Waiting versus Diagnosing

[armymom]

I am glad that this forum is here, because I think it is just the right place to ask this particular question.

I just started Jr. K with my dd4. She is very excited. However, I have noticed some...oddities about her. When I mentioned these to my husband, he became quite concerned and asked me what we were going to do about the situation. Honestly, it hadn't really dawned on me to DO anything. I always tend towards the "give it time and most stuff clears up" philosophy. So, my questions are: if it is a definable special need, is it best to get a diagnosis? And how early should you go about getting it looked at? Should we wait until she has a reading impairment before we worry, or try to head something off before it is necessarily an issue?

I have trouble quite saying what is "wrong" per se, but there is some strangeness about things. For example, she can match pictures, match numbers to amounts, match upper to lowercase letters, but I was using a Developing the Early Learner book the other day, doing the exersize where you are meant to match sounds, and she was guessing. I mean shot in the dark guessing. And we were comparing a clap to a rattle. She has know her letters and their sounds perfectly for ages - perfect memorization, instant recall - but she does not understand ANY of the phonological awareness games in AAR pre level 1. She gets lost quite easily in certain stories. She is constantly asking "What?""what did you say?" So I told my husband maybe she was hard of hearing and he pointed out that the other day she was listening to a CD playing quietly from the back of the car and made a connection between a sung version of the 10 Commandments and her catechism class at church. She accused her beloved Daddy of choking her, which troubled us for a week before we figured out she meant joking her. (She also told me that chair starts with j. But she pronounces the word chair correctly.) It just seems strange to talk all day long with this child and still have as much confusion and failure to communicate as we do.

The result of this is that I am not sure how to address all this. Are these issues that maturity will clear up if I wasn't pushing the pre-reading too hard? But to me immaturity would mean disinterest or short attention span. She is interested and paying attention and still certain things just don't seem to make sense to her. So, to those who have dealt with these types of things, how do you tell whether you need an early intervention versus when your expectations are just too high for a given child's normal development?

Lena

[CelticaDea]

normally I'm a huge supporter of early assessment and early intervention (my dd2 has been in speech since 18 mo and just started spec Ed for speech). I'm not sure tho about your daughter. have you mentioned it to your pediatrician? i think there is a pretty big jump between knowing the corresponding sound to letter and connecting that info to real words.
if it makes you feel a little better my dd4 (also just started JK) constantly says "I don't know" even for things I know she certainly does know. I'm trying to get her to understand that I want an answer of some sort.
I would say that if it seems odd enough bring it up with your doctor. early intervention, if a problem does exist, greatly improves the outcome.

[armymom]

I know that it is a leap to understanding that sounds make up words. But she gets confused about any game that is supposed to isolate and build those phonemic skills. So it isn't that she gets confused about mouse and horse rhyming, but she can't tell you if mouse rhymes with house or leg.

We are a military family so we are on our seventh or so pediatrician in four years. On average, I have not been impressed with how seriously my concerns are taken. (We have had a lot of discussions with a lot of pediatricians about getting babies to sleep, very little of it helpful, and most of the time rarely even acknowledging that severity can vary on these things.) That being said, since my daughter is asking for us to repeat nearly half of what we say to her each day, we have decided at a minimum to take her in to get her hearing tested in the next couple of months.

Lena

[CelticaDea]

sorry to hear youre not getting much out of your docs. a hearing test is a the perfect place to start. if that comes out fine, another thing to look at regarding "hearing" is auditory processing. to be honest I'm not sure who evaluates that although an audiologist may be able to give you more info. good luck and keep us updated!

[Enigma]

Auditory Processing Disorder was the first to spring to my mind, as well. My oldest and third son have this. They hear fine, misses the message often though. An occupational therapist trained in sensory disorders can help. There are many therapies like Fast ForWord, Eararobics.

Hearing loss occurs in the whole range of sound so even if she hears quiet music and recognizes it she can still have a loss. It can be low pitches she cannot distinguish or high. For example, my hearing loss covers the entire range of human speech (real fun) but my Dad's and one brother's are in high pitches only. So crying babies do not bother them as much.

Treat her as you would a deaf child. Make sure she is looking at you when you speak, do not give more than 2 step directions and have her repeat them back, speak slowly and clearly, charts are a huge help with pictures showing steps in processes/routines, read the same books repeatedly, use the fewest words possible to convey your message, choose books/wkbks with lots of white space, etc.. These were all things we were told to do at home with our oldest. He attended a school called The Parish School here in Houston. Their website might be useful to you or send them an email.

A great book about APD is When the Brain Can't Hear.

http://www.amazon.com/When-Brain-Can...n+can%27t+hear

Another book we found helpful is The Out of Sync Child. It covers more than APD but ususally APD is only part of the whole picture.

http://www.amazon.com/Out---Sync-Chi...+of+sync+child

Your library might have both of these.

I also think some of what you are experiencing school-wise is maturity. I would stop pushing early reading skills for now unless she asks. It is one thing to know the letter sounds and names but quite another to be ready to put them together into words. Explode the Code Primers, MP Alphabet wkbks, AAR PreLevel 1 (I have not used or seen this one.), or even Oak Meadow Kinder are all good choices while you wait for her to be ready to make the leap from sounds to words. Just be prepared to go slowly. You really cannot force it. One day, the light bulb will just turn on, I promise. Give that bit time.

[cherylswope]

Dear Lena,
I have been out of town with my grandmother for several days but would like to respond to your original post.

You have already received such good advice, especially the resources from Enigma and this from Celtica Dea:

a hearing test is a the perfect place to start. if that comes out fine, another thing to look at regarding "hearing" is auditory processing....


I'd like to return to your original message to our forum. I have read your words several times. It seems to me you already have good reasons to pursue your concerns, whether through formal or informal evaluation:

1. “She is very excited.”

Because your daughter wants so much to learn, yet struggles in unusual ways with learning, this is sufficient reason to investigate. Her enthusiasm will be difficult to sustain, if she continues to experience failure. She will need modifications, such as those Enigma suggested. The more information you have, the better able you will be to create success in her early learning.


2. “When I mentioned these to my husband, he became quite concerned and asked me what we were going to do about the situation.”

Your husband's nudging here indicates that he is not dismissing your concerns, but shares them. His desire to support you in finding ways to help her will be so important.


3. Your own careful analysis.

You describe your daughter's intelligence and skill with visual pre-reading tasks. Then you note many examples of her difficulty with auditory tasks, including normal conversation. With your own good observations, you have already begun the process of evaluating her!


4. Your own realization that other factors may contribute to some of her difficulties: maturity, early academics, or unrealistic expectations.

You are willing to accept your own role in her difficulties and modify if necessary. This is important, even as your own intuition says that these factors are not completely causative here.


So where do you go from here? First, understand that early evaluation with intervention can be considered as on a continuum. You have several options, both informal and formal:

1. You can explore the possibility of “auditory processing” difficulties on your own. With the internet, this forum, and good books, you can take a few months to see if various strategies help in this area. You can note which techniques help and which do not. As you do, you will be gathering even more data, if you decide to pursue a formal evaluation.

2. You can wait for results of the hearing tests and talk to the audiologist.

3. As soon as you have completed the audiologist's recommended testing, you can request a formal evaluation. Because the difficulties involve everyday conversation, I would begin with a Speech and Language evaluation. Take your good observations with you, preferably in bullet-point format.

If you decide to pursue a formal evaluation, request a referral from the pediatrician only if you need it for insurance. Given your own less-than-satisfying experiences with the doctors in your situation, contact your insurance provider to see if you can request such an evaluation directly from the Speech and Language therapist. Such therapists can be found in hospitals, or the audiologist can recommend someone for you.

Regardless of where you wish to begin on the continuum, it is not at all too soon. You do not need to wait until she is having even more trouble with reading, conversing, and learning. You can move forward based solely on the solid observations you have already made. The Wepman Test of Auditory Discrimination, just as an example of a standardized measure of auditory processing, is normed for children ages 4 to 8.

When you see the audiologist, be sure to mention all of your concerns. He or she may be able to assist with some of the testing beyond mere acuity. In fact, you may have already taken the first important step to obtaining a more accurate evaluation of your daughter's difficulties.


Rather than add to the length of this message, if you would like a “primer” on auditory processing I would be happy to share some definitions, characteristics, and strategies in another post.

For now, you can know with certainty that you are not alone. In just the few days after your inquiry, you have already heard from families with similar difficulties. My own son tests even today at the 1-2%ile for auditory processing. In other words, 98-99% of all children his age process information more readily than he does. Nonetheless, he learned to read at 4-1/2. Like your daughter, he was very excited. This helped. I can also share what we used for his reading, if you would like.

Cheryl

[armymom]

Well, we managed to get an appointment at the clinic, and it was worth the two and a half hour wait. The early indication is that we might have a more "mundane" issue - actual hearing loss. They gave her a simple in office hearing check and she was one for three tones in each ear. It wasn't clear that she heard anything in the right ear. I admit, this really surprises me, because she does not talk like I would expect someone who is hard of hearing to speak. Anyway, we will be getting a followup appointment with the audiologist to find out a better diagnosis. Thank you for all of the encouragement. I might have been more hesitent to say anyhting until she was actually struggling. Maybe now we will prevent some issues before they make learning too much work and frustration to enjoy.

Lena

[CelticaDea]

I'm so happy to hear you were able to get her checked out so quickly! And you're right, addressing it now will prevent or limit problems later. I hope all is addressed quickly and easily and she can get back to enjoying learning