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.

Gus, my DD8 has a very similar wisc v profile and behavioral quirks--reversals, margins, hates puzzles, misses pluses and minuses. Her biggest handwriting hangup was spaces between words, and that sorted itself out in the past 6 months. Now her biggest struggle is her dyslexic spelling.

I was wondering what kind of math your DD has been asked to do. DD8 is in 3rd but it's accelerated a year maybe such that she's currently working on adding fractions with different denominators. While DD struggled with memorizing addition and subtraction facts (she kept using fingers and worked a little slower--99.8-50th processing speed there?) she easily memorized multiplication facts and has no problem with harder concepts despite a visual perception deficit--even in geometry (so far). I'm wondering if your DD will do better with harder math too.

DD does still have problems with neatness that affects her accuracy, but thankfully it's not affecting her understanding of the concepts. For example, she's likely to mistake a 0 for a 6 in her scribble at the end of working out 64532/41 and get the problem wrong, but her sloppiness is not affecting the overall process.

I don't have experience with wisc V so can't comment specifically on that, but we have experience with Wisc IV. My dd was tested right after she turned 8 and she is now 11. She also has a big problem with math fact fluency, however her math MAP scores are high. She does the same thing with her writing, in that each line starts further to the right than the last one. She says that when she is writing, she doesn't even really notice she's doing it. Her WISC profile is completely different though. Her perceptual reasoning score was 147 with matrix reasoning, picture concepts (which may not be on WISC V) and block design all being in the 16-19 range. I think she hit the ceiling of the test for matrix reasoning. She is very good at puzzles but has an odd way of doing them. She doesn't even look at the picture on the box half the time. She pulls pieces randomly out of the box 1 by 1 and somehow knows where tehy should go. I'm not really sure how she is able to do them that way. She says that she doesn't take them all out of the box at once because seeing too many pieces causes anxiety.
She has a dx of ADHD and an IEP and the neuropsych thinks her challenges stem from impaired executive functioning, for instance problems with organization. She did pretty poor on a test called Rey Complex Figure where her approach to it was really disorganized. With the math facts, she's not able to retrieve them from memory quickly, no matter how much effort we put into learning them, she will improve for a while in terms of speed but then any gains are lost if we don't drill all the time. He said to just do accommodations (like use a calculator). She was around 9 when he said that though, I think with most younger kids it's too soon to give up. Not sure if this helps you at all but thought i'd share our experience.

Gus, Reflex Math is a fun online math fact game for kids that you could try with your DD. Interesting Sanne, I didn't realize that at age 11 highly intelligent students EF typically exceeds that of peers. I wonder if that has been the observation of parents of gifted children IRL. Personally I have noticed that my DS had more EF issues earlier and that now they are mostly concerned with issues related to organizing himself and his materials (he is able to organize his thoughts really well in essays). I wonder what other parents experiences have been.

Thanks for these additional thoughts and suggestions. It’s helpful to hear about others’ experiences.

DD is working on a 2nd grade common core curriculum, Ellemenope, where the main focus has been on learning to add and subtract double digit numbers. DD isn't a mathy kid, but she could do that in K. So, it’s an awkward fit. DD is under-challenged conceptually, but still needs to practice those basic operations. Kids in her class are offered enrichment work only after they’ve finished their regular classwork. DD never gets a chance to work on harder math because she’s slow. She’s bored and frustrated and sees that her peers are grasping it more easily than she is. She has started asking me for harder math and asked to work on LOF over the summer. I can test how things go when DD is offered more advanced tasks and concepts -- alongside her basic fact practice. I totally agree, Blackcat, that it’s too early to give up work on basic math fact fluency.

Reflex Math looks interesting, Stemfun. Thanks for the rec. I’ll have DD give the free trial a whirl this weekend. If she finds it engaging, it would be a nice break from other forms of practice and well worth trying.

When my son needed practice, but was bored with math facts, I wrote out problems that used the math facts he was struggling to remember but presented them with a novel piece of information. I would identify the specific math facts he had trouble remembering and hand write out worksheets with problems that used those numbers frequently, mixed in with just enough that he didn't notice. My son also did well with "big numbers". Rather than give him 10 2-digit problems, I could give him 2 10-digit problems. For subtraction, it's the same amount of borrowing, but the novelty of "big numbers" makes it more palatable.

If she has a tough time with 5+7, you can write out 132 - x = 75, for example. Or a story problem like the perimeter of a rectangle is 132, two of the sides are 75 cm, how long are the other 2 sides. This would be a great time to introduce decimals and calculating money. One of the activities I did with my son was to take him grocery shopping and have him add up everything I put in the cart and check at the cash register. (Very, very slow shopping trip! LOL). He liked this activity a lot, although he never had the right answer in the end!

If you're not interested in presenting new material, you can make targeted worksheets at math-aids.com. Their 0-99 addition worksheet would be just right, as you can customize the top and bottom addends and the number of problems per page. http://www.math-aids.com/Addition/Zero_to_99.html. By focusing on a small set of numbers at a time, you can help her improve fluency with less repetition. Mixed problems with decimals worksheet might be useful also. http://www.math-aids.com/Mixed_Problems/Decimal_Worksheets.html

Does your daughter's accuracy drop with the number of problems? You might be able to negotiate reduced length of assignments for her. This worked very well for my son. If he could do the last 5 problems right (the hardest problems), then he could skip the other 25 and move on.

My son benefitted emotionally from collecting data on his incorrect problems. I had him make a chart of his mistakes and their frequency. He began seeing the patterns of his mistakes being "wrong operation" or "copied the problem down wrong". This helped him feel more competent and more control over the situation. He had a list of his 3 most frequent mistakes and could check his work for them.

I would also suggest giving her 2 highlighters. Before she starts a worksheet, have her highlight the operations with a color code.

If she has trouble keeping numbers lined up in columns, have her turn looseleaf paper sideways! Super handy trick!

Sanne, I just wanted to thank you again --- these are fantastic suggestions. I will give it all a try.