Reading problem - Who should evaluate?

[smallworld]

Original title to thread: Sheila, Martie, anyone: Who should evaluate for reading problem?

My daughter (difficult child 2) is just finishing 5th grade. As you can see from my profile, she has a working diagnosis of bipolar disorder. She is a straight-A student. Although she taught herself to read at age 5, I have felt for several years that she has a reading problem that I can't quite define. She avoids reading at all costs, including novels assigned for school. On the rare occasion that she picks up something to read on her own, it is generally a beginning chapter book that her 2nd grade sister can zip through. She tells me that she's a slow reader, that reading is hard and that it's difficult to concentrate on it. She is an excellent math student and an above-average writer. In fact, she quite readily just completed a 15-page fiction story assigned for school. I was impressed by her use of dialogue, her word choices and her development of a conflict and resolution.

Last July, difficult child 2 underwent neuropsychologist testing that concluded she has dxes of Cognitive Disorder - not otherwise specified (executive dysfunction, cognitive impulsivity); Depressive Disorder - not otherwise specified (later changed by her current psychiatrist to Bipolar Disorder - not otherwise specified); and Mild Mixed Receptive-Expressive Language Disorder (relatively inefficient retrieval and relatively modest short-term auditory/working memory). I am happy to share any specific test scores with you, but I didn't know what you would need to know to answer my questions.

I didn't get a clear sense from the neuropsychologist what difficult child 2's specific reading challenges are. So . . . who is the best professional to assess for reading difficulties? What tests should be performed to cover all the bases?

Thanks, in advance, for your help.

 

[Martie]

Dear Smallworld,

I need one more piece of information to make a recommendation: is your difficult child 2 a good "word caller?" (can identify words in isolation.) How is her reading comprehension? How is her reading comprehension compared to her word identification?

I guess this is three questions but they are all related.

Martie

 

[smallworld]

Martie,

I don't know if these test scores will answer your questions, but here goes:

On the WISC-IV, her verbal comprehension index score is 126 (96 percentile) and her working memory index score is 104 (61 percentile). On the Woodcock-Johnson, her passage comprehension score is 113 (81 percentile) and her reading fluency is 109 (72 percentile). On the TRC-3 Paragraph Reading subtest she scored at the 63rd percentile.

Verbal expression/production tests: On the WJ-III Retrieval Fluency subtest she scored at the 59th percentile; on the controlled Oral Word Association Test, she scored at the 84th percentile; on the WJ-III Rapid Picture Naming subtest, she scored at the 15th percentile; and on the WJ-III Picture Vocabulary subtest, she scored at the 78th percentile.

Verbal learning/memory tests: On the WRAML Sentence Memory subtest, she scored at the 25th percentile and on the WJ-III Memory for Words subtest, she scored at the 57th percentile.

I personally think she has more problems with understanding what she's read (comprehension) rather than actually reading the words (decoding). When she reads aloud, it's more choppy and less fluent than her 2nd grade sister, and she frequently has trouble retrieving individual words when orally telling a story. I think the test scores bear that out.

Hope that helps answer your questions. Thanks again.

 

[Martie]

Smallworld,

What you asked is who should evaluate next, but your difficult child 2 has been evaluated thoroughly. Every score except Rapid Picture Naming is above average and the W-J III is a "different" test where some kids score poorly (or well) or at least differently than they have on other individual cognitive or achievement tests.

Sentence Memory is low average but in the presence of all the other scores above the mean, I would say that emotional issues associated with being BiPolar (BP) is more likely the cause of the inability to read both fluently or sustained silent reading.

I have LOTS of experience with this particular problem because my ex-difficult child tested fine in everything--with the highs not as quite as high as your difficult child and nothing below the 40th percentile but he HATED to read--and wouldn't do it. Under testing conditions, his comprehension was fine (as is your daughter's) but left to do SSR in class or reading "independently," he never did know what he had just read.

Some people would attribute this to neurologic dysfunction and your difficult child does have some "blips" but I've seen really low test scores in kids who read well if they aren't internally distracted. Therefore, I think that everything else that is going on (and a 2nd grade sib that reads well) is probably causing "internal noise" or distraction that interferes with both memory and comprehension. Clearly, in a 1:1 situation, her comprehension is strong but I bet she can't USE that independently.

I have another question: does her comprehension vary depending on interest? A child cannot have a neurologic underwrite for "I can understand about horses but not about computers." Or, in my ex-difficult child's case--"I can read and understand material written for adults if it's about music but I can't read anything else." Neither dyslexia nor true learning disabilities works this way.

Based on the scores, it looks as though your daughter has a mild word retrieval problem and does not retrieve at all well under time pressure. HOWEVER, since you say that she can write well, that suggests to me that the problem may be more one of performing on demand (increases anxiety) than actually not being able to think of words. If the expressive language problem were severe, her writing would be affected.

I had a very difficult time getting teachers to understand the difference between motivational/emotional problems in sustained independent reading and a neurologically underwritten Learning Disability (LD). I had my ex-difficult child evaluated by a school psychologist (privately), a clinical psychologist, and a psychiatrist. The SD evaluated him also (school psychiatric and reading specialist.) He never "produced" identifiable reading problems on testing so there is nothing to diagnosis but he sure had problems in school using the abilities he obviously had in his head somewhere. He was never evaluated by a neuropsychologist because he has no "soft signs" that would raise a concern.

What happened in the end is "nothing" directly related to reading intervention. Ex-difficult child received TONS of intrapsychic therapy and could probably have used a bit more cognitive behavioral therapy as well but has had to figure that stuff out the hard way. Eventually, his internal noise was reduced sufficiently and he was no longer depressed: then he could read IF he wanted to. He got some C- and D in English in high school (the cog behavior mod would have helped him get over "not liking it" more quickly.) However, he just finished freshman year and in English got a C+ first semester and an A- second semester. He DECIDED that more Cs never mind Ds were not going to get him were he wants to go for graduate school. Therefore, he did it.

I have NEVER made this suggestion to anyone before because usually you can't strategize a kid out of a reading problem that is Learning Disability (LD) or dyslexic in nature. However, I don't think there is anything to diagnosis in your daughter because she scored well. Any time children score poorly, there is always the chance that it is well below their true score, but when a child scores well, there is no question of validity (assuming the test was administered correctly.) Her only obvious problem is word retrieval and that could be addressed in language therapy but your daughter isn't severe to warrant that in my opinion. Even if her word retrieval scores came up with therapy, there is no guarantee her reading would improve.

If it were my child, I would look for the best, non rip-off reading tutoring program around your area that stresses internal motivation and student directed strategies for improving comprehension. If she were more motivated and less internally distracted, I think she could read much more effectively. I know this is simple to say...harder to do. It took 10 years for my son to be able to more or less read effectively on demand.

However, my ex-difficult child did get very discouraged about some of the things he had to read last year, especially when they were books that he really didn't have the background information to understand the context. Even at age 19, if he feels this way, he reads less effectively. He had to read Toni Morrison's Sula, which I read (it's short) so I could talk to him about it. It is about a tight-knit group of related African American women over a time span of about 50 years beginning in 1910. Unfortunately, this is not a book likely to appeal to young males. However, after talking for an hour or so on the phone about it, ex-difficult child felt much better, "got" a little of the context, which I related to more modern things he would understand. He went on to do well on the final that included this book.

The reason I bring this up is kids who don't LIKE to read may not ever read for pleasure (my son does not) and may dislike certain tasks forever, but the solutions they need are different than for kids who have LDs. The problem may look the same to some teachers but in my opinion, it isn't and requires different approaches to solve it.

Martie

 

[dreamer]

I am not sure if what I am going to post is relevant or not, if not, I apologize.
I know I am bipolar and when I am cycling, I cannot read. I LOVE to read and would read 24-7 normally, even skipping meals. I also was A honor roll in college even in my early 40s with 3 kids. BUT......when cycling? whoa. when on a downward spiral, I guess I simply cannot be bothered, do nt care, or cannot find the energy it takes to even try to read. when on an upswing? I am too "busy" my mind is busy with everything I am doing at one time. Reading takes more focus than is available to me.

My son cannot read near grade level, but his neuros have said it is due to his seizures and heterotopia.
He also cannot write legibly, due to poor fine motor function. BUT when you get the kid going, present things to him visually, and orally, he has an incredibly gift and if he is permitted to present his knowledge orally, YIKES......it is amazing and incredible.

My oldest child is diagnosis'ed bipolar and she was in the gifted student program until her BiPolar (BP) symptoms got too severe. Sadly, she began to complain of a loss of ability to read and spell.
Similar happened to my husband. My husband loved to read, read a LOT for recreation, but after he began his journey into ?? mental ilness? well, he has not even tried now to read for well over 10 years and he even has difficulty reading the directions on a can of soup or the TV Guide. I think his mind is just too busy or something. And even when he does read, he forgets it right away.

 

[Martie]

Dreamer,

Thank you for your insightful comments. All of the family examples you give pertain to what I am calling "internal noise." It can come from a variety of sources but as you have said, it interferes with reading in people who do not have anything resembling dyslexia or Learning Disability (LD).

Have a good day!

Martie

 

[Sheila]

We’ve been through the mill with our son regarding “reading.” I’ll give you an overview in case something rings a bell.

“Reading” is comprised of many skills that must smoothly integrate in order for a child to read appropriately. difficult child could do all the components well, except when he got through reading, he had little to no comprehension ability. Ironically, nobody but me could see this – that is until he failed the 3rd grade reading accountability testing. Even then, I got the excuse that difficult child “didn’t take the test seriously. He didn’t try.” He failed it in the 4th grades and 5th grades also. Additionally, my concerns were not addressed because difficult child was making A’s and B’s in Language Arts in 2nd, 3rd and part of 4th grades.

Most information I’ve read on reading problems list the components of reading as word reading, word decoding, phonological awareness, letter knowledge, rapid naming, spelling, vocabulary, fluency rate and comprehension. In order to get to the goal (comprehending what one reads), all the listed skills must seamlessly integrate.

While not typically listed, there are other factors like processing speed, recall, working memory, weaknesses in identifying emotions, ability to inference, etc. Then there’s interferences such as with ADHD, bipolar, etc.

It’s difficult to get to the underlying problem. And there can be (and typical is) more than one problem.

One of the things that helps children with reading problems the most is practice, practice, and more practice. But when reading is difficult for the student, it’s not likely going to happen. They avoid, avoid, avoid.

Ultimately, it was determined that difficult child has multiple language disorders. (receptive, expressive, Auditory Processing Disorders (APD), etc.) To complicate matters, his processing speed is in the 70’s. Throw in lack of inferencing ability and very week emotion identification capability and you’ll see the dilemma. I can assure you the inattentive part of the ADHD doesn’t help one bit.

The first time around, the MDE team through the school just couldn’t/wouldn’t identify any problems with-difficult child’s reading comprehension problem. I located a reading specialist at Texas Children’s Hospital who reviewed difficult child’s test data. He referred us to an Speech Language Pathologist (SLP) that has a subspecialty in reading problems such as difficult child’s. In addition to language therapy 2x per week for 9 months, we also did Earobics therapy and Visualizing and Verbalizing (LindaMood Bell) at home. Both of these programs are computer based.

I had difficult child evaluated via the school district again. All their data reflected the problems, but they refused to acknowledge. (Dyslexia testing, WJ IV & WIATII, Speech Language Pathologist (SLP), etc.) Frankly, I think it was beyond their expertise. difficult child’s subtest scores were all over the board – from very very low to very very high. The subtest scores converted to average or above Standard and Scaled Scores. Age-wise, he ranged from +/-3 to 26 yrs old.

We got an IEE and at a cost of $6,000+ to the school district later, the private MDE team pulled it all together. difficult child has just completed daily 50 minute language therapy over a 9 month period at school which was designed by the private specialists. For the very first time, he passed the TAKS reading on the first try. The private MDE team consisted of an Speech Language Pathologist (SLP), psychologist, educational diagnostian and some other professional (can’t recall).

difficult child does not have what is commonly thought to be dyslexia. He has Reading Comprehension Disorder attributable to the language disorders. (Called Reading Comprehension Disorder by the Speech Language Pathologist (SLP); MDE team classified it as Multiply Language LDs) Same thing.

 

[smallworld]

Thanks all for your insights. I've been mulling your comments over for the last few days, and I think the "internal noise" scenario makes a lot of sense for difficult child 2. Martie, I had never had anyone explain it to me in quite the terms you did (even the neuropsychologist, even the psychiatrist), and it just made me realize how hard my daughter struggles with schoolwork. And Dreamer, your family examples rang true, too. I appreciate your sharing them with me.

Sheila, thank you for the information on all the issues that can affect reading. difficult child 2's psychiatrist offered one interesting comment in this regard. The psychiatrist said she thinks difficult child 2 struggles most when working memory (one of the executive functions) intersects with language. To that end, I am in the process of locating a tutor who will begin working with difficult child 2 in the fall on both executive function and reading issues.

Thanks again. I knew you all would help me sort this all out.