Can someone give me some input on evaluations and testing?

[Heather in VA]

We have been concerned about our 4 (5 in May) year old daughter for a while. She seems to have trouble with things like following directions and understanding things without visually being shown. She's definately a visual learner but it's more than that. I really couldn't put my finger on the problem because it's not like she isn't learning. She's starting to read, she knows all the sounds and letters, she can count to 100, recognize her numbers and match them with visual representations of the quantity etc. One thing we know for sure is that she has ADHD type behaviour. My brother was/is ADHD so I am pretty familiar. But that's a medical diagnosis so evaluations don't include that - at least not here. So we decided to have her evaluated. The way it works in our county is that you have the evaluation and then if the evaluator suspects there might be a problem you go before a committee to determine if the evaluation warrants more testing and possible referral for services.

So we went for the evaluation. After the evaluation what I was told is that her biggest issue was related to problems with prepositions. Apparently they do two tests - one was called the Denver and I don't know the name of the other. She passed all aspects of the Denver and was on the edge with the preposition thing with the other test. She said she was on the fence about even seeing the committee but it was my right to do so if I wanted. So we have an appointment for that. Two other things she had trouble with was repeating sentences and describing jobs. For the repeating thing, you got no credit if you got a word wrong and she repeated the sentences for the most part but would say 'was' instead of 'is' or something like that. It didnt' seem to bother the examininer. But I do notice that in daily life. Today I asked her to give me a card with 500, 40 and 30. She knows those cards but would forget what I asked for. The other problem was in describing tasks. She asked her to tell her all the steps to washing your hands. She knows how to wash her hands but she just said 'you roll up your sleeves and wash your hands'. If you prompted her with 'what about turning on the water' she would agree you needed to do that but it wouldn't spark things like 'oh and soap'.

My question is what do I do now? Does this raise a flag to anyone? Is there something that prepositions issues could indicate that I should be concerned about? What about the combination of these things. The examiner only seemed at all interested in the prepositions but I'm wondering if the combination of these things is a flag. I don't want to push for services we don't need but I don't want them writing her off as 'fine' if getting some help would benefit her.

Thanks in advance....

[Claire]

If you're up to it, I would push for a complete speech and language evaluation by a speech pathologist. The problem with prepositions and auditory memory indicate a possible problem with receptive and/or expressive language.

What you might want to do is call a local speech and language clinic to describe your dd and ask if an evaluation would be a good idea. If they say yes, ask about medical insurance coverage for an evaluation (assuming you have medical insurance). Usually these clinics can tell you exactly how a referral needs to be worded or coded so that your medical insurance will cover an evaluation, and a private evaluation is more comprehensive than the type that a school can provide. Take this information to your GP or pediatrician so that the referral gets written up correctly.

There may be other things going on but, from just your one post, I would probably start with the speech/language eval.

[Heather in VA]

Thanks Claire - My dd's name is Claire :-). I will look into independent testing. I have long assumed her issues were related to auditory processing so that does fit. We think she has a speech delay but the woman claimed she didn't. I know she has a lisp but again the woman said it wasn't significant.

Do you have any idea how I find a speech and language clinic?

[Claire]

Do you have any idea how I find a speech and language clinic?

I found ours by talking to neighbors and friends. However, you can also simply look in the yellow pages of your phone book. Our clinic and many others were listed there. It just happened that the clinic that was recommended happened to also be the closest clinic to us.

I'm not sure how you evaluate the quality of a clinic aside from recommendations from people who have actually used it. I would probably try to find out how long the clinic has existed and who would actually be doing the testing on my dd. You really want a licensed speech pathologist. Be sure to mention that you suspect auditory processing problems and ask if they do screening tests for APD.

Do you have a university nearby that offers a degree in speech pathology? If you don't have medical insurance that will cover a private evaluation, that would be the next best place to go. The degree candidates need to get experience administering tests and doing evaluations, and some universities even run speech and language clinics to give their interns experience. The cost is much less than in private speech clinics. However, if you have medical insurance, I would just get a private eval first.

[Ottakee]

Just another thought. I would also have her get a FULL hearing evaluation done by an audiologist. This is much more complete than the "screening" they do at a doctor's office or even speech clinic. If there is a slight hearing loss, you want to know that and address that as well.