Gifted Issues Discussion homepage Forums Twice Exceptional Neuropsych Eval Questions

So it seems the neuropsych my son has been referred travels nationally speaking about ADHD. And while my son has some characteristics of ADHD, a previous assessment ruled that out as a cause. I am looking forward to the upcoming assessment (we still don't have an appointment yet - in the jumping through insurance and referral hoops stage), but there is a bit of concern that with this person's focus on ADHD that there might be a tendency to attribute those characteristics in my son to ADHD.

Any advice on broaching the subject with the neuropsych without twerking his jaw out of joint? I want him to test deeper, because I'm pretty sure the memory issues are not ADHD.

The initial child psychiatrist we met with last week said that this neuropsychologist picks his cases and doesn't accept new patients without a referral and reviewing the case, so I guess we should be grateful to have been accepted. But I don't want my son's case to be part of an "agenda" (not that it will, but it might be).

I'm practicing my eggshell walking techniques, but any advice you all have would be very appreciated.

(Oh, and I finally heard from the math teacher. She's given my kiddo a list of assignments he can redo and turn in on Monday. He will be passing and not needing summer school because of the zeros. Yay for understanding teachers!)

The most gentle touch is known to twerk the jaw of some neuropsychologists out of joint.

One of my clients just had an exam with a neuropsych. He fell asleep, so she threw a shoe at him. That did not end well.

So my advice is to definitely not throw a shoe at him if he falls asleep during the exam. Just wait patiently until he wakes up on his own and pretend nothing happened.

Most Neuropsychs and psychologists have a 'focus' or specialty. I would trust that they are still capable of evaluating each case on it's own, though I'm sure when one focuses a lot on a particular issue, like ADHD, you tend to notice those traits more easily than others.

I think if you are that worried about this issue, that you need to cancel the appointment and travel to see someone who is 'known' for teasing out the complicated picture that giftedness can present.

If this is the only way you can get any help at all, I would work on being open to the possibility that your child does actually have ADHD 'as this particular expert sees it' and try the medication and see for yourself if it helps more than it hurts.

Hope that helps,
Grinity

Neuropsych evaluation reports tend to be pretty formulaic.

If you've read a dozen, you will get a good feel for what they are telling you separate from any diagnosis.

I would be concerned about the specialty issue as well. That's one reason why I steered away from a particular practice where all the bios were ADHD experts. One of the men I spoke to "tsked tsked" me when I said that my DD had that eval when she was younger and it was ruled out. I did feel a little like something was about to be "sold" to me. It's sort of unfortunate for ADD/ADHD in general, with so many latching on to it, it sort of waters it down or makes it less viable.

http://www.greatpotentialpress.com/adhd-autism-and-giftedness-an-invitation-to-a-conversation

I'm hoping that this grows into a really useful resource to parents and professionals.

Might be. Although he may also be good at differential diagnosis.


Definitely share all prior test results up front, and have a detailed list of your concerns at hand. You can ask him what disorders he tests for and what tests he will choose, and what those tests do. I think talking those things through will help you understand where he's coming from.


Do you know why you got referred to this doc and not another one?

I guess I wouldn't assume there's an agenda until you see one. Although it does matter to find a professional who has professional expertise in the particular thing you're trying to figure out, some of these folks do have multiple kinds of expertise.


That sounds workable; good for you for hanging in there. If you can get better supports into place, I hope he can learn to have things more put together next year. Our DS has needed a lot of training in this regard, too...

DeeDee

ABQMom I haven't read up previous posts on your child at all. So I am not commenting on your child in anyway, but I wanted to share our experience briefly.

When my eldest had her first Ed Psych evaluation at 7yrs the psychologist said during the appointment: "Well she presented like a classic case of inattentive ADHD at the start of the assessment but for reasons x,y,z she clearly is not." Despite her having index scores ranging from the 13th percentile (WMI) to the 96th (VCI) there was no mention of possible giftedness being masked by disability OR of disability being masked by giftedness and no diagnosis of anything. We were lead to believe our daughter's primary problem was a poor school fit at the previous school, that things were looking up at the new school and would all be fine soon.

2yrs later, with great intervention at school and home she was doing FAR better, but we realised things still weren't ok. I did some reading and realised that the reasons we were given for her NOT having ADHD-I were pretty much the text book argument for why she DID have ADHD-I. She was re-assessed by a variety of professionals and we have a new list :

1) FSIQ in the gifted range (only just)
2) ADHD-i (only just made the criteria)
3) Dyslexia (only just made the criteria)
4) CAPD (only just made the criteria)
5) borderline for Aspergers, as in so borderline they won't label her but are worried they have missed it and want to make a 3rd assessment in another 6 months.

ADHD of any form had never occurred to us prior to that first psych evaluation, so hearing it mentioned was a surprise and having it dismissed was a relief. We left re-assured and confident. We trusted our psych. And our daughter DID make vast gains in those following 2 years. But I can't can't tell you how badly I wish we had NOT be given the all clear on ADHD-i back then.

Now my child is one of the kids MoN mentions:

"but honestly, we'd sometimes sit in a meeting and hear, "well, we could call it this or this or this, but the bottom line is what we have is the same thing by any name" because often there were multiple overlapping diagnoses. Then as a team, we'd pick the one based on parental report that the parent was most likely to find beneficial, and the one most likely to result in the services needed."

Problem is that we started trying to get the diagnosis AFTER years of doing everything we could to help her. Now she's not quite anything strongly or clearly enough for any single professional to unequivocally give her a label and attack it head on. But she's still not ok. She's a gifted child working her butt off to look barely average.

I totally understand you not wanting your son misdiagnosed with ADHD because it's this psych's specialty. But consider also that the first proffessional might have been wrong. You don't want a missed diagnosis either.

Excellent video, Grinity - thanks for sharing. And thank you all for such helpful advice and input. It helps.

One question that I thought was interesting that the initial psychiatrist asked my son that I thought was interesting: Do you have racing thoughts, where you just can't seem to quiet your mind? When my son said he did, the next question was the one I found interesting - are there a lot of different thoughts and ideas fighting for attention where it is hard to pay attention to any of them or is it one thought that just won't stop - if this then this then that, etc.

My son said it was the latter - a thought that led to more what-if thoughts all in a single line.

The psychiatrist said that the multiple thoughts is one indicator of ADHD, the latter not so much.

Hi, ABQMom,
I would really like to take DD to someone like this--who seems to be making a determination based on their own experience and expertise (for example, rather than relying on questionnaires from the present teachers who don't like or get DD or giftedness--as did the local psych who did DD's last evaluation--and she didn't seem to know anything about giftedness). We are looking at having DD re-evaluated by an expert and I would really like to find one like this--do you think that any of the people recommended by Davidson would do this kind of eval, or do I need to screen them somehow? And our insurance coverage is so poor that I think we'll end up paying for it all anyway, so I want to get it right this time--and I really want to know, so I can start being more emphatic about what DD does and doesn't 'have'.

If you feel like posting or PMing me their name, I would appreciate it.

Thanks,
Dbat

I PM'd you his contact info

Thanks very much, ABQMom!

It turns out this apparently astute psychiatrist is out West; anyone have a recommendation for someone who does this kind of evaluation on the East Coast (or near D.C.)? I mean an evaluation based on their own expertise rather than on questionnaires from others (although I don't mind if they ask us some questions--just not DD's current teachers
I know the Hoagie's list and have some names from the Davidson people, which was helpful, but I would like to find somebody who has really worked well for someone with a kid like our DD8.

Possible diagnoses include ADD, Asperger's, ODD, and dysgraphia (I believe the dysgraphia, but having read the Misdiagnosis book by James Webb don't think DD meets the criteria for any of the others--although behavior is certainly an issue). She scores high on math and VCI, lower on coding and tests involving handwriting, so her GAI is significantly higher than her FSIQ. If only I could get her to behave!!

Very interesting thread, I need to check out the link that Grinity posted as well.

ABQMom, Could you PM me the info as well?

Thought I'd throw in our experiences. DD was dx'd with CAPD,dysgraphia, SI issues,reading dyslexia, vision issues etc. We spent thousands and thousands of dollars on various therapies with marginal results.Her memory was fabulous..in fact she was able to fool her piano teacher for 5 years into thinking she could actually read the music . However what she did memorize was the number sequence for each hand and hit the wall with a sonatina. Fast forward to post-bac and she was dx'd with ADHD. All the CAPD , dysgraphia, SI issues, reading dyslexia etc. disappeared while on ADHD meds. NO ONE of the plethora of gifted psych's, neurologists etc ever even gave us a whiff of ADHD. I just ran across her original neuropsych report yesterday and upon reading it I was flabbergasted, because with what I know now about ADHD all the red flags were there and waving.
We were real lucky to have a specialist in ADHD who understood how the HG+ ADHD person presents and it is not like the mainstream picture of ADHD. Dr. Thomas brown out of Yale has pretty much dedicated his practice and research to HG+ ADHD and his research papers are online.http://www.drthomasebrown.com/

The face of ADHD is changing as they learn more about the neurobiology. Nadeau and Quinn have also been involved in gifted ADHD plus have been leaders in the field with women.

Nadeau has quite a few articles on gifted and ADHD especially as it pertains to secondary education when many of those kids hit the wall.http://chesapeakeadd.com/adhd-articles/

DD told me yesterday that her brain is a series of relational databases with an exquisite VLOOKUP and then went onto tell me that her brain was also like a very messy desktop on the pc with every program open and once she takes her adderall it's a "snap to grid" and she can easily access all that she needs.

Finally Our ADHD doc was telling us that the majority of his patients are HG+(doctors, lawyers and Indian chiefs)plus quite a few professors and he flat out said ADHD is the wiring issue of the HG+ and once you harness the tremendous brain power you can soar.
Kristine

My main annoyance with that article was the opening sentence and what was not said. The authors of the research paper that reported the 66% rise also said that they attributed that increase to better awareness by physician's.

Frances Kaufman published this study in 2001 that did a synthesis of the research on ADHD and the gifted. http://www.sengifted.org/archives/a...d-gifted-students-what-do-we-really-know

"n recent years, several authors (Baum, Olenchak, & Owen, 1998; Cramond, 1995; Freed & Parsons, 1997; Lind, 1993; Tucker & Hafenstein, 1997; Webb & Latimer, 1993) have expressed concern that giftedness is often misconstrued as ADHD and that the diagnosis of ADHD among the gifted population has run amok. We acknowledge for the purposes of this discussion that there are cases of mistaken diagnosis, although as of this writing, we have found no empirical data in the medical, educational, or psychological literature to substantiate the extent of this concern.

The lack of scientific data heightens our dismay over the wave of skepticism that appears to prevail about the existence of ADHD in gifted children"

When SENG launched their new campaign in January they said that due to recent research and literature that it was their opinion that ADHD was being mis-diagnosed in GT kids. I wrote to them starting in March asking for a list of the research and literature that led them to this opinion since I could find nothing new since Kaufman's paper in 2001.I did finally hear back after multiple email requests and was advised they are gathering the sources- I'm still waiting to hear back.

Thanks for posting all of that, Kristine!

I saw and liked the video Grinity posted; thought it was great about ADHD, but was a little puzzled about why they mentioned autism because I thought they only mentioned it in passing and didn't really discuss the *mis*diagnosis issues. But a great start, and it's wonderful that people are working on this for gifted kids.