Kevin's Psychoeducational Assessment Results

Yesterday, Rod and I went for a meeting with the doctor who performed Kevin's psychoeducational assessment last month, and she gave us the results.

I had been worried that Kevin would perform so well in the one-on-one, zero-distraction interactions that she wouldn't be able to see what we see on a daily basis.  Yes, she also had us and Kevin's teacher complete a pile of assessment questionnaires, but would our answers match up, and would she find them valid?  For the most part, they did. And yes, she did.

It was a bit overwhelming to receive A REPORT 22 PAGES LONG, but I couldn't have asked for anything more thorough or detailed.  This included over 5 pages of extensive recommendations, mostly for the school, but also for us at home.

Because the report is so complex, I'll try to stick to summarizing the most important points.

DIAGNOSIS

1. Autism Spectrum Disorder (Without Accompanying Intellectual and Language Impairment)--Level 2: Requiring Substantial Support
2. Unspecified Anxiety Disorder
3. Unspecified Depressive Disorder
4. Specific Learning Disorder
5. Impairment in Written Expression (Spelling, Grammar, Organization) - Mild to Moderate

My Comments and Some Explanations on the Diagnosis

1. I was really surprised, but also pleased, that Kevin is now recognized as having ASD: Level 2. His old diagnosis of "Mild Autism" would likely have put him in ASD Level 1.  I'm hoping the school will take his diagnosis more seriously now that they will see the increased need for supports. Here is a table which gives a basic explanation of the ASD Levels. (click on it for a larger view)
   
2. His psychiatrist had already diagnosed him with Anxiety Disorder. "Unspecified" simply means that there are lots of different types of anxiety disorders out there, and Kevin's symptoms don't all lend themselves to one particular type. It's good to have this formal diagnosis from a second professional and on paper, though.
3. The Depressive Disorder means yes, Kevin shows signs of depression, but again, his symptoms don't lead to one particular kind of depressive disorder.  I know, you're probably thinking, "Kevin? Depressed?" but remember depression shows itself in more ways than just the sadness and suicidal thoughts most people associate with it.  Kevin displays difficulties with "emotional distress" and sometimes "feelings of helplessness, hopelessness, and worthlessness." His "socio-emotional difficulties" are "negatively impacting upon his self-esteem," and he is "self-conscious." I don't like to talk about it much, but Kevin has had outbursts during his upset or meltdown moments where's he said things like, "I wish I was dead!/I'm just going to kill myself!/I can't do anything right!/I hate my life!/There's nothing good in my life!"  Those moments break my heart.  I honestly don't think he'd ever hurt himself, but just knowing he feels that way about himself/his life is devastating.  Plus, if you click on this link, and scroll down to "How Can I Tell if My Child is Depressed?" you will see that depression can show up in kids in other ways like irritability and difficulty concentrating, too. The doctor thinks that we can do a lot to help Kevin's depression by getting him more of the supports he needs, especially in the classroom. If he feels more confident in his learning and less self-conscious, it would ease his other issues.
4. The Specific Learning Disorder is interesting.  It doesn't exactly have a name. But what we see is that he has some kind of Visual Learning disability. His Visual Spatial Index Score on the Wechsler Intelligence Scale shows him to be in "Average" range; however, as I'll discuss later, this doesn't fit in with his incredibly high scores on the other parts of that scale. The doctor noted, "He encounters difficulties with analyzing and synthesizing abstract visual stimuli (e.g., completing visual puzzles in his mind)."   Kevin's Processing Speed Index also fell into Average range (the ability to process visual information quickly under a time pressure), but again, this doesn't match up with his superior scores on other areas of the scale. Kevin frequently "required extra time to produce his responses" and "his performance suggested some difficulties with his visual memory." 
5. The Impairment in Written Expression is reflected in Kevin's scores on the Wechsler Individual Achievement Test (academic).  In all areas he was in a 4th to 8th grade level (remember, he's in grade 3), except Alphabet Writing Fluency and Sentence Composition; both of those were at a grade 2 level. Once again, Kevin "required additional time to output his responses." He also "adopted a labour-intensive approach to writing." Kevin is noted to lack "a basic foundation for the conventions of written language" and "demonstrates difficulties with his fine motor skills and the mechanics of writing."  You might be thinking, "Well, he's only a year behind." But the doctor's summary explains the problem here very well: "It will be important to perform verbal testing with Kevin or have a scribe assist him with outputting his thoughts on paper to ensure an adequate representation of his abilities. Without ongoing remedial assistance . . . the gap between Kevin's level of academic achievement and that of his peers will continue to increase over time."  In other words, his writing abilities can't keep up with, and don't reflect, his level of intelligence. And it will only get harder as the demands of schoolwork increase as he gets older.

EXECUTIVE FUNCTIONING

People with autism often have deficits in what is called Executive Functioning. Here's a good page with information about understanding executive functioning issues in children. Basically, executive function "describes a set of cognitive abilities that control and regulate other abilities and behaviours." The rating scales we completed for Kevin's assessment looked at "attention, emotional regulation, flexibility, inhibitory control, initiation, organization, planning, self-monitoring, and working memory." The results suggested "significant executive functioning difficulties" at home and 

and "minimal executive functioning difficulties" at school (although many of the ratings the teacher gave on this scale contradicted similar ratings she gave on other questionnaires, baffling the doctor; maybe the teacher was trying to focus on his best days?).

Anyway, in both home and school environments, Kevin shows "significant difficulties with Emotion Regulation, Flexibility, Inhibitory Control, and Initiation."

To summarize, "Kevin's scores suggest that he may have difficulty handling his emotions and recognizing the consequences of his reactions, especially during highly stressful situations ..."  Well, we knew that!

The results also show that "Kevin may have difficulties beginning, starting, or 'getting going' on tasks, activities, and problem-solving approaches appropriately." However, in the doctors' closing notes, she made an interesting point that I hope Kevin's future teachers will take into serious consideration:  "It is important to realize that deficits in executive functioning can often appear to reflect non-compliance or disinterest in a task or activity on the part of the student, but that for Kevin, this likely is not the case." It's a new perspective for me, as well. I know Kevin's behaviour always has a cause, and I try to keep that in mind, but I wasn't aware how much executive functioning deficits can impact daily life. However, there are skills which we can teach Kevin to help him compensate for his executive functioning difficulties. The doctor put some ideas in her recommendations.

STRENGTHS

It's time to focus on Kevin's assets.

But can I say just one thing here? This kid is complicated. To quote the report: "Kevin's Full Scale IQ  . . . cannot be meaningfully interpreted as there was too much variability among his index scores. A better representation of Kevin's overall intellectual ability [includes focusing on the individual] estimates of his abilities in . . . five areas." In three of the five areas, he is in Superior/Very Superior range.

To sum it up: My child qualifies as both gifted and having a learning disability.

But back to the STRENGTHS:

• Kevin has a Verbal Comprehension Index Score in the 99th percentile--Very Superior range.     "[H]e has superior abilities when using words to express his ideas and to solve problems," and "is able to successfully reason about information that is both simple and complex."
• Kevin has a Fluid Reasoning Index Score in the 95th Percentile--Superior Range. "He has superior abilities when comprehending tasks that involve patterning and whole-part relationships and understanding the concept of equality among visual objects. He is able to effectively use his quantitative reasoning skills and follow a logical pattern through to another conclusion."
• Kevin has a Working Memory Index Score in the 98th percentile--lower end of the Very Superior Range. "He has superior ability when he is required to memorize new information and hold information in short-term memory and when he is required to concentrate and manipulate that information to produce some results."

Academic Achievement: [keep in mind he is currently in Grade 3]

• Word Reading: Grade 7-8
• Pseudoword Decoding: Grade 6
• Reading Comprehension: Grade 5-6
• Spelling: Grade 4-5
• Numerical operations: Grade 4-5 

As a lead-in to the discussion of the doctor's recommendations, I thought I'd share this paragraph she wrote under Kevin's Academic Achievement results section.  It is extremely important to be aware that he can only access his strengths when the proper accommodations are in place:  

"It is important to note that Kevin often required constant repetition and redirection during the academic portion of the assessment session. He encountered difficulties with working quickly during independent work. Without one-on-one support and redirection, his scores would have been significantly reduced. [emphasis mine] This has significant implications in terms of the amount of information he will retain in the classroom setting."

RECOMMENDATIONS

As I said at the start, there were over 5 pages of detailed recommendations for both school and home. To keep it brief, I'll only highlight the ones that really stood out to me:

• It is essential that he have the following assistive technology: personal laptop computer, printer, scanner, and associated software (voice-to-text, text-to-voice, Word Cue, Smartideas, etc.)*
• consultation from an Occupational Therapist; assess Kevin's difficulties with fine motor skills and provide him with appropriate treatment*
• continued assistance from a Speech and Language Pathologist for articulation and fluency*
• extra time to complete written tasks and copies of information that is written on the blackboard*
• It is important to check for comprehension when providing Kevin with instructions to complete a task, especially if that task is more abstract/less structured (i.e. have him paraphrase instructions and information in his own words before beginning the task).
• For executive functioning, teach Kevin problem-solving processes in which he learns to describe problems, set a goal, establish ways to reach the goal, and evaluate the outcome.
• He would benefit from having pictures paired with words whenever possible.*
• Kevin should have a multi-sensory learning experience
• recognition of Kevin's strengths, interests, and accomplishments will be critical to his ongoing motivation; his efforts should be liberally recognized and reinforced
• he would benefit from individual therapeutic interventions to assist with self-regulation, emotional control, social skills training, and provide him with coping skills
• Kevin's difficulty regulating his behaviours and emotions should be addressed through development of a specific behaviour plan* 
• Do not expect Kevin to acknowledge he is sad, frustrated, or upset.  In the same way he has difficulty perceiving others' feelings, he struggles to identify his own feelings.  Visual aids (like a faces chart) would help him identify his feelings and advocate for help.
• would benefit from accommodation often provided for children with anxiety: preferential seating, frequent cueing, increased time to complete asks, incentive programs, removing pages from workbooks, textbooks, etc. to present one at a time to prevent him becoming overwhelmed
• Kevin worked well with one-on-one support and was noted to persevere with encouragement and positive feedback.  In other words, he needs an Educational Assistant (EA) nearby at all times.* He needs constant repetition of instructions and redirection to stay focused on the task at hand.
• We should request an IPRC (Identification, Placement, and Review Committee) meeting for Kevin.  It would make his identification formal and any accommodations requested legal and binding. However, we would likely have to fight for that as the Catholic school board no longer does IPRCs.
• Similarly, we must insist on a formal IEP (Individual Education Plan) for Kevin.* He requires many accommodations to be successful in school and should be provided with as much assistance as possible from the Learning Support Teacher. 

*These are things that are not currently in place for Kevin, and that the school is obligated to provide, given his diagnosis and needs.

At the meeting with the school that I requested last month, I emphasized the need for a behaviour plan and an IEP.  They were going to formulate a behaviour plan, but were hesitating on the IEP.

I am hoping that, when presented with this new document, they will read it THOROUGHLY and take it SERIOUSLY, and begin implementing all these recommendations. Now that we have a new, current, and very thorough assessment in front of us, I see no excuse for them to deny/minimize Kevin's needs any longer.  

I feel it's time to go into battle. No more timid, nice-nice mama. I can see now, very clearly, how Kevin's deficits are holding him back and making his time in the classroom very difficult for him. My child is GIFTED. We need to ensure that he is able to harness those gifts and reach his full potential. We need to make his classroom experience as positive as possible. In doing so, we can increase his comfort level, decrease his negative self-image, and let him shine! <3