Not dyslexia/dysgraphia, but possibly attention, tracking, processing speed!

[niccig]

This I didn't see coming. We finally got back to see the clinical psychologist that is doing the educational testing for DS. He tested average for most of her testing - he's 10.5 and going into 5th grade. He tested low in a couple of areas, so she wants to do more testing to tease out those areas more.

Tracking - scored low on a tracking test. His reading is 7th grade and on one test even 12th grade, but his reading speed is 4th grade, which makes her want to investigate tracking more, as that may be reason for discrepancy.
Visual-motor and verbal processing was fine but the processing speed test was low and he ran out of time on some of the timed tests - was getting things right but needed more time.
Attention - one of her tests suggests moderate attention issues, she wants to do full attention testing as that one test alone isn't enough. I didn't flag this as an issue, so she didn't do all the tests. I've never thought of him as having attention issues, but she said it can be more subtle and if he's mostly well behaved, the teachers won't flag it either.

His writing - some things he was 90-100%, others he was low average (spelling, punctuation). Not enough to say dysgraphia. But the issues I'm seeing could be explained by what the testing has shown so far.

So still no answers, but more testing to see if more can be figured out.

[sste]

How is his working memory? Did she test rapid naming? I think working memory can cause issues with handwriting. Does he have any motor issues in his handwriting --formation, speed, endurance, handwriting fluency? Not to send you on more evals but OT evaluations are often covered in full by insurance, at least in my state.

Did she have the teacher fill out a form on attention?

Is the tracking visual tracking? If so, you may need to assess for amblyopia (lazy eye) and also ocular-motor (I think this is OT again or there is vision therapy though that is more "iffy" IMO).

Hope I am not overwhelming you! FWIW, my son has had basically two comprehensive evals -- neuropsych, OT, and SLP. The first was the eval and 9 months later we went back for progress monitoring. I def. feel like we have gotten a better understanding over time -- the initial eval told us a lot but the subsequent one refined it and exposed some additional areas/therapies.

Last but not least your son may have remediated mild-moderate dyslexia. What you did for him in early elementary mirrors many of the major components of dyslexia intervention -- phon. awareness etc. A common hallmark of the remediated dyslexic is that they can read at grade level but their fluency (of which speed is one big part) remains somewhat below. When you remediate it, it is hard to tell unless there are major rapid naming issues -- the P.A. picks up, the reading picks up, the child is at grade level, there isn't a mack truck sized gap anymore between IQ and reading.

[inmypjs]

Last but not least your son may have remediated mild-moderate dyslexia. What you did for him in early elementary mirrors many of the major components of dyslexia intervention -- phon. awareness etc. A common hallmark of the remediated dyslexic is that they can read at grade level but their fluency (of which speed is one big part) remains somewhat below. When you remediate it, it is hard to tell unless there are major rapid naming issues -- the P.A. picks up, the reading picks up, the child is at grade level, there isn't a mack truck sized gap anymore between IQ and reading.

This. The 2 major components of dyslexia according to the IDA are phonological awareness problems and rapid naming problems. Anyone evaluating for dyslexia should be giving tests for both of those. (If they aren't, I would seriously question what they know about dyslexia.) If you've remediated his PA, it often shows up as fluency problem. Eye tracking could be part of it, but many times dyslexics who have been remediated remain slow readers. It's just the nature of the game. I also don't know many psychologists that are very skilled in dysgraphia evals. Around here an OT would be needed for that. I have never seen spelling or punctuation considered as part of a dysgraphia evaluation - typically it is more about letter formation, placement on page, writing endurance, speed, those kinds of things.

About the attention, if the evaluator did the computer test where numbers go across the screen (the name of that is escaping me!), then visual processing and tracking problems can completely affect that. The child will not be able to do well on that test if they can't track the numbers around the screen and click accordingly. Hope that makes sense.

We also had 3 major evals - neuropsych, OT and developmental optometrist. I would have seen an SLP if our psychologist did not have an extensive background in language testing.

Good luck, hope you continue to get information that helps!

[niccig]

How is his working memory? Did she test rapid naming? I think working memory can cause issues with handwriting. Does he have any motor issues in his handwriting --formation, speed, endurance, handwriting fluency? Not to send you on more evals but OT evaluations are often covered in full by insurance, at least in my state.

Did she have the teacher fill out a form on attention?

Is the tracking visual tracking? If so, you may need to assess for amblyopia (lazy eye) and also ocular-motor (I think this is OT again or there is vision therapy though that is more "iffy" IMO).

Hope I am not overwhelming you! FWIW, my son has had basically two comprehensive evals -- neuropsych, OT, and SLP. The first was the eval and 9 months later we went back for progress monitoring. I def. feel like we have gotten a better understanding over time -- the initial eval told us a lot but the subsequent one refined it and exposed some additional areas/therapies.

Last but not least your son may have remediated mild-moderate dyslexia. What you did for him in early elementary mirrors many of the major components of dyslexia intervention -- phon. awareness etc. A common hallmark of the remediated dyslexic is that they can read at grade level but their fluency (of which speed is one big part) remains somewhat below. When you remediate it, it is hard to tell unless there are major rapid naming issues -- the P.A. picks up, the reading picks up, the child is at grade level, there isn't a mack truck sized gap anymore between IQ and reading.

Rapid naming for working memory is fine. So is his visual-spatial working memory. It's the processing speed of the working memory where he had issues - this is something she wants to do more testing to see. He does seem to need more time to complete work and he has mentioned he doesn't have time in class to get everything done.

Motor issues with writing - I do want to do an OT eval and hoping she has a recommendation. I think there's some issues, some of which may be bad habits e.g. he writes with his right hand and his left hand is on his forehead and not holding the paper, and I've noticed the paper moving as he writes.

No teacher forms on attention as this wasn't something I brought up to her. His teacher did comment last year that he was talking more in class and she thought this was getting in the way of his academics but never mention attention as an issue. He did score low on her testing for attention (but only 1 test) and she noticed his attention was poor for less interesting tasks. And by coincidence, my mother (teacher for decades) commented on his attention when we were home saying he can be very focused if he's interested but very unfocused when he's not. Need to do more testing to see if attention is an issue. Sounded like psychologist was thinking more subtle attention issues. I can see why she wants to do more testing to rule it out or in, some of things we've seen could be due to attention issues.

Tracking is visual tracking. I don't have the report yet, so can't remember the actual sub test, but it's the one where they have a symbol for a number and have to go through and copy the symbol for all the numbers. What he did was correct, but very slow. Combined with the high reading scores, but slower reading speed for paragraphs, she wants to investigate tracking more. This could explain the difficulty I've seen with the online math problems DS has been doing over the summer (his school uses an online program and I've had him do some occasionally). He has difficulty copying the sum to paper correctly (writes wrong digits) or he gets the right answer on paper but enters the answer incorrectly on the computer. He also has difficulty copying spelling e.g. the word is in the question, but he can't copy it correctly and doesn't copy writing from the classroom board correctly. But this could also be inattention causing the errors. If it is tracking, we can see what to do about that. I know vision therapy can be iffy, and we may need to have a different consult to determine if it is tracking or not.

I was wondering about the reading speed and knowing that can lag, but it's been a couple of years, so do wonder why still slow, which is one of the reasons we decided to do an eval. I do have a dyslexia book here so I'll look at that again as I remember a section on reading fluency. The 12 grade reading level was for word reading ability of unknown words, he's very good at phonological awareness now and he ages out of all the testing they do at school with 100% accuracy

His spelling is very phonetic. I've been having him do some writing on the computer and he's self-correcting his spelling using the webster dictionary app (I was reading about self-correcting can help learn the correct spelling), and it was working well as I was doing less correcting. He's spelling of homophones is poor and even if corrected 1 day, a couple of days later he still makes same mistakes, but when reminded that there's 2 spellings, he can give you the correct spelling. Still not sure what is going on here.

So like everyone else has found, testing just gives you more questions to ask!!! We go back in 2 weeks for more testing, then she'll do her report and recommendations. If we are looking at accommodations at school, I'm thinking of having her come to first IEP meeting as know with DS being at grade level, the school will be less inclined to do anything. I'll update and have more questions!

[niccig]

This. The 2 major components of dyslexia according to the IDA are phonological awareness problems and rapid naming problems. Anyone evaluating for dyslexia should be giving tests for both of those. (If they aren't, I would seriously question what they know about dyslexia.) If you've remediated his PA, it often shows up as fluency problem. Eye tracking could be part of it, but many times dyslexics who have been remediated remain slow readers. It's just the nature of the game. I also don't know many psychologists that are very skilled in dysgraphia evals. Around here an OT would be needed for that. I have never seen spelling or punctuation considered as part of a dysgraphia evaluation - typically it is more about letter formation, placement on page, writing endurance, speed, those kinds of things.

About the attention, if the evaluator did the computer test where numbers go across the screen (the name of that is escaping me!), then visual processing and tracking problems can completely affect that. The child will not be able to do well on that test if they can't track the numbers around the screen and click accordingly. Hope that makes sense.

We also had 3 major evals - neuropsych, OT and developmental optometrist. I would have seen an SLP if our psychologist did not have an extensive background in language testing.

Good luck, hope you continue to get information that helps!

I'm pretty sure his rapid naming was fine - I can't remember the scores. I don't have the full report yet, but I'll update when I get the full report so I can get all your input. This meeting was to tell us she wants to do more testing to figure things out further.

I hear you that the fluency could be remediated dyslexia and I'll definitely keep that in mind. As we live in a large metro area, I know I can find someone to help with reading fluency if it's not related to tracking. DS has commented that he couldn't read everything on a timed reading test at school.

If tracking is an issue, who do you see for that?

I do want to do an OT eval, so I'll start asking around for a recommendation. There were several writing sub tests (can't remember them all), but it wasn't about formation, placement etc. Length of output, information contained, organization, spelling, punctuation were all within average limits. Teacher considers him at grade level for writing. I don't think his letter formation, placement is great, but when I compare to his classmates, he's also not the worse in his class. I don't know enough though to really compare, so I'll get an OT eval.

Yes the attention test was the test with numbers going across the screen and clicking. She said same thing about tracking and processing affecting that test, which is why wants another session to evaluate him. She's not charging us for extra session as she's willing to dig more before making recommendations.

I will definitely be back with more questions.

[sste]

The homophone stuff is very common in dyslexics also copying is a common issue in dyslexia - - I think it may be that combining the effort entailed to read/write in light of the dyslexia plus the visual-motor-cognitive of copying sort of overwhelm the system. A lot of times for milder problems you see the effects when there are multiple "cognitive demands." For math is he reversing numbers or missing digits or just copying the wrong ones entirely? Not trying to make your son dyslexic btw just that these are all labels and sometimes you have a lot of subtle, subclinical stuff going on that *cumulatively* impact function.

FWIW, my son's rapid naming test was fine but our team felt that he showed rapid naming issues in his speech-language testing -- he had a terrible time with the describe the card in a sentence test and has mild-moderate speech organization/categorization challenges, much improved with therapy. His phonemic awareness was I think in the average or low-average range but that was with a full year of speech therapy under his belt already. He just could not read despite a high iq, that is what finally got him an ironclad diagnosis!

For vision, you might start with the OT and see if s/he can do a visual tracking test. You are going to need to hunt around to find an OT with "visual perception" and "visual-motor" expertise but you def. have the contacts for that. The other option is to see a developmental optometrist, one who has the COVD certification is best. Our COVD did a very extensive visual exam. We have done vision therapy, we have seen some gains, I don't regret it on a leave no stone unturned theory . . . but most of the utility of it was a program of at-home exercises. And there are some unscrupulous providers out there. I wonder if an OT could work on the tracking and be covered by insurance?? Our insurance covers speech and OT but not vision therapy.

Good luck! Also be sure to ask them about strengths -- often these tests uncover some areas of real aptitude that are just as helpful if not more than the "deficit" ones to know about. :)

ETA: I have heard good things about "read naturally" program for fluency.

[JCat]

Oooh good luck at your meeting! My son has ZERO tracking ability and the school acts like it's no big deal. I am sure it's going to have an effect on his schoolwork eventually.

[inmypjs]

For the vision stuff, you would need to see a developmental optometrist, not a regular optometrist or opthamologist. They will have COVD after their name. You can find one here: http://locate.covd.org/. Vision therapy is controversial. Everyone has to make up their own mind about it. We did it for 6 months. It was really hard. It was not "the" answer but it did help and I am not sorry we did it.

Dyslexia with both phonological awareness and rapid naming deficits is called double deficit dyslexia. Dyslexia without rapid naming is common too. You can certainly work on fluency, but all of the conferences and reading I have done stress that LDs are lifelong - they can't always be "fixed" and fluency is the toughest to remediate. Sometimes it just doesn't improve even when you work on it. Such is the nature of LDs. Most of us feel that if our child can read accurately with good comprehension, they are doing well.