Wednesday, June 11, 2008

Isaac's results

Isaac has now officially been diagnosed with Asperger's Syndrome (Autistic Spectrum Disorders).

He is a high-functioning AS kid with an IQ in the High Average range. He stands on the 87th percentile of his peer group. What this means is that in a room of 100 kids his age, he would have an IQ higher than 87 of them. On almost all tests, he is scoring well above his grade range. In the North American context (where the tests come from), his current grade would be grade 6.5 (.5 because halfway through the school year) in local terms, Pri 6. But in his test scores, Isaac consistently performs at higher grades (7.5 to 13.5) with the exception being 5.3 for handwriting! Note that grade 12 is equivalent to 17-18 year-olds in the American school system.

As a matter of interest, she said that Singaporean children do tend to score slightly higher than their North American peers - possibly thanks to the school system. But even after adjusting for cultural differences, at a confidence level of 68%, Isaac's scores were still pretty high.

The testing was pretty comprehensive. His scores in all areas range from highly average to highly superior. His working memory scored 99.7 - in the highly superior range. So if you told him: "duck 6 horse car 9 4 spoon 3 10 1 elephant hat tractor" he would be able to remember all that and reel it back off to you. The psychologist said she was quite excited during that test because it was so rare to see someone doing this, despite her years of testing.

He had one borderline score in phonemic awareness - that means he is unable to discern sounds to put words together. For example, instead of saying "Apple", you say "ah-el" (taking out the P sound), he would not be able to discern what the word is. For that test, he scored 0.5. With a score this poor, it would be hard for him to learn Chinese because of the different tones/intonations the language requires. Whereas in a language that is romanised eg Malay or French, it would be easier because his reading skills are very strong. We asked if there is something we could do to improve this, but apparently there isn't much to be done because this is just how his brain processes sounds. Its got nothing to do with pinyin or with phonics because other tests demonstrate that he is well able to use phonics to blend sounds etc. For example, one test was on spelling and he was asked to spell 'vacillate' - he spelled it as 'vaselate' which is consistently with the phonic sounds of the word. So he is using phonic rules and he is aware of them, but his brain just cannot connect the dots re phonemic awareness.

With all the interviews, the questionnaires that KH and I filled out, Isaac also filled one out and plus her clinical observations of him during that time, and assessing him on the Gilliam Aspergers Disorders Scale and the Gilliam Autism Rating Scales, Isaac was finally diagnosed with Aspergers'.

The psychologist also gave a letter of recommendation in support of exemption for Chinese. This is because of (1) the AS diagnosis, (2) his poor phonemic awareness scores and (3) consistently failing Chinese badly for all his school life.

She mentioned that MOE is now increasingly strict with exemptions - there was apparently a trend of 'wrongly diagnosed' dyslexics who got exemption, so MOE is now more cautious in granting exemptions. She said that there have been many children who have been assessed by her for the same reason - seeking exemption - but she has not always supported them all. For her own professional credibility, she says she has to be very strict on assessments and diagnoses. In Isaac's case, however, there are clearly grounds for exemption so she is recommending for it.

KH was very happy to hear that! Well, that is half the battle won. So next step is to start the exemption application process tomorrow.

After our meeting with the psychologist, I felt very light. Like a burden just got lifted. I feel... vindicated, I suppose.

After years of not really knowing, only suspecting, being told by KKH that Isaac could not conclusively be defined as autistic but neither could he be defined as normal, finally, finally, finally I have an answer. It is not that he was not autistic, nor that he was under-stimulated, nor that he was 'cured' or came out of it. It was hard telling people I believe he is autistic only to be met with doubtful looks and comments like "No lah... are you sure? He looks so normal! If you hadn't told me, I would not have known!" That makes me look like someone with Munchausen Syndrome!! Attention-seeking mother who makes kids out to be ill! Argh!

The psychological testing proved me right.

He IS autistic. He has Asperger's Syndrome. And reading about AS this morningd, I quote this passage from Tony Attwood's book 'Asperger's Syndrome - A Guide for Parents and Professionals': "...a proportion of children who had the classic signs of autism in their pre-school years may show significant improvement in communication and abilities. The previously withdrawn and severely language impaired child develops fluent speech and the ability for supported inclusion in an ordinary classroom. This improvement can be remarkably rapid and occur just before the age of five (Shah, 1988). We are not sure of this is a natural phenomenon for some children or a tribute to early intervention programmes; probably both. Nevertheless, the previous diagnosis of classic autism was accurate when the child was very young, but the child has progressed along the autistic continuum to the expression we call Asperger's Syndrome."

This fit Isaac's profile to a T. Early classic symptoms, non-verbal, poor language skills, atypical behavior, then with therapy, then suddenly very quick progress, language fluency, strong reading skills etc. By the age of 5, he appeared normal.

But bottomline is: he never got out of autism. He is just an AS kid. And this is how AS develops. Which makes me pissed with KKH now! Had they been more aware of the possibility of AS, or the characteristics that define the AS progression, they should have called for a more detailed, comprehensive psychological testing back then - instead, a lot of what they discerned was based on the fact that he had 'improved', from parents' observations (and heck, which parent would not be grateful to see improvement?!) No real testing was ever done.

The psychologist who did Isaac's testing yesterday told us as much - that the early therapy could have damped down the severity of the condition, but as he grows and social demands change, the differences will grow more obvious. As it has.

We were given several red flags to look out for - increasing social isolation for one, particularly as he enters teenhood. He is also classified to be 'at-risk' of depression because of his social isolation. There is still so much to absorb and to ponder. KH and I will have our work cut out for us. But for now, I just feel a deep sense of relief.


Vidhya Logendran said...

Hi - I would like to find out more about where you got your son tested. COuld you pls get in touch with me

Anonymous said...

Hi - Am not sure if you are still active on this blog. My son seems to be the exact profile as yours - non verbal at early stages, therapy, rapid progress to the extent of appearing normal (albeit a bit odd by P1). He has been consistently struggling with MT - he is doing PSLE this year - and I am applying for exemption. I am afraid it is too late - but also going by the maxim better late than never. Would love to talk to someone who has gone through the process. Could you pls get in touch with me at