

Good luck.

NeuroNet can be done on an out-patient basis. Can’t remember the details, but I think it goes something like this: You get specific tests done by an audiologist so it can be determined whether NeuroNet is likely to help. If the criteria are met, you travel to the NN office and over a week’s time get trained in how to provide the program. I think they send you home with video tapes of all the exercises. After a period of time you go back for evaluation of progress and adjustments to the exercises.

NeuroNet is the only program I know of that claims any success with word retrieval, and even that is dependent on the type of CAPD problems the child has.

If NN is out of the question, then I think your best bet would be sensory integration therapy with a qualified OT. This might not directly address the word retrieval problem, but would likely help many of the vestibular and motor problems.

One other home-based therapy to check out is Balametrics (http://www.balametrics.com). NeuroNet actually incorporates Balametrics into its program. On the plus side, Balametrics is relatively inexpensive, doesn’t take much time, can be done at home, and is actually rather fun for the child. On the minus side, it won’t address all of the issues and probably is not sufficiently aggressive.

Mary

Greetings aceeb,

>He just can’t generate appropriate responses in a timely manner, if at all<

Frankly, that sounds like a processing issue to me. My daughter would take up to 10 seconds before responding appropriately to a question. As it turns out, she has both auditory and visual processing issues and dysnomia (word retrieval disorder). Interestingly enough, Fast ForWord DID help improve her word retrieval and PACE has brought her even further.

I agree with Andy though that a thorough workup would ultimately save you and your child precious time and money.

Blessings, momo

That’s really interesting about FastForWord helping word retrieval! Now I am wondering if I am confusing word retrieval with rapid naming.

momo, did your dd ever have a CAPD eval? If so, was she identified as having the auditory decoding deficit sub-type? As far as I can figure out, that is what FFW reliably helps, but I have wondered if FFW positively impacts other sub-types as well.

Aceeb, I think momo is making a very valid point about processing issues — something I missed completely.

At least a CAPD eval would give some indication of whether FFW would be worthwhile. Since a CAPD eval is usually covered by medical insurance, it makes a lot of sense to do it before making decisions about therapies.

Mary

p.s. momo, I think the online Audiblox book is gone. I couldn’t find it.

Greetings Mary,

My daughter had a central auditory processing evaluation 11/96. At that time, she had the SCAN, SSW and TAC. According to the clinical audiologist, she did not have auditory processing problems, that her difficulties were not auditory in nature but arose from language and/or learning type disabilities because she had “dichotic listening patterns characteristic of learning-disabled children”. However, further on he states that she would benefit from “speech and language therapy activities that center around deferred auditory memory tasks, specifically verbal recall tasks” (sounds like auditory processing to me).

The assessments used in her psycho-ed eval in 5/99 were the Comprehensive Receptive and Expressive Vocabulary Test (CREVT), Woods and Moe Analytical Reading Inventory, Bender Visual Motor Gestalt Test and the Detroit Test of Learning Aptitude (DTLA-3). Both the WISC-III she had done in 11/96 and the Detroit pointed to dysnomia which was also clearly observed during the CREVT. All data gleaned through all test information “denotes a bright child who is very frustrated with her inability to process and retrieve auditory information”.

Mary, where can I find info that explains the auditory processing sub-types? Also, thanks for checking about the Audiblox book.

Blessings, momo

Your gut instinct usually means more because you live with your child and really know his ability more than therapist.

I will share this info if it helps any. My daughter does have significant language deficits and did need FFW because of no phonemic awareness. However, she was also diagnosed with Apraxia- Output Disorder by a developmental pediatrician. Because she had perfect annuciation and appeared to be able to say what she wanted, many speech therapist never agreed with this diagnosis. However, the developmental ped based this on testing which pinpointed her inability to make sounds come out. He explained that there is a mucsle that she uses to make sounds and it was not working properly so the things in her mind were not coming out as and when she tried. She also has CAPD so her case is very complex. But I did want you to be aware that this output disorder does exist and is also referred to as oral dyspraxia. With our complicated situation I felt it took a developmental pediatrician who was very astute to discover this. Best Wishes, Sharon

Please read my post under IM, PACE, Phonographix above. I bet your son would benefit from essential fatty acid supplementation too.

Linda

Thank you to everyone for responding. An interesting thing happened this morning. I told a friend how my son couldn’t name the names of more than two boys in one minute. She said, ask him to name something that he’s really interested in. So this morning I asked him to name all the Legos he was interested in. He said, “First I’ll name the King Leo’s,” and proceeded to name about 14 Legos in this group. He then named the Ninja group, which consisted of about 10 Legos; then the Fright Night series. I finally stopped him. The bottom line is now I’m totally confused. Could it all be an attentional problem; he still talks really slowly and you would think even if not interested he would be able to name more than 2 boys.

I keep debating having an eval with a neuropsych or developmental ped., but keep putting it off for several reasons: 1) our insurance would not cover it and money is definitely an issue for us (else I’d try every program in the book) and 2) he is a very inconsistant tester. He is very hypoactive and is oftern like a computer in that, if he isn’t bumped a bit, he easily goes into sleep mode. Testing often puts him in the sleep mode. Again thanks for everything. I learn more here than I do from all my paid “experts.”

I had to laugh at your message. Your son sounds like mine!! At the beginning of first grade I asked my son why he could name all the dinosaurs but not the letters of the alphabet. He looked at me like I was crazy and told me “that dinosaurs are much more interesting!!!”. I still am not sure what this means, although my own suspicion is that memory tasks are more difficult for him and unless there is interest, he doesn’t bother. Related to this, was the total surprise I got from teachers working with him in first grade that he comprehended Hardy Boys stories read aloud to him. I think that all this means that your child and mine are capable but don’t have efficient ways of doing things.

Thanks for the info, momo. Sounds to me like an auditory processing problem also!

For the CAPD sub-types, go to http://pages.cthome.net/cbristol/

Click on “Auditory Processing Links”. It’s the 3rd link down that has a ball in front of it. It’s labeled something like “subprofiles: primary and secondary”.

Mary

The reality is that we learn most effectively- that is, we take in information, store it and retreive it as needed- when it is meaningful and relevent to us. LEGOS and dinosaurs are very meaningful to most young boys- I can’t count the number of times I stepped on the little ones in my house:) They handle them, look at them, play with them, develop fantasies with strong imagery with them- of course their retrieval is going to be fast and accurate. Math facts and correct spelling and high frequency words just don’t have the same intensity of association. It is the best argument for multseensory teaching that I can think of- for all ages.

The folks who have suggested that your son’s difficulties are a combination of things are on the right track. Your specialists are getting turf oriented. He may in fact have some memory deficits, and it may be associated with the extra processing layer from the apraxia. At this point, my comment to the two of them would be “Does it matter?” You know what the presenting behaviors are- what he has difficulty with- sit them down at the table with your casemanager if possible- and tell them you want a coordinated therapy based on what his behaviors are- not what they think the etiology is. Very likely you and they will find that the activities are not much different despite their differing views on the source of the difficulty. Good Luck!

Robin

Thanks for your reply. At this point I am my son’s case manager, and most of the time I feel like I’m in a fog. The problem with the dueling therapists is the speech therapist wants my son to do Fast Forward for the previously mentioned issues. My OT thinks that Fast Forward would not address the issues. We are not rolling in money so I must truly figure out whether there is a good chance that a program like Fast Forward would help my son. Thanks.

I don’t know when his last eval was but most cognitive testing includes a section on auditory short term memory and working memory. The CELF (sp and lang) has a section also- recalling sentences I think. So… you could look back through his testing and see what those results say. On the off chance that this is not informative there is a test called the WRAML- I can’t recall what the acronym stands for- a forties moment- but I will find out if someone else doesn’t chime in- that specifically assesses different aspects of memory function.

As for Fast Forward- I thought it trained auditory processing skills- taught kids to recognize the subtle differences between the sound of language- not memory. If his phonemic awareness is okay then likely his auditory processing is also. For all the wonderful things I have heard about FF, increasing memory is not high on the list. It happens I guess but more as a side benefit than the focus of the program. Hmmm…

Robin

Robin,

One of the primary reasons my son’s audiologist had him do FFW was to increase his auditory memory. And it did get him the lower end of normal—which three years of speech therapy did not do. Now he also had decoding problems. There isn’t anything in FFW that seems to explicitly work on memory so it must be something to do with correcting the underlying auditory processing so that the child receives the information.

Beth

Thank you. :)
Robin