Reply to IEP for emotional disability vs. OHI?

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[quote=Anonymous][quote=Anonymous]OP here again. 9:50, thank you, that was extremely helpful. I have been thinking more and more about the speech issues and I am starting to think that we do need more testing in this area.

Neuropsych did WISC and WJ. There was also a lot of testing for anxiety, depression, and executive function. The ADHD-Combined diagnosis is new and that is mainly what we were looking at. She did do the VMI also. The achievement subtests included:

Letter-Word Identification
Reading Fluency
Story Recall
Understanding Directions
Calculation
Math Fluency
Spelling
Writing Fluency
Passage Comprehension
Applied Problems
Writing Samples
Word Attack
Quantitative Concepts

I'm not certain what the school speech person tested, I don't have that report in hand yet. I know it included things like rapid naming of colors, naming things related to a picture cue, etc.

She did have an IEP for speech in preschool, for expressive language delay. She only had about 20 words until about age 3 when her language completely exploded and she began using complete sentences. I honestly never really thought much about these other speech issues until recently when I began to suspect that her continued struggle to get words out or to orally re-tell an event began to seem less age normal, KWIM?

I appreciate your help and detailed info.[/quote]

Were all of these  within 1 std deviation of IQ and each other -- no significant discrepancies?  I would expect, based on what you describe that some of the fluency tests might be lower than ability, but still in the "average" range.

Unfortunately, I don't see any testing on your list that really goes to higher level language function.  I think you really need some speech/language testing from an SPL and/or neuropsych that goes to higher level oral expression.  The story recall is mostly memory and organization, not much complex expressive function.  Rapid-naming may go to difficulty with word-finidng and slow-processing, but just on the one word level.  Naming things related to a picture can also be very "low-load", i.e. not testing complicated expression just one word level.  Ask the school SPL specifically about each test she did or google for yourself to find what they test.  Ask specifically which tests go to higher level linguistic functioning, or language processing, or language tasks with a higher "meta-cognitive load".  You can also call the neurospsych who did your testing and explain that you are more interested in her complex expressive language ability and which tests did he/she do that go to that or are there any additional tests they would recommend in that area (and how much it will costs to do a few additional tests & report).

IME, bright kids with language issues can often test near their IQ/ability range on one word or sentence level assessment, but fall apart as the complexity rises, either in terms of length (i.e. paragraph level and higher) or in terms of the "meta-linguistic" level or in terms of the number of tasks necessary to complete to respond to the same question.  My MERLD child can have a conversation (if you ignore a lot of the ummms, wrong word use, awkward grammar and wandering) about anything he is interested in.  But, when asked to respond to a prompt which has multiple requirements, it becomes much tougher.  Participating in a dialogue of several exchanges of question and answer is excruciating and exhausting for him.  He can write a poem if the prompt is open, but if the poem prompt is "write an acrostic poem on an assigned subject including 3 of the following vocabulary words," he will have a melt-down.

You mention that your DC is often melting down in class and requiring the intervention of outsiders.  Do you have any details on that?  Often a very complete description can identify triggers that are causing the outbursts.  IME, when my DC has a problem in class, it is almost impossible to get him to explain fully about it (due to expressive difficulties and his emotional take on the situation).  It can take a week and several conversations to get the details about a particular incident from him, and then I have to also talk to the teacher and the person who intervened from outside the classroom.  Often, once I get all those pieces, it becomes more clear that expression was a clear part of the problem.  Teachers often think oral expression is "fine" because they think in general terms whether the student can talk and communicate needs which is a pretty low bar.  They also have so many students that it's hard to notice a pattern of expressive difficulty in the classroom over time in one student, plus they are often mischaracterizing the problem as shyness, lack of self-confidence, lack of motivation, etc.

It's hard to know whether the oral expression problems are a language processing problem in their own right or a part of the ADD/executive dysfunction.  The more complex language tasks require the brain to pay attention to several things at once, and that may be more problematic for kids with executive dysfunction.  Plus, the pragmatic (i.e. body language, conventions of expression) part of language is yet another task to pay attention to while thinking about the actual expression itself.  In any case, whether the problem is ADD/exec. dysfunction or Speech/language impairment is a differential diagnosis that might not actually be that easy (or necessary to make) and may be irrelevant if the ways of coping/treatment/therapy would be the same.

For my kid with expressive difficulty good accommodations in the classroom involve reducing the demands for quick, immediate replies and giving a chance to use notes while speaking.  So, those stupid math fact tests that require immediate oral response are just anxiety provoking and shouldn't happen with my kid.  Telling the whole class "I'm going to read you a story, but before I do, I want you to know that I am going to ask you which character you think is most important and why.  Use some paper if you want to take notes while I"m reading" instead of reading the story and pointing to a kid and asking a question for an on the spot response works much better.  Or saying, "Students X, Y, and Z, please give me three reasons why the character made his choice", and then letting the kid with expressive difficulty know privately he/she will always be the last in the set to answer so he/she has extra time to find words, etc.  Also, alternate presentation of responses can be good accommodations -- the students can be given a choice whether they want to stand up and give a speech, or create a video on the same topic.  The video has the advantage that the language impaired child can do more planning, and shorter bits of speech, and more editing, rather than standing up and speaking in public.  [/quote]

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