readermom, I'm just noticing that while there is some great advice above, we kinda went around your original questions. So looping back, here's some thoughts from a house full of ADHD (albeit the inattentive kind).
However, I'm trying to figure out what other steps we need to take if he's having trouble with focus. I'm trying to figure out what needs to be done to find out if ADD/ADHD is in play vs. immaturity vs. discipline issues vs. a bad classroom fit. Here's a couple of questions I have.
1. How do you determine that your child is having enough of a functional problem to pursue testing? What do functional difficulties look like?
With most issues, I've found you usually know you have a problem when the child starts showing signs of misery or anxiety - and those signs include avoidance and lying, both super common ADHD (mal)coping mechanisms. If the child is unhappy or having negative impact on family/ friends/ class, then there is a problem that needs investigating. I have especially seen children who can't control their own impulsive behaviour even when they try and really want to, and they find it a huge relief to get help being the person they want to be.
If your child is just happily bouncing around being super energetic but distracting others, and not actually harming themselves or anyone else in any way, then the problem is probably more about channeling that energy, burning more of it, and finding acceptable ways for them to keep moving enough at school. Is the child's behaviour really problematic, or is he an energetic 8 year old boy with a teacher who expects developmentally-inappropriate levels of compliance?
Next question is do you see these problems happening in only one, or one kind, or environment? Where does the child thrive, and what's different there? As many note below, a bad environment match can cause similar issues as ADHD, as a busy mind desperately seeks ways to stay busy. If the class is not meeting his needs, he should not be disciplined for behaviour that is caused by that mismatch. However, I've found that there is nothing that sets off the ADHD like a bad classroom match. Except - the huge exception - work that is too easy
but also makes big demands on an LD or other learning issue. So if he's having trouble hearing and following what's going on in class even when he really tries, AND he's trying to put in all that effort for work that is inappropriate and doesn't meet his needs - well, in my kids that combo creates a perfect ADHD storm.
The TL/DR version: it may be bad match of classroom environment,
or ADHD,
or both feeding each other.
2. What sort of testing is most important? Is it necessary or recommended to get detailed IQ tests done when dealing with a gifted kid?
Full IQ testing isn't required for it's own sake, although it would be part of any full-scale psycho-educational assessment. While any doc can diagnose ADHD, with a kid who has more complex learning needs, getting a bigger picture and putting their weaknesses and strengths into better context can be really helpful. An awful lot of things can look like ADHD. And ADHD can mask/ distract from lots of other things, too. If you are able to access full testing, it's certainly worth considering.
With respect to the IQ testing itself, you already have some basic info from the Cogat, so the big question would be whether that info feels reasonable accurate and complete to you. The Cogat is less reliable for kids with learning issues (and more highly gifted). If the Cogat results match your reality, good. But if they don't quite make sense when you look at the kid in front of you, it's helpful to use a higher-quality instrument.
3. Any practical suggestions to help my son learn to focus before we aim for testing/medication/etc?
The most important thing I've learned about ADHD is that it is not actually an inability to pay attention. Rather, it's an
inability to control where your attention goes. The brain loves the new shiny object, but lacks the normal over-ride mechanisms that enable most people to deal with the drudgery. One of the best descriptions I've found posits that it is fundamentally a deficit in extrinsic motivation. ADHD brains respond to that which is intrinsically motivating. Which is crazy-making for people around them, because it looks. so. volitional. You can pay attention to the stuff you like, so clearly you are
choosing not to pay attention to this other stuff. Except they aren't choosing: they genuinely can't.
Which leads to two points. First, figuring out "can't" vs "won't" is really, really hard as a parent. I still struggle with this every day. But if it's a genuine "can't", then seeing it as a discipline issue just makes it worse, in every possible way. So I try to approach every problem hunting for the potential "can't", or the "missing skill" in Ross Greene-speak. What are we asking this kid to do that's triggering this behaviour? Can we change the ask? Can we teach/ scaffold/ work around this missing skill so the child can do this task?
Which doesn't mean there are never discipline issues. Avoidance and lying are problems that need to be addressed - but understanding how and why they are the ADHD go-to helps me figure out how to address the upstream causes of the behaviours, and not just deal with them as something to be punished, after-the-fact, and in isolation.
So taking this back to teachers, I have been told over and again that life sucks, kids near to learn to deal with the boring stuff, and life can't just be new shiny objects. OK, granted - but can we talk just a little about my child's ratio of new shiny objects to drudgery? Because if school is almost entirely the latter, we have a school environment problem, not a behaviour problem.
Bottom line: First, look at how the school environment is or is not meeting your kid's needs, and if there is a severe mismatch, see what can be changed. What's different in environments where he thrives, and how can more of that be incorporated into his everyday reality?
Keep both brain and body as busy as possible. Some teachers realize that some kids need to move to think, and encourage it. Others see it as inherently disrespectful and punish it. Find the former if you can. Work wth the teacher to identify the times/ tasks most likely to set him off, and try to come up with ways to keep him busier at these times - with meaningful tasks, not busywork. Find the stuff that is intrinsically motivating for him, and get as much of it into him as possible. Also note that ADHD brains don't tend to do time well. Make sure he gets immediate and meaningful rewards - hard math! a good book! whatever drives him - for doing the right thing.
And always start with appropriate work first. Appropriate work leads to better behaviour. But most teachers go the other way - they try to use appropriate work as a reward for compliance with inappropriate work. I've found the big difference between gifted kids without vs with ADHD/ LDs, is the former can whip through the boring stuff and get their good stuff reward. Mine never, ever got to the good stuff. They genuinely could not complete the inappropriate work. I myself was the former too, and this has been hard for me to understand. It will take 2 minutes, just GET IT DONE AND MOVE ON! Nopity nope nope. Did I mention crazy making?
Meds can help kids become capable of exerting more control over their own attention and choices. However, meds don't magically create skills where those don't exist (like executive function, or flexibility, or social awareness); they don't fix LDs; and they definitely don't fix a poor educational match. So in my experience, it's important to do everything you can to fix those other three things first, and keep at them on an ongoing basis. And then, if the child is still struggling, meds in addition to the coaching is considered the optimal therapy.
oy - thought I could be quick here, and as always I've gone on and on (and on). Hope this helps!
Two great resources:
ADDitude magazine:
https://www.additudemag.comLives in the Balance (Ross Greene):
https://www.livesinthebalance.org
