Here is the actual full transicrit the doctor put together after testing my little one. He actually is a neuropsychologist doctor which is good: This has been going on since she was 1 year old.
Ive met initially with ******* to give her a synopsis of what was done, and to reassure her that there are lots of things she did very well and that I am hopeful we will have a recommendation that will help her to achieve her goal and that is to control her impulsiveness and be more socially appropriate so that friendships can evolve and socialization can occur. She has been excused and now mother and maternal grandmother have joined me to review the results.
The quantitative neurological examination showed that her height at 51 ½ inches puts her well beyond the 95[SUP]th[/SUP] percentile and she is just above the 95[SUP]th[/SUP] percentile with her weight of 62.7 pounds. She is right handed with a laterality quotient of +100, right-eyed, right-footed, and *******. When holding the writing instrument in writing, she uses a non-inverted wrist but full grasp hand posture. Writing speed is slow in order to try to gain control of the letters. Overflow movements from the left to the right hand occur. Balance is reduced on the right versus the left lower extremity. Timed alternate motion rate in the right hand is slower than in the left, but otherwise no other lateralizing signs in reflexes, coordination or involuntary movements was detected.
Academic measures showed that the Gray Oral Reading Test was accomplished at the end of the 1[SUP]st[/SUP] grade with adequate decoding skills. Writing is difficult, but she can spell at a 1[SUP]st[/SUP] grade level. Math skills were hampered by problems in accuracy in more complex addition, such as 4+3 = 2, and she does not have mastery of the concept of subtraction, and she is in grade K but is a retained child from entry into 1[SUP]st[/SUP] grade.
Parent rating scales on the DSM-IV show impulsivity, borderline hyperactivity, but not clear evidence of inattentiveness. On the Achenbach Behavior Checklist, aggressiveness, problems in socialization, social withdrawal and obsessiveness were prominent, with lower levels of personality traits seen in children with attentional problems. On Rapid Automatized Naming she did well, getting 10 animals in one minute, which is normal, and picture naming, all 8 identified in 17 seconds, but substituted fire truck for bus, U for horseshoe and hook for anchor, all three of which are common at age 6 years 2 months. On the Students Depression Inventory, ******* endorsed difficulties with interpersonal relationships as a major concern, as well as a moderate level of lack of joy in her life.
Neuropsychological measures showed on the Rey Auditory Verbal Learning Test that the verbal learning curve is good. The top score is 7 out of a possible 10, normal 6 or more, and a total score of 30, normal mid-20s or more. Recall was borderline at 4 words or 57% recall. Ideally, wed like that closer to 75%. On Kagans Matching Familiar Figures Test, her time was normal at 176 seconds, and the error rate at 15 on this visual discrimination task was
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NAME: *******
DATE: October 12, 2011
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within the normal range at 15, normal 20 or less. Letter Cancellation was done in normal time at 3 minutes 9 seconds for the 1-letter version of this task. It is a proofreading task of attention. Three errors were made, which is borderline in significance for inattentiveness, but all three were in the right hemi space, suggestive of left hemispheric dysfunction, as was the quantitative examination. On digits forward, she did adequately for chronological age, getting 4 out of 8 trials up to 4 numbers in a row in sequence properly repeated, but she could not reverse even 2 numbers. That is borderline, but there are 6 year olds who just dont have the concept of how to reverse the sequence of 2 numbers. On the Rey-Osterrieth Complex Figure Test she had difficulty with visual-motor skills and visual perception. Short term and long term visual spatial memory are also weak. However, this specific task will not optimize until age 13, so it is hard to be harsh with her. Finally, on the Conners Continuous Performance Test, this computerized test of attentiveness confirmed that for whatever reason attention is not easy for her at this moment.
The routine electroencephalogram showed a dysrhythmia grade 1.5, a mild to moderate change, slowing but no sharp wave discharges as occur in epilepsy, and this is confined to the left temporal parietal region. The computer assisted analysis confirmed the clinical impression of the routine study, as well as the N100/P300 both having prolonged latencies as occur in developmental disorders at 220 milliseconds, normal less than 100 milliseconds, and 328 milliseconds, respectively, normal less than 300 milliseconds.
This, in my judgment, is a brain-based disorder in which biological dysfunction forces the child into behaviors that she cannot control that include trying to control the behavior of others. This is not oppositional-defiant behavior. This does not mean she can never been oppositional and defiant. It means that the symptoms of greatest concern are not voluntary. Whether the brain dysfunction contributes to this is hard to prove by the physiology measure, but chemical therapy is appropriate. We have talked about SSRIs (there are two family members who have been responsive favorably to Celexa) and the atypical neuroleptics. We know of one family member who did not tolerate Abilify while on Celexa. She has not been tolerant of Prozac or Paxil, as well as the psychostimulants which either made her overly obsessive or explosive. Antiepileptics are a consideration, but without sharp wave discharges, I would prefer to consider first the atypicals and perhaps Risperdal because of its generic availability and cost effectiveness is worth considering, starting with just half of a 0.25 mg at bedtime. That can be increased to a full and later on, after I return from overseas, I would anticipate we will be adding a half or a full in the morning. These are very low dosages, but observation for appetite stimulation should be carried out. Withdrawal is not an issue and general health effects, unless there is weight gain, are not a concern either.
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NAME: ******
DATE: October 12, 2011*******
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DISMISSAL DIAGNOSES: 300.3; 345.40; secondary inattentiveness
