Expert: James Michael Roan - 9/22/2006

Question
James,
Strengths in communication:
uses words and some small sentences,
attempts to  say things with and without prompting,
knows his alphabet,
can spell,
writes short sentences,
is great on the computer,
can read but not clearly understood,
pulls and points to make someone understand his needs.
Weakness in communication:
Hard to understand if one is not use to his form of comm,
can not tell you his needs,wants,if something is hurting him,
if content just sitting on the sidelines watching
Strengths in socialization:
Enjoys other people
enjoys watching for the side lines
try to involve himself sometimes
likes going places and trying new things
Weaknesses in socialization:
not being able to talk and get his point across
being ok with doing his on thing'
Peer interaction:
Some when he wants to be involved,but like I have said he is fine just watching,he enjoys trying things,but never seems tofeel left out. What do I know though maybe he does feel left out,these questions have really made me think and I do realize Connor has very poor social skills to add to his language being very limited.  I do feel that there is something ticking inside his head and do think he is capable of more,I just do not know of what,More of what to help him left out of this fog,I have so enjoyed talking with you,please make some recommendations for me or do you do evaluations and treatment plan,I wish there was some where close to me,we live in Lafayeet LA which is in south LA,I am 3 hours form New Orleans and 4hours from Houston if that hewlps with recommendation around me,At this point I will go to the other end of the earth to help Connor out of the fog,I know he can do it.Please help.Thank you again,Penn
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Followup To

Question -
James,
Connor is great with puzzles and putting things together,I noticed that you said that could be a possible difficulty,also I have done alot of research on AS,I read the book "Helping a child with nonverbal learning disorder or AS " Wrtten byKathryn Stewart,in her ex[lanation of AS children Connor did have some of the characteristics, Connor's receptive lang is much better than his expressive lang and always has been. I do agree AS is a possibility. I will advise the type of IQ test you recommended,I also am working with a private phsycologist who has gone into the school and shadowed Connor and also came to our home for a family eval,should I ask her to do this type of IQ test also?  Do you have any advise on what type of school atmoshere we should be wanting for our son?  Is main streaming a good thing or does he need more one on one or a more defind program like a autistic class setting?  Your answer in refrence to the math is very true,I never thought of it that way,please give me any more tips or if you know of any type of program or facility that could evaluate and give us a better treatment plan to follow please send me the contact.  Thanks,look forward to hearing back from you.
Penn
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Followup To

Question -
James, The answer to your questions are as follows,Recent IQ test was march 04,it was the WPPSI his recpt lang was in the 3rd%,His full scale was below the 1st%.  He is up for re-eval march07,I have requested it to be done asap. Geographically disoriented easily,yes ,gets lost,sometimes,Noticeable leftside body weakness,yes,and also has low tone.Yes,has trouble understanding age-appropriate social behavior.
Early language,I think he had some words and they were very clear and understood by everyone,at 18 months after his mmr we noticed he lost some of these words.  He was always behind with all milestones ,rolling over crawling late,walking etc.  He was a very floppy baby,always happy,ate well,sleep well,just behind in normal things.  He began speech at 10 months of age we have had ever kind of speech that is offered in this area.  Socially he went to Mothers day out at 2and loved it,he liked doing his own thing but did follow directions and was always happy,potty training was a hard one we finally got it around 6 years old.He loves other children and seems to id his friends well,he loves looking at the yearbook and can find any friend you ask him to. He has never seemed to regress with any of his learning skills he loves letter,spells well he is reading on level according to his 2nd grade teacher,he hates math and freaks out when the math book is taken out in class,they have started taking him to the resource room during math and he does fine one on one. Intrest and hobbies,loves to read books,color,watch a variety of dvd moves,he can load unload turn on the dvd player,tv and most electronic equipment better than me.He enjoys riding his bike and swinging outside ,he is a very content child and only gets upset for minor things.  We have never had any behavior issues with Connor,the freaking out in math is the first we have seen of him really refushing and having a tantrum.  We have always treated Connor as a normal child and always expected him to try,this is very out of character for him and we are so worried.  It also does not help that we live in Louisiana which is the armpit of the universe where education is concerned.  The public schools are the only place for children with special needs,they are under staffed and under educated. This does nothing to help my child that is labeled OTHER HEALTH IMPARMENT?  I could go on for ever,but my main priority is to make sure I am getting Connor everything he needs in an educational setting. I would say that Connor's characteristics and behaviors are unusual in some ways ,he enjoys doing things alone and is fine doing things at his own speed,he is always happy and can get things across to people who are use to his communicating skills,he can say words and get across the point he is trying to make,he never has to want for much because there is always someone around to help him out.  We will always be there to help him out but would like him to have as much indepedant abilities as he can for a person with his disabilities.  I have looked at diff,methods and treatments like the louvse method,aba therapy,we did a glutin casin free diet and kelation therapy a few years ago with no changes,we did secritin shots no change,we have seen evey kind of Doctor that we could think of,with no luck.  Everyone has different opions,lets see one thought prader willy syndrome-ruled out form alot of unneccessary bloodwork,MRI-normal,EEG-normal,Autism questionaire test by pshycologist-not autistic,Neurologist#1 delayed,#2neuro-motor disfunction,#3developmental delay,#4may never know, Peditricans,#1thru#5 developmental delay,low tone,hypotonic,etc,etc.  In other words none of the 5 knew anything about language disorders. Orthopedic,low tone typically floppy baby said he would catch up. John Hopkins age 3 developmental ped,sever sp/language disorder with mild to mod ataxia.  OT who specializes in sensory inogration therapies,un- explained id for Connor,but he loved working with her and enjoyed the therapy seasons with her. #1 thru#10 speech therapist and or evaluations,non-verbal,languge disorder,apraxia,muscle weakness in mouth and facial area,on and on. I am sure you now wish you had not ask me to tell you as much as I can,I could go on and on,I hope some of this information will help you with my questions.  It is funny that I feel more in touch with someone on the internet than I have with any of these Doctor/ ,specialist we have seen in the past 5 years.  Please give me some ideas and help on what I can do to make Connor's life easier and I hope I can let go of all the past bad advise,diagnosis,and stuiped tips We have ben given.  One more I forgot,Family practice DR.  PDD was her answer,she advised Connor's problems stemmed from thermarisol in the vactionations he was given as a baby after many blood test hair analysis,urine test,saliva test,scratch test to skin,she advised natural vitamins,cod liver oils,about 8-10 pills 3xday etc,etc.
This is a true store I hope I have not lost you in my soap opera above. I look forward to hearing back from you and you opions.
Thank's,
Any other questions let me know,thank you so very much for your time.Please excuse my spelling my 3year old has been on my lap as I respond back to you.Penn S.
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Followup To

Question -
My son is 8 years old,he is diagnosed in the school system as non specific learning disorder.  He has a diagnosis from a developmental ped,from John Hopkins that he was given at age 3,of Severe speech and language disorder with mild ataxia.  We are presently in the public school system and are main streamed in a 2nd grade class with an aid.  My son does well with reading,writting,spelling etc.He hates math and freaks out when the math book comes out.
My son does not speak,he has some words and seems to understand and follows directions well. I feel that his diagnosis is not correct and that we need to re-evaluate and get a more firm diagnosis.Please advise on your opion of the above information,if you have further questions please email me. Thank you for your time,Penn S.

Answer -
Hi Penn;

Can you give me a breakdown of the most recent IQ scores. For the WISC-III or WISC IV it will be the Performance and Verbal Scores. For the Stanford-Binet IV or V it will be Verbal Reasoning, Visual-spatial Reasoning, Quantitative, and Short-term Memory.

Does he get geographically disoriented easily? Does he get lost? Does he have a noticeable left-side body weakness? Does he have trouble understanding age-appropriate social behavior?

Tell me as much as you can about his early language and social development as well as current development in terms of social competence, friendship making and keeping skills, and interests/hobbies. Are there any unusual characteristics or behaviors? Tell me as much as you can.

Kind Regards,
James

Answer -
Hi Penn;

Thank you for all the information. Since I only have your observations and little test data, the more you can tell me about your son the better.

I suspect the difficulty with getting a clear diagnosis may be from the possibility that he may have a nonverbal learning disability (NVLD or NLD). It looks very much like high functioning autism (HFA) or Asperger's Syndrome (AS) but is not. Your son's aversion to math, getting lost, etc. point to an impairment of his nonverbal reasoning ability. It's very hard to diagnosis because like AS, a NVLD results in low social skills, low social cognition, and/or low social competence. It also presents itself with difficulty in assembling puzzles and putting things together. Aside from these behaviors, an IQ test will reveal significantly low performance or visual spatial reasoning compared with the child's verbal reasoning skills.

You do need a reevaluation and don't let the psychologist use the WPPSI. They can use as an IQ test such as the WISC-III or IV, the SB-IV or V, or any mainstream IQ test that separates verbal from visual-spatial skills.

If you would, please do some research on both Asperger's Syndrome (see Dr. Tony Attwood) and nonverbal learning disabilities and get back with me on your opinions of both after reading descriptions of both conditions.

Kind Regards,
James

Answer -
Hello Penn;

For sake of clarity, please list Conor's strengths and weaknesses in the areas of communication and socialization with peers. Please be very specific about his peer interactions. I suspect this may be the most important piece. Then I can either recommend more direct assessment and/or placement and interventions.

Either psychologist can do the IQ testing. It would be nice to use either the WISC-IV or SB-IV or SB-IV because they give working/short-term memory figures.

Hang on...we're almost there!

Regards,
James

Answer
Hi Penn;

I will look today and Monday for institutions who you could contact for an assessment in your area.

It's hard to separate out Conor's speech delays from his social behavior. I/you need a thorough assessment to determine the most appropriate interventions.

Here are my recommendations:

1. Leiter-R nonverbal intelligence test.

2. Woodcock-Johnson III-Tests of Achievement (WJ-III).

3. Gilliam Asperger's Disorder Scale (GADS).

4. Receptive, expressive, and pragmatic language assessment to include a thorough oral motor evaluation.

5. Behavior Assessment Scale for Children, Second Edition (BASC-II)-Parent and teacher report forms.

6. A Walker-McConnell Scale of Social Competence and School Adjustment.

7. An evaluation via direct observation of Conor interacting with his peers in class and at play.

8. A motor evaluation by an occupational therapist.

9. An adaptive behavior (self-help skills using in order of preference: The Scales of Independent Behavior-Revised (SIB-R) or the Vineland Adaptive Behavior Scales, Second Edition (VABS-II).

10. As an optional measure: The Behavior Rating Inventory of Executive Function (BRIEF)-Parent and teacher report forms.

This would yield enough data to get to the heart of what is going on with Conor.

If you don't hear from me by Monday regarding a place to go for an assessment, just email me again please.

Kind Regards,
James