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    lost/surprised by evaluation results

    I'm not even sure where to start on this....
    I've known for some time that my younger daughter (2.5 yrs old now) would possibly have some learning struggles since she is apraxic (speech) and generally she has been a challenge from a sensory processing angle. but with speech and OT through the school system (at home since she's <3) we've got a handle on regulating her emotions and her speech has been progressing. We will be transitioning to the in school program this summer when she turns 3 and the level of services will drop pretty drastically so we went to a private ST to get an actual diagnosis and idea for treatment. Short version of that is that she does indeed have Childhood Apraxia of Speech and Sensory Processing Disorder, specifically relating to low response to motor/proprioceptive/vestibular and is sensory seeking. None of that is surprising.

    What really surprised me is what has transpired regarding my older daughter (4.5 yrs old). While going over the paperwork, the SLP read the part about siblings and I had written that I had some concerns that there might be dyslexia or something going on regarding mixing up sounds, not being able to rhyme etc. She offered to take a quick look at her without charge.

    After this eval, the SLP said that she also is likely apraxic and that her trouble with multisyllabic words, r's, th's, very deliberate in her speech and some other errors are from that. She also brought up some concerns about her behavior/thinking: very concrete, slow (auditory?) processing, socially immature, anxiety->sensory seeking (thumb sucking, we had told her not to suck her thumb while she was talking to 'the lady' so instead she was chewing on her finger, and explained that thought process to the SLP when she was asked why she was chewing on her finger), distractibility, lack of social pragmatics, trouble with socially pragmatic language, talking-talking about a subject not relevant to the task at hand....after my husband asked if these needed a psychologist or what to maybe look at autism or something, she admitted that she was showing many signs of maybe having Asperger's Syndrome on top of the CAS. (my mind wasn't going there at all, so I had a double surprise that not only was the SLP seeing this but that my husband was too and I hadn't). So not only did I have no thoughts in my head that she had a speech disorder; apparently that may be the least of her longer term concerns. (dyslexia seems blessedly simple to me at the moment). She also mentioned that she seems to have difficulty answering open ended questions but I don't remember if that was an apraxic thing or asperger's type thing. I know at home she has a very difficult time answering the story comprehension q's with JK. Her most frequent answer for almost anything is "I don't know" even if there is no right or wrong answer and I just want her opinion but she can choose if given options. She does fine with requesting her food and all. The SLP says that it shows more in novel questions and that our 'normal' day to day questions, she knows what to expect and what/how to answer. Oh, and she loves to sing her statements or sing while she does school work. She recently starting singing her prayers. The SLP was really surprised when she started singing her responses. (maybe she's using the singing to help process??)

    She recommended that she also be evaluated by the OT to see what might be going on. So...The little one had her eval with few surprises although I learned an interesting bit about how normal people's eyes react to spinning and how my little daughter's eyes shows how she reacts....she has to get going really fast for a long time to _start_ to show what normally reacting people would. And has low tone<-didn't know that.

    The older one: I had thought since infancy that she may have some sort of gross motor processing problem. She was eval'd at 9 mo but wasn't delayed enough to qualify at the time. She still can't make a bike/tricycle move (with or without pedals), can't catch, only within the last year got the little-kid-ride-on toys to move, didn't run til she was >2 1/2 yrs old-although she could walk really fast! We put her in gymnastics to help with being able to jump and she's now learned how to hop, skip, gallop, and jump with two feet. So during her OT eval, she did well but was visibly scared and trembling as she usually is with new or difficult things but was able to do tasks that I was sure would result in tears.

    At the end, the OT said that she was also showing the same low responsive results in sensory processing for motor/vestibular/proprioceptive but instead of being sensory seeking, she gets scared and freezes or cries (latches on with a death grip to whatever adult is nearby), or refuses to try the task. She also remarked on slow processing and low tone. But says that she didn't see a problem with gross motor planning (dyspraxia) because she could do the task if given an anchor or support (in this case given by the OT).

    I trust these people because besides being nationally recognized in the field, the OT eval my younger daughter got yesterday was _SO_ many times better than another recent one from a local private OT. So now we'll be taking both girls there each week for ST and OT. (an hour away).

    Oh, and I have to do the insurance paperwork.....and with the gov't in shambles, my husband may be caught up in the federal worker furlough that will happen if the sequester happens...

    I'm trying really hard to stop trying to drive this train and just follow directions for a little while until I understand what's going on and what it means for us. I'm also trying to keep perspective of counting blessings instead of troubles. (saw that on some random guys pin today).

    Can you fix/treat slow processing? concreteness?? should I put her in preschool so she can get more practice with socially pragmatic language and behavior??

    I'm so lost and surprised. I'm not feeling at all confident at raising my children let alone schooling them.

    (thanks for reading through all of this, I hope it makes sense)

    #2
    Hugs!!! You can get through this. Once the shock wears off, you will be better able to see your way.
    Last edited by Enigma; 02-21-2013, 06:07 PM.
    The Homeschool Grads:
    J- 6/96
    S- 11/98

    Still Homeschooling:
    G- 4/04
    D- 5/05
    F- 7/08 (my only girl)

    Future Homeschooler:
    M- 9/16

    Comment


      #3
      CelticaDea,

      First, know that you have helped your younger daughter in wonderful ways, and you will be given the strength to do this too. As Enigma suggested, the shock itself feels overwhelming. After this subsides, you can look more objectively at the needs of both children. You're wise to wait until you understand the implications before you make any decisions.

      Second, fwiw, the same thing happened in our family. My daughter's needs became so obvious, we addressed them...only to learn that our son - whom we had hoped would be our "normal" child - suffered from even more daunting challenges. Our daughter had always been our squeakier wheel, so when, by comparison, our son seemed so much more "high functioning" and more capable, we failed to appreciate his own difficulties. When we received the diagnosis in an evaluation similar to yours, the news was as difficult to interpret as it was devastating to hear.

      I would like to respond more fully to your actual concerns (e.g., autism spectrum) after some time to reflect. When I do, likely in the morning, I'll also help define some of the terms in CelticaDea's post. [Our friend doesn't realize it, but she's already such a veteran in these areas, special-educational jargon has become household terminology for her!]


      You do not have sufficient strength for all of this, but He does. Your loving heavenly Father will sustain and keep you through all of this.

      Just rest for now. You'll have time to create plans, make decisions, and implement strategies soon enough.

      Cheryl
      "In the day of my trouble I will call upon thee, O Lord; neither are there any works like unto thy works....O turn unto me, and have mercy upon me; give thy strength unto thy servant...."
      from Ps. 86:7, 16

      Comment


        #4
        thank you so much for the virtual hugs and encouragement.

        Cheryl, I would really appreciate an explanation of terms. with the exception of the speech and to a lesser extent the sensory stuff, I was mostly just writing out the words they said to me. I'm so lost at this point I look forward to some clarification.

        Comment


          #5
          My apologies for responding more slowly than I had anticipated. My own special-needs children surprise me with new challenges at times! Below please find a review of previous terms with expanded information on apraxia.

          Now that CelticaDea's children are both considered to have apraxia, I wanted to provide a better explanation for anyone interested. You will also find here some new resources.

          Our next post will address new terms that surfaced in CelticaDea's recent message and, if possible, offer some suggestions for her new challenges.

          Defining terms:

          SLP = speech & language pathologist (aka speech therapist)

          apraxia of speech = inability to perform the motor tasks of speech
          (a - without, praxis - Greek for action, activity, deed)

          The following is from The American Speech-Language-Hearing Association:
          It is important to have your child evaluated by a speech-language pathologist (SLP) who has knowledge of CAS to rule out other causes of speech problems. General things to look for include the following:

          A Very Young Child
          Does not coo or babble as an infant
          First words are late, and they may be missing sounds
          Only a few different consonant and vowel sounds
          Problems combining sounds; may show long pauses between sounds
          Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
          May have problems eating

          An Older Child
          Makes inconsistent sound errors that are not the result of immaturity
          Can understand language much better than he or she can talk
          Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
          May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
          Has more difficulty saying longer words or phrases clearly than shorter ones
          Appears to have more difficulty when he or she is anxious
          Is hard to understand, especially for an unfamiliar listener
          Sounds choppy, monotonous, or stresses the wrong syllable or word

          Potential Other Problems
          Delayed language development
          Other expressive language problems like word order confusions and word recall
          Difficulties with fine motor movement/coordination
          Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch)

          Children with CAS or other speech problems may have problems when learning to read, spell, and write
          From www.asha.org

          For more on apraxia, www.apraxia-kids.org and www.teachmetotalk.com


          speech delay
          = speech that is relatively normal, just slower to develop

          sensory seeking behaviors = craving unusual amounts of "input" from various senses, e.g., taste, smell, or touch [also common in autism, for example, as when a child smells people or objects]

          proprioceptive = from proprius - Latin for own or very own - one's perception of one's own placement in space, position, movement; considered a "sense"

          For more on sensory/proprioceptive: www.out-of-sync-child.com

          For a resource on sensory/proprioceptive matters w/photos, definitions, and suggested exercises:
          www.ot-mom-learning-activities.com

          More to come....

          Comment


            #6
            CelticaDea's post revealed some new terms, including the vestibular system, hypotonia, the "concrete thinker," and Asperger Syndrome.

            See below for brief explanations:

            Vestibular = related to balance and spatial orientation

            From www.autism.com...
            Note the similarities to CelticaDea's description of her two girls:

            The vestibular system refers to structures within the inner ear (the semi-circular canals) that detect movement and changes in the position of the head. For example, the vestibular system tells you when your head is upright or tilted (even with your eyes closed).

            Dysfunction within this system may manifest itself in two different ways. Some children may be hypersensitive to vestibular stimulation and have fearful reactions to ordinary movement activities (e.g., swings, slides, ramps, inclines). They may also have trouble learning to climb or descend stairs or hills; and they may be apprehensive walking or crawling on uneven or unstable surfaces. As a result, they seem fearful in space. In general, these children appear clumsy. On the other extreme, the child may actively seek very intense sensory experiences such as excessive body whirling, jumping, and/or spinning. This type of child demonstrates signs of a hypo-reactive vestibular system; that is, they are trying continuously to stimulate their vestibular systems.


            Hypotonia (Low muscle tone)
            Hypotonia means low or decreased muscle tone....The condition can affect children or adults. Infants with hypotonia seem floppy and feel like a "rag doll" when held. They rest with their elbows and knees loosely extended, while infants with normal tone tend to have flexed elbows and knees. They may have poor or no head control. The head may fall to the side, backward, or forward. Infants with normal tone can be lifted with the parent's hands placed under the armpits.

            Hypotonic infants tend to slip between the hands as the infant's arms rise without resistance. Muscle tone and movement involve the brain, spinal cord, nerves, and muscles. Hypotonia may be a sign of a problem anywhere along the pathway that controls muscle movement. from www.nlm.nih.gov.

            Concrete Thinker
            A concrete thinker is one for whom thinking in abstractions or generalities is difficult. The concrete thinker is immature in his thinking, so he can identify nouns: chicken, peas, apple; but he might have difficulty understanding that these items all fall in the general category of “foods.” The concrete thinker also has difficulty transferring one skill to another situation and finds humor difficult to appreciate. Amelia Bedelia is a silly example of a concrete thinker, as she “pitches the tent” by throwing it across the yard. (CLS)


            Asperger's Syndrome
            Leading expert internationally in the field of Asperger's Syndrome, Dr. Tony Attwood writes, www.aspergersyndrome.org:
            Dr Hans Asperger, an Austrian pediatrician, originally described Asperger’s Syndrome in 1944. The syndrome has more recently been classified as an autistic spectrum disorder. Children and adults with Asperger’s Syndrome have an intellectual capacity within the normal range, but have a distinct profile of abilities that has been apparent since early childhood.

            The profile of abilities includes the following characteristics:
            -A qualitative impairment in social interaction:
            -Failure to develop friendships that are appropriate to the child’s developmental level.
            -Impaired use of non-verbal behaviour such as eye gaze, facial expression and body language to regulate a social interaction.
            -Lack of social and emotional reciprocity and empathy.
            -Impaired ability to identify social cues and conventions.
            -A qualitative impairment in subtle communication skills:
            Fluent speech but difficulties with conversation skills and a tendency to be pedantic, have an unusual prosody and to make a literal interpretation.
            -Restrictive Interests:
            The development of special interests that is unusual in their intensity and focus.
            -Preference for routine and consistency.

            The disorder can also include motor clumsiness and problems with handwriting and being hypersensitive to specific auditory and tactile experiences. There can also be problems with organizasional and time management skills and explaining thoughts and ideas using speech.

            The exact prevalence rates have yet to be determined, but research suggests that it may be as common as one in 250. The aetiology is probably due to factors that affect brain development and not due to emotional deprivation or other psychogenic factors.

            The characteristics of Asperger’s Syndrome described above are based on the diagnostic criteria and current research and have also been modified as a result of my extensive clinical experience. I would like to provide a personalised description of Asperger’s Syndrome that also incorporates the person’s qualities as well as their difficulties.

            From my clinical experience I consider that children and adults with Asperger’s Syndrome have a different, not defective, way of thinking. The person usually has a strong desire to seek knowledge, truth and perfection with a different set of priorities than would be expected with other people.

            There is also a different perception of situations and sensory experiences. The overriding priority may be to solve a problem rather than satisfy the social or emotional needs of others. The person values being creative rather than co-operative.

            The person with Asperger’s syndrome may perceive errors that are not apparent to others, giving considerable attention to detail, rather than noticing the ‘big picture’. The person is usually renowned for being direct, speaking their mind and being honest and determined and having a strong sense of social justice.

            The person may actively seek and enjoy solitude, be a loyal friend and have a distinct sense of humour. However, the person with Asperger’s Syndrome can have difficulty with the management and expression of emotions. Children and adults with Asperger’s syndrome may have levels of anxiety, sadness or anger that indicate a secondary mood disorder. There may also be problems expressing the degree of love and affection expected by others....

            Copyright © 2005 Tony Attwood, www.aspergersyndrome.org

            Note: Dr. Tony Attwood's books and seminars may prove helpful for any parent or teacher whose student has Asperger Syndrome.

            In the next post, we'll examine visual and auditory processing....

            Cheryl

            Comment


              #7
              To complete this third in a series of three posts designed to define terms, this message will address "processing."

              Please keep in mind with all of these terms: they describe real conditions some of our children face, but the challenges themselves are often not nearly as difficult to understand or appreciate as the language chosen to describe them!

              Some may even assert that "experts" first created such jargon in efforts to make overly complicated otherwise simple (yet significant) maladies. I'm hoping this primer will help.

              Remember that real parents and teachers - armed with simple information, compassionate understanding, and determined perseverance - can understand and educate their own students, even those who face special learning needs.

              Soon we will address CelticaDea's questions, after we define two more terms: visual and auditory visual processing.

              All definitions and interventions in this post come from the excellent website www.ldonline.org:
              Visual processing disorder
              What is it?

              A visual processing, or perceptual, disorder refers to a hindered ability to make sense of information taken in through the eyes. This is different from problems involving sight or sharpness of vision. Difficulties with visual processing affect how visual information is interpreted, or processed by the brain.

              Reading and math are two subjects where accurate perception and understanding of spatial relationships are very important. Both of these subjects rely heavily on the use of symbols (letters, numbers, punctuation, math signs).

              Examples of how difficulty may interfere with learning are in being able to perceive words and numbers as separate units, directionality problems in reading and math, confusion of similarly shaped letters, such as b/d/p/q. The importance of being able to perceive objects in relation to other objects is often seen in math problems. To be successful, the person must be able to associate that certain digits go together to make a single number (ie, 14), that others are single digit numbers, that the operational signs (+,,x,=) are distinct from the numbers, but demonstrate a relationship between them.

              First, a few words about interventions in general. Interventions need to be aimed at the specific needs of the child. No two children share the same set of strengths or areas of weaknesses. An effective intervention is one that utilizes a child's strengths in order to build on the specific areas in need of development. As such, interventions need to be viewed as a dynamic and ever changing process....

              The following examples provide some ideas regarding a specific disability. It is only a beginning which is meant to encourage further thinking and development of specific interventions and intervention strategies. The following represent a number of common interventions and accommodations used with children in their regular classroom:

              For readings

              Enlarged print for books, papers, worksheets or other materials which the child is expected to use can often make tasks much more manageable. Some books and other materials are commercially available; other materials will need to be enlarged using a photocopier or computer, when possible.

              There are a number of ways to help a child keep focused and not become overwhelmed when using painted information. For many children, a "window" made from cutting a rectangle in an index card helps keep the relevant numbers, words, sentences, etc. in clear focus while blocking out much of the peripheral material which can become distracting.

              As the child's tracking improves, the prompt can be reduced. For example, after a period of time, one might replace the "window" with a ruler or other straightedge, thus increasing the task demands while still providing additional structure. This can then be reduced to, perhaps, having the child point to the word s/he is reading with only a finger.

              For writing

              Adding more structure to the paper a child is using can often help him/her use the paper more effectively. This can be done in a number of ways. For example, lines can be made darker and more distinct. Paper with raised lines to provide kinesthetic feedback is available. Worksheets can be simplified in their structure and the amount of material which is contained per worksheet can be controlled. Using paper which is divided into large and distinct sections can often help with math problems.


              Auditory processing disorder
              What is it?

              An auditory processing disorder interferes with an individual's ability to analyze or make sense of information taken in through the ears. This is different from problems involving hearing per se, such as deafness or being hard of hearing. Difficulties with auditory processing do not affect what is heard by the ear, but do affect how this information is interpreted, or processed by the brain.

              An auditory processing deficit can interfere directly with speech and language, but can affect all areas of learning, especially reading and spelling. When instruction in school relies primarily on spoken language, the individual with an auditory processing disorder may have serious difficulty understanding the lesson or the directions....

              Though phonological awareness develops naturally in most children, the necessary knowledge and skills can be taught through direct instruction for those who have difficulty in this area.

              Interventions

              The following represent a number of common interventions and accommodations used with children in their regular classroom:

              Do not rely solely on an area of weakness.

              If instructions are given orally, try to supplement this with written or other visual cues. While it is important to address the area of need directly and try to build up areas of weakness, it is also necessary that the student be able to function successfully in the classroom. A simple accommodation like backing up verbal directions with visual or written cues is one way to facilitate this.

              Keep the area of difficulty in mind.

              Simplifying verbal directions, slowing the rate of speech, and minimalizing distractions can make a big difference to a person with auditory processing difficulties.

              Plan specific activities for the areas of difficulty.

              There are many activities that can help build auditory processing skills, whether it be in the area of phonological awareness, auditory discrimination, or any of the other areas in this realm. Rhyming games, for example, can help build phonological awareness as well as discriminating between similar and different sounds. Sorting games can help build auditory memory, as the number of variables and steps involved in the sorting can be easily controlled to adjust the level of difficulty.

              This information is representative of the materials available from the National Center for Learning Disabilities Information and Referral System.


              For much more helpful information about processing difficulties and other specific learning disabilities, see www.ldonline.org, the source of these definitions.

              Our next post will address CelticaDea's own questions more directly....

              Cheryl

              Comment


                #8
                Dear CelticaDea,

                You may recall when some of your previous messages revealed concerns about your older daughter. Moreover, your husband had his own suspicions which may be receiving confirmation now. The good news is that you both have been observant with your older daughter, even as you have been working so hard with your younger one. And it appears that you both may have been right. Yet possible diagnoses for your daughter have left this reality far less than comforting.

                You knew something needed attention, but you did not want to jump to conclusions. You were so smart to ask for help from the good evaluators who tested your younger daughter!

                To refresh our memories, these posts below are from you. Though spaced for readability, the words are your own. Look how hard you had already been working! When such efforts do not bear fruit, this often becomes additional evidence that the difficulty is not the parent's, but the child's.

                from CelticaDea Jan 2013
                "I have been using MP JK full curriculum since the fall with my dd4 (aug bday). She understands beginning sounds but not ending sounds.

                She can pick out front and end of a line of objects though. When ending sounds started coming up in her alphabet books, she was just guessing. She's still just guessing. I've blatantly told her and then tried to work back up to finding them...no luck.

                I am trying just to have her tell me what she hears at the end (not to tell me the letter) and still just guessing. I then realized that she also doesn't seem to understand rhyming words. After a few weeks of rhyming matching card games (downloaded), she's starting to be accurate about 50% of the time with pictures/words that she's gone through once already.

                I've also pulled out the Dr Seuss books (hop on pop, green eggs and ham, etc...)and with each page, initially just repeat the rhyming words, then have been able to occasionally get her to fill in the rhyme by waiting. I've tried pausing before saying the end of the phrase as I read in these and other picture books that rhyme for her to fill in the blank...she's just as likely to come up with a word that makes total sense for the story but doesn't rhyme at all.

                At best, I seem to be getting her to memorize words that rhyme but not be able to come up with them (at this point I have about 30 matching pairs to play with (only use 8 at a time so far...."



                And this from CelticaDea Feb 2013:
                "Apparently not understanding rhyme or hearing locations of sounds within words by age 4 (and a host of other things I hadn't even realized were involved), while individually are not concerning, when taken together are early signs of Dyslexia. Not the end of the world certainly, but it would change how you approach your teaching...."


                In the most recent post, you note these concerns, many of which read like the symptom list in some of our "primer" posts of definitions. Between you and your husband, you really knew your daughter, her abilities, and her difficulties far more than you think you did! You just didn't have the categories and labels and confirmation to help you delve more deeply into conditions and interventions. Now you do, with more to come as you continue working with the therapists.

                Remember, too, that the dear daughter who walked into the evaluation is the same little girl who left with you. You're just learning more about her now.

                Below are some concerns that could be categorized as a beginning step toward making specific plans, as you discover even more about your daughter and her conditions over the next weeks and months.

                from CelticaDea:
                "What really surprised me is what has transpired regarding my older daughter (4.5 yrs old). While going over the paperwork, the SLP read the part about siblings...."

                "I had written that I had some concerns that there might be dyslexia or something going on regarding mixing up sounds, not being able to rhyme etc."

                [B]Apraxia[B]
                "The SLP said that she also is likely apraxic and that her trouble with multisyllabic words, r's, th's, very deliberate in her speech and some other errors are from that."

                Concrete Thinker, Slow Processing, Social immaturity, Anxiety, Sensory seeking, Distractibility, Difficulties with Social Pragmatics and Pragmatic Language - including perseveration described below
                "She also brought up some concerns about her behavior/thinking: very concrete, slow (auditory?) processing, socially immature, anxiety->sensory seeking...distractibility, lack of social pragmatics, trouble with socially pragmatic language, talking-talking about a subject not relevant to the task at hand...."

                Note: social pragmatics and social pragmatic language difficulties simply mean challenges with using language and behavior socially. She might talk to her orange juice, for example, but have difficulties looking Aunt Mary in the eyes during a conversation. Or she might talk quite a bit, but only about topics that interest her and without the reciprocal nature of typical conversation. For a more detailed definition, search Semantic Pragmatic Language Disorder or see the explanation offered below. My own daughter was diagnosed with Semantic Pragmatic Language Disorder* from toddlerhood.

                "After my husband asked if these needed a psychologist or what to maybe look at autism or something, she admitted that she was showing many signs of maybe having Asperger's Syndrome on top of the CAS."

                "So not only did I have no thoughts in my head that she had a speech disorder; apparently that may be the least of her longer term concerns. (dyslexia seems blessedly simple to me at the moment). She also mentioned that she seems to have difficulty answering open ended questions but I don't remember if that was an apraxic thing or asperger's type thing. I know at home she has a very difficult time answering the story comprehension q's with JK. Her most frequent answer for almost anything is "I don't know" even if there is no right or wrong answer and I just want her opinion but she can choose if given options. She does fine with requesting her food and all. The SLP says that it shows more in novel questions and that our 'normal' day to day questions, she knows what to expect and what/how to answer."

                "Oh, and she loves to sing her statements or sing while she does school work. She recently starting singing her prayers. The SLP was really surprised when she started singing her responses. (maybe she's using the singing to help process??)"

                "I had thought since infancy that she may have some sort of gross motor processing problem. She was eval'd at 9 mo but wasn't delayed enough to qualify at the time. She still can't make a bike/tricycle move (with or without pedals), can't catch, only within the last year got the little-kid-ride-on toys to move, didn't run til she was >2 1/2 yrs old-although she could walk really fast! We put her in gymnastics to help with being able to jump and she's now learned how to hop, skip, gallop, and jump with two feet. So during her OT eval, she did well but was visibly scared and trembling as she usually is with new or difficult things but was able to do tasks that I was sure would result in tears."

                "At the end, the OT said that she was also showing the same low responsive results in sensory processing for motor/vestibular/proprioceptive but instead of being sensory seeking, she gets scared and freezes or cries (latches on with a death grip to whatever adult is nearby), or refuses to try the task.

                -She also remarked on slow processing and low tone...."
                (See definitions in previous post.)

                Excerpt below from www.brighttots.com For more information on children and autism, visit the website.
                *Definition of Semantic Pragmatic

                Semantic - Memory for the meaning of words, interpretation behind a word.

                Pragmatic - Concerned with the facts, or actual occurrence.

                Markers:

                Many of these children babble or use jargon speech much longer than children of the same age. Their first words are late and learning language is difficult. Problems are usually first identified between 18 months and 2 years when the child has little speech and trouble with communication. At times one wonders if perhaps the child is deaf because they do not appear to respond to his or her name. These children ignore their names in the early years yet react to the ring of telephone or the door bell. Early on in their lives, Semantic-Pragmatic Disordered children are found to have problems following instructions, and they “shut down” when taken out of the normal routine.

                Children who find it difficult to extract any kind of meaning will find it even more difficult to generalize and grasp the meaning of new situations. They will insist on to keeping situations predictable. Maintaining sameness, by following routines, will eat certain foods or wearing particular clothing and develop obsessional interests are characteristics of children with SPD.

                These children have difficulty extracting meaning both orally and visually, the more stimulating the environment it becomes difficult processing information. Children with SPD can often respond to instructions without difficulty. They are better at visible cues that are occurring at the time. The objects are in sight and they have very little difficulty understanding visible concepts like size, shape and color.

                Early Signs of Ages 0-4

                • Quiet baby, content most of the time.

                • Likes playing alone repetitively.

                • Difficult toddler with no sense of danger.

                • Does not respond to name, at times appears deaf.

                • Late talker, does not babble.

                • Speaks out of context, memorizing phrases of favorite tv shows.

                • Inconsistent eye contact.

                • Late pointer, unable to express wants.

                • Fussy eater, refuse to eat certain textures.

                • A loner, prefers to play alone then with peers of the same age.

                • Late in recognizing self in pictures or mirror.

                • Unable to initiate play with other children but will interact with in rough tumble play.

                • Difficulty sharing, tantrums persist.

                • Good with jigsaw puzzles, numbers, letters, shapes & colors.

                • Prefers helping in real activities like washing up, or operating a computer.

                • Repeats like a parrot.

                • Obsessional interests.

                • Very independent, does not ask for help.

                • Inappropriate response to sensory stimuli like touch, pain, sound.

                • Difficulty in following rules.

                SPD children are skilled at the following:

                • Using long sentences

                • Speaking clearly

                • Learning new vocabulary, in specific interests areas

                • Using familiar phrases and terms

                • Love music and have a good memory for tunes.

                • Good rote skills in math and computers.

                • High IQ’s

                Today research shows that children with Semantic-Pragmatic Disorder have difficulty in speaking and understanding speech. It’s believed that the issue with SPD kids may be the way their brain processes the information, they are not able to understand the meaning instead focus details. For example if your are speaking to an SPD toddler, they will hear without understanding.

                Sensory Problems:

                • Some children have a heightened awareness of loud noise. Others ignore loud noise and focus on peripheral sound.

                • Many have a heightened awareness of smell or taste and may refuse certain foods. Others have a diminished awareness of hunger and may only eat if told.

                • Some avoid touching certain materials particularly sticky or wet substances.

                • Some children seem to have a diminished awareness of pain. After a serious fall they’ll brush it off and only display distress after observing blood.

                Understanding Language:

                Comprehension problems usually improve with speech therapy. They learn to express their wants and dislikes so that by the age of four years, many of the children appear to be function very well. By the age of 5 communication becomes more natural. Although these children continue to have problems with certain aspects of communication. Examples of difficulties is language which require more than listening to the words. One needs to comprehend what the speaker is thinking and implying. They need to understand non literal expression, jokes, and sarcasm. These children take in the details of speech and often this type of communication makes them feel uncomfortable.

                Diagnosis

                Children who are diagnosed as having semantic pragmatic disorder are more accurately described as high-functioning autistic. Clinicians tend to give all autistic children who have good intelligence the label Asperger syndrome, even if a child actually has very limited speech. Children with Aspergers’ are able to talk in sentences by the age of three, whereas Semantic Pragmatic children develop their speech late. However, a child with semantic pragmatic difficulties in language eventually becomes a fluent talker. Lastly, children with SPD tend to have better socialization skills than those with Aspergers’. Many children improve dramatically and diagnostic labels can change.
                www.brighttots.com



                Finally, you write:

                "I'm trying really hard to stop trying to drive this train and just follow directions for a little while until I understand what's going on and what it means for us. I'm also trying to keep perspective of counting blessings instead of troubles. (saw that on some random guys pin today)."

                Yes, much for you to take in. No rush on any of this! At age 4, your daughter will benefit from all that you will give her. For many of us, when we learn of a clear diagnosis for our child, this new understanding helps immediately with the way we think about and treat our special-needs child, whether in learning or family settings - or both, as with homeschooling. Over time, intense frustration can yield to deep love and compassion.


                You ask:

                "Can you fix/treat slow processing? concreteness??"

                No, I do not believe you cannot "fix" these or treat them into non-existence. But you can most certainly help slow processing to become faster and help concrete thinking to become more abstract! CelticaDea, in my opinion, this is where classical education truly shines!

                What helps processing?
                Recitations, repetition, and review. You can take the same excellent, beautiful material in the Memoria Press books you already own, but set your own pace to suit your daughter's difficulties. You will know without question that you cannot fly as swiftly through the program as others might do. You will likely need to do some work over the summers each year to prevent regression. You will need to review more than you might with another child. You will need to use your own creativity and ingenuity more than other moms might. But you can do this.

                What helps "concreteness?" Classical education is about ideas, concepts, and thinking beyond this moment in time and space. The study of history, literature, themes, the human condition, the Christian faith - all of these are rich in abstract thought!

                You ask, "should I put her in preschool so she can get more practice with socially pragmatic language and behavior??"

                In my own personal opinion - but you should do whatever you and your husband believe to best - I would say, "No." If you embark on a literature-rich, intentional classical education with both girls - combined with the excellent therapies they will receive - you can do so much for them.

                As for the hour-long drives, utilize excellent audio language stimulation (not visual entertainment). This can be in the form of conversations (if you have the energy) or sing-along audio tapes that teach such things as: songs every child should know, the names of the Presidents in order, math facts, or beautiful sacred Latin songs (Lingua Angelica).

                For socializing, you can enjoy activities such as you have done with gymnastics, so they learn turn-taking, following directions, getting along in a group - all with the bonus of improving coordination and balance - and all while still allowing you to teach her, read to her, and coach her.


                Finally you write, "I'm so lost and surprised. I'm not feeling at all confident at raising my children let alone schooling them."


                These comments are why my posts to you have been so very lengthy here. I know that the process of finding out (e.g., the realization that something is seriously wrong and you have no power to "fix" it, but instead must work through and endure it alongside your child) is so very difficult. Even if you suspected some of it all along, this remains true.


                As you continue thinking about this, if you need resources, or have questions beyond these answers, feel free to ask. I know we have many reading here who feel for you, pray for you, and support you.

                Your family and others like yours are exactly the reason we are working on a special-needs classical curriculum package. We hope to bring this to you soon, as I think this will help simplify matters quite a bit. Even with your heartfelt story here, know that you are helping to urge such resources into completion.

                For general encouragement, or for anyone who did not view the plenary session on classical education and special needs, it is now available alongside the other plenary sessions, if you are interested:

                http://www.memoriapress.com/curricul...conference-dvd

                Until we can provide a separate special-needs curriculum package, you can just adapt simply by slowing everything down for success. Your journey will be as with the Tortoise and the Hare, as we have noted in other families on our forum: slow and steady. Whether with apraxia, Asperger's, coordination difficulties, or semantic pragmatic language disorder - or all of the above and then some! - slow and steady will prevent many difficulties. Your therapists can help you integrate their strong suggestions directly into your classical education.

                Finally, note that the difference between "remedial" and our slow-and-steady classical education is that our overarching view is always toward that which is True, Good, and Beautiful. The pace does not change the excellence of the content, but only makes the rich content more accessible.

                Blessings to you as you navigate through this new set of challenges for your family.

                Cheryl

                Comment


                  #9
                  Thank you so much for all your information. It was especially helpful to be able to show my mom and others the whole posting for explanation. Everybody asks me what all this means and I'm often just as lost

                  I've been thinking about your words for a few days now. The ones that are most frequently coming to mind are:

                  "You do not have sufficient strength for all of this, but He does. Your loving heavenly Father will sustain and keep you through all of this. "

                  this was a great reminder that I don't have the control or the ability to do this by myself. This simple statement has brought me both near tears but also peace.

                  and

                  "Remember, too, that the dear daughter who walked into the evaluation is the same little girl who left with you. You're just learning more about her now."

                  I find that I keep seeing whatever little things she does and instead of just enjoying her or smiling at whatever silly thing it is, I'm mentally comparing it to a list of 'symptoms'. I keep trying to get back to just enjoying her.

                  ...

                  Do you know if being able to hear rhymes or sounds in words is related to any of the things we've been talking about? (apraxia, spectrum, slow processing-maybe auditory) or is this really only a dyslexia or auditory processing thing?

                  I also can't help but try to think about what we'll be doing for Kindergarten next year. With the previous frustrations and now these eval's I've felt frozen for fear of messing something up or at the least, making her not want to learn at all. I have decided that I will keep things simple while we learn to read and do arithmetic and not worry about doing all the 'other' courses but I hope to do some of the science and maps and things in a simple & fun way as a pleasant thing to balance out the harder work we'll have.

                  Do you know if a program like First Start Reading will likely be a good fit for her? or if I should do a program like All About Reading? (an OG type program). I'm sure I'll end up having to do a lot of trial and error to figure out what sort of programs will work but if you have any input, I'm all ears.

                  Comment


                    #10
                    Dear CelticaDea,

                    You ask...

                    Do you know if being able to hear rhymes or sounds in words is related to any of the things we've been talking about? (apraxia, spectrum, slow processing-maybe auditory) or is this really only a dyslexia or auditory processing thing?

                    As you indicate here, when a child has multiple diagnoses it sometimes becomes difficult to determine which condition is responsible for a specific symptom. If her hearing acuity has not been checked recently, this would also be good to do.

                    At some point, we parents and teachers of multiply-challenged children learn to accept the answer I often hear from my own children's doctors, "This is probably multifaceted and not the result exclusively of any single factor." Because your daughter now appears to have a language disorder, an autism spectrum disorder, and auditory processing difficulties, any of these conditions could be challenging for her as she learns language. The primary question then becomes, "How best can I teach her?"

                    Thus your conclusion...

                    I have decided that I will keep things simple while we learn to read and do arithmetic and not worry about doing all the 'other' courses but I hope to do some of the science and maps and things in a simple & fun way as a pleasant thing to balance out the harder work we'll have.

                    Yes! The core areas, always essential for the classically educating teacher, become even more of a focal point for those with special-needs children. Other areas (science, history) can be addressed less formally for now with surprisingly good results while you tend to the foundational areas of reading, writing, oral language, and early mathematics.

                    Finally, you ask...

                    Do you know if a program like First Start Reading will likely be a good fit for her? or if I should do a program like All About Reading? (an OG type program). I'm sure I'll end up having to do a lot of trial and error to figure out what sort of programs will work but if you have any input, I'm all ears.

                    My personal preference is always to start with the good classical materials and then adapt if needed. First Start Reading could be an excellent fit because it is sequential and structured, exactly what your daughter will need. Be prepared to work through portions orally first, review, then return to add written components. If you are willing to adapt as needed, she may do very well progressing in the same prescribed order, just in a smaller-steps approach.

                    A side note if you are planning to attend this year's Louisville conference: we will be offering special-needs workshops for each content area (reading, writing, literature, mathematics, science, history, Latin, Christian studies). These might be helpful to you both as an overview for the coming years and also as an opportunity to hear specific strategies from others in similar situations.

                    Cheryl

                    Comment

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