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

Hi,

I posted on the general discussion forum but I think this one is the one I really needed:

My 12yo daughter was given WISC-V and the results are the following:
VCI-130
VSI -144
FRI - 125
WMI - 115
PSI-108

FSIQ = 134, 99%ile

The huge difference between VCI-PSI and VSI-PSI (1.5-2 STDs) is supposedly a hallmark of ADHD? She has zero hyperactivity, but inattention issues are rampant... Very sweet and loving otherwise. It doesn't affect her school grades to a very large degree (one or two Bs only, mostly due to missing/incomplete assignments), because she can compensate for it and because I help with non-stop reminders.

What have you done if you have a child like mine? Have you diagnosed, medicated? Have you tried anything caffeine, omega3/6, specific exercise (we do swimming already)?

My younger son hasn't been tested, and he is very bright, but his attention span is vastly different from my daughter - he can concentrate like nobody else, so I don't think this is typical in all intelligent kids.

A relative dip in PSI happens with some students with ADHD, but it can also be due to quite a few other things, or it might mean nothing at all other than a relative weakness in abilities. The tricky thing is that there are other types of challenges which can appear to be inattention when they aren't recognized and accommodated. Has your dd been through an actual ADHD evaluation (which would include behavioral surveys for parents and teachers, plus possibly other types of tests of executive function and attention)?

Best wishes,

polarbear

Thanks for responding!

The psychologist who gave her IQ test didn't suggest that she needed further ADHD testing, even though I asked about it.

Instead he sent me a publication that showed that "average" gifted group of children would score very similarly to my daughter - (VCI 131.7, PRI - 126.4, WMI - 117.7, PSI - 104.3). And I agree that it could be something like that, but...

The reason I even started researching this is that she tends to score significantly worse on the standardized tests like Cogat or Iowa. Some results go as low as 75%ile, suggesting that her academic results at school are more correlated with her WMI/PSI than her other subscores, indicating a potential learning issue. Also, things like her CogAT scores can just jump several stanadard deviations, test to test - one year scoring in 98% percentile on verbal and the next scoring typically - in the 55%. Something is going on....

What do they typically assess during ADHD screening? Would she be able to compensate for it with her high cognitive abilities, masking the problem?

It may or may not reflect ADHD, as there are many possible causes of lowered WMI and PSI. Keep in mind, btw, that there are three main subtypes of ADHD--primarily inattentive, primarily hyperactive/impulsive, and combined. So the absence of hyperactivity is not per se incompatible with ADHD.

I also have a child with some traits of ADHD, but no apparent significant effects on major life functions. Mine has a school history (now we homeschool) of being consistently responsible, high achieving, and socially-adept, but is both distractible and impulsive (and talks non-stop!). I am pretty sure that the main characteristic that would be missing in a diagnosis is pathology--which, of course, is the only one that really matters.

If the inattention and Index discrepancies aren't playing out IRL as restricting her access to anything of current or future importance to her, then it's just another one of those things to know about oneself, and learn to manage. My approach is to make healthy self-care choices, monitor academic progress and general happiness, and admire it as the beauty of human diversity.

Why did you chose to homeschool?

The time at the elementary school was great. She was in the gifted program and enjoyed it tremendously. Switching to the middle school this year brought two unpleasant things - she didn't re-qualify for the gifted program (!?) and the social aspects of being in a larger group of students seriously bother her. I started thinking of switching to a local gifted school (they require 130 WISC as their entrance criteria), but it comes with a lot of complications, such as lack of bus service and the school being somewhat small. We specifically moved to an excellent school district ten years ago (and pay rather large real estate taxes), so it is just difficult to rationalize the move from the best schools in the country to an unknown school with the emphasis on gifted. At least not yet. Homeschooling isn't an option for us - both of us work and I am also in the middle of my doctorate, so not right now.

We tried to do a lot outside of school. Some stuff she enjoys and some she doesn't. She loves music and plays piano beautifully (better than I ever was). She doesn't really like swimming much, but I believe swim team is very important for her overall health so keep pushing it on.

While I am a great supporter of human neurodiversity (my younger son has some Asperger traits which I treasure), I also think that realization of the big dreams and potential that she has is more important here, so I would like to find a way to help get through the confusing middle school years with more confidence in her abilities, focus and sustained attention.

My son has very low PSI & WM scores compared to his VSI & VCI scores. He has never been diagnosed with ADHD nor have I ever heard of such a correlation. There are other tests for ADHD, but I don't know off my head what they are. And no we haven't medicated for it since he wasn't diagnosed.

I have 2 kids both with wide differences between VCI and PSI (and also PRI and PSI - they both did the WISC-IV) neither has been diagnosed with ADHD. DS9 has a 4 SD gap and we started this adventure into gifted because the school was convinced he had ADHD-Inattentive. He's now been through 2 full rounds of testing and both times he didn't come out with an ADHD diagnosis (he does have an LD in written expression though). He also did not test well on the Cogat. This year he moved to a gifted class and school has been going really well for the first time. He can focus really well when he is interested/challenged and properly accommodated for writing tasks, otherwise not so much. We've also spent a lot of time talking about how to deal with the frustration he feels with dealing with the LD challenge.

DD7 has a 2 SD gap and no one has ever suggested ADHD for her. We mostly tested because of her brother's scores and TBH I'm still kind of surprised at how similar the results were because in real life they are very different kids. She's breezed through school so far although this year we're starting to see cracks in her tolerance of "boring" worksheets.

My DS and DD also have similar presentation in SD differences, and in fact, slightly lower PSI. I've been told it's fairly common among gifted kids, and nobody has flagged ADHD for either.

DS has some visual processing issues, but both of them are on the careful and meticulous side, and think things through. He has no attention issues at all that I can tell. DD maybe has some executive functioning challenges, isn't a great speller, and she kind of daydreams.

Our reports didn't suggest ADHD but did suggest things like possibly allowing more time, avoiding timed math tests like minute math, or allowing them to do more difficult questions rather than all of the questions -- advice our school doesn't seem to follow, but hasn't really even been an issue, but if it is for your DD, perhaps it's worth mentioning? I've explained to my kids that fast in math doesn't equate to good at math, and they are cool with that and both feel good at math despite not being the fastest in class at timed math, because they are really good at reasoning and getting their actual work done easily.

I have a different perspective on this, because my child is older - 12 and in middle school. What I thought was intolerance to boredom and lack of patience for certain tasks in the elementary school was in fact some struggle with focus and sustained attention. I remember thinking that her mind restlessness/daydreaming was a good thing and more or less an indication of creativity potential and ability to think out of the box, but I no longer think like that.

Elementary school being easy/boring was actually a very bad thing because it didn't teach her responsibility, study skills and work ethics level, which are critical in the later years of schooling. She flew through minute math or book reports or "science", never needing to practice before the test day or anything else.
On the parent's side, the school being easy didn't flag the need for more organizational/structural support at home.

PSI+WMI equates to what psychologists call executive function or EF. What they say is that typically, unless the child is very obviously affected, the EF doesn't play a big role in child's life until much later, but once it does it may have a bigger impact on child's life than the first cognitive scores combined (GAI) and I tend to agree with that. My daughter currently scores at the level of PSI+WMI on standardized tests instead of VCI+VSI+FRI as she should. PSI+WMI being low seems to be common in high FSIQ individuals, and it is hypothesized that it may account for a significant rate of high school dropouts among high IQ individuals (up to 20%, which is higher than for kids with above average IQ).

That's why I am here. I am absolutely sure it isn't too late and I am looking for solutions. I don't like the idea of medicating my child, and the current research shows little effect from stimulants on the academic performance, but it does seem to address the executive function in the child to some degree and I am 100% sure that lower PSI+WMI scores and somewhat lower academic achievement are completely related to that at the older age.

I want to start small and see if simple changes in routine, diet may help, but don't know where to go with and there is so much "noise" on Google as to what actually helps, specifically in case of gifted children. I've read that 100mg of caffeine has the same action as low-dose stimulants and is safe in older children (she is physically a young adult). 100mg is an equivalent of a cup of coffee. The research is iffy on this subject for ADHD patients but seems to support the idea of memory, focus and attention increase in otherwise healthy people. What do you think? Is that crazy or us, adults, clearly benefit from it, so why can't an-almost-adult do it too? Would CBT therapy be useful (cognitive behavior therapy)? Any recommendations on how to boost organizational aspect of her life?

One last point... I agree that to be diagnosed with ADHD one's attention levels have to be below typical, as in below 85 or at least 100 on PSI and WMI on WISC. She is 115/108. So it isn't a true ADHD, but it is an issue regardless, because it inhibits her ability to reach her true cognitive potential.

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.

Wow, polarbear! Thanks a lot for taking so much to answer my concerns!



How old is your son? I think our challenges are similar to yours, but to a smaller degree, because the school helps organize her homework and makes a lot of it accessible on the google drive system electronically. All kids have school google chrome laptops. As a result, she remembers herself without any reminders about 90% of her homework. I help with another 5%, but another 5% is missed/incomplete/turned in late. She is also pretty neat when it comes to her bedroom and her locker - something that came out from years of teaching her to do it and my personal OCD-lite, regarding house cleaning and general order in the house. One big challenge is not studying at all for tests, quizzes etc. Again due to good organization at school, there are a lot of electronic study tools available to them, so there is no one-on-one with books anymore, which is good for now, but could be a disaster-waiting-to-happen. Another challenge is difficulty with standardized testing, specifically with reading comprehension parts. For example, if you look at the subsections of her Iowa test, vocabulary section could be in 96-99%ile, but her reading comprehension scores in 55-75%ile, resulting in scores much lower than required for gifted program in the middle school. She loves to read and isn't dyslexic at all, but reading about things that are of no interest to her needs work and I would appreciate some pointers on how to teach critical reading skills to her. What do you think is behind that?



I fully agree with that. It is easy to see similarities in your children, but difficult to see their individual challenges. For a while, after seeing somewhat lower standardized scores, we started thinking about things like regression to the mean in terms of IQ scores in children, but getting her IQ tested was very reassuring and encouraged me to reach out to your community to try to address her specific problems, instead of assuming that she just wasn't that gifted.



Do you think something like a Wobl watch requires some coordination with the school district? Should I let them know?

A great starting point on executive function is Peg Dawson's book Smart But Scattered. Lots of help understanding where and what the problem points may be, and practical ideas for dealing with them. She is especially good at helping you think through how to dig down to the underlying causal issue that needs help, as opposed to the more visible symptoms.

Another good resource is the website ADD-itude. Rather overwhelming sometimes (where is the irony emoji?), but it has a ton of practical suggestions for supporting and building executive function challenges.

http://www.amazon.com/Smart-but-Sca...1144&sr=1-1&keywords=smart+but+scattered

http://www.additudemag.com/resource-center/adhd-at-school-better-organization.html

DD's lowest score in the WISC was 94 for processing speed and working memory was around 126 or 127. However, she is a pretty extreme in terms of focus issues. It can take her 3X longer than anyone else to do a math test, even if she ultimately scores very well. Every time Dh or I have entered or exited the school building when she is in class, I can count on her to say later on "Hey, I saw you walk out of the school building (out the window) while I was in math (or reading or writing), what were you doing?" She is actually much more scattered when she is not medicated. One day I forgot her meds and when I realized they were still on the table, I emailed 2 teachers asking if I should bring them in and within 5 minutes they both emailed me practically begging me to bring in her meds because she's not able to function otherwise. I don't think absolute numbers on IQ tests (like below 100 or below 85) should be used, but rather, if there are large discrepancies. In DD's case her GAI was 150 and processing speed 94.

The neuropsych gave her a test called "Rey Complex Figure", which assesses EF ability, and her score was pretty bad. Seemed more accurate than the WISC scores in determining poor EF.

How do you calculate GAI based on scaled subscores? I found it for WISC-IV but I can't find it for WISC-V (WISC-IV conversion isn't applicable because they used six subscores in IV and only five for V for GAI calculation). I know what sub scores are used in GAI, but I don't know how to translate the total into a standard score. It wasn't reported together with FSIQ. Thanks!

Thanks a lot!

Long term assignments surprisingly aren't a problem. It is day-to-day stuff that is difficult for us. Most are due the morning after they were given so there is very little opportunity for me to intervene. I'm setting an iPhone calendar to do daily reminders, so we'll see if it works....

I'll contact our psychologist about this. Summer time sounds a great opportunity for us to start this. I found metaanalysis of CBT studies. The strongest results are in the area of anxiety, control and stress. Not much in the inattention area. It looks like it is more typically done in adults, right?

It's not freely-downloadable. Post/PM me her subtest scores, and I can calculate it for you, if you like.

Yes, CBT historically has been done with adults and adolescents, because of the level of cognition needed for it to be effective, but a bright child certainly can be successful with it. Typically, anxiety, stress reduction, depression are some of the concerns for which it has been effective.

You might try setting a daily reminder for doing her homework, and possibly one for putting it into her backpack. It also helps to have an afterschool homework routine and homework office, so that the environment becomes part of her scaffolding and cues.

There are also some good strategies in HOPS, which is a systematic homework intervention. https://nasp.inreachce.com/Details/Information/4855787c-7a1e-47d7-94cb-9e9aa942c495

CBT in a nutshell: thoughts, emotions, and behaviors interact. Emotions are the most difficult to change intentionally. By changing a behavior or thought, the hope is negative emotional state is reduced.

So if a person learns to recognize negative thoughts and replace them with more positive ones, the body/brain can calm down and be more effective.

Person learns relaxation techniques (combination of cognitive and behavioral) and feels less stress, more able to access rational thoughts/strategies.

The homework interventions for EF deficits are behavioral. Person uses strategies leading to increased self-efficacy, more positive emotional state results.

There's nothing magical about using a counselor, but for some people it's helpful to have an objective listener to help with insight into processes. Most tuned-in parents "do CBT" with their children all the time, naturally, but we can't really be objective.

As an aside: we may try the caffeine experiment in this house, over the summer. I have a son with pretty severe EF deficits and also anxiety. He has a really hard time with stimulant medications. They help with impulsivity and sustained attention, but do nothing for organizational problems, and the side effects are very not fun. I wouldn't choose this route unless you are seeing pathology.

My DD's WISC testing showed 4sd difference in her GAI and her Processing speed. Her GAI was 157 (or 170 with extended norms) but processing was 103.
This was a red flag for our Psych who then put us in contact with an ADHD specialist. He ran observations, looked at videos, filled out a million questionnaires and eventually dx her with severe ADHD. In hindsight, it was obvious. He didn't query the IQ scores discrepancy.
We now homeschool and she is medicated which has made a huge difference, but she still needs list, reminders, help with planning and organisation as well as intensive exercise daily. We can do intensive school work in the morning...lots of subjects for about 20-30 mins at a time which helps keep her focused.

How old was your daughter when she was diagnosed? Did you chose to homeschool because of high GAI or because of ADHD? Did she go through any standardized testing at school - PARCC, Iowa etc before you decided to homeschool? If yes, was it as high as her GAI or as high as her processing scores?

She was 8 when diagnosed.
We chose to homeschool for anxiety reasons (she is selectively mute) but also school reasons. ADHD wasn't a factor in the decision, but her general mental well being was. The anxiety was tied up in the academics or lack of.
The ADHD is more managed now she is at home, plus all the secondary aspects of it can be monitored, e.g. she forgot to eat and drink at school, so we can now stop the after school food meltdowns, we can exercise her more etc.
The only other testings she's had were the WPPSI at age 5, she still scored very high but with a big discrepancy between PSI, we were testing for issues with verbal and receptive language (for the mutism) so didn't look at why there were the variations in scores. She's also done Ravens (as part of an ADHD study)but the only reported score was 99+.

Is maladaptive daydreaming (MD) a real disorder, different from ADHD-PI?

After reading quite a lot in the last couple of weeks about inattentive ADHD, including some of the references provided here, I found MD mentioned a couple of times and realized that it describes what is going with my daughter closer than ADHD-PI. I understand it can manifest similarly and definitely can result in lack of attention in class and reduced focus, but, correct me if I am wrong here, ADHD inattention is slightly different in nature and isn't caused by overactive imagination, but more like issues with impulse control, emotional regulations and anxiety, making it difficult for the child to focus even if she wants to.

The most common ways to address MD are the same things already suggested here - reminder watch (arriving today!), caffeine, CBT, diet, sleep...

The reason it caught my attention so much is because it describes me even better than my daughter, specially when people mentioned that they look forward to times of the day when they can indulge into their daydreaming guilt-free. For me it is the swim practices for my kids, night time etc. I know low interest things are a huge trigger for me, even during the work meetings. I sort of stay tuned in, but with minimal attention to the details. I am no Walter Mitty though. Not yet anyway.

Maladaptive daydreaming has come up several times; here's one of the more detailed threads:

http://giftedissues.davidsongifted.org/BB/ubbthreads.php/topics/202725/maladaptive_daydreaming.html

I don't believe there is a DSM for MDD.

From what I can tell the difference between MDD and regular daydreaming is the addictiveness. There is some anecdotal evidence that it may be sometimes treatable with SSRIs. I spoke to someone whose career is psychiatry and they felt that it was part of Fantasy Prone personality. https://en.wikipedia.org/wiki/Fantasy_prone_personality

I think with gifted kids that it is natural based on being a child and having a vivid imagination that they have these types of experiences, without it being MDD. However, it could also be Non-Autistic Motor Stereotypy - which has a much better prognosis and a similar description.

MDD's main characteristic appears to be the addictiveness of the fantasies (most prefer their fantasy worlds to reality, so much so that they remain in their worlds the majority of the time to where it affects day to day life on an often profound scale).

Just want to provide a quick update... I think I'm finally moving in the right direction here.

First of all, the three things we introduced in early May (reminder watch, caffeine and iPad schedule) paid off - she got straight As for the first time since they started grading in the 3rd grade (she just finished the 6th). Yay!!! It was great to see her getting through the final weeks/tests without bombing anything!

Second of all, I finally got in touch with the school regarding her focus issues, bouncing grades, unstable scores etc... and was surprised about how open they were to an idea of providing extra monitoring, counseling etc - basically putting her on the radar finally. It doesn't require a 504 - it is done as RTI - intervention for the first year.

So thanks to everybody here for the great advice and motivating me to act!!!
Feels great to finally be doing something.

That is fabulous news! So happy to hear she's experiencing success.