Thursday, August 30, 2007

Contradictions

Green, first off, I'll NEVER complain about a comment. I want comments. Hell, I LUST after comments. Nothing would make me happier than to get 73 bajillion comments on a single post, like some people I know [coughJanecough]. I'd be happy even if some of them were to piss me off. Which yours DID NOT. So, not to worry. Promise.

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Kristen mentioned a possible language processing disorder being behind what I've been calling N's pragmatics problem. I started looking at that possibility, and hit the same old wall that I always hit when talking about N: The kid is an enormous mass of contradictions.

The initial reason we started worrying about him was his social skills (or complete lack thereof), and so we had his school district evaluate him, when he was almost 4.5 years old, to see if he might qualify for any kind of services. On the Batelle Developmental Inventory, he scored in the FIRST PERCENTILE on peer interaction. You can't score any lower than that. BUT, he got a 75th percentile score on adult interaction, putting his overall personal-social percentile at 30, which is in the normal range, thus allowing the school district to say no to services.

All of that is water under the bridge, and he did ultimately get some social skills therapy, and he'd probably score a lot better in peer interaction if tested today, though it's clearly still an issue. But my point is: contradiction. HUGE contradiction. First percentile; 75th percentile. It's not just that there's a difference in these different skills; that's to be expected. It's that the difference is so HUGE.

Same thing with his motor skills. This is a kid whose gross motor skills are, at least in some areas, not just fine, but remarkable. This is the kid who could throw and catch a ball at nine months, though he couldn't roll from front to back until *18* months of age, well after he was walking and running. Bizarre. This is the kid who could hit a pitched ball at age 2. This is the kid whose golf coaches are almost literally drooling over him. And yet, this is the kid who, at 6.5, still can't draw, has a hard time coloring in the lines, and whose scissor skills are pretty poor. Contradiction? To some degree.

And so it seems to be with processing. Most everything I'm reading seems to lump language and auditory processing together. In many ways, N's auditory skills are awesome. He's never had a problem understanding what is said to him, never had a problem following instruction. I also THINK he has a fairly advanced ability to take information and generalize it or draw conclusions from it--the problem is in his ability to express those generalizations and conclusions in a way that is understandable if you weren't the one to give him the initial information and thus know where he's drawing his seemingly bizarre sentences and phrases from.

In addition, his vocabulary is quite advanced for his age, even if he can't necessarily say all the words in an understandable form.

I dunno. I'm trying to find a speech and language pathologist in our area who would be covered by our insurance, at least for an eval, as you guys all suggested, both publicly and privately. I'll bring along the posts I'm collecting, and I'll also bring along the old reports, including the one from the developmental pediatrician we saw after the school district denied services--the one who seemed to think the social issues were secondary to language issues, and whose opinion I at that time pooh-poohed. Ah, hindsight, you 20-20 darlin'.

In looking it over, two years later, I can see that the same issues I'm talking about now were in evidence then: "N does not describe his daily experiences in logical sequence in any depth without significant prompts," she wrote. "He sometimes will ignore a question and talk about something unrelated to the topic at hand. N will often retreat into speaking 6-8 different babyish voices, more so at home or in the parents' presence than at school...N also demonstrates a somewhat immature speech pattern and exhibits some frustration when he is not understood correctly..."

I would make some "the more things change the more they stay the same" comment here, except nothing has changed. So...onward.

3 comments:

kristen said...

I think this is frustrating and difficult for you because you have had a couple of evaluations that didn't really lead to a diagnosis.

It may be that there is no diagnosis. But it may be that now, a couple years down the road, some things are more apparent.

I can't tell you how many people told me my son was fine--well-meaning, kind and generous people. Family, friends, the pediatrician. They all said, "oh he'll get there; they all develop at their own pace."

You have to follow your heart and your instincts as a parent. Whatever you do, whatever choices you make are rooted in love and in the end, that has to be enough.

Ambre said...

Lori, the peer/adult dichotomy is totally par for the course with social delays. There is a huge reason for this. Peers are unforgiving, and expect other peers to follow the rules of communication. Adults, when interacting with children, "fill in the gaps" and don't mind taking on more than their share of the communication burden.

I told you this at the time- you can not average out peer and adult social skills and get some sort of "oh he's ok, when you average them out." It's like saying a child is not delayed physically because, even though he can't walk at 5, he can throw a ball. One skill can not compensate for the other.

You've heard my opinion. I think he has both a communication problem and a speech problem (although you can usually understand his words, I can not). I think you should kick the school district's asses.

Meg said...

TO some extent, you have described a typical case of asynchronous development. My kids are definitely much better with incoming auditory processing than expression (especially written expression). Large motor skills are definitely better than fine motor, even as they have gotten older. Some of this may just be that N is better at golf than at writing.

Of course the big question is when is a difference a problem? When does a delay signal something that will come with maturity versus something that needs to be fixed. I certainly don't pretend to be able to answer that question easily. The other problem is even if you get an answer, there might not be much the school can do. I still recall the principal telling me that my son's really bad handwriting was good enough to not require any further help.

However, reading Ambre's comment that she really can't understand him would really worry me as N is going into first grade. He should be completely understandable outside the home. The school may say the sounds he can't make are not delayed enough (in our state they have to be two years behind), but for an introverted, sensitive child not being understood may have a big impact on his willingness to speak in class and to interact with others. I think you may need to get a private eval and then bring the diagnosis to the school. It is also possible that if you ask, the school will evaluate him, now that he is older.