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  1. #1
    lmh2402's Avatar
    lmh2402 is offline Diamond level (5000+ posts)
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    Default any thoughts on these specific "tests"?

    The psychiatrist that will be seeing DS next week told me she is planning to do a cognitive assessment (Differential Ability Scales-II or possibly WPPSI), the ADOS-2 and something for pre-academics (possibly WIAT-III, Wechsler individual achievement test)

    I know there are very savvy parents on here that are well experienced with different testing methods - would really appreciate any thoughts on the tests suggested above.

    Also, any perspective on the Autism Diagnostic Interview - revised ADI-R - she was using this to guide our discussion during the parents meeting at the end of last week.

    Many thanks
    mama to my awesome sporty boy (4/09) , precocious little girl (7/12) , and loving doggies (10/05 & 1/14)

  2. #2
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    hillview is online now Blue Diamond level (20,000+ posts)
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    Well DS2 had the APPSI and the WIAT-III as part of his work up. Here are the tests he had. He was 5 when he had these tests so they skew young. In addition we had some what looked like oppositional issues (not really oppositional) so there are some extra tests for that. DS2 ended up with a dx of something on the spectrum (ish). So it included some tests for autism. Both kids have been tested and generally there are several tests. I guess I would just ask what the overall plan is -- to do these tests and determine what's next?

    Wechsler Preschool and Primary scale of Intelligence – 3rd ed. (WPPSI-III)
    Wechsler Individual Achievement Test – 3rd ed. (WIAT-III) – selected subtests
    Boston Naming Test (BNT)
    Wide Range Assessment of Memory & Learning – 2nd ed. (WRAML2), Selected Subtests
    Beery Buktenica Test of Visual-Motor Integration – 5th ed. (VMI)
    NEPSY, Second Edition (NEPSY-II) – Selected Subtests
    Achenbach Child Behavior Checklist
    Teacher Report Form
    Conners - Parent & Teacher
    BRIEF – Parent & Teacher


    In terms of usefulness WPPSI--III was pretty useful as it found high level discrepancies in categories and high level weaknesses and strengths.
    The WIAT-III was good for understanding his academic strengths and weaknesses although when he was 5 this was not a KEY issue or concern (we were largely concerned about behavior issues). I think those 2 are good for a starting point as they can help direct additional testing (which for us, additional testing was KEY to understand the details of what was going on with him).

    I am SO not an expert -- I just pulled up his test results and tried to summarize. Hope someone else is smarter here
    DS #1 Summer 05
    DS #2 Summer 07

  3. #3
    lmh2402's Avatar
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    Thanks, Hillary. So we're in the same boat - DS is also only 5 so right now we are not worried so much about academics as we are behavior/phobias/rigidity.

    Your DS had much more testing done. Now i'm feeling really nervous that this woman isn't doing enough.

    gah!
    mama to my awesome sporty boy (4/09) , precocious little girl (7/12) , and loving doggies (10/05 & 1/14)

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    Are you sure the psychiatrist will be doing the cognitive testing? That would be unusual; they don't usually have the training, though they could be qualified to do the ADOS-2. The other tests, however, should be completed by a doctorate level psychologist.

    Anyway, the DAS-II and the WPPSI are cognitive tests that provide IQ scores. I like both but the DAS is great for young kids as it is very engaging and play-like so it helps kids stay focused and really show what they can do.

    The WIAT-III is a standard achievement test but at the age of 5, unless there are extraordinary deficits or strengths, it is often less important. A comprehensive evaluation, however, should always include achievement tests in addition to IQ/cognitive testing.

    The ADOS-2 is the Autism Diagnostic Observation Schedule. It is a good "test" for accurately identifying autism spectrum disorders. Ideally, the rater, your doctor, should have had specific training to use it. It is more than just a basic rating scale that anyone could use.
    DD '06
    DD '14

  5. #5
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    oops, i meant psychologist, not psychiatrist

    thanks for the thoughts, Victoria
    mama to my awesome sporty boy (4/09) , precocious little girl (7/12) , and loving doggies (10/05 & 1/14)

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    We've done tons of testing over the years, both privately and through the school. Of the ones you mentioned, I know did the ADOS and the ADI. Those were quite a longtime ago, since DS was diagnosed right around his 3rd birthday and now he's 10. I remember that back then the ADOS was considered the gold standard for diagnosing autism spectrum disorders. However, it was known to sometimes miss higher-functioning kids. I know it has different modules for testing individuals of different age groups and verbal abilities. I don't know how the newer revised version differs from the original that was used with DS. I remember we did the ADI with the psychologist, but I don't remember anything specific about it. There were so many specialists and so many discussions about DS's developmental history - they all run together after a while.

    I did did not allow any intelligence testing when DS was very young, not until he was 8. At that point they did the WISC-IV. I waited due to DS's difficulties with verbal language, which I knew would cause difficulties with getting an accurate test result. It still did cause problems with testing at age 8, but the subtest scores gave us better information than the full scale IQ.
    Gena

    DS, age 11 and always amazing

    “Autistics are the ultimate square pegs, and the problem with pounding a square peg into a round hole is not that the hammering is hard work. It's that you're destroying the peg." - Paul Collins, Not Even Wrong

  7. #7
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    So what exactly is she testing for? That looks like IQ, ability, and autism.

    Is she also screening for anxiety and ADHD, which I know were concerns?
    Beth, mom to older DD (8/01) and younger DD (10/06) and always missing Leah (4/22 - 5/1/05)

  8. #8
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    With any child presenting with ASD symptoms, my advice has been to carefully consider Lyme as part of the differential diagnosis using more reliable tests. New research Linking Austism Spectrum Disorder to Lyme Disease backs up my advice: http://www.medical-hypotheses.com/ar...233-3/abstract
    Abstract: This paper proposes that some children with an autism spectrum disorder (ASD) in the United States have undiagnosed Lyme disease and different testing criteria used by commercial laboratories may be producing false negative results. Two testing protocols will be evaluated; first, the Centers for Disease Control (CDC) and Infectious Disease Society of America (IDSA) approved two-tiered Enzyme Immunoassay(EIA) or Immunofluorescence Assay (IFA) followed by an IgM and/or IgG Western Blot test. Second, a clinical diagnosis (flu like symptoms, joint pain, fatigue, neurological symptoms, etc.) possibly followed by a Western Blot with a broader criteria for positive bands [1]. The hypothesis proposes that the former criteria may be producing false negative results for some individuals diagnosed with an ASD. Through an online survey parents of 48 children who have a diagnosis of an ASD and have been diagnosed with Lyme disease were asked to fill out the Autism Treatment Evaluation Checklist (ATEC) before they started antibiotic therapy and after treatment. Of the 48 parents surveyed 45 of them (94%) indicated their child initially tested negative using the two-tiered CDC/IDSA approved test. The parents sought a second physician who diagnosed their child with Lyme disease using the wider range of Western Blot bands. The children were treated with antibiotics and their scores on the ATEC improved. Anecdotal data indicated that some of the children achieved previously unattained developmental milestones after antibiotic therapy began. Protein bands OSP-A and/or OSP-B (Western blot band 31) and (Western blot band 34) were found in 44 of 48 patients. These two bands are so specific to Borrelia burgdorferi that they were targeted for use in vaccine trials, yet are not included in the IDSA interpretation of the Western Blot.

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    sste is offline Diamond level (5000+ posts)
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    Melbel, can you remind me what tests you rec to accurately diagnose lyme? Also do you know the % of false positives with those tests (is there even a way of figuring out false positives for those tests)? And does the treatment have any harmful side effects?

    I did have a tick bite when I was pregnant but I tested negative for lyme using conventional tests, no symptoms, DS is not on the spectrum but he has some developmental quirks! No cognitive impairment or physical issues and he is almost seven. His quirks were there so early and have not worsened . . . I suspect it is just him. Still I am willing to rule out any underlying conditions.
    ds 2007
    dd 2010
    baby dd 2014

  10. #10
    Melbel's Avatar
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    Quote Originally Posted by sste View Post
    Melbel, can you remind me what tests you rec to accurately diagnose lyme? Also do you know the % of false positives with those tests (is there even a way of figuring out false positives for those tests)? And does the treatment have any harmful side effects?

    I did have a tick bite when I was pregnant but I tested negative for lyme using conventional tests, no symptoms, DS is not on the spectrum but he has some developmental quirks! No cognitive impairment or physical issues and he is almost seven. His quirks were there so early and have not worsened . . . I suspect it is just him. Still I am willing to rule out any underlying conditions.
    We have seen symptoms range from subtle to debilitating. Many kids with milder issues are crashing at puberty due to hormonal fluctuations that suppress immune function. I think it is wise to carefully consider Lyme as part of the differential diagnosis sooner vs. later. Teenage kids also tend to be less compliant with diet and treatment as a general rule, so it helps to catch things earlier.

    Due to difficulty in culturing the actual bacteria, most Lyme Disease tests rely upon an antibody response. The two tier testing paradigm for Lyme Disease recommended by the CDC misses approximately 1/2 of actual cases pursuant to numerous peer reviewed studies. Due to testing unreliability, most Lyme Literate Medical Doctors (LLMDs) advise patients to skip the initial Lyme Disease ELISA screen, and instead start with the confirmatory test, the Western Blot. Many prefer to have a Western Blot through the lab iGeneX (www.iGeneX.com) for four reasons: (1) iGeneX tests for multiple strains of Borrelia Burgdorferi (Bb), the bacteria that causes Lyme Disease (commercial labs such as Labcorp and Quest only test for a single strain of Bb; this is particularly important for those who live outside of the NE); (2) IGeneX also considers additional highly relevant bands 31 and 34 (assuming you did not have the Lyme vaccine that was briefly on the market); (3) iGeneX reveals intensity for specific bands (not present, equivocal, low, medium and high); and (4) iGeneX has outperformed other labs in proficiency testing, scoring over 98% for the past 9 years. Insurance often covers iGeneX testing, particularly if you pre-certify and/or file a form provided by iGeneX when seeking reimbursement. Medicare also covers iGeneX testing.

    Western Blot test results will include both IgG and IgM assays. It is critically important that one not lookat the NEGATIVE or POSITIVE summary result of the Western Blot test. Instead, it is important to carefully consider Lyme-specific bands (those bands that represent evidence of serological exposure toBb). Many Lyme doctors believe that a single Lyme-specific band, along with clinical presentation, is sufficient to diagnose Lyme Disease (with an acknowledged 3% false positive rate). Likewise, in China, a single positive IgG band coupled with a single IgM band is considered to be a positive Western Blot. In comparison, the CDC’s surveillancecriteria require a total of seven (7) positive bands; iGeneX requires a total of four (4) positive bands. The following bands are generally considered to be "significant" or Lyme-specific: 18 (most sources), 22-25, 28, 30, 31, 34, 35, 37, 39, 58 (some sources), 66 (some sources), 83 and 93.


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