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    #235123 11/29/16 09:22 AM
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    My son was recently evaluated with the WISC-V, in our effort to get to the bottom of what seem to be attention and anxiety issues.� He is 10 years old and in 5th grade. After testing, the psychologist says he is likely 2e, based on the discrepancies in his subtest scores. We�re unsure what to make of it just yet, and looking for outside opinions and recommendations from those who may have experience with a similar situation.

    Background: He was an early reader (letters/sounds mastered at 2, words at 3, books at 4, short chapter books at 5). He was put into an accelerated class in second grade based on an average of reading and math test scores (our school uses MAP). He was always uneven though; reading was always in the high 90�s while math has been inconsistent, anywhere from 70's to 90's percentile-wise. We have viewed him as a fantastic reader who was just good enough at math to get him into the high classes. His MAP scores this fall were 242 in reading (99th) and 228 in math (88th).

    We have noticed that he takes a long time to complete homework compared to his friends in the advanced class. He gets frustrated VERY easily when faced with challenge, it makes him extremely uncomfortable. In math, his teachers say he isn�t necessarily slower to understand, but slower to complete work. Most of his math errors are careless, due to missing details/instructions, not reading the entire problem, or not showing work. His teachers also notice that they can�t put him at the back of the class or they lose his attention. They have said he is not defiant, just distracted. At home he lacks focus when something doesn�t interest him, and often doesn�t follow instructions due to distraction. He can read for ages, but that�s where his area of focus ability seems to be. We've wondered for a long time if he has inattentive ADD, but the parent evaluations, and his own self evaluations, were just borderline.

    He did take the OLSAT in 3rd grade.� His overall percentile was 93rd, and nonverbal was 93rd, but we were very surprised that his verbal score was only 87th.

    On the WISC-V, his scores were as follows:
    Verbal Comprehension 127 96th%
    Verbal Expanded Crystallized 130 98th%
    Visual Spatial 102 55th%
    Fluid Reasoning 106 66th%
    Working Memory 115 84th%
    Processing Speed 100 50th%
    Auditory Working Memory 106 66th%
    Cognitive Proficiency 109 73rd%
    Nonverbal Ability Index 106 66th%
    GAI 116 86th%
    FSIQ 116 86th%

    We expected to see higher verbal scores than anything else, of course, but you can imagine our surprise when we saw the FSIQ that put him at barely outside the average range, when he�s been placed in advanced classes and the highest ability groups in a fairly large elementary school, and we watched him fluently read entire books as a 4 year old. The psychologist said he underperformed and the gaps make the FSIQ unreliable, but the GAI is exactly the same, so that's a bit confusing. (Supposedly he showed evidence of some attention problems and was also unwilling to even try if a task on WISC appeared a little too difficult, makes me want to shake him since we paid for this out of pocket!)

    The WISC was inconsistent with his relatively good performance on the nonverbal portion of the OLSAT, and the psychologist is not as worried about the verbal/nonverbal gap on WISC because he did well there on the OLSAT and is generally above average in math at school.

    However, the inconsistency overall in math, the "flip flopping" on the OLSAT, and the gap between processing speed and verbal scores he thinks point to a general classification as 2e. Gifted level abilities in the verbal area, but all else is brought down by the processing speed "problem" (even though it is average, the gap makes it a problem he says). We do see this in real life, as stated above with the time it takes to get work done at home. His opinion is that a mish-mash of factors are combining to create the second "e", those factors being attention, anxiety, and processing speed challenges.

    Does anyone agree or disagree with this interpretation? We are still processing a lot of information, but we're very interested to hear if anyone else has experience with this type of kid, firsthand experience with what kind of things can help with processing speed, whether ADD meds are ever helpful in this situation, etc.

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    First, welcome!

    It should go without saying that it's difficult to say for sure whether this formulation is accurate, since we don't have the benefit of knowing your DC in person, observing his test behavior, subtest scores, error analysis, etc.

    That being said:

    I can speculate that the evaluator may have felt the VSI was a low estimate of his ability because processing speed was a relative weakness, and both VSI subtests are timed. Possibly he saw an unusually high number of correct responses that were uncredited because of missing time limits. FRI is less impacted by timing; it is also more plausible that it is genuinely a relative weakness, since you report that your child has consistently been just a bit above average in math, while performing at much higher levels in reading, and this is the area that typically is most predictive of math achievement. If what I've thrown out there turns out to be the case, I would still consider this a nonverbal learning disability, although not, perhaps, quite a classical one. Some children with more subtle NVLDs don't start to struggle with mathematics until they reach higher level math, often the spatial parts of geometry (as distinguished from the logical proof part). In fifth grade, even GT math is fairly concrete, and essentially all some variant of arithmetic, which one could argue is actually as much a language task as it is anything else.

    The GAI is easily explained. Five subtests go into the GAI (minus the working memory and processing speed subtests): the two core verbal subtests, the two core fluid reasoning subtests, and one visual spatial subtest. If the index scores are representative of the subtest scores, then the GAI was derived from three Average scores and two Superior scores, which is pretty much the same balance as the FSIQ. A simplification: say the VCI subtests average 14, the VSI subtests average 10, the FRI subtests average 10.5, WMI averages 12, and PSI averages 10. The mean subtest score for the FSIQ would be 11.6, while the mean subtest score for the GAI would be 11.8, a negligible difference. The bottom line is that three of his weakest subtest scores are in both the FSIQ and the GAI, and one of his moderately stronger scores is omitted in the GAI (namely, working memory). GAI is not a magic bullet for highlighting all 2e learners.

    HIs history and classroom presentation, as you report them, are actually quite consistent with his current testing (with the possible exception of artifactual lowering of visual spatial measures because of low processing speed--but only your evaluator has access to that data).

    Psychostimulant meds are a discussion for you and your pediatrician. Anecdotally, I think I've seen them help with processing speed when internal distractibility was the reason for the slow speed. If it's actual processing time that's the issue, they may or may not be helpful. Sometimes they can hurt, as slow processing speed could also reflect deficits in cognitive shift/flexibility (more likely with this profile than with some others, btw, given the relatively lower FRI), and some kids hyper focus and get stuck when on psychostimulants, which makes them even slower. At this point, you don't have a diagnosis of ADHD, so I'd be hesitant to go that route without further evaluative data from someone qualified in that area (like a good child psychiatrist or neuropsychologist--not a run-of-the-mill pedi or other PCP).


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    Thank you for your response! The clarification on GAI was helpful; I'd only read that GAI was sometimes more reliable because it leaves out Processing Speed, which is often lower in bright kids anyway just due to the way they prefer to think.

    I didn't include all of the subtest scores because I'd already written a novel and didn't want to lengthen it. Verbally, his only Very Superior score (17) was in Vocabulary. Not surprising considering his voracious reading. The others were Superior. VSI, FRI, and PSI all had 10's and 11's (Average). WMI scores were Digit Span 13, Picture Span 12, and Letter-Number Sequencing 9. Working memory was the only spot that showed a noticeable difference in subtest scores.

    On one hand, I can see why the psychologist suspects an actual problem (or, as he calls it, a mish-mash of problems) that would lead him to a 2e classification. On the other hand, I could also accept that we have a kid who is verbally talented but just not the greatest at mathematical thinking. The old school part of me wants to say he's just got uneven talents; why does it have to be labeled as a condition? If it were that simple, just that he's great at verbal and not so great at nonverbal, that would be fine. Our concern is with the sometimes painfully long process that homework becomes, which will get worse in middle school, and the frustration that he shows when challenged. The psychologist said he seems to have two zones on the comfort zone chart: 100% comfortable and won't-even-go-there. He felt that our son would be able to perform much better if he'd just GO THERE. But he won't, and we aren't sure what he is afraid of that keeps him from it--anxiety is the most prominent suspect though.

    We saw real life drama from the comfort zone issue starting in 1st grade. He was given higher level verbal work to bring home (example: produce 10 sentences using pairs of homophones). My sweet child became a monster, threw a pencil, crawled under the table and hid, yelling and crying that he just couldn't think of anything. As the years have passed, that extreme reaction has evolved into fist-shaking and growling (better I suppose) but the anxiety with challenge is still there. We want to help him with that, and figuring out the source of the problem is key.

    With math, the inconsistency is what the psychologist keeps pointing to as a sign of some kind of problem. MAP testing is up and down through the years. Just last night, he faltered on a very simple fraction exercise, could not process any information without writing it down...then 15 minutes later when I asked him what half of 7 1/2 was, he quickly answered correctly with no trouble, without writing anything down. It's so strange, but it is the story of his life and his inconsistency keeps him from being able to develop any confidence. Environment and distraction were the factors that were different in those two situations last night, so maybe I need to start paying more attention to the environment when he's able to think clearly vs when he isn't.

    As far as processing speed goes, I've seen high verbal with relatively low processing speed called the frustration profile, and I would absolutely agree. He can talk all day about a topic, and his knowledge in interest areas is amazing, but when asked to write about them, you get a few sentences at best and he requires a lot of coaching. Getting his thoughts organized seems to be a problem, and when I saw the lower PSI I thought "Ahhhhh, there it is." Ah ha moment.

    The ADD Inattentive suspicion comes from the fact that he has trouble following instructions and noticing details on school work and in real life, is very careless, very forgetful, and we have to remind him constantly to focus when he is doing homework. If I ask him to go to the living room and pick up his tennis racquet, he very happily says "OK" and then walks right past it to stare out the window. We made him a list of things to do to get ready every day to try to keep him on track, posted it on the wall...he doesn't remember to look at it. Executive function is not so functional for him. He's almost a walking checklist for ADD Inattentive, which makes me wonder if trying meds would be worth it, just to see if it could bring him into focus a little better. However, your mention of deficit in cognitive shift/flexibility does ring a few bells when I think about how he operates. Hmm.

    As for a nonverbal learning disorder, some of those things fit him, but he also does not seem to have any social problems. Has always had friends, tends to have a close knit smaller group and always seems to find intellectual peers even when put into mixed groups. He doesn't seem to have problems reading nonverbal cues from others at all. However, if NVLD exists on a spectrum and you can have parts of it without the social issues, that is a possibility I guess. Worth a mention to the psychologist to see what his feelings are there.

    Thanks so much for your input!

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    It might also be worth mentioning that this particular child's frustration level is likely increased by living with a younger brother (2 year age difference) who IS math-talented, is a very quick thinker, can produce a lot of written work in a short time, and can answer most questions while big brother is still thinking. Big brother's weakness is often highlighted--at least he may feel that it is--because of little brother's talent. Sometimes I wonder how much that affects him. The frustration with challenge existed before little brother was of school age, so a lot of it is just in his makeup somehow, but I'm sure it is exacerbated by having a gifted younger brother (FSIQ in the 130's but has his own issues with hyperactivity/impulsivity and borderline OCD habits) in the house who has a talent for quick and accurate thinking--especially with math. Perhaps we should work harder on teaching him to appreciate his own talents and just focus on being the best version of himself, instead of worrying about comparisons. Easier said than done, but I do think this may be part of his unwillingness to get out of his comfort zone and work.

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    My kids sound very similar but have the opposite in terms of test scores.
    DS is kind of borderline ADHD in that he performs in the average range on the computerized test for ADHD and other executive functioning tests but in real life he can act very spacey, distracted, loses his assignments, etc. My other child is definitely ADHD, you can tell if she's medicated just by looking at her. (she looks "wild" when she's not medicated). Both of them have slower processing speed but it's hard to get an accurate assessment with DS because his motor skills are really poor and the tests involve motor skills. With DD the slower processing is evident because you can ask her what's 6X4 and she'll look at you blankly for about 8 seconds before answering. I don't see that with DS and he is much faster with assignments, tests, etc. If you get academic testing done, like the woodcock johnson acheivement, I'm guessing you would see lower scores in the areas of fluency, like math fluency, writing fluency, etc. (probably not reading fluency, though, my kids are the same, very fast and fluent readers and they read very early. I am not sure how much verbal IQ actually has to do with early reading...it probably has to do more with decoding ability and visual memory than verbal ability, IMO).

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    blackcat--Funny you should mention the multiplication problem example...most the time if you ask ours a simple math question like that, he has to repeat it aloud, slowly, and look around for a few seconds before he can answer it. He was able to pass his timed multiplication quizzes in 3rd grade, somehow, but now that he never drills on those anymore, he's very slow to process that and most other simple math problems. I guess the difference may be that he's not pulling from his immediate memory the way he was when he memorized the facts.

    He also took a computerized test for attention, maybe the same one, had to only click certain things as they appeared on the screen. Diagnosed ADHD kids scored about 47/48 on that, and he scored about 51. Not far off, but not quite there either. He only clicked one that he shouldn't (I guess that means not so impulsive) but did miss several that he should have clicked. In his words, trying to focus on something he isn't interested in is "kind of like trying to lift something that weighs 2,000 pounds" which sounds pretty difficult to me; but then people say of course he doesn't like to focus on things he doesn't like, he's 10!

    I'm not sure about the correlation between Verbal IQ and early reading either, his history of interests and abilities just seemed to match with good Verbal scores so I wasn't surprised by it. Even when he was 18 months old and playing with his Leap Frog fridge toy, a talking toy with letter and number inserts, he'd plug in letters all day long to hear their sounds, but if I put a number in there, he'd turn his head and say "NO". Rejected numbers completely while he was soaking up the letters, he was probably 3 before I was able to talk to him about numbers. He was making a choice even then.

    Thanks for your input. Even if it doesn't solve problems, it still helps to hear from people with similar real life experiences! The psychologist said the next step would be some academic testing, if we're interested. We may do that.

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    Just wanted to note that my daughter (w/ obvious ADHD) did the conners computerized test as well and scored in the average range. I think it misses some kids. In my daughter's case I think it was because it's a controlled setting with no distractions in the room which you would get in a chaotic, noisy classroom. Probably same with my son. A lot probably depends on the effort/motivation of the child at that particular time and trying to get a good score, kind of like a computer game.

    Back in third grade I worked with her a lot trying to make her fluent w/ math facts and she would always improve in terms of speed, but then regress again days or weeks later. The neuropsych said she should have accommodations for math, like a cheat sheet for the math facts, calculator when appropriate, reduced amount of problems, etc.


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