This week I saw a 6 year, 5 month old child who had been evaluated at a speech diagnostic. The child had a normal birth and developed normally aside from phonological delays. He had a history of OM, but had not recently experienced problems with his ME.
I had seen him prior to his current visit. During the previous visit, normal hearing and normal (Type A) tympanograms were found. The child responded at 500, 1000, 2000, & 4000 Hz at 0 dB HL with insert earphones. A threshold search was not performed below 0 dB HL. The child had normal SRTs, which were in good agreement with the PTA, and excellent WR abilities at 30 dB SL bilaterally, as well. During his initial visit, the speech supervisor asked if the child could be evaluated for an APD. She noted that speech testing raised concerns about normal auditory processing. Because the child's hearing was normal and because he was cooperative during PT and speech testing, my supervisor scheduled him approved a follow-up appointment for APD testing.
At the follow-up appointment, the child's demeanor was curious and cooperative. He asked many questions and responded appropriately to our questions during interactions prior to testing. He responded in an age-appropriate manner by using various sentence types, including complex sentences, with appropriate syntax and vocabulary. His questions and responses were pragmatically appropriate, he displayed appropriate turn-taking, and used humor and imagination during play. His mother stated that the child's teachers had complained that he often didn't follow directions in class and that he seemed to more inattentive than the other children in his class. The child's mother also noted that he doesn't listen to directions at home sometimes as well; however, she didn't feel as though he didn't understand her.
When testing commenced, the SCAN-C and the SSW were administered. I gave the child a brief explanation of what he could expect before I began the tests. He seemed to understand my explanation and instructions. He was seated quietly when the test began, and he was able to do the practice items on the SCAN-C. On the filtered words, auditory figure-ground, and competing words subtests, the child scored in the normal to 1 standard deviation below the norm range. His scores on the competing sentences subtest were lower than the other subtests, but they were still not in the disordered range. The child's attention also seemed to be waning during the final subtest.
The SSW revealed normal results; however, only half of the test was scored because the child became impatient during the end of the test. In fact, when the recorded test played the carrier phrase "Are you ready," the child responded by yelling "NOOO!," which caused him to miss some of the test items.
Results were discussed with the parent, and she stated that she felt that unrealistic teacher expectations had pressured her into bringing her child for testing. She explained that her child's school has very high standards, and she believes that children, like her son, who are average acheivers and have difficulty staying on task, are not looked fondly upon and are perceived as disordered. We assured her that our results indicated that he was not, in fact, disordered. My supervisor stated that maturity and many other factors may contribute to her child's behavior in school, and we recommended that she bring her child back to our clinic in one year in order to repeat testing and monitor any changes in her son's APD test results. We also recommended that, if behavioral problems in school do not improve, the administration at the child's school should be contacted. Because the child's mother was concerned about the child's ability to attend to message, we stated that additional evaluations, such as with a psychologist, could be scheduled.
The following article,
Can We Differentially Diagnose an ADD without Hyperactivity from a CAPD?, addresses an issue that is a core concern of my client's mother ... differentiating ADD from APD. The article describes a case study about a boy named Corey. Corey, like the child I saw, was having difficulty in school. He was not staying on task, he was asking his teachers to repeat instructions, he was acting out, and he had a history of phonological delays and OM. Corey underwent a full psychoeducational.
During an interview with Corey, the investigators found that he had skewed social competence. Specifically, he blamed others for his difficulties and didn't understand why he kept getting in trouble and getting rejected from same-age friends. Both a speech-language pathologist's and a school psychologist's interpretations of results were given. Both professionals cited similiar difficulties, such as inability to maintain attention, difficulty processing complex sentences and directions, and weak figure-ground scores. However, the two professionals suggested two different diagnoses: APD and ADD. This article provides a real-world example of a child who may not fall neatly into a diagnostic category. It emphasizes that APD and ADD can be mistaken for each other and can also occur concurrently. Significantly, the authors also advised multiple case histories and interviews with the children in order to arrive at more accurate diagnoses.
http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=9501134652&site=ehost-live
