Expert: Catherine Ridenour - 8/6/2005

Question
my son is 8 and the school system has labeled him as mildly retarded.  the most pervasive issue for him is apraxia.  he is now able to communicate more effectively with others but still is not age appropriate.  he loves people and is very friendly but plays best with children who are younger than himself.  he is very imaginative, extremely visual and kinetic in memory.  he has memorized the star wars movies but cannot memorize the alphabet.  he does not like loud noises, has some coordination problems both gross and fine motor, he is very ritualistic and and will eat a very limited diet.  in fact, he has gagged when we try to introduce new foods, mainly veggies.  i am wondering how to pursue a definitive diagnosis.  the testing he has taken has all been based upon being able to verbally answer questions and i feel it does not truely show what he is capable of because of the apraxia.  i just want what is best for him and if i am heading down the wrong path in trying to help him, i would like to know.  how and what kind of testing should i request in trying to diagnose him, besides the psychological and speech testing done in the school system?  thank you very much.

Answer
Hi Mary,

Here is the list of diagnotic tests that may help in assessing your child:

Vineland Adaptive Behavior Scale (Vineland) is a semi-structured parent interview for collecting information about the child's functioning in everyday life. The focus of the interview, which takes about 45 minutes to administer, is on the child's performance across 3 domains: communication, daily living, and socialization. The Vineland has been standardized for age and gender with a mean of 100 and a standard deviation of 15 for each scale.


Child Symptom Inventory (CSI) is a parent-completed checklist that screens for DSM-IV disorders, including PDD, for children 5 to 12 years of age. It takes about 20 minutes for a parent to complete the rating. The clinician can then review the responses and use the information to guide the clinical interview.


Children's Yale-Brown Obsessive-Compulsive Scale -- Pervasive Developmental Disorders (CYBOCS-PDD) is a semi-structured interview that measures the severity of repetitive behavior in children and adolescents with PDD.[11] The instrument, which takes about 20 minutes to complete, includes a checklist of repetitive behavior and 5 severity scales that can be totaled for an overall score (range 0 to 20). It is sensitive to change.


Aberrant Behavior Checklist (ABC) is a 58-item scale that can be completed by a parent or a teacher to gather information about a range of behavioral problems. The scale contains 5 subscales: Irritability, Social Withdrawal, Stereotypes, Hyperactivity, and Inappropriate Speech. The ABC has normative data for children through adulthood with developmental disabilities and is sensitive to change.


SNAP-IV is an 18-item scale based on the DSM-IV symptoms of ADHD.[7] It may be completed by parents or teachers to gather information across settings. The SNAP-IV provides a score for Inattention, Hyperactivity/Impulsiveness, and a Total score. It is brief and can be used as a measure of change.


Parent-Defined Target Symptoms are brief narratives that characterize the child's 2 most pressing problems. The problems are identified by the parent. Then, through a set of semi-structured questions, the clinician develops and documents the narrative. The narrative contains a label for the behavior, the frequency, intensity, and impact of the behavior. This narrative can be reviewed and reassessed periodically to evaluate progress in treatment.


I hope this is helpful.  Good luck.

Catherine