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

We have been the Autism route (mainly looking at Asperger) through both a therapist who specializes in ASD (and her consulting pyschologist) and through the school. The therapist said no to ASD but yes to ADHD and ODD (but we didn't believe it then). The school said:

"Overall, while Son does exhibiit difficulty with social interaction with his peers, it does not appear to be at the level that would typically be indicative of an ASD. Also, Son does not display significant differences in the areas of communication (aside from his pragmatic difficulties), and restricted repetetive and sterotyped patterns of behavior, interests, and activities. Son does not meet the the criteria as a student with an ASD."

He got a watch for his birthday which he has tried using as a reminder to stop a particular activity but he just ignores it.

I do believe the ODD diagnosis - he was out of control. Screaming, kicking, throwing things, crying, refusing absolutely to do things, it was awful. Consequences have no effect on him. He has lost all sorts of priveleges and it makes no difference. He's missed baseball games, birthday parties, lost computer time, lost his DS, lost all of his reading time, been put in timeout. None of it matters. Rewards didn't work either. He once went 3 weeks without any kind of junk food (pizza, chiken nuggets, ice cream, cookies, sugar, sodas, anything) because he was fighting with us about brushing his teeth. The rule was that he lost all "goodies" until he had brushed his teeth twice a day for seven days in a row. If the prozac has done nothing else, at least he gets his teeth brushed now!

One psychologist had us put him on an extreme time-out system. If he didn't do what was asked, we were to put him on time-out. If he didn't go to time-out, we were to physically take him to time-out and hold him down until he calmed down. He's too big for me to do that so if he acted up when my husband wasn't home, I had to ignore him until husband got home and he immediately had to take him to time-out and hold him down. Sometimes it would last for an hour. It made all three of us crazy and exhausted and didn't do a thing.

We've also seen an audiologist for CAPD. That was a "no", too. We haven't looked at sensory except that the school had us fill out a rating scale about it to see if he qualified for OT as well as speech. He didn't but they did note that he has "difficulty with sensory processing in the home environment". He shows none of these at school.

We haven't seen a neuropsych or a dev. pediatrician. My husband is so opposed to any more assessments that we are fighting about it. He just wants son to be "normal". Well, he's NOT NORMAL so accept it and figure it out.

This is so confusing. I'm ready to just accept the ADHD diagnosis and put him on the medication to see what happens. If it helps, it helps. If it doesn't, we do something else. The doc is recommending Strattera instead of a stimulant because needs it more at home than at school.

Who would we have look at the sensory issues report from the school? An OT? A neuropsych? The psychiatrist we are seeing is not interested in any of the reports from anyone else so mabye we need a different psychiatrist. I don't know. I just want things to get better so that he's happier and I'm less exhausted. When he messes up, like playing a computer game instead of doing his homework, he starts saying things like "I'm so stupid" or "I hate myself" and that worries me. I wish the school didn't assign so much homework on the computer so that I could just not let him use it. But, he has to have access to one for homework. I've blocked a lot of things but I can't block everything. I guess I'll have to sit next to him while he's using the computer (it's in the kitchen).

Okay, rambling again, sorry. Thanks for the ideas and recommendations.

ETA: Oh, forgot to mention that both his piano and martial arts teachers have asked if he is ADHD. One has known him six years and the other three years. Does that count toward "two environments"?

A neuropsych or developmental ped should be able to diagnose any sensory integration problems, and more importantly, direct you on where to go for help! The neuropsych who saw my DS gave us a report for the school that included specific recommended 504 accommodations for him.

So many things to consider, but looking at the scores and the age... I wonder if some of it isn't a teen (mental age) mind looking for personal control and self-definition and encountering controls more common to a young grade schooler.

Petunia, we've been through school evals for different challenges, and I have one caution about school input based on our experience (as well as what I've heard from other parents in other districts): the school can have a bias and motivation to not find a child eligible for services. Some schools will give you a thorough and great evaluation, but had we gone through our ds' school eval without also having private evals, and had we not known what to question re the school's eval and had we not been familiar with our ds' rights and how to advocate for them, we would have been led to believe that everything was hunky-dory, our ds had no LD diagnosis, and life was grand (at school, while it was falling apart for ds at home!). So I would be skeptical that if the school says your child "shows some signs" but not enough for a diagnosis - there might very well be enough for a diagnosis from a professional who doesn't have an interest in downplaying symptoms in order to avoid having to qualify a student for services and accommodations. It's also much easier to ask follow-up questions from a private professional than it is from school psychologists so taking the whole school issue out of the loop and just looking at helping your child, you'll usually get "better" or more complete information and action plans by having a private evaluation.

If your ds hasn't had a neuropsych eval, that's what I'd pursue next.

Best wishes,

polarbear

ps - totally unrelated challenge, but fwiw, our ds has a diagnosis of expressive language disorder from a school speech therapist, but the eval was done through her private business. Our ds does not qualify as a child with expressive language disorder according to our school and state guidelines for that specific disorder - but working with a private SLP who diagnosed him with it has been *the* most beneficial therapy he's ever had. If we'd trusted what the school officially said about our ds re expressive language, we would have missed the most important thing we've probably been able to do for him in helping him become a happy functioning person.

This is my husband too. In his defense he's not with us when we do this stuff (he's at work), so he doesn't see how DS is fine with it... our trips to the hospital for his CAPD assessment, for example, were adventures and went over very well.


Our school district psychologist suggested that we medicate diagnostically as well. We've opted not to, mostly because DS is pretty well adjust and is making progress without meds. For what it's worth, though, I have a friend whose daughter has done extremely well on a slow release stimulant.

I feel for you and your DS, petunia. It doesn't sound like your current arrangement is working for anyone. I feel compelled to point out how asinine it is that the school deems your DS too "immature to grasp the complexities of LA reading/writing" when he is profoundly verbally gifted according to his VCI. That to me is a red flag that they completely don't understand him and he is not getting what he needs there. This certainly merits some sort of further investigation.

I am wondering if his VCI is even higher than reported due to his two 19s. Did your tester look at extended norms?

I think I'm personally about to tell my doctor that I'm going to diagnostically medicate myself with a slow release stimulant.

What testing instruments did the therapist use? Did s/he do the ADOS or other autism-specific standardized tests? or was it a gut-level assessment?


Forgive me, but the "aside from his pragmatic difficulties" IS a significant difference in communication. As Polar said, the school has a vested interest in not qualifying him for services. Whether he has ASD or not-- only your outside professionals are qualified to diagnose, I certainly will not from this distance. But schools are not allowed to diagnose medical or psychological conditions, either, and their educational assessments (which they are allowed to do) often seriously underrate what's there.


ASD can also look like that. I would really encourage getting in touch with a behavior therapist (google Board Certified Behavior Analyst, BCBA) to work on this stuff; they have good tools for this kind of behavior change.


I would not expect such a system to work; and it sounds utterly exhausting.


Indeed. I hope you can get DH to spend more time dealing with DS one on one so that he will agree to further assessment, because I think a really high-quality neuropsych workup-- preferably with someone who has seen lots of autistic kids as well as gifted and ADHD-- would help you sort this out.

You need better help, for your sake as well as your DS's.


The very good thing about Strattera for a first try with this kid is that it is less likely than a stimulant to increase anxiety and make the oppositional behaviors worse. I would worry about the stimulant drugs in that regard. But there is something to be said for finding out what you are dealing with before starting the med experiments, too. I am not sure which way I would lean on this.


That kind of thing, and the angry/oppositional behavior, in a boy can be depression or anxiety. I really think a neuropsych is the person you want to see. The full workup.


If you can, for the short term, I would.

Hang in there,
DeeDee

Thanks, everyone. That's a lot to consider. I don't know how to convince my husband to do anything else. Every time I bring something up he says "when are you going to be satisfied?", and I respond "when I have an answer". Granted, he's absorbed and very busy in his job, but this is my job and something is just not right.

The reason I'm not fighting to put him in the gifted language arts is selfish: it's more homework and I just can't deal with that right now. It's hard enough to get him through what he's got. He was in it in 4th and 5th grades and we furloughed him on the school's advice for 6th. They were concerned that his immaturity would make him a target for the other kids to pick on him. Personally, I thought that would be THEIR problem to make sure it didn't happen but we went along with it. He learned nothing in LA last year and really should be in the gifted class. I just can't deal with it right now. However, the shcool has not yet seen these most recent scores. They are working off testing we had done at age 6.

VCI: I don't know if the tester looked at the extended norms, I'll have to check the report and see. She did say "may wish to consider having the Stanford-Binet LM administered since he did notobtain ceiling scores on many subtests on the WISC-IV".

I noticed a couple of people from North Texas, which is where I am. Do you have recommendations for a neuropsych who has experience with Autism, ADHD,and Gifted?

Again, thanks all. I'll have to ruminate on this and see what I can come up with. We have applied to the Davidson Young Scholars but I don't know that they can help with this.

I've been looking and there just aren't very many neuropsychologists in my area. What's the differnce between a neuropsych and a regular psychologist? I mean, obviously, the former deals with the nervous system, but what would he/she look at or do that a psych wouldn't? What's the difference in approaches? Please help me understand.

With the WISC, WIAT, CAPD, and school assessments, do you think there would be lot more involved as far as an assessment goes? My insurance pays for none of this so I'm trying to figure out how much of what we've already done would suffice.

Hi Petunia,

A neuropsych is much more able than a regular psych to do detailed testing work that differentiates one diagnosis from another. They specialize in diagnosis, not treatment.

You might find information about where to locate a tester at the "Help and services" links on the left side of this page (searchable by state): http://www.aspergersyndrome.org/Home.aspx

In addition to IQ and achievement testing, I would want to make sure the tester would do most or all of the tests listed here, or their equivalents. I draw this list from the things the tester did with my DS when he was dxed with Asperger's (autism spectrum disorder) at age 5.

Children's Memory Scale (memory)
VMI-V (visual-motor integration)
NEPSY Social Perception (social awareness/understanding)
ADOS (autism diagnostic observation schedule)
Vineland (adaptive behavior - parent report)
PDDBI (ASD characteristics - parent report)
CBCL/TRF (general behavior - parent/teacher report)
PLSI (pragmatic language - teacher report)

Hope that helps,
DeeDee

Thanks, we do have some of those tests so we'll see. I don't see that the school will cooperate much since they just did their autism assessment last spring and he's so well-behaved at school.

Does the neuropsych also do sensory stuff or would that be on OT?

We had the sensory stuff tested by an OT while we were on the waiting list for the neuropsych - best decision we made in this whole mess.

This is a problem of professional discipline. Many neuropsychs are skeptical about sensory issues. Many OTs overplay them as "THE" answer to what is really a more complex problem. You definitely can't replace a neuropsych with an OT, because an OT's toolkit is much more limited. But if you are looking for someone to evaluate solely for the sensory piece, a qualified OT would do.

I would never want to limit this investigation to an OT, however; the science of SPD is in its infancy and that diagnosis is very often a cover for other disorders that would be identified by a fuller evaluation.

DeeDee

Ditto to what DeeDee said

polarbear

Shucks, Polar. :-)

DeeDee

Hi, Zen, missed this in my first readings of responses, sorry. What you say makes sense but it that's part of it, what would you do about it?

np, Petunia, it's a lot here and just looking to offer another pov. Hard to guess how it works out, mine's only 6.5. More seeing how things played out with my older brother conflicting with my parents and such; I didn't much go through it myself. Personally, I'd go the "hey kid, it's your life, what can I do to help you make it better?" and pull out controls and measures from my end, then maximize respect given; cold turkey. But it is a personal philosophy thing for me and everyone has unique challenges in their own situations.

Bad morning. Can I just put my head down and cry?

I think that depends on whether you feel worse or better after you cry.

I rarely ever cry but I actually did feel a little better yesterday for it.

I've found a neurophsych but the wait time is forever. Meanwhile, we've decided to try the Strattera. That will give us a chance to see if it works and also give me a chance to get my husband on board with another evaluation.

We spoke to the psychiatrist (who turns out to be a neuropsychiatrist) this morning and he explained the ADHD to husband and what the medicine might do. When he asked what we wanted to talk about, I looked at husband (who's the one who wanted the appointment!) and he just shrugged and said "she wants him on medication". Argh! So, the doctor reviewed notes and went over it all and told me I looked worn out (I wasn't sure whether to be offended or relieved that someone noticed!). He thinks the Strattera can help and doesn't think we need more evaluation but I'm not convinced. At this point, I'm ready to just try it and see what happens while we wait for the NP.

I also asked him about ASDs and he said that even if my son is diagnosed with Aspergers, he would treat it the same way. Medication and then organization and planning help, as well as behavior modification. He did caution us not to try any new behavioral modifications for a while since we'll just be digging the hole deeper until the medicine starts to kick in. He encouraged positive reinforcement and limited time to video, computer, and TV (which we already do).

It's funny, though, on the way to the appointment I had made up my mind that I didn't like this doctor and that I'd find someone else to administer medicine. After we left the office, though, I thought "that makes a lof of sense, maybe he's on to something". Weird.

There is something to what Zen says but I don't think I could let go of that much control. (Maybe the whole problem is that I'm a control freak!!!)

So, to sum up, next steps:
1. start the Strattera
2. talk hubby into NP eval
3. do lots of positive reinforcement
4. try to implement more structure and organization
5. look for a behavioral therapist
6. consider an OT eval

Thank you all again for your input and responses.

Those are good steps. I might put 5 before 3, but that's me. 2 still seems really crucial.

Think I said this a ways upstream, but Strattera is at least the right med to try first with an anxious kid. I wouldn't try a stimulant ADHD med with a kid who tends to be anxious and act out unless other options are exhausted first and there's a plan for addressing the anxiety.


Do they run a cancellation list? People often cancel, leaving them with evaluation slots open. That's how we got DS's done relatively quickly.

Also: try the autism center of a children's hospital. They will at least have several clinicians.


Well, yeah, the general outline is the same-- except that the kind of behavior modification that you need may be different with an ADHD vs. an ASD diagnosis. The particulars are quite different.

In addition, if you are treating an ASD with meds (keeping in mind that there is no med that is specifically approved for that) it is more typical to start with an anti-anxiety med (often an SSRI unless there is a family history of bipolar or other contraindications)-- so knowing what you are dealing with definitely matters. IMHO.

This is in part a difference of professional discipline. In general a psychiatrist's first line of attack is medication. In general a psychologist's first line of attack is behavior modification strategies, talk therapy, that sort of thing, depending on their training and expertise. For my money, the psychiatrist's perspective is a little limited here.

Hang in there. I think you're on the right road.
DeeDee

ETA: this is not to suggest that the Strattera is a bad idea. In fact, I think it could be a good thing to try given what you have said here so far. Only to suggest that the psychiatrist isn't spot on about treating ADHD and ASD being the same.

I would assume the Dr meant even with a diagnosis of Asd he'd still prescribe the Strattera, and which makes sense. You don't medicate ASD, but you do sometimes add medication for specific behaviors - anti-anxiety, mood stabilizer, etc.

Thanks, DeeDee. I did ask about the cancellation list and was told that there are already "multiple people" on it but there's a chance we could get something sooner. I did call one children's hospital but was told that they don't deal much with higher IQ kids, mostly with lower end. There's another children's hospital, though, that I just remembered that I should call.

I'm holding off on the behavioral therapist because I have to have knee surgery and need to focus on getting ready for that and then recovering.

The dr. did talk about using a mood-stabilizer or an SSRI but son is already taking Prozac for ODD so he thought the combination might be helpful, with the goal of getting off the Prozac at some point.

And, Amy, you're exactly right - not medicating the ASD per se but medicating the behaviors.

At least hubby agreed to try the medication. I truly don't understand why he was resistant. He did tell the dr that "son is so much like me that it doesn't really bother me that much" and "I just want the two of them to stop fighting". Neither of which made me feel very supported but that's another story (he's probably both ADHD and Asperger, if you get right down to it).

One hard part is that the Strattera takes 4 - 6 weeks to kick in so that'll be hard on my patience. At least, we're doing something, though, and it's not permanent and there doesn't seem to be any harm in it.

Whoa, you do have a lot on your plate. I hope it all goes smoothly.


That makes good sense to me. Prozac ought to help manage the anxiety, I would think. (Note for full disclosure: I am just a mom, not a doc.)


Sometimes dads aren't the ones managing the behavior all the time, so they have a different view of the child. And dads do have hopes and dreams-- they like to think of their child being successful, and they don't like to imagine disabilities getting in the way. That combination can mitigate against a clear view of the difficulties.

DH has been very helpful in our process, in part because he frequently saw DS in the context of Sunday school and Cub Scouts, where DS's challenges were clearly apparent.


I hope you get good mileage out of it.

DeeDee

I don't know, but I found the raw scores in the report. The only ones that seem to fall underd the extended norms criteria are in the Verbal Comprehension, but I don't know how to read the chart. Here's the info, if anyone can tell me anything:
Similarities: RS 38, SS 18, PR 99.6
Vocabulary: RS 60, SS 19, PR 99.9
Comprehension: RS 39, SS 19, PR 99.9

And what would it mean if we used extended norms? Would that make his IQ higher? We did apply to DYS and were accepted so that's good news.

It's really academic but in the context of the school saying he can't handle more advanced language arts work, his extended VCI makes this claim even more starkly absurd. It looks to me like his Vocabulary scaled score would go up from 19 to 20 no matter his age but his Comprehension subtest would go up to 21 or 22 depending on exactly how old he was when he took the test. There are three different tables for 11 year olds according to years and months. If he is below 11 years 8 months then he is a 22, otherwise a 21.

This makes his extended VCI around 160, way off in the tail of the bell curve. It raises his FSIQ too. These numbers are really only useful if you want to change the level of his LA work though. Otherwise they are just a footnote.

Hmmm ... it's something to think about. I've wondered the same thing myself sometimes, but then shrug it off as too "out there". I don't know what we'd DO about it though. I can't see skipping him another grade or homeschooling or sending him to college. What options are there?

What path did you take? You can PM me if you want.

Forgive my skepticism, but for a child diagnosed with pretty severe behavioral issues, and already accelerated, it seems unlikely to me that addressing the giftedness alone will get the child where he needs to be.

It's lovely to think that these problems can easily be solved by focusing on the child's strengths, but it is frequently the case that a child has both giftedness and something else going on, and that both need to be addressed.

Petunia said her DS is already not taking GT language arts because he can't comply with homework demands. The likelihood is that further acceleration will mean a larger quantity of homework. That doesn't sound like a great solution to me, for Petunia or her DS, at least until the behavior issues are improving. YMMV, of course.

DeeDee

And, in the next episode, I sent the report to the GT coordinator at the school yesterday and she called this morning saying that they want to move him to the GT English class ASAP. Hmmm. I'm not sure about the ADHD diagnosis yet but maybe it's time to bring that up and ask for accommodations/modifications because the GT class does have more homework. We could always change it later if the diagnosis doesn't stick. Hmmmmm...

Petunia, what behavior do you see at homework time? How is he likely to respond?

DeeDee

He diddles and he dawdles and he gets distracted. Last night, he was supposed to be doing his vocabulary cards and I checked on him and he was looking up the word "traipse" in the dictionary. ME: Oh, is that one of your words? Him: No, I just wanted to know it's precise definition. Me: Why's that? Him: I just want to". He'll go to the bathroom and if there's any reading material within 10 feet, he'll read in the bathroom. He also has trouble getting through the tedious stuff. He wants to move on to the next thing because, of course, that's much more interesting than whatever he's doing. If he's supposed to read one chapter, he'll read until I make him stop. If he's supposed to be doing math, he might be reading the newspaper or his science report or playing with the dog or whatever.

For example, yesterday, he got home at 4:30 and had a snack and then went to piano lesson, and got home about 5:40. I told him to get right on his homework because he had a scout meeting at 7 and he asked for 5 minutes of downtime. So, 5 minutes later, I told him his time was up, and to get busy. He finally got around to getting his homework out at about 6:20. I have no idea what he was doing in that time - daydreaming, creating sand castles in his head, solving the mystery of the universe, who knows? Ten minutes later, supper was ready so he ate and went back to his homework about 6:40. He "worked" on it until 8:00 when I told him to put it away and play with his dad. "What'll I do about it? It's due tomorrow?". I told him I didn't know but that he had had plenty of time to do it. Then, he realized that he had missed scouts and started calling himself stupid.

This sounds like one my my normal days at work.

My DS almost 9 is Gifted/ADHD. He has similar profile as your DS though his WM is a little higher and PS is 109. He was initially tested on the WISC at 7.5 and was diagnosed ADHD at a little after 8 years. He is grade skipped and is in the 4th grade in a self contained gifted class (it's a 3/4 classroom). Here is how I explained him to his teacher this year after I summarized his IQ scores and told her he has ADHD.

"DS needs a lot of mental stimulation and has a level of understanding and analysis far beyond his actual years. However, his relative area of weakness on the WISC is in processing speed (PSI is 109 which is average) which manifests itself in difficulty in task initiation and persistence, focusing on uninteresting things for long periods, slow written output and difficulty in taking large projects and breaking them down. He is happy, inclusive and friendly. He generally likes everyone. He has a positive attitude, is a hard worker and is willing to try anything new.

While DS is several years advanced academically, generally, he behaves like a younger 3rd grader. Additionally, because his executive functioning abilities are impaired he does have some behavioral issues. He struggles with impulse control (sometimes acts immediately & impulsively, rarely listens the first time), and responding to social cues (does not understand why classmates find his tapping annoying and/or does understand but is too impulsive to respond appropriately). At the end of last year, we sat down with a team and prepared a 504 plan to accommodate his ADHD which highlights many of the strategies that we developed last year in dealing with some of DS's challenges."

He has accomodations at home and at school to help him with task initiation and persistence. I am a big fan of the books Smart But Scattered and the Nutured Heart Approach - Transforming the Difficult Child Handbook.

I agree that there is likely something else going on with your DS and whether it is ADHD, I don't know (sometimes I still don't know about my own DS.) But, the situation you described above is not that unusual in our house and we have just tried to come up with strategies to help. Sometimes though if my DS has baseball or rehearsal or something else after school, I just don't push the homework and he usually gets it done on time. He does have some accomodations at school that give him additional time if needed. I know my DS is younger than yours but we have put a lot of structures and supports in place (lots and lots of checklists) and he has made significant growth over the last year.

Have you thought about applying to DYS?

I would also just throw in that if your DS has ADHD - impulsive type, and he is able to hold it together at school - especially given that it is likely terribly boring and he is extremely gifted - it is no real surprise to me that he cannot control himself at other times. He should get a lot of credit for holding it together all school day!

petunia, everything you've written above sounds like something that would happen with my ds if we put him in the situation of having two different activites after school and add in homework. It's just a lot of stuff for any kid to handle. My ds12 does *not* have ADHD but he has the same relative dip in processing speed that your ds has. School days are long for him - he gets tired because the dip in processing speed does impact him academically. I don't know if it is impacting your ds, but it might be and perhaps no one realizes the way it impacts him simply because he's so bright.

When our ds gets home from school, he needs downtime for at least 30 minutes and a snack. If he has one activity in the evening, he needs some time to get back in gear mentally before taking it on. He needs to know he has plenty of time to finish his homework, and he stresses if he thinks he has more to do than he can accomplish. He wants to get good grades in school. He feels like he's slow, even though his processing speed really isn't slower than average - but it feels that way to him. Boy Scouts is meant to be an add-on, but if his Boy Scouts is like my ds' Boy Scout experience, it includes a lot of work too - it's not just throw-a-bunch-of-boys-into-a-room and let them play, kwim? You'd never realize to look at my ds from the outside in without knowing all that that he's tired or stressed or worried about school - it comes out differently. He's 12 and it can look like he doesn't care or like he's a space cadet. But he's not - he's a kid who is challenged in school by his processing speed and who is never probably going to a rock-star I can do everything and do it great and hold-it-all-together kid. BUT - he does really well when we give him a schedule and structure and room to breathe and relax.

Perhaps none of that applies to your ds - I just thought I'd offer it up as food for thought. Your OP asked about the possibility of an impact from the dip in his processing scores and working memory - from what you've said above, it sounds like it would help to have a full neuropsych eval if you haven't had one to explore further what's causing that dip. My ds is also in 7th grade, and the workload is really increasing. No matter how intellectually higher level work may be, if there's a challenge with processing speed and working memory, just *getting the work done* at school can be mentally exhausting.

polarbear

My DYS had similar scores and patterns with even lower PSI (see 9/22/09 post). We found great help here http://www.education.uiowa.edu/belinblank/Clinic/.

It seemed that everything was looked at in context of the knowledge that he is gifted and that was very reassuring - and a first as the nueropsychologist he saw who was less familar with gifted gave a much less helpful report.

If the only thing keeping him from taking an advanced class is homework (as opposed to ability) then yes, the advanced class with accommodations would likely be a good plan. A couple of accommodation options: assign all of his homework for the week on Monday (to be due the following Monday); homework only required to show mastery (rather than the things designed to reinforce concepts); acceptance of late work; projects broken into smaller pieces or smaller pieces put together into one large project (I've had kids who do better each way)...I'm sure you could come up with more but those are off the top of my head.

Good ideas. As to the homework and activities issue, I guess I need to rethink the plan. We usually don't schedule two activites the same night but his scout troop changed their meeting night and so there wasn't much we could do. I think, too, that right now the Strattera is making him very tired - yesterday he fell asleep at 5:15 and I started waking him up at 6 so he could go to his baseball game. It took him 30 minutes to fully wake up. I'm hoping that's a side effect that will go away.

All of your posts are giving me things to think about. Thanks.

Well, we've been on the Strattera for 5 weeks and I can't say that I can tell a difference. My husband thinks son is expressing his emotions more but that his behavior hasn't changed. We go back to the psychiatrist next week.

I haven't done much since I last posted here - I had knee surgery three weeks ago and have been recuperating from that and a nasty complication.

I did read part of a book titled "10 Steps to Help your Defiant Teen" (or something like that) by Russell Barkley that was recommended to me. It has a behavior modification program that we are considering. I don't know if it will work. I will start looking into a behavioral therapist soon.

Eldertree, thanks for the suggestions for accomodations ideas. I think my husband and I need to agree on the ADHD diagnosis before we approach the school.

He got in trouble today because he was supposed to be doing his homework and I got up to check on him and he was playing a game on his computer (he was supposed to be typing his HW). I had told him no games and then asked him twice if he was playing or working. He got in trouble for cheating and lying about the game playing so I told him he didn't get to go to baseball. Then, he went into a complete tailspin and the rest of the evening was miserable. I think I'd have been better off taking him to baseball and not having to put up with him.

To sum up: I'm still frustrated. I had high hopes for the Strattera.

That happens. No two drugs work exactly alike, and finding the drug that will work for a given patient can be difficult. Or it may be that the dosage isn't right. Sometimes it takes several trials to find the medication that will make a difference. IMO it matters to find the most expert prescriber you can, and also get the diagnosis pinned down as accurately as possible, so that you know exactly what you're dealing with.


I hope you're feeling better. Sometimes the day to day is all one can manage.


It would be good to get agreement on the diagnosis; but the problems are real no matter what you call them. I can't remember now whether the school has evaluated him; but they should, if services and supports are needed. It takes a long time to get that all into place, might as well start.


Mine does that sort of impulsive thing all the time too. At our house, we wouldn't typically take away an outside social activity-- we feel that DS needs the practice and it's not connected to the infraction. We might suspend leisure computer usage for a few days, though, because it's directly tied to what he did wrong (a natural consequence).

Hang in there.

DeeDee

So the school doesn't see it, your husband doesn't see it, one of the more effective ADHD drugs hasn't worked, maybe there is a different conclusion to be had.

Actually, Strattera is one of the *less* effective meds. But often chosen for people who are anxious, because it's a non-stimulant.

I'm all in favor of Petunia seeking better diagnostic refinement when she is up to it; but everything points IMO to something neurological being seriously in the way of her DS's managing his behavior.

DeeDee

I realise my child is just one child... But the only clear impact stimulant medication had on my DD was reducing her anxiety and improving her mood. If the anxiety is caused by the inattention...

A behaviour management approach that our neuropsychologist recommended for my DS12 (ADHD, with some ODD type behaviour) is "collaborative problem solving" outlined in The Explosive Child by Ross Greene. I find the approach very helpful, although it takes practice and planning. I think it is particularly good for kids with advanced verbal reasoning skills. None of the reward/punishment approaches worked very well for us.

Here is the author's website:

http://www.livesinthebalance.org/