Serving Two Categories of LD: Oral Expression and Listening

As a resource teacher I have never had a child placed as LD in listening comprehension. This is a child who would be placed under receptive language, diagnosed and seen by the LSH specialist. (sometimes called SLP).

We are very lax with qualifying for language. Technically for a child to qualify as language impaired, the child has to have a 1.5 deviation from ability. However, we do not routinely do ability assessments on children who are referred for language, so we qualify every child whose score is low, like in the 70’s.

On a few occasions I have assisted with expressive/receptive language therapy, though I am not trained. It is generally all I can do to make time to meet these more individualized needs with the size and breadth of my caseload. With 7 grade levels to manage and one slightly under fulltime aide, my day is packed and I don’t get really enough time with the reading/writing/math skills my students need. While they make progress, I find that I have to select the priority areas, teach these with much less emphasis on lesser priorities.

I really see this as a language disability. Children who have this profile do need to be adequately assessed by the LSH and I believe these are the persons who have the knowledge, assessment tools and the training to best serve this population. We desperately need more trained LSH personnel and we need to have them on staff in our schools more than the two days per week we see our LSH.

I left out the oral expression category. Indeed, we would consider this to be expressive language. Most of the time I see expressive and receptive language disorders in tandem, part of an overall disability in learning and using language. I do not see this condition to a significant degree frequently, but it is there. Sometimes these children are called aphasic. One I worked with for a year, before he moved, had multiple issues. A brain imaging study would be very interesting.

Oftentimes this is part of high functioning autism, but in the abovementioned case the autism behaviors were not present.

With 100 as a mean, 70 is 2 SD below. So, like here, they’re not getting a big break considering that with a 100 IQ they’d qualify under the LD category with an 87. My district seems to handle it about the same, though. There aren’t enough SLP’s for all the needed services.

Expressive (Oral) and Receptive (Listening) are two categories of LD, but I’ve never seen an IEP with those as the primary category of disability either. Allegedly the category is different than a language disability and would cover things like APD. Not every Expressive Language kid is apraxic here—not sure about there. Kids with dysnomia could fit that category if other things were also impaired (e.g. ability to put sentences together using pragmatically or grammatically appropriate language).

I, too, don’t think I’m qualified to design goals and implement them. However, I could help and I’d be glad to do that if it would help my kids read better. I get ideas from the SLP all the time for these kids. For some it’s all they’re going to get.

That fact concerns me.

You lost me here:

“considering that with a 100 IQ they’d qualify under the LD category with an 87”

85 would be one std. deviation below the mean, and 77.5 would be 1.5…so did you mean to type 77?

Janis

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Wonderful question and something I have given a LOT of thought. First I’ll answer your questions.

1) What is the eligibility criteria in your state plan for Listening Comp and Oral Exp?
All areas of eligibility require 1 std. deviation (IQ minus 15 points). We would have massive numbers of struggling kids if we had a 2 std. deviation requirement. It amazes me that the federal goverment allows such a wide interpretation of IDEA.

2)What assessment tools do you use to qualify students in these categories?

Right now, I cannot say if we have any chidlren classified in these two areas, but the assessment used would be the Woodcock Johnson III which has at least two subtests in both areas. That test is used for all areas of LD placement.

3) In your district (or districts), who has the main responsibility for writing the IEP goals for these categories—SLP or Sped Teacher?

We just had a third year reval on one of my moderate hearing impaired children yesterday. I had asked for all subtests of the WJ III. She is labelled HI which doesn’t require any specific discrepancy, but she would have qualified LD in all areas. The LD resource teacher at her home school wrote the reading, writing, and math objectives, the SLP wrote language goals/oral expression, and I, as HI teacher, wrote the Listening Comprehension goals. She is at her home school and I just serve her on an itinerant basis. The reason that few children are labelled LD/ LC or OE is that teachers do not understand what tests to request. They are told when there is an initial referral to tell the disgnostician which subtests they want given. Because most LD teachers know little about those areas, they invariably ask for the reading, written language, and math sections. Classroom teachers basically are looking at the subjects the child has difficulty with, so that’s where the focus of concern usually lies.

4) Who implements these goals in your district (SLP/Sped or collaborative)? Is it usually the same from each IEP?

I doubt any kids are labelled LD/ LC or OE.

5) Do you feel that these two categories are underrepresented from an eligibility and service delivery standpoint in your district? Why or why not?

Oh my gosh, yes! I explained above why kids aren’t tested for these two areas. Regular teachers mainly refer to SLP when there are articulation problems or very, very obvious language delays. Many many kids with language based reading disabilities will score low on these sections, particularly those with APD as someone above mentioned. I don’t think the connection between the areas is common knowledge. Even SLP’s don’t know a whole lot about APD in most cases. I think that’s why there is confusion abotu who should serve.

I will continue my thoughts in another post as I don’t know how much I can write in one.

Janis

Thank God that my brain is faster than my fingers, or else I’d be in special ed!!!!!!!! :-)

Janis

I cannot remember in which state you are located.

Does your state serve Language as primary disabling conditions with 1.5 SD also?

I can see using the WJIII for this purpose. I like that idea. Right now, sped teachers in my district look at me with a “what is LD/OE and LD/LC?” kind of expression. We have such a shortage of SLP’s that I just cannot overburden our staff any more than I already tax them. If we test/label these two categories, I’m not sure how I would serve them without more speech/language minutes or collaboration.

Part two of my thesis:

I have great interest in this topic because I teach HI and LD and my child has APD. When she was diagnosed APD, it was like the school did not really know what to do with her. I referred her myself for S/L testing at the school, because the teacher was no that in tune with her problems. Probably thought she was just a little ADD inattentive. I don’t think the LD teacher there had ever given the LC and OE parts of the WJ. Again, because many people do not understand the connection with APD, language based LD’s, and reading disorders. In my opinion, EVERY child referred for reading testing should also be given the LC and OE subtests. A low score might trigger the idea of referring for APD testing. Personally I think there are many undiagnosed kids with APD sitting in regular and resource classrooms. The sad thing is, many of those kids are being referred for ADHD testing and meds when the lack of focus is really APD. I have more ideas on misdiagnosis of ADHD, but I’ll save that for another day.:-)

Now, as to who should serve. There certainly can be overlap between the responsibilities of the LD teacher and the SLP. The SLP here would not serve unless she had done her own evaluation and then she’d work on the low areas found in her testing. This usually results in goals for receptive and expressive language and/or articulation. I think where the question comes in is who should be working on phonemic awareness as one example? Who would be better to carry out a program like Lindamood-bell LiPS? Technically, either should be qualified to do this if they have had the training. Our SLP’s generally work with small groups just as the LD resource teachers do, so it’s not like a child can get individual therapy in public schools very often. My child is in a public charter school and she does get 3 times/week, 30 minutes individual S/L therapy…all auditory and language skills. When she was tested last fall at the beginning of first grade, she did not have the 15 point discrepancy to place LD in R, W, or M. (You know, if you know the letters of the alphabet you can score 1.0). However, at that time, the LD teacher had not changed over to the WJ-III, so she did not have the LC and OE subtests to give on the WJ-R (as far as I know). I plan to have her tested with the LC and OE subtests sometime this year. She is repeating first grade so there is no point in repeating the R, W, or M sections. But she was able to qualify speech/language impaired due to the language tests given by the SLP (still 1 std. deviation). Actually, that would be my preference due to the fact that she gets one-on-one service. She would not if labeled LD LC.

Thanks for asking such a great question! I have been most concerned that these areas are being ignored in my district (and no one cares about my opinion! ;-).

Janis

Janis

Susan, see my post below for more details. But yes, 1 std. deviation (15 points) is required for placement in language impaired as well. I am in NC. In all areas, a child must have two low scores (-15 or more) to qualify. For example, they must have two subtests within math calculation that meet the -15 requirement. If there is only one, you can use the composite math score to give you the second -15 if you have it. My child’s composite language scores would not have qualified her, but she had about three areas of very low subtests that were confirmed on two different language tests, so she qualified on that basis.

I think the WJ is pretty sensitive in picking up the LC and OE. I have had it given to two of my HI children this fall, and the LC and OE scores were even lower than the R,W, and M scores, which to me, confirns the underlying problem. In these kids, we KNOW there are auditory problems, but I think it would also help pick up on APD problems as well.

Janis

P.S. I am in NC.

This next comment pertains to only the achievement portion of the WJIII:

The WJIII is more stringent and kids are scoring lower. I happened to see the professor, the neuropsychologist, and he told me to throw away my WJ-R as I’m not doing kids w/LD a favor by using it because fewer will qualify. My school doesn’t own the WJIII. We’re still using the R, unfortunately, and i don’t have an extra $600-1000 in the budget to replace it this year.

My goodness. I thought WE were the ones that are behind. I thought it was just always recommended that when a test is revised that the district replace it and use the new version. Our system began using the WJ III at the beginning of the 2001-2002 school year.

We are not at all finding that the WJ III scores lower than the WJ- R. I am hearing that fewer kids are qualifying on the new one here. But there would be no real way to prove that either way unless we were to give a sample of kids both tests to see.

Janis

One more thought. Our district employs two diagnosticians to give the WJ III. So they only had to buy two copies. We do not have a copy at every school.

Janis

Our district owns several WJIII copies, but I work at a voluntary alternative high school (as opposed to a day-treatment program or a non-voluntary program that includes things like long-term suspension). We only have 80-100 kids—but believe me that’s enough when dealing with this age and level of at-risk behavior.

We’re discussing whether we see lower scores on the WJ-III ACH than the WJ-R. I saw one of my old profs (Neuropsychologist at children’s hospital) and he says he’s seeing greater discrep’s using the III over the R. What about you?

I have a question regarding apd and my son.
Here is some background. In 1st grade he was struggling with letter sounds and learning to read. The teaching method was the ‘write to read’ computer program for kindergarten and 1st. My son went through it in k, nothing said about problems, had to redo it in 1st, lots of problems. Difficulty with attention and staying on task, didn’t know all the letter sounds, problems with learning to read and spell,no behavior problems. Took him to the doc who suggested possible learning disability, dev. pediatrician dxed add/inattentive. SLP dxed mild/mod. capd. This was in ‘95.

In 2nd grade he was given eval by school because he was still a non reader, called a late bloomer, apd not ‘significant’ as told by school psych. He continued to be in reading class outside reg. classroom. In 4th grade he was evaled again, add and apd found to be affecting his ability to succeed in classroom (this time the apd was ‘significant’), qualified for sp.ed. He was in pullout for lang.arts/reading during 5th.

We moved from VA to Germany during summer after 5th with an active IEP. In 6th grade he was evaled by DODDS (they said not enough data for DODEA criteria) using the WJ-R, no apd was found. He still qualifies under his add, slow processing speed and weakness in fluid reasoning. His scores were average elsewhere on the test although some of his scores were as low as 81 all the way up to 112, everything averaged together put him in the average range.

My question is how is it that the apd seems to come and go depending on his age and the tests? He was given the TAPS in 4th (along with about 8 other tests) and only the one test in 6th (WJ-r cognitive processing and achievement). We are planning his triennial this Feb. should I ask if they have the WJ-III? The teacher seems to think he may test too high to qualify for sp.ed although she agrees that he will need the accommodations he has now well into high school. He starts 9th grade next year and we want to have everything in place before he gets there, especially if we move from Germany back to the states this summer.

Also, does he sound like the profile of someone with apd? He struggled for many years to learn to read even with school help and tutoring, he has been doing pretty well the last two+ years with lang., he is now struggling with 8th grade math. He needs much repetition to learn and has some difficulty retaining things, he still can’t spell but his actual writing is pretty good. He is a very bright kid that can’t seem to show his knowledge on tests. He has been on some form of ritalin since 1st grade, it makes a huge difference in whether or not he is available to learn in the classroom.

Appreciate any information you can give. Thanks.
Amy

You wrote
>SLP dxed mild/mod. capd. This was in ‘95.

It has always been my understanding that school personnel cannot be a sole diagnostician of APD—they don’t have the equipment for figure-ground and other things. It is a medical diagnosis.

> In 2nd grade he was given eval by school because he was
> still a non reader, called a late bloomer, apd not
> ‘significant’ as told by school psych. He continued to be in
> reading class outside reg. classroom. In 4th grade he was
> evaled again, add and apd found to be affecting his ability
> to succeed in classroom (this time the apd was
> ‘significant’), qualified for sp.ed. He was in pullout for
> lang.arts/reading during 5th.

So, what tests did the schools use for reading and math achievement measurement? WJ-R? If so, get the Woodcock Reading Mastery or Woodcock Diagnostic Reading Battery done next time. The tests are different, but what really makes the difference is separating out the basic skills (word attack/word ID in isolation) from the context reading/comprehension piece. Lots of kids don’t qualify ont he WJ-R or WJ-III because the comprehension and word ID are “clustered” together and their comprehension props up the word attack too much for them to look “needy” enough to qualify.

> We moved from VA to Germany during summer after 5th with an
> active IEP. In 6th grade he was evaled by DODDS (they said
> not enough data for DODEA criteria) using the WJ-R, no apd
> was found.

So what did they use?

He still qualifies under his add, slow processing
> speed and weakness in fluid reasoning. His scores were
> average elsewhere on the test although some of his scores
> were as low as 81 all the way up to 112, everything averaged
> together put him in the average range.
>
> My question is how is it that the apd seems to come and go
> depending on his age and the tests?

It doesn’t come & go. Most disorders fall along a continuum from mild to severe. What instruments are used to test may make a huge difference on where scores fall. Check over on the parent bb and do a search on APD. People have posted some good assessment information on this site over the years. For some kids, however, the neurological pathways mature over time and some of the affects may diminish. Auditory processing would probably never be a strength, though.

>He was given the TAPS in
> 4th (along with about 8 other tests) and only the one test in
> 6th (WJ-r cognitive processing and achievement). We are
> planning his triennial this Feb. should I ask if they have
> the WJ-III?

Try to get them to use these tests: Woodcock Reading Mastery or Diagnostic Battery (as mentioned above), the Key Math -Revised, The Test of Written Language - 3, and you might get him tested by an audiologist for the CAPD-D thing if it’s still an issue. There are some good visual and auditory procesing tests on the WJ-III and you could suggest those. Some of the SLP’s that look in may have some other ideas on the Language tests that may qualify him for addtional assistance.

The teacher seems to think he may test too high
> to qualify for sp.ed although she agrees that he will need
> the accommodations he has now well into high school. He
> starts 9th grade next year and we want to have everything in
> place before he gets there, especially if we move from
> Germany back to the states this summer.
>
> Also, does he sound like the profile of someone with apd? He
> struggled for many years to learn to read even with school
> help and tutoring, he has been doing pretty well the last
> two+ years with lang., he is now struggling with 8th grade
> math. He needs much repetition to learn and has some
> difficulty retaining things, he still can’t spell but his
> actual writing is pretty good. He is a very bright kid that
> can’t seem to show his knowledge on tests. He has been on
> some form of ritalin since 1st grade, it makes a huge
> difference in whether or not he is available to learn in the
> classroom.

He does sound like someone who could have APD. Lots of APD (and non-APD) kids struggle to read. It’s that early sound manipulation thing that throws ‘em.

I hope others will jump in. I’m strickly academics—reading, writing, math—where others have speech/language, etc. as their specialties.

Not sure about its public education, but I sure love N.C. My son has attended SOAR a couple of times in the Asheville region. The smoke definitely got in my eyes. I enjoyed the coastal areas, too. Charlotte is a wonderful city, too.

Amy,

Susan, as always, has given you excellent advice. I won’t repeat all that she said, but I do want to talk a little more about APD. It certainly is possible that your son has APD. However, it sounds as though he has never had the appropriate testing to actually get an accurate diagnosis, as Susan suggested. Speech/language testing can identify delays in receptive language that may have APD at the root, but it cannot dignose APD. The TAPS-R cannot differentiate language processing from auditory processing (I am told this by an APD expert). Therefore, APD can only be diagnosed by an audiologist who specializes in APD. There are many audiologists who may do some APD testing but do not specialize in it. I would not go to one of these. It is too important to go to someone who can help with therapy suggestions. If you return to VA, then I can refer you to someone excellent in the DC area.

Also, APD does not come and go. But the difficulties may only be present in particular circumstances, such as if a child has difficulty understanding speech-in-noise. If you get good APD testing and present all the school tests to the audiologist, then you should get advice on where the reading deficits lie and what types of therapy will help.

The Woodcock Johnson III is useful because besides the standard sections on reading, writing, and math, it also has sections on listening comprehension and oral expression. I would insist that ALL subtests be given especially since APD is suspected. Just understand that no achievement test or language test can officially diagnose the APD. But he technically could qualify as LD in listening comprehension even if he did not qualify in the areas of reading, writing, and math.

Janis

Susan:

<>

We just did! A few weeks ago, we completed a triennial reassessment on one of my students. {In my state we use a regressive formula. Our state publishes a table that lists what numbers are needed in order to have a discrepancy. The lower the IQ above 70, the less the discrepancy needs to be and the higher the IQ, the greater the discrepancy must be). Anyway, this student did not have the discrepancy to remain in Special Ed. under the LD label, but he did continue to qualify for Speech and Language services based on his poor articulation, which was causing significant problems with spelling and both oral and written expression. Most kids don’t qualify for Speech with articulation problems, but his is severe enough to interfere with his ability to communicate with both peers and staff. We were quite creative with the IEP, and he will still receive Special Ed., but as a related service to help with the written expression. His primary disability on the IEP is Speech/Language Disability. Clinical judgement and a good IEP team can sometimes work miracles!

Marilyn

Janis:

<>

Doesn’t your state require a documented processing deficit in addition to the discrepancy to qualify for LD? Since the hearing impairment is an acuity issue and not a processing deficit (in my state it is an exclusionary item on our multidisciplinary form), I would have to assume that your student has significant visual processing deficits. That would be the only way she could receive dual services.

My other question for you would be why the discrepancy formula is not also used for the hearing impairment? (I am also a certified teacher of the hearing impaired, so my question is not being asked for lack of knowledge on my part). Consider that if the child does not have the discrepancy, she can still receive the following services (i.e. paraprofessional services, sign language/oral interpreter, Speech/Language and audiological services) with a 504 Accommodations Plan and remain in the mainstream classroom. It’s really an academic question since I’m not on the IEP team and do not know your student.

Marilyn

In ‘95 ( at age 6) he was screened by an slp at the military hospital using the following tests,
PPVT-R form m= average performance
TOLD-2P= average with the exception of word discrimination=poor
Goodman Fristoe test of artic.= no artic. errors in single words
TAPS= Strengths
number memory: fwd average, reverse low average
sentence memory: average
interpret. of directions: average
aud. processing; thinking and reasoning: average

Weaknesses
word discrimination: poor
word memory: below average

In 4th grade(1998) the school eduational diagnostition used the Kaufman test of educational achievement/nu
reading composite 86-84
math composite 74-72
spelling 93
battery comp. 80

His WISC-III scores are FSIQ 101, VIQ 100, PIQ 102

Differential Ability Scales score was 93, cluster scores were Verbal ability 90,
Nonverbal reasoning ability 86 and Spatial 107

Bender Visual Motor Gestalt test score was 95 indicators associated with lack of planning and poor organizational skills were noted.

TAPS auditory perceptual quotient was overall 79 8th percentile rank
test score fluctuations from 2nd percentile to 66 percentile; greatest difficulty was tasks assessing his aud. short term memory tretieval and ability to interpret aud. instructions

VADS test suggests difficulty when required to integrate two sensory modalities, especially when requiring written expression.

WIAT-screener=basic reading 92, spelling 99, math reasoning 91

In 6th grade he was given the Woodcock Johnson-r tests of cognitive ability
cluster scores follow
long-term retrieval=92 (range was 86-100)
short-term memory= 95 (range was 87-101)
processing speed=94 (range was 83-112)
aud. processing= 99 (range ws 90-110)
visual processing= 112 (range was 98-119)
comprehension/knowledge= 106 (range was 98-113)
fluid reasoning= 86 (range was 81-96)

Woodcock Johnson-r tests of academic achievement
Broad reading= 95 (91-99)
letter/word id. = 91-99
passage compr.=90-102
Broad math= 93 (89-97)
calculation= 89-97
applied problems= 91-103
Broad written lang.= 88 (84-92)
dictation= 88 (83-93)
writing sample= 95 (89-101)

Wanted to mention that in the 6th grade testing, on the test of academic achievement, the tester stated that my son would not guess on any questions, was even stopped and reminded that he could guess and continued not to, tester felt like that would have negatively affected his scores. The test summary was of a student with ‘learning differences’ not deficits. My first question at the time was ”do all the teachers know how to teach to a learning difference?”

He appears to be an average student and for the most part makes b’s and c’s in reg. classes with some help and accomodations. Currently not doing well in 8th grade math, I discussed this with the sp.ed teacher and his weakness in fluid reasoning is partly to blame along with the adhd and possibly that elusive creature apd. Personally I would include the teacher and so does my son’s tutor who thinks he isn’t doing his job.

Amazingly, in the early grades our biggest struggle was in learning to read, in middle school it has been math.

About the medical dx of apd. I have gotten the run around here about this. The school says a med. problem, ped. says school problem, audiology clinic says it has to go through school and on to the EDIS folks (I can’t remember what the acronym stands for but they basically are the child find folks/ preschool kid screeners). Since the last test didn’t see a problem with apd, I don’t exactly have something to go on to push on with EDIS. This would probably be easier if I were in the states but here I have to deal with all military folks. Possibly for at least another year and a half.

If you plowed through all that, thanks so much.

Thanks for replying Susan.

I appreciate everyone’s input.

Amy

I really appreciate your help in this, sorry the other posts are so long, I seem to type longwinded. I think I will pursue the testing with EDIS, supposedly the audiologist there is very passionate(?) about the subject of apd. I had spoken to my audiologist about this recently, since I am HOH, I had hoped they were the ones to help. Everything here is so compartmentalized, it’s frustrating.
Thanks again.
Amy

Hi, Marilyn,

Good to “see” you! We were not qualifying this child for LD. She would have qualified LD in all areas IF she did not have the hearing impairment. You are absolutely correct that it would have been inappropriate to have changed her placement to LD. I had to explain that to the resource teacher as a matter of fact. Although, I will tell you that I certainly see kids who I know have processing issues in addition to hearing loss. And yes, it is possible to have hearing loss AND auditory processing disorder. I learned this from an APD expert (audiologist/SLP) who also has a background in HI. Even though I used the term “LD resource teacher” to refer to the person who serves this child in reading, writing, and math, she serves any special ed. student that needs basic instruction in those subjects regardless of category at that school. She, of course, would not be qualified or able to work with severe HI kids. They are pulled into a centralized school where I or my assistant works with them. Unfortunately, I am doing the job that two of us did last year, so I am losing my mind since I can’t serve anyone as they should be served at the moment!

“My other question for you would be why the discrepancy formula is not also used for the hearing impairment?”

I suppose the basic answer to that question is that it is not required by law. But the answer I would give is that a child can be a year behind in a subject (like reading) and really need help but not have the 15 point discrepancy. The hearing loss gives them the right to services for that educational delay. It is usually only the mild loss kids that fall into that category, though. The severe loss kids invariably have much more than a 15 point discrepancy. The child I was talking about above has aided hearing in the speech range, but she did not get aids until she was five years old. So she missed hearing well during some critical years which probably explains part of her delays. She also has a brother labeled LD, so that is why I also suspected possible processing issues in addition.

Janis

As always, I read with interest anything both Janis and Susan Long write.
Just a question. I note that APD and ADD seem to “mimic” each other. Janis mentioned children diagnosed ADD when they are, in fact, APD.

However, just ignorance on my part, but would the various ADD meds also improve APD symptoms and if so, is it b/c they are so similar?

My daughter, who is both ADD & APD (I’m sure that would be debateable (SP?), depending on who’s observing), states that the ADD meds “Make all the noise in the room go away so I can read better”. That could be both. She has significant APD.

Just your thoughts, please?

What an excellent question, Leah! And I have heard this discussed before in depth on the APD listserve. And thanks for naming me in the same sentence as Susan Long…that’s a real compliment for me!

Let’s see if I can explain it. ADD (ADHD) meds have no effect on APD. But to a child who cannot focus due to ADD, the meds will give them the perception that they suddenly can hear, or pay attention better. A child who has APD and NOT ADD will only show a mild positive effect from a stimulant medication just as any of us would by taking it, but it would have no effect on the APD itself. That’s a pretty good way to eliminate ADD as a possibility…if the meds don’t help the listening/focus problems it’s more likely the APD. Of course, there are children like your daughter who have both problems, and that can present tremendous challenges. I am assuming yourdaughter was tested for APD while on meds, right? That would be essential to get a valid APD test result. APD and ADD are really quite different; I think they just have some similar outward symptoms.

Janis

Janis,

Thanks for responding so quickly.

My daughter was evaluated at the very beginning of 2nd grade (private). She came up with “severe specific LD’s in all academic areas evaluated” and significant processing delays both auditory and visual. Gifted IQ and SI problems and motor planning problems (BIG TIME) (Oh and fine and gross motor skill deficits). The evaluator said she was NOT ADD. Her opinion was that b/c Jami was struggling so, she got “off task” primarily b/c she couldn’t do the work.

We continued through 2nd grade. Jami spent almost every recess doing classwork she could not finish. Homework was taking 3 hours. I called evaluator, and again she insisted she was NOT ADD. 3rd grade was an “inclusion” classroom. It was a nightmare (we moved out of there), but the only good thing was that the teacher and I discussed ADD and the teacher said “Although students are MANY times overdiagnosed, your daughter CANNOT focus”. We had her observed in class and the pediatrician wrote her a prescription for Concerta based on letters from her ESE teacher, the observation and a letter from her tutor. She started on a Sat and on Monday she went in and wrote a FULL PARAGRAPH during writing (she usually only got the prompt copied). She began finishing classwork for the 1st time as well. And homework only took about 45 minutes! Now however, in 4th grade, she ‘s struggling to finish again (I guess b/c more is expected and she does have some significant impairments).

The big thing I notice with her reading is that if she is NOT taking the meds she will be reading about a farm and then she’ll start talking, “Remember, mom, that horse farm we went riding and blah, blah, blah…”, and I’ll have to say, “Yes, that was great, now c’mon let’s read” and point back at the book, but when she’s on the meds she is able to continue reading without getting off task.

Funny thing is, she doesn’t take it on the weekends b/c she is not ADHD, just ADD. And some parents will say, “well if they don’t need it on the weekend, they don’t need it”

Sorry for the long post/explanation. But I guess no one really wants to medicate their child unless its absolutely necessary and I keep second guessing myself and the decisions I make.

BTW, your name is worthy to be placed alongside Susan Long. I have learned so much from both of you and always know that if you or Susan have written it, it’s worth noting!

APD isn’t my specialty. We each have our nitches and one no better than another. Thanks for the compliment but I’m just as pleased to be named in a sentence with you, you know.

Janis,

Just noticed I missed a question you had.

No, Jami was NOT checked for APD while on the ADD meds b/c as I noted in the prev. post, she was not considered ADD. In testing situations, one on one, must people don’t see the ADD, but put her in a classroom with noise, and distractions, and it rears it’s ugly head.

So, you think her APD score may not be valid due to no ADD meds?

Janis:

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I can see this if the child has a mild to moderate hearing loss that benefits greatly from hearing aids. Otherwise, this would not make the least bit of sense to me. Actually, I’m wondering if this audiologist might have a different perspective on the definition of auditory processing. For instance, his definition may have more to do with the difficulties a hearing impaired child may have when provided with aural rehabilitation—learning how to “hear” with his/her new hearing aid (i.e. loudness, direction, frequency). I think this differs greatly from an LD child who has severe phonological processing deficits that have absolutely nothing at all to do with his hearing acuity.

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But our “slow learners” are in that very same position if not worse. They do not qualify for services, and they can’t even qualify for a 504 Accommodation Plan in most places. It seems to me that a hearing impaired child with a 15 pt. discrepancy and a 504 Accommodations Plan has a more level playing field with his hearing peers with average ability level than the slow learner who gets no help at all Theoretically, I believe the discrepancy should apply. Again, it’s an academic opinion, and it is up to each team to decide each child’s needs on a case by case basis.

Marilyn

Leah,

I definitely agree with taking ADD meds on school days and not on weekends. Concentrating on school work which is difficult anyway is much different than playing and watching TV! Besides, it is good to give the body a rest from the meds. ADD inattentive is definitely different from ADHD.

Did she actually have an APD test by an audiologist after medication? If not, I would question the validity of all the test results given without the ADD meds. I am not saying that I think she doesn’t have processing deficits, just that all the testing would have been tainted by her unmedicated ADD state. I have had a couple of severe ADD kids in my class, and if they forgot their meds their handwriting became illegible! So I know an child with ADD unmedicated cannot have very accurate test results.

Thanks again for the kind words! I really value all of you here as well!

Janis

{{{{Susan}}}}, thanks!

Janis

Okay, you saw my question. Yes, she should definitely be re-evaluated for APD while on the ADD meds. Are you in FL? Who tested her earlier?

Janis

She was tested by a private psychologist, not a audiologist. Yes, I’m in Florida. The lady who evaluated her was a former school psychologist and head of an ESE department in her county. I can Email you her name if you want it.

Jami has had both private and school provided OT though if she doesn’t take her meds, her handwriting gets worse, but it’s not illegible (It was in 2nd grade b4 OT)

Also, she probably still has deficits but not as large as previously thought. She evaluator thought it was sensory integration that was causing the large gaps.

Her IQ has never been retested (Her evaluator believes it doesn’t change (or at least not significantly) (OUCH, I can hear all those that disagree now!) She did get her SS retested after one year of LMB (I requested that be done b/c I wanted to make sure it was making a difference) She went up like 6 pts. in reading comprehension. (This was after she began meds), though she was still considered LD, no sweat).

So, where do you suggest I go from here? Is it necessary to get this testing redone? Her evaluator suggested she be retested (again, not IQ) at the end of 5th grade/beginning of 6th (just b4 middle school).

Being completely honest, she is able to attend gifted resource, but JUST made the gifted scale. I am afraid with a bad day she could drop the 1 pt. and no longer qualify gifted (It’s her favorite part of school) and this would be a HUGE blow to her.

Suggestions?

Okay, I’ll respond within your text to make this more efficient:

“She was tested by a private psychologist, not a audiologist. Yes, I’m in Florida. The lady who evaluated her was a former school psychologist and head of an ESE department in her county.”

You really can’t get a true APD diagnosis without audiological testing. I had Anna tested at the U of FL in Gainesville at the APD audiology clinic there. Unfortunately, Dr. Deborah Moncreiff who was there last fall has moved to a new location. So I cannot recommend it without knowing who is there now. I have “met” another FL APD audiologist online and I have her web-site:

http://www.familyhearingassociates.com/

“Jami has had both private and school provided OT though if she doesn’t take her meds, her handwriting gets worse, but it’s not illegible (It was in 2nd grade b4 OT)
Also, she probably still has deficits but not as large as previously thought. She evaluator thought it was sensory integration that was causing the large gaps.”

Without meds, I’m just not sure about the accuracy of that testing. Especially since the evaluator missed the ADD altogether.

“Her IQ has never been retested (Her evaluator believes it doesn’t change (or at least not significantly) (OUCH, I can hear all those that disagree now!) She did get her SS retested after one year of LMB (I requested that be done b/c I wanted to make sure it was making a difference) She went up like 6 pts. in reading comprehension. (This was after she began meds), though she was still considered LD, no sweat).”

Well, you can have private testing and then it is your private information to share or conceal depending on how it will benefit the child. The evaluator is indeed wrong about IQ staying the same…has she not read about the Matthew Effect? I also had my child tested at the reading/language clinic at the U of FL. They are very good and not too high priced.

“So, where do you suggest I go from here? Is it necessary to get this testing redone? Her evaluator suggested she be retested (again, not IQ) at the end of 5th grade/beginning of 6th (just b4 middle school).”

My personal opinion…I’d be scheduling new, private evaluations immediately. She must be tested on medication, in my opinion, if you want any idea of her real abilities and disabilites, and yes, that includes a new IQ test, Woodcock Johnson III achievement (all subtests including listening comprehension), other language/ reading tests, and APD by an audiologist who specializes in APD. Do not use the same evaluator as before.

“Being completely honest, she is able to attend gifted resource, but JUST made the gifted scale. I am afraid with a bad day she could drop the 1 pt. and no longer qualify gifted (It’s her favorite part of school) and this would be a HUGE blow to her.”

That is why I wouldn’t let the school do the IQ test at this point. Better to pay for one so you can control the results. The results could even be higher since she’d be on meds, but you never know. But I wouldn’t take the chance. I think it’s worth it to get one good outside evaluation (by experts in the different fields, of course) if you possibly can.

Janis

Janis,

I emailed you off line. I will look into UNF and also the website you gave me. Thanks for all your input. Boy, you just never can tell, can you?

I have used the WJIII for two years. I don’t think students score any lower, except possibly the passage comprehension subtest where there are several my upper graders read and NEVER get correct. I have already addressed this on this site. I have a hard time accepting a question as valid, when in two years I cannot get any, or only 1, child to correctly answer the question, despite their word reading ability, verbal IQ and ability to answer questions on an IRI. I have given over 60 WJIIIs.

I’ll be seeing that Prof this evening and I’ll mention this feedback. See what he says.

I am not Janis or Susan Long and don’t know how valuable my input will be—but here goes any way. I have a 14 year old son who has struggled with school since the age of 4. His first dx was “developmental delay”, from there he moved to ADHD, inattentive type, from there to mixed receptive expressive language and finally to APD. He was tried on various meds when they thought the dx of ADD, inattentive was his main problem. None of the meds worked for him. They just made this already quiet, slow moving child, more quiet and slow moving. The first time we started noticing improvement with his was when the speech pathologist started working with Earobics with him. He showed more improvement after classical music was played in the backround when he worked. When he was old enough and finally had the words to start telling us what was going on he would say “I can’t hear the individual words, everything is all garbled. Now at 14 it seems some of his systems are maturing and he is more “available” for learning.What I mean is his “inattentiveness” is not as much a problem. Most his teachers do not see him as inattentive. They do see him as a child who struggles with processing of auditory material but don’t feel he is inattentive. It has been a pleasure to go to school and hear the teacher say “Mike is a role model student, he always comes to class well prepared and ready to work.” “He sets right to work and works until the bell rings.” This is so much different then what I used to hear from teachers. So what I am saying is I think some kids with APD are misdiagnosed at first and this leads to the wrong remediation. Just my humble opinion.

Lisa, I agree. I think ADD is really the catch-all diagnosis. When my son couldn’t concentrate in high school (and finally told us…we just thiguht he was unmotivated), he was diagnosed ADD inattentive. But when he took the meds, it did not make all the problems go away. It took awhile to find someone to spend the time necessary to diagnose him correctly, but we now believe he has an anxiety disorder/OCD. So yes, it scares me when so many little kids are diagnosed ADD or ADHD when it is really something else, and the something else might need a different kind of medication. As a matter of fact, I have since read that Ritalin is bad for OCD. So while we were trying to help him, we really might have been making him worse. But he kept a lot of his feelings and symptoms to himself, which made it harder to figure out. Of course, he didn’t know how “normal” felt either, so that made it hard for him to express.

True ADD or ADHD kids usually will have marked improvement with meds. If there are still problems after meds, then I would suspect something else. A lot of mental disorders have overlapping symptoms. And I almost never hear of young children diagnosed with things like anxiety disorder. Probably because, like my son, they are not able to express how they are feeling inside adequately.

Janis

I know Terri Bellis, a leading APD expert, says you ought to take care of any ADD before assessing APD because it can confound the results. I thought that was interesting because we have followed exactly the opposite course. My reasoning has been that APD can be documented while ADD is much more a matter of judgment. And indeed we got attention improvements when his auditory processing improved vis a vis Fast Forward. But clearly other things were going on with him and by the end of third grade after his auditory processing had been largely been remediated, all we heard was how bad his attention was. I then had him evaluated by a neurologist who diagnosed ADD-inattentive. Interestingly enough, a therapist we have worked with for several years thinks it is still processing, not ADD. Interactive Metronome was very effective for him in improving his attention—not sure whose point of view that supports!!!

Beth

Hi, Beth, I was wondering if you’d see this! Yes, it is SO complex. Have you tried the meds yet? I can’t remember. I need therapy for working memory!!!

Janis

After all that I laugh. I am in a funny situation and I am thinking of doing just this. I have a demand for an OHI eval. on a child who is from a foreign country and speaks E.S.L. This child maintains average grades on grade level standards and has always maintained average SAT 9 scores. He is in 5th grade. he has a blood disease which causes anemia and results in fatigue.

The hospital caseworker is getting very pesky demanding an IEP because he will need one in high school. Of course, we know how the IEP process works, it is not a case of let’s put this child on an IEP so we will have it there 4 years from now. The demands of elementary school for him are not that great. We feel a 504 plan documenting the modifications and accomodations already in place is what is called for at this time. This is working as demonstrated by test data, work samples and grades. Of course, the Chinese (excuse “racism” here) don’t want modifications, he is to do what everyone else does, even though he cannot do as much due to fatigue.

So, to deal with this nasty hospital worker I decided to do a WJIII. He is at 2nd to 3rd grade level in listening comprehension, picture vocabulary and academic knowledge. Less language dense things are at grade level. He is learning. However, he may not be as English proficient as might be desirable. This MAY cause a little more challenge in science and social studies (very concept and vocabulary dense subjects, though teachers handle very effectively and child is a “C” student).

This hospital lady has called everyone and badgered. She insists on an IEP. So, I am considering one in vocabulary/listening comprehension. I believe the source of the delay is English language learning, NOT OHI. However, the presence of an OHI condition muddies the water. No other child in our school who is an E.L.L. will get resource assistance (there are plenty) because he is an E.L.L. But, he may.

My other concerns on this child’s behalf are: 1) is there a global language delay; and 2) what is the nonverbal intelligence. We are to the end of the timeline and so we cannot just decide to do further testing and start a new timeline. Of course, if we place him and he turns out to have an overall IQ of 85 (nonverbal, too), then he is most certainly learning what he can, as much as he can. Once he is placed, we won’t get him unplaced and on a 504.

So, what would your do? Write a language goal and see him 30 minutes per day? He is off P.E. so I could see him during his P.E. and not cause him to miss instruction. Of course, never mind the two third grade girls I teach during his P.E. time, they will just have to share my time with him now.

Janis,

That is the working mom with LD kid effect!!

No, we haven’t tried meds. I moved back his appt once and then cancelled it altogether. Both his teachers report no issues with attention this year. One of these is his resource teacher who had him last year. She said at his IEP meeting that she “kept waiting for the old Nathan to come back.” Honestly, I don’t see big changes at home but then one on one he has never been as bad as they reported at school.

IM is clearly a big part of his success. We followed IM with more Neuronet and he made rapid progress with the exercises. His NN therapist told me that after his ADD-inattentive diagnosis that she thought it was all processing. She had an explanation for everything I attributed to ADD-inattentive. For example, her explanation for his inability to sustain attention when reading (always wants to know what has not been explained) is that he doesn’t visualize well and thus doesn’t anticipate what is going to happen. We have visualizing written into his next IEP so we’ll see if that helps.

My mom expert opinion is that he is ADD but not to the extent that the neurologist thught. I see mild symptoms in my husband and my nephew is the same way. Neither have learning disabilities though and that makes a big difference. Thus, I must admit I still wonder if medication would make learning easier for him.

I also have made some dietary changes which may be helping as well. I read Dr. Amen’s book on ADD and he suggested a high protein, low carbo diet for these kids as well as a multi vitamin. We stopped giving our kids vitamins after the younger one at two climbed on the counter and got the bottle from the top shelf and finished it off!!! Nathan is a huge breakfast eater but only ate carbos. So I started giving him and his younger brother (Mr. Hyper) cheese and meat as well. I am thinking of trying some of the supplements Amen suggests as well and see if they make a difference.
Beth

Beth,

Oh boy, Anna eats almost all carbs! I’d have a heck of a time increasing her protein!

I understand the “little bit ADD”. I think that describes me! I use coffee for my morning meds and it works out fine! I had one mom tell me she read that some people are trying Mountain Dew instead of Ritalin for their mild ADD kids. I think that’s a pretty good idea! (That made me wonder if they’d use regular or diet, though. Seems like the sugar in regular might be counterproductive.)

I am just so delighted that N is having such a great year! That is such an accomplishment in fourth grade!!!

Janis

Anitya,

I had a VERY similar situation although the child was placed without my input. The child comes from a Spanish speaking home and I sincerely believe her academic delays were due to ESL issues. She did have a physical handicap that needed PT. So the school used a unilateral (one side) hearing loss (one ear completely normal) to place her HEARING IMPAIRED!!! so they could give her academic and related services. That’s about like labeling a child with glasses VI!

However, the child was very eager to learn and hugged me everyday. I’m glad I didn’t have to make the placement decision as I might have said HI- no way. But the bottom line was, she did need vocabulary to increase her reading comprehension, so I’m glad she was able to have the help. But she moved last month, so I don’t have her anymore.

I don’t know the answer. Obviously what you are thinking would help him. I think ESL kids are very hard to accurately place sometimes.

Janis

Once when I taught VBS, I was complaining about the hard to handle ADHDer’s in my group and the spec ed teacher said to give them some DIET Coken with Caffeine. No sugar, just caffeine. She said caffeine can have some of the same effect as Ritalin (b/c its a stimulant).

I think I’d be pretty ticked off if someone else decided to try to medicate my child, even with caffeine, without my consent. My ADHD son also has an anxiety disorder, and is on meds for that. The last thing in the world I want in his system is an indeterminant amout of a stimulant substance.

For that matter, I don’t like my kids drinking or eating artificially sweetened foods. Those chemicals have their own whole set of possible problems.

Karen