Gifted Issues Discussion homepage Forums Twice Exceptional ADHD based on scores?

Is this a belief or a hard and fast rule?

That's why I floated the question about how she functions IRL. Your additional information indicates that her profile does interfere with her access to opportunities and skills that have value for her in her present and future life. In that case, then I would certainly agree that investigating interventions makes sense.

I would not, however, agree that having WMI/PSI scores above 85 rule out "true" ADHD. I have assessed students whose scores all fell in the Average range, but who still clearly met criteria for ADHD. In particular, high-cognitive individuals are often able to use cognition to compensate for executive functions that are weaker, sufficient to raise scores into the Average range. This does not mean that they are not doing so at significant cost to higher-level thinking, in which they could otherwise engage.

As to improving organization and regulation of attention without using prescription medication, I would start from healthy lifestyle habits (regular and sufficient sleep, exercise, diet), outside time, routines for activities of daily living and studying.

You can also try self-monitoring aids. Many children with attentional difficulties do not have a clear sense of when they are attentive and when they are not. You can help her to learn what it feels like to be focused by helping her identify, in the moment and in retrospect, episodes when she is. One self-monitoring strategy may be to set a periodic silent reminder (vibrate) on her phone (if she has one) to remind her to check her attention (say, every 15 minutes), during a time period when she frequently has a tendency to zone out.

Another strategy that can be helpful is to create artificial time pressure by giving her targets for work to be completed before a timer goes off. The key is to set the interval to a span that is just beyond her natural attention span for a task, and to make the target work something that just fits into that span. So if her attention span is about 10 minutes, and she can realistically complete 5 problems in 10 minutes, set the timer for 12 minutes, and ask her to complete six problems, then complete the rest of the assignment in spurts of similar length, interspersed with brief mental rest periods. (If she wants, or needs to, she can reward herself with a very small treat--for example, my DC may eat one Skittle for every one or two problems completed, or make a cup of tea when two paragraphs have been written.) This is also partly about learning what it feels like to be continuously focused and on-task. As she becomes better at this, you can gradually increase the spans, or the work demands (depending on the nature of the task), or both. If using rewards, you can phase out the rewards by gradually reducing the amount or frequency of reinforcement.

Adolescents are also at a point where it can be quite valuable to introduce them to the technological organizational aids that we rely on as adults. Set up a gmail or similar account and have her schedule all her homework, long-term assignments, and upcoming tests and quizzes into Google Calendar, with reminders. This is another excellent use of the ubiquitous smart phones that teens tend to carry. Make sure her calendar is shared to you, so you can be an additional human reminder initially. As she becomes more fluent in using the calendar and its reminders, you will become more of a backup. She might even benefit from using GoogleDrive or other cloud storage for schoolwork that can easily be produced on a computer. It won't get lost, and some teachers will accept electronically-submitted work.

Remember that this is a long-term project. Start teaching her strategies for self-monitoring and organizational scaffolding now, and by the time she is late in high school, she will probably have developed a decent independent ability to use the tools. I've seen a lot of inattentive/disorganized young adolescents develop into reasonably functional young adults, who are, granted, still clearly ADHD, but have developed effective compensatory strategies. The first year of middle school and the first year of high school are difficult organizationally for almost everyone. I find that children with EF deficits tend to lag by a few years, so that, often, some time in the latter half of high school, it seems to come together well enough that organization is no longer a major obstacle to them. This doesn't happen in isolation, of course; that seems to be a common age at which the years of adult-led scaffolding and remediation finally take hold, probably as a combination of overlearning and slightly delayed frontal lobe maturation.

Oh, and on another note: we started homeschooling mainly for academic reasons, as children needed more advancement than was practical in the b&m schools we had available to us, and one was also markedly asynchronous across academic subjects. The one with characteristics of ADHD was actually functioning well as a very young middle schooler (two years young for grade), but that may partly have been because the content was insufficiently challenging, so diverting mental energy to compensating for executive functions was not impacting performance.

I know I'm not the OP here, but this has been rather enlightening to me. Thank you for giving me things to watch for and to try. 😀

Thanks again for responding!!!

I don't know if this is a belief or a fact but whatever it is, it isn't mine.
Our psychologist said almost verbatim "she had s typical executive function, but very superior cognitive ability".

He mentioned that if I looked at IQ studies in ADHD diagnosed people I would see two things: PSI scores in inattentive ADHD are mosly in 85-90s, when the other scores are above 100, and that gifted and ADHD studies focus on people with IQ > 120 (instead of 130 as typical), again indicating overall lower FSIQ, most likely affected by lower than average PSI/WMI scores. As I mentioned above, studies on groups of gifted children in Denver indicate commonality of this presentation in this group, but do not call it a disability or disorder, but more like a typical functioning.

I agree with that notion. I don't think she is affected as in disabled by this, because she is still straight As or close in a very competitive school district, plays piano, does math two grades ahead etc. That was another point, made by the psychologist. But it doesn't mean that she isn't affected at all, she is, but relative to what she is capable of doing cognitively, which clearly indicates a weakness that needs to be addressed, but may not qualify as a human disorder.

The idea with the 15-min alarms sound very appealing, but the school doesn't allow any electronics during the school hours, specially phones. A watch, maybe, but I can't afford an apple watch and I'm not sure if there are any other products similar to it that you can program with 20 alarms. Any ideas?

A complication with teaching organization is that whatever my daughter has is probably generic - because I have this issue too. I can't say it affected me to a great degree in my life - I have two graduate degree in engineering and half-done phd, but it is clearly identifiable, compared to some of my coworkers (but not to others - mostly engineers like me). Yet another reason why I think this isn't a true ADHD, because I know precisely what she has. I don't lose track of things but I don't take any notes or put little things into calendar. So, with a great regret, I have to say that I may not be able to help her much with this because I'm not consistent enough myself. I know I comprnsate for it with other things, just like her. Something I need to change, clearly, in myself, to help her deal with daily challenges. Any advice on what we can do together and what is more important - how to enforce so it becomes a habit?

I think we do well with other things like sleep, exercise, diet and rest. She swims on the swim team. Eat mostly organic and little to no red meat.

Looking at her more and more through my own perspective in life makes me think I probably have a very similar WISC-V profile because I'm super in conceptual tasks but doing things like project management can really kill me.

My base model Timex Ironman watch does 15 min repeating timers (or whatever interval you set it to). She could just stop it whenever it isn't needed. Not sure how a teacher would feel about something beeping every 15 minutes though and there isn't an option to set it to vibrate. It is a LOT cheaper than a Apple watch though. If she uses a laptop in class there would be options there as well.

aeh - thanks for the great ideas. We're already using google drive and calendar with DS and I suspect it will only be more critical as time goes on.

This made me wonder about anxiety. Attention issues and anxiety are common co-morbids. Have you considered taking her to a counselor? CBT could be really helpful for both anxiety and EF issues--non-pharma.

Middle school is a bear for some kids. EF demands are so much higher, not to mention social pressures. Therapy that helps with strategies for managing anxiety (which interferes pretty dramatically with EF) might be a good front line intervention.

She has a Google drive provided by school (and a laptop) but she can't make any changes to it. It is only for the teachers to post assignments and tests. The real kicker is to get her to use it/check it everyday! I think the idea with the watch and setting up some kind of electronic calendar/schedule on her iPhone and iPad may work. Do you have any apps in mind that worked for you or anybody else on this site?

"A small degree of anxiety" was noted during the timed portions of WISC on the final report. What does CBT entail? How often/intense does it need to be done to have an effect (she's pretty busy during the week, but summer is wide open)? How do I find the right practitioner for it (reviews etc)? Should I just go with the same psychologist who tested her?

I didn't see any responses related to caffeine. It has a very positive impact on me, in terms of less sluggishness, more focus etc, and zero sleep/anxiety issues, in fact I would say it has a calming effect on me. She is old enough to try it. Anybody can recommend it as a "dietary" supplement to stimulate attention during school hours?

I would try not to get caught up in personal issues with terms - words like "disorder" can sound negative, but they don't need to have that negative connotation. Having a diagnosis can be really important for two reasons: first and foremost, understanding why certain behaviors are challenging, and second, because having a professional diagnosis can help with getting accommodations etc in place at school. Note - I'm not saying - get a diagnosis just to help get accommodations at school, but that, in general, if you *have * an official diagnosis to back up a request for accommodations it can really help.


I would expect this is an accommodation you could request in a 504 plan - although my ds doesn't use this specific accommodation in school, he is allowed the use of assistive technology through his 504 plan. Electronics and phones in general aren't allowed at school due to the potential distraction, but they are commonly used as AT devices.

Another strategy with accommodations is to remember that even if you can't use an accommodation at school at the present time, you can use it at home - and this will give your child practice in the skill, as well as practice in using the accommodation. We did this with our ds and it helped tremendously both with getting work done and with developing skill at whatever specific task it was he needed to learn how to cope with, even if he didn't have access to that accommodation at school yet. I'd keep in mind - by the time your dd is in high school, if it's anything like our district, phones will no longer be taboo in class and the phone most likely won't be an issue at all.


Whether or not it's "generic" difficulties with organization are not limited to people with ADHD. It's something that is both a common trait among all kids entering middle school (hence the emphasis on organizational skills in many classrooms), and it's something that can be problematic in people with other types of diagnoses. For instance, my ds is diagnosed with DCD, does not meet the criteria in really any way at all for ADHD, but he has had some tremendous organizational challenges tied to his DCD. This is going to sound like I'm talking out of two sides of my mouth ... but I am a firm believer in two things: first, understanding what's behind the behavior (is it ADHD or is it something else?) *and* at the same time, understanding that there are often shared methods (across diagnoses) that can be used to cope with, remediate, and accommodate challenges. For instance, as I mentioned, my ds doesn't have ADHD - but we've used techniques for organizational strategies that work well for students with ADHD have also worked well for helping him learn how to cope with his own set of organizational challenges. The key is first understanding, if possible, what's behind the challenges so that you don't spend large amounts of time and effort on something that isn't ever going to help because you haven't tackled the underlying issue (for instance, assuming a child who's having difficulty learning how to read needs a specific type of remedial program because it's used in a widespread way with children who have difficulty learning to read... when really the child has a vision issue that hasn't been diagnosed yet).


It's not uncommon for challenges such as this to seem to have a genetic component. One thing that's potentially an upside to this is that it's something you can share with your dd - you have an understanding of what it's like to live with her set of challenges. On the other hand, it's often so easy to see ourselves (parents) reflected in our children that we miss seeing something different. Prior to our ds' 2e diagnosis, my dh and I both tended to look at behaviors which were indicating challenges through the lens of our own lives - I was a perfectionistic in school (and life) for a long time, so when my ds wasn't completing assignments in a timely manner, I made the automatic leap to perfectionism - I was, he's mine, therefore he's got my whatever, case solved. When really we were missing something that neither of us (parents) had as a challenge.


On the other hand, you could both work on tactics for dealing with it together - which in the long run not only gives your dd strategies for the nitty-gritty specifics, but also has the most likely *more* important upside of giving her the reassurance of seeing that a) she's not alone, other people have the same challenges, b) she *can* make progress at overcoming the challenge, and c) you've got her back, you're going to be there to support her. Put those three things together and she's gained something far more lasting and meaningful than simply how to focus on and complete a task.


I don't know enough about your dd's specific challenges to know if this will work, but for our ds a large part of the key was repeat, repeat, repeat... and then repeat again. For instance, he seemed to be hopelessly disorganized about getting what he needed from school to home and back (books needed for homework were often forgotten at school, homework assignment list not recorded so he didn't know what he was supposed to be doing for homework once he was home, completed homework going into his backpack but getting completely lost between the backpack and school, things like that). What we did was for me to physically go inside the school each day at the end of the day to pick him up, we checked the homework list on his classroom board together, went through his locker to make sure he had everything he needed (verbally went through the entire list of his classes together - what did they do in class today, what was the homework, what did he need to bring home to complete it). I made sure that his locker was left neat and in order. I did this with him every single day for almost the full first year of middle school - and as you might guess, he hated it! But he also realized after a relatively short period of time that it was helpful. I promised him that once he was able to show me that he was doing the organizing etc instead of relying on me to lead, I'd step back and only come in once per week, and knowing that gave him the motivation and self-confidence that I believed it would work. It took a long time - most of the year, but he got to that point. We continued with once a week checks through the first part of the next year, and he eventually got to the point that he no longer needed my help.

That may seem like overkill, but the idea is - kids who need extra help in learning ef skills need extra help. They aren't going to "get it" as automatically or with as little practice as nt kids. Look at what your own dd's specific task challenges are, and think of what you can do to support her that is repeating that task in a way that eventually it will sink in. The key is - don't give up because it takes more time than it would take a nt kid to "get it".

Best wishes,

polarbear

I found a watch designed specifically for this purpose with a kid-friendly look. I'll post the link (I am not sure if I am allowed to). If it doesn't come through it is called Wobl vibrating reminder watch.

http://www.amazon.com/WobL-Alarm-Vibrating-Reminder-Watch/dp/B00O4DMXUY/ref=pd_srecs_cs_241_1?ie=UTF8&dpID=41I3dE2gKjL&dpSrc=sims&preST=_AC_UL250_SR170%2C250_&refRID=1TP0BHMFFBS52ZD39K2N

Pretty much any calendar app that allows multiple reminders will work. Some possible reminders:
1. at the time the assignment is due (to remind her to turn it in)
2. the day before
3. two days before
4. at weekly intervals before a long-term assignment is due.

For long-term assignments, I would also suggest breaking them down into intermediate steps, and creating deadlines for each of those components, with proportionate consequences of personal significance.

For example, a two-page paper (about 5-7 paragraphs) due in one months might become a series of benchmarks:

week 1: identify topic, complete research, write outline.
week 2: write 3 paragraphs (or one page)
week 3: complete first draft and submit to teacher to review
week 4: complete final draft and turn it in.

You could even make the benchmarks smaller:

week 2 day 1: write one paragraph
week 2 day 2: write second paragraph
week 2 day 3: write third paragraph
week 2 day 4: re-read and mark paragraphs with self-edits
week 2 day 5: revise paragraphs

Even if the EF of her go-to adult resources is not that strong, this can work, as the key is to set up all these reminders at the time the assignment is given, and then let the technology do the reminding along the way. If there is anyone in her life that she feels comfortable with pulling in as accountability for this, she could also share this calendar with that person, and ask them to harass her (I mean reinforce!) about sticking to it.

On caffeine, I don't think there's a huge downside to it, and if you find it helpful for yourself, then it is quite possible she will, too. But I'm not an MD.

CBT can be very helpful for anxiety. If you and she feel comfortable with the psych who assessed her, that might be a good place to begin. If he/she doesn't do it, ask for referrals. You may also ask the adjustment/guidance counselors/social workers/school psychologist in her middle school for referrals to outside providers. They often have a good sense of practitioners in the area who are suitable for young adolescents. It is not unusual for individuals to be in biweekly therapy, and find it effective, though, like many therapies, a little more frequency than that would probably be better. The intensity of it, I think, is not as important as rapport and fidelity.