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I am writing to seek advice about what kind of evaluation I should seek for my son and if anyone has a recommendation for the Bay Area.

My son has always experienced problems related to writing. He had difficulty with handwriting and struggled to put words onto a page. His handwriting was oddly spaced and he seemed to visibly pause before writing every word, like there was some kind of issue with translating his thoughts onto the page. His writing was very different in character from the quality of thoughts and ideas he expresses verbally. I have checked in with teachers several times over the years and they were never concerned enough to recommend an evaluation. They recognized it was an area of relative weakness for him but not relative to his peers. I often wondered about dysgraphia but my son is an excellent speller and doesn’t seem to have other symptoms of dysgraphia. I had hoped that once my son could use a computer, some of these issues would disappear.

My son is now in third grade and continues to struggle with some writing tasks. Specifically, he has a hard time, when doing a report, figuring out which facts are important to include and then getting it down on paper. Reading comprehension doesn’t seem to be an issue. He can read at a very high level and demonstrates sophisticated understanding- as one would expect from a child who tested in the 140s on the verbal portions of the WPPSI. He really struggles, however, with tasks where he is supposed to read a paragraph and pull three important facts from it (for example).

When my son’s class recently did reports on a historical figure my son’s paper was one and a half pages long. He worked on this paper for eight weeks. It was well written and insightful but he really struggled with figuring out what biographical facts he should include and needed a lot of scaffolding to get anything on paper. Other kids’ papers were 5-7 pages and my son noticed that and felt really bad about it. He did note that copying facts down seems problematic because he doesn’t want to infringe on any copyrights. He has often expressed reservations about regurgitating material instead of expressing a new idea- but I don’t think that is the main barrier. He told me he just cannot figure out what facts are important and should be included.

Other writing tasks do not seem to pose a problem. My son has been into writing creative stories at home and he is able to write one or two pages in a half hour. Yes, the stories are a bit rambling and not well organized but they are creative and include wonderful imagery and use of metaphors. My son claims he can only write if it is his idea/interest and that he cannot write when assigned a topic and forced to write about it.

My son also wrote and made a presentation on the Large Hadron Collider to hundreds of people when he was in second grade. His presentation was fantastic and he received a standing ovation and even now people who saw the presentation stop me and tell me that he is a “genius”. But he didn’t work from a text. He pulled all the material from his knowledge based on extensive reading about the subject and wrote a very well organized, compelling presentation. So that was less of a challenge than reading a simple text and then pulling some key facts from it, which I find puzzling.

Besides his frustration with writing my son excels in school, especially in math and science. He has no problems writing about procedures for his science experiments or writing an analysis of the data. He is socially awkward and a bit uncoordinated. He took the WPPSI when applying for kindergarten. His processing speed was exactly 100, more than 40 points below his verbal and working memory scores. I also remember a relative weakness in fluid reasoning subtests. We weren’t sure if the slower processing speed was related to anxiety (my son has anxiety and Tourettes Syndrome) or a slow, careful approach to everything (which my son has).

I’ve been keeping an eye on this issue for a while and am concerned that something is going on that we need to figure out so we can help my son with this area where he is struggling. I’ve done some online research and there is an organization called the Summit Group that does testing on 2E kids. Does anyone have experience with them or other recommendations or perspective to share?

I should add that I suspect some kind of executive functioning issue. I've wondered about inattentive ADD, as my son is very dreamy and either very focused on something he is interested in or just "living in his own head" when he isn't. He seems to struggle with initiating tasks but is very good about remembering homework and doesn't lose or misplace things.

I also wonder about an expressive disorder. My son often seems to struggle with articulating what he is thinking. He pauses, speaks slowly and fumbles a lot. A psychologist I spoke with said that was unlikely, given his very high verbal scores but I'm not sure that is true?

I'm bumping this up just in case anyone can offer any advice. I checked in with the Summit Center and it looks like an evaluation would cost between $5,000 and $7,000, which we cannot afford.

Have you talked to his pediatrician about it? I'm just wondering if there is a way to get it covered under health insurance. We had our testing completely covered when it was part of an evaluation for autism, for example. Who diagnosed the anxiety and Tourette's? Perhaps you should start with that person.

Typically, the evals covered under health insurance won't include extensive educational achievement testing, which you will need for looking at writing challenges, but you may be able to get parts of what you need done. E.g., In addition to your thought regarding executive functions, I'd particularly want to pursue the speech and language angle for possible expressive language disorders. And yes, it is possible to have extremely high verbal cognition, and yet struggle with expressive language. Thinking is not the same thing as communicating.

It sounds like he can integrate knowledge and concepts, and communicate them, when he is speaking out of a very deep pool of background knowledge and context, but that without enough context to organize a smaller pool of data, he struggles to create his own framework. (Notice also that science labs and experimental write-ups have standard structures.) Something like a biography would be particularly challenging, as there is more ambiguity about the natural organization of biographical information. Does he do better when scaffolded with a graphic organizer of some sort? E.g., a timeline-based bio would have three or so anchor time points: origins, period of historical significance (when this person did or was whatever makes them historically important), end-of-life. Depending on how low the product was supposed to be, one could have additional subcategories, like under origins, you might have family history and birth, childhood and early education, and other influential experiences, people, or circumstances. If he can complete and apply a graphic organizer successfully, that might suggest that the challenge is principally one of executive functions. He'd probably benefit from explicit instruction in the classic five-paragraph essay (and all its upward and downward extensions), to give him a standard algorithm for written expression.

BTW, I just have to say that 5-7 typed pages is not typical third-grade fare, even for a long-term project. Were these typed or handwritten pages?