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Post by michellea on Jul 14, 2013 19:30:17 GMT -5
My son has a very similar split between his verbal and PRI scores. That said, I can say with certainty that my son does not have NVLD. As more is learned about the diagnosis, most practitioners do not rely solely on the "10 point difference" criteria between to the two scores. A student with NVLD typically has social issues stemming from a difficulty to read non-verbal body language/expressions, difficulty with math and number sense, difficulty with abstract comprehension (reading between the lines, making inferences, making connections), difficulty with humor, sarcasm, and figurative language, difficulty knowing where he is in space (clumsiness), difficulty speaking in an organized and concise manner.
I think that this points to the limits of any label. The various disordered are named to help us understand a student's profile. But, there are many complex kids that defy a perfect "label". I think that it is better to look at the student, try to understand their profile by looking at the strengths and weaknesses, and making an individualized plan to meet their needs. Data must be collected along the way to confirm (or not) that the interventions are appropriate, sufficient and working, and the plan must be readjusted as the student grows and changes.
So - if a student has difficulty with math for instance, gather data to pin point as closely as possible where the breakdown occurs. Take a look at the cognitive data to see if it gives further insight. Then, develop a plan to address the issues, continue to gather data and adjust accordingly.
Also - I disagree that most kids with NVLD do not have ADHD. I actually have seen the opposite. The executive dysfuncitions that plague kids with ADHD are often the same that cause problems for kids with NVLD.
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Post by michellea on Jul 14, 2013 19:31:38 GMT -5
Bros - I think I will shamelessly steal your words: a cornucopia of diagnoses.... It does paint quite an image.
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Post by shragae on Jul 14, 2013 19:52:21 GMT -5
NVLD is a possible diagnosis, but then again, the child could just have a cornucopia of diagnoses. ... Oh, hurray... quite an image I think you're likely right about the cornucopia -- the labels are already accumulating for DS, and his difficulties seem to interact in complex and individual ways. For years we struggled for a diagnosis. My son would be very "on" one day and then totally lost the next. He forgets what he learns. . . I didn't get a true picture of what was causing all of my son's issues until he had an extensive neuro-psychological exam. This is not something typically given by schools. If you haven't had a neuro-psych on your son I highly recommend seeing if you can get your insurance company to pay for one (they are very expensive). Good luck. You will find this forum to be great for support and for information. They've done wonderful things for me over the years!
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Post by shragae on Jul 14, 2013 19:58:38 GMT -5
Also - I disagree that most kids with NVLD do not have ADHD. I actually have seen the opposite. The executive dysfuncitions that plague kids with ADHD are often the same that cause problems for kids with NVLD. Terrific post, but we'll have to agree to disagree on your final point. While many NLDers have ADHD symptoms (attention, hyperactivity, focusing problems, etc.) it may or may not be ADHD, or just NLD with ADHD "like" symptoms. That is why I gave the link from that article on ADDitude. While some kids have NLD and ADHD comorbid, the medical professionals seem to state that most do not. However, there are studies that do show ADHD and NLD can be comorbid. (e.g., Gross-Tsur, Shalev, Manor, & Amir, 1995; Voeller, 1986). As the old saying goes -- when you see one kid with NLD you see one kid with NLD. Each is unique, and not all share the spectrum of symptoms. I'm not looking to label anyone, simply point out an area that might be tested, to determine what the OP's son's true LDs might be -- so he can be helped in the way that works best for him.
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Post by bros on Jul 14, 2013 20:04:41 GMT -5
NVLD is a possible diagnosis, but then again, the child could just have a cornucopia of diagnoses. ... Oh, hurray... quite an image I think you're likely right about the cornucopia -- the labels are already accumulating for DS, and his difficulties seem to interact in complex and individual ways. Eh. I have a cornucopia of diagnoses and i'm doing alright. Bros - I think I will shamelessly steal your words: a cornucopia of diagnoses.... It does paint quiet an image. I've always found it a useful way to preface my medical history when asked about it by a doctor. Or when they seem exasperated/shocked at all my diagnoses
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Post by SharonF on Jul 15, 2013 13:21:15 GMT -5
Cornucopia of diagnoses....I love the term, bros!
But for my both of my kids, they often were not given clinical "diagnoses." We were simply told they had bits of this. Pieces of that. Traits of various things but not classic anything. Their eval scores and classroom performance baffled the doctors and frustrated the teachers. No one seemed to know what single term that described either of my kids' learning profiles. That lack of commonly-used and commonly-understood terminology to define my kids' issues tended to paralyze the process.
My dd's VCI was 34 points higher than her PRI. (VCI is Verbal Comprehension Index or Verbal IQ. Perceptual Reasoning Index is nonverbal IQ. Fifteen points is one standard deviation, or considered worth noting. That means dd's verbal IQ index is more than two standard deviations above her perceptual reasoning index.) But the neuropsychologist who diagnosed her with Nonverbal Learning Disability (clinically diagnosed as LD-NOS or Learning Disabled, Not Otherwise Specified) did NOT rely on her WISC spread to make the NLD diagnosis. I'm grateful for that.
Just as michellea pointed out, dd's neuropsych diagnosed the NLD by studying dd's patterns of strengths and weaknesses. And the neuropsych's report to the school explaining dd's pattern was very helpful in moving beyond "analysis paralysis" to action.
Despite having NLD, dd is incredibly empathetic. She's amazingly good at reading body language and tone of voice. She has a great sense of humor and uses sarcasm very well. She is very organized and extremely responsible.
For her, the NLD diagnosis was based on her extensive difficulty with abstract reasoning and fine motor.
Abstract reasoning difficulty affected her in every subject. In literature, she could easily answer "who" "what" "where" questions but struggled with "why" and "how." (Despite having brown hair, her brother often accused her of being blonde because she often had trouble understanding the most obvious things.) When learning history, she memorized dates and factoids easily, but didn't understand their relevance. That's because she struggled to see *patterns* within history. Math was her hardest subject starting in elementary school. Even as a college graduate, she still counts on her fingers.
She couldn't tell time on an analog clock. She still struggles to park evenly between the white lines. Visual-spatial skills are either an extreme strength for her--or are barely there at all.
She was an award-winning soccer goalie who instinctively read other teams well, knowing who would kick with what foot or pass at the last minute. She was a very good musician, playing woodwinds and drums. But many aspects of her fine motor skills are still clumsy and awkward. At the age of 21, she writes like a 7-year old. Multiple school-based and private OTs tried to help, and all concluded there was NOTHING they could do to help her.
Despite her ADHD-in, dd is extremely organized and has fantastic time management skills. Her ADHD-in affects her ability to concentrate and focus, especially on word-based information. ADHD meds work wonders for her.
My point: VCI/PRI spread can sometimes be a red flag for NLD, but there's often more to it than that. There is also a lot of evidence that NLD and Aspergers (both are Spectrum disorders) affect females very differently than males. Most of the diagnostic crtieria for NLD, Aspergers and ADHD are based on males, not females.
And like michellea noted, the research I've seen indicates a significant proportion of people with Spectrum disorders do have some type of ADHD. But it's kind of a chicken-egg thing.
On top of her NLD and ADHD was dd's diagnosis of Central Auditory Processing Disorder. Sometimes, the diagnoses combined to make each set of problems worse. Other times, aspects of one disorder seemed to cancel out aspects of another disorder.
Instead of trying to tease out what's ADHD and what's not, or what's NLD and what's not, my advice is to find ways to address the issues that are creating the biggest problems. In the end, it doesn't really matter what name you put on the "stuff" that is shoved into that big old cornucopia. It's what you do to empower the person to find success!
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Post by ceratops on Jul 17, 2013 10:32:18 GMT -5
... I think that this points to the limits of any label. The various disordered are named to help us understand a student's profile. But, there are many complex kids that defy a perfect "label". I think that it is better to look at the student, try to understand their profile by looking at the strengths and weaknesses, and making an individualized plan to meet their needs. Data must be collected along the way to confirm (or not) that the interventions are appropriate, sufficient and working, and the plan must be readjusted as the student grows and changes. ... Just as michellea pointed out, dd's neuropsych diagnosed the NLD by studying dd's patterns of strengths and weaknesses. And the neuropsych's report to the school explaining dd's pattern was very helpful in moving beyond "analysis paralysis" to action. ... Instead of trying to tease out what's ADHD and what's not, or what's NLD and what's not, my advice is to find ways to address the issues that are creating the biggest problems. In the end, it doesn't really matter what name you put on the "stuff" that is shoved into that big old cornucopia. It's what you do to empower the person to find success! This strikes me as very good advice, especially as it's starting to look like my DS does not fit neatly into just one category. Sharon, thank you for painting the picture of your DD's strengths and weaknesses -- it is very helpful to see how unique the mix of traits can be. It reminds me of a conversation I had with an elementary school special ed teacher 3 or 4 years ago (someone who is very good and intuitive in her job, and who told me, informally, that she thought there were some subtle issues with DS's reading and writing skills) -- she said that every child is unique and different, and that the labels are limited in their usefulness.
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Post by shragae on Jul 17, 2013 13:21:03 GMT -5
. . .a . . . special ed teacher. . .told me. . .that every child is unique and different, and that the labels are limited in their usefulness. Amen. That is why I love the quote "When you've met one kid with NLD you've met ONE kid with NLD." Each person is unique. IMHO we all have strengths and weaknesses -- Einstein couldn't remember his own phone number!
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Post by ceratops on Sept 25, 2013 8:25:47 GMT -5
Now that the new school year is underway, I am re-surfacing. Please excuse my absence on the forum over the past few months... I don't think I know enough yet to help out much with comments/advice in other people's threads...
DS is now in his new school (middle school, in 6th grade), and we had a team meeting last week to review his IEP.
I think DS needs to become more aware of his own strengths/weaknesses re learning, and that he could really benefit from some goals in self-awareness and self-advocacy. I remember that some posters (Michellea comes to mind, and there may have been others) spoke in favor of a self-advocacy goal on the IEP.
I brought this up at the meeting, and although some of the school representatives seemed to grasp the idea, they said they didn't know how to write goals for this. It was also interesting -- the person who really 'got' it was the administrator present; the special ed teacher (i.e. DS's case manager) seemed perplexed. I somehow thought that self-advocacy would be a common need for quite a few students with IEPs, and that the school staff would know how to proceed, but it seemed that they had never written this type of goal.
I have to say, I don't know right off how to phrase such a goal, and how to describe measurable objectives. Can anyone give me any hints/suggestions how the language might look? Maybe there are examples out there to look at?
On a different topic, I'm uneasy (as I was at the previous team meeting at DS's old school) about the 'expertise' of the special ed staff. DS is categorized under OHI-ADHD on the IEP, and I tried to make the team members aware that it was likely that he has some specific learning disabilities in addition to the ADHD. I thought this would be useful to them as they work in the classroom with DS. The school psychologist seemed receptive to the idea. The special ed lady, however, responded with a comment like, "but his test results look average." (!!) Given the test results described near the beginning of this thread, I don't think "average" is a very useful or insightful way to look at this child, especially coming from the mouth of someone in the special education field. I pointed out that some of his test results were way above average and that others were way below average -- but, given her off-the-cuff summary of "average", I'm not sure that helped.
As further follow-up, DS is not yet on any meds for the ADHD; we do have an initial appointment with a child/adolescent psychiatrist coming up in a few weeks.
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Post by dihicks6 on Sept 25, 2013 10:59:48 GMT -5
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Post by shragae on Sept 26, 2013 7:50:59 GMT -5
I think DS needs to become more aware of his own strengths/weaknesses re learning, and that he could really benefit from some goals in self-awareness and self-advocacy. I remember that some posters (Michellea comes to mind, and there may have been others) spoke in favor of a self-advocacy goal on the IEP. I brought this up at the meeting, and although some of the school representatives seemed to grasp the idea, they said they didn't know how to write goals for this. This might come under the heading of a behavioral intervention plan (BIP) which can be part of an IEP. Schools tend to think of BIPs for problem students, but they can be used to change behaviors of all kinds. My son had one to keep him on task (it told the teachers how to redirect him if he lost focus and to make him conscious of this issue so he could learn to self-correct). Here is more information on BIP (link).
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Post by ceratops on Sept 26, 2013 8:46:19 GMT -5
Thank you both for the links!
As I suspected, DS is hardly the first child for whom such goals would be useful/appropriate. After I read some more, perhaps I need to suggest some appropriate goals to be added the the IEP... ? Somehow I thought that was going to be someone else's area of expertise on the planning team. Oh well...
Regarding BIP, the school is already doing a 'PBIS' (stands for 'positive behavior intervention' something-or-other) program with all the kids. I have to find out more about what the 'positive' part is. What we see so far is a whole system of negative consequences (various flavors of detention is what it amounts to) for behavioral faux-pas. So far, DS has run into this several times, for turning in homework late, and for forgetting to bring required materials to class. So far, he has only experienced so-called 'lunch detention' as a consequence -- i.e. having to sit in a different (smaller and quieter) room to eat lunch. I don't know if the kids are supposed to do work while eating, but most of them apparently just eat (seems a reasonable thing to do during lunch IMO). DS doesn't mind the lunch detentions much, and actually seems relieved to be in the quieter environment versus the echoing cave of the cafeteria. However, I've noticed that he has trouble remembering which particular misstep actually led to a particular detention -- if he misses that connection, it doesn't seem to be a very effective 'consequence.'
Going on from there, if a student accumulates enough of these minor violations, this can eventually lead to a loss of 'status' (they have some acronym for this, which I haven't yet memorized) with a resulting loss of privileges at school. This is starting to bother me -- if DS ends up in this loss-of-status category, as a result of behaviors that grow directly out of his disability category (as identified on the IEP), that just doesn't seem right. Nor is it likely to be effective in motivating him to do better. Another reason to dislike school and feel like a screw-up there -- that's all he needs.
One general thing I've noticed about DS is that negative consequences are not usually motivating or effective for him, even when directly linked to his behaviors. This is especially so if the consequence is delayed in time at all. He seems to view these negative consequences as bad things that are arbitrarily imposed on him from without, not something he has control over through his own actions.
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Post by bros on Sept 26, 2013 15:22:33 GMT -5
PBIS is a schoolwide behavior management system and is completely separate from a BIP.
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Post by ceratops on Sept 26, 2013 15:25:50 GMT -5
yes, I know it is a school-wide system; however, it has repercussions that may not be desirable for DS
The reason I was reminded of it in the context of BIP is that the website you get to from shragae's link is called pbisworld.com -- that reminded me of the behavior interventions being used school-wide under the PBIS plan.
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Post by bros on Sept 26, 2013 20:55:23 GMT -5
Students can be exempt from schoolwide behavior systems in their IEPs, I believe.
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Post by ceratops on Oct 3, 2013 2:25:53 GMT -5
Students can be exempt from schoolwide behavior systems in their IEPs, I believe. Food for thought... DS told me, rather hesitantly, at bedtime yesterday that he has now lost his 'status' for 30 days, having accumulated 3 infractions in one classroom (the specific infractions that he remembered were turning in an assignment one day late, not following the teacher's plan for organizing papers in his folder, and showing up at class without a pencil one day). He thought he was going to lose an additional 30 days due to similar incidents in another classroom, since he had just stacked up another misstep in that other classroom yesterday. The loss of status under this PBIS system leads to the loss of certain privileges. DS already sounded almost resigned to staying in the 'lost status' population indefinitely -- I don't think he sees any way to prevent racking up more of these mistakes in the future. I've politely asked the school for more information, to make sure I understand the situation, before doing anything else. My gut reaction, though, is that this is an insane system to inflict on a kid with ADHD, and that it's just plain unfair to punish him for missteps that grow directly out of the disability that's on his IEP. Telling him that he's a second-class citizen at his school and that he doesn't fit in with the 'good' kids -- yeah, that's really likely to be helpful to a student who already says he 'hates school' several times each week. It's not likely to be motivational either, as DS doesn't react well to negative consequences in general, especially not delayed negative consequences. And it's not like he can just make up his mind to be 100% organized from now on. I've thought DS was actually doing pretty well with school so far this year -- more cooperative and mature and organized than I've seen him in the past. And now he's being 'demoted' instead of praised for his performance, or so it seems. Arggghhhh
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Post by dihicks6 on Oct 3, 2013 6:07:46 GMT -5
It sounds like they are punishing him for symptoms/effects of his disability which is a no-no. You always have the right to request an IEP meeting for this exact reason. IDEA states if the student is not making progress than the IEP must be revised (and add the exemption from their 'plan' to the IEP).
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Post by empeg1 on Oct 3, 2013 21:40:36 GMT -5
I have a totally off the wall question to ask. Is your ds your biological child or did you adopt him?
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Post by ceratops on Oct 4, 2013 8:23:20 GMT -5
He is our biological child. Uncomplicated pregnancy, born full term.
I'm curious, what did you have in mind in asking the question?
We do see similarities, some to myself, some to DH, when we look at DS's difficulties. DH finds that some of the problems with reading, writing, and memorization of stuff like the multiplication table look very familiar to him.
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