Gifted Issues Discussion homepage Forums Twice Exceptional Gifted and ADHD?

Hello,

I recently had my 11 year old son tested. His scores are below. We've also been seeing a psychiatrist for behavioral problems that only occur at home. Son has been diagnosed with ODD (treated with Prozac) and ADHD (not yet treated). He is grade-skipped so in the 7th grade. I'm not sure about my question - I've read and reread the chapters in Misdiagnosis and Dual Diagnosis at least three times but I'm so confused. He seems unmotivated, lazy, off-task, no sense of time, can't give up "now" for what will benefit him later (stop playing and put on your baseball uniform so we can go to your game). The doctor said to me at our last appointment that I am being son's "frontal lobe". My husband, for some reason, is opposed to ADHD diagnosis and treatment. Son also has Pragmatic Language Disorder (Social Language) for which he recieves speech therapy at school (which he hates). I'm at my wit's end with how to get him through the morning and evening routines and get HW and music practice done. The teachers report that he is somewhat immature but overall doing well, is helpful, is organized (he was selected as section leader in the 8th grade band, hah!), is polite, etc. Wish they'd send that kid home. I guess I'm wondering if the low (relatively) processing speed and working memory could cause the problems instead of ADHD or if they indicate anything or if they could make the ADHD worse?? He's in a school where he is in gifted classes in all subjects but Language Arts. The school feels he is too immature to grasp the complexities of the LA reading/writing. I'm not willing to argue with them about it right now but I think he should be in the gifted class for that as well. The tester was astonished that he was not in that gifted class.

Any thoughts, comments, questions, answers?
Thanks.
WISC-IV
Verbal Comprehension Index 152 >99.9
Similarities 18 99.6
Vocabulary 19 99.9
Comprehension 19 99.9
Perceptual Reasoning 127 96
Block Design 17 99
Picture Concepts 12 75
Matrix Reasoning 14 91
Working Memory 123 94
Digit Span 15 95
Letter-Number Sequencing 13 84
Processing Speed 118 88
Coding 11 63
Symbol Search 15 95

WIAT-II
Reading Composite 139
Word Reading 129 97 >19:11 >12.9 (in all subtests)
Reading Comprehension 140 99.6
Pseudoword Decoding 114 82
Math Composite 160
Numerical Operations 158 >99.9
Math Reasoning 145 99.9
Oral Language Composite 160
Spelling 128 97
Listening Comprehension 134 99
Oral Expression 160 >99.9

(My usual disclaimer: I am new here and not very expert...)

Is it possible he does better at school because there is a more rigid and dependable schedule? Especially if he has trouble transitioning from one type of activity to another -- often rigid and dependable schedules can really help. At school he knows what to expect, he knows when he has to stop doing the fun activity and start doing the less fun activity. At home it's just you telling him to do it, and so he resists you?

MGL - Your son is obviously very gifted. It's VERY difficult to tease out the quirks of someone who is that able to compensate for their weaknesses. My husband was very resistent to an ADHD diagnosis for our children, and has ongoing moments of resistance to medication - while also having the jaw dropped OMG WOW response to the improvements on medication for one of our kids... One of those improvements was near complete resolution of the oppositional behaviour btw. I find it interesting that your husband is ok with an ODD diagnosis and prozac but not with ADHD and stimulant medication?

But to answer the question in your second post - my eldest has a fistful of acronyms already and is currently being assessed for Aspergers. We tried getting her assessed 9 months ago and we got an answer of "Maybe" - because she was doing great at school. A school that the assessors did note was spectacularly perfect for her. She's moved school, she's falling apart at the seams and her new teacher wants her diagnosed yesterday and so we are on the assessment bandwagon again... So for us it was a resounding YES our DD did do better at school, at the right school... And I would put that down to a) she'd been there since before her particular social deficits were more obvious b) small classes, serene & structured environment c) incredibly clear communication about everything that is expected, will happen, is happening, has happened, etc. Signs on the board about what's happening today, signs on the door about where we are right now, colour coding, significant organisation scaffolding from school for ALL children. Yes they tried to get kids to organise themselves but they ALWAYS made sure that the kids actually were so that no-one slipped through the cracks. Well it didn't seem like always when we were there, but compared to new school, their scaffolding was WOW.

Also, my kids are much more likely to resist a direct instruction TO THEM but to compliantly go with the flow of a well behaved group of kids. So even the one with significant oppositional behaviour at home never showed that side at school. Group instructions just don't seem to affront her sense of identity the same way. Or so I thought, in retrospect I think her ADD was so bad that she couldn't hold onto instructions long enough to transition so would refuse to try, where as at school she could go with the flow and figure out what to do based on what everyone else was doing.

mgl, I think he holds it together at school using every ounce of self-control he has and then falls apart at home. I've read a lot about how being gifted can help kids compensate for other things. We've tried doing a rigid schedule at home to no avail.

Mumofthree, my husband was VERY resistant to the ODD and prozac. It basically came down to "we either put him on medication or we put me on medication because I can't cope with this any longer, and, oh, by the way, he'll be going to work with you every day this summer if he's not medicated." Hard fought.

This oppositional behavior started when he was 5 and now he's 11. I'm afraid we've waited too long to treat it, although we've seen 4 physchologists and 3 therapists, plus two phone consults and now the psychiatrist. I'm just worn out.

I guess I'm wondering if anyone sees anything in his testing results that would point to something other than ADHD? And also how to know if it is gifted behavior vs. ADHD? The psych didn't do any evaluations or rating scales before going to the ODD and ADHD diagnosis. He just said it's obvious based on his years of working with these kids. I brought up the giftedness issue and even showed him the book but he said "so, what? if it's a problem for you, it's a problem for you". He said that since son isn't having problems at school we don't have to treat it but if it's bothering me enough then we can treat it.

I know I'm not making myself clear; I just don't know what to do to get him to do the things that need to be done. The school is no help (except for the speech disorder) because he's not a behavior problem there. They think it's all just a "power struggle" at home and I need to assert control. We've also heard "you have a hierarchy problem" and "he's just a little immature" and "stop expecting so much of him".

I had my husband read a couple of articles on ADHD (I can't get him to read a book) and his reponse was "I think I'm ADHD, maybe I need medication". Yeah, well, duh! Could have told him that!

Sorry for the rambling and thanks for your responses.

Hi Petunia,

With that combination of traits (ODD, ADHD, pragmatic language disorder)-- did anyone look at autism spectrum disorders? Because those add up to a fairly close approximation of how some kids present with autism. If it hasn't been considered, I wonder if it would be a simpler explanation.

I would also ask with MGL whether there is so much structure at school that it helps him be more successful there. Some kids do also "save it" and fall apart at home because it feels safer to do that there.

I understand your DH's reticence to medicate your DS. Nobody likes medicating their kid, and it is hard to get to the right med and dosage. For my DS, ADHD meds really turned things around for him, reducing his anxiety (because he could trust himself to be less impulsive, and he got into less trouble) and allowing him to be more successful.

DeeDee

Hi,
I would second DeeDee's point about autism spectrum stuff. Our DD has a profile similar in some ways to your son and although we are not convinced we have a correct diagnosis yet I think the closest thing for her is PDD-NOS and gifted. You might want to take another look at that chapter in the Misdiagnosis book, but if you really want to know, you're going to have to go to an expert on gifted and 2e kids. There is a list on Hoagie's Gifted, but unfortunately there may not be one too close to you. But it might be worth it.
Our DD was 'diagnosed' last year with ODD as well, but I don't believe it for a second--however, she will argue with adults (including teachers) if she thinks something isn't fair. What works very well with her is predictable consequences for inappropriate behavior. If she's doing something inappropriate, we promptly give her (one) reminder that she should stop and remind her of what the consequence will be if she does not--and then follow through promptly and calmly if she does continue. Other techniques do not work as well. Last year her teacher would not call her on anything unless the teacher got annoyed and then she would impose a consequence that DD did not expect, which usually resulted in DD getting *very* upset (due to the 'unfairness') and getting in even more trouble. It was just a disaster. But the previous two years (and this year so far, knock on wood) with teachers that did what we do at home, her behavior is very manageable and continues to improve. Just a thought; maybe it isn't relevant to your situation at all. We also let DD unwind at home; fortunately she doesn't have much homework yet (she's 9) so we haven't had that yet but we usually have her 'earn' video game time as a reward for doing chores or being good in school and that has been working pretty well so far.
We did also just get a "Motivaider" as recommended by DeeDee (THANKS DeeDee!) and DD said it helped her some yesterday (her first day)--we'll see. It's a silent 'buzzer' to remind you to keep on task and it's easy for them to set.
Good luck figuring stuff out; hang in there.

This, to me, is a rather large strike against ODD and ADHD, in my opinion. One of the diagnostic criteria is that the symptoms happen in multiple areas, including home and school. If he isn't showing any symptoms in school I'd personally be looking in another direction - autism spectrum or a sensory problem. Kids who are getting overwhelming sensory input can sometimes hold it together (especially with the help of a med like Prozac) for a while, but eventually they have to react and let out their emotions.

Has he been seen by a neuropsychologist or developmental pediatrician? If not, that's where I would head next.

Last year (grade 2) my son used every resource he had to contain himself to the confinements of desk life, and at three he'd come TEARING out of the school, hug-slam into me, drop his back pack and zoom off to the play ground. (We called him hurricane).

This year (grade 3) he's been calmly sauntering out like the other kids and walking up to me. I'm wonder if the teacher is making him do jumping jacks all day ;p

This is a huge red flag for me as well.

The same is sort of true for my DS... his behaviours and reactions change according to his environment, and yet the psychologist still said ADHD.

I can't get a straight answer - everyone has a different take on how ADHD (and ASD) presents, no doubt in part due to the complexity of the conditions as well as the individuality of kids. Luckily there are pieces from both that overlap which makes addressing it all easier.

Welcome, Dbat!!!

DeeDee