Ryan's Assessment Results

I finally received Ryan's results from his "post-treatment" neuropsychological assessment for the time he spent at Summit Centre. (The assessment was at the end of November!) I've been really anxious to see, in official numbers, what progress he was able to make over the 2 and a half years we worked with them doing intensive ABA therapy, between the Unity program and the STEPS program.

During the assessment, the testing person asked me a question which made me pause and reflect, and I was hesitant to answer, at first: What age do you think Ryan is at, cognitively and developmentally? Considering he's your third child, in comparison, at what age would you place his skills?

I wasn't sure how to answer that. Wasn't that why I was here? To get a professional's opinion on this?

I replied, tentatively: "A year to eighteen months?"
It turns out, I was pretty much spot on.

The Big Numbers

I'm going to get into some detail here, as much to organize my own thoughts as anything else.

MSEL Early Learning Composite Score, 2013: represents a developmental level of 7 months old
MSEL Early Learning Composite Score, 2015: represents a developmental level of 12 months old

Adaptive Behaviour Competence Score (VABS-II), 2013: places his overall level of functioning in the low range; equivalent of 8 months old
Adaptive Behaviour Competence Score (VABS-II), 2015: places his overall level of functioning in the low, moderately deficient range; equivalent of 13 months old

According to both of the major assessment procedures, Ryan gained about 5 months of development over 2.5 years of intensive ABA therapy.

More Detailed Numbers/Comparisons (in age equivalents)

MSEL

Visual Reception: 2013--7 months; 2015--11 months gained 4 months
Fine Motor: 2013--8 months; 2015--16 months gained 8 months
Receptive Language: 2013--9 months; 2015--14 months gained 5 months
Expressive Language: 2013--7 months; 2015--8 months gained 1 month

VABS-II

Receptive Language: 2013--9 months; 2015--6 months LOST 3 months
Expressive Language: 2013--5 months; 2015--8 months gained 3 months
Written Language: 2013--22 months; 2015--no change
Personal Skills: 2013--6 months; 2015--20 months gained 1 year 2 months
Domestic Skills: 2013--7 months; 2015--10 months gained 3 months
Community Skills: 2013--<1 month; 2015--no change
Interpersonal Relationships: 2013--6 months; 2015--no change
Play and Leisure Time: 2013--8 months; 2015--no change
Coping Skills: 2013--10 months; 2015--2015--7 months LOST 3 months
Gross Motor Skills: 2013--18 months; 2015--28 months gained 10 months
Fine Motor Skills: 2013--11 months; 2015--18 months gained 7 months


My Thoughts

Although I'm not surprised by the results, I'll admit I was hoping to see more gains.  I also do not agree there has been no change in the Play and Leisure Time and Interpersonal Relationships categories. I feel like I've seen improvement there. I also don't see how he's lost skills on the VABS-II Receptive Language and Coping Skills categories.  Maybe there's more of a disparity between what's expected at his chronological age now, since he was only 3 at the time of the first assessment and almost 6 at his most recent one?

This brings me to another point. While I'm happy to see so many areas with at least some gains, you've got to keep in mind that he was only 3 years 2 months old at the first assessment and was 5 years, 9 months old at the second assessment.

In 2013, he was 2 years, 5 months developmentally behind for his chronological age.

Now (2015), he is 4 years, 9 months developmentally behind for his chronological age.

The developmental gap has not diminished. It has basically doubled.

I had hoped these results would give me a clue as to where to go from here in terms of Ryan's therapies.  It turns out I'm more confused than ever.  Did he make gains doing ABA? Yes. Did he learn some new skills? Yes. Is it worth continuing to pursue intensive therapy privately? That I don't know.

The doctor's summary of "Implications" at the end of the latest assessment report has changed very little from the one in 2013. The main points haven't changed, and the wording is essentially the same:

• "Ryan will learn best in a highly-structured environment . . . consistent expectations . . . clearly defined rules . . . modification and accommodation . . . . Verbal directions should be clear and concise . . . visual aids and extra cueing . . . The use of nonverbal (pictorial, gestural) cues . . . tasks should be concrete and involve an active hands-on learning . . . provided with ongoing corrective feedback regarding his performance . . ."
• "Focusing on basic compliance tasks (e.g., working at a table, transitions, waiting, taking direction from a non-familiar adult) is imperative and will eventually facilitate his ability to participate in any future placements he attends outside the home (e.g., daycare, recreation program, school)."
• "It is important that Ryan receive support in developing his receptive and expressive communication skills, social skills and daily living skills."

Well, yeah, we have been doing all that since 2013, and we continue to do that at home and school. But again, the question is, should we be doing this as intensive therapy sessions guided by ABA professionals, or should we simply use the tools we've already learned to apply in incidental learning at home and school?  Is the incidental learning enough?  Would he make more progress back in a setting of intensive, one-on-one therapy with professionals? 

I don't know.  It took us 2 and a half years to gain 5 months, and we're still almost 5 years behind.  

What I do know is that I will never give up on him.  I will never stop trying to teach him the skills he needs to interact appropriately with others and take care of his daily living needs. It's more of a question of how hard we're going to push, what approach we're going to take, and what is best for Ryan emotionally and physically.

I stepped out of the room mid-blog, and came back to find Ryan inspecting my work. ;)