Falling IQ scores

[smallworld]

Does anyone know what it means when IQ scores drop significantly and the child is relatively stable med-wise? GFG2 took the WISC-IV in July 2005 when still on Paxil (and having strange and aggressive episodes every night). She just took it again as part of applying to private school for next year. Her Verbal score dropped 18 points, her Working Memory dropped 18 points, her Processing Speed dropped 6 points, and her Full Scale dropped 9 points. While her Perceptual Reasoning went up 10 points, there is now a 45-point spread between that score and Working Memory (our educational consultant says this spread, with falling grades this year, could help her qualify for sped). In terms of meds, she is taking Lamictal and Lexapro -– neither of which I thought caused cognitive dulling.

Any insight?

[Sheila]

Worrisome.

I don't know whether any of the meds your gfg is on can cause cognitive dulling. It would be a question best posed to the pdoc and/or pharmacist.

It does happen that a student is tested on a bad day.

"Why Are My Child's IQ Scores Falling?" at http://www.wrightslaw.com/advoc/ltrs..._IQscores.html explains other potentials.

[Martie]

Smallworld,

I would not trust any psychoactive med to not have cognitive effects. What is strange about what you report is the increase in perceptual reasoning with other areas dropping.

I would be most worried about a drop of 18 points in verbal. This is the strongest evidence of cognitive dulling and is the subtest most closely associated with academic performance.

I had ex-gfg evaluated on mainline ADs (no effect) but (the areas are not comparable bec. it was the WISC III) he lost a lot in processing speed and memory tasks on ANY mood stabilizer. His verbal performance on Topomax didn't need to be assessed: his word firding difficulty was so obvious that he stopped talking. Of the two I had assessed (Lamictal and lithium) lithium had more effect on processing speed and memory than Lamictal but the effects were present for both.

Just because it happens to one child, it does not mean it happens to another. However, I will restate that I believe there is a chance that any psychoactive drug has measurable cognitive effects.

Also, motivation is a huge factor and scores can be affected by mood as well.

I checked the "Matthew Effect" on Wrightslaw--I knew it was there but forgot the name--LOL--that's middle age not meds-- It seems to me that the Matthew Effect is least likely as a cause for these decreasing scores unless something has been going on with your gfg that I do not know about. Are there major educational problems I have forgotten?

Ex-gfg had plenty of processing speed to "give" and still be in the superior range but he could not afford to lose verbal or memory abilities--the mood stabilizers put him about 15 points lower on each--that's a full standard deviation, and is not likely to be due to random error alone. You have effects as large or larger in some areas.

However, (there is always a however in this line of work), if the meds are helping with mood and her motivation is OK, then maybe the loss is better than the alternatives. It is difficult to know what to do and I at least, had nagging worries that these changes might not be reversible as with tardive dyskensia. Ex-gfg stopped all meds over 18 months ago and is no longer evaluated by professionals of my choice. However, his speed when playing organ or piano is extremely fast so I think he "recovered" there. His memory still seems to be totally related to motivation and his vocab is growing (it's obvious without being assessed.) This gives me hope that the meds that are necessary for so many adolescents are not causing irreversible changes in their cognitive abilities.

Martie

[smallworld]

Sheila and Martie, thanks so much for your insight.

To fill in the picture a bit more, GFG2 has been struggling with inattention and inability to engage in schoolwork and homework all year. She was a straight-A student last year. This year in 6th grade, her individual test, quiz and project grades are all over the map (literally A through F). She never in her life failed a math test (her strongest subject) before this year. When we met with school officials both in September and December, they claimed it was merely an adjustment to middle school that was causing the grade scatter (I didn't buy it, but I'm only the mom). Her pdoc thought the inattention was related to anxiety and depression and added Lexapro the first week in December. The pdoc also increased Lamictal by 25 mg to cover any mood instability that might occur. GFG2's mood is now less irritable and more even, and she is falling asleep more easily at night. But the inattention has persisted, and she seems to be having an even harder time settling down to do homework at night. I’m not convinced it's related to mood (but could it be anxiety?), and we have never before thought she had ADHD. After reading Martie's post, I'm now beginning to question whether the inattention is a side effect of Lamictal. I've faxed the psychologist's report over to the pdoc and have a call into her to see what she thinks.

About her Perceptual Reasoning score (increased from 121 to 131): I'm actually not surprised it jumped 10 points because I thought that index score was low in her first testing. When she was 7.5 years old, she took the Raven as part of our SD’s GT testing. She scored a 51 out of 60, which would have qualified her as GT as an 11-year-old. The Raven correlates with the Matrix Reasoning subtest of the WISC-IV, and GFG2 this time scored an 18 (last time she scored a 14), which I think is more commensurate with her abilities.

About her Verbal score (dropped from 126 to 108) and Working Memory score (dropped from 104 to 86): GFG2 is not a reader. I have questioned for a long time why a bright child would not want to read. Her WJ-III reading scores are not all that bad, except for relative weaknesses in Passage Comprehension at 107 (67th percentile) and Reading Fluency at 108 (70th percentile). Many professionals have suggested that the “internal noise” from GFG2’s mood disorder interferes with her ability to attend to reading. When I asked the first neuropsych who tested her in July 2005, he said she doesn’t like to read because she has a relative weakness in Working Memory, and it’s hard to keep the details in mind as she reads. I find it ironic that both Verbal and Working Memory dropped 18 points – perhaps they are related? Or could we finally be seeing a reading LD surfacing? Hard to know.

Coincidentally, her brother (GFG1) underwent neuropsych testing in December. His full-scale IQ dropped 19 points, but his testing in 2001 was the WISC-III and this time around it was the WISC-IV, which I understand is a harder test. His Verbal score dropped 17 points, but he’s still in the Superior range so I'm not as concerned as I am with GFG2. In addition, he’s still significantly depressed, and we’ve been told depression can depress IQ scores. We have a meeting with his pdoc next week to go over his neuropsych eval and figure out where he should go to high school next year (yikes!).

If anything jumps out at you, please let me know. Thanks!

[Martie]

Smallworld,

Our kids are alike in many ways--and ex-gfg doesn't have a lot of kids with whom he shares many commonalities.

I am almost CERTAIN that his dislike of reading as a child began as "internal noise" that either distracted him OR increased his anxiety due to content and was directly related to his MOOD DISORDER, rather than the LD or ADHD drum the teachers were beating

He always tested well on the WJ Reading Mastery Test BECAUSE (IMO) it is a unique test and does not replicate reading tasks in the classroom. My ex-gfg could score very well on the nonsense decoding (forgot the name of the subtest, I haven't given a W-J RM for about 10 years) and even his passage comprehension was OK because it is only a long paragraph. Plus, in a psychologist's office, ex-gfg would be adrenalized which would suppress the "internal noise" and increase his attention to task.

How this played out over the years substantiated my beliefs: the child who "could not read" (according to his classroom teacher in 2nd grade--but who tested at or above grade level) had read directions to put toys together that were written for adults when he was in KDG. Granted, there were diagrams, a strength for gfg, but still--he could extract meaning from text with no problem. Example two: Music scores come with introductions about the composer and ex-gfg was so ahead of himself in music that the stuff he was reading about the composers with no problems was written far above his tested grade level. I argued with the school (backed up by my own IE AND their testing), that ex-gfg could not be LD in one situation and not in another--it is just not possible. OBVIOUSLY, his performance was fluctuating based on environmental demands (hating school didn't help) but even more on his MOTIVATION to do a task and the internal noise caused by the reading material.

How this evolved further is ex-gfg refused (rather than saying he could not do it) to read about the bombing of Hiroshima and Nagasaki because it is too upsetting to him. He also refused to read Night which is a staple for 8th graders in our SD. By this time, the SD personal could clearly see the ED and exceptions to both assignments were granted after his pdoc stated that they were necessary due to risk of exacerbating suicidality. SHEESH--you would think they could figure this stuff out themselves.

My point is I doubt that your gfg#2 can "develop" an LD at this point in time. Her academic performance can certainly be affected by many factors and she needs accommodation and support but to me, that is not the same as having an LD that is present from an early age. To some, the interventions might be the same so the Dx does not matter. This is not true IMO with bright kids with mood disorders. It is very empowering to my ex-gfg to know that his teachers were wrong, he was right, and if he wants to, he can read anything but often prefers not to due to lack of motivation. My ex-gfg has enough residual differences to cope with without having a mis-Dx of LD to make him anxious. He remains "different" but if that is confined to mood and motivation (over which he has some control due to insight and maturity) he is much better off emotionally. Being better off emotionally comes back around to "internal noise": the more positive his mood, the less distracting internal noise even today as a college sophomore.

I rarely talk about this stuff because I do not want to bore others with anecdotes that I usually think pertain to the differences (not disabilities) of my ex-gfg. However, in many ways, your gfgs have similar issues. Therefore, I would look carefully at the possible side effects of all meds AND/OR "internal noise" causing gfg#2’s "ADHD" My ex-gfg could look VERY distracted in real life (and still occasionally does) while testing in the 99.9% for the attention-concentration factor of the WISC-III. It's always better to have an ability than not have it BUT there is no guarantee that a kid with a mood disorder will use what he/she has. I guess there is no guarantee anyone will, but when you add in adolescence, middle school, and a mood disorder, the chances of performance problems that are not underwritten by a "permanent" LD or ADHD greatly increases IMO. If my weird experiences with my non-LD, non-ADHD academically underperforming, sometimes distracted but also gifted and mood disordered child can help ANYONE, it makes my day.

Best to you,

Martie

[smallworld]

Martie,

Thank you for your lengthy reply. I so appreciate your sharing your experiences with your ex-gfg because you give me hope for the future. And yes, I think our experiences share common threads, even down to the fact that my GFG2 plays the piano (since age 6). I'm certain she's not bound for Julliard, but she is talented and her fingers fly across the keyboard (somehow her working memory and processing speed "work" for piano). I hope I make your day when I say that you are indeed helping me.

An update of sorts: GFG2's pdoc is very concerned about the significant drop in IQ scores, particulary in Verbal and Working Memory. The pdoc said this type of drop is not generally expected with a mood disorder (the pdoc is head of child and adolescent psychiatry at Georgetown University Hospital and treats lots of kids with mood disorders). While the mood stabilizers Topamax, Neurontin and Lithium are known to cause cognitive dulling, Lamictal is not; however, it cannot be ruled out, and the pdoc has a call into the neurologist we work with to get his opinion. She has arranged for GFG2 to undergo both projective testing to gauge her emotional state and the IVA to evaluate the extent of her inattention. As I said in my earlier post, we have never felt she had ADD, but she has become increasingly inattentive since school began in the fall. The question is why –- medication, worsening anxiety, something else (with school environment and no 504 or IEP thrown in, I'm sure). We hope the testing results will shed light on this issue.

Thanks again for sharing your experiences with me.

[Martie]

SmallWorld,

Short piece of advice that you may already know: Do NOT share projective testing with your SD in it's entirety. Have your independent evaluator write a summary particularly for the school if something needs to be shared. There will be stuff in there that will be misuesed unless you have a very unusual set of school professionals.

I think projective testing done by a very skilled examiner can be quite helpful for children with mood disorders but I would keep the results for your use with your own professionals.

Martie

[labesi]

This is the first thread anywhere that I have ever replied to, but I felt it was very important here.

I a myself on Lamictal and Lexapro. My quality of life have improved tremendously, and everyone close to me is surprised at the difference (I am Bipolar light). But I noticed an incredible decline in my short term memory, cannot quickly solve even rudimentary math problems - particularly regarding dates, and I find myself reasoning at the level of everyone else, in other words average, from being gifted. I am 39 years old and have been on the effective doses for almost a year. The cognitive skills do get slightly better over time, I noticed the same thing with one of my best friends on the combo, but I am still not near where I was without meds. Luckily I was very intelligent to start out with. Now I am just slightly above average.

I have just started attempting to improve the situation with short-term memory games, etc. It is even possible to improve IQ scores in areas like short term memory by up to 18 points. There can be a marked and large improvement from this sort of training. But I have to say that if I were still studying, I would probably go off the meds in order to get the full experience of studying. At the same time, it might be better for a young person to not feel that their identity is in their intelligence, but rather their compassion, or some other trait. To be totally honest, if I didn´t become very attractive as and adult, I would not have much extra currency left.

I hope this helps you and anyone else here to make the decisions that are best for you/them. I really wish you and your child the best.

[labesi]

I a myself on Lamictal and Lexapro. My quality of life have improved tremendously, and everyone close to me is surprised at the difference (I am Bipolar light). But I noticed an incredible decline in my short term memory, cannot quickly solve even rudimentary math problems - particularly regarding dates, and I find myself reasoning at the level of everyone else, in other words average, from being gifted. I am 39 years old and have been on the effective doses for almost a year. The cognitive skills do get slightly better over time, I noticed the same thing with one of my best friends on the combo, but I am still not near where I was without meds. Luckily I was very intelligent to start out with. Now I am just slightly above average.

I have just started attempting to improve the situation with short-term memory games, etc. It is even possible to improve IQscores in areas like short term memory by up to 18 points. There can be a marked and large improvement from this sort of training. But I have to say that if I were still studying, I would probably go off the meds in order to get the full experience of studying. At the same time, it might be better for a young person to not feel that their identity is in their intelligence, but rather their compassion, or some other trait. To be totally honest, if I didn´t become very attractive as and adult, I would not have much extra currency left.

I hope this helps you and anyone else here to make the decisions that are best for you/them. I really wish you and your child the best.

[InsaneCdn]

Others have covered the med-effect side of things...

IQ scores are not static. For anybody.
The testing is set up for a "normally developing" child.
But many of "our" kids have subtle developmental issues...
Which means, the brain is developing unevenly.
So... last time round, some areas of testing may have ranked higher than what she "really is", because she was developmentally advanced in those areas. Just because the comparative score has dropped, doesn't mean she has gone backwards. It more likely means that those areas have "normalized", and others are developing.

Another interesting thing is that many evaluators are not aware of the fine-print in grading an IQ test. For the test to be valid as a comprehensive score, certain comparison points can't be more than a set number of points apart. If the spread is greater, the sub-tests are still valid but it isn't possible to give an overall ranking of IQ. These big-spread scores happen in an estimated 2-3% of the population - so its not far-out unlikely or unreasonable... but just few enough that they don't have a way to normalize the scores. The full-scale number may well be invalid (I don't know the actual scoring rules).