What are some possible therapies to improve school performance with Turner Syndrome?

Auditory integration therapy:

• Improves auditory processing and the way the brain processes information, particularly in normally noisy environments
• With auditory integration therapy, there may be an improvement in reading, writing, speech, and language development as well as greater abilities in handling noisy environments and social situations. There may also be improvements in comprehension and increased development of neural pathways that could improve handwriting and other fine and gross motor skills

Cognitive behavioral therapy:

• This is guided therapy that enables the child or adult with NLD to perform better with everyday tasks such as concentrating and focusing on tasks and making appropriate choices in social situations

Sensory integration therapy:

• Helps with organizing and interpreting sensory signals in the environment, particularly for those who are overwhelmed by the many sensory signals that come from the environment such as smells, tastes, and sights

Social skills groups:

• Helps increase social success and gives tips and strategies for confronting the challenges of being socially successful

What are the school evaluations and when should they be administered?

School evaluations for girls with Turner Syndrome should be conducted when the student begins to experience academic difficulties or when there are discrepancies observed between performance in different subject areas, such as excelling in reading and failing in mathematics.  A psychoeducational assessment should also be conducted in the early elementary school years if a child has experienced an early history of developmental problems during infancy and/or preschool. Possible evaluations for academic issues include:

Neuropsychological evaluations—assessment of cognitive abilities, language abilities, visual processing skills, reasoning, memory, handwriting skills, information processing, attention, and executive functioning (planning and managing complex activities)

• Given at an age when a child is accustomed to doing schoolwork
• Test length varies based on age, purpose, and mental abilities
• A follow-up appointment will discuss the results of the evaluation and recommendations

Psychoeducational evaluations—assess a student’s functioning in three main areas that impact learning and academic functioning:

Learning aptitude or intellegence (IQ) tests measure a student’s abilities in several categories including:

• Verbal/linguistic skills — includes tests of memory, abstract reasoning, vocabulary development, comprehension
• Nonverbal skills – assess organization and visual memory, nonverbal reasoning, planning ability, visual motor coordination, and spatial visualization (being able to place objects in space)

Basic academic skill development tests – assess skills in reading, written expression , mathematics, and sometimes other academic areas.

In some cases, behavioral and personality assessments should be considered. These assessments focus on coping strategies and personality traits such as self-esteem, issues with anxiety, etc.

For example, the Vineland Adaptive Behavior Scales (Second Edition) measures adaptive behaviors such as the ability to cope with changes in the environment, learning new everyday skills, and demonstrating independence. This instrument, which is administered as a survey or questionnaire to the child’s parents/caregivers and/or teachers, measures four main areas including:

1. Communication — evaluates how the child responds to communication, expresses themselves verbally, and writes
2. Daily living skills — measures personal behavior as well as how the child interacts with others at home and in the community
3. Socialization — assesses how the child is during play and relaxation, how the child relates to others, and how she develops coping skills
4. Motor skills — assesses gross and fine motor skills

The scale is completed by parents or school administrators and is given then when the child is of school age.

Other possible instruments to measure adaptive behavior skills include the AAMR Adaptive Behavior Scale- Second edition (ABS-2) and the Adaptive Behavior Assessment System – Second Edition (ABAS-II)

Personality Inventory for Children—evaluates the child in many different dimensions and looks specifically at behavioral, emotional, and cognitive status

• Given between the ages of 5 to 19
• Administered to someone who knows the child well such as a parent
• Dimensions in the inventory include:

1. Impulsivity and distractibility
2. Delinquency
3. Family dysfunction
4. Social withdrawal
5. Social skills deficits

What are optimal re-evaluation intervals?

For the neuropsychological evaluation:

• A year after the test to reassess academic achievement if there are questions about the student’s progress (alternate form will be given)

Psychoeducational evaluations:

• Usually three years after the initial assessment to see if there are any differences in performance on the various sections of the assessment over time. If the assessment is being conducted by the child’s school district, the most common interval is three years. If parents choose to pay for an evaluation outside the school district, there may be a shorter interval between assessments.

All other school evaluations for girls with Turner Syndrome could be repeated if there have been any significant changes in the child since the test or inventory was first taken.