Gifted Issues Discussion homepage Forums Twice Exceptional Thoughts on uneven test results?

My DD8 had a private neuropsych. evaluation last year when she was in 1st grade (7 year, 1 month old). Her WISC-V scores were very uneven. Generally speaking, the evaluator characterized DD as having areas of relative weakness not amounting to deficits. This conclusion was based in part on the fact that DD’s WISC-V subtest scores generally averaged out to be no lower than “High Average.” In her report, the evaluator did note that DD was slow to produce written output; that her retrieval of information is not exceptional; that she does not appear to enjoy tasks in which she must shift sets quickly; and that she could be inefficient/methodical-to-a-fault in problem solving.

I’m hoping that folks on this forum would be willing to give DD’s test results a second look to see if the patterns of highs and lows are suggestive of a learning challenge or deficit. Is there additional testing you feel would be valuable? We are seeing DD’s neurologist in a few weeks and it would be a great time to reopen the conversation.

IRL, DD has weak fine motor and handwriting skills, weak executive function skills, and is fairly inflexible in her problem solving approach. Despite having 99th% MAP scores, DD struggles with basic addition and subtraction facts. On math worksheets (but not language arts), she regularly skips/misses problems or performs the wrong operation (adds instead of subtracts, for example). She also seems to struggle with visual-spatial tasks. She has always refused to do jigsaw puzzles. The few times we’ve done them she doesn’t seem to “see” the relationships between the shapes or colors on the pieces. She rarely played with blocks when she was younger, and when she did her buildings were never straight lines and they were always one story tall. She never built up. She struggled to learn which way b&d face in first grade. She seems to have learned that now but still asks me from time to time. When she writes long paragraphs on lined or graph paper, they are not justified to the left margin. They start out that way but each line indents just a little further to the right so they end up looking like inverted pyramids.

If it’s helpful, I’d also mention that DD has Tourette’s and a history of anxiety and sensory integration difficulties, although I do not feel that these are significantly impacting her current functioning or that they impacted her testing results.

Thanks very much in advance for any thoughts.

I don't really see an LD that jumps out. The only thing I would keep an eye on is the orthographic processing (rapid naming is a little low given her other language scores) and the immediate learning on the CVLT (although that really could be a function of age and a long testing session) is a little below expectations given her extremely high working memory scores. The orthographic processing is normal now but she is also young, so you could see a shift there later as same age peers have an improvement in their skills. Do you see anything with your daughter that concerns you? That is the biggest factor to consider. Also remember that to count as a learning disability the DSM 5 states that the scores have to be below average (typically below SS or 90) to be considered a learning disability. So relative weaknesses in very bright children do not count unless you are able to establish a functional limitation.

I believe that the correct way to assess weaknesses is comparing to the child's abilities, not the norming, and measuring in terms of standard deviations. 111 to 150 Seems significant to me. Do you have the percentil rank for those scores?

A large discrepancy between verbal comprehension and processing speed suggests ADHD. At 6 years old, my son's verbal comprehension was 114 and processing speed 88 - a spread of 26 points, his neuropsych commented it was the largest discrepancy he'd ever seen. In terms of percentile rank, it's the difference of 82nd to 21st. Your daughter's spread is larger on the composite score scales!

Behaviorally, this sounds like ADHD to me, and possibly something else affecting her handwriting. Poor handwriting is associated with ADHD, but weak fine motor skills makes me wonder if she might simply lag in fine motor skills or if it could be part of dysgraphia.

My son has ADHD diagnosis. He struggled with slow output, slow writing, skipping problems, doing the wrong operation, struggles to recall math facts, inflexible problem solving, inverted pyramid writing like you describe. My son could not do visual-spatial tasks. He also refused to do puzzles. He could not sweep, vacuum, or wipe a surface - he can't keep track of where he has been or plan where to go next. He had 99 percentile on MAPS tests, so I didn't think anything of it until he starting having more severe emotion and behavior problems and anxiety.

With ADHD treatment, the anxiety is gone. His IQ popped up about 30 points and GAI calculation even higher. My son accelerated dramatically in school with ADHD treatment too. He still struggles with math fact recall, but it hasn't held him back more advanced math. He can sweep/vacuum/wipe. He likes puzzles now. His play is more imaginative and productive.

I would suggest reading through the diagnostic criteria for ADHD and reading about the difficulties in identifying ADHD in girls. Also check out the relationship between Tourette's and ADHD!

ADHD is a disorder of difficulty modulating attention. It's not an attention "deficit" per se. A person with ADHD might not be able to draw attention away from sensory experience. I have ADHD too, the first thing I noticed when I got treatment was I was not bothered by sensory overstimulation and distress. Perhaps her difficulty with sensory experiences was difficulty modulating attention, as part of a ADHD cluster of symptoms?

I also need to mention that it's a normal pattern for highly intelligent children to have executive functioning lags - as compared to age peers - until age 11, at which point their executive functioning exceeds that of age peers. It's also completely normal for highly intelligent children to be more likely to have sensory difficulties than their neurotypical age peers.

This brings us to a point where there is conflict. Some people strongly believe that these struggles are normal and part of being "gifted". Some people believe they're not.

My personal opinion is based on the sensory part. About 30% of the general population fits into the highly sensitive group, while about 50% of the highly intelligent population are highly sensitive. This indicates to me that what the gifted community calls "overexcitabilities" (and the rest of the world calls "openness to experience") is not so strongly related to intelligence that it is "just part of the deal." If symptoms are causing your child to be distressed or are causing family conflict, it's worth look at the situation outside of the lens of "normal for gifted".

I would offer a few perspectives:

1. DSM-5 criteria for learning disorders are not universally accepted, and in fact, there is considerable disagreement with them in the LD field. The ICCD (international diagnostic standards) is more in alignment with the position of many of the leading researchers, and takes into account achievement expectations based on ability, not only normative expectations. So even if this doesn't meet DSM tests for LD, it may meet ICCD criteria (which, btw, are still the diagnostic codes used by Medicaid and Medicare).

2. Regardless of which medical diagnostic standards are used, educational disability has its own standards, with mostly overlapping federal, state, and local standards. Federal standards allow the use of either normative weaknesses (typically in RTI states, and typically - 1SD, or below 85 standard score/16th %ile) or personal weaknesses (typically in severe discrepancy states) to be used as the criteria. States have made their own decisions as to whether either or both of these standards may be used for determining special education eligibility.

In your child's case, the severe discrepancy definition might be applicable, but the normative weakness one likely would not, with some exceptions. OSEP guidance on ADHD in particular (but this is actually applicable to other disabilities as well) has stated that eligibility decisions cannot be based purely on grades or achievement scores, but should also consider the effort and time expended to attain those performance levels.

3. I am struck mainly by the marked difference between verbal/auditory tasks and nonverbal/visual spatial (including processing speed, rapid naming, and digit span backward, which is often associated with visual memory strategies) tasks, a difference which is not restricted to motor-involved tasks (though fine motor does appear to exacerbate the weakness a bit).

The cognitive profile is borne out in the achievement scores, with the weakest areas (pretty comparable to visual spatial cognition) in math computation and especially math fluency, which aligns with the rapid naming relative weaknesses and fine-motor processing speed. Interestingly, oral word fluency, which is a retrieval fluency task using a meaningful semantic cue, was much stronger than the fluency tasks using rote or linguistically nonmeaningful materials.

4. The IRL concerns you list are largely ones that are found in the Tourette's population, so you don't necessarily have to reach for a new diagnosis to explain them. But comorbidity of Tourette's and ADHD is also very high (63%: https://www.cdc.gov/ncbddd/tourette/otherconcerns.html), so that might be an avenue to explore if there are treatment options you would consider. The same source found LD comorbid at 47%.

5. If your child is already on an IEP, it should not matter what eligibility classification is listed; the IEP goals and services should be designed around the child's identified needs, not locked to the named disabilities.

Thanks so much, everyone. I really appreciate it.

My DD doesn't have an IEP. She attends a private school, and to be honest I hadn't thought things through that far. I was approaching the question more from the perspective of trying to understand her learning needs and making the most of the time we have with DD’s neurologist. Part of my question, though, is how/where one draws the line between a relative weakness and a disability. Perhaps it’s not the correct/sole question to be asking if the goal is to promote best functioning regardless of whether medical or educational disability standards are met.

To your point about concerns, sallymom, foremost on my mind has been her difficulty with math and wondering about dyscalculia. DD's school really emphasizes math fact fluency. We practice A LOT. She's trying so hard and it just doesn't stick. I find it hard to reconcile that the child who can memorize lines from a play on one reading can't reliably and instantly remember what 6 + 4 equals. That, coupled with visual spatial weakness, had me wondering about an LD. I also wondered whether there was a common thread to the highs and lows in her subtest scores. From what you are saying, aeh, it sounds like they break pretty consistently along the verbal vs. nonverbal/visual spatial divide.

Your DS sounds so much like my DD, sanne. I need to double check my recollection, but I think that the VCI was >99.9th percentile while processing speed was at 77th percentile. I will do some reading on ADHD and raise the question with DD’s neurologist. She has been on an extended personal leave. This will be the first time we’ve seen her since receiving the neuropsych results. ADHD was one of the referral questions. DD’s examiner ruled out ADHD but I’d like to hear the neurologist’s thoughts.

Thanks again, all.

On a practical level, many parents of children with a similar profile have found success with Times Tales, using narrative mnemonics for multiplication facts. There is a somewhat similar product on their website for addition and subtraction: http://www.timestales.com/TwoPlusTwo.html

I haven't tried it, but it appears to be inexpensive enough to give it a try.

There are also resources like the Times Alive videos and equivalent addition product at City Creek Press: https://www.citycreek.com.

To read about a variety of identifying clues for LDs, and approaches to best functioning at home and at school Understood.org may be of interest, including this webpage on learning disabilities and this webpage on ADD/ADHD.

To read about identification, eligibility, IEP/504, etc, Wrightslaw may be of interest, including this index of topics and this webpage on eligibiity.

Thank you, aeh. You anticipated my next question. I just ordered Two Plus Two is Not Five, and bookmarked the other resources. Will report back on how Two Plus Two works for DD (sample size of one kiddo, I know).

Thank you for the links, Indigo. Your roundups are really helpful. I was up this morning reading EF links that you posted for another forum member.:)

You are very welcome. I began building a roundup of roundups here, gathering together some links for topics which are discussed frequently. If you find something helpful, please pass the link along to possibly help someone else... there are always new members seeking information. While we live in a golden age of information availability, the downside is that locating a helpful resource can be like finding a needle in a haystack. Hopefully the roundups are more needles than hay.