Gifted Issues Discussion homepage Forums Twice Exceptional Fine line?

At what point does it go from highly gifted child with a few quirks to highly functioning development disorder with high intelligence?

Is that something that very skilled professionals can distinguish easily or is there a pretty wide area of grey?

Depends on how many of the quirks fall within the same diagnosis. It's been a pretty wide, gray area from our own experience.

I think it's really hard to call (having a barely MG girl who was very hard to diagnose). Her verbal IQ is 96th (I actually think this is a weakness for her), the speechie she saw recently first tested her on the CELF4, as usual for my DD she had highly scattered scores, one on the 99.9th, nothing terribly low, despite the spread, I get the impression most speech pathologists would stop there. But this one then pulled out a less used test that was purely pragmatic/social language. DDs highest score was the 40th percentile, ranging down to the 1st, her overall score 16th, her highest age equivalency was nearly 3 years delayed. Which is what you would expect from a child with aspergers, but not what ANYONE expects from my DD, because her initial presentation is too good.We already had a diagnosis at this point, but it had been a long road with not many professionals prepared to look below the pretty shiney surface of a polite, well behaved girl who presents nicely 1:1 with an adult.

We've been trying to figure this out since DD9 was about 2 and still don't have an answer. If you haven't already, you should check out James Webb's 'Misdiagnosis' book, but a number of the people we've spoken to don't acknowledge what it discusses (notably, absolutely everyone we've spoken to in our state). What that book says makes sense to me, but what difference does it make if nobody else will respond when you ask about it??? Honestly, assuming it's a close question and the kid can operate okay in some settings with some people, I think the answer to your question is in the mind of each beholder. But if you get an unsympathetic or impatient teacher, you will find they want to apply a label so the issues aren't 'their fault,' or at least that's been our experience. Probably more specific information would be helpful if you want more relevant advice.

mum~
is the CELF4 test used for speech only? Your DD speech therapist administered it? And do you happen to know the name of the "pragmatics" test she took??

My DS6 will getting a full Speech Assessment sometime in the near future, it is listed down in his current IEP as mandatory before his next IEP--- to assess if he needs to continue with Speech. I'm ok with an assessment, but want the correct ones to accurately assess his true abilities or lack thereof...

thank you

Dbat~
I'm getting this book asap! Thanks!!

My DS6 is at that border and was Dx shortly before 3 b/c of presenting s/sx (aut), and I was told this was a good thing b/c DS qualified for therapy- which he needed for speech, & for fine motor.
but then 2mos later the school Psych didn't agree that he had Dx
at all, she thought if anything he was gifted, but gave Dx again so he could receive the obviously needed speech...

On another thread someone said they can lose their Dx but that the "stigma" stays with them-- how others view them etc.

Currently I have had problems with DS teacher who claims to not have known he was autistic, and now realizing he has that Dx, she seems to think he couldn't possibly be gifted and needs to be in special ed. That's a long story, but the ending for that is, DS has a new teacher starting next wk.

Thanks again for book title.

Cc6 - I am in Australia, I can pull out the report and look at the test name but it may not be the "right" test in the USA... The CELF4 is a language test, not a speech test, my DD had no formal speech assesment as her actual speech has always been excellent, but the CELF is more general than the second one she did.

We seem to have cross posted. Yes there is a possibility of a negative response from some people to having a diagnosis. But kids who don't get a formal label get informal ones - rude, weird, deliberately obtuse, obnoxious, frustrating, etc... My DD "seems perfectly normal" but annoys the heck out of most people, has few friends (and pretty much all her friends are on the spectrum or have ADHD), doesn't get asked to birthday parties or playdates....

thx mum!
I meant to say "speech and language assessment" for my DS6. He has no real "speech" issues himself,
maybe a lil bit artic with the "th"? but DS has excellent receptive and expressive language, he also can sing an has near perfect pitch,

he has pragmatic issues, mainly in the areas of self advocacy, which I have been told is also an age thing,

but also in more typical social situations ie approaching a group of kids and saying hi- he will do this much, kids will usually welcome him into whatever they are doing, and he is fine as long as not much "talking" is needed- he doesn't always stay on topic or get when another kid isn't interested in what he is saying, and he also complains most boys his age are babyish in what they want to talk about, my son wants to discuss new inventions and ways to save the planet or whatever, though geez he is also way into scooby doo and spongebob also...

but DS loves to have fun, and is fun, and ppl tend to gravitate towards him so he doesn't have too much of a problem making "friends" wherever he goes, still, I'm not sure he'd be able to sustain early friendships on his own...

He's young enough that I have to be involved in the whole playdates thingy... So parents still do a lot of the initiating at 6 with boys I am finding... Also as said above, boys are more about moving than talking,
compared with girls who definitely are more socially talking even at 6!

Girls can be tough! ((I have an older dtr so I know!!)
*have you tried DD in clubs with just regular kids? Whatever her interests are etc?

oh- my DS likes the idea of being different. He actually doesn't want to be like every other kid he see's. He thinks that is boring...

I have nothing to contribute to the original topic but wanted to say how happy I was for you when I read that your DS will be getting a new teacher! Yeah!

This is exactly what I am dealing with on an on-going basis. I have a daughter in 7th grade. I am sure she meets some of the criteria of Aspergers and this has come up since she was very young - most recently 2 weeks ago with a new psychiatrist. The problem I have is that the criteria is so broad, and for every characteristic I can check "yes" to I can think of an example where the exact opposite was true. It is also frustrating not to know how her intelligence and introversion plays into her nature, particularly with her impatience and intolerance with others, especially other middle-schoolers. She already has a dx of ADHD. Reading James Webb's 'Misdiagnosis' a bit I see dd in the pages - like ADHD with intellectual, imaginational, and sensorial OEs. At this point, I am working to accept the grey area. DH is adamant that no label will be applied to her. I think it is unfortunate that this label would likely be used to define everything about a person rather than a way to understand her and give her the tools she needs to navigate the social world comfortably. For example, she is highly intelligent solely as a by-product of Aspergers, not vice-versa, or gifted with Aspergers. This is something that was implied by the psychiatrist.

Hils, I guess that this isn't an definitive answer to your question. Unfortunately, that is why it is so "grey." I think that professionals come with their own bias and will apply that bias. Of course, right now the tool they use is the DSM, and therefore what is defined in the DSM is what they see. There is no DSM diagnosis of giftedness that would take in to account the theories in James Webb's book, so they can't apply criteria to "choose" between giftedness and "other." Since DSM criteria is broad and interpretation of behaviors is based upon each professionals subjective experience and limited interactions with each patient, the giving of a dx seems to be discretionary and that makes it hard to accept. If you are looking for your own dc, the best you can do is learn what you can, get to know your child, find a professional that can connect with your child, and do the best with the information you have.

Discussion along the lines of this topic - with people much more knowledgeable than I am - is in the thread "Gifted Should Not Be Considered a Disorder."

Sorry to say this, but time to find a new psychiatrist. Most people with Asperger's are of average intelligence, not gifted. The intelligence of most people with autism is hard to measure because of their moderate-to-severe language and social communication-impairments.

It is simply NOT TRUE that Asperger's can "cause" people to be gifted.

The gifted ones are a tiny minority; they also compensate better, so they tend to look like borderline cases, even while their struggles are real.

I'd want to get someone who really knows about autism, and has seen the autism+gifted combo, to help you sort this out. The person you're seeing... I'm suspicious that they don't know enough.

Hang in there,

DeeDee

We're dealing with the fine line as well. Two boys, DS4.5 PDD-NOS and DS3 High functioning Autism. I am more and more convinced that DS4.5 is NOT on the spectrum. At this point his only issues are sensory processing related (I had to deal with that all my childhood and still do), being overly sensitive at times and fighting boredom. A lot of things he used to do (rituals, etc.) went away as he learned to cope better. But we now have this diagnosis that the school is going by (unfortunately that is what we originally wanted :() and the school (special ed preschool class) is dead set on trying to correct something that in my mind does not need correcting. He's extremely verbal and always asking questions and always explaining something or talking to himself because he doesn't have anyone else to talk to and always wanting to answer all the teacher's questions. And the school sees it as an issues and possibly might be recommending him to be held back from K in the fall and attend pre-school again. The teacher is very nice but she's so busy trying to teach the other 9 kids to count to 10 that she doesn't see how under challenged DS4.5 is. She never in those 4 months he's been there realized how much of what she says he is taking in (pretty much all of it). And there are things she's said the he now understands are the law because he's teacher said that and we're working hard at home to reverse that. We had a parent teacher conference last week where I mentioned some of the issues that arose from this and the OT (who seems to get him!) suggested to the teacher to have a normal "adult" conversation with him because that's how you need to speak with him and explain again the things we're having issues with. The preschool has been great in terms of getting him be with age peers but that's about it. Everything else has been a fail. His teacher has absolutely no idea what he actually knows academically, which means there is no way she could ever even try to accommodate him in the slightest possible way. Apparently his biggest problem at school is that it takes him 15 minutes to take off his coat in the morning because he's too busy thinking out loud and because of that misses the first part of their table time! lol ... NOT an issue at home. I explained to him a little while ago that if he stops talking, he can get things done a lot faster. So when he gets home, it's coat and shoes off first and THEN he can tell me all about his day . But back to the "fine line" ... as soon as I mention getting more challenge for him (in my emails to the teacher or at the conference), it always comes down to them wanting to work on his "areas of weakness" and not one suggestion that would solve the boredom issue. His IEP is for speech with OT consult. Meaning he gets ST at school once a week and the OT just sits there with him and some other kids and just oversees their behavior. He has NOT needed any speech therapy in well over a year. If anything, he needs OT for fine motor skills. But his diagnoses called for ST and that's what he's getting. Because of this and because of health issues (allergies and being sick all the time), we'll be most likely homeschooling K and possibly 1st grade. In the meanwhile I am planning on getting him tested to see where he's at. We are pretty sure he is gifted just not sure where exactly on the scale. But as for the PDD-NOS diagnosis, I am 99% sure he does NOT have it.

DS3 is very different from his older brother. Most likely more gifted than his brother (doing most things 1.5-2 years ahead of his advanced brother) but he is also the one with more issues and for him the High Functioning Autism diagnosis will probably last, though for reasons other than what the evaluators initially saw in him. But we won't know for sure until he's fully verbal. At this point he acts autistic one day and "almost normal" the next day. I am saying "almost normal" because he doesn't do very many age-appropriate things so it's hard to call his behavior normal. But because of these switches in behavior, it really is a fine line as well. And once again, EVERYONE concentrates on his diagnosis and NOBODY pays any attention to the needs that his brain has even though a lot of the autistic behavior seems to be coming from his brain working so hard wanting to learn more.

Sigh. Nothing about this surprises me.

In fact, I've had somewhat similar conversations with doctors about my DD's atypical asthma. (The concern is that the dx will "follow" her, with potential repercussions.)

What is the concern about an asthma diagnosis "following" the child?

Our school has been reasonably responsive when we have needed to change the diagnostic information in our IEP. And school records, while sensitive and affecting things while one is in school, do not typically "follow" a person into the world. Once a person ages out of the school system, it's not likely that anyone would see those records or use that information for anything.

Maybe I'm missing some crucial piece of the picture. But I just don't see it.

DeeDee

It's an insurance concern, or so I was told (maybe they're worried about it being a pre-existing condition?) DD really is atypical, so there's adequate reason to say that she may not have asthma. The concern is also that she will be overtreated with meds she may not need.

Asthma is a disqualifying condition for an enlistment or commission in the US armed forces.

Thanks, Dude--that's helpful to know, and I didn't know it. (My son also has asthma; he really does have it, I think, but I don't believe it is "officially" on his file either. They like to put "reactive airway disease" on kids' files insetad.)

No problem. Since the question was asked about how an asthma diagnosis could hurt someone, that came immediately to mind.

It turns out that asthma is one of those conditions that can be outgrown, because of airway expansion, and possible changes to allergy responses. At the time I enlisted, if you hadn't had an attack since age 13, you were golden. This was during peacetime, when they could be a little selective. The rules have a funny way of changing when they're coming up short on recruiting targets... at least for enlistees.

I kind of view a lot of the diagnostic game as kind of as a joke, at least in the world of mental health.

I say this after having read a ton of psychological and medical reports.

If you liked the DSM-IV-TR, you're going to love the DSM-V.

Unless I am mistaken, folks Dx w/ Autism, can't enlist either.

DeeDee, Thank you for your response. I was concerned about this psychiatrist's experience from the beginning. I asked my psychiatrist if she understood giftedness. His answer was that she had lived in VA/DC area where they have lots of smart people. Okay then. I am sure she's an expert. Unfortunately, we have little choice in mental health professionals.

I hope you know what a valuable resource on this board to those of us with 2E kids, especially in these types of grey situations where the issues are really but it is hard to know how to address and advocate. Thank you for your patience. I know that you were here for me about 3 years ago when this issue came up previously. At that point, the therapist she was seeing felt that it was more introversion and some mal-adapive behaviors. We have since moved states and haven't seen anyone in almost 2 years. We are finally getting a new therapist, which she sees next week. We'll see how it goes.

Same here. The school staff in DS's life insist he has autism and the doctors all agree (vehemently) that he does not. Turns out the school staff are focusing on behaviours and characteristics and the doctors are focusing on diagnostic criteria.

At the end of the day, he's still the same kid.

I just finished reading "Lost at School" by Ross Greene, and one of the things I liked about the book was that he put "labels" aside and referred instead to individual lagging skills.

Consider this... when a child has some but not all of the lagging skills associated with a label and they don't meet the dx criteria, the remaining skill deficits are sometimes shrugged off: "oh, well he doesn't have autism after all - I guess we don't need to pursue that."

Whereas... if our system was set up in a different way: If individual skill deficits were each assessed, recognized and funded/supported individually in lieu of the existing "A total of six (or more) items from (1), (2), and (3)" etc etc in order to qualify for support, then the OP's original question wouldn't matter.

Wouldn't that be better? (What am I missing?)

How wonderful that you got that in writing!! (Our private psychologist said she'd be happy to write me a letter as well, but wanted to meet with me first... I thought "hmmm, I wonder if she'll charge me for that meeting." ...I never did call her to ask or schedule the meeting).

And how awful that they just designated your daughter without confirmation!! It sounds like your school was more aggressive than ours. I don't think that they're allowed to label a child without a copy of a report from a qualified tester. Our school "handled me with kids gloves" and then backed down once I took DS to a provincial specialist (this after I'd spent $$$ on private testing and submitted a 17 page report, which wasn't good enough for the school... I was NOT IMPRESSED).

Fun, isn't it...