Cognitive assessment system - info and request for interpret

You should have it interpreted by the evaluator, but another description is at
http://alpha.fdu.edu/psychology/DAS%20description.htm This is a very useful site, but it loads slowly. Good luck.

What a terrific site. Thanks for sharing it.

I’ve seen that web site, and it is terrific. However, the test they refer to as DAS is a different test I believe. Das and Naglieri were the 2 guys who developed the CAS, as opposed to Differential Ability Scale. You can see why I’m confused ha ha. Anyway, the evaluator did explain it, but I have to say the information I’ve learned from the people on this board about the WISC has gone well above and beyond her report and I’m just hoping to find someone who can shed similar light on the CAS. Thanks!

Karen,

The two low areas are in Planning and Attention. Low scores in these areas can indicate a problem with Executive Function. Below are the articles online that you can look at. The second article gives a good discription of the problems that occur for the child with EF problems. Would be interested if the evalulator mentioned Executive Function to you.

Executive Function
The Almost but not quite Dyslexic Child by Thomas D. Scheidler
http://www.greenwoodinstitute.org/resources/resalmos.html

There’s a good article on Executive Function at
http://www.tourettesyndrome.net/ef.htm

This is another good article:
http://www.washingtonparent.com/articles/9906/executive-functioning.htm

Helen

No, she didn’t mention executive function - but from my own research and reading I’ve come to the conclusion that he is impaired in that area. Thanks for the links.

So glad you look in here. Are you the same Helen in assessments that I remember from 2-3 years ago? Washington state area?

Since you pointed me towards these articles I’m going to throw my questions in your direction. Do you know how executive function impairment is related to NLD? Also, I realize there is a memory component in EF, but my son has extremely strong auditory memory, so I’m trying to understand how that fits in… Thanks.

Karen,

The following article which I copied some parts below deals with your questions. Executive function is a primary impairment in NLD. People with NLD usually are better at verbal memory ( which is auditory processing) then with visual memory. If your son had the WRAML was his verbal memory superior to his visual memory?

http://www.nldontheweb.org/roman.htm

The Syndrome of Nonverbal Learning Disabilities: Clinical Description and Applied Aspects by Michael A. Roman, PhD

Executive functions and higher level reasoning Rourke (1995a) has also identified deficits in executive functioning as among the primary impairments in NVLD (Strang & Rourke, 1983). Executive functions include such higher level abilities as abstract reasoning, logical analysis, hypothesis testing, and cognitive flexibility, or the ability to “shift gears” mentally. The ability to focus, shift, and distribute attention, organize information into memory to aid learning and remembering, and otherwise regulate thought processes are also examples of executive functions. Although similar etiologies have been proposed to explain both nonverbal learning disability and executive dysfunction (i.e., impairments of subcortical white matter), poor performance on measures of executive functioning are not always found in children with NVLD. There is no clear data to indicate how frequently executive functioning deficits occur in the NVLD population. It is the author’s experience that such deficits are common in more severe cases of NVLD and quite rare in more subtle cases.
Many measures of executive functioning exist. Some of the more commonly administered measures include the Wisconsin Card Sorting Test (Berg, 1948), the Category Test (Reitan, 1979), the Tower of London (Shallice, 1982), the Trail Making Test (Reitan, 1979), and the Progressive Figures and Color Form Tests (Reitan & Wolfson, 1985). In addition, many tests of attention and working memory could appropriately be considered measures of executive functioning (Pennington, 1994).

Memory functions
Significant discrepancies between verbal and nonverbal memory are also frequently observed. As with other nonverbal functions, NVLD children frequently demonstrate greater impairments on nonverbal memory tasks as the spatial component of the task increases. For example, it is typical to find poorer performance on the Design Memory subtest than the Picture Memory subtest of the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990). On more simple nonverbal tasks, or those that are more readily verbally encoded, deficits in performance may not appear. For example, both the Visual Memory subtest and the Visual-Sequential Memory subtest of the Test of Visual Perceptual Skills - Revised (Gardner, 1996) frequently score within the average range, particularly for older children. In addition, NVLD children frequently demonstrate problems with more complex measures of verbal learning and memory (Fletcher et al., 1992). This finding is consistent with Rourke’s prediction that strengths in verbal learning and memory are largely confined to simple, rote tasks (Rourke, 1995a).
Deficits in executive functions, including working memory, are hypothesized to be responsible for these difficulties on more complex verbal memory measures (Rourke, 1995a). Of course, it is reasonable to expect that NVLD children that do not demonstrate executive functioning deficits will be less likely to show deficits on verbal memory measures. However, weaknesses in nonverbal memory are still likely to be observed.

No, I’m in CA. I have been around a while. I got some writing G&O’s from you a few years back.

Helen

Hope you don’t mind if I just in here:

–The ability to focus, shift, and distribute attention, organize information into memory to aid learning and remembering, and otherwise regulate thought processes are also examples of executive functions. –

(Off your post)

Sounds like this could also mimic ADD as well? Just wondering b/c my daughter has also been diagnosed with motor planning (dyspraxia), EF problems.

Since I live near where Dr. Russell Barkley works, and have heard him speak..thought I’d mention there is a school of thought that says that executive function problems are a class of ADHD.

And so it comes full circle. Its so confusing! My son was suspected of having ADD inattentive and dyslexia. (which is why the greenwood article Helen refers to called “the not quite dyslexic child” was such a good read for me) .
Neither the neuropsych or the psychiatrist we ‘ve seen feel he has ADD. The testing also didn’t strongly support dyslexia. Much of his testing looks like NLD, come to think of it most of the behavior that’s NLDish for him is related to executive function.

So could someone have impaired executive function without being fully NLD?

I’m not as crazed about getting an actual diagnosis - just trying to understand where we can intervene most effectively, and why despite high phonemic awareness and reading achievement scores that are less than 1 grade level below, the child really struggles with reading.

My theory is that he has some right brain glitch that results in behaviors and deficits that look like many of these right brain disorders - but not severely enough to warrant a clear diagnosis at this time.

For what is it worth, the neurologist I took my son to (who diagnosed right brain dysfunction and ADD) told me that right brain problems cause reading problems more often than people think.

My son’s reading is also less than a year behind but still really problematic. I am taking him to consultant the neurologist recommended tomorrow. She is supposed to be really good at figuring out how to approach reading with kids with different profiles and recommending specific tutors.

Beth

What are specific, everyday examples of EF? What types of things will the child have trouble with?

Karen asked:

So could someone have impaired executive function without being fully NLD?

Yes, when I did a search on google for NLD and Executive Function together most of the articles treated them as separate disorders. You can be NLD without having all of the characteristic and it seems that with EF their are three parts and you can have problem in one area but not the others.

I don’t know the age of your child but as they progress through the school years they are expected to do more and more without prompting and steps broken down. A child with organizing and planning problems who is functioning at a Kindergarten level runs into vast problems. A Kindergartener is not asked to decide on a topic, reasearch it, decide out to order the information and write a 3-5 page paper but by about 5th grade this is what is expected.

I have a friend whose son has these problems. He would start the year fine but as the expectations when up and he didn’t know how to deal with the projects he became stressed out and didn’t want to go to school. He also had trouble sleeping which could have been because of the stress which made it harder to get him up in the morning (missing 20% of school). The school labeled him ED. The second page of http://www.tourettesyndrome.net/ef.htm gives a good description of what accomodations a child with EF needs to be sucessful. Toward the end of 8th grade the school district placed the child in a private school where the child works and progresses more individually. The thing is the school district would have had a hard time justifiying the placement and getting approval without an ED label. The child is happy at school and goes willingly the parent has reservations because the school is more ED then LD.

I hope this description did not upset you but kids with EF disorders can have a difficult time in school and need a lot of advocacy and support from home. EF can be a hidden disorder that schools don’t understand and put a lot o blame on the child.

Helen

The tourettesyndrome.net/ef.htm is a great site on executive function, very readable and has useful recs for school systems; many psychologists classify ef problems with ADD.

Maybe she talked around it, rather than use the term that many don’t understand?

ADHD is characterized as an executive function disorder. As I read through the helpful information Helen posted, I also thought of classic dyslexic-like or type LD. Working memory is found to be an issue with these students in many studies. This is an executive function, also.

Now, I think the question is: is executive function one thing? or, is executive function more domain specific? If the latter is the case, then an individual can perform some executive function tasks just fine and others poorly.

I am putting my money on the domain specific hypothesis that suggests a child can have some executive functions in place and others can be deficits. This can perhaps explain why certain executive functions manifest in ADHD behavior, but not as a reading or a math disability (I do test students who are ADHD, but who can read, do math and pass grade level competencies on tests), and in other students the executive function deficits show up in visual-spatial thinking or in word reading.

Thanks Sar,

I read it after I posted that. I guess my own EF dysfuntion was kicking in. Note to self read all the available, posted information first, then ask questions.

After reading the information I have to say that my son has some of what could be classified as EF dysfunction but he doesn’t fit the whole picture. He is a very flexible thinker. He can put things that he knows together to understand some pretty complex ideas for his age. He has very good auditory comprehension. Yet, he does have trouble with organisation and planning of every day things. He has trouble with sequencing the days of the week and months of the year. He also has trouble with losing things which I have read elsewhere is related to visual perception. (For him, all roads seem to lead there)

I seem to have alot of trouble putting my son into classifications that don’t break things down into very specific deficits. As Beth says, “He didn’t read the book on how to be LD”

Beth, will you keep us posted on what you learn? At least in a general way so the teachers among us may have some data we can apply to similar profiles? I don’t need all the private details that you may not want to share. I appreciate your input so we all can learn more.

If you read her very thorough write - up its clear that he has some executive function issues. I didn’t know what it was called though until I met you all on this board. Plus I didn’ t know there was a connection between this and reading- which has been the big puzzle for us all along. He clearly has issues of a neurological origin - but you can’ t tell from the neuropscyh report why he struggles with reading. Also , there were some tests that weren’t done that might have shed some light there. She didn’ t have him to the WRAML - her memory analysis is limited to whatever is shown from the WISC and CAS. His auditory memory is superior, but clearly that isn’t the whole story.

obviously our children have alot in common - we keep ending up in the same discussions. I’d be very curious to see if you uncover anything I haven’t already considered. Its very confusing - some experts think my son needs hard core OG, others recommend a more “metacognitive” approach, utilizing OG of course, but with other stuff too. And a big looming question for us is if he should be in a special school. Noone seems to think so, but I don’t see him being happy while he struggles with the basics.

Is a big issue we expect to face this coming year. My son is at a progressive private school for regular kids. Most are quite bright. Because they are flexible and individual in nature, they are willing to accomodate him. Because most of our experts feel the reading will click for him they are n’t advocating a special school. But I hear you about the types of difficulties these kinds of kids can have down the road. (BTW, he’s only 8 , going into 3rd)

We are thinking about a special school for kids with language disabilities (despite the fact noone thinks he’s actuallty dyslexic) for 4th grade simply b/c 1) he needs to learn to read and write
2) it will greatly improve his self esteem if he’s surrounded by other smart kids who’s brains are “wired differently”

It will be a very diffficult decision, disruptive for the whole family, and dependent on how this coming year goes.

I am not sure there is any private information on my son—I have posted most everything!!!

I am not holding my breath at this point—but will post anything that seems interesting and useful to me (or to anyone else).
Beth

I know at the LD school where I taught, about 10% of ‘em were nothing like the “classic dyslexic” but still struggled (“inexplicably,” sometimes) with specific skills. WIth our tiny class size we could take time and figure out what would work for these “puzzle kids” and not try to make ‘em fit into our standard routines that worked so well for most of our kiddos.

I’m curious if you have any thoughts on how to determine what the threshold for making this kind of decision should be. My son is already in a nurturing, noncompetitive environment. Were it not for the reading issue we wouldn’t be thinking about moving him (at this point) just b/c of his mild social skills and organizational deficits. He gets by, and does quite well in the areas where he is strong. He’s very bright and clearly uses his strengths to compensate for his weaknesses. So we wouldn’t want to just send him to an “easier” school - or even just hold him back a year. Intellectually he’s ready for complex topics . But on the other hand he needs to read so much better to really study the things that interest him. I think he’s a borderline case right now, and many kids like him stay in his school but with lots of tutoring and support. But I also feel like we have a window of opportunity to teach him solid reading and writing skills. I’m sure it gets harder every passing year.

How are your son’s achievement scores?

It sounds like for now he is in a good school environment; small class size.

Helen

I for one would not send a child to a more restrictive setting unless things were going very badly at the present school; also, I’m in Mass. and know students who have tried to get into the private LD schools here, the Carroll School and Landmark, and they are VERY fussy about the incoming students having certain characteristics (above average IQ, language-based LD, no Adhd,no NVLD, no emotional problems, etc) Why can’t the present school meet his needs? My younger son just finished 3rd grade(public school), and there was a big range of reading abilities in his class, and yes they were still teaching reading (via pull-out groups). Are your child’s abilities very far from the rest of the students his age?

You’ve said everything I’ve thought - but that’s why its a tough subject. My son is in a private school, so he gets no services integrated in his day. He did get pulled out for reading with a small group this year, and probably will again, but only 3 days. That’s it. And its clearly not enough so we are supplementing it with 2x/week tutoring. Its a heavy schedule and yet the results are still painfully slow. We would only consider the 1 or 2 schools in our area (NYC) that cater to kids like him - above average IQ, no behavior problems. I do think he is NLDish (more so than dyslexic) but surprisingly people here don’t seem up to date on it. You hear more about aspergers. Anyway we are going to see how 3rd grade goes. Our main concern is his self esteem. Oh, and there is always the possibility that the school will not want him to stay - apparently around 5th grade they will approach you if they feel your child really can’t do the work.

Yes, the school is lovely. And his achievement scores aren’t bad. He was last tested half way thru 2nd grade, and had an overall reading score of 1.9 with some components well above grade level. I think the worst reading related score (spelling of sounds) was 1.1. And yet he is reading preprimer/primer material with his tutor who is worried. He is a slow reader, hates it, and has great anxiety about his performance. We believe he can be taught to read - we are mostly worried about the emotional toll. Its hard to know what to do - I am hoping this coming year really clarifies the issue either because he has a breakthrough, or its clear he can’t do 4th grade work by the end of 3rd grade. I just keep thinking maybe an immersion environment would bring his skills up faster, and preserve his self esteem.

Had the state wrong, but remember the GnO’s.

Because of all the different ways EF presents (and other things), I believe that one or thousands of neural pathways could be intact or disfunctional. Some neurons rewire—dendrites branch to make new & different electrical connections. While not as fast or direct, they are functional and continue to build processing speed as the coverings hardens on the axons.

Chemical imbalances cause disfunction, too, adding another million or so components into the mix. For example, a malfunctioning fight-or-flight response mechanism shifts the control to amydala from pre-frontal cortex. This is great if there is really something from which we need brains chemicals to protect us, not great if it is going off at inappropriate times/for no real reasons, only perceptually inaccurate ones.

Serotonin re-uptake and all the other chemicals that cross synaptic clefts can cause inappropriate wiring because the energy isn’t flowing properly. That is, they believe (or did believe when I stopped thinking about that part), where ADHD comes into the mix. However, that person might also have other neural issues, thus compounding the problems.

I finally came to the conclusion that, at this time, there are too many variables to isolate without being able to better take a look at brain in action. Maybe new developments. If so, I’d enjoy thinking about them.

Karen,
I know exactly what you’re going though. It’s very difficult to know what the right choise might be. Like you, I agonize over choises (and I’m currently doing this with both my children!!! Decisions decisions! :-o). I worry about making a “wrong” choise and wasting precious time.

But whatever decision you do decide on, you can always change later. For example, you may want to wait and see the results of IM before changing schools (couldn’t you always change at a later date? Could you move later in the year?). Also, if you don’t see any progress during the year, you might want to pull your son out temporarily for LMB or some other program.

Yes to all of your suggestions. It takes a year to arrange admissions into a private school, so we are looking for Fall 2003 at the same time we are waiting to see what happens this year, after IM and all the other stuff we plan to do. But if we do pull him out of his present school it really is like domino effect, impacting where we live, and where his sister goes to school. (Its too soon to worry about this - but somehow the discussion veered in this direction. ah yes, talking about the longer term difficulties for kids with EF dysfunction)

Karen,

The tutor thought he needed a modified OG approach utilizing a number of different programs. I think this is because he really isn’t a classic dylexic—much like your son. This essentially was what the neurologist said to me also. He said he needed to work with someone who knew lots of programs and was very flexible in approach.

Now what I found interesting is that she thought he was right brained. Her reasoning was he was much better at whole words than individual sounds. His sight vocabulary is actually 4th grade level (he is going into fourth grade) but he is dismal at decoding, especially when the word is arcane, despite lots of teaching. One interesting observation is that he could decode a word correctly if it was in his vocabulary but couldn’t decode a word with the same pattern in a word he didn’t know.

I asked her if she had seen his IQ scores—they were right on her desk. I asked her how she reconciled her observation with the neurologist’s diagnosis of right brain dysfunction. She said we were talking about different parts of the right brain here. His weakensses were in visualization.

Made me feel like I really needed a good neurospychological exam!!

Beth

Who are the experts that think reading will click for him?

If you really like the school, I would spend the next school year putting him thru the Lindamood bell lips program. He will be reading by the midpont of the year. A family I know was in the exact same situation and that is what they did and they said it was the best decision they ever made. Their third grader was ecsatic too.
It really does hurt kids emotionally at that age when the rest of the kids read and they can’t. I now go back and look at the third grade journal may son kept in class. He wrote several times, he wished he knew how to read. I did not know about LB back then. We started it in the beginning of 4th grade. It was the only method that really worked for him. Unfortunately since then, the school work became so hard that he couldn’t keep up because because he was such a late reader and we ended up having to change schools to a private LD school after 5th grade.
Please don’t wait any longer.
RobinA

Unfortunately noone told me about LMB last spring when we were first getting into all this stuff. I would have done it over the summer, but by the time I realized he should do it it was too late. I think we’ll let the school year begin, we’ll be applying to private LD schools no matter what so we keep our options open, and then maybe pull him for LMB during the year. I’d rather do an intensive LMB program out of school, then going a few times a week after school. They are n’t located in a convenient spot, and I have another child to juggle. I’m thinking he could go during x-mas break and then just keep going and miss a few weeks of school in January. That would certainly give us an idea if that method will help him enough to keep him in school for the following school year. Just thinking out loud…

How did you assess that your son couldn’t do the work? I see lots of LD kids getting by at my son’s school all the way thru high school, with lots of tutoring, and probably a fair amount of psychotherapy. The question I keep asking myself is at what point is all this support an indication that a child would be better off in an environment where they are taught the way they need to be taught.? Because its not just about reading, I suspect its also going to be about written expression and organization etc etc.

What kind of LD school is your son in? I’d welcome any advice you might have to a parent who plans to start looking at schools in september.
Thanks!

>How did you assess that your son couldn’t do the work? <
In fifth grade it became painfully obvious that he was over his head. He could not do a report nor did he have anyidea of where to start. Even tho he was finally reading by the end of fourth grade, he still needed time to practice reading at a lower leverl just to gain literacy/fluency skills. I also took a class on learning disabulities where I learned that even after a person learned to decode, the must practice paractice practice reading familiar material. If they don’t (this is where adult literacy programs fail) trying to read things such as a text book (which is usually written several grade levels ABOVE the audience reading it) reading will become to laborious, comprhension becomes nil and the whole process leads to failure.
It took at least 2 hours to do his homework every night even with “accomodations” because I was trying to get him to “see” what he was learning. My husband has a long commute and gets home around 8pm, I have two other children, one is a pre-schooler and I was becoming a screaming impatient nervous wreck. I also work full time.
I had a nuuropsych eval done and she recommended an small LD school setting because he was becomeing depressed and overwhelmed and saw no escape out of his situation.
As far as shopping for schools, start looking in October as some are first come first serve. Check the web, the phone book , parents, support groups and look at ALL of them. Many do not publisize, in fact the school we ended up choosing, I found on a parents website post.
Find out if the schools are state certified, a certified school will be easier to battle the district for tuition or placement. You can get a non certified school but then you will have to pay and then wait for the district to reimburse you.
The school my son is starting in fall is awsome. My son came home from his visiting day there talking about all he had learned that day. He said, “That is a school I can really learn at!” In the four hours he spent there, he had discovered the joy of learning. We were sold!

Thanks for sharing that story - the struggle and the joy. I guess I am trying to intervene before my son fails in the 4th or 5th grade, but that means making the decision before we know what will happen. I don’t want to go the special ed. route unnecessarily, but a little voice in the back of my mind thinks that the right school could change his life.

>I guess I am trying to intervene before my son fails in the 4th or 5th grade<

It happens before you know it. I was doing all the right things. He was getting speech and OT before the age of 4, resource help entering 2nd grade which in theory could have worked if the teachers had been skilled enough to realize the methods were not working and to remedy them. In fact, none of them did. After 2 years in resource (at the end of 3rd grade) he scored a miserable 1% in reading on the state wide achievement tests. When I brought this up at the 4th grade IEP, I was told he was doing just fine! Thats when I put him in the LB lips program. Even tho he made huge gains, the teaching style was inadequate to build on the gains he had made. That means it is time to go a private LD school.
BTW my son started his new school this week. He is estatic so far! Even tho his transportation is alomost 2 hours each way, he doesn’t care. All he cares about is being at the school of his dreams. My bother used to take 3 buses each way to get to his LD school but he didn’t care because he was so “at home” there.

Your story is like ours. My son did speech and OT before Kindergarten. More speech and social skills work in 1st grade. Special pullout reading group in 1st and 2nd. Finally got a tutor in 2nd grade for reading. . He’ll be seeing his tutor 2X a week, and a psychotherapist. Seems like a bit much So here we are. He starts 3rd grade in 1 week, and I’ve got the applications for the special schools on my desk. There are dozens in my area, but only 2-3 worth considering. A friend of ours happens to be a school psychologist at one of the LD schools, and is going to test my son to see where his reading really is at, and tell us if he thinks we should go for the private LD school. The application process takes months to complete but we won’t have to make a final decision really until next March, when his current private school requires a deposit. (And at this point I’d hold spots in both schools if I’m not sure.)

But it certainly sounds like you’ve made the right decision for your son. If he’s happy, learning, excited about learning than that is everything. Good for you.