Thursday, February 23, 2012

Stanford Binet

Sweets had her cognitive eval today. An IQ test. In the past, she's had IQ type testing done as subtests for other tests, but they were just quick tests.

Her first testing at 13 months was the Bayley Scales of Infant Development. She scored an 80 for cognitive at that time, though there was a lot of question as to how much of that was due to her communication difficulties as opposed to true cognitive. When she was retested at 24 months with this same test, she scored a 90, which is within the normal range.

More recently, she was tested at 33 months with the DAYC - Developmental Assessment of Young Children. Sweets scored an 84 on the cognitive subtest of this assessment.

Today, Sweets had an in-depth cognitive assessment done, the Stanford Binet Intelligence Scales. Based on her scores in the past, I expected her to score in the 80's on this test. Her actual IQ on this test was 73, which was 4th percentile, so quite a bit lower.

The subtests on this assessment each have a verbal and a nonverbal component. The subtest scores are on a scale where 10 is average and the standard deviation is 3. The composite scores are on a scale where 100 is average and the standard deviation is 15.

Subtest Nonverbal Verbal Composite
FR (Fluid Reasoning) 10 6 88 (21%)
KN (Knowledge) 7 6 80 (9%)
QR (Quantitative Reasoning) 6 4 72 (3%)
VS (Visual Spatial Processing) 7 6 79 (8%)
WM (Working Memory) 9 9 94 (34%)
IQ 73 (4%) 76 (5%) 73 (4%)

Certain subtests were really good, like working memory. The examiner said that this subtest would score low in children with ADHD, and for Sweets it scored in the normal range. Sweets also scored well in reasoning, which measures problem solving, so that's great! She scored most poorly on math skills. She was not able to count to 3, and she did not demonstrate knowledge of the concepts of bigger/smaller, more/fewer.

Overall, she doesn't seem to be held down by her communication skills in this test, because her verbal scores were not significantly lower than her nonverbal skills. If they were, then this might indicate that she should take a test specifically for nonverbal assessment. The examiner considered giving her one anyway, but didn't think Sweets would be engaged with that test.

So, where do we go from here? I don't really know what this means. I think that it makes it more likely that she will qualify for services with an IEP though. I still don't have a great understanding of what the criteria are for qualification, but from what I've read it is something like 2 standard deviations below in one area or 1.5 standard deviations below in two or more areas. One standard deviation is 15, making 1.5 standard deviations below a score of 77.5 and 2 standard deviations below a score of 70.

Sweets now has 73 for cognitive, 74 for PT, and 79 for speech. I find it very odd that she scored the highest from speech out of these, considering I feel like speech is her biggest issue. But she does have two scores below 77.5 now, so at least that means I think she will qualify for services. I really hope that is going to include speech services, since that's what I think she needs most. I wonder if this will qualify her for developmental day as well now, which would mean mostly free daycare. There's got to be a silver lining, right?

Wednesday, February 15, 2012

Apraxia: Yes, No, Maybe So...

Last month Sweets had a speech eval at NCEENT which diagnosed her with apraxia. Today we had our second opinion on the apraxia diagnosis at Duke.

The Duke examiner said she does NOT think that Sweets has apraxia. She said maybe phonological disorder instead. But she is reluctant to make any call before 4 years old. Of note, this was (by chance) the same examiner we saw last year, who said she didn't think Sweets had apraxia then either. She said she still stands by that opinion today.

She said that Sweets is able to mimic well enough, and she doesn't hear a lot of variability in her mimicked words, specifically in the vowels. She had her say "Bye bye bubbles" as she blew and popped bubbles, which Sweets said. The examiner said that a kid with apraxia would have a really hard time saying that.

The examiner at NCEENT had told me that just because Sweets can mimic, it doesn't mean it's not apraxia. She said that while adults with apraxia can't mimic, kids often can. One reason she thinks it is apraxia is because of the difference between her spontaneous pronunciation and her mimicked pronunciation.

The Duke examiner still thinks that tactile cuing therapy would be useful though, which is the same thing that the NCEENT examiner said. She said she isn't that familiar with PROMPT (which the NCEENT examiner had recommended), but that she knows it is a type of tactile cuing therapy, and would support that on top of play-based therapy. So the general recommendations are the same at least.

She thinks that we should go back to using ASL signs with Sweets again. We had been using them successfully for about a year, but when she started the new daycare in August it dropped off a lot because they don't know the signs and it wasn't reinforced. She also recommended communication/picture boards, which we have had in the past but we didn't get much use out of them because Sweets was signing a lot at the time. She gave me a simple one with "I Want" on it, that you can velcro different things that you want on the board.

This afternoon, the NCEENT examiner just happened to call me to see if I wanted to start Sweets in PROMPT therapy there. I did book a PROMPT session for Monday. I also told her about what the Duke examiner said. She said she wasn't surprised at all that the Duke therapist does not think Sweets has apraxia. But she really thinks it is apraxia.

How confusing.

Tuesday, February 14, 2012

PT Eval - 33 months

Sweets had a PT eval yesterday. It had been almost a year since the last one, and about 8 months since we quit PT. My main questions were where her current ability levels are and whether she still needs to wear the orthotics.

The outcome is that she will continue with the orthotics, and she scored lower than I expected for her current ability levels.

Stationary skills: standard score of 7, age equivalent 18 months, 16%
Locomotion skills: standard score of 6, age equivalent 23 months, 9%
Object manipulation skills: standard score of 5, age equivalent 20 months, 5%
Overall: gross motor quotient of 74, 4%

Surprisingly, this is about the same percentile that she scored for PT when she was about 13 months old, when she couldn't walk, cruise, or crawl.

At 13 months, she scored age equivalent to 9 months, which was <5th percentile. Now at 33 months, she is scoring 18-23 months age equivalent, which is actually a higher percentage of delay by age.

The main impediments that were noted were that Sweets could not jump up off the floor or the trampoline (she tries, but only her heels get off the ground), and she could not stand on one leg for 3 seconds. She also may have scored lower on ball activities because she isn't really that interested in balls. Though by my observation I felt like she did just fine with all the ball activities they asked her to do (pick it up, throw it, kick it, etc). I guess that's why I'm not a PT though, since she seems fine to me.

Overall, I had felt like Sweets was doing fine with PT and would not qualify for anything, but it turns out she is still pretty delayed. I guess once a kid knows how to walk, we stop worrying about PT. I feel very surprised that she actually scored worse on her PT than she did on speech. I feel like her speech delay is much more obvious and much more of a problem.

The PT eval discussed options for therapy with me. We won't be taking her to the clinic because it is very expensive to go there. We went there 4 times when Sweets was 13 months old, until early intervention kicked in, and it cost us $75 per session, which is ridiculous.

I mentioned that if she qualifies for IEP, that hopefully she could get PT through the school. The evaluator said that even with delay, the school often won't provide PT unless the child can't access all areas of the school and playground. As far as I know though, Sweets can access her school and playground just fine, so she still may not qualify for services.

The other option is for us to find a PT who will see her at school the way her early intervention PT did, and we will just pay it through insurance. The issue here is that we want to make sure we have enough insurance visits for the speech therapy, so that will depend on what the school provides for speech. Even if the school provides speech therapy, our docs are recommending PROMPT therapy once per week, which we would have to provide separately somehow because I don't think the school has access to this kind of therapy. We only have 75 combined therapy visits per year, and we would rather use them for speech than PT if we have to choose.

So I'm still not even sure if we are going to do PT for her at all at this point. Though I feel like we should now that I've seen her low scores.

Wednesday, February 1, 2012

Grumpy Morning, Happy Morning

I don't know how she does it, but on weekends Sweets is like an alarm clock. She wakes up right at 7am, no matter when she went to bed.

But on weekdays, I often have to wake her up to get her ready for daycare.

This morning, I went to wake her up at 7:15, and she was grumpy!

She didn't want to get dressed, she didn't want to eat breakfast. But she did ask to nurse.

Sweets hasn't been nursing in the morning every day lately. She used to always nurse twice per day: in the morning when we get up and when we got home from work. But lately, she skips one or even both of these some days. She skips the morning nursing more often, and I'd say she only nurses in the morning about 60% of the time lately.

But this morning, she wanted to nurse. And she didn't want to nurse in this seat, it had to be in that seat.


I'm telling you, grumpy.

She nursed for maybe 20 minutes and got progressively happier and happier and more giggly and playful as she switched back and forth a few times between sides.

When she was done, she started just looking up at me with the most smiley, happy face! She was just so adorable!

I looked down at her and I said "Oh, I just love you!"

And she looked back at me and said "Yah Yoo Doo."

Love You Too.

And my heart melted.

And then she happily got down and went to the kitchen to eat the waffle that was waiting for her. Then she trotted over to the door, ready to go, and said happily "Ass Doh!" (Let's Go!)

I'm so glad we are still nursing. We can still turn a grumpy morning into a happy morning, just like that!

This post is cross-posted from my breastfeeding blog, Lactation Narration.